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1.
Medicine (Baltimore) ; 98(39): e17303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574857

RESUMO

Treatment with nitisinone (NTBC) has brought about a drastic improvement in the treatment and prognosis of hereditary tyrosinemia type I (HT1). We conducted a retrospective observational multicentric study in Spanish HT1 patients treated with NTBC to assess clinical and biochemical long-term evolution.We evaluated 52 patients, 7 adults and 45 children, treated with NTBC considering: age at diagnosis, diagnosis by clinical symptoms, or by newborn screening (NBS); phenotype (acute/subacute/chronic), mutational analysis; symptoms at diagnosis and clinical course; biochemical markers; doses of NTBC; treatment adherence; anthropometric evolution; and neurocognitive outcome.The average follow-up period was 6.1 ±â€Š4.9 and 10.6 ±â€Š5.4 years in patients with early and late diagnosis respectively. All patients received NTBC from diagnosis with an average dose of 0.82 mg/kg/d. All NBS-patients (n = 8) were asymptomatic at diagnosis except 1 case with acute liver failure, and all remain free of liver and renal disease in follow-up. Liver and renal affectation was markedly more frequent at diagnosis in patients with late diagnosis (P < .001 and .03, respectively), with ulterior positive hepatic and renal course in 86.4% and 93.2% of no-NBS patients, although 1 patient with good metabolic control developed hepatocarcinoma.Despite a satisfactory global nutritional evolution, 46.1% of patients showed overweight/obesity. Interestingly lower body mass index was observed in patients with good dietary adherence (20.40 ±â€Š4.43 vs 24.30 ±â€Š6.10; P = .08) and those with good pharmacological adherence (21.19 ±â€Š4.68 vs 28.58 ±â€Š213.79).intellectual quotient was ≥85 in all NBS- and 68.75% of late diagnosis cases evaluated, 15% of which need pedagogical support, and 6.8% (3/44) showed school failure.Among the 12 variants identified in fumarylacetoacetate hydrolase gene, 1 of them novel (H63D), the most prevalent in Spanish population is c.554-1 G>T.After NTBC treatment a reduction in tyrosine and alpha-fetoprotein levels was observed in all the study groups, significant for alpha-fetoprotein in no NBS-group (P = .03), especially in subacute/chronic forms (P = .018).This series confirms that NTBC treatment had clearly improved the prognosis and quality of life of HT1 patients, but it also shows frequent cognitive dysfunctions and learning difficulties in medium-term follow-up, and, in a novel way, a high percentage of overweight/obesity.


Assuntos
Cicloexanonas/uso terapêutico , Diagnóstico Tardio , Nitrobenzoatos/uso terapêutico , Obesidade , Qualidade de Vida , Tirosinemias , Adulto , Criança , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Inibidores Enzimáticos/uso terapêutico , Feminino , Seguimentos , Humanos , Recém-Nascido , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Triagem Neonatal/métodos , Obesidade/diagnóstico , Obesidade/etiologia , Prognóstico , Estudos Retrospectivos , Espanha , Tempo para o Tratamento , Tirosinemias/complicações , Tirosinemias/diagnóstico , Tirosinemias/tratamento farmacológico , Tirosinemias/psicologia
2.
Methodist Debakey Cardiovasc J ; 15(2): 158-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384382

RESUMO

This column is supplied by Benjamin J. Lee, MD, MAS, an assistant professor of clinical medicine at both the Houston Methodist Institute for Academic Medicine and Weill Cornell Medical College. After earning his medical degree at Harvard Medical School, Dr. Lee completed a residency in internal medicine at the University of California, San Francisco (UCSF). He subsequently completed a nephrology fellowship at UCSF while simultaneously obtaining a Master of Advanced Study in clinical research from the UCSF Department of Epidemiology and Biostatistics. Dr. Lee is a Fellow of the American Society of Nephrology, a Certified Hypertension Specialist through the American Hypertension Specialist Certification Program, and a member of the American Society of Transplantation. He maintains his clinical practice with the Houston Kidney Consultants.


Assuntos
Cianose/etiologia , Cardiopatias Congênitas/complicações , Nefropatias/etiologia , Rim/fisiopatologia , Cianose/diagnóstico , Cianose/fisiopatologia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/tratamento farmacológico , Cardiopatias Congênitas/fisiopatologia , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Nefropatias/diagnóstico , Nefropatias/tratamento farmacológico , Nefropatias/fisiopatologia , Prognóstico , Fatores de Risco
3.
Intern Med ; 58(13): 1885-1889, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257276

RESUMO

Intravascular large B-cell lymphoma (IVLBCL) frequently involves the hepatobiliary system, but its clinical course and pathophysiology are still not fully known. We herein describe a case of IVLBCL mimicking acute hepatobiliary infection. An 85-year-old woman was admitted because of fever and epigastric pain, and she was diagnosed to have acute acalculous cholecystitis based on gallbladder wall thickening with fluid collection. The gallbladder swelling regressed within several days, and areas of intrahepatic hypoperfusion appeared. Inflammation continued despite treatment with antibiotics, and she died within 21 days. An autopsy examination revealed IVLBCL. IVLBCL can present as acute cholecystitis with an improvement in the imaging findings and the presence of a subsequent liver mass.


Assuntos
Nefropatias/terapia , Hepatopatias/terapia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Hepatopatias/diagnóstico , Hepatopatias/microbiologia , Hepatopatias/fisiopatologia , Linfoma Difuso de Grandes Células B/fisiopatologia
4.
Br J Radiol ; 92(1103): 20190448, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31335170

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disorder characterized by the infiltration of one or more organs with IgG4-positive plasma cells resulting in inflammatory lesions and fibrosis. Although the pancreas is the most commonly affected organ, involvement of extrapancreatic organs is an increasingly recognized manifestation of the disease. Patients may be asymptomatic and serum IgG4 concentrations may be elevated or normal. Treatment consists of glucocorticosteroid treatment, with excellent response. A definitive diagnosis requires histopathology with imaging playing a key role in avoiding treatment delays. This pictorial review will focus on the most current knowledge regarding IgG4-RD including its common and less common manifestations and the roles of multidetector CT, MRI and ultrasound in the diagnosis and management of suspected IgG4-RD. Knowledge of the varied imaging findings of this multi systemic disease is essential for radiologists to avoid misdiagnosis and assist with timely and effective treatment.


Assuntos
Doença Relacionada a Imunoglobulina G4/complicações , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Dacriocistite/diagnóstico , Dacriocistite/etiologia , Feminino , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/etiologia , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Nefropatias/diagnóstico , Nefropatias/etiologia , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Imagem por Ressonância Magnética , Masculino , Mastite/diagnóstico , Mastite/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/etiologia , Pancreatopatias/diagnóstico , Pancreatopatias/etiologia , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/etiologia , Sialadenite/diagnóstico , Sialadenite/etiologia , Ultrassonografia
5.
Nat Commun ; 10(1): 2832, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31249312

RESUMO

Defining cellular and molecular identities within the kidney is necessary to understand its organization and function in health and disease. Here we demonstrate a reproducible method with minimal artifacts for single-nucleus Droplet-based RNA sequencing (snDrop-Seq) that we use to resolve thirty distinct cell populations in human adult kidney. We define molecular transition states along more than ten nephron segments spanning two major kidney regions. We further delineate cell type-specific expression of genes associated with chronic kidney disease, diabetes and hypertension, providing insight into possible targeted therapies. This includes expression of a hypertension-associated mechano-sensory ion channel in mesangial cells, and identification of proximal tubule cell populations defined by pathogenic expression signatures. Our fully optimized, quality-controlled transcriptomic profiling pipeline constitutes a tool for the generation of healthy and diseased molecular atlases applicable to clinical samples.


Assuntos
Núcleo Celular/genética , Nefropatias/genética , Rim/metabolismo , Rim/patologia , Análise de Sequência de RNA/métodos , Idoso , Núcleo Celular/metabolismo , Feminino , Perfilação da Expressão Gênica , Humanos , Nefropatias/diagnóstico , Nefropatias/metabolismo , Nefropatias/patologia , Masculino , Células Mesangiais/metabolismo , Pessoa de Meia-Idade , Análise de Célula Única/métodos
7.
Lakartidningen ; 1162019 May 28.
Artigo em Sueco | MEDLINE | ID: mdl-31192397

RESUMO

Shrunken Pore Syndrome was defined in 2015 and is characterised by the glomerular filtration of 5-40 kDa molecules being selectively decreased compared to that of molecules <0.2 kDa, e.g. water and creatinine. The diagnose is based upon identification of a decreased eGFRcystatin C/eGFRcreatinine ratio, and ratios -< 0.6 or 0.7 have most often been used to identify the diagnose. The mortality is strongly increased in all investigated populations and increases progressively with a decrease in the eGFRcystatin C/eGFRcreatinine ratio used to identify the syndrome. The prevalence of the syndrome varies with the eGFRcystatin C/eGFRcreatinine ratio used for diagnosis, but when a ratio of 0.6 is used, the prevalence has varied between 2 and 8%. The pathophysiology might be the accumulation of atherosclerosis-promoting proteins occurring in patients with the syndrome. The syndrome might explain the superiority of eGFRcystatin C over eGFRcreatinine in identifying high-risk kidney patients.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Nefropatias , Biomarcadores/sangue , Creatinina/sangue , Cistatina C/sangue , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Síndrome
8.
Turkiye Parazitol Derg ; 43(2): 89-91, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31204463

RESUMO

Hydatic cyst is a crucial and prevalent parasitic disease in the developing countries in the Mediterranean region. Its diagnosis is sometimes problematic because of non-specific complaints and unavailability of any positive results in a routine laboratory analysis. Isolated renal hydatid cysts are very rare. In this study, a primary left renal hydatid cyst which was found in a 12-year-old boy was presented. He was referred by another hospital to our department with a flank pain and cystic mass in left kidney. Indirect haemagglutination test (IHA) for Echinococcus was negative. Nephrectomy was performed with the diagnosis of renal cyst hydatic. Renal cyst hydatid may present with various clinical findings ranging from asymptomatic clinical course to total loss in renal function. It will be beneficial to consider a renal hydatid cyst in patients with blurred flank pain, even if IHA is negative.


Assuntos
Equinococose/diagnóstico , Nefropatias/parasitologia , Animais , Criança , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Echinococcus granulosus/isolamento & purificação , Testes de Hemaglutinação , Humanos , Nefropatias/diagnóstico , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Masculino , Nefrectomia , Tomografia Computadorizada por Raios X , Ultrassonografia
9.
Transplant Proc ; 51(5): 1410-1414, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056251

RESUMO

BACKGROUND: Graft biopsy is the gold standard for diagnosis of BK polyomavirus-associated nephropathy (BKPyVAN), and polymerase chain reaction is the most specific screening technique. Development of a noninvasive, cost-effective marker for BKPyVAN is important. METHODS: We reviewed 492 adult kidney transplant patients. We investigated peripheral blood lymphocyte (PBL) count and urinary cytology at graft biopsy in patients with BKVPyAN (n = 21), acute T-cell-mediated rejection (n = 79), and no evidence of acute rejection (n = 149). We performed univariate and multivariate logistic regression and receiver operating characteristics analyses to compare the test performance of PBL count, urinary cytology, and their combination for diagnosis of BKPyVAN. RESULTS: The PBL count at biopsy was significantly lower in the BKPyVAN group than the acute T-cell-mediated rejection and no acute rejection groups (959 ± 290/µL, 1433 ± 673/µL, and 1531 ± 549/µL, respectively; P < .01). The PBL count was 959 ± 290/µL at diagnosis of BKPyVAN and increased to 1123 ± 377/µL, 1238 ± 419/µL, and 1292 ± 491/µL at 1, 2, and 3 months after treatment, respectively (P < .05). On univariate analysis, the area under the curve was significantly higher for the combined model than for PBL and cytology alone (0.930, 0.797, and 0.875, respectively; P < .01). The improved test performance in the combined model remained significant after multivariate adjustment (0.972, 0.844, and 0.928, respectively; P < .01). CONCLUSIONS: Decreased PBL count was found in BKPyVAN, and the predictive performance of the combination of PBL count and urinary cytology was significantly enhanced for diagnosis of BKPyVAN.


Assuntos
Diagnóstico Precoce , Nefropatias/diagnóstico , Transplante de Rim , Infecções por Polyomavirus/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Vírus BK/genética , Feminino , Humanos , Nefropatias/virologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Infecções por Polyomavirus/sangue , Infecções por Polyomavirus/urina , Complicações Pós-Operatórias/virologia , Valor Preditivo dos Testes , Infecções Tumorais por Vírus/sangue , Infecções Tumorais por Vírus/diagnóstico , Infecções Tumorais por Vírus/urina
10.
Medicine (Baltimore) ; 98(20): e15453, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096441

RESUMO

Preoperative renal dysfunction is associated with mortality in patients who undergo coronary artery bypass graft and valve surgery. However, the role of preoperative renal dysfunction in type A aortic dissection (TAAD) remains unclear. This study aimed to evaluate the impact of preoperative renal dysfunction on the outcome of surgical intervention in patients with TAAD.We retrospectively studied the outcomes of 159 patients with TAAD who were treated at a tertiary referral hospital between 2005 and 2010. The demographics and surgical details of patients were analyzed according to their renal function. Risk factors for outcomes were analyzed using multivariable logistic regression. Thirty-two of the patients (20.1%) had preoperative serum creatinine of 1.5 mg/dL or more. The multivariable logistic regression model revealed independent risk factors of in-hospital mortality to be renal dysfunction (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.64-8.77), preoperative shock (OR, 8.75; 95% CI, 2.83-27.02), and bypass time (OR, 1.008; 95% CI, 1.003-1.013). In addition, patients with renal dysfunction exhibited a lower 90-day survival rate than did patients without the condition (P of log-rank test = .005).Preoperative renal dysfunction may have a critical role in the surgical outcomes of patients with TAAD. Additional large-scale investigations are warranted.


Assuntos
Aneurisma Dissecante/cirurgia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Rim/fisiopatologia , Adulto , Idoso , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Ponte de Artéria Coronária/mortalidade , Creatinina/sangue , Feminino , Mortalidade Hospitalar , Humanos , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
11.
BMJ ; 365: l1516, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036557

RESUMO

OBJECTIVE: To investigate associations between pre-eclampsia and later risk of kidney disease. DESIGN: Nationwide register based cohort study. SETTING: Denmark. POPULATION: All women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015. MAIN OUTCOME MEASURE: Hazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression. RESULTS: The cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest. CONCLUSION: s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.


Assuntos
Hipertensão Renal/epidemiologia , Nefropatias/diagnóstico , Nefropatias/etiologia , Pré-Eclâmpsia/diagnóstico , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Dinamarca/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão Renal/complicações , Nefropatias/epidemiologia , Monitorização Fisiológica/normas , Período Pós-Parto , Pré-Eclâmpsia/epidemiologia , Gravidez , Fatores de Risco , Adulto Jovem
12.
Internist (Berl) ; 60(5): 485-501, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-30997523

RESUMO

Kidney diseases are among the most frequently reported diseases with a poor prognosis that are diagnosed too late. According to current Kidney Disease Improving Global Outcomes (KDIGO) guidelines, diagnosis and risk stratification are mainly based on functional markers (creatinine and cystatin C), which are used to determine the estimated glomerular filtration rate (eGFR) and the analysis of urinary albumin excretion as a marker of kidney damage. These methods have limitations that can complicate the interpretation of the results and can lead to a delay of the diagnosis as well as to a misinterpretation of the prognosis. Therefore, new damage markers are required that sensitively and specifically detect kidney damage and enable targeted treatment. Urinalysis complements the laboratory diagnostic spectrum of diseases of the kidneys and urinary tract. It is mainly used for screening and provides important information on localization (renal/postrenal) and differentiation of kidney diseases (glomerular/tubulointerstitial).


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Nefropatias/diagnóstico , Testes de Função Renal/normas , Insuficiência Renal/diagnóstico , Biomarcadores/sangue , Humanos , Rim/fisiopatologia , Nefropatias/sangue , Nefropatias/fisiopatologia , Urinálise
14.
Int J Mol Sci ; 20(8)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31018516

RESUMO

Fibrosis, or tissue scarring, is defined as the excessive, persistent and destructive accumulation of extracellular matrix components in response to chronic tissue injury. Renal fibrosis represents the final stage of most chronic kidney diseases and contributes to the progressive and irreversible decline in kidney function. Limited therapeutic options are available and the molecular mechanisms governing the renal fibrosis process are complex and remain poorly understood. Recently, the role of non-coding RNAs, and in particular microRNAs (miRNAs), has been described in kidney fibrosis. Seminal studies have highlighted their potential importance as new therapeutic targets and innovative diagnostic and/or prognostic biomarkers. This review will summarize recent scientific advances and will discuss potential clinical applications as well as future research directions.


Assuntos
Nefropatias/genética , Nefropatias/patologia , Rim/patologia , RNA não Traduzido/genética , Animais , Fibrose , Terapia Genética , Humanos , Rim/metabolismo , Nefropatias/diagnóstico , Nefropatias/terapia , Terapia de Alvo Molecular , RNA não Traduzido/análise
15.
Stud Health Technol Inform ; 258: 179-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30942741

RESUMO

Due to demographic change the number of serious kidney diseases and thus required transplantations will increase. The increased demand for donor organs and a decreasing supply of these organs underline the necessity for effective early rejection diagnostic measures to improve the lifetime of transplants. Expert systems might improve rejection diagnostics but for the development of such systems data models are needed that encompass the relevant information to enable optimal data aggregation and evaluation. Results of a literature review concerning published data models and information systems concerned with kidney transplant rejection diagnostic lead to a set of data elements even if no papers could be identified that publish data models explicitly.


Assuntos
Sistemas Especialistas , Nefropatias , Transplante de Rim , Rejeição de Enxerto , Humanos , Nefropatias/diagnóstico , Nefropatias/terapia , Modelos Estatísticos
17.
Blood Press Monit ; 24(3): 114-119, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30969228

RESUMO

OBJECTIVES: Exaggerated blood pressure response (EBPR) to exercise tests is an additional cardiovascular risk factor and predictor of future development of hypertension. However, there are conflicting data on the diagnostic threshold of EBPR and its clinical importance in kidney disease. The aim of this study was to investigate vascular inflammation and subclinical nephropathy in otherwise healthy volunteers with EBPR. PATIENTS AND METHODS: The study included 170 middle-aged, healthy volunteers (mean age: 43.3±6.9; range: 35-65 years: 100 men and 70 women). Participants performed a treadmill exercise test until they reached their age-adjusted maximum heart rate and were divided into EBPR and normal/physiological blood pressure response groups. Before exercise tests, serum high sensitive C-reactive protein (hs-CRP) and urine albumin-to-creatinine ratio were measured to evaluate vascular inflammation and subclinical nephropathy, respectively. Anthropometrical measurements, fasting serum glucose, fasting lipid profile, and the full blood count of participants were also evaluated. RESULTS: EBPR was detected in 31 (18.2%) participants. Hs-CRP levels (1.03 vs. 0.46 mg/l) (P<0.001) and albumin-to-creatinine ratio levels (6.90 vs. 5.22 mg/g) (P=0.002) were higher in the EBPR group. BMI, abdominal obesity, and hs-CRP levels were found to be related to increased development of EBPR. CONCLUSION: EBPR is an overlooked clinical finding during exercise tests and should be evaluated in apparently healthy, middle-aged populations for the early detection of possible subclinical nephropathy.


Assuntos
Pressão Sanguínea/fisiologia , Exercício/fisiologia , Hipertensão/etiologia , Nefropatias/sangue , Vasculite/sangue , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Proteína C-Reativa/análise , Teste de Esforço , Feminino , Voluntários Saudáveis , Humanos , Inflamação , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Obesidade Abdominal/complicações , Obesidade Abdominal/fisiopatologia , Vasculite/diagnóstico
18.
J Vasc Access ; 20(1_suppl): 15-19, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032727

RESUMO

The prevalence rate and the incidence rate of hemodialysis and functioning kidney transplant recipients have continuously increased; on the contrary, those of peritoneal dialysis have continuously decreased since 2006. Dialysis patients have been getting older and have been maintained on dialysis longer. Diabetic nephropathy was the leading cause of end stage renal disease. The type of hemodialysis vascular access has been stable during the last 5 years (arteriovenous fistulas 76%, arteriovenous grafts 16%, central venous catheters 8% at 2016). Peritoneal dialysis catheter was mostly inserted surgically (67%), and swan neck straight tip peritoneal dialysis catheter was the most commonly used (48%). Vascular access was managed by radiologists and surgeons, and the management was fragmented among them in the past. However, since the nephrologists became interested in and knowledgeable about the vascular access, they began to play roles in vascular access management. Vascular access has been mostly created by vascular surgeons (≈60%); tunneled central venous hemodialysis catheter insertion and endovascular intervention such as percutaneous transluminal angioplasty (PTA) and thrombectomy have been mostly performed by radiologists (≈70%). Tunneled hemodialysis catheter insertion and endovascular intervention by nephrologists have slowly but consistently increased. Recently, the number of central venous hemodialysis catheter insertion has decreased, and tunneled hemodialysis catheter has been inserted more than non-tunneled hemodialysis catheter, indicating that vascular access has been created timely and the vascular access team has been educated about and following international guidelines.


Assuntos
Derivação Arteriovenosa Cirúrgica/tendências , Implante de Prótese Vascular/tendências , Cateterismo Venoso Central/tendências , Nefropatias/terapia , Avaliação de Processos e Resultados (Cuidados de Saúde)/tendências , Diálise Peritoneal/tendências , Padrões de Prática Médica/tendências , Diálise Renal/tendências , Idoso , Angioplastia/tendências , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Obstrução do Cateter , Cateterismo Venoso Central/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Nefrologistas/tendências , Radiologistas/tendências , República da Coreia/epidemiologia , Cirurgiões/tendências , Trombectomia/tendências , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
J Vasc Access ; 20(1_suppl): 60-64, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032729

RESUMO

INTRODUCTION: Long-term use of peritoneal dialysis catheter is associated with complications such as infection and malfunction, necessitating removal of catheter with subsequent reinsertion or permanent transfer to haemodialysis. This study aims to investigate the outcome in patients who underwent reinsertion. METHODS AND MATERIALS: A single-centre retrospective study was performed in Singapore General Hospital for all adult incident peritoneal dialysis patients between January 2011 and January 2016. Study data were retrieved from patient electronic medical records up till 1 January 2017. RESULTS: A total of 470 patients had peritoneal dialysis catheter insertion with median follow-up period of 29.2 (interquartile range = 16.7-49.7) months. A total of 92 patients required catheter removal. Thirty-six (39%) patients underwent catheter reinsertion. The overall technique survival at 3 and 12 months were 83% and 67%. Median time to technique failure of the second catheter was 6.74 (interquartile range = 0-50.2) months. The mean survival for patients who converted to haemodialysis and re-attempted peritoneal dialysis was comparable (54.9 ± 5.5 vs 57.3 ± 3.6 months; p = 0.75). Twelve (13%) patients had contraindication for peritoneal dialysis and were excluded from analysis. Of 11 patients who required catheter removal due to malfunction, 7 (64%) underwent catheter reinsertion and 6 (86%) patients ultimately converted to haemodialysis during study period. Of the 69 patients who had catheter removal due to infection, 29 (42%) underwent catheter reinsertion and 8 (28%) patients eventually converted to haemodialysis during the study period. CONCLUSION: Patient survival was comparable between patients who re-attempted peritoneal dialysis and patients who transferred to haemodialysis. Patients who had previous catheter removal due to infections had favourable technique survival than those due to catheter malfunction.


Assuntos
Infecções Relacionadas a Cateter/terapia , Cateteres de Demora , Remoção de Dispositivo , Nefropatias/terapia , Diálise Peritoneal/instrumentação , Diálise Renal , Adulto , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/etiologia , Remoção de Dispositivo/efeitos adversos , Registros Eletrônicos de Saúde , Falha de Equipamento , Feminino , Humanos , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Singapura , Fatores de Tempo , Resultado do Tratamento
20.
J Vasc Access ; 20(1_suppl): 38-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032732

RESUMO

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.


Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Nefropatias/terapia , Diálise Renal , Idoso , Angioplastia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/economia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Custos de Cuidados de Saúde , Humanos , Japão/epidemiologia , Nefropatias/diagnóstico , Nefropatias/economia , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/economia , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
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