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1.
Pancreas ; 50(3): 393-398, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33835971

RESUMO

OBJECTIVE: The clinical significance of increased serum pancreatic enzymes (PEs) in coronavirus disease 2019 (COVID-19) patients has not yet been fully understood. We aimed to investigate the frequency and the impact on clinical outcome of PE elevation and acute pancreatitis in such patients. METHODS: Clinical data, laboratory tests, and cross-sectional images were analyzed from COVID-19 patients admitted to the Tor Vergata Hospital in Rome. Variables associated with PE abnormalities, intensive care unit (ICU) admission, or death were investigated through univariate and multivariate analyses and Cox proportional hazard model. RESULTS: Pancreatic enzymes were available in 254 of 282 COVID-19 patients. Among these, 66 patients (26%) showed mild elevation of PE, and 11 patients (4.3%) had severe elevation (>3 times of the upper limit of normal). Overall, 2 patients met the diagnostic criteria for acute pancreatitis. Hepatic and renal involvements were associated with PE elevation. Multivariate analysis showed that mild and severe PE elevations were significantly associated with ICU admission (odds ratios, 5.51 [95% confidence interval, 2.36-12.89; P < 0.0001] and 26.2 [95% confidence interval, 4.82-142.39; P < 0.0001]). CONCLUSIONS: Increase in serum PE, but not acute pancreatitis, is frequent in hospitalized COVID-19 patients and associates with ICU admission.


Assuntos
/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva , Pâncreas/enzimologia , Pancreatite/epidemiologia , Idoso , Idoso de 80 Anos ou mais , /enzimologia , Feminino , Humanos , Nefropatias/sangue , Nefropatias/enzimologia , Nefropatias/epidemiologia , Hepatopatias/sangue , Hepatopatias/enzimologia , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Pancreatite/sangue , Pancreatite/enzimologia , Prognóstico , Modelos de Riscos Proporcionais
2.
Medicine (Baltimore) ; 100(11): e24762, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725942

RESUMO

ABSTRACT: Chemokines are majorly involved in inflammatory and immune responses. The interferon-γ-inducible chemokines C-X-C motif chemokines 9 and 10 (CXCL9 and CXCL10) are considerably associated with Th1 cells and monocytes, and their expression levels rapidly increase during the early episodes of renal allograft rejection and various infectious diseases. CXCL13 is one of the most potent B-cell and T follicular helper-cell chemoattractants. The expression of CXCL13 in the presence of infection indicates an important chemotactic activity in multiple infectious diseases. C-C motif chemokine ligand 2 (CCL2) can attract monocytes and macrophages during inflammatory responses. However, there are no studies on the role of these chemokines in posttransplant infection in kidney transplant recipients.In this study, CXCL9, CXCL10, CXCL13, and CCL2 were analyzed using the Bio-Plex suspension array system before transplant and 30 days after transplant.The serum levels of CXCL9 and CXCL13 30 days after kidney transplant were associated with infection within 1 year after transplant (P = .021 and P = .002, respectively). The serum levels of CXCL9 and CXCL13 before surgery and those of CCL2 and CXCL10 before and after surgery were not associated with infection within 1 year after transplant (P > .05). The combination of postoperative day (POD) 30 CXCL9 and postoperative day 30 CXCL13 provided the best results with an area under the curve of 0.721 (95% confidence interval, 0.591-0.852), with a sensitivity of 71.4% and specificity of 68.5% at the optimal cutoff value of 52.72 pg/mL.As important chemokines, CXCL9 and CXCL13 could be used to predict the occurrence of infection after kidney transplant.


Assuntos
Quimiocina CXCL13/sangue , Quimiocina CXCL9/sangue , Infecções/etiologia , Nefropatias/sangue , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Biomarcadores/sangue , Quimiocina CCL2/sangue , Quimiocina CXCL10/sangue , Feminino , Humanos , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos
3.
Nutr Metab Cardiovasc Dis ; 31(2): 626-633, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33594986

RESUMO

BACKGROUND AND AIM: Vascular calcification is an independent risk factor for cardiovascular diseases and all-cause mortality in end stage renal disease, and particularly in hemodialysis patients. Vitamin D deficiency has been shown to be associated with vascular calcification among this category of patients. Cholecalciferol or vitamin D3; the native inactivated 25-hydroxy vitamin D [25(OH)D], has been proposed to have a good impact on vascular calcification and vitamin D deficiency. However, clinical data is still limited. METHODS AND RESULTS: A prospective, randomized, placebo-controlled study was carried out to evaluate the effect of oral cholecalciferol on vascular calcification and 25(OH)D levels in hemodialysis patients. A total of sixty eligible hemodialysis patients were randomly assigned to either a treatment group (Oral 200.000IU Cholecalciferol per month) or a placebo group, for 3 months. Serum 25-hydroxy vitamin D (25(OH)D), fetuin-A, fibroblast growth factor (FGF-23), osteoprotegerin (OPG), calcium, phosphorus, their product (CaXP) and intact parathyroid hormone (iPTH) levels, were all assessed at baseline and at the end of the study. ClinicalTrials.gov registration number: NCT03602430. Cholecalciferol significantly increased serum levels of 25(OH)D and fetuin-A in the treatment group (p-value < 0.001), while no significant difference was observed in the placebo group. Cholecalciferol administration showed no effect on either FGF-23 or OPG. None of the treatment group patients experienced any adverse effects. CONCLUSION: Cholecalciferol was shown to be an effective, tolerable, inexpensive pharmacotherapeutic option to overcome vitamin D deficiency, with a possible modulating effect on fetuin-A, among hemodialysis patients. CLINICALTRIALS. GOV REGISTRATION NUMBER: NCT03602430.


Assuntos
Colecalciferol/uso terapêutico , Nefropatias/terapia , Diálise Renal , Calcificação Vascular/sangue , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/análogos & derivados , Vitaminas/uso terapêutico , Adulto , Biomarcadores/sangue , Colecalciferol/efeitos adversos , Egito , Feminino , Humanos , Nefropatias/sangue , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Diálise Renal/efeitos adversos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico , Calcificação Vascular/etiologia , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Vitaminas/efeitos adversos , alfa-2-Glicoproteína-HS/metabolismo
4.
Nutr Metab Cardiovasc Dis ; 31(4): 1148-1155, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33618923

RESUMO

BACKGROUND AND AIMS: Iron deficiency is prevalent, but there is limited data about the relationship between iron status and poor outcomes in chronic kidney disease patients undergoing peritoneal dialysis (PD). We aimed to investigate the association between iron status and mortality in PD patients. METHODS AND RESULTS: This retrospective study was conducted on incident PD patients from January 2006 to December 2016 and followed up until December 2018. Patients were categorized into four groups according to baseline serum transferrin saturation (percent) and ferritin levels (ng/ml): reference (20-30%, 100-500 ng/ml), absolute iron deficiency (<20%, <100 ng/ml), function iron deficiency (FID) (<20%, >100 ng/ml), and high iron (>30%, >500 ng/ml). Among the 1173 patients, 77.5% had iron deficiency. During a median follow-up period of 43.7 months, compared with the reference group, the FID group was associated with increased risk for all-cause [adjusted hazard ratio (aHR) 1.87, 95% confidence interval (95% CI) 1.05-3.31, P = 0.032], but not cardiovascular (CV) mortality. Additionally, the high iron group had a more than four-fold increased risk of both all-cause and CV mortality [aHR 4.32 (95% CI 1.90-9.81), P < 0.001; aHR 4.41 (95% CI 1.47-13.27), P = 0.008; respectively]. CONCLUSION: FID and high iron predict worse prognosis of patients on PD.


Assuntos
Distúrbios do Metabolismo do Ferro/sangue , Ferro/sangue , Nefropatias/terapia , Diálise Peritoneal/mortalidade , Adulto , Biomarcadores/sangue , China/epidemiologia , Feminino , Ferritinas/sangue , Humanos , Ferro/deficiência , Distúrbios do Metabolismo do Ferro/diagnóstico , Distúrbios do Metabolismo do Ferro/mortalidade , Nefropatias/sangue , Nefropatias/diagnóstico , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Transferrina/metabolismo , Resultado do Tratamento
5.
Eur J Endocrinol ; 183(6): R185-R196, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33077688

RESUMO

Primary aldosteronism is common and contributes to adverse cardiovascular, kidney, and metabolic outcomes. When instituted early and effectively, targeted therapies can mitigate these adverse outcomes. Surgical adrenalectomy is among the most effective treatments because it has the potential to cure, or attenuate the severity of, pathologic aldosterone excess, resulting in a host of biochemical and clinical changes that improve health outcomes. Herein, we review the role of surgical adrenalectomy in primary aldosteronism while emphasizing the physiologic ramifications of surgical intervention, and compare these to other targeted medical therapies for primary aldosteronism. We specifically review the role of curative adrenalectomy for unilateral primary aldosteronism, the role of non-curative adrenalectomy for bilateral primary aldosteronism, and how these interventions influence biochemical and clinical outcomes in relation to medical therapies for primary aldosteronism.


Assuntos
Adrenalectomia/tendências , Aldosterona/sangue , Hiperaldosteronismo/sangue , Hiperaldosteronismo/cirurgia , Adrenalectomia/métodos , Doenças do Sistema Endócrino/sangue , Doenças do Sistema Endócrino/cirurgia , Cardiopatias/sangue , Cardiopatias/prevenção & controle , Humanos , Nefropatias/sangue , Nefropatias/prevenção & controle
6.
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
7.
Arch Pathol Lab Med ; 144(10): 1209-1216, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32649215

RESUMO

CONTEXT.­: Point-of-care testing allows rapid analysis and short turnaround times. To the best of our knowledge, the present study assesses, for the first time, clinical, operative, and economic outcomes of point-of-care blood gas analysis in a nephrology department. OBJECTIVE.­: To evaluate the impact after implementing blood gas analysis in the nephrology department, considering clinical (differences in blood gas analysis results, critical results), operative (turnaround time, elapsed time between consecutive blood gas analysis, preanalytical errors), and economic (total cost per process) outcomes. DESIGN.­: A total amount of 3195 venous blood gas analyses from 688 patients of the nephrology department before and after point-of-care blood gas analyzer installation were included. Blood gas analysis results obtained by ABL90 FLEX PLUS were acquired from the laboratory information system. Statistical analyses were performed using SAS 9.3 software. RESULTS.­: During the point-of-care testing period, there was an increase in blood glucose levels and a decrease in pCO2, lactate, and sodium as well as fewer critical values (especially glucose and lactate). The turnaround time and the mean elapsed time were shorter. By the beginning of this period, the number of preanalytical errors increased; however, no statistically significant differences were found during year-long monitoring. Although there was an increase in the total number of blood gas analysis requests, the total cost per process decreased. CONCLUSIONS.­: The implementation of a point-of-care blood gas analysis in a nephrology department has a positive impact on clinical, operative, and economic terms of patient care.


Assuntos
Gasometria/economia , Nefropatias/sangue , Nefrologia/economia , Sistemas Automatizados de Assistência Junto ao Leito/economia , Testes Imediatos/economia , Humanos
8.
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
9.
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
10.
J Cardiothorac Surg ; 15(1): 134, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522213

RESUMO

BACKGROUND: In a rabbit model of cardiopulmonary bypass (CPB) and cardioplegic arrest, we previously showed that hyperoxic myocardial reperfusion was associated with increased left ventricular (LV) systolic dysfunction and myocardial injury compared with normoxic reperfusion. The aim of this study was to evaluate in our experimental model the impact of post-CPB reperfusion conditions on other organs potentially vulnerable to ischemic injury such as the brain and kidney. METHODS: After 60 min of CPB, aortic cross-clamp, and cold cardioplegic arrest, rabbits were reperfused under hyperoxic or normoxic conditions for 120 min. Left ventricular systolic contractility (LV + dP/dt) and diastolic relaxation (LV -dP/dt) were continuously recorded, and end-organ injury was assessed by measuring circulating biomarkers specific for kidney (cystatin C and creatinine) and brain injury [S100B and neuron specific enolase (NSE)]. At completion of the protocol, kidney and brain tissues were harvested for measuring oxidant stress (OS), inflammation and apoptosis. RESULTS: Following aortic cross-clamp removal, rabbits exposed to normoxic reperfusion demonstrated preserved LV systolic and diastolic function compared with hyperoxic reperfusion (LV + dP/dt: 70 ± 14% of pre-CPB vs. 36 ± 21%, p = 0.018; LV -dP/dt: 72 ± 36% of pre-CPB vs. 33 ± 20%, p = 0.023). Similarly, CPB increased plasma creatinine, S100B and NSE that were significantly attenuated by normoxic reperfusion compared with hyperoxic reperfusion (creatinine: 4.0 ± 0.5 vs. 7.1 ± 0.8 mg/dL, p = 0.004; S100B: 4.0 ± 0.8 vs. 6.7 ± 1.0 ng/mL, p = 0.047; NSE: 57.7 ± 6.8 vs. 101.3 ± 16.1 pg/mL, p = 0.040). Furthermore, both kidney and brain tissues showed increased mRNA expression and activation of pathways for OS, inflammation, and apoptosis, that were reduced under normoxic compared with hyperoxic conditions. CONCLUSIONS: Normoxic reperfusion ameliorates cardiac, renal and neural injury compared with hyperoxic reperfusion in an in vivo animal model of CPB and cardioplegic arrest. This protective effect of normoxic reperfusion may be due to a reduction in signaling pathways for OS, inflammation, and apoptosis.


Assuntos
Isquemia Encefálica/sangue , Ponte Cardiopulmonar/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Nefropatias/sangue , Oxigênio/administração & dosagem , Traumatismo por Reperfusão/sangue , Animais , Apoptose , Biomarcadores/sangue , Encéfalo/fisiopatologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Creatinina/sangue , Cistatina C/sangue , Inflamação/metabolismo , Rim/fisiopatologia , Nefropatias/etiologia , Nefropatias/fisiopatologia , Masculino , Estresse Oxidativo/genética , Fosfopiruvato Hidratase/sangue , RNA Mensageiro/metabolismo , Coelhos , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/fisiopatologia , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Função Ventricular Esquerda
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.
Oncology ; 98(9): 612-620, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32485713

RESUMO

INTRODUCTION: Conventional first-line chemotherapy for patients with metastatic urothelial carcinoma (UC) is gemcitabine and cisplatin (GC). However, cisplatin can cause renal failure, necessitating abundant fluid replacement and hospitalization during treatment. Recent evidence exists for short hydration methods in cisplatin-based chemotherapy. OBJECTIVE: This study aims to analyze the efficacy of newly established modified short hydration GC (m-shGC) therapy in patients with UC. METHODS: From May 2017 to March 2019, 48 patients with UC who received m-shGC therapy were treated with 1,000 mg/m2 gemcitabine on days 1, 8, and 15, and 70 mg/m2 cisplatin and 2,000 mL fluid replacement on day 1, in each 28-day cycle. We retrospectively evaluated renal function, serum electrolyte abnormalities, and adverse events (AEs) following treatment, and retrospectively compared patients under m-shGC therapy with those under conventional GC (c-GC) therapy from 2015 to 2017. In addition, from April 2019 to August 2019 in a prospective analysis, 15 patients were newly enrolled, and AE profiles and physical activity during m-shGC therapy were quantified using a wearable tracker. RESULTS: In a retrospective analysis of 101 patients (53 c-GC and 48 m-shGC), patient characteristics were not statistically significant between the two groups. Myelosuppression, including predominant neutropenia and decreased platelets, fatigue, nausea, and constipation were the main common AEs. However, renal function and serum sodium levels in the m-shGC group remained unchanged. Grade 3-4 AEs were not more severe in the m-shGC compared with the c-GC group. Furthermore, in a prospective analysis using a wearable tracker, the amount of walking by patients on day 1 significantly declined. However, immediate recovery occurred reflecting the short hydration. CONCLUSION: Our m-shGC therapy has an acceptable AE profile compared with conventional therapy, with UC patients showing good physical activity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hidratação/métodos , Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Neoplasias Urológicas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Estudos de Coortes , Creatinina/sangue , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/induzido quimicamente , Nefropatias/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sódio/sangue , Neoplasias da Bexiga Urinária/sangue , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias Urológicas/sangue
13.
Am J Physiol Renal Physiol ; 318(6): F1489-F1499, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32390513

RESUMO

Recently, we reported that obese Dahl salt-sensitive (SS) leptin receptor mutant (SSLepRmutant) rats display progressive renal injury. The present study demonstrated that the early development of renal injury in the SSLepRmutant strain is associated with an increase in the renal infiltration of macrophages compared with lean SS rats. We also examined whether depletion of macrophages with clodronate would reduce the early progression of renal injury in the SSLepRmutant strain. Four-week-old SS and SSLepRmutant rats were treated with either vehicle (PBS) or clodronate (50 mg/kg ip, 2 times/wk) for 4 wk. While the administration of clodronate did not reduce renal macrophage infiltration in SS rats, clodronate decreased macrophages in the kidneys of SSLepRmutant rats by >50%. Interestingly, clodronate significantly reduced plasma glucose, insulin, and triglyceride levels and markedly improved glucose tolerance in SSLepRmutant rats. Treatment with clodronate had no effect on the progression of proteinuria or renal histopathology in SS rats. In the SSLepRmutant strain, proteinuria was markedly reduced during the first 2 wk of treatment (159 ± 32 vs. 303 ± 52 mg/day, respectively). However, after 4 wk of treatment, the effect of clodronate was no longer observed in the SSLepRmutant strain (346 ± 195 vs. 399 ± 50 mg/day, respectively). The kidneys from SSLepRmutant rats displayed glomerular injury with increased mesangial expansion and renal fibrosis versus SS rats. Treatment with clodronate significantly decreased glomerular injury and renal fibrosis in the SSLepRmutant strain. Overall, these data indicate that the depletion of macrophages improves metabolic disease and slows the early progression of renal injury in SSLepRmutant rats.


Assuntos
Ácido Clodrônico/farmacologia , Nefropatias/prevenção & controle , Rim/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Obesidade/tratamento farmacológico , Receptores para Leptina/genética , Animais , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Proliferação de Células , Modelos Animais de Doenças , Progressão da Doença , Feminino , Fibrose , Insulina/sangue , Rim/metabolismo , Rim/patologia , Nefropatias/sangue , Nefropatias/etiologia , Nefropatias/patologia , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Mutação , Obesidade/sangue , Obesidade/complicações , Obesidade/genética , Ratos Endogâmicos Dahl , Fatores Sexuais , Fatores de Tempo , Triglicerídeos/sangue
14.
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
15.
Stroke ; 51(6): 1758-1765, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32404035

RESUMO

Background and Purpose- The RE-SPECT ESUS trial (Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source) tested the hypothesis that dabigatran would be superior to aspirin for the prevention of recurrent stroke in patients with embolic stroke of undetermined source. This exploratory subgroup analysis investigates the impact of age, renal function (both predefined), and dabigatran dose (post hoc) on the rates of recurrent stroke and major bleeding. Methods- RE-SPECT ESUS was a multicenter, randomized, double-blind trial of dabigatran 150 or 110 mg (for patients aged ≥75 years and/or with creatinine clearance 30 to <50 mL/minute) twice daily compared with aspirin 100 mg once daily. The primary outcome was recurrent stroke. Results- The trial, which enrolled 5390 patients from December 2014 to January 2018, did not demonstrate superiority of dabigatran versus aspirin for prevention of recurrent stroke in patients with embolic stroke of undetermined source. However, among the population qualifying for the lower dabigatran dose, the rate of recurrent stroke was reduced with dabigatran versus aspirin (7.4% versus 13.0%; hazard ratio, 0.57 [95% CI, 0.39-0.82]; interaction P=0.01). This was driven mainly by the subgroup aged ≥75 years (7.8% versus 12.4%; hazard ratio, 0.63 [95% CI, 0.43-0.94]; interaction P=0.10). Stroke rates tended to be lower with dabigatran versus aspirin with declining renal function. Risks for major bleeding were similar between treatments, irrespective of renal function, but with a trend for lower bleeding rates with dabigatran versus aspirin in older patients. Conclusions- In subgroup analyses of RE-SPECT ESUS, dabigatran reduced the rate of recurrent stroke compared with aspirin in patients qualifying for the lower dose of dabigatran. These results are hypothesis-generating. Aspirin remains the standard antithrombotic treatment for patients with embolic stroke of undetermined source. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239120.


Assuntos
Aspirina , Dabigatrana , Fibrinolíticos , Embolia Intracraniana , Nefropatias , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Aspirina/farmacocinética , Dabigatrana/administração & dosagem , Dabigatrana/farmacocinética , Método Duplo-Cego , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/farmacocinética , Humanos , Embolia Intracraniana/sangue , Embolia Intracraniana/tratamento farmacológico , Nefropatias/sangue , Nefropatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Recidiva , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/tratamento farmacológico
16.
Am J Physiol Renal Physiol ; 318(5): F1252-F1257, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223309

RESUMO

Recently, research has redirected its interests in uric acid (UA) from gout, an inflammatory disease in joints, to groups of closely interrelated pathologies associated with cardiovascular and kidney dysfunction. Many epidemiological, clinical, and experimental studies have shown that UA may play a role in the pathophysiology of the cardiorenal syndrome continuum; however, it is still unclear if it is a risk factor or a causal role. Hyperuricemia has been well studied in the past two decades, revealing mechanistic insights into UA homeostasis. Likewise, some epidemiological and experimental evidence suggests that hypouricemia can lead to cardiorenal pathologies. The goal of this review is to highlight why studying both hyperuricemia and hypouricemia is warranted as well as to summarize the relevance of UA to kidney function.


Assuntos
Hiperuricemia/sangue , Nefropatias/sangue , Rim/metabolismo , Ácido Úrico/sangue , Animais , Biomarcadores/sangue , Homeostase , Humanos , Hiperuricemia/epidemiologia , Hiperuricemia/fisiopatologia , Rim/fisiopatologia , Nefropatias/epidemiologia , Nefropatias/fisiopatologia , Fatores de Risco
17.
PLoS One ; 15(4): e0229959, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243480

RESUMO

Sickle cell disease (SCD) is characterized by deoxygenation-induced polymerization of hemoglobin in red blood cells, leading to hemolytic anemia, vaso-occlusion, and the development of multiple clinical complications. To characterize the clinical burden associated with differences in hemoglobin concentration and hemolysis measures, a systematic literature review of MEDLINE, EMBASE, and related meta-analyses was undertaken. For quantitative analyses related to hemoglobin concentration, pooled results were analyzed using random effects models to control for within-and between-study variability. To derive risk ratios associated with hemoglobin concentration change, we combined ratios of means from select studies, which reported hazard and odds ratios in meta-analyses for hemoglobin concentration-related outcomes and changes between groups. Forty-one studies were identified for inclusion based on relating hemoglobin concentration to clinical outcomes. Meta-analyses demonstrated that mean hemoglobin concentration was significantly lower in patients with cerebrovascular disease (0.4 g/dL), increased transcranial Doppler velocity in cerebral arteries (0.6 g/dL), albuminuria (0.6 g/dL), elevated estimated pulmonary artery systolic pressure (0.9 g/dL), and in patients that subsequently died (0.6 g/dL). In a risk reduction meta-analysis, modeled increased hemoglobin concentrations of 1 g/dL or greater resulted in decreased risk of negative clinical outcomes of 41% to 64%. In conclusion, chronic anemia is associated with worse clinical outcomes in individuals with SCD and even modest increases in hemoglobin concentration may be beneficial in this patient population. This systematic review has been registered on Prospero (Registration number CRD42018096860; https://www.crd.york.ac.uk/prospero/).


Assuntos
Anemia Falciforme/sangue , Transtornos Cerebrovasculares/sangue , Hemoglobinas/metabolismo , Nefropatias/sangue , Anemia/sangue , Anemia/epidemiologia , Anemia/patologia , Anemia Falciforme/mortalidade , Anemia Falciforme/patologia , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/patologia , Hemoglobina Falciforme/genética , Hemoglobina Falciforme/metabolismo , Hemólise , Humanos , Nefropatias/epidemiologia , Nefropatias/patologia , Razão de Chances , Ultrassonografia Doppler Transcraniana
18.
Am J Respir Crit Care Med ; 201(8): e26-e51, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293205

RESUMO

Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure.Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability.Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality.Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.


Assuntos
Cardiomiopatias/diagnóstico , Nefropatias/diagnóstico , Hepatopatias/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Biópsia , Broncoscopia , Cálcio/sangue , Cardiomiopatias/sangue , Cardiomiopatias/fisiopatologia , Creatinina/sangue , Ecocardiografia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Endossonografia , Oftalmopatias/diagnóstico , Oftalmopatias/fisiopatologia , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Nefropatias/sangue , Hepatopatias/sangue , Linfonodos/patologia , Linfadenopatia , Imagem por Ressonância Magnética , Mediastino , Tomografia por Emissão de Pósitrons , Pneumologia , Sarcoidose/sangue , Sarcoidose/diagnóstico , Sarcoidose/patologia , Sarcoidose/fisiopatologia , Sarcoidose Pulmonar/sangue , Sarcoidose Pulmonar/patologia , Sarcoidose Pulmonar/fisiopatologia , Sociedades Médicas , Vitamina D/sangue
19.
AJR Am J Roentgenol ; 215(1): 142-147, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32255686

RESUMO

OBJECTIVE. The objective of our study was to develop a novel method to estimate single-kidney glomerular filtration rate (GFR) using a combination of contrast-enhanced CT and serum creatinine (SCr) values and to validate the resulting estimated glomerular filtration rates (eGFRs) by comparing them with the single-kidney Gates GFR, which is based on renal dynamic imaging. MATERIALS AND METHODS. Sixty-two patients with asymmetric renal disease who underwent unenhanced and triphasic contrast-enhanced CT of the kidneys, 99mTc-diethylenetriamine pentaacetic acid renal dynamic imaging, and SCr testing within 1 week were retrospectively included. The eGFR was split into single-kidney GFRs of the left and right kidneys by a proportionality factor derived from the products of renal volume and CT number increments of the multiphasic CT images, which produced unenhanced phase (yielded by the renal volume proportional factor alone), arterial phase, venous phase, and nephrographic phase CT split eGFRs. The four CT split eGFRs were compared with the Gates GFR using the paired-sample t test, Pearson correlation analysis, and Bland-Altman analysis. RESULTS. Correlation coefficients and 95% CIs between the four CT split eGFRs and Gates GFR were as follows: unenhanced phase, 0.729 (95% CI, 0.626-0.805); arterial phase, 0.781 (95% CI, 0.685-0.849); venous phase, 0.788 (95% CI, 0.690-0.839); and nephrographic phase, 0.842 (95% CI, 0.758-0.902) (all, p < 0.001). The paired differences between the CT split eGFRs and Gates GFR were as follows: unenhanced phase, 2.04 ± 10.85 (95% CI, 0.01-4.07) mL/min/1.73 m2; arterial phase, 2.04 ± 10.56 (95% CI, 0.06-4.02) mL/min/1.73 m2; venous phase, 2.04 ± 10.04 (95% CI, 0.16-3.92) mL/min/1.73 m2; and nephrographic phase, 2.04 ± 8.92 (95% CI, 0.37-3.71) mL/min/1.73 m2. These results suggest a maximum deviation from the Gates GFR of ± 44.9% for the unenhanced phase eGFR, ± 43.7% for the arterial phase eGFR, ± 41.6% for the venous phase eGFR, and ± 36.9% for nephrographic phase eGFR. CONCLUSION. Split renal function can be estimated using a combination of contrast-enhanced CT and SCr values to calculate eGFR. The CT images of the nephrographic phase may be the optimal choice to use in this proposed method.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular , Nefropatias/diagnóstico por imagem , Nefropatias/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Nefropatias/sangue , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Pentetato de Tecnécio Tc 99m
20.
Presse Med ; 49(1): 104017, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234380

RESUMO

IgG4-RD may affect several organs including kidneys. The kidney is involved in approximately 20% of patient with IgG4-RD. The most common intrinsic kidney disease is tubulointerstitial nephritis (IgG4-TIN). Retroperitoneal fibrosis (IgG4-RPF) may induce obstructive acute renal failure. More rarely, IgG4-RKD can manifest as a glomerular disease, in particular as a membranous nephropathy (MN). It mostly affects middle-aged to elderly men and causes acute or chronic renal dysfunction, multiple hypodense lesions on CT-Scan and various extra-renal lesions. Increased serum IgG4 and hypocomplementemia are the most important serological findings for the diagnosis of IgG4-RD and thus should be systematically assessed when IgG4-RKD is suspected. Specific diagnosis criteria for IgG4-TIN including interstitial infiltration of IgG4-positive plasma cells, storiform fibrosis and tubular basement membrane immune complex deposits have been proposed. Corticosteroids are effective and remain the first-line therapy but relapses or severe forms could respond to immunosuppressive therapy.


Assuntos
Doença Relacionada a Imunoglobulina G4/complicações , Nefropatias/etiologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Creatinina/sangue , Feminino , Glomerulonefrite Membranosa/sangue , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/etiologia , Glomerulonefrite Membranosa/patologia , Humanos , Imunoglobulina G/sangue , Doença Relacionada a Imunoglobulina G4/sangue , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Doença Relacionada a Imunoglobulina G4/patologia , Rim/diagnóstico por imagem , Nefropatias/sangue , Nefropatias/tratamento farmacológico , Nefropatias/patologia , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/sangue , Nefrite Intersticial/tratamento farmacológico , Nefrite Intersticial/etiologia , Nefrite Intersticial/patologia , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/tratamento farmacológico , Fibrose Retroperitoneal/patologia , Esteroides/uso terapêutico
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