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1.
N Z Med J ; 133(1523): 76-86, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032305

RESUMO

AIMS: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are classes of medications shown to reduce cardiovascular events and slow decline in renal function in people with type 2 diabetes (T2DM). They are recommended for many people as second-line agents after metformin by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). PHARMAC have proposed criteria for funding in New Zealand. This clinical audit compares which patients would be eligible for treatment under each criterion. METHODS: This retrospective audit was conducted in December 2019 of all registered patients with T2DM at three general practices within the Wellington/Porirua region. Relevant data were extracted from the electronic health records to enable assessment of eligibility under PHARMAC and ADA/EASD criteria. RESULTS: Of the 23,517 patients enrolled, 1,160 had T2DM. Under PHARMAC criteria 399 (34.4%) patients would be eligible for funded access compared with 339 (27.2%) by the 2018 ADA/EASD criteria and 559 (48.2%) by the revised 2020 ADA/EASD criteria. Differences in eligibility relate to threshold of HbA1c and inclusion of microalbuminuria for treatment. CONCLUSION: The proposed PHARMAC criteria will give access to these important drugs to those people with T2DM who will likely benefit the most.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipoglicemiantes/uso terapêutico , Nefropatias , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Auditoria Clínica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Progressão da Doença , Feminino , Humanos , Nefropatias/complicações , Nefropatias/epidemiologia , Nefropatias/fisiopatologia , Nefropatias/prevenção & controle , Masculino , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
2.
Arch Osteoporos ; 15(1): 165, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33079274

RESUMO

In this study, the risk of fatality after hip fracture but not the risk of subsequent hip fractures was higher among men. INTRODUCTION: The purpose of this study was to analyze the risk factors for subsequent hip fractures and fatality after an initial hip fracture among Koreans older than 50 years of age using information in the national claims database. METHODS: Our study was conducted using data from the Korean National Health Insurance Service database from 2007 to 2016. A total of 16,915 Korean patients aged ≥ 50 years with a first hip fracture in 2012 were followed for 4 years. Data on fracture, comorbidity, and prescription variables were retrieved from the national registry. The Cox proportional hazards model was used to identify the risk factors affecting subsequent hip fractures and fatality after the initial hip fracture. RESULTS: A total of 952 patients had subsequent hip fractures, and 6793 patients died. The cumulative incidence rates were 1.3% after 1 year and 5.6% after 4 years. Old age, renal disease, dementia, and Parkinson's disease were associated with a higher risk of subsequent hip fractures. The fatality rate after the initial hip fracture was 1.6 times higher among men than among women. Certain risk factors for fatality, such as pneumonia after fracture, cerebrovascular disease, mild liver disease, renal disease, and malignancy, were more prevalent among men. CONCLUSION: During the study period, the risk of fatality after hip fracture but not the risk of subsequent hip fractures was higher among men. The gender difference in fatality might be explained by the larger burden of comorbid diseases among men.


Assuntos
Demência/complicações , Fraturas do Quadril/mortalidade , Nefropatias/complicações , Doença de Parkinson/complicações , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Causas de Morte , Comorbidade , Feminino , Fraturas do Quadril/etnologia , Fraturas do Quadril/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia , Vigilância da População , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais
3.
Nutr Hosp ; 37(5): 1039-1042, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32960622

RESUMO

Introduction: Background: coronavirus disease 2019 (COVID-19) can induce an exaggerated inflammatory response. Vitamin D is a key modulator of the immune system. We hypothesized that vitamin D deficiency (VDD) could increase the risk of developing severe COVID-19 infection. Methods: patients with confirmed COVID-19 seen at the emergency department of our hospital with recent measurements of 25(OH)D were recruited. We explored the association of vitamin D deficiency (VDD), defined as 25-hydroxyvitamin D < 20 ng/mL, with a composite of adverse clinical outcomes. Results: we included 80 patients, of which 31 (39 %) presented the endpoint. VDD tended to predict an increased risk of developing severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease [OR 3.2 (95 % CI: 0.9-11.4), p = 0.07]. Age had a negative interaction with the effect of VDD on the composite outcome (p = 0.03), indicating that the effect was more noticeable at younger ages. Furthermore, male gender was associated with VDD and with severe COVID-19 at younger ages. Conclusions: in this retrospective study, vitamin D deficiency showed a signal of association with severe COVID-19 infection. A significant interaction with age was noted, suggesting VDD may have a greater impact in younger patients. These findings should be confirmed in larger, prospective, adequately powered studies.


Assuntos
Fatores Etários , Betacoronavirus , Infecções por Coronavirus/etiologia , Pneumonia Viral/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Adulto , Idoso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Feminino , Cardiopatias/complicações , Humanos , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologia , Vitamina D/sangue
4.
Artigo em Espanhol | IBECS | ID: ibc-188111

RESUMO

La pandemia SARS-CoV-2, es una emergencia sanitaria global y necesitamos conocer más sobre ella. Los pacientes con riesgo cardiovascular (ECV) y renal previo, se han identificado especialmente vulnerables para una mayor morbi-mortalidad cuando sufren la COVID-19; y una proporción considerable de pacientes puede desarrollar una lesión vascular en el contexto de la enfermedad que conlleva una mayor letalidad. Las complicaciones cardiovasculares y renales representan un problema y, probablemente en un futuro próximo, puedan suponer una amenaza para los pacientes que han sobrevivido a la COVID-19. Cómo médicos no podemos olvidar que durante una epidemia como esta, otras enfermedades -crónicas- siguen presentes, y los pacientes continúan precisando atención. Estamos obligados a vigilar de una forma incluso más intensa, sus tratamientos y grado de control. Además, no debemos olvidar que las situaciones urgentes siguen presentándose en esta situación de pandemia y precisando atención rápida; en esta situación actual es muy probable que muchos pacientes, por miedo, no hayan buscado atención médica. La situación durante la epidemia y la incertidumbre de la época post COVID-19, exige la intensificación en el control y seguimiento de la ECV y renal de nuestros pacientes. La atención primaria constituye un nivel asistencial clave para el cuidado de la población con ECV. Del mismo modo, y ante este nuevo escenario sanitario, necesitamos impulsar las medidas de prevención y control que emanen de los estudios actualmente en desarrollo. Ahora, más que nunca, necesitamos la investigación, crucial para mejorar el pronóstico cardiovascular y renal de nuestros pacientes


The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk (CVD) and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of CVD and kidney in our patients. Primary care constitutes a key level of care for the care of the population with CVD. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Vírus da SARS/isolamento & purificação , Doenças Cardiovasculares/complicações , Nefropatias/complicações , Fatores de Risco , Infecções por Coronavirus/complicações , Vírus da SARS/patogenicidade , Indicadores de Morbimortalidade , Múltiplas Afecções Crônicas/epidemiologia , Pandemias
5.
Acta Cir Bras ; 35(7): e202000705, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785417

RESUMO

Purpose Studies have demonstrated that star fruit consumption by nephropathic patients triggers severe neurotoxic effects that can lead to convulsions or even death. Brain areas likely susceptible to star fruit poisoning have not been investigated. The objective of the present study was to map possible epileptogenic areas susceptible to star fruit intoxication in nephropathic rats. Methods The study analyzed 25 rats (5 groups). Rats in the experimental group underwent bilateral ureteral obstruction surgery and orogastric gavages with star fruit juice. An electroencephalogram was used to confirm convulsive seizures. Urea and creatinine levels were used to confirm the uremia model. Immunohistochemical analysis was used to map cells with c-Fos protein (c-Fos+ cells) to identify brain areas with increased neuronal activity. Control groups included non-nephropathic and nephropathic rats that did not receive star fruit. Results A statistically significant increase (p<0.01) in c-Fos+ cells was noted in nephropathic animals receiving star fruit juice compared to control groups, in brain areas commonly related to epileptogenic neural circuits including the hippocampus, amygdala, rhinal cortex, anterior cingulate area, piriform area, and medial dorsal thalamus. Conclusion These data corroborate the neurotoxic capacity of star fruit in nephropathic patients.


Assuntos
Frutas , Nefropatias , Proteínas Proto-Oncogênicas c-fos , Animais , Encéfalo , Córtex Cerebral , Frutas/envenenamento , Hipocampo , Humanos , Nefropatias/complicações , Proteínas Proto-Oncogênicas c-fos/metabolismo , Ratos
6.
Drug Des Devel Ther ; 14: 3001-3013, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32801640

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now a global outbreak of disease. The antiviral treatment acts as one of the most important means of SARS-CoV-2 infection. Alteration of physiological characteristics in special populations may lead to the change in drug pharmacokinetics, which may result in treatment failure or increased adverse drug reactions. Some potential drugs have shown antiviral effects on SARS-CoV-2 infections, such as chloroquine, hydroxychloroquine, favipiravir, lopinavir/ritonavir, arbidol, interferon alpha, and remedsivir. Here, we reviewed the literature on clinical effects in COVID-19 patients of these antiviral agents and provided the potential antiviral agent options for pregnant women, elderly patients, liver or renal dysfunction patients, and severe or critically ill patients receiving renal replacement therapy or ECMO after SARS-CoV-2 infection.


Assuntos
Antivirais/farmacologia , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Idoso , Antivirais/efeitos adversos , Antivirais/farmacocinética , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Humanos , Nefropatias/complicações , Hepatopatias/complicações , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez
7.
Curr Urol Rep ; 21(9): 33, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32666391

RESUMO

PURPOSE OF REVIEW: Advances in preservation and transplantation techniques have made renal autotransplantation (RA) a modality that can be utilized in complex renovascular diseases (renal artery aneurysms), high ureteric injuries, chronic kidney pain, as well as conventionally unresectable renal tumours. In the current review, we present the Oxford experience, the only UK commissioned centre to perform RA for complex renal cell cancers, and review the published RA experience from other UK centres. RECENT FINDINGS: The evidence and literature generated from the RA experience in the UK are largely limited to case reports. The main indications reported for performing RAs include renovascular disease, ureteral pathology and prophylaxis from radiation. Renal autotransplantation is an option for a highly select group of patients. It has short-term and long-term complication rates comparable to those of other major operations. Extensive preoperative counselling in conjunction with multidisciplinary professionals is of utmost importance for informed decision making.


Assuntos
Nefropatias/cirurgia , Transplante de Rim , Humanos , Nefropatias/complicações , Nefropatias/mortalidade , Transplante Autólogo , Reino Unido
8.
Indian Pediatr ; 57(7): 641-651, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32727941

RESUMO

The coronavirus outbreak is a rapidly evolving pandemic, placing unprecedented strain on health-care systems. COVID-19 presents challenges for management of children with renal diseases, especially those receiving long-term immunosuppressive medications, including renal transplant recipients and those with chronic kidney disease and acute kidney injury requiring dialysis. Our preparedness for managing this vulnerable group of children is the need of the hour. The purpose of this article is to provide guidance to caregivers and health care personnel involved in management of children with renal diseases and to ensure patient well-being, while protecting staff from infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Nefropatias/terapia , Pneumonia Viral/terapia , Criança , Infecções por Coronavirus/complicações , Humanos , Imunossupressão , Nefropatias/complicações , Nefropatias/virologia , Transplante de Rim , Pandemias , Pneumonia Viral/complicações , Diálise Renal
10.
Transplant Rev (Orlando) ; 34(4): 100567, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32690437

RESUMO

The global pandemic of severe acute respiratory coronavirus 2 (SARS-CoV-2), which causes the novel beta coronavirus 2019 disease (COVID-19), has become an unprecedented medical, economic, and psychosocial crisis. The pandemic and its management strategies have resulted in immense challenges for health systems, not only in caring for those with COVID-19 but also in the ongoing management of chronic medical conditions. Kidney transplant recipients present a unique challenge given their need for ongoing monitoring and management as well as their higher risk of COVID-19 infection. In the absence of clear guidelines, it is unclear how to best provide routine care to this unique patient population during the pandemic. Rigorous medical and psychosocial patient-centered risk stratification strategies are needed to avoid adverse outcomes in stable solid organ transplant recipients. This review will focus on the challenges faced by kidney transplant recipients and health care providers and provides strategies to address these issues.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Nefropatias/complicações , Nefropatias/psicologia , Transplante de Rim , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Nefropatias/cirurgia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
11.
Am J Cardiol ; 129: 42-45, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540168

RESUMO

Studies have shown that highly selected patients who underwent combined heart-kidney (HK) and heart-liver transplants (HLv) have short- and long-term outcomes comparable to those observed in primary heart transplantation (HT). Adults patients with stage D heart failure that underwent combined HK, HLv, and heart-lung (HL) were identified in the United Network for Organ Sharing registry from 1991 to 2016, with follow-up through March 2018. We conducted inverse probability of treatment weighting survival analysis of long-term survival stratified by type of combined organ transplant, accounting for donor, recipient, and operative characteristics. We identified 2,300 patients who underwent combined organ transplant (HK 1,257, HLv 212, HL 831). HL recipients were more likely white (77%), women (58%), with congenital heart disease (44.5%), and longer waiting list time (median 195 days). HK transplant increased significantly during the study period where as HL decreased significantly. Median survival was 12.2 years for HK (95% confidence intervals [CI] 10.8 to 12.8), 12 for HLv (95% CI 8.6 to 17.6) but significantly lower at 4.5 years for HL (95% CI 3.6 to 5.8). Combined HK and HLv transplantation rates are increasing and long-term survival is comparable to primary HT, unlike HL which is associated with decreasing trends and significantly lower survival.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Transplante de Rim , Transplante de Fígado , Mortalidade , Adulto , Afro-Americanos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Restritiva/complicações , Grupo com Ancestrais do Continente Europeu , Feminino , Rejeição de Enxerto , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/complicações , Transplante de Coração-Pulmão , Hispano-Americanos , Humanos , Nefropatias/complicações , Nefropatias/cirurgia , Hepatopatias/complicações , Hepatopatias/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Reoperação , Taxa de Sobrevida
12.
Epidemiol Infect ; 148: e123, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32580809

RESUMO

This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan-Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3-5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9-7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4-4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4-14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/complicações , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/complicações , Complicações do Diabetes/complicações , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Nefropatias/complicações , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Pandemias , Pneumonia Viral/complicações , Distribuição de Poisson , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
13.
Clin Exp Rheumatol ; 38 Suppl 124(2): 201-206, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32441648

RESUMO

OBJECTIVES: In ANCA-associated vasculitis (AAV), renal relapses are cause of concern as they are unpredictable and predictors of end-stage renal disease (ESRD). We aimed to assess the frequency of major renal (MR) relapses in AAV and to identify independent base-line predictors. METHODS: We performed a retrospective monocentric observational cohort study of patients affected by granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and renal limited vasculitis (RLV), diagnosed from 2000 to 2019, and who achieved clinical remission defined as Birmingham Vasculitis Activity Index version 3 (BVASv3)=0 and/or clinical judgment. MR relapse was defined as the occurrence of major items of renal BVASv3. Univariate and multivariable analysis was performed with competitive risk analysis. RESULTS: We included 96 patients: 73 GPA, 21 MPA and 2 RLV. Eighty-five (90%) patients were ANCA-positive: 56 c-ANCA/PR3, 28 p-ANCA/MPO and 1 double positive. During the follow-up, 17/96 patients developed at least one MR relapse, 2/96 progressed to ESRD and 3/96 died without events; 74 did not develop MR relapse. Patients with MR relapse were all ANCA positive and had higher frequency of skin (p=0.034), kidney (p=0.004) and nervous system (p=0.024) involvement and lower fre¬quency of ear, nose and throat (ENT) manifestations (p=0.043). At multivariable analysis, renal involvement at baseline (sHR 20.4, 95% confidence interval (95% CI) 2.6-158.2, p=0.004) and remission-induction treatment without cyclophosphamide and/or rituximab (sHR 4.2, 95% CI 1.5-12.0, p=0.007) were independent predictors of MR relapses. CONCLUSIONS: Baseline renal involvement predicts MR relapse in AAV while intense initial treatment seems to be protective.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Nefropatias/complicações , Granulomatose com Poliangiite , Humanos , Poliangiite Microscópica , Recidiva , Estudos Retrospectivos
14.
Semergen ; 46 Suppl 1: 78-87, 2020 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-32448633

RESUMO

The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of cardiovascular and kidney disease in our patients. Primary care constitutes a key level of care for the care of the population with cardiovascular disease. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients.


Assuntos
Doenças Cardiovasculares , Infecções por Coronavirus , Nefropatias , Pandemias , Pneumonia Viral , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Complicações do Diabetes/virologia , Dislipidemias/complicações , Humanos , Nefropatias/complicações , Nefropatias/terapia , Nefropatias/virologia , Pneumonia Viral/complicações , Fatores de Risco
15.
Cardiovasc Pathol ; 48: 107218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32388447

RESUMO

Cardiac amyloid A (AA) amyloidosis is rare. We present the case of a 72-year-old woman with obstructive hypertrophic cardiomyopathy (HCM) and biopsy-proven renal AA amyloidosis whose dyspnea and exercise intolerance had worsened over the previous year. Her AA amyloidosis was suspected to be secondary to chronic diverticulitis for which she had undergone hemicolectomy and sigmoidectomy 3 years prior. Echocardiographic findings were consistent with worsening left ventricular outflow tract obstruction at rest. Cardiac magnetic resonance imaging revealed patchy areas of midwall late gadolinium enhancement. Right ventricular endomyocardial biopsy did not reveal amyloid deposition, and cardiac technetium-99m pyrophosphate scintigraphy did not suggest transthyretin amyloidosis. The patient underwent septal myectomy with resection of an accessory papillary muscle. Pathological examination of the myectomy specimen was consistent with HCM. In addition, there was a thick layer of diffuse endocardial and vascular amyloid deposition that was identified as AA type by laser-microdissection with liquid chromatography-coupled tandem-mass spectrometry. This case report highlights the presence of 2 distinct disease processes occurring simultaneously and the importance of tissue diagnosis of AA amyloidosis, a condition that is not commonly associated with HCM.


Assuntos
Amiloidose/complicações , Cardiomiopatia Hipertrófica/complicações , Insuficiência Cardíaca/etiologia , Nefropatias/complicações , Miocárdio/patologia , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Amiloidose/metabolismo , Amiloidose/patologia , Amiloidose/fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica/metabolismo , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Nefropatias/metabolismo , Nefropatias/patologia , Miocárdio/metabolismo , Proteína Amiloide A Sérica/metabolismo , Resultado do Tratamento , Função Ventricular Esquerda , Obstrução do Fluxo Ventricular Externo/metabolismo , Obstrução do Fluxo Ventricular Externo/patologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
16.
Epidemiol Infect ; 148: e105, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32418552

RESUMO

Although patients with end-stage renal disease (ESRD) are known to be at high risk for developing bloodstream infections (BSI), the risk associated with lesser degrees of renal dysfunction is not well defined. We sought to determine the risk for acquiring and dying from community-onset BSIs among patients with renal dysfunction. A retrospective, population-based cohort study was conducted among adult residents without ESRD in the western interior of British Columbia. Estimated glomerular filtration rates (eGFR) were determined for cases and incidence rate ratios (IRR) were calculated using prevalence estimates. Overall, 1553 episodes of community-onset BSI were included of which 39%, 32%, 17%, 9%, 2% and 1% had preceding eGFRs of ≥90, 60-89, 45-59, 30-44, 15-29 and <15 ml/min/m2, respectively. As compared to those with eGFR ≥60 ml/min/m2, patients with eGFR 30-59 ml/min/m2 (IRR 4.4; 95% confidence interval (CI) 3.9-4.9) and eGFR <30 ml/min/m2 (IRR 7.0; 95% CI 5.0-9.5) were at significantly increased risk for the development of community-onset BSI. An eGFR <30 ml/min/m2 was an independent risk factor for death (odds ratio 2.3; 95% CI 1.01-5.15). Patients with renal dysfunction are at increased risk for developing and dying from community-onset BSI that is related to the degree of dysfunction.


Assuntos
Bacteriemia/sangue , Bacteriemia/complicações , Nefropatias/complicações , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
Nephrol Dial Transplant ; 35(6): 920-925, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32445573

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has created major challenges for all countries around the globe. Retrospective studies have identified hypertension, cardiovascular disease, diabetes and older age as risk factors for high morbidity and mortality from COVID-19. There is a general concern that patients with immune-mediated kidney diseases, namely those on immunosuppressive therapies and/or those with more advanced kidney failure, could particularly be at risk for adverse outcomes due to a compromised antiviral immunity. Uncertainties exist on how management routines should be reorganized to minimize the risk of severe acute respiratory syndrome coronavirus 2 infection and what measures are necessary for infected patients. The aim of the present review of the Immunonephrology Working Group of the European Renal Association-European Dialysis and Transplant Association is to provide recommendations for the management of patients with immune-mediated kidney diseases based on the available evidence, similar circumstances with other infectious organisms and expert opinions from across Europe. Such recommendations may help to minimize the risk of encountering COVID-19 or developing complications during COVID-19 in patients with immune-mediated kidney disease.


Assuntos
Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Nefropatias/imunologia , Nefropatias/terapia , Nefrologia/normas , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Antivirais , Betacoronavirus , Infecções por Coronavirus/complicações , Europa (Continente) , Humanos , Imunossupressores/uso terapêutico , Nefropatias/complicações , Pandemias , Pneumonia Viral/complicações , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sociedades Médicas
18.
Blood Purif ; 49(3): 259-264, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-27685

RESUMO

The World Health Organization has recognized the pandemic nature of the coronavirus disease 19 (COVID-19) outbreak. A large proportion of positive patients require hospitalization, while 5-6% of them may need more aggressive therapies in intensive care. Most governments have recommended social separation and severe measures of prevention of further spreading of the epidemic. Because hemodialysis (HD) patients need to access hospital and dialysis center facilities 3 times a week, this category of patients requires special attention. In this editorial, we tried to summarize the experience of our centers that hopefully may contribute to help other centers and colleagues that are facing the coming wave of the epidemic. Special algorithms for COVID-19 spreading in the dialysis population, recommendations for isolation and preventive measures in positive HD patients, and finally directions to manage logistics and personnel are reported. These recommendations should be considered neither universal nor absolute. Instead, they require local adjustments based on geographic location, cultural and social environments, and level of available resources.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Unidades Hospitalares de Hemodiálise/organização & administração , Nefropatias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Agendamento de Consultas , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Humanos , Nefropatias/complicações , Pneumonia Viral/complicações , Pneumonia Viral/transmissão
20.
J Hum Genet ; 65(8): 675-681, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32313195

RESUMO

Previous studies are inconclusive on the relationships between BLK gene polymorphisms and clinical features of systemic lupus erythematosus (SLE). The present study aimed to estimate association between BLK loci and SLE clinical features in Chinese population. Associations between BLK single-nucleotide polymorphisms (SNPs) and susceptibility to SLE in this study were estimated using data of 1205 health controls previously reported in the same population. And a total of 814 SLE patients recruited from two different sources according with ACR criteria were analyzed for genotype-phenotype associations. A meta-analysis was conducted of the associations between BLK loci and renal disorder in SLE. The expression quantitative trait locus (eQTL) data were also extracted from the public databases for the selected SNPs. Significant associations were observed between these SNPs and susceptibility to SLE. In addition, the data showed that rs2618479 and rs7812879 were associated with renal disorder [OR = 1.51 (95% CI: 1.15, 1.99) and 1.61 (95% CI: 1.21, 2.14), Pcorr = 0.033 and 0.011, respectively] and proteinuria [OR = 1.47 (95% CI: 1.12, 1.95) and 1.52 (95% CI: 1.14, 2.03), Pcorr = 0.048 and 0.040, respectively]. The consistent associations were observed in two independent centers as well as new cases group. The result of meta-analysis for rs2618479 was also significant [OR = 1.35 (95% CI: 1.12, 1.62)]. In addition, bioinformatics analysis demonstrated that the two SNPs were significantly associated with the expression of BLK in whole blood and several immune cells. Our data support that variant loci of BLK are associated with presence of renal disorder in patients with SLE.


Assuntos
Nefropatias/genética , Lúpus Eritematoso Sistêmico/genética , Quinases da Família src/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Feminino , Estudos de Associação Genética , Humanos , Nefropatias/complicações , Nefropatias/fisiopatologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Locos de Características Quantitativas , Quinases da Família src/sangue , Quinases da Família src/metabolismo
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