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1.
Transplantation ; 104(8): 1695-1702, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732849

RESUMO

BACKGROUND: Reports about prognosis of adults receiving small pediatric-donor kidneys (PDK) as compared to those receiving elder pediatric or adult donor kidneys (ADKs) are controversial. This study aimed to examine the outcomes of adults receiving small PDK and possible prognostic factors. METHODS: The records of adults who received kidneys from donors < 10 years old at our center from July 1, 2011 to June 30, 2018 were reviewed. RESULTS: A total of 121 adults were small PDK recipients. Twenty-three patients received 29 biopsies or nephrectomy between 6 and 896 days posttransplantation days. Seven patients (30.4%) had pediatric donor glomerulopathy (PDG), which developed from 113 to 615 days posttransplantation. The incidence of proteinuria and hematuria was significantly higher in the PDG group. The characteristic pathological finding in PDG was irregular lamination and splintering of the glomerular basement membrane (GBM). Donor age, donor weight, and donor kidney volume were significantly less in PDG cases compared with the non-PDG cases. For the risk factors of PDG, increasing urinary RBC count during follow-up was an independent predictor, while increasing donor age and body weight were protective factors. PDG was not a significant risk factor for Scr increasing of PDKs. CONCLUSIONS: PDG is a potential cause of abnormal urinalysis in adults receiving small PDKs. The pathological characteristic change of PDG is splitting and lamination of GBM. Persistent hematuria after transplantation in recipients of PDK is a predictor of PDG development.


Assuntos
Glomerulonefrite/patologia , Hematúria/epidemiologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Proteinúria/epidemiologia , Adolescente , Adulto , Fatores Etários , Aloenxertos/anatomia & histologia , Aloenxertos/patologia , Biópsia , Peso Corporal , Criança , Pré-Escolar , Feminino , Seguimentos , Membrana Basal Glomerular/patologia , Sobrevivência de Enxerto , Hematúria/etiologia , Hematúria/patologia , Hematúria/urina , Humanos , Lactente , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/urina , Prognóstico , Fatores de Proteção , Proteinúria/etiologia , Proteinúria/patologia , Proteinúria/urina , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 99(29): e20678, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702818

RESUMO

BACKGROUND: Diabetic nephropathy (DN) is among the common and serious complications of diabetes and is also a major cause of end-stage kidney disease. Early DN is also called diabetic microalbumin period, the main treatment is in the control of blood sugar on the basis of kidney protection and urine lowering protein. There are few effective methods of western medicine treatment, and most of them are accompanied by adverse reactions. But some studies have shown that traditional Chinese medicine has achieved the curative effect and has certain superiority. However, there are few systematic reviews on the treatment of traditional Chinese herbal medicine for early DN currently. Therefore, this study conducted a systematic review of clinical efficacy and safety of Chinese herbal medicine for the treatment of patients with early DN, aim to comprehensively analyze the role of traditional Chinese herbal medicine in the treatment of early DN. METHODS AND ANALYSIS: The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-4-0139/) and INPLASY registration number is INPLASY202040139. A systematic literature search will be conducted in 3 English database and 4 Chinese databases with a language limitation of English and Chinese. Search for clinical research literature on Chinese herbal medicine treatment of DN published in domestic and foreign biomedical journals. The time is limited from January 2010 to February 2020. We will investigate heterogeneity across studies and publication bias. To assess the risk of bias and quality of the included studies, we will use the Cochrane Collaboration's ROB tool. According to the relevant standards in the Cochrane Intervention System Evaluation Manual, it will be divided into low risk, high risk, and unclear. We will also use the RevMan 5.3 software and Stata 13.0 software for meta-analysis of the effectiveness and symptom scores of DN proteinuria. ETHICS AND DISSEMINATION: The ethical considerations are not required because the systematic review is based on published studies. The systematic review and meta-analysis will be published in a peer-reviewed Journal.


Assuntos
Nefropatias Diabéticas/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Complicações do Diabetes/epidemiologia , Nefropatias Diabéticas/classificação , Nefropatias Diabéticas/complicações , Feminino , Humanos , Falência Renal Crônica/etiologia , Masculino , Proteinúria/diagnóstico , Proteinúria/etiologia , Proteinúria/urina , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Sensibilidade e Especificidade , Resultado do Tratamento
4.
J Korean Med Sci ; 35(28): e257, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32686373

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This disease, which is quickly spreading worldwide, has high potential for infection and causes rapid progression of lung lesions, resulting in a high mortality rate. This study aimed to investigate the effects of SARS-CoV-2 infection on renal function in patients with COVID-19. METHODS: From February 21 to April 24, 2020, 66 patients diagnosed with COVID-19 at Chungnam National University Hospital were analyzed; all patients underwent routine urinalysis and were tested for serum creatinine, urine protein to creatinine ratio (PCR), and urine albumin to creatinine ratio (ACR). RESULTS: Acute kidney injury (AKI) occurred in 3 (4.5%) of the 66 patients, and 1 patient with AKI stage 3 underwent hemodialysis. Upon follow-up, all 3 patients recovered normal renal function. Compared with patients with mild COVID-19, AKI (n = 3) occurred in patients with severe COVID-19, of whom both urine PCR and ACR were markedly increased. CONCLUSION: The incidence of AKI was not high in COVID-19 patients. The lower mortality rate in SARS-CoV-2 infection compared with previous Middle East respiratory syndrome and SARS-CoV infections is thought to be associated with a low incidence of dysfunction in organs other than the lungs.


Assuntos
Lesão Renal Aguda/virologia , Albuminúria/urina , Infecções por Coronavirus/patologia , Creatinina/sangue , Pneumonia Viral/patologia , Proteinúria/urina , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/patologia , Idoso , Albuminas/análise , Betacoronavirus , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Pandemias , República da Coreia/epidemiologia
5.
Scand J Immunol ; 92(3): e12915, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32533866

RESUMO

Systemic lupus erythematosus is an autoimmune syndrome characterized by the development of autoantibodies to a wide range of antigens. Together with B cells, respective self-reactive T cells have an important contribution in disease progression as being responsible for inflammatory cytokines secretion, B cell activation and promoting amplification of the autoimmune response. Annexin A1 is expressed by many cell types and binds to phospholipids in a Ca2+ -dependent manner. Abnormal expression of annexin A1 was found on activated B and T cells in both murine and human autoimmunity suggesting its potential role as a therapeutic target. In the present study, we have investigated the possibility to suppress autoimmune manifestation in spontaneous mouse model of lupus using anti-annexin A1 antibody. Groups of lupus-prone MRL/lpr mice were treated with the anti-annexin A1 monoclonal antibody, and the disease activity and survival of the animals were following up. Flow cytometry, ELISA assays, and histological and immunofluorescence kidney analyses were used to determine the levels of Annexin A1 expression, cytokines, anti-dsDNA antibodies and kidney injuries. The administration of this monoclonal antibody to MRL/lpr mice resulted in suppression of IgG anti-dsDNA antibody production, modulated IL-10 secretion, decreased disease activity and prolonged survival compared with the control group.


Assuntos
Anexina A1/antagonistas & inibidores , Anexina A1/imunologia , Anticorpos Monoclonais/farmacologia , Fatores Imunológicos/farmacologia , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/metabolismo , Animais , Autoanticorpos/imunologia , Biomarcadores , Citocinas/metabolismo , Modelos Animais de Doenças , Progressão da Doença , Humanos , Imunoglobulina G/imunologia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/patologia , Camundongos , Camundongos Endogâmicos MRL lpr , Proteinúria/etiologia , Proteinúria/urina , Baço/imunologia , Baço/metabolismo , Linfócitos T/imunologia , Linfócitos T/metabolismo , Resultado do Tratamento
6.
PLoS One ; 15(5): e0233214, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433710

RESUMO

The aim was to describe and assess a new late pregnancy point-of-care urinary preeclampsia screening test. Urine samples were collected from a consecutive series of 1,532 pregnant women hospitalized at 20-41 weeks gestation in a Chinese single obstetric unit. A simple disposable Congo red based device was newly developed and employed to prospectively test misfolded proteins in pregnant women's urine. A total of 140 preeclampsia cases were clinically diagnosed, 101 severe and 87 pre-term. Detection and false positive rates were similar in the training and validation subsets with combined 74% and 3.0%. The detection rate was 83% in severe, 86% in pre-term, 49% and 50% in mild and term cases (P<0.0001) respectively. In conclusion, a simple point-of-care urinary test for misfolded proteins can be used to screen for preeclampsia in late pregnancy with very high screening performance. To the best of our knowledge, this is the first study to screen for preeclampsia using Congo red based device in Chinese pregnant population.


Assuntos
Programas de Rastreamento , Sistemas Automatizados de Assistência Junto ao Leito , Pré-Eclâmpsia/urina , Proteinúria/urina , Adulto , Feminino , Humanos , Gravidez , Sensibilidade e Especificidade
7.
PLoS One ; 15(5): e0233639, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32453760

RESUMO

Diabetes is the leading cause of end-stage renal disease worldwide. Our understanding of the early kidney response to chronic hyperglycemia remains incomplete. To address this, we first investigated the urinary proteomes of otherwise healthy youths with and without type 1 diabetes and subsequently examined the enriched pathways that might be dysregulated in early disease using systems biology approaches. This cross-sectional study included two separate cohorts for the discovery (N = 30) and internal validation (N = 30) of differentially excreted proteins. Discovery proteomics was performed on a Q Exactive Plus hybrid quadrupole-orbitrap mass spectrometer. We then searched the pathDIP, KEGG, and Reactome databases to identify enriched pathways in early diabetes; the Integrated Interactions Database to retrieve protein-protein interaction data; and the PubMed database to compare fold changes of our signature proteins with those published in similarly designed studies. Proteins were selected for internal validation based on pathway enrichment and availability of commercial enzyme-linked immunosorbent assay kits. Of the 2451 proteins identified, 576 were quantified in all samples from the discovery cohort; 34 comprised the urinary signature for early diabetes after Benjamini-Hochberg adjustment (Q < 0.05). The top pathways associated with this signature included lysosome, glycosaminoglycan degradation, and innate immune system (Q < 0.01). Notably, all enzymes involved in keratan sulfate degradation were significantly elevated in urines from youths with diabetes (|fold change| > 1.6). Increased urinary excretion of monocyte differentiation antigen CD14, hexosaminidase A, and lumican was also observed in the validation cohort (P < 0.05). Twenty-one proteins from our signature have been reported elsewhere as potential mediators of early diabetes. In this study, we identified a urinary proteomic signature for early type 1 diabetes, of which lysosomal enzymes were major constituents. Our findings highlight novel pathways such as keratan sulfate degradation in the early kidney response to hyperglycemia.


Assuntos
Diabetes Mellitus Tipo 1/urina , Sulfato de Ceratano/metabolismo , Proteinúria/genética , Proteômica , Adolescente , Adulto , Criança , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/patologia , Proteínas da Matriz Extracelular/urina , Feminino , Humanos , Sulfato de Ceratano/genética , Rim/metabolismo , Rim/patologia , Lisossomos/metabolismo , Lisossomos/patologia , Masculino , Espectrometria de Massas , Proteinúria/metabolismo , Proteinúria/urina , Proteoma/genética , Proteoma/metabolismo , Adulto Jovem
8.
Ann Biol Clin (Paris) ; 78(1): 87-92, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32108586

RESUMO

Serum proteins and urinary proteins electrophoresis are useful biological tests. They are often prescribed for the screening of monoclonal gammopathys and also during follow-up for treatment response. This test can be accredited according to standard NF ISO 15189 since laboratories use analysers and adapted reagents, but there are numerous protocols for the method validation. This paper present the results of a survey proposed in 2019 to biologists by CNBH and SFBC. The aim of this survey is to give biologists a choice among several protocols that have been positively evaluated by COFRAC.


Assuntos
Acreditação , Análise Química do Sangue/normas , Eletroforese/normas , Laboratórios/normas , Urinálise/normas , Análise Química do Sangue/métodos , Proteínas Sanguíneas/análise , Proteínas Sanguíneas/química , Comportamento de Escolha , Testes Diagnósticos de Rotina/normas , Eletroforese/métodos , Humanos , Ensaio de Proficiência Laboratorial/métodos , Proteinúria/diagnóstico , Proteinúria/urina , Controle de Qualidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Inquéritos e Questionários , Urinálise/métodos , Estudos de Validação como Assunto
9.
Artigo em Inglês | MEDLINE | ID: mdl-31918306

RESUMO

The aim of this study was to identify potential proteomic biomarkers for chronic active antibody-mediated rejection (CAMR) in kidney transplant recipients (KTRs). Among 385 KTRs enrolled in a cross-sectional multicenter study, 26 KTRs with biopsy-proven CAMR, 57 KTRs with long-term graft survival (LGS), and 10 rejection-free matched KTRs were included. A proteomic approach was employed to measure urinary extracellular vesicle (EV) changes in the KTRs. The urinary EVs were trypsin-digested using a gel-assisted protocol and quantified by label-free liquid chromatography with tandem mass spectrometry, using a data-dependent acquisition (DDA) mode. Western blot analysis was performed to confirm the protein levels for each candidate biomarker. Analysis of the isolated EV proteins revealed 93 and 97 proteins in the CAMR and LGS patients, respectively. Proteins that were identical in both groups were excluded and only high-significance proteins with a fold change of at least 1.5 were selected as candidate biomarkers. Six proteins (APOA1, TTR, PIGR, HPX, AZGP1, and CP) that were distinguishable between CAMR and LGS were selected. The proteins were confirmed by immunoblot analyses using independently acquired urinary EV samples. AZGP1 in particular was found to be a CAMR-specific proteomic biomarker that was distinguishable from the rejection-free control group with matching kidney function, duration of transplantation, and age. We identified and validated six proteomic biomarkers for CAMR and clarified one CAMR-specific proteomic biomarker in KTRs. Further clinical trials are needed before these rejection-specific biomarkers can be applied for the early prediction, diagnosis, and monitoring of the clinical response of KTRs to the treatment of CAMR.


Assuntos
Biomarcadores/urina , Vesículas Extracelulares/química , Rejeição de Enxerto , Transplante de Rim/efeitos adversos , Proteinúria/urina , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/urina , Humanos , Masculino , Pessoa de Meia-Idade , Mapeamento de Interação de Proteínas , Mapas de Interação de Proteínas , Proteoma/análise , Proteoma/genética , Proteoma/metabolismo , Proteômica/métodos
10.
Gut ; 69(3): 513-522, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900289

RESUMO

OBJECTIVE: Pre-eclampsia (PE) is one of the malignant metabolic diseases that complicate pregnancy. Gut dysbiosis has been identified for causing metabolic diseases, but the role of gut microbiome in the pathogenesis of PE remains unknown. DESIGN: We performed a case-control study to compare the faecal microbiome of PE and normotensive pregnant women by 16S ribosomal RNA (rRNA) sequencing. To address the causative relationship between gut dysbiosis and PE, we used faecal microbiota transplantation (FMT) in an antibiotic-treated mouse model. Finally, we determined the microbiome translocation and immune responses in human and mouse placental samples by 16S rRNA sequencing, quantitative PCR and in situ hybridisation. RESULTS: Patients with PE showed reduced bacterial diversity with obvious dysbiosis. Opportunistic pathogens, particularly Fusobacterium and Veillonella, were enriched, whereas beneficial bacteria, including Faecalibacterium and Akkermansia, were markedly depleted in the PE group. The abundances of these discriminative bacteria were correlated with blood pressure (BP), proteinuria, aminotransferase and creatinine levels. On successful colonisation, the gut microbiome from patients with PE triggered a dramatic, increased pregestational BP of recipient mice, which further increased after gestation. In addition, the PE-transplanted group showed increased proteinuria, embryonic resorption and lower fetal and placental weights. Their T regulatory/helper-17 balance in the small intestine and spleen was disturbed with more severe intestinal leakage. In the placenta of both patients with PE and PE-FMT mice, the total bacteria, Fusobacterium, and inflammatory cytokine levels were significantly increased. CONCLUSIONS: This study suggests that the gut microbiome of patients with PE is dysbiotic and contributes to disease pathogenesis.


Assuntos
Translocação Bacteriana , Disbiose/complicações , Microbioma Gastrointestinal , Placenta/imunologia , Placenta/microbiologia , Pré-Eclâmpsia/microbiologia , Animais , Pressão Sanguínea , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Quimiocinas/genética , Creatinina/sangue , Citocinas/genética , Modelos Animais de Doenças , Disbiose/fisiopatologia , Faecalibacterium , Fezes/microbiologia , Feminino , Reabsorção do Feto/microbiologia , Fusobactérias , Humanos , Intestino Delgado/imunologia , Camundongos , Placenta/metabolismo , Pré-Eclâmpsia/fisiopatologia , Gravidez , Proteinúria/urina , RNA Mensageiro/metabolismo , Linfócitos T Reguladores , Células Th17 , Veillonella
11.
PLoS One ; 15(1): e0227414, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31905213

RESUMO

BACKGROUND: Oxidative stress is a major factor responsible for minimal-change nephrotic syndrome (MCNS), which occurs most commonly in children. However, the influence of oxidative stress localized to mitochondria remains unclear. We examined the effect of a mitochondrion-targeting antioxidant, MitoTEMPO, in rats with puromycin aminonucleoside (PAN)-induced MCNS to clarify the degree to which mitochondrial oxidative stress affects MCNS. MATERIALS AND METHODS: Thirty Wistar rats were divided into three groups: normal saline group (n = 7), PAN group (n = 12), and PAN + MitoTEMPO group (n = 11). Rats in the PAN and PAN + MitoTEMPO groups received PAN on day 1, and those in the PAN + MitoTEMPO group received MitoTEMPO on days 0 to 9. Whole-day urine samples were collected on days 3 and 9, and samples of glomeruli and blood were taken for measurement of lipid peroxidation products. We also estimated the mitochondrial damage score in podocytes in all 3 groups using electron microscopy. RESULTS: Urinary protein excretion on day 9 and the levels of lipid peroxidation products in urine, glomeruli, and blood were significantly lower in the PAN + MitoTEMPO group than in the PAN group (p = 0.0019, p = 0.011, p = 0.039, p = 0.030). The mitochondrial damage score in podocytes was significantly lower in the PAN + MitoTEMPO group than in the PAN group (p <0.0001). CONCLUSIONS: This mitochondrion-targeting agent was shown to reduce oxidative stress and mitochondrial damage in a MCNS model. A radical scavenger targeting mitochondria could be a promising drug for treatment of MCNS.


Assuntos
Antioxidantes/farmacologia , Sistemas de Liberação de Medicamentos , Mitocôndrias , Nefrose Lipoide , Compostos Organofosforados/farmacologia , Piperidinas/farmacologia , Proteinúria , Puromicina Aminonucleosídeo/efeitos adversos , Animais , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Nefrose Lipoide/induzido quimicamente , Nefrose Lipoide/tratamento farmacológico , Nefrose Lipoide/patologia , Nefrose Lipoide/urina , Estresse Oxidativo/efeitos dos fármacos , Podócitos/metabolismo , Podócitos/patologia , Proteinúria/induzido quimicamente , Proteinúria/tratamento farmacológico , Proteinúria/patologia , Proteinúria/urina , Puromicina Aminonucleosídeo/farmacologia , Ratos , Ratos Wistar
12.
Clin Nephrol ; 93(2): 99-105, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31829928

RESUMO

AIMS: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) has been implicated as a mediator of chronic inflammatory processes. Recently, it was reported that TWEAK may play an important role in the pathogenesis of kidney damage. In the present study, we investigated the role of TWEAK in immunoglobulin A nephropathy (IgAN). MATERIALS AND METHODS: The levels of serum TWEAK (sTWEAK) and urinary TWEAK (uTWEAK) in 45 patients with IgAN and 15 healthy subjects were measured. We analyzed the correlations of uTWEAK level with clinical and pathological parameters in patients with IgAN. We then divided the patients into two groups according to uTWEAK level and investigated 5-year chronic kidney disease (CKD) progression. RESULTS: The level of uTWEAK was significantly higher in patients with IgAN than in healthy controls (p < 0.001). sTWEAK level showed no significant difference between the two groups (p = 0.225). The level of uTWEAK correlated significantly with serum albumin (p < 0.001), urine protein excretion (p < 0.001), and histological classification (p < 0.016) in patients with IgAN. uTWEAK was significantly increased even in patients with IgAN who had lower proteinuria. There was a significant association between uTWEAK level and CKD progression (p = 0.049). CONCLUSION: Although uTWEAK is not a superior biomarker compared to proteinuria, it has a significant correlation with IgAN patients and seems to be useful in determining disease progression.


Assuntos
Citocina TWEAK/urina , Glomerulonefrite por IGA/patologia , Glomerulonefrite por IGA/urina , Insuficiência Renal Crônica/urina , Adulto , Biomarcadores/urina , Estudos de Casos e Controles , Citocina TWEAK/sangue , Progressão da Doença , Feminino , Glomerulonefrite por IGA/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Proteinúria/urina , Insuficiência Renal Crônica/etiologia , Albumina Sérica/metabolismo , Adulto Jovem
13.
Int J Gynaecol Obstet ; 149(1): 76-81, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31869445

RESUMO

OBJECTIVE: To determine the diagnostic accuracy and optimal threshold of the spot protein-to-creatinine ratio (PCR) compared to the gold standard, 24-hour proteinuria (24HP) in patients with suspected pre-eclampsia. METHODS: A prospective observational study was performed from June 2015 to May 2017 consisting of patients hospitalized for suspected pre-eclampsia in a tertiary care referral center. To compare the two diagnostic tests, a spot urine sample was obtained to perform the PCR before starting the collection of the 24HP. Only patients who had both tests were analyzed. RESULTS: In total, 148 patients (216 samples) were included. The two tests were highly correlated (r=0.80, P<0.001). The receiver operating characteristic curve analysis and the area under the curve (AUC=0.92) highlighted the accuracy of PCR in diagnosing significant proteinuria and thus pre-eclampsia. The optimal cut-off using the Liu method was 56.9 mg/mmol (sensitivity=79.3%, specificity=91.5%). CONCLUSION: The results suggest that PCR could replace 24HP when diagnosing proteinuria in pre-eclampsia. Moreover, it is a simple test, easy to realize and standardize, and cheap with no need for systematic hospitalization. The best cut-off should be chosen by thinking about the risks for adverse maternal and/or fetal outcomes. The test may help to optimize medical care in pre-eclampsia worldwide.


Assuntos
Creatinina/urina , Pré-Eclâmpsia/diagnóstico , Proteinúria/diagnóstico , Adulto , Testes Diagnósticos de Rotina , Feminino , Humanos , Pré-Eclâmpsia/urina , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Proteinúria/urina , Curva ROC
14.
BMC Ophthalmol ; 19(1): 261, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856768

RESUMO

BACKGROUND: Fluorescein angiography is an important and frequently used diagnostic tool in ophthalmological practice. In this case report we describe a patient who experienced an anaphylactic reaction after the injection of fluorescein. Furthermore, we report an interference with laboratory testing by fluorescein in this patient and summarize the literature on this topic. CASE PRESENTATION: An 86-year old Caucasian woman undergoing fluorescein angiography due to suspected peripapillary neovascularizations collapsed after the injection of fluorescein. The patient developed an anaphylactic reaction. With fluid resuscitation and oxygen therapy, the patient regained consciousness after a few minutes. The patient was admitted to the geriatric ward for observation, and routine blood and urine tests were performed. Urine protein concentration appeared to be falsely increased as a consequence of disturbance of the laboratory analysis by the presence of fluorescein. CONCLUSIONS: Serious complications can occur with fluorescein angiography, such as an anaphylactic reaction. In the case of anaphylaxis appropriate supportive measures including the use of oxygen and epinephrine (e.g. EpiPen), should be available to prevent morbidity and mortality from this test. Furthermore, these potential complications should be taken into consideration when choosing the healthcare setting for fluorescein angiography, such as the immediate availability of an acute medical team. Several studies have demonstrated the interference of laboratory analyses by fluorescein. The majority of these studies were published 10 to 30 years ago. By presenting this case, the authors hope to bring renewed attention to this phenomenon among clinicians, as falsely increased or decreased laboratory values can result in unnecessary diagnostics and/or therapy.


Assuntos
Anafilaxia/induzido quimicamente , Angiofluoresceinografia , Fluoresceína/efeitos adversos , Proteinúria/urina , Idoso de 80 Anos ou mais , Anafilaxia/diagnóstico , Anafilaxia/terapia , Técnicas de Laboratório Clínico , Feminino , Hidratação , Humanos , Injeções Intravenosas , Oxigenoterapia , Neovascularização Retiniana/diagnóstico , Urinálise
15.
Tokai J Exp Clin Med ; 44(4): 118-123, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31769002

RESUMO

OBJECTIVE: Proteinuria is a marker for cardiovascular diseases and all-cause mortality. In the Specific Health Checkups in Japan, when subjects show trace proteinuria (grade±) on dipstick assay, further examination is recommended to them. Although 150 mg/gCr is a threshold for diagnosing chronic kidney disease (CKD), little data on the relationship between dipstick grade± and the protein-creatinine ratio have been reported. METHODS: A cross-sectional study using urine specimens obtained in a single institute, JCHO Saitama Northern Medical Center, was performed from October 2014 to March 2016. The level of proteinuria was measured in fresh morning urine samples from 819 volunteer participants of the Specific Health Checkups by two methods: Eiken Uropaper III to detect and qualitatively grade proteinuria, and total protein concentration by the pyrogallol red method. RESULTS: Sensitivity, specificity, and the positive likelihood ratio to detect proteinuria of 30 mg/dL by 1+ were 90.3%, 97.8%, and 41.9, whereas 150 mg/gCr by ± were 45.3%, 81.4%, and 2.4, respectively. Therefore, screening for 150 mg/gCr by dipstick grade± had a false-negative rate of 54.7% and false-negative rate was significantly higher in women (8.0%) than in men (1.7%) (p < 0.0001). CONCLUSIONS: Although the dipstick assay is useful to detect clinically significant proteinuria, substantial numbers of false-negative results occur in checkups for identifying subjects with a risk of CKD.


Assuntos
Creatinina/urina , Proteinúria/urina , Insuficiência Renal Crônica/urina , Urinálise/métodos , Adulto , Idoso , Estudos Transversais , Reações Falso-Negativas , Feminino , Humanos , Limite de Detecção , Masculino , Pessoa de Meia-Idade , Prevalência , Proteinúria/epidemiologia , Fitas Reagentes , Insuficiência Renal Crônica/epidemiologia , Sensibilidade e Especificidade , Fatores Sexuais , Urinálise/instrumentação
16.
Int J Mol Sci ; 20(19)2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31623319

RESUMO

Metabolic dysfunction associated with obesity threatens to inundate health care resources by increasing the incidences of obesity-related diseases. The aim of the present study was to investigate the changes in the urinary proteome of 18 individuals classified into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) patients. Proteome analysis was performed using the two-dimensional difference in gel electrophoresis (2D-DIGE) coupled with mass spectrometry (MS). Upon analysis, a total of 54 proteins were found to be affected with ≥1.5-fold change (ANOVA, p ≤ 0.05), of which 44 proteins were upregulated and 10 proteins were downregulated. These differentially abundant proteins were related to nuclear factor κB (NF-κB) and p38 mitogen-activated protein (MAP) kinase pathways and were involved in cellular compromise, inflammatory response, and cancer. Proteins involved in inflammation (fibrinogen alpha (FIBA), serotransferrin (TRFE, and kininogen-1 (KNG1)) and insulin resistance (ADP-ribosylation factor (ARF)-like protein 15 (ARL15) and retinol-binding protein 4 (RET4)) were found to be significantly increased in the urine samples of MUHO compared to MHO patients. Investigating the effects of obesity on urinary proteins can help in developing efficient diagnostic procedures for early detection and prevention of obesity-related complications.


Assuntos
Obesidade/urina , Proteinúria/urina , Proteoma , Proteômica , Adulto , Biomarcadores , Feminino , Nível de Saúde , Humanos , Masculino , Obesidade/complicações , Mapeamento de Interação de Proteínas , Proteinúria/etiologia , Proteômica/métodos
17.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31510053

RESUMO

Standard methods for detecting and monitoring of IgA nephropathy (IgAN) have conventionally required kidney biopsies or suffer from poor sensitivity and specificity. The Kidney Injury Test (KIT) Assay of urinary biomarkers has previously been shown to distinguish between various kidney pathologies, including chronic kidney disease, nephrolithiasis, and transplant rejection. This validation study uses the KIT Assay to investigate the clinical utility of the non-invasive detection of IgAN and predicting the progression of renal damage over time. The study design benefits from longitudinally collected urine samples from an investigator-initiated, multicenter, prospective study, evaluating the efficacy of corticosteroids versus Rituximab for preventing progressive IgAN. A total of 131 urine samples were processed for this study; 64 urine samples were collected from 34 IgAN patients, and urine samples from 64 demographically matched healthy controls were also collected; multiple urinary biomarkers consisting of cell-free DNA, methylated cell-free DNA, DMAIMO, MAMIMO, total protein, clusterin, creatinine, and CXCL10 were measured by the microwell-based KIT Assay. An IgA risk score (KIT-IgA) was significantly higher in IgAN patients as compared to healthy control (87.76 vs. 14.03, p < 0.0001) and performed better than proteinuria in discriminating between the two groups. The KIT Assay biomarkers, measured on a spot random urine sample at study entry could distinguish patients likely to have progressive renal dysfunction a year later. These data support the pursuit of larger prospective studies to evaluate the predictive performance of the KIT-IgA score in both screening for non-invasive diagnosis of IgAN, and for predicting risk of progressive renal disease from IgA and utilizing the KIT score for potentially evaluating the efficacy of IgAN-targeted therapies.


Assuntos
Biomarcadores/urina , Glomerulonefrite por IGA/urina , Monitorização Fisiológica/métodos , Corticosteroides/uso terapêutico , Adulto , Creatinina/urina , Progressão da Doença , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/tratamento farmacológico , Humanos , Imunoglobulina A/urina , Fatores Imunológicos/uso terapêutico , Rim/patologia , Rim/fisiopatologia , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteinúria/urina , Rituximab/uso terapêutico , Sensibilidade e Especificidade , Adulto Jovem
18.
Ren Fail ; 41(1): 875-882, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31517550

RESUMO

Purpose: Typically, IgA nephropathy is a slowly progressive type of glomerulonephritis. High-grade proteinuria and hypertension are predictors of reduced kidney function. However, we found some normotensive patients with mild proteinuria could exhibit impaired renal function at the time of IgAN diagnosis. We therefore conduct a study to highlight the occurrence of these cases and to define their clinical characteristics and outcomes. Methods: The clinical, laboratory, pathological manifestations and outcomes of these IgAN patients were collected and were compared with normotensive IgA nephropathy patients with mild proteinuria and normal renal function. Patients were analyzed according to different pathological characteristics. Survival curves were constructed according to the Kaplan-Meier method. Results: Of all normotensive IgA nephropathy patients with mild proteinuria, 108 (10.1%) patients had impaired renal function. Ischemic sclerosis (79 patients) and fibrous crescent (25 patients) were the main pathological characteristics. Macroscopic hematuria (1.3%), prodromal infection (13.9%) and high serum IgA (11.4%) were significantly lower prevalences, but only proteinuria (26.6%) was more common in ischemic sclerosis group patients. Only hematuria were not found in ischemic sclerosis group and crescent group patients. The median follow-up were about 5 years. Patients in crescent group had a poor outcome compared with patients in ischemic sclerosis group. Conclusions: Some normotensive IgA nephropathy patients with mild proteinuria had impaired renal function at diagnosis. Ischemic sclerosis and fibrous crescent were the main pathological features in these patients. Patients in the crescent group had a worse outcome than patients in the ischemic sclerosis group.


Assuntos
Glomerulonefrite por IGA/complicações , Glomérulos Renais/fisiopatologia , Proteinúria/fisiopatologia , Insuficiência Renal/mortalidade , Adolescente , Adulto , Biópsia , Pressão Sanguínea/fisiologia , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/fisiopatologia , Glomerulonefrite por IGA/urina , Humanos , Estimativa de Kaplan-Meier , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , Proteinúria/urina , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Adulto Jovem
19.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 122-126, jul.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-182718

RESUMO

El embarazo es un estado donde se aumenta la litogenicidad y la estasis biliar, generando mayor incidencia en la formación de cálculos biliares. Aunque la colelitiasis por sí sola no es una urgencia quirúrgica en la paciente obstétrica, puede requerir de intervención si se presentan complicaciones, las cuales se dan hasta en un 10% de las pacientes obstétricas con colelitiasis sintomática. En este artículo se presentará un caso clínico de una paciente obstétrica que presentó colelitiasis con coledocolitiasis de alto riesgo que requirió manejo con colangiopancreatografía retrógrada endoscópica


Lithogenesis and biliary stasis increases during pregnancy. This generates a high incidence in the production of gallstones. Cholelithiasis is not usually a surgical emergency in pregnancy, but when there are complications, which can be in up to 10% of obstetric patients, these complications can require intervention. A case report is presented on an obstetric patient with cholelithiasis, and high risk of choledocholithiasis, that required intervention using endoscopic retrograde cholangiopancreatography


Assuntos
Humanos , Feminino , Gravidez , Adulto , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/terapia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colelitíase/diagnóstico por imagem , Colelitíase/terapia , Trabalho de Parto Prematuro , Acetaminofen , Betametasona/administração & dosagem , Proteinúria/urina , Ductos Biliares/diagnóstico por imagem , Hiperbilirrubinemia/diagnóstico , Esfincterotomia/instrumentação , Ultrassonografia Pré-Natal/instrumentação
20.
Saudi J Kidney Dis Transpl ; 30(4): 989-994, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464262

RESUMO

Mammalian target of rapamycin (mTOR) inhibitors are used in renal sparing protocols and transplant immunosuppression in patients with solid organ and stem cell transplants. They cause various side effects, including proteinuria, which is mediated by blockade of the vascular endothelial growth factor receptor pathway. There have been various reports of mTOR inhibitors causing proteinuria or worsening proteinuria form preexisting renal glomerulo-pathies. We report a 73-year old male with diabetic glomerulosclerosis, acute liver failure due to Budd-Chiari syndrome, chronic low platelets, and worsening proteinuria from 0.46 g protein/g creatinine to 2.2 g protein/g creatinine. Workup revealed no thrombotic microangiopathy through skin biopsy, and a renal biopsy confirmed only clinically suspected diabetic and hypertensive glomerulosclerosis and possible calcineurin inhibitors. On discontinuation of everolimus urine protein decreased back to 0.6 g/g creatinine. We review the mechanism of mTOR-induced proteinuria and how this may affect diabetic nephropathy secondarily. We also consider the clinical implications of this in transplant patients receiving these agents.


Assuntos
Nefropatias Diabéticas/complicações , Everolimo/efeitos adversos , Imunossupressores/efeitos adversos , Falência Hepática Aguda/cirurgia , Transplante de Fígado/efeitos adversos , Proteinúria/etiologia , Idoso , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/urina , Progressão da Doença , Humanos , Falência Hepática Aguda/complicações , Falência Hepática Aguda/diagnóstico , Masculino , Proteinúria/diagnóstico , Proteinúria/urina , Fatores de Risco , Resultado do Tratamento
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