Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.668
Filtrar
1.
Clin Exp Rheumatol ; 38 Suppl 126(4): 116-124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33095138

RESUMO

OBJECTIVES: To investigate the prevalence, associated factors, and effects of primary overt renal disease on morbidity in patients with primary Sjögren's syndrome (pSS). METHODS: All patients in the Sjögrenser (registry of adult pSS patients of the Spanish Society of Rheumatology) cohort were retrospectively investigated for the presence of clinically significant renal involvement directly related to pSS activity. RESULTS: Of the 437 patients investigated, 39 (9%) presented overt renal involvement during follow-up. Severe renal disease necessitating kidney biopsy was relatively rare (2%). Renal involvement may complicate pSS at any time during the disease course and is associated with severe disease (indicated by higher scores of involvement, activity, and damage), systemic multiorgan involvement, and a higher frequency of lymphoma. Multivariate analysis showed that older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.07), higher European League Against Rheumatism Sjögren's Syndrome Disease Activity Index scores (OR 1.1, CI 1.03-1.18), serum anti-La/SSB positivity (OR 6.65, CI 1.41-31.372), and non-vasculitic cutaneous involvement (OR 5.47, 1.03-29.02) were independently associated with this complication. Chronic renal failure developed in 23 of 39 patients (59%); only 1 of them progressed to end-stage renal disease necessitating renal replacement therapy. Patients with overt renal disease showed higher Sjögren's syndrome disease damage index scores, higher rates of hospitalisation due to disease activity and higher rates of clinically relevant comorbidities. CONCLUSIONS: Overt renal involvement in pSS is not uncommon. Although it usually shows a favourable prognosis, is associated with significant morbidity.


Assuntos
Nefropatias , Síndrome de Sjogren , Adulto , Idoso , Estudos de Coortes , Humanos , Rim , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Estudos Retrospectivos , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia
2.
Eur J Endocrinol ; 183(5): 497-504, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107440

RESUMO

Background: Hypophosphataemic rickets (HR) comprise a clinically and genetically heterogeneous group of conditions, defined by renal-tubular phosphate wasting and consecutive loss of bone mineralisation. X-linked hypophosphataemia (XLH) is the most common form, caused by inactivating dominant mutations in PHEX, a gene encompassing 22 exons located at Xp22.1. XLH is treatable by anti-Fibroblast Growth Factor 23 antibody, while for other forms of HR such as therapy may not be indicated. Therefore, a genetic differentiation of HR is recommended. Objective: To develop and validate a next-generation sequencing panel for HR with special focus on PHEX. Design and methods: We designed an AmpliSeq gene panel for the IonTorrent PGM next-generation platform for PHEX and ten other HR-related genes. For validation of PHEX sequencing 50 DNA-samples from XLH-patients, in whom 42 different mutations in PHEX and 1 structural variation have been proven before, were blinded, anonymised and investigated with the NGS panel. In addition, we analyzed one known homozygous DMP1 mutation and two samples of HR-patients, where no pathogenic PHEX mutation had been detected by conventional sequencing. Results: The panel detected all 42 pathogenic missense/nonsense/splice-site/indel PHEX-mutations and in one the known homozygous DMP1 mutation. In the remaining two patients, we revealed a somatic mosaicism of a PHEX mutation in one; as well as two variations in DMP1 and a very rare compound heterozygous variation in ENPP1 in the second patient. Conclusions: This developed NGS panel is a reliable tool with high sensitivity and specificity for the diagnosis of XLH and related forms of HR.


Assuntos
Raquitismo Hipofosfatêmico Familiar/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Nefropatias/diagnóstico , Endopeptidase Neutra Reguladora de Fosfato PHEX/análise , Distúrbios do Metabolismo do Fósforo/diagnóstico , Proteínas da Matriz Extracelular/análise , Raquitismo Hipofosfatêmico Familiar/genética , Feminino , Doenças Genéticas Ligadas ao Cromossomo X , Humanos , Nefropatias/genética , Masculino , Mutação , Fosfoproteínas/análise , Distúrbios do Metabolismo do Fósforo/genética , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Análise de Sequência de DNA
3.
Arch Cardiovasc Dis ; 113(10): 630-641, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32888873

RESUMO

BACKGROUND: Pulmonary hypertension (PH) is a heterogeneous, severe and progressive disease with an impact on quality of life and life-expectancy despite specific therapies. AIMS: (i) to compare prognosis significance of each PH subgroup in a cohort from a referral center, (ii) to identify phenotypically distinct high-risk PH patient using machine learning. METHODS: Patients with PH were included from 2002 to 2019 and routinely followed-up. We collected clinical, laboratory, imaging and hemodynamic variables. Four-year survival rate of each subgroups was then compared. Next, phenotypic domains were imputed with 5 eigenvectors for missing values and filtered if the Pearson correlation coefficient was>0.6. Thereafter, agglomerative hierarchical clustering was used for grouping phenotypic variables and patients: a heat map was generated and participants were separated using Penalized Model-Based Clustering. P<0.05 was considered significant. RESULTS: 328 patients were prospectively included (mean age 63±18 yo, 46% male). PH secondary to left heart disease (PH-LHD) and lung disease (PH-LD) had a significantly increased mortality compared to pulmonary arterial hypertension (PAH) patients: HR=2.43, 95%CI=(1.24-4.73) and 2.95, 95%CI=(1.43-6.07) respectively. 25 phenotypic domains were pinpointed and 3 phenogroups identified. Phenogroup 3 had a significantly increased mortality (log-rank P=0.046) compared to the others and was remarkable for predominant pulmonary disease in older male, accumulating cardiovascular risk factors, and simultaneous three major comorbidities: coronary artery disease, chronic kidney disease and interstitial lung disease. CONCLUSION: PH-LHD and PH-LD has 2-fold and 3-fold increase in mortality, respectively compared with PAH. PH patients with simultaneous kidney-cardiac-pulmonary comorbidities were identified as having high-risk of mortality. Specific targeted therapy in this phenogroup should be prospectively evaluated.


Assuntos
Mineração de Dados/métodos , Cardiopatias/epidemiologia , Nefropatias/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Aprendizado de Máquina , Hipertensão Arterial Pulmonar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Comorbidade , Feminino , França/epidemiologia , Nível de Saúde , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Humanos , Nefropatias/diagnóstico , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Estudos Prospectivos , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/mortalidade , Hipertensão Arterial Pulmonar/fisiopatologia , Sistema de Registros , Medição de Risco , Fatores de Risco
4.
Mayo Clin Proc ; 95(8): 1649-1659, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753139

RESUMO

OBJECTIVE: To characterize the use of cystatin C (cysC) across and within hospitals. PATIENTS AND METHODS: This 2-part study first evaluated access to cysC testing across 129 hospitals in the state of Minnesota, using a telephone-based survey. Second, granular data from a single center (Mayo Clinic) with on-site, rapid-turnaround testing (<1 day) and automated estimated glomerular filtration rate (eGFR) reporting was used to describe temporal patterns. The characteristics of hospitals that offered cysC testing and of patients who underwent rapid cysC testing at Mayo Clinic between January 1, 2011, and March 31, 2018, were described. Poisson regression analyzed temporal trends in cysC testing. RESULTS: Of the 114 hospitals (88%) that responded to the statewide survey, cysC was available in 91 (80%), but only 3 of 91 (3%) reported a turnaround time of <1 day. At Mayo Clinic, cysC use increased from 0.74 tests per 1000 patient-days in 2011 to 14 tests per 1000 patient-days in 2018 (P=.004). Of the 3774 patients with cysC tests, the mean first available eGFR was 46 mL/min per 1.73 m2 using cysC and 59 mL/min per 1.73 m2 using serum creatinine (P<.001). CysC testing was used across all intensities of care and was ordered by a variety of specialties. Nephrology was consulted in only 42% of cases. CONCLUSION: In the hospital, rapid-turnaround cysC testing is necessary for practical use but was not widely available in Minnesota. When available, a marked increase in cysC testing was observed over the study timeframe. Additional research is needed to determine optimal strategies for implementation of cysC within hospitals.


Assuntos
Cistatina C/sangue , Hospitais/estatística & dados numéricos , Nefropatias/diagnóstico , Testes de Função Renal/estatística & dados numéricos , Biomarcadores/sangue , Difusão de Inovações , Feminino , Humanos , Nefropatias/sangue , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Minnesota , Inquéritos e Questionários
6.
Arch Cardiovasc Dis ; 113(10): 660-670, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32660835

RESUMO

Renal function is often affected in patients with chronic heart failure with reduced ejection fraction (HFrEF). The complex interplay between heart and renal dysfunction makes renal function and potassium monitoring mandatory. Renin-angiotensin-aldosterone system (RAAS) blockers are a life-saving treatment for patients with HFrEF, regardless of worsening renal function. Uptitration to the maximum-tolerated dose should be a constant goal. This simple fact is all too often forgotten (only 30% of patients with heart failure receive the target dosage of RAAS blockers), and the RAAS blocker effect on renal function is sometimes misunderstood. RAAS blockers are not nephrotoxic drugs as they only have a functional effect on renal function. In many routine clinical cases, RAAS blockers are withheld or stopped because of this misunderstanding, combined with suboptimal assessment of the clinical situation and underestimation of the life-saving effect of RAAS blockers despite worsening renal function. In this expert panel, which includes heart failure specialists, geriatricians and nephrologists, we propose therapeutic management algorithms for worsening renal function for physicians in charge of outpatients with chronic heart failure. Firstly, the essential variables to take into consideration before changing treatment are the presence of concomitant disorders that could alter renal function status (e.g. infection, diarrhoea, hyperthermia), congestion/dehydration status, blood pressure and intake of nephrotoxic drugs. Secondly, physicians are invited to adapt medication according to four clinical scenarios (patient with congestion, dehydration, hypotension or hyperkalaemia). Close biological monitoring after treatment modification is mandatory. We believe that this practical clinically minded management algorithm can help to optimize HFrEF treatment in routine clinical practice.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Síndrome Cardiorrenal/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Nefropatias/tratamento farmacológico , Rim/efeitos dos fármacos , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Volume Sistólico/efeitos dos fármacos , Função Ventricular Esquerda/efeitos dos fármacos , Assistência Ambulatorial/normas , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Síndrome Cardiorrenal/diagnóstico , Síndrome Cardiorrenal/fisiopatologia , Cardiologia/normas , Doença Crônica , Consenso , Progressão da Doença , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Rim/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Nefrologia/normas , Recuperação de Função Fisiológica , Sistema Renina-Angiotensina/efeitos dos fármacos , Resultado do Tratamento
7.
Asian Cardiovasc Thorac Ann ; 28(8): 476-481, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32718181

RESUMO

BACKGROUND: Data regarding predictors of the eventual need for postoperative peritoneal dialysis in infants undergoing open heart surgery is still limited. We aimed to determine whether prolonged cardiopulmonary bypass time, surgical complexity classified according to Risk Adjustment for Congenital Heart Surgery category, younger age, and lower body weight increase the probability of requiring postoperative peritoneal dialysis. METHODS: We retrospectively analyzed data of 181 infants who underwent open heart surgery at our institution from January 1 to December 31, 2018. Cardiopulmonary bypass time, Risk Adjustment for Congenital Heart Surgery category, age, body weight, and the need for postoperative peritoneal dialysis were recorded and analyzed. RESULTS: Thirteen (7.2%) of the 181 patients required postoperative peritoneal dialysis. This group was found to have a longer cardiopulmonary bypass time, younger age, and lower body weight. Longer cardiopulmonary bypass time (p = 0.001), higher Risk Adjustment for Congenital Heart Surgery category (p = 0.018), younger age (p < 0.001), and lower body weight (p < 0.001) significantly increased the risk of postoperative peritoneal dialysis. CONCLUSION: Longer cardiopulmonary bypass time, more complex surgery, younger age, and lower body weight increase the probability of requiring postoperative peritoneal dialysis in infants undergoing open heart surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Nefropatias/terapia , Diálise Peritoneal , Fatores Etários , Peso Corporal , Ponte Cardiopulmonar , Bases de Dados Factuais , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Humanos , Lactente , Recém-Nascido , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Duração da Cirurgia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
Farm. comunitarios (Internet) ; 12(3): 14-20, jul. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193726

RESUMO

INTRODUCCIÓN: en la farmacia comunitaria se realizan determinaciones de parámetros analíticos cada vez con más frecuencia. Los valores obtenidos son muy útiles en el trabajo de atención farmacéutica. Uno de ellos, la creatinina en sangre, puede ser especialmente útil para la detección y seguimiento de la enfermedad renal crónica. Además, permitiría sugerir al clínico la desprescripción o ajuste de dosis de determinados medicamentos nefrotóxicos o de eliminación renal en función del filtrado glomerular calculado. Se plantea valorar la utilidad de un nuevo aparato, el StatSensor Xpress Creatinine® de Nova Biomedical como paso previo a la realización de un estudio sobre la posibilidad de implantar un servicio con estas características. MATERIAL Y MÉTODOS: a partir de una muestra de sangre proporcionada por uno de los investigadores y una solución control de creatinina se preparan 35 muestras que son analizadas con el aparato problema. Otras 35 muestras alícuotas de las primeras son analizadas por un laboratorio de referencia. Se evalúan la exactitud, rendimiento diagnóstico y precisión mediante las pruebas Passing Bablock, coeficiente de correlación de Lin, Bland Altman, sensibilidad y especificidad diagnóstica y coeficiente de variación. RESULTADOS: la prueba de Passing Bablock y el coeficiente de Lin son correctos. Bland Altman es estadísticamente significativa en valores superiores a 5 mg/dl. La sensibilidad y especificidad diagnósticas son del 100 % y el coeficiente de variación es menor del 5 %. CONCLUSIÓN: el analizador de mano StatSensor Xpress Creatinine® es válido en el rango de valores habituales en farmacia comunitaria


INTRODUCTION: At community pharmacy, determinations of analytical parameters are made more and more frequently. The values obtained are particularly useful in Pharmaceutical Care work. One of them, blood creatinine, can be especially useful for the detection and monitoring of chronic renal disease. In addition, it would allow to suggest to the clinician the deprescription or dose adjustment of certain nephrotoxic or renal elimination drugs according to the calculated glomerular filtrate. The usefulness of a new device, the StatSensor Xpress Creatinine® by Nova Biomedical, is being considered as a preliminary step to carrying out a study on the possibility of implementing a professional service with these characteristics. MATERIAL AND METHODS: From a blood sample provided by one of the researchers and a creatinine control solution, 35 samples are prepared and analyzed with the test device. Another 35 aliquots of the former are analyzed by a reference laboratory. Accuracy, diagnostic performance and precision are evaluated using the Passing Bablock, Lin correlation coefficient, Bland Altman, diagnostic sensitivity and specificity, and coefficient of variation tests. RESULTS: The Passing Bablock test and the Lin coefficient are correct. Bland Altman is statistically significant at values greater than 5 mg/dL. Diagnostic sensitivity and specificity are 100% and the coefficient of variation is less than 5%. CONCLUSION: The StatSensor Xpress Creatinine® Handheld Analyzer is valid in the range of common community pharmacy values


Assuntos
Humanos , Serviços Comunitários de Farmácia , Nefropatias/sangue , Nefropatias/diagnóstico , Creatinina/sangue , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Valores de Referência
9.
Nephrology (Carlton) ; 25(11): 822-828, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32621527

RESUMO

AIM: The COVID-19 pandemic poses unprecedented operational challenges to nephrology divisions in every country as they cope with COVID-19-related kidney disease in addition to regular patient care. Although general approaches have been proposed, there is a lack of practical guidance for nephrology division response in a hospital facing a surge of cases. Here, we describe the specific measures that our division has taken in the hope that our experience in Singapore may be helpful to others. METHODS: Descriptive narrative. RESULTS: A compilation of operational responses to the COVID-19 pandemic taken by a nephrology division at a Singapore university hospital. CONCLUSION: Nephrology operational readiness for COVID-19 requires a clinical mindset shift from usual standard of care to a crisis exigency model that targets best outcomes for available resources. Rapid multi-disciplinary efforts that evolve flexibly with the local dynamics of the outbreak are required.


Assuntos
Defesa Civil , Infecções por Coronavirus , Procedimentos Clínicos/tendências , Prática de Grupo , Nefropatias , Pandemias , Pneumonia Viral , Insuficiência Renal Crônica , Betacoronavirus , Defesa Civil/normas , Defesa Civil/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Prática de Grupo/organização & administração , Prática de Grupo/tendências , Hospitais Universitários , Humanos , Comunicação Interdisciplinar , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Nefropatias/virologia , Nefrologia/tendências , Inovação Organizacional , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Singapura/epidemiologia
10.
Cerebrovasc Dis Extra ; 10(2): 59-65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32610309

RESUMO

BACKGROUND: Although mechanical thrombectomy is a standard endovascular therapy for patients with acute ischemic stroke (AIS), the incidence of and risk factors for contrast-induced nephropathy (CIN) following mechanical thrombectomy are infrequently reported. OBJECTIVES: The aim of this study was to investigate the incidence and risk factors for CIN following mechanical thrombectomy for AIS, and whether the incidence of CIN is related to a poor prognosis. METHODS: We examined consecutive patients who underwent a mechanical thrombectomy in the period from January 2014 to March 2018. The patients' clinical backgrounds, treatments, and clinical prognoses were analyzed. CIN was defined as an increase in the serum creatinine level of ≥44.2 µmol/L (0.5 mg/dL) or 25% above baseline within 72 h after exposure to the contrast medium. RESULTS: In total, 80 patients (46 men and 34 women aged 74.5 ± 11.5 years) who met our inclusion criteria were analyzed. CIN occurred in 8.8% (7/80) of the patients following mechanical thrombectomy. Although no patients needed permanent dialysis, 1 required temporary dialysis. The median amount of contrast medium was 109 mL. A comparison between the groups with and without CIN showed a significant difference in white blood cell (WBC) count at the time of admission (11.6 ± 2.7 × 103/µL and 8.1 ± 2.7 × 103/µL; p < 0.01) and the cut-off value was 9.70 × 103/µL. In multivariate analysis, contrast volume/estimated glomerular filtration rate by creatinine and WBC count were significantly associated with the incidence of CIN, with odds ratios of 1.64 (95% CI 1.02-2.65; p = 0.04) and 1.61 (95% CI 1.15-2.25; p < 0.01), respectively. CONCLUSIONS: This study found that CIN occurred in 8.8% of patients with AIS following mechanical thrombectomy. High WBC count was associated with an increased risk of CIN and may be helpful for predicting CIN.


Assuntos
Isquemia Encefálica/terapia , Meios de Contraste/efeitos adversos , Nefropatias/induzido quimicamente , Leucócitos , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico por imagem , Creatinina/sangue , Feminino , Humanos , Incidência , Nefropatias/sangue , Nefropatias/diagnóstico , Nefropatias/terapia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
11.
Nutr Metab Cardiovasc Dis ; 30(8): 1382-1388, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32513581

RESUMO

BACKGROUND AND AIM: Lipid abnormalities are common in peritoneal dialysis (PD) patients and no effective treatment to decrease serum lipoprotein (a) [Lp(a)] in dialysis patients is known so far. Therefore, this research was designed to investigate the effects of soy isoflavone supplement on serum lipids and Lp(a) in PD patients. METHODS & RESULTS: In this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the isoflavone or the placebo group. The patients in the isoflavone group received 100 mg soy isoflavone daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 mL of blood was obtained from each patient and serum triglycerides, total cholesterol, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and Lp(a) were measured. Serum Lp(a) reduced significantly up to 10% in the isoflavone group at the end of week 8 compared to baseline (P < 0.05), and the reduction was significant in comparison with the placebo group (P < 0.05). Serum HDL-C increased significantly up to 11.5% in the isoflavone group at the end of week 8 compared to baseline (P = 0.05), and the increment was significant in comparison with the placebo group (P < 0.05). There were no significant differences between the two groups in mean changes of serum triglycerides, total cholesterol, and LDL-C. CONCLUSIONS: This study indicates that daily administration of 100 mg soy isoflavones reduces serum Lp(a) and increases HDL-C concentration which are two determinants of cardiovascular disease in PD patients. CLINICALTRIALS.GOV: NCT03773029. REGISTRATION NUMBER AND DATE: NCT03773029 - 2018.


Assuntos
HDL-Colesterol/sangue , Suplementos Nutricionais , Isoflavonas/administração & dosagem , Nefropatias/terapia , Lipoproteína(a)/sangue , Diálise Peritoneal Ambulatorial Contínua , Soja , Biomarcadores/sangue , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Isoflavonas/efeitos adversos , Isoflavonas/isolamento & purificação , Nefropatias/sangue , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Soja/química , Fatores de Tempo , Resultado do Tratamento
12.
Nutr Metab Cardiovasc Dis ; 30(8): 1289-1298, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32576415

RESUMO

BACKGROUND AND AIMS: Uric acid, the end-product of human purine metabolism, is associated with hypertension, diabetes and obesity. It has also been independently associated with the onset of chronic kidney disease in several populations. In this study, the association between serum uric acid (SUA) level and estimated glomerular filtration rate (eGFR) was investigated in healthy individuals belonging to two Brazilian birth cohorts. METHODS AND RESULTS: Data from 3541 to 3482 individuals, aged 30 and 22-years old, respectively, was included. eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on creatinine measurement. Regression analyses were sex-stratified due to interaction between SUA and sex (p < 0.001) and adjusted for perinatal, cardiometabolic and behavioral variables. We observed an inverse association between eGFR and SUA even after adjustment. In the highest tertile (3rd) of SUA, the eGFR coefficients at 30-years were-0.21 (95%CI -0.24;-0.18) for men and -0.20 (95%CI -0.23; -0.17) for women; at 22-years, were -0.09 (95%CI -0.12;-0.05) for men and -0.13 (95%CI -0.15; -0.10) for women. Higher differences among exponential means (95% CI) of eGFR between the 1st and the 3rd tertile of SUA were seen in older participants, being more pronounced in men. At 22-years, the highest difference was found in women. CONCLUSIONS: In young healthy individuals from a low-middle income country, SUA level was inversely associated with eGFR. Gender-related differences in eGFR according tertiles of SUA were higher in men at 30-years and in women at 22-years.


Assuntos
Hiperuricemia/sangue , Nefropatias/fisiopatologia , Rim/fisiopatologia , Ácido Úrico/sangue , Adulto , Fatores Etários , Biomarcadores/sangue , Brasil/epidemiologia , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/epidemiologia , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Prognóstico , Fatores de Risco , Fatores Sexuais , Adulto Jovem
14.
Reumatol. clín. (Barc.) ; 16(3): 239-241, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194358

RESUMO

El síndrome pulmón-riñón rara vez ha sido reportado como cuadro clínico de presentación de vasculitis causada por el consumo de cocaína contaminada con levamisol. Se reporta el caso de un paciente con este cuadro clínico y se señalan las dificultades que se presentaron durante el abordaje diagnóstico y terapéutico


Pulmonary-renal syndrome has rarely been reported as the clinical presentation of vasculitis caused by the consumption of cocaine adulterated with levamisole. We report the case of a patient in whom we detected the clinical manifestations and indicate the difficulties that arose in relation to the diagnostic and therapeutic approach


Assuntos
Humanos , Masculino , Adulto , Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol/efeitos adversos , Vasculite/induzido quimicamente , Vasculite/diagnóstico , Glomerulonefrite/induzido quimicamente , Pneumopatias , Nefropatias/diagnóstico , Vasculite/imunologia , Vasculite/terapia , Pulmão/patologia , Pulmão/diagnóstico por imagem , Tomografia
15.
J Vasc Access ; 21(4): 536-538, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32390495

RESUMO

The recommendations recently proposed by the European and American Vascular Societies in this new 'Covid-19' era regarding the triage of various vascular operations into urgent, emergent and programmed based on the nature of their pathology aim at reserving health care expenses and hospital staff towards managing the current unexpected worldwide pandemic to the highest possible degree. The suggestion for implementation of these changes into real-world practice, however, does not come without a cost. In particular, the recommendation for deferral of access creation in pre-dialysis patients, ethical, socio-economic and medico-legal issues arise which should be seriously taken into consideration. At the end of the day, vascular access creation is the lifeline of haemodialysis patients and the indication for surgery warrants patient-specific clinical judgement rather than 'group labelling'.


Assuntos
Derivação Arteriovenosa Cirúrgica , Betacoronavirus/patogenicidade , Cateterismo Venoso Central , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Nefropatias/terapia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Nefropatias/diagnóstico , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Segurança do Paciente , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Tempo para o Tratamento , Virulência
16.
Cardiovasc Ther ; 2020: 2683740, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32405322

RESUMO

Background: We performed a network meta-analysis (NMA) comparing the efficacy (stroke or systemic embolism) and safety (major bleeding) among different non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) and renal impairment, with the aim of recommending the proper drug and the dose based on renal function. Methods: We searched PubMed, EMBASE, Web of Science, and Cochrane Library with the items "dabigatran, edoxaban, apixaban, rivaroxaban, warfarin, and atrial fibrillation" through August 2019. NMA was analyzed with R (version 3.5.1, R Foundation for Statistical Computing) with the packages gemtc recalling JAGS (version 4.3.0) for the efficacy and safety of each drug with regard to different levels of renal function. NetMetaXL (version 1.6.1) and winBUGS (version 1.4.3) were used to obtain the cumulative ranking curve (SUCRA) of each drug. Result: In patients with normal renal function, dabigatran150 was ranked as the most effective drug (SUCRA 0.90), followed by dabigatran110 (SUCRA 0.68), apixaban (SUCRA 0.66), and rivaroxaban (SUCRA 0.59). With regard to the safety for preventing major bleeding, there was high probability that edoxaban30 (SUCRA 0.99) ranked first, compared to dabigatran110 (SUCRA 0.78) and edoxaban60 (SUCRA 0.66). For patients with mild renal impairment, with respect to the most effective drug for preventing stroke or systemic embolism, edoxaban60 ranked first (SUCRA 0.98), in comparison with dabigatran150 (SUCRA 0.74) and apixaban (SUCRA 0.64). Possibility of ranking first for the safest drug was edoxaban30 (SUCRA 0.99), followed by dabigatran110 (SUCRA 0.70) and apixaban (SUCRA 0.69). In patients with moderate renal function, dabigatran150 (SUCRA 0.95) ranked as the most effective drug in comparison with apixaban (SUCRA 0.66). Dabigatran110 (SUCRA 0.53), rivaroxaban (SUCRA 0.51), and edoxaban60 (SUCRA 0.50) had the similar probability of ranking third. When referred to the safest drug, probability of ranking first for preventing major bleeding was edoxaban30 (SUCRA 0.98), followed by apixaban (SUCRA 0.85) and edoxaban60 (SUCRA 0.64). Conclusion: In patients with AF and renal impairment and for patients with normal renal function, dabigatran 110 mg (bid) might have a better effect on the clinical results. And it does not coincide with patients taking dabigatran 110 mg with dose reduction for other factors including aged ≥75 years, renal impairment (CrCL 30-50 mL/min), gastritis, esophagitis, or gastroesophageal reflux, receiving concomitant verapamil, and so on. For patients with mild renal impairment, apixaban 5 mg (bid) would be a better choice for preventing stroke or systemic embolism and major bleeding, while apixaban 5 mg (bid) and edoxaban 60 mg (qd) were recommended for patients with moderate renal impairment. However, considering the fact of no RCTs for the head-to-head comparison, caution should be exercised over selecting each of NOACs for patients.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Embolia/prevenção & controle , Taxa de Filtração Glomerular , Nefropatias/fisiopatologia , Rim/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Tomada de Decisão Clínica , Embolia/diagnóstico , Embolia/epidemiologia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Metanálise em Rede , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
17.
Nutr Metab Cardiovasc Dis ; 30(7): 1130-1136, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32446868

RESUMO

BACKGROUND AND AIMS: The monocyte to high-density lipoprotein cholesterol ratio (MHR) is associated with multiple cardiovascular diseases. However, the role of the MHR in predicting cardiovascular diseases in patients on peritoneal dialysis remains unclear. METHODS AND RESULTS: Eight hundred and eighty incident peritoneal dialysis patients were enrolled from November 1, 2005, to February 28, 2017, and followed until May 31, 2017. Primary outcomes were cardiovascular events. Using the X-tile program, these patients were divided into three groups according to the MHR. Kaplan-Meier method and Cox regressions were used for survival analysis. During a median follow-up period of 26 months (interquartile range: 12-39 months), 139 cardiovascular events were recorded. After multiple adjustment, the high MHR group was associated with a 1.97-fold increase in the cardiovascular events hazard compared to that of the low group in the overall population (hazard ratio: 1.97; 95% CI, 1.19-3.28; P = 0.009). Subgroup analysis demonstrated that the association between the MHR and a higher risk of cardiovascular events was strongest in the subgroup of patients with diabetes (P for interaction = 0.004). In this subgroup, the high MHR group was found to be associated with a higher risk of cardiovascular events compared to the low group (hazard ratio: 7.69; 95% CI, 2.76-21.47). CONCLUSION: This study suggests that the MHR is independently associated with the risk of cardiovascular events in patients undergoing peritoneal dialysis, and diabetes status can influence the association between the MHR and the risk of cardiovascular events.


Assuntos
Doenças Cardiovasculares/epidemiologia , HDL-Colesterol/sangue , Nefropatias/terapia , Monócitos , Diálise Peritoneal , Adulto , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , China/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Nefropatias/sangue , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
Nutr Metab Cardiovasc Dis ; 30(7): 1188-1195, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32448719

RESUMO

BACKGROUND AND AIMS: Glomerular hyperfiltration (GH) is proposed as one of the earliest events in obesity (OB)-associated renal disease. Children with GH and type-1 diabetes showed increased chemokine levels. Chemokine associations with glomerular filtration rate (GFR) and metabolic features in prepubertal children with overweight (OW)/OB are unknown. METHODS AND RESULTS: Cross-sectional study. 75 prepubertal children (aged: 9.0 ± 1.7 years) with OW/OB were studied. Clinical and metabolic characteristics (including non-esterified fatty acids, NEFA) and GFR (combined Zappitelli equation) were assessed. GH was defined as GFR >135 ml/min.1.73 m2. Serum levels of regulated on activation, normal T cell expressed and secreted (RANTES)/CCL5, interleukin-8 (IL-8)/CXCL8 and monokine-induced by interferon-γ (MIG)/CXCL9 were measured by ELISA. Age- and sex-adjusted correlations and differences were tested. 48% of the cohort was female and 13% were OW, 54% OB and 33% severe OB. Prepubertal children with GH showed lower z-BMI (-12%), NEFA (-26%) and uric acid (-22%) than those without GH (all p < 0.05). Similarly to high sensitivity C-reactive protein (hsCRP), there were no differences in serum chemokines between children with GH or not (all p > 0.05). Adjusted correlations were significant for RANTES and z-BMI (r = 0.26; p < 0.05) and for MIG with z-BMI (r = -0.26; p < 0.05) and with NEFA (r = 0.27; p < 0.05). CONCLUSION: GH was not associated with higher chemokine levels in prepubertal children with OW/OB. Decreased rather than elevated GFR values were correlated with obesity and worse metabolic profiles. Chemokines levels in children with severe OB suggest a regulation of the immune response. Follow-up studies are needed to address the clinical implications of these findings.


Assuntos
Quimiocinas/sangue , Desenvolvimento Infantil , Metabolismo Energético , Taxa de Filtração Glomerular , Nefropatias/fisiopatologia , Rim/fisiopatologia , Obesidade Pediátrica/sangue , Fatores Etários , Biomarcadores/sangue , Criança , Estudos Transversais , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Obesidade Pediátrica/complicações , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/imunologia , Estudos Prospectivos , Fatores de Risco
19.
Biochim Biophys Acta Proteins Proteom ; 1868(9): 140449, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32450146

RESUMO

d-Serine, a long-term undetected enantiomer of serine, is now showing its potential as a biomarker for kidney diseases. The intra-body dynamics of d-serine, currently defined by blood levels and urinary excretion dynamics, are useful for a comprehensive assessment of kidney function and disease activity. Thus, widespread adoption of d-serine as a biomarker can resolve the long-standing clinical challenge of the early detection and prognostic prediction of kidney diseases. Accuracy and reliability of the measurements are particularly important because these measurements will affect treatment decisions and thus impact the patient's emotional state and quality of life. Accordingly, this review focuses on current clinical challenges in kidney diseases and the potential for monitoring of d-serine to overcome these issues, and discuss the requirements of accurate quantification.


Assuntos
Biomarcadores/sangue , Biomarcadores/urina , Nefropatias/diagnóstico , Serina/sangue , Serina/urina , Lesão Renal Aguda/diagnóstico , Tomada de Decisão Clínica , Taxa de Filtração Glomerular , Humanos , Nefropatias/metabolismo , Nefropatias/terapia , Prognóstico , Qualidade de Vida , Insuficiência Renal Crônica/diagnóstico , Reprodutibilidade dos Testes , Serina/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA