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1.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 198-200, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31833740

RESUMO

Renal artery thrombosis is a rare clinical condition. Often, there is a delay in diagnosis due to non-specific clinical complaints. We presented a woman with an elderly atrial fibrillation who developed thrombosis of the left renal artery. Despite the anticoagulant treatment given, patient did not benefit and the kidney was fully damaged.


Assuntos
Fibrilação Atrial/complicações , Nefropatias/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , Feminino , Humanos , Nefropatias/complicações , Artéria Renal/patologia , Trombose/complicações , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(49): e18167, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804331

RESUMO

RATIONALE: Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%). PATIENT CONCERNS: A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces. DIAGNOSES: Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules. INTERVENTIONS: A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess. OUTCOMES: A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility. LESSONS: A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.


Assuntos
Abscesso Abdominal/complicações , Actinomicose/complicações , Nefropatias/complicações , Cirrose Hepática Alcoólica/complicações , Espaço Retroperitoneal/patologia , Abscesso Abdominal/tratamento farmacológico , Actinomicose/tratamento farmacológico , Actinomicose/cirurgia , Adulto , Antibacterianos/uso terapêutico , Humanos , Nefropatias/tratamento farmacológico , Nefropatias/cirurgia , Masculino , Nefrectomia
3.
Transplant Proc ; 51(9): 2962-2966, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31607616

RESUMO

INTRODUCTION: Preoperative liver and renal dysfunction remain surgical risk factors for both postoperative morbidity and mortality. The Model of End-Stage Liver Disease Excluding INR (international normalized ratio), or MELD-XI, score calculation may help as a predictor in patients with advanced heart failure. We analyzed the impact of progressive elevated MELD-XI values among recipients of heart transplant at our institution. METHODS: The data of a total of 425 consecutive adult patients who underwent heart transplantation, between January 2000 and August 2018, have been reviewed and divided into 3 cohorts according to preoperative MELD-XI calculations (MELD-XI < 11; MELD-XI 11-18; and MELD-XI > 18). Early and late outcomes have been analyzed. RESULTS: Patients with a MELD-XI score > 18 had a more critical clinical condition preoperatively and had a higher risk of early mortality (hazard ratio [HR] 1.45 [1.11-1.67], P < .001). They showed high risk for postoperative dialysis (HR 2.8 [1.5-5.3], P < .001), rethoracothomy for bleeding (HR 2.1 [1.2-4.1], P = .001), prolonged time of mechanical ventilation, time of intensive care unit stay (HR 2.2 [1.3-3.8], P = .005), and graft failure requiring mechanical circulatory support (HR 1.9 [1.1-3.3], P = .003). After risk adjustment per MELD-XI cohort, ischemic dilated cardiomyopathy, redo operation, and cold ischemic time > 240 minutes resulted in being the strongest predictors of early mortality (P < .001). The 5-year and 10-year survival for MELD-XI > 18 cohort was 63% and 47% vs 72% and 59% in the control group (MELD-XI < 18) (log-rank, P < .001). CONCLUSIONS: Patients with an elevated preoperative MELD-XI profile presented more comorbidities and significantly lower survival. This suggests the MELD-XI score may provide further insight into appropriate recipient and eventual donor selection. Renal insufficiency and congestive hepatopathy should be properly optimized before heart transplantation.


Assuntos
Doença Hepática Terminal/complicações , Transplante de Coração , Nefropatias/complicações , Índice de Gravidade de Doença , Adulto , Estudos de Coortes , Doença Hepática Terminal/mortalidade , Feminino , Transplante de Coração/mortalidade , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco
4.
Metas enferm ; 22(7): 65-71, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184101

RESUMO

La función cardiaca y la función renal están íntimamente asociadas, ya que el corazón y los riñones llevan a cabo la regulación hemodinámica del organismo. Cuando se producen alteraciones de forma bidireccional en ambos órganos se activa una serie de mecanismos compensadores que provocan un efecto nocivo de uno de ellos sobre el otro. Es lo que se conoce como síndrome cardiorrenal. Actualmente se dispone de protocolos de Enfermería estandarizados para el manejo de la insuficiencia cardiaca y para la insuficiencia renal; no obstante, es necesario ampliar la información para entender de forma óptima la relación cardiorrenal y aplicar la mejor evidencia científica a los cuidados. Por ello se expone un caso clínico abordado desde Atención Primaria, con el desarrollo de un plan de cuidados elaborado una vez identificados los diagnósticos de Enfermería que se han derivado de la valoración enfermera siguiendo el modelo de las 14 necesidades básicas de Virginia Henderson


Cardiac function and renal function are closely related, because the heart and the kidneys carry out the hemodynamic regulation of the body. When there are bidirectional alterations in both organs, a series of compensating mechanisms are activated, which cause harmful effects of one over the other. This is known as Cardiorenal Syndrome. There are current standard Nursing protocols available for the management of heart failure and renal impairment; however, it is necessary to increase information for an optimal understanding of the cardiorenal interaction, and to apply the best scientific evidence into care. To this aim, we present a case record addressed at Primary Care, with the development of a plan of care prepared after the Nursing diagnoses were identified, derived from nursing assessment following the model of the 14 Basic Needs of Virginia Henderson


Assuntos
Humanos , Feminino , Idoso , Cuidados de Enfermagem , Atenção Primária à Saúde/métodos , Síndrome Cardiorrenal/complicações , Síndrome Cardiorrenal/enfermagem , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/enfermagem , Padrão de Cuidado/normas , Nível de Saúde , Atenção Primária à Saúde , Nefropatias/complicações , Cardiopatias/complicações , Implementação de Plano de Saúde/normas , Insuficiência Cardíaca/enfermagem
5.
PLoS Negl Trop Dis ; 13(8): e0007603, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31412021

RESUMO

Trypanosoma brucei (T.b.) rhodesiense is the cause of the acute form of human African trypanosomiasis (HAT) in eastern and southern African countries. There is some evidence that there is diversity in the disease progression of T.b. rhodesiense in different countries. HAT in Malawi is associated with a chronic haemo-lymphatic stage infection compared to other countries, such as Uganda, where the disease is acute with more marked neurological impairment. This has raised the question of the role of host genetic factors in infection outcomes. A candidate gene association study was conducted in the northern region of Malawi. This was a case-control study involving 202 subjects, 70 cases and 132 controls. All individuals were from one area; born in the area and had been exposed to the risk of infection since birth. Ninety-six markers were genotyped from 17 genes: IL10, IL8, IL4, HLA-G, TNFA, IL6, IFNG, MIF, APOL, HLA-A, IL1B, IL4R, IL12B, IL12R, HP, HPR, and CFH. There was a strong significant association with APOL1 G2 allele (p = 0.0000105, OR = 0.14, CI95 = [0.05-0.41], BONF = 0.00068) indicating that carriers of the G2 allele were protected against T.b. rhodesiense HAT. SNP rs2069845 in IL6 had raw p < 0.05, but did not remain significant after Bonferroni correction. There were no associations found with the other 15 candidate genes. Our finding confirms results from other studies that the G2 variant of APOL1 is associated with protection against T.b. rhodesiense HAT.


Assuntos
Alelos , Apolipoproteína L1/genética , Predisposição Genética para Doença/genética , Nefropatias/complicações , Nefropatias/genética , Tripanossomíase Africana/complicações , Adulto , Estudos de Casos e Controles , Citocinas/genética , Progressão da Doença , Feminino , Estudos de Associação Genética , Marcadores Genéticos/genética , Genótipo , Humanos , Nefropatias/epidemiologia , Malaui , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Trypanosoma brucei rhodesiense , Tripanossomíase Africana/epidemiologia , Uganda/epidemiologia
6.
Adv Exp Med Biol ; 1165: 37-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399960

RESUMO

Arterial hypertension remains to be a serious problem with considerable morbidity and mortality worldwide in the present age. Hypertension is a major risk factor for cardiovascular diseases such as stroke, myocardial infarction, renal failure, and heart failure. Hypertensive nephropathy is the second leading cause of death in chronic kidney disease (CKD) around the world. Long-time hypertension loading results in renal interstitial fibrosis, which is associated with aberrant activation of renal fibroblasts and excessive generation of extracellular matrix (ECM) proteins. Increasing evidence supported that proteinuria, tubular hypertrophy, oxidative stress, activation of renin-aldosterone-angiotensin system (RAAS), collagen turnover, chronic inflammation, and vasoactive substances synergistically contributed to the pathogenesis of hypertensive renal fibrosis. However, the mechanisms involving the pathogenesis of hypertensive renal fibrosis are complex and not fully understood. Also, the effective clinical therapy to halt or even reverse renal fibrosis in hypertension is still limited. In this chapter, we aimed to provide an overview of the main pathophysiologic and mechanistic features of renal fibrosis under hypertensive state. The completion of the studies in these directions would improve our understanding of renal fibrosis in hypertension and also help us better screen treatment strategies for preventing renal destruction associated with hypertension.


Assuntos
Hipertensão/complicações , Nefropatias/complicações , Fibrose , Humanos , Hipertrofia , Rim/patologia , Estresse Oxidativo , Proteinúria , Sistema Renina-Angiotensina
7.
Indian J Cancer ; 56(3): 241-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389388

RESUMO

BACKGROUND: Impaired kidney function is associated with different diseases. However, its impact on colorectal cancer has not been clarified. In order to understand the effect of preoperative kidney function on the outcome of patients with cancer, we analyzed colorectal cancer patients with localized or regional diseases. MATERIALS AND METHODS: In total, 3731 stage I to III colorectal cancer (CRC) patients were analyzed in Chang Gung Memorial Hospital. Modification of Diet in Renal Disease (MDRD) formula was used for estimated glomerular filtration rate (eGFR). Receiver operating characteristic (ROC) analysis for kidney function cut-off value; Chi-square method, independent t test, or analysis of variance (ANOVA) method for clinicopathological factors; Kaplan-Meier method for disease-free survival (DFS); Cox proportional hazard model for multivariate analysis. RESULTS: Among colon cancer patients, low eGFR (MDRD <70) was associated with more male patients, T2 stage, patients without adjuvant chemotherapy, and patients with elevated creatinine level. Low eGFR is a significant risk factor only for stage III colon cancer (hazard ratio 1.70, 95% CI: 1.28-2.26; P < 0.001). Furthermore, postoperative adjuvant chemotherapy did not significantly increase 5-year DFS for both high and low eGFR groups in stage II patients (5 yrs DFS, 94.8% vs. 84.1%, P = 0.098 for high eGFR subgroup; and 75.0% vs. 75.8%, P = 0.379 for low eGFR subgroup). However, significant improvement of 5-yrs DFS after chemotherapy was found in low eGFR stage III colon cancer patients (64.7% vs. 39.4%, P < 0.001 for low eGFR subgroup). In contrast, no significant DFS difference was caused by chemotherapy for high eGFR stage III subgroup (70.5% vs. 63.9%, P = 0.110). CONCLUSIONS: Although low eGFR is an independent risk factor for stage III colon cancer. However, the adjuvant chemotherapy impacts on stage III colon cancer patients differently according to eGFR status.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante/mortalidade , Neoplasias Colorretais/mortalidade , Nefropatias/complicações , Cuidados Pré-Operatórios , Idoso , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
9.
Medicine (Baltimore) ; 98(29): e16544, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335736

RESUMO

To investigate the status of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and analyze the reasons for not receiving PCI.A cohort of 387 consecutive hospitalized AMI patients aged ≥80 years were recruited from 2005 to 2014. Their clinical data were collected and analyzed.Among 387 elderly patients with AMI (190 men and 197 women, mean age 84.1 ±â€Š3.9 years), there were 171 patients with ST-elevation myocardial infarction (STEMI) and 216 patients with non-ST-elevation myocardial infarction (NSTEMI). The emergency and elective PCI treatment rate was 40.6% and 12.1%, respectively, in patients with STEMI; and 1% and 18%, respectively, in patients with NSTEMI. PCI treatment rate of elderly AMI patients enrolled after 2009 showed no significant difference compared to that before 2009 (P > .05). The in-hospital mortality decreased significantly in PCI treatment group. After adjustment for age, sex, and other factors, PCI treatment was identified as the independent protective factors for in-hospital mortality (odds ratio = 0.323, 95% confidence interval 0.147-0.710, P = .005). The main influence factors for not receiving PCI treatment were hemorrhage, severe renal dysfunction, infection, or severe anemia-associated complications, whereas delayed treatment was the important reason for patients not undergoing emergency PCI.PCI treatment is the independent protective factor for in-hospital mortality of elderly patients with AMI. Due to various complications, PCI treatment rate is still low in elderly patients with AMI and has not been improved recently. Paying attention to performing PCI treatment for elderly patients with AMI has positive significance.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso de 80 Anos ou mais , Anemia/complicações , China , Procedimentos Cirúrgicos Eletivos , Serviço Hospitalar de Emergência , Feminino , Hemorragia/complicações , Mortalidade Hospitalar , Humanos , Nefropatias/complicações , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Centros de Atenção Terciária , Tempo para o Tratamento
11.
Urologiia ; (3): 166-169, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356031

RESUMO

Disturbances of urinary flow result in an increase in intrapelvis pressure and a decrease in the kidneys ability to filter urine. The impairment of the blood flow in renal parenchyma represents one of the causative factors. Compensatory mechanisms in case of prolonged occlusion include collecting system dilation as well as pyelorenalis reflux. These changes lead to urine circulation via glomerular and tubular apparatuses, the interstitial tissue and lymphatic vessels and lead to the pyelovenous reflux. The results of studies dedicated to impairment of blood flow in the kidney parenchyma during the ureteral occlusion and in different types of the surgical treatment of urolithiasis are presented in the article.


Assuntos
Nefropatias , Circulação Renal , Cálculos Urinários , Hemodinâmica , Humanos , Rim/irrigação sanguínea , Nefropatias/complicações , Cálculos Urinários/complicações
12.
Medicine (Baltimore) ; 98(24): e16077, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192970

RESUMO

RATIONALE: Secondary hyperparathyroidism (SHPT) is often complicated with chronic renal failure. Though the total parathyroidectomy (TPTX) with forearm autotransplantation (FAT) has been commonly used to treatment refractory renal SHPT, the recurrence of SHPT is not infrequent, resulting from hyperplastic autograft, remnant parathyroid tissues, and supernumerary parathyroid gland (SPG). PATIENT CONCERNS: A 67-year-old man undergoing TPTX+FAT 4 years previously for renal SHPT, who received regular hemodialysis with active vitamin D supplements of Rocaltrol treatment postoperatively, was admitted to our hospital with progressively elevated serum intact parathyroid hormone (iPTH) from 176 to 1266 pg/mL for 8 months and bilateral ankle joints pain for 1 month. Tc-sestamibi dual-phase imaging with single positron emission tomography (SPECT)/computed tomography (CT) revealed a nodule in suprasternal fossa, besides a nodule in autografted site, accompanied with intense radioactivity. DIAGNOSIS: Recurrent SHPT was easily diagnosed based on previous medical history, painful joints, increased serum iPTH level and positive findings of Tc-sestamibi imaging. Routine postoperative pathology showed that the nodules were consistent with an adenomatoid hyperplasic autograft and a supernumerary parathyroid adenoma in suprasternal fossa, respectively. INTERVENTIONS: Reoperation for removing nodules in suprasternal fossa and autografted site was performed 1 month later. Then regular hemodialysis 3 times a week with Rocaltrol was continued. OUTCOMES: During 12 months of follow-up, the joints pain improved obviously and the serum iPTH level ranged from 30.1 to 442 pg/mL. LESSONS: Although rare, recurrent renal SHPT may be caused by a coexistence of both hyperfunctional autograft and SPG after TPTX+FAT. The Tc-sestamibi parathyroid imaging with SPECT/CT is helpful to locate the culprits of recurrent renal SHPT before reoperation. To prevent recurrence of renal SHPT, the present initial surgical procedures should be further optimized in patient on permanent hemodialysis.


Assuntos
Adenoma/complicações , Autoenxertos , Hiperparatireoidismo Secundário/etiologia , Nefropatias/complicações , Neoplasias das Paratireoides/complicações , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Idoso , Autoenxertos/patologia , Antebraço , Humanos , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/patologia , Hiperparatireoidismo Secundário/cirurgia , Hiperplasia , Nefropatias/diagnóstico por imagem , Nefropatias/patologia , Nefropatias/cirurgia , Masculino , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Recidiva , Reoperação
13.
Res Vet Sci ; 125: 136-140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226571

RESUMO

Periodontal disease (PD) is one of the most frequent and widespread inflammatory diseases in dogs. The onset of PD pathogenesis is prompted by the dental microbial biofilm combined with the animal immune-inflammatory response. Along with local effects, systemic consequences can occur secondary to dental plaque-associated bacteraemia, affecting distant tissues and organs. The main goal of this retrospective study was to access and evaluate the association between PD and systemic consequences (renal, hepatic and cardiac) in a group of 136 dogs. Clinical records of all animals were assessed for general and systemic information, further analysed by general linear model and Odds-Ratio. Animals were organized in two groups, PD group and control group, formed by animals without PD. In this population, increasing age was proven to be a risk factor (OR = 1.04, p < .01) for PD establishment. Small breeds (<10 Kg) were the most prevalent in the PD group, being more susceptible to this disease. On the other hand, no influence of gender or reproductive status in PD progression was observed. Regarding systemic diseases, a statistically significant association (p = .026) was obtained between PD and cardiac disease. Results show that PD can have a significant adverse impact on animals' health, being related with systemic consequences, which may increase morbidity and mortality rates of these animals. PD prevention, with focus on owner's information about this disease and its management, are essential points for an active PD control program.


Assuntos
Doenças do Cão/epidemiologia , Cardiopatias/veterinária , Nefropatias/veterinária , Hepatopatias/veterinária , Doenças Periodontais/veterinária , Animais , Cães , Feminino , Cardiopatias/complicações , Cardiopatias/epidemiologia , Nefropatias/complicações , Nefropatias/epidemiologia , Hepatopatias/complicações , Hepatopatias/epidemiologia , Masculino , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Portugal/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
14.
Expert Rev Clin Pharmacol ; 12(8): 805-813, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31242039

RESUMO

Objective: To evaluate the predictive performance of eight renal function equations to describe amikacin elimination in a large standard population with a wide range of age. Methods: Retrospective study of adult hospitalized patients treated with amikacin and monitored in the clinical pharmacokinetics laboratory of a pharmacy service. Renal function was calculated as Cockcroft-Gault with total, adjusted and ideal body weight, MDRD-4, CKD-EPI, rLM, BIS1, and FAS. One compartment model with first-order elimination, including interindividual variability on clearance and volume of distribution and combined residual error model was selected as a base structural model. A pharmaco-statistical analysis was performed following a non-linear mixed effects modeling approach (NONMEM 7.3 software). Results: 198 patients (61 years [18-93]) and 566 measured amikacin plasma concentrations were included. All the estimated glomerular filtration rate and creatinine clearance equations evaluated described properly the data. The linear relationship between clearance and glomerular filtration rate based on rLM showed a statistically significant improvement in the fit of the data. rLM must be evaluated carefully in renal failure for amikacin dose adjustment. Conclusions: Revised Lund-Malmö (rLM) and CKD-EPI showed the superior predictive performance of amikacin drug elimination comparing to all the alternative metrics evaluated.


Assuntos
Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Nefropatias/complicações , Modelos Biológicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amicacina/farmacocinética , Antibacterianos/farmacocinética , Creatinina/metabolismo , Relação Dose-Resposta a Droga , Feminino , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Estudos Retrospectivos , Distribuição Tecidual , Adulto Jovem
15.
Urology ; 130: 138-141, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31063764

RESUMO

Fibroepithelial polyps represent a rare cause of intrinsic ureteropelvic junction obstruction in the pediatric population, accounting for less than 5% of cases. Herein, we present this peculiar case of a 10-year-old boy with multiple large intraluminal FEPs resembling Medusa's hair and the challenges associated with its subsequent treatment plan.


Assuntos
Nefropatias/complicações , Pelve Renal , Pólipos/complicações , Obstrução Ureteral/etiologia , Criança , Humanos , Nefropatias/patologia , Masculino , Pólipos/patologia
16.
17.
EuroIntervention ; 15(11): e1014-e1021, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31085502

RESUMO

AIMS: The aim of this study was to compare the outcomes between multivessel and infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), multivessel disease (MVD), and severe renal dysfunction (RD) using the nationwide AMI registry. METHODS AND RESULTS: Among 13,104 patients, 537 diagnosed with AMI and MVD who had severe RD at presentation (estimated glomerular filtration rate [GFR] <30 mL/min/1.73 m2, mean: 19.1±7.5 mL/min/1.73 m2) and underwent PCI during index hospitalisation were selected. The patients were classified according to treatment strategy, i.e., multivessel PCI (49.0%) or IRA-only PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction, re-hospitalisation for heart failure, and any repeat revascularisation at one year. The safety outcome was the worsening of renal function (WRF), defined as a 30% reduction in estimated GFR from baseline to 12-month follow-up. The adjusted MACE risks were similar in groups after Cox regression (41.8% vs 39.8%, hazard ratio [HR] 1.008 [0.743-1.367]) and propensity score-matching analysis (HR 0.974 [0.651-1.377]). Multivessel PCI showed a significant tendency of higher rates of WRF (24.8% vs 11.1%, adjusted odds ratio 2.134 [0.976-4.668]). CONCLUSIONS: Multivessel PCI was associated with similar outcomes compared to IRA-only PCI in patients with AMI, MVD, and severe RD.


Assuntos
Doença da Artéria Coronariana , Nefropatias , Infarto do Miocárdio , Intervenção Coronária Percutânea , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Humanos , Nefropatias/complicações , Pacientes , Resultado do Tratamento
19.
Korean J Gastroenterol ; 73(5): 260-268, 2019 May 25.
Artigo em Coreano | MEDLINE | ID: mdl-31132832

RESUMO

The incidence of inflammatory bowel disease (IBD) is increasing rapidly and extra-intestinal manifestations in IBD are also increasing. The prevalence of renal and urinary involvement in IBD ranges from 4-23%. Nephrolithiasis is the most common urinary complication in IBD patients. Parenchymal renal disease is rare but has been well documented and presents most commonly as glomerulonephritis or tubulointerstitial nephritis. The overall morbidity of IBD-related renal manifestations is significant. Therefore, a high index of clinical suspicion and optimal monitoring of the renal function are needed for the early diagnosis and prevention of IBD-related renal manifestations and complications.


Assuntos
Doenças Inflamatórias Intestinais/patologia , Nefropatias/diagnóstico , Amiloidose/complicações , Amiloidose/tratamento farmacológico , Amiloidose/patologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Glomerulonefrite/complicações , Glomerulonefrite/patologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Nefropatias/complicações , Nefropatias/patologia , Testes de Função Renal , Nefrolitíase/complicações , Nefrolitíase/patologia
20.
Clin Nephrol ; 91(6): 344-352, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935460

RESUMO

AIMS: We attempted to classify 115 consecutive nonedematous hyponatremic patients according to their history and saline responsiveness. We hereby describe 6 out of them presenting a transient renal salt wasting (TRSW) state of unknown origin. MATERIALS AND METHODS: Six patients with an initial SNa of 126 ± 3 mEq/L were included in the study. They were treated with 2 L isotonic saline infusion over 24 hours. The evolution of the biochemical data of 5 patients were compared to 6 patients with syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH), 6 hyponatremias following the use of thiazides, and to 5 salt-depleted hyponatremic patients of similar age and body weight, treated in the same way. RESULTS: The mean values of FEurea and FEuric acid in the 6 described patients, together with a clearly inappropriate natriuresis suggested SIADH. However, the high mean fractional potassium excretion (FEK = 34 ± 15%) was not observed in SIADH (13 ± 3%) (p < 0.01). Plasma sodium levels improved quickly after saline infusion in most of these patients, while fractional solute excretions and diuresis decreased. Calciuria is increased in patients with renal salt waisting (RSW), while low calciuria values are observed in the thiazide group. Four of the 6 hyponatremic patients were admitted for syncopal malaise or fall. CONCLUSION: We observed in 6 out of 115 consecutive hyponatremic patients a TRSW. RSW as a diagnosis has to be considered when in hyponatremia with excessive natriuresis, high FEK and an intake of diuretics is ruled out. This hyponatremia is saline-responsive, but relapse can be frequently observed.


Assuntos
Hiponatremia/sangue , Hiponatremia/etiologia , Nefropatias/sangue , Sódio/sangue , Idoso , Idoso de 80 Anos ou mais , Cálcio/urina , Diurese , Diuréticos/efeitos adversos , Feminino , Hidratação , Humanos , Hiponatremia/terapia , Hiponatremia/urina , Síndrome de Secreção Inadequada de HAD/sangue , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/urina , Soluções Isotônicas , Nefropatias/complicações , Nefropatias/urina , Potássio/urina , Solução Salina/uso terapêutico , Tiazidas/efeitos adversos , Ureia/urina , Ácido Úrico/urina
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