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1.
Rev Med Liege ; 77(1): 18-24, 2022 Jan.
Artigo em Francês | MEDLINE | ID: mdl-35029336

RESUMO

Both renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i, gliflozins) reduce the risk of heart failure and of progressing towards end-stage renal disease, especially in patients with type 2 diabetes (T2D). Positive results reported in patients with T2D have been confirmed in people without diabetes. These two pharmacological classes now occupy a privileged place in international guidelines, in diabetology, cardiology and nephrology. The present article describes similarities and differences between these two types of medications. It emphasizes the importance of combining both approaches in order to optimize the cardiovascular and renal prognosis, while maintaining a good safety profile.


Les inhibiteurs du système rénine-angiotensine-aldostérone (iSRAA) et les inhibiteurs des cotransporteurs sodium-glucose de type 2 (iSGLT2, gliflozines) réduisent le risque d'insuffisance cardiaque et de progression vers l'insuffisance rénale terminale, notamment chez les patients avec un diabète de type 2 (DT2). Les effets positifs rapportés chez les patients DT2 ont été confirmés chez les personnes non diabétiques. Ces deux classes pharmacologiques occupent maintenant une place de choix dans les recommandations internationales, en diabétologie, en cardiologie et en néphrologie. Cet article fait le point sur les similitudes et les différences entre ces deux familles médicamenteuses. Il insiste sur l'importance de les combiner pour optimiser le pronostic cardiovasculaire et rénal, tout en maintenant un bon niveau de sécurité.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Inibidores do Transportador 2 de Sódio-Glicose , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Rim , Sistema Renina-Angiotensina , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
2.
Afr J Paediatr Surg ; 19(2): 83-88, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35017377

RESUMO

Background: Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT. Methodology: This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant. Results: Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1-7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant. Conclusion: The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.


Assuntos
Neoplasias Renais , Tumor de Wilms , Feminino , Humanos , Lactente , Rim , Neoplasias Renais/terapia , Masculino , Nigéria , Estudos Retrospectivos , Tumor de Wilms/terapia
3.
Mymensingh Med J ; 31(1): 80-87, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34999684

RESUMO

Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.


Assuntos
Insuficiência Renal Crônica , Adolescente , Adulto , Bangladesh/epidemiologia , Biópsia , Feminino , Humanos , Rim , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
4.
Orv Hetil ; 163(3): 83-91, 2022 01 16.
Artigo em Húngaro | MEDLINE | ID: mdl-35034007

RESUMO

Összefoglaló. A jelenlegi hazai gyakorlatban sokszor indokolatlanul korlátozzák a vesebetegek kontrasztanyagos vizsgálatát, és halasztódik a metformint szedok vizsgálata is, kontrasztanyag által okozott akut vesekárosodástól (contrast-induced acute kidney injury, CI-AKI) tartva. Összefoglalónk célja az ezzel kapcsolatos újabb ismeretek áttekintése és egy szakmai javaslat ismertetése annak érdekében, hogy a betegellátás szempontjából fontos vizsgálatok ne maradjanak el, ugyanakkor azok a maximális betegbiztonság jegyében készüljenek. Az elmúlt évek tanulmányai alapján a CI-AKI elofordulása a korábbinál kevésbé gyakori, és jelentosen különbözo a kontrasztanyag intravénás vagy intraarteriális alkalmazásától függoen. Legfontosabb rizikótényezoje a csökkent glomerulusfiltrációs ráta (GFR), mely stabil állapotú vesebetegnél, intravénás kontrasztanyag adásakor 30 ml/min/1,73 m2 alatt, intraarteriális alkalmazásakor 45 ml/min/1,73 m2 alatt képez magas rizikót. Proteinuria esetén a CI-AKI és a kontrasztanyaggal társult akut vesekárosodás (contrast-associated kidney injury, CA-AKI) kockázata is nagyobb, ezért a számított GFR mellett indokolt a vizelet albumin/kreatinin vagy fehérje/kreatinin hányados meghatározása is a vizsgálat elott. Az instabil állapot, az akut veseelégtelenség mindenkor magas kockázatot jelent, ilyenkor a számított GFR pontatlan, nem használható. Csökkent vesefunkció mellett figyelni kell a beadott kontrasztanyag mennyiségére, a vizsgálat 48-72 órán belüli ismétlésének kerülésére, a nemszteroid gyulladásgátlók vagy más nephrotoxicus szerek lehetoség szerinti szüneteltetésére. Prevenciós intézkedés a magas rizikóval bíró betegek esetében javasolt intravénás hidrálás formájában, fiziológiás koncentrációjú nátrium-klorid vagy nátrium-bikarbonát infúziójával. Az egyéb eljárások hatástalanok, és nem indokolt a beavatkozás utáni dialízis végzése sem végstádiumú veseelégtelen betegekben. A metformint 60 ml/min/1,73 m2 feletti eGFR-rel rendelkezo beteg vizsgálata kapcsán szükségtelen elhagyni, ettol rosszabb vesemuködés esetén kell szüneteltetni. Amennyiben a vizsgálat indikációja sürgosségi, az a metformin egyideju elhagyásával elvégezheto, de a gyógyszer csak 48 óra múlva, az akut vesekárosodás kizárását követoen adható vissza. Orv Hetil. 2022; 163(3): 83-91. Summary. In the current clinical practice, studies with iodinated contrast agents are often limited in patients with kidney disease and delayed in those on metformin therapy due to fear of contrast-induced acute kidney injury (CI-AKI). We aim to review the most recent information about CI-AKI and provide recommendations in order to avoid cancellation of important contrast-enhanced tests, but maximize safety considerations. According to the most recent findings, CI-AKI occurs less frequently nowadays than previously, and depends significantly on the route of contrast administration (intraarterial or intravenous). The most important risk factor is the decreased GFR, which, in stable patients with intravenous contrast administration provides high risk if the eGFR is less than 30 ml/min/1.73 m2, and with intraarterial contrast is less than 45 ml/min/1.73 m2. In patients with proteinuria, the risk of both CI-AKI and CA-AKI (contrast-associated kidney injury) is increased, therefore urinary albumin/creatinine or protein/creatinine ratios are recommended to measure before the contrast material administration, beside the eGFR determination. Unstable condition, acute renal failure always mean high risk; in these cases, eGFR calculation is imprecise and useless. If renal function is decreased, the amount of contrast material needs consideration, repeated contrast-enhanced studies should be avoided in 48-72 hours, the non-steroidal anti-inflammatory agents and other nephrotoxic drugs have to be discontinued. For high risk patients, preventive intravenous hydration should be given, either by physiologic saline or sodium bicarbonate infusion. Other drugs aiming prevention have proved to be useless; dialysis treatment immediately after contrast administration in end-stage renal disease patients is unnecessary. There is no indication to discontinue metformin if eGFR is higher than 60 ml/min/1.73 m2, but if the patient has less than that value, the metformin needs to be stopped. In urgent studies with contrast agent, metformin administration has to be discontinued simultaneously with the intervention, and this drug can only be readministered after ruling out acute kidney injury in 48 hours following contrast exposure. Orv Hetil. 2022; 163(3): 83-91.


Assuntos
Meios de Contraste , Rim , Meios de Contraste/efeitos adversos , Humanos , Rim/fisiologia
5.
Orv Hetil ; 163(3): 109-115, 2022 01 16.
Artigo em Húngaro | MEDLINE | ID: mdl-35034008

RESUMO

Összefoglaló. Bevezetés: Az aortabetegségek kezelése során az orvos által módosított sztentgraftok alkalmazása vitatott. Döntoen sürgosségi esetben, nagy rizikójú nyitott mutét alternatívájaként vagy nehéz anatómiai konfigurációk esetén alkalmazzák oket. Módszer: Cikkünkben három eseten keresztül klinikánk kezdeti tapasztalatait mutatjuk be az orvos által a mutét során módosított sztentgraftokkal kapcsolatosan. Eredmények: Elso esetünkben egy 75 éves férfi beteg 50 mm-es saccularis infrarenalis aortaaneurysma miatt került felvételre. A rövid infrarenalis tágulat proximalis rögzítési zónájának átméroje lényegesen nagyobb volt, mint a terminális aortaszakasz. A kaliberdiszkrepancia megoldására a legalkalmasabb egy reverz helyzetu iliacagraftszár volt, így egy graftszárat a felvezetorendszerérol eltávolítottunk, majd megfordítva az aorta tágulatába deponáltuk. Hasonló megoldást választottunk egy 67 éves férfi beteg jobb oldali, 65 mm-es arteria iliaca communis aneurysmájának kezelése során. Egy 81 éves nobeteg hasi aortaaneurysma tartott rupturája miatt korábban behelyezett unilateralis graft proximalis endoleakjének megoldása miatt érkezett. Az ectaticus aorta, valamint az arteria mesenterica superior és a primer intervenció során bekerült unilateralis graft elkeskenyedo része közti rövid távolság miatt konvencionális sztentgraft beültetése nem volt lehetséges. A szituáció egy rövid thoracalis sztentgrafttal volt megoldható: egy thoracalis sztentgraft distalis végébol 3 cm-t kauter segítségével levágtunk, majd az eszközt a felvezetorendszerbe visszatöltöttük. A módosított sztentgraftot az arteria mesenterica superior alá pozicionáltuk, egy 'chimney' sztentgraft segítségével biztosítottuk a jobb vese perfúzióját. Technikailag mindhárom beavatkozásunk sikeres volt. Következtetés: Az endovascularis aortamutétek azonnal elérheto eszközparkja a típusos anatómiájú betegek megoldására általában alkalmas. A szokatlan anatómiával rendelkezo elektív esetek, illetve a sürgeto beavatkozást igénylo komplex endovascularis mutétek során az orvos által módosított sztentgraftok hatékonyan alkalmazhatók. Alkalmazásuk nagy forgalmú aortacentrumokban javasolt. Orv Hetil. 2022; 163(3): 109-115. INTRODUCTION: Physician-modified endografts are mainly used in urgent cases of aortic disease as an alternative to high-risk open surgical repair or in difficult anatomical configurations. METHOD: We present our initial experiences with physician-modified stent graft implantation. RESULTS: A 75-year-old male patient was admitted with a 50 mm saccular infrarenal aortic aneurysm. However, the diameter of the proximal sealing zone was significantly larger than that of the distal sealing zone, so we decided to use an iliac limb stent graft with reverse mounting resulting in an upside-down configuration to accommodate this diameter mismatch. A similar approach was used to treat a 67-year-old male patient with a 65 mm right common iliac artery aneurysm. An 81-year-old female patient was admitted with a type I endoleak associated with an aorto-uni-iliac endograft. The wide juxtarenal aortic diameter together with the short distance between the superior mesenteric artery and the proximal end of the previously deployed uni-iliac graft made the patient unsuitable for conventional endovascular repair, thus the distal 3 cm was cut from a standard thoracic stent graft and the device was reloaded. The modified graft was positioned below the superior mesenteric artery, while renal perfusion was secured by a chimney graft. Technical success was obtained in all three cases. CONCLUSION: The available toolkit of endovascular aortic surgery is generally suitable for the treatment of patients with typical anatomy. In elective cases of patients with unusual anatomy, or in urgent cases with complex aortic pathologies, physician-modified endovascular graft implantation can be used effectively. Orv Hetil. 2022; 163(3): 109-115.


Assuntos
Endometriose , Médicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Artéria Ilíaca , Rim , Masculino
6.
Environ Int ; 158: 107018, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34991270

RESUMO

In 2011, phthalates, mainly di-(2-ethylhexyl) phthalate (DEHP), were found to have been added to a variety of foods in Taiwan, increasing the risk of microalbuminuria in children. Exposure to melamine perhaps modifies that risk. This prospective cohort study investigates whether renal injury resulting from exposure to DEHP-tainted foods from the 2011 Taiwan Food Scandal is reversed over time. The temporal and interactive effects of past daily DEHP intake, current daily DEHP intake, and urinary melamine levels on oxidative stress and renal injury were also examined. Two hundred possibly DEHP-affected children (aged < 18 years) were enrolled in the first survey wave (August 2012-January 2013), with 170 and 159 children in the second (July 2014-February 2015) and third waves (May 2016-October 2016), respectively. The first wave comprised questionnaires that were used to collect information about possible past daily DEHP intake from DEHP-tainted foods. One-spot first morning urine samples were collected to measure melamine levels, phthalate metabolites, and markers indicating oxidative stress (malondialdehyde and 8-oxo-2'-deoxyguanosine), and renal injury (albumin/creatinine ratio (ACR) and N-acetyl-beta-D-glucosaminidase) in all three waves. Generalized estimating equation (GEE) modeling revealed that both past daily DEHP intake and time might affect urinary ACR. However, most interactions were negative and significant correlation was observed only during the second wave (P for interaction = 0.014) in the group with the highest past daily DEHP intake (>50 µg/kg/day). Urinary melamine levels were found to correlate significantly with both urinary ACR and oxidative stress markers. The highest impact associated with exposure to DEHP-tainted foods in increasing urinary ACR of children was observed during the first wave, and the effect may partially diminish over time. These results suggest that continuous monitoring of renal health and other long-term health consequences is required in individuals who were affected by the scandal in 2011.


Assuntos
Dietilexilftalato , Ácidos Ftálicos , Criança , Dietilexilftalato/toxicidade , Exposição Ambiental/efeitos adversos , Contaminação de Alimentos , Humanos , Rim/química , Estresse Oxidativo , Estudos Prospectivos , Taiwan , Triazinas
7.
Trials ; 23(1): 18, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991694

RESUMO

BACKGROUND: One of the main effectors on the quality of life of living-kidney donors is postoperative fatigue. Caloric restriction (CR) and short-term fasting (STF) are associated with improved fitness and increased resistance to acute stress. CR/STF increases the expression of cytoprotective genes, increases immunomodulation via increased anti-inflammatory cytokine production, and decreases the expression of pro-inflammatory markers. As such, nutritional preconditioning by CR or STF represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and postoperative fatigue. To investigate whether preoperative STF contributes to a reduction in fatigue after living-kidney donation, a randomized clinical trial is indicated. METHODS: We aim to determine whether 2.5 days of fasting reduces postoperative fatigue score in subjects undergoing living-kidney donation. In this randomized study, the intervention group will follow a preoperative fasting regime for 2.5 days with a low-dose laxative, while the control group will receive standard care. The main study endpoint is postoperative fatigue, 4 weeks after living-kidney donation. Secondary endpoints include the effect of preoperative fasting on postoperative hospital admission time, the feasibility of STF, and the postoperative recovery of donor and recipient kidney function. This study will provide us with knowledge of the feasibility of STF and confirm its effect on postoperative recovery. DISCUSSION: Our study will provide clinically relevant information on the merits of caloric restriction for living-kidney donors and recipients. We expect to reduce the postoperative fatigue in living-kidney donors and improve the postoperative recovery of living-kidney recipients. It will provide evidence on the clinical merits and potential caveats of preoperative dietary interventions. TRIAL REGISTRATION: Netherlands Trial Register NL9262 . EudraCT 2020-005445-16 . MEC Erasmus MC MEC-2020-0778. CCMO NL74623.078.21.


Assuntos
Transplante de Rim , Qualidade de Vida , Jejum , Humanos , Rim/cirurgia , Transplante de Rim/efeitos adversos , Doadores Vivos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
In Vivo ; 36(1): 206-211, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34972716

RESUMO

BACKGROUND/AIM: This study performed 99mTc-MAG3 renal scintigraphy on rabbit kidneys and evaluated its ability to identify obstructive or non-obstructive kidneys. MATERIALS AND METHODS: Renal function was assessed during a four-week post-obstruction period by obtaining planar images of 99mTc-MAG3 activity following an ear vein injection. The individual renal function was evaluated by renal scintigraphy in conjunction with histopathological and morphological examinations. RESULTS: The renal perfusion of 99mTc-MAG3 in the right kidney with a ureteral obstruction decreased with time. The width, height, and cortical thickness of the obstructed right kidney were significantly larger than those of the left kidney. A histopathological examination four weeks after the ureteral obstruction revealed a typical pattern of urinary tract obstruction, including multiple tubules, enlargement of the interstitial area, and cytoplasmic vacuoles. CONCLUSION: 99mTc-MAG3 renal scintigraphy provides the kidney shape and size and can identify potential obstructive and non-obstructive kidneys in rabbits.


Assuntos
Renografia por Radioisótopo , Obstrução Ureteral , Animais , Rim/diagnóstico por imagem , Rim/fisiologia , Coelhos , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Mertiatida , Obstrução Ureteral/diagnóstico por imagem
9.
In Vivo ; 36(1): 510-521, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34972756

RESUMO

BACKGROUND/AIM: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare subtype of renal cell carcinoma and generally considered a low-grade renal epithelial neoplasm. However, MTSCC with distant metastases often shows a poor prognosis. This is the first reported case of cytoreductive nephrectomy after nivolumab plus ipilimumab combination treatment. CASE REPORT: A 26-year-old man had a 72-mm tumor at the left kidney with multiple osteolytic bone metastases. A biopsy of the renal tumor and bone metastases resulted in the diagnosis of MTSCC of the kidney with bone metastases. After nivolumab plus ipilimumab combined treatment, he underwent cytoreductive nephrectomy. The excised specimen showed higher PD-L1 expression in the spindle components than in the tubular components, but CD4- and CD8-positve T-cells showed greater infiltration in the tubular components than the spindle components. CONCLUSION: Combination immunotherapy of nivolumab and ipilimumab may be an effective treatment option for metastatic MTSCC of the kidney.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias Ósseas/secundário , Ipilimumab/uso terapêutico , Neoplasias Renais , Nivolumabe/uso terapêutico , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/cirurgia , Adulto , Procedimentos Cirúrgicos de Citorredução , Humanos , Rim , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Masculino , Nefrectomia
10.
Zhonghua Bing Li Xue Za Zhi ; 51(1): 23-27, 2022 Jan 08.
Artigo em Chinês | MEDLINE | ID: mdl-34979749

RESUMO

Objective: To study the clinical pathological characteristics, immunophenotype, molecular changes and prognosis of the papillary renal neoplasm with reverse polarity (PRNRP). Methods: Nine cases of PRNRP, diagnosed from 2013 to 2019, were retrieved from the Department of Pathology of Nanjing Jinling Hospital, Nanjing University School of Medicine. Histomorphology, immunophenotype and molecular genetics were analyzed with review of the literatures. Results: There were five male and four female patients, aged from 49 to 70 years, with an average age of 60.1 years. During a mean follow-up of 29 months, one patient died for other cause, and the others survived without disease. Microscopically, the tumor cells arranged in papillary structure with a fibrovascular core, the surface of which was covered with a single layer of cuboidal or columnar cells. The most prominent feature was that the tumor nuclei located at the top of the cytoplasm far from the basement membrane, and they were monotonous in size and arranged neatly with no or few nucleoli. Immunohistochemically, all nine cases of PRNRP showed diffuse positive expression of CK7 and E-cadherin, various degrees of P504s expression, and no expression of CD10 and CD117, with a Ki-67 index of 1%-3%. Unlike other papillary renal cell carcinoma, the nine cases of PRNRP all showed characteristic positive expression of GATA3. The fluorescence in situ hybridization assay showed that the majority of PRNRPs (8/9) did not have triploids on chromosomes 7 and 17. The sequencing of the KRAS gene confirmed the presence of a nonsense KRAS mutation in 8 of the 9 cases. Conclusions: PRNRP is a subtype of papillary renal cell carcinoma with characteristic morphological, immunophenotypic and molecular features, and indolent behaviors. More data are needed to define PRNRP as "carcinoma", and a definitive diagnosis of PRNRP is of great significance for proper treatment choice and accurate prognostication.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Biomarcadores Tumorais , Carcinoma de Células Renais/genética , Feminino , Humanos , Hibridização in Situ Fluorescente , Rim , Neoplasias Renais/genética , Masculino , Pessoa de Meia-Idade , Prognóstico
11.
Trials ; 23(1): 52, 2022 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-35042554

RESUMO

BACKGROUND: Delayed graft function, or the requirement for dialysis due to poor kidney function, is a frequent complication of deceased donor kidney transplantation that is associated with inferior outcomes. Intravenous fluids with a high chloride content, such as isotonic sodium chloride (0.9% saline), are widely used in transplantation but may increase the risk of poor kidney function. The primary objective of the BEST-Fluids trial is to compare the effect of a balanced low-chloride crystalloid, Plasma-Lyte 148 (Plasmalyte), versus 0.9% saline on the incidence of DGF in deceased donor kidney transplant recipients. This article describes the statistical analysis plan for the trial. METHODS AND DESIGN: BEST-Fluids is an investigator-initiated, pragmatic, registry-based, multi-centre, double-blind, randomised controlled trial. Eight hundred patients (adults and children) in Australia and New Zealand with end-stage kidney disease admitted for a deceased donor kidney transplant were randomised to intravenous fluid therapy with Plasmalyte or 0.9% saline in a 1:1 ratio using minimization. The primary outcome is delayed graft function (dialysis within seven days post-transplant), which will be modelled using a log-binomial generalised linear mixed model with fixed effects for treatment group, minimization variables, and ischaemic time and a random intercept for study centre. Secondary outcomes including early kidney transplant function (a ranked composite of dialysis duration and the rate of graft function recovery), treatment for hyperkalaemia, and graft survival and will be analysed using a similar modelling approach appropriate for the type of outcome. DISCUSSION: BEST-Fluids will determine whether Plasmalyte reduces the incidence of DGF and has a beneficial effect on early kidney transplant outcomes relative to 0.9% saline and will inform clinical guidelines on intravenous fluids for deceased donor kidney transplantation. The statistical analysis plan describes the analyses to be undertaken and specified before completion of follow-up and locking the trial databases. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000358347 . Prospectively registered on 8 March 2017 ClinicalTrials.gov identifier NCT03829488 . Registered on 4 February 2019.


Assuntos
Transplante de Rim , Solução Salina , Austrália , Soluções Cristaloides , Função Retardada do Enxerto/diagnóstico , Função Retardada do Enxerto/prevenção & controle , Hidratação , Sobrevivência de Enxerto , Humanos , Incidência , Rim , Transplante de Rim/efeitos adversos
12.
Crit Care ; 26(1): 13, 2022 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991653

RESUMO

BACKGROUND: Galectin-3 (Gal-3) is a proinflammatory and profibrotic protein especially overexpressed after Acute Kidney Injury (AKI). The early renal prognostic value of Gal-3 after AKI in critically ill patients remains unexplored. The objective was to evaluate the prognostic value of plasma level of Gal-3 for Major Adverse Kidney Events (MAKE) and mortality 30 days after ICU admission across AKI stages. METHODS: This is an ancillary study of a prospective, observational, multicenter cohort (FROG-ICU). AKI was defined using KDIGO definition. RESULTS: Two thousand and seventy-six patients had a Gal-3 plasma level measurement at ICU admission. Seven hundred and twenty-three (34.8%) were females and the median age was 63 [51, 74] years. Eight hundred and seven (38.9%) patients developed MAKE, 774 (37.3%) had AKI and mortality rate at 30 days was 22.4% (N = 465). Patients who developed MAKE had higher Gal-3 level at admission compared to patients without (30.2 [20.8, 49.2] ng/ml versus 16.9 [12.7, 24.3] ng/ml, p < 0.001, respectively. The area under the receiver operating characteristic curve of Gal-3 to predict MAKE was 0.76 CI95% [0.74-0.78], p < 0.001. Gal-3 was associated with MAKE (OR 1.80 CI95% [1.68-1.93], p < 0.001, non-adjusted and OR 1.37 CI95% [1.27-1.49], p < 0.001, adjusted). The use of Gal-3 improved prediction performance of prediction model including SAPSII, Screatadm, pNGAL with a NRI of 0.27 CI95%(0.16-0.38), p < 0.001. Median Gal-3 was higher in non-survivors than in survivors at 30 days (29.2 [20.2, 49.2] ng/ml versus 18.8 [13.3, 29.2] ng/ml, p < 0.001, respectively). CONCLUSION: Plasma levels of Gal-3 were strongly associated with renal function, with an increased risk of MAKE and death after ICU admission. Trial registration ClinicalTrials.gov NCT01367093. Registered on 6 June 2011.


Assuntos
Injúria Renal Aguda , Galectina 3 , Biomarcadores , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Rim/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Ann Transplant ; 27: e934800, 2022 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-35042838

RESUMO

BACKGROUND This study aimed to analyze the preventive effect of nitric oxide (NO)-releasing nanofibers against ischemia-reperfusion injury (IRI) and to determine the mechanism of action as a novel NO delivery system in a rat model. MATERIAL AND METHODS Eight-week-old male Sprague-Dawley rats, weighing 250 to 280 g, were divided into 3 groups: sham, untreated (n=5); control, renal ischemia injury for 55 min (n=4); and NO24, renal ischemia injury for 55 min with kidney wrapping of NO-releasing nanofiber for 24 h (n=6). mRNA expression was measured by real-time polymerase chain reaction (PCR), whereas protein expression was assessed by immunohistochemistry and western blot analysis. RESULTS Serum creatinine levels in the sham, control, and NO24 groups were 0.48±0.08, 4.66±0.33, and 2.60±1.00 mg/dL, respectively (P=0.002). Anti-apoptotic Bcl-2 protein expression differed significantly between the control and the NO24 groups (Bcl-2/ß-actin; control, 0.50±0.12; NO24, 1.56±0.56; P=0.024). mRNA expression level of the inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) was significantly higher in the control group (23.24±11.32, P=0.016) than in the sham group (1.00±1.21), and mRNA expression of TNF-alpha in the NO24 group (1.28±1.16, P=0.010) was significantly lower than in the control group. Histological analysis revealed decreased atrophy and necrosis in the NO24 group compared to those in the control group. CONCLUSIONS This study demonstrated that kidney wrapping of NO-releasing nanofibers had a protective effect against kidney IRI through anti-apoptotic and anti-inflammatory mechanisms.


Assuntos
Nanofibras , Traumatismo por Reperfusão , Animais , Rim , Masculino , Óxido Nítrico , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/prevenção & controle
14.
Braz J Med Biol Res ; 55: e11873, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35043862

RESUMO

Sepsis causes long-term disability, such as immune dysfunction, neuropsychological disorders, persistent inflammation, catabolism, and immunosuppression, leading to a high risk of death in survivors, although the contributing factors of mortality are unknown. The purpose of this experimental study in rats was to examine renal (rSNA) and splanchnic (sSNA) sympathetic nerve activity, as well as baroreflex sensitivity, in acute and chronic post-sepsis periods. The rats were divided into two groups: control group with naïve Wistar rats and sepsis group with 2-mL intravenous inoculation of Escherichia coli at 108 CFU/mL. Basal mean arterial pressure, heart rate, rSNA, sSNA, and baroreflex sensitivity were evaluated in all groups at the acute (6 h) and chronic periods (1 and 3 months). Basal rSNA and sSNA were significantly reduced in the surviving rats, as was their baroreflex sensitivity, for both pressor and hypotensive responses, and this effect lasted for up to 3 months. A single episode of sepsis in rats was enough to induce long-term alterations in renal and splanchnic sympathetic vasomotor nerve activity, representing a possible systemic event that needs to be elucidated. These findings showed that post-sepsis impairment of sympathetic vasomotor response may be one of the critical components in the inability of sepsis survivors to respond effectively to new etiological illness factors, thereby increasing their risk of post-sepsis morbidity.


Assuntos
Barorreflexo , Sepse , Animais , Pressão Sanguínea , Modelos Animais de Doenças , Frequência Cardíaca , Rim , Ratos , Ratos Wistar , Sistema Nervoso Simpático
15.
J Synchrotron Radiat ; 29(Pt 1): 214-223, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34985438

RESUMO

Renal oxalosis is a rare cause of renal failure whose diagnosis can be challenging. Synchrotron deep ultraviolet (UV) fluorescence was assayed to improve oxalosis detection on kidney biopsies spatial resolution and sensitivity compared with the Fourier transform infrared microspectroscopy gold standard. The fluorescence spectrum of synthetic mono-, di- and tri-hydrated calcium oxalate was investigated using a microspectrometer coupled to the synchrotron UV beamline DISCO, Synchrotron SOLEIL, France. The obtained spectra were used to detect oxalocalcic crystals in a case control study of 42 human kidney biopsies including 19 renal oxalosis due to primary (PHO, n = 11) and secondary hyperoxaluria (SHO, n = 8), seven samples from PHO patients who received combined kidney and liver transplants, and 16 controls. For all oxalocalcic hydrates samples, a fluorescence signal is detected at 420 nm. These spectra were used to identify standard oxalocalcic crystals in patients with PHO or SHO. They also revealed micrometric crystallites as well as non-aggregated oxalate accumulation in tubular cells. A nine-points histological score was established for the diagnosis of renal oxalosis with 100% specificity (76-100) and a 73% sensitivity (43-90). Oxalate tubular accumulation and higher histological score were correlated to lower estimated glomerular filtration rate and higher urinary oxalate over creatinine ratio.


Assuntos
Oxalato de Cálcio , Síncrotrons , Estudos de Casos e Controles , Humanos , Rim/diagnóstico por imagem , Microscopia de Fluorescência
16.
Phytomedicine ; 94: 153818, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34798521

RESUMO

BACKGROUND: Rehmannia Glutinosa Libosch. is applied for the treatment of renal and inflammatory-related diseases, and oleic acid (OA) is a compound isolated from Rehmannia Glutinosa Libosch.. Unfortunately, the pharmacological activity of OA on LPS treated acute kidney injury (AKI) has not been investigated. AIMS: The research is aiming to probe the activities of OA on LPS-induced AKI. METHODS: Information of OA effect on AKI were from network pharmacology. H&E staining, creatinine (CRE) and urea nitrogen (UN) were performed to evaluate the activities of OA on kidney function. Inflammatory factors in serum were measured by cytometric bead array. Increased ratio of reactive oxygen species (ROS) in kidney and immune cells in the peripheral blood were determined by flow cytometry (FCM). PPAR-γ, MAPK and apoptotic signaling pathways were measured by Western blot. Then, a metabolomics approach was utilized to investigate OA's response to AKI. The role of salirasib (FTS, Ras inhibitor) in OA acted on ROS, Ca2+, MMP and Ras signaling pathway in LPS treated NRK-52e cells were investigated by FCM and In-cell western. RESULTS: It is proved that OA effetively ameliorated renal function, alleviated inflammatory response and oxidative stress, and transformed apoptotic, MAPK and PPAR-γ signaling pathways in mice with AKI, regulated phenylalanine metabolism, purine metabolism, sphingolipid metabolism, taurine and hypotaurine metabolism, moreover, the role of OA in injury of NRK-52e was blocked by FTS. CONCLUSION: In a word, OA could alleviate AKI by restraining inflammation and oxidative stress via regulating the Ras/MAPKs/PPAR-γ signaling pathway, phenylalanine metabolism, purine metabolism, sphingolipid metabolism and taurine and hypotaurine metabolism, which might be a useful strategy for treating AKI.


Assuntos
Injúria Renal Aguda , Lipopolissacarídeos , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/tratamento farmacológico , Animais , Inflamação/tratamento farmacológico , Rim , Lipopolissacarídeos/toxicidade , Camundongos , Ácido Oleico , Estresse Oxidativo , PPAR gama , Transdução de Sinais
17.
Curr Opin Nephrol Hypertens ; 31(1): 36-46, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34846312

RESUMO

PURPOSE OF REVIEW: Severe COVID-19 disease is often complicated by acute kidney injury (AKI), which may transition to chronic kidney disease (CKD). Better understanding of underlying mechanisms is important in advancing therapeutic approaches. RECENT FINDINGS: SARS-CoV-2-induced endothelial injury initiates platelet activation, platelet-neutrophil partnership and release of neutrophil extracellular traps. The resulting thromboinflammation causes ischemia-reperfusion (I/R) injury to end organs. Severe COVID-19 induces a lipid-mediator storm with massive increases in thromboxane A2 (TxA2) and PGD2, which promote thromboinflammation and apoptosis of renal tubular cells, respectively, and thereby enhance renal fibrosis. COVID-19-associated AKI improves rapidly in the majority. However, 15-30% have protracted renal injury, raising the specter of transition from AKI to CKD. SUMMARY: In COVID-19, the lipid-mediator storm promotes thromboinflammation, ischemia-reperfusion injury and cytotoxicity. The thromboxane A2 and PGD2 signaling presents a therapeutic target with potential to mitigate AKI and transition to CKD. Ramatroban, the only dual antagonist of the thromboxane A2/TPr and PGD2/DPr2 signaling could potentially mitigate renal injury in acute and long-haul COVID. Urgent studies targeting the lipid-mediator storm are needed to potentially reduce the heavy burden of kidney disease emerging in the wake of the current pandemic.


Assuntos
Injúria Renal Aguda , COVID-19 , Insuficiência Renal Crônica , Trombose , Injúria Renal Aguda/etiologia , COVID-19/complicações , Fibrose , Humanos , Inflamação , Rim/patologia , Lipídeos , Insuficiência Renal Crônica/patologia , SARS-CoV-2 , Trombose/patologia
18.
J Pharm Biomed Anal ; 207: 114422, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34688201

RESUMO

Morinda officinalis, a well-known traditional herbal medicine in China, is used to treat deficiency of kidney-yang syndrome. Although this medicine has the property of "reinforcing kidney to strengthening Yang," the chemical constituents responsible for this effect remain to be elucidated. Here, we aimed to identify the main active compounds responsible for reinforcing kidney to strengthening Yang, based on spectrum-effect relationships combined with chemometrics. We used the UPLC-diode array detection method to establish the chromatography fingerprint of M. officinalis. Hydrocortisone-induced and adenine-induced kidney-yang deficiency patterns were established to evaluate the efficacy of M. officinalis. Serum triiodothyronine, free thyroxine, thyrotropin, testosterone, cortisol, luteinizing hormone, follicle-stimulating hormone, corticotropin-releasing hormone, and adrenocorticotropic hormone levels were determined as pharmacodynamic indices. Analytic hierarchy process was used to determine the weight of each index to the total pharmacodynamic contribution. Lastly, the spectrum-effect between the fingerprint and the pharmacological effects were established using grey relational analysis and partial least squares. Our findings indicated that peaks 1, 2, 3, 5, 6, 7, 8, 9, 11, 13, 15, 17, and 20 might represent the main components that positively correlated to the total effect, of which four were identified by comparison with reference standards. The identified components were monotropein (peak 1), deacetyl asperulosidic acid (peak 3), asperulosidic acid (peak 8), and asperuloside (peak 9). Our results suggest that the "reinforce kidney to strengthening Yang" effects were attributable to the combined effects of the multiple chemical components of M. officinalis and provide a valuable method to identify the active "reinforce kidney to strengthening Yang" components of M. officinalis and establish the quality control of M. officinalis.


Assuntos
Medicamentos de Ervas Chinesas , Morinda , Medicamentos de Ervas Chinesas/uso terapêutico , Rim , Fitoterapia , Deficiência da Energia Yang/tratamento farmacológico
19.
J Pharm Biomed Anal ; 207: 114432, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34715580

RESUMO

The traditional Chinese medicine syndrome "Kidney yang deficiency" is a kind of chronic kidney disease. With the development of society, the incidence of chronic kidney disease is increasing year by year, which also brings great economic pressure to people. Semen Cuscutae is an important traditional Chinese medicine to tonify liver and kidney, mainly used to tonify deficiency of liver and kidney, spleen and kidney deficiency and diarrhea. Although there are a lot of research at the molecular and cellular level to study the Semen Cuscutae on the treatment of Kidney yang deficiency syndrome, but there's no comprehensive research complete with metabolomics method from plasma, feces and urine metabolites aspects. The purpose of this study is to find the potential differential biomarkers of the Kidney yang deficiency model and blank group rats in plasma, urine and feces, and to investigate the mechanism of Semen Cuscutae in the treatment of Kidney yang deficiency syndrome. In this study, ultra high-performance liquid chromatography-quadrupole time-of-flight Mass Spectrometry (UPLC-QTOF/MS) was used to identify potential biomarkers. Through the analysis of metabolic profiles of plasma, urine, and feces, as well as multivariate statistical analysis and pathway analysis, the therapeutic mechanism of Semen Cuscutae for Kidney yang deficiency syndrome was described. The results showed that there were 69 differential metabolites in plasma, 93 differential metabolites in feces and 62 differential metabolites in urine, and the changes of the levels of these biomarkers showed that Semen Cuscutae had a good therapeutic effect on Kidney yang deficiency syndrome. Through the analysis of the channel, the metabolite changes mainly affected the steroid hormone biosynthesis, arachidonic acid metabolism, primary bile acid biosynthesis, sheath lipid metabolism and biosynthesis of tyrosine, phenylalanine metabolism, retinol metabolism,taurine and hypotaurine metabolism, lysine degradation and vitamin B6 metabolism, tryptophan metabolism, terpenoid backbone biosynthesis and starch and sucrose metabolism. Therefore, the results suggested that Semen Cuscutae could exert a good therapeutic effect by reversing the levels of some biomarkers.


Assuntos
Metabolômica , Sêmen , Animais , Cromatografia Líquida de Alta Pressão , Rim , Espectrometria de Massas , Ratos
20.
Urol Clin North Am ; 49(1): 161-173, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776049

RESUMO

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for large and complex renal stones. The technological advances over the past several decades gave birth to different varieties of minimally invasive PCNLs, including the mini-PCNL, ultra-mini PCNL, super mini-PCNL, and micro-PCNL, with indications being extended to stones even larger than 20 mm. This article provides an update of all these available techniques of miniaturized PCNL along with its anatomic and physiologic impact. This should assist urologists in providing a personalized approach to the patient based on various patient- and stone-related factors to provide the best of all available technology for treatment.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Animais , Cicatriz/etiologia , Humanos , Rim/lesões , Miniaturização , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Ferida Cirúrgica/etiologia
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