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1.
Magn Reson Med ; 89(1): 343-355, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36089805

RESUMO

PURPOSE: To assess the potential of DCE MR CEST urography for assessing renal function in mice with unilateral ureter obstruction (UUO) by simultaneous pH and renal uptake/clearance measurements following injection of iopamidol. METHODS: The right ureter of nine mice was obstructed via suture ligation. The animals were imaged at day 1, 2, and 3 post-obstruction on an 11.7T MRI scanner. Ninety-six sets of saturated CEST images at 4.3 and 5.5 ppm were collected. Renal pH values were obtained by calculating the signal ratio for these two frequencies and using a pH calibration curve. Renal time activity curves were measured as a percentage change in the post-injection CEST signal at 4.3 ppm relative to the average pre-injection signal. RESULTS: For the healthy mice, the time activity curves of both kidneys were nearly identical and displayed rapid excretion of contrast. For the UUO mice, the dynamic CEST curves for the obstructed kidneys displayed prolonged time to peak (TTP) values and delayed contrast excretion compared with the contralateral (CL) kidneys. Renal pH maps of the healthy animals showed similar acidic values for both kidneys (pH 6.65 ± 0.04 vs 6.67 ± 0.02), whereas in the obstructed kidneys there was a significant increase in pH values compared with the CL kidneys (pH 6.67 ± 0.08 vs 6.79 ± 0.11 in CL and UUO kidneys, respectively). CONCLUSION: Our findings indicate that DCE-MR-CEST urography can detect changes in renal uptake/excretion and pH homeostasis and distinguish between obstructed and unobstructed kidney as early as 1 day after UUO.


Assuntos
Ureter , Obstrução Ureteral , Animais , Camundongos , Obstrução Ureteral/diagnóstico por imagem , Rim/diagnóstico por imagem , Rim/fisiologia , Imageamento por Ressonância Magnética/métodos , Concentração de Íons de Hidrogênio , Urografia
2.
Sci Total Environ ; 858(Pt 1): 159746, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36306844

RESUMO

E-waste handling activities release large quantities of polychlorinated biphenyls (PCBs) and halogen flame retardants (HFRs) into the surrounding area, creating a high exposure risk for local residents. However, the possibility of PCBs and HFRs exposure contributing to renal injury has not been extensively studied. To fill this knowledge gap, we conducted an epidemiological analysis of adolescents and adults recruited from an e-waste recycling area and a control area. Some PCBs and HFRs compounds were statistically significantly associated with the levels of ß2-microglobulin (ß2-MG), blood urea nitrogen (BUN), serum creatinine (SCr), and uric acid, with thyroid hormone-related genes found to partly mediate these associations. The interactions of PCBs and HFRs with metals also influenced renal function indexes. Exposure to high concentrations of PCBs and HFRs resulted in higher levels of ß2-MG and lower levels of BUN and SCr in the exposed group. As indicated by the elevated ß2-MG levels, high exposure to PCBs and HFRs may increase the risk of early renal injury for adolescents. These findings help to clarify the impacts of PCBs and HFRs on renal function and highlight the need to protect the health of residents in regions impacted by e-waste handling activities.


Assuntos
Resíduo Eletrônico , Retardadores de Chama , Febre Hemorrágica com Síndrome Renal , Bifenilos Policlorados , Adulto , Humanos , Adolescente , Retardadores de Chama/análise , Bifenilos Policlorados/análise , Resíduo Eletrônico/análise , Éteres Difenil Halogenados/análise , Halogênios/análise , Reciclagem , Rim/fisiologia , Rim/química , Monitoramento Ambiental
3.
Pediatr Blood Cancer ; 70(1): e29981, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36129239

RESUMO

BACKGROUND: The purpose of this study is to analyze renal function outcomes in abdominal neuroblastoma patients undergoing proton therapy (PT). PROCEDURE: From 2011 to 2019, two single-institution Institutional Review Board-approved protocols prospectively enrolled neuroblastoma patients for data collection. To assess renal function, serum creatinine (Cr), blood urea nitrogen (BUN), and creatinine clearance (CrCl) before proton therapy (pre-PT) were compared with the values at last follow-up. RESULTS: A total of 30 children with abdominal neuroblastoma with median age 3.5 years (range, 0.9-9.1) at time of PT were included in this study. All patients underwent chemotherapy and resection of primary tumor prior to PT. Two patients required radical nephrectomy. Median follow-up after PT was 35 months. Mean dose to ipsilateral and contralateral kidney was 13.9 and 5.4 Gy, respectively. No patients developed hypertension or renal dysfunction during follow-up. There was no statistically significant change in serum BUN (p = .508), CrCl (p = .280), or eGFR (p = .246) between pre-PT and last follow-up. CONCLUSION: At a median follow-up of almost 3 years, renal toxicity was uncommon after PT. Longer follow-up and larger patient cohort data are needed to further assess impact of PT on renal function in this population.


Assuntos
Neuroblastoma , Terapia com Prótons , Criança , Humanos , Pré-Escolar , Prótons , Nefrectomia , Neuroblastoma/radioterapia , Neuroblastoma/etiologia , Rim/fisiologia , Terapia com Prótons/efeitos adversos , Seguimentos
4.
Artif Organs ; 46(4): 597-605, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34951495

RESUMO

BACKGROUND: M101 is an extracellular hemoglobin isolated from a marine lugworm and is present in the medical device HEMO2 life®. The clinical investigation OXYOP was a paired kidney analysis (n = 60) designed to evaluate the safety and performance of HEMO2 life® used as an additive to preservation solution in renal transplantation. The secondary efficacy endpoints showed less delayed graft function (DGF) and better renal function in the HEMO2 life® group but due to the study design cold ischemia time (CIT) was longer in the contralateral kidneys. METHODS: An additional analysis was conducted including OXYOP patients and patients from the ASTRE database (n = 6584) to verify that the decrease in DGF rates observed in the HEMO2 life® group may not be due solely to the shorter CIT but also to HEMO2 life® performance. Kaplan-Meier estimate curves of cumulative probability of achieving a creatinine level below 250 µmol/L were generated and compared in both groups. A Cox model was used to test the effect of the explanatory variables (use of HEMO2 life® and CIT). Finally, a bootstrap strategy was used to randomly select smaller samples of patients and test them for statistical comparison in the ASTRE database. RESULTS: Kaplan-Meier estimate curves confirmed the existence of a relation between DGF and CIT and Cox analysis showed a benefit in the HEMO2 life® group regardless of the associated CIT. Boostrap analysis confirmed these results. CONCLUSIONS: The present study suggested that the better recovery of renal function observed among kidneys preserved with HEMO2 life® in the OXYOP study is a therapeutic benefit of this breakthrough innovative medical device.


Assuntos
Isquemia Fria , Transplante de Rim , Isquemia Fria/efeitos adversos , Isquemia Fria/métodos , Função Retardada do Enxerto , Sobrevivência de Enxerto , Hemoglobinas , Humanos , Rim/fisiologia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Estudos Prospectivos , Fatores de Risco
5.
Medicine (Baltimore) ; 101(47): e31298, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36451476

RESUMO

Edoxaban (Edx) has been approved to prevent venous thromboembolism after total knee and/or hip arthroplasty in Japan. However, the risk of anemia with Edx treatment remains elusive. No risk factors for Edx-associated anemia after orthopedic surgery have been reported. This study aimed to clarify the risk of anemia associated with Edx treatment and determine the risk factors for Edx-associated anemia after orthopedic surgery with a high risk for bleeding. First, the association between Edx treatment and the incidence of anemia-related events was retrospectively investigated by pharmacovigilance analyses using data from 5769,866 reports between the first quarters of 2016 and 2020 in the Food and Drug Administration Adverse Event Reporting System and 2752,050 reports between the fourth quarters of 2011 and 2019 in the Japanese Adverse Drug Event Report. Second, 221 patients who underwent Edx treatment after total knee and/or hip arthroplasty between July 2011 and June 2012 at a single center were included in a case-control study to clarify the risk factors for anemia. Edx treatment was associated with an increased risk of anemia-related events in orthopedic patients. Reduced renal function was identified as a critical risk factor for Edx-associated anemia after orthopedic surgery. The present study indicates that renal function should be considered in the risk management of increased Edx-associated anemia after orthopedic surgery.


Assuntos
Anemia , Artroplastia de Substituição , Estados Unidos , Humanos , Estudos Retrospectivos , Estudos de Casos e Controles , Anemia/epidemiologia , Rim/fisiologia
6.
Front Endocrinol (Lausanne) ; 13: 1052794, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36465621

RESUMO

Objective: This study aims to investigate the effect of single urine C peptide/creatinine (UCPCR) in assessing the islet ß Cell function of type 2 diabetes mellitus (T2DM) patients with different renal function. Methods: A total of 85 T2DM patients were recruited in this study, all the patients were assigned to one group with estimated glomerular filtration rate (eGFR)≤60 ml·min-1·1.73 m-2 and another group complicated with eGFR>60 ml·min-1·1.73 m-2. Serum creatinine, urine creatinine, serum fasting C-peptide (FCP), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C) and 24-hour urinary C-peptide (24hUCP) were measured. The modified homeostasis model assessment-islet ß cell function [HOMA-islet (CP-DM)], the modified homeostasis model assessment-insulin resistance [HOMA-IR(CP)] and UCPCR were calculated. Results: When compared with group eGFR ≤60 ml·min-1·1.73 m-2, the levels of UCPCR, FCP, the modified HOMA-IR(CP) and HOMA-islet (CP-DM) were promoted and the concentrations of HbA1C, FPG, creatinine were decreased in the patients of eGFR>60 ml·min-1·1.73 m-2 (P<0.05); FCP was uncorrelated with 24hUCP while associated with UCPCR in the patients of eGFR ≤ 60 ml·min-1·1.73 m-2; UCPCR was positively correlated with FCP and HOMA-IR(CP) in the T2DM patients with different levels of renal function; the cut-off (UCPCR ≤ 1.13 nmol/g) had 88.37% sensitivity and 95.24% specificity [95% confidence interval (CI):0.919-0.997] for identifying severe insulin deficiency in T2DM patients[area under the curve (AUC) 0.978]. Conclusion: UCPCR can be used to evaluate islets ß Cell function in T2DM patients with different renal function status.


Assuntos
Diabetes Mellitus Tipo 2 , Humanos , Peptídeo C , Creatinina , Diabetes Mellitus Tipo 2/complicações , Hemoglobina A Glicada , Rim/fisiologia
7.
BMC Pharmacol Toxicol ; 23(1): 89, 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36451204

RESUMO

BACKGROUND: Linezolid causes hematological toxicity, mostly thrombocytopenia, which leads to treatment discontinuation and failure. Recent studies revealed that during linezolid therapy, the incidence of treatment-related hematological toxicity is significantly higher in patients with decreased renal function (DRF) than in those with normal renal function. Linezolid monitoring is necessary due to the high frequency of hematological toxicity in patients with DRF and the relationship between blood concentration and safety. We performed a systematic review and meta-analysis to evaluate the safety correlation between DRF and trough monitoring. METHODS: Articles published before June 24, 2022, on MEDLINE, Web of Sciences, Cochrane Register of Controlled Trials, and ClinicalTrials.gov were systematically analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method and the variable effects model. RESULTS: The incidence of hematological toxicity was significantly higher in patients with DRF than in those without DRF (OR = 2.37; p < 0.001). Subgroup analysis, performed according to hematotoxicity classification, including thrombocytopenia, anemia, and pancytopenia, revealed a significantly higher incidence of thrombocytopenia (OR = 2.45; p < 0.001) and anemia (OR = 2.31; p = 0.006) in patients with DRF than in those without; pancytopenia (OR = 1.41; p = 0.80) incidences were not significantly higher. Based on a systematic review, linezolid trough concentrations > 6-7 µg/mL may be associated with an increased incidence of thrombocytopenia. However, no confidential threshold values for the development of thrombocytopenia were found in the area under the concentration curve values for children or adults. CONCLUSION: We observed a high frequency of hematological toxicity during linezolid therapy in patients with DRF. To ensure safety, linezolid trough concentrations should be ≤6-7 µg/mL.


Assuntos
Pancitopenia , Trombocitopenia , Adulto , Criança , Humanos , Linezolida/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/epidemiologia , Razão de Chances , Rim/fisiologia
8.
Physiol Rep ; 10(23): e15526, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36461656

RESUMO

Intravascular volume is largely regulated by the kidneys but how differences in intravascular volume profiles interact with chronic kidney disease (CKD) to influence outcomes in chronic heart failure (HF) has not been explored. Our hypothesis was that a greater degree of volume expansion (VE) would moderate the impact of CKD on HF-related clinical outcomes. Quantitative blood volume (BV) data were available in 137 patients at the time of hospital discharge using a nuclear medicine radiolabeled albumin indicator-dilution technique. The study patients were stratified by the cohort median glomerular filtration rate (GFR, 44 ml/min/1.73 m2 ). An a priori cut-point of ≥+25% above normal BV was then used to further stratify the two GFR subgroups and prospectively analyzed for 1-year HF-related mortality or 1st re-hospitalization. Persistent BV expansions ≥+25% were present in 51% of the cohort. In the subgroup with GFR above the median (N = 68) greater or lesser BV expansion from +25% did not differentiate outcomes. However, in the subgroup with GFR below the median (N = 69), BV expansion-stratified risk (log-rank p = 0.022) with <+25% VE associated with poorer outcomes, while VE ≥ + 25% was associated with lower risk and comparable to GFR above the median. In patients with chronic HF, significant intravascular VE and CKD are common co-existing conditions. The presence of larger VE, however, appears to be a factor mitigating the impact of declining renal function on clinical outcomes, and as an element of volume pathophysiology warrants further study.


Assuntos
Insuficiência Cardíaca , Insuficiência Renal Crônica , Humanos , Insuficiência Renal Crônica/complicações , Coração , Rim/fisiologia , Volume Sanguíneo
9.
BMC Cancer ; 22(1): 1143, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344958

RESUMO

BACKGROUND: To assess prognostic value of pre-operative ipsilateral split renal function (SRF) on disease-free survival (DFS) and its association with aggressive pathological features in renal cell carcinoma (RCC) patients.  METHODS: We examined patients registered in SNUG-RCC-Nx who underwent partial or radical nephrectomy at Seoul National University Hospital between January 1, 2010 and December 31, 2020. Patients with the following criteria were excluded from the study. 1) non-kidney origin cancer or benign renal tumor, 2) no pre-operative Tc 99 m-DTPA renal scan, 3) single kidney status or previous partial or radical nephrectomy, and 4) bilateral renal mass. Finally, 1,078 patients were included. RESULTS: Among 1,078 patients, 899 (83.4%) showed maintained ipsilateral SRF on DTPA renal scan; 179 patients (16.6%) showed decreased SRF. The decreased SRF group showed significantly large tumor size (maintained vs. decreased SRF; 3.31 ± 2.15 vs. 6.85 ± 3.25, p < 0.001), high Fuhrman grade (grade 3-4) (41.7% vs. 55.6%, p < 0.001), and high T stage (T stage 3-4) (9.0% vs. 20.1%, p < 0.001). Pathological invasive features, including invasion of the renal capsule, perirenal fat, renal sinus fat, vein, and collecting duct system, were associated with low SRF of the ipsilateral kidney. Univariate Cox regression analysis identified higher SSIGN (The stage, size, grade, and necrosis) score and decreased ipsilateral SRF as significant risk factors, while multivariate analysis showed SSIGN (5-7) (hazard ratio [HR] 11.9, p < 0.001) and SSIGN (8-10) (HR 69.2, p < 0.001) were significantly associated with shortened DFS, while decreased ipsilateral SRF (HR 1.75, p = 0.065) showed borderline significance. Kaplan-Meier analysis showed that decreased ipsilateral SRF (< 45%) group had shorter DFS than the other group (median DFS: 90.3 months vs. not reached, p < 0.001). CONCLUSIONS: Among unilateral RCC patients, those with low ipsilateral SRF showed poor prognosis with pathologically invasive features. Our novel approach may facilitate risk stratification in RCC patients, helping formulate a treatment strategy.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Neoplasias Renais/patologia , Nefrectomia , Rim/diagnóstico por imagem , Rim/fisiologia , Rim/patologia , Prognóstico , Ácido Pentético , Estadiamento de Neoplasias
10.
BMC Pediatr ; 22(1): 643, 2022 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344956

RESUMO

INTRODUCTION: Infection is one of the most frequent causes of morbidity and mortality in diabetic patients. Some microorganisms become more virulent in a high glucose concentration. Diabetics are more likely to have asymptomatic and symptomatic bacteriuria. NGAL is secreted in high concentrations into the blood and urine within two hours of AKI. OBJECTIVES: The aim of the study is early detection of UTI in type1diabetic children through screening of their urine samples, and measurement of NGAL urinary levels in cases with asymptomatic bacteriuria for early detection of AKI to prevent serious complications. PATIENTS AND METHODS: One thousand twenty-two known diabetic children on regular follow up in endocrine outpatient clinic at Minia Children University hospital were screened for UTI. From them only 52 diabetic children were diagnosed as asymptomatic bacteriuria (group I), 52 diabetic children with normal urine analysis (group II) and 52 apparently healthy children, age and sex matched, served as controls (group III). CBC, Renal function test, HbA1c, hs- CRP, Albumin/creatinine ratio, urine examination, urine culture, GFR and urinary NGAL were done to all children. RESULTS: Thirty-seven females (71.2%) had asymptomatic bacteriuria, Hs CRP and urinary NGAL were significantly higher, while GFR was significantly lower in diabetic children with bacteriuria than the other two groups. For diabetic children with bacteriuria, (AUC) for NGAL was 1 with optimal cutoff value of > 44.1 (Sensitivity 100% and Specificity 100%) while AUC for hsCRP was 0.887 with optimal cutoff value of > 1 (Sensitivity 82.69% and Specificity 90.38%). CONCLUSION: Routine urine analysis should be done for all diabetic children even if they are asymptomatic. NGAL and hsCRP are non-invasive methods that could detect early renal injury in these patients thus, early, and proper management of UTI should be started to prevent renal injury.


Assuntos
Injúria Renal Aguda , Bacteriúria , Diabetes Mellitus Tipo 1 , Criança , Feminino , Humanos , Bacteriúria/complicações , Bacteriúria/diagnóstico , Lipocalina-2 , Diabetes Mellitus Tipo 1/complicações , Proteína C-Reativa , Injúria Renal Aguda/diagnóstico , Rim/fisiologia , Biomarcadores/urina
11.
BMC Nephrol ; 23(1): 356, 2022 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333795

RESUMO

AIMS: To examine the association of the screening frequency of estimated glomerular filtration rate (eGFR) with the substantial reduction in eGFR (≥ 25%) among type 2 diabetes (T2D) patients with normal (eGFR≥60 ml/min/1.73 m2) and impaired kidney function (eGFR< 60 ml/min/1.73 m2). METHODS: A longitudinal study involving 5104 T2D patients with follow-up period of 6.8 years (1.9 SD) were treated at the Rovaniemi Health Center, Rovaniemi, Finland during 2011-2019. The association between the screening frequency of eGFR (yearly vs. non-yearly) and the substantial reduction in eGFR was studied with logistical models and adjusted with biochemical variables and preventive medications. RESULTS: Among the T2D patients with normal kidney function, non-yearly eGFR screening was significantly associated with substantial eGFR reduction in both unadjusted (odds ratio [OR] 3.29, 95% confidence interval [CI] 2.54-4.33) and adjusted models (OR 2.06, 95% CI 1.21-3.73) compared with yearly screening frequency. In the group of patients with impaired kidney function in the unadjusted model, non-yearly eGFR screening was significantly associated with substantial eGFR reduction (OR 2.38, 95% CI 1.30-4.73), but became non-significant after adjustments (OR 1.89, 95% CI 0.61-7.21). CONCLUSIONS: This study underscores the role of regular eGFR screening in the prevention of kidney function decline.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Insuficiência Renal , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/complicações , Estudos Longitudinais , Taxa de Filtração Glomerular , Rim/fisiologia , Atenção Primária à Saúde
12.
Braz J Cardiovasc Surg ; 37(5): 613-621, 2022 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-36346770

RESUMO

INTRODUCTION: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a powerful predictor of perioperative outcomes. We evaluated the burden of CSA-AKI in patients with preserved baseline renal function. METHODS: The data of 2,162 adult patients who underwent cardiac surgery from January 2005 to December 2020 were analyzed. Logistic regression models were used to determine predictors of CSA-AKI and their associations with hospital mortality up to 30 days. RESULTS: The prevalence of acute kidney injury was 43.0%, and 2.0% of patients required renal replacement therapy. Hospital mortality rate was 5.6% (non-acute kidney injury = 2.0% vs. CSA-AKI = 10.4%, P<0.001), and any degree of CSA-AKI was associated with a significant increase in death rates (stage 1 = 4.3%, stage 2 = 23.9%, stage 3 = 59.7%). Multivariable logistic regression analysis identified age, obesity, left ventricular dysfunction, previous cardiac surgery, and cardiopulmonary bypass duration as predictors of CSA-AKI. Moreover, CSA-AKI was confirmed as independent predictor of hospital mortality for stage 1 (odds ratio, 2.02; 95% confidence interval, 1.16 to 3.51; P=0.013), stage 2 (odds ratio, 9.18; 95% confidence interval, 4.54 to 18.58; P<0.001), and stage 3 (odds ratio, 37.72; 95% confidence interval, 18.87 to 75.40; P<0.001) patients. CONCLUSION: Age, obesity, left ventricular dysfunction, previous cardiac surgery, and cardiopulmonary bypass duration are independent predictors of CSA-AKI in patients with preserved baseline renal function. The development of CSA-AKI is significantly associated with worse outcomes, and there is a dose-response relationship between acute kidney injury stages and hospital mortality.


Assuntos
Injúria Renal Aguda , Procedimentos Cirúrgicos Cardíacos , Disfunção Ventricular Esquerda , Humanos , Fatores de Risco , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Rim/fisiologia , Disfunção Ventricular Esquerda/etiologia , Obesidade/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
13.
Int J Mol Sci ; 23(21)2022 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-36361819

RESUMO

Renal ischemia in the peri-transplant period causes a number of changes that adversely affect the initiation of normal vital functions in grafts after transplantation. To minimise the extent of ischemic damage, organs are stored in preservation fluid. The components of the fluid are supposed to ensure stabilisation of the cell cytoskeleton, protect against oxygen free radicals, reduce cell swelling, and ensure endothelial cell integrity. The aim of this study was to analyse the protective effect of Cu2+, as a component of Biolasol preservative fluid, in the prevention of nephron damage occurring during the graft storage period. Analyses of the effectiveness of copper in the presence of prolactin added to Biolasol fluid were also carried out. Forty isolated pig slaughter kidneys were used in the study, avoiding the use of laboratory animals. The kidneys were stored using simple hypothermia. After 2 h and 48 h of graft storage, selected biochemical indicators of renal function were determined in the collected perfusates. The addition of Cu2+ at a dose of 1 µg/L to the composition of Biolasol fluid was found to affect the generation of ischemic damage in the isolated pig kidney. The intensity of the occurrence of these processes is exacerbated by the presence of prolactin at a dose of 0.1 µg/L.


Assuntos
Hipotermia , Preservação de Órgãos , Suínos , Animais , Cobre/farmacologia , Prolactina/farmacologia , Rim/fisiologia , Isquemia , Perfusão
14.
Am J Case Rep ; 23: e936921, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36374795

RESUMO

BACKGROUND Delayed graft function (DGF) is defined as failure of the transplanted kidney to function in the early -post-transplant period. DGF is a rare complication after living donor kidney transplant and is most common after deceased donor kidney transplant, probably due to prolonged warm and cold ischemia times during retrieval. Most cases of DGF resolve spontaneously within days to weeks. There are very few reported cases in the literature of DGF lasting over 4 weeks. We present a case that resolved after 55 days. The recipient subsequently achieved normal renal function. CASE REPORT Our patient was a 52-year-old man with end-stage renal disease who underwent a second living donor renal transplant. The donor was his son, with whom he had 1 antigen mismatch. Postoperative day 1, the patient developed anuria and failed to improve with fluids and diuretics. Investigations ruled out common causes of renal dysfunction (rejection, ischemia), but failed to disclose the cause of this condition. After an extended period of watchful waiting, the graft function returned, reaching normal creatinine and urine output levels. CONCLUSIONS DGF after living donor kidney transplantation is rare, and few cases lasting more than a month have been reported. Before diagnosing DGF, other causes of renal dysfunction (rejection, ischemia, medication adverse effects) must be ruled out. In the absence of these, expectant management is appropriate and full graft recovery can be expected, even with anuria and hemodialysis.


Assuntos
Anuria , Função Retardada do Enxerto , Masculino , Humanos , Pessoa de Meia-Idade , Função Retardada do Enxerto/etiologia , Sobrevivência de Enxerto , Rejeição de Enxerto , Doadores Vivos , Anuria/complicações , Fatores de Tempo , Doadores de Tecidos , Rim/fisiologia , Fatores de Risco
15.
JACC Heart Fail ; 10(11): 842-850, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36328653

RESUMO

BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are underused in patients with kidney dysfunction, and their efficacy among patients with chronic kidney disease (CKD) is uncertain. OBJECTIVES: The goal of this study was to analyze the efficacy and safety of steroidal MRAs across the spectrum of estimated glomerular filtration rates (eGFRs) in randomized controlled trials. The study included patients with heart failure (HF) or myocardial infarction and advanced CKD who participated in the RALES (Randomized Aldactone Evaluation Study), EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure), TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) in the Americas, and EPHESUS (Eplerenone Post-AMI Heart Failure Efficacy and Survival Study) trials. METHODS: This study used individual patient data meta-analysis using Cox models stratified by trial with treatment-by-eGFR interaction terms. eGFR was recalculated by using the Chronic Kidney Disease Epidemiology Collaboration creatinine formula. RESULTS: A total of 12,700 patients were included, of whom 331 (2.6%) had an eGFR ≤30 mL/min/1.73 m2 (mean eGFR: 26.8 ± 3.2 mL/min/1.73 m2). Patients with advanced CKD had higher annualized event rates for all studied outcomes: placebo event rate for the composite of cardiovascular death or HF hospitalization was ∼3-fold higher in patients with eGFR ≤30 compared with those with eGFR >90 mL/min/1.73 m2: 41.6 vs 14.6 events per 100 person-years. MRAs (vs placebo) reduced the composite of cardiovascular death or HF hospitalization, but the effect was attenuated as eGFR decreased: the corresponding HRs by eGFR categories were: HR for >90 mL/min/1.73 m2: 0.62 (95% CI: 0.49-0.78); HR for 61-90 mL/min/1.73 m2: 0.69 (95% CI: 0.61-0.77); HR for 46-60 mL/min/1.73 m2: 0.84 (95% CI: 0.74-0.95); HR for 31-45 mL/min/1.73 m2: 0.79 (95% CI: 0.68-0.91); and HR for ≤30 mL/min/1.73 m2: 0.96 (95% CI: 0.70-1.32) (treatment-by-eGFR interaction P for trend = 0.033). Investigator-reported hyperkalemia and worsening renal function were more frequent (2- to 3-fold) among MRA users, and hyperkalemia was more frequent as eGFR decreased (treatment-by-eGFR interaction P for trend = 0.002). CONCLUSIONS: Steroidal MRAs reduced HF hospitalizations and mortality across a wide range of eGFR. However, declining benefit and worsening safety may limit their use in patients with lower eGFR, particularly those with levels ≤30 mL/min/1.73 m2.


Assuntos
Insuficiência Cardíaca , Hiperpotassemia , Insuficiência Renal Crônica , Humanos , Eplerenona/uso terapêutico , Hiperpotassemia/induzido quimicamente , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/epidemiologia , Rim/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Biomolecules ; 12(11)2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36358966

RESUMO

Acute heart failure (AHF) is a common and severe condition with a poor prognosis. Its course is often complicated by worsening renal function (WRF), exacerbating the outcome. The population of AHF patients experiencing WRF is heterogenous, and some novel possibilities for its analysis have recently emerged. Clustering is a machine learning (ML) technique that divides the population into distinct subgroups based on the similarity of cases (patients). Given that, we decided to use clustering to find subgroups inside the AHF population that differ in terms of WRF occurrence. We evaluated data from the three hundred and twelve AHF patients hospitalized in our institution who had creatinine assessed four times during hospitalization. Eighty-six variables evaluated at admission were included in the analysis. The k-medoids algorithm was used for clustering, and the quality of the procedure was judged by the Davies-Bouldin index. Three clinically and prognostically different clusters were distinguished. The groups had significantly (p = 0.004) different incidences of WRF. Inside the AHF population, we successfully discovered that three groups varied in renal prognosis. Our results provide novel insight into the AHF and WRF interplay and can be valuable for future trial construction and more tailored treatment.


Assuntos
Insuficiência Cardíaca , Humanos , Doença Aguda , Creatinina , Rim/fisiologia , Aprendizado de Máquina
18.
Am J Case Rep ; 23: e937386, 2022 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-36433638

RESUMO

BACKGROUND There has been, to our knowledge, no reports on LifeCycle Pharma tacrolimus (LCPT) taken during pregnancy after simultaneous pancreas-kidney transplantation (SPK). Here, we report a 25-year-old female SPK recipient who gave birth to a healthy infant in posttransplant month 32. We analyzed the long-term graft function, obstetric/neonatal course, LCPT dosage, tacrolimus (TAC) levels, concomitant medication, and complications. CASE REPORT Her medical history consisted of type 1 diabetes with chronic nephropathy, arterial hypertension, and atypical haemolytic uremic syndrome with critical deterioration of her general condition requiring clinically indicated early termination of her first pregnancy prior to SPK. SPK was performed according to surgical standards. The immunosuppressive prophylaxis consisted of thymoglobulin, mycophenolate mofetil, standard TAC formulation, and steroids. Due to rapid TAC metabolism, the patient was converted from a standard TAC formulation to LCPT in the first month posttransplant. Her long-term immunosuppression, including the obstetric and peripartal course, consisted of LCPT, prednisolone, and azathioprine. She was normotensive without antihypertensive medication and maintained excellent function of both grafts during the observation period of 48 months posttransplant. All (mostly infectious) complications were reversible, especially temporary polyoma viremia within normal renal function, and 2 episodes of urosepsis. No relapse of her pretransplant episode of atypical haemolytic uremic syndrome occurred posttransplant. Her child is in good health at the age of 12 months without any malformations. CONCLUSIONS This case suggests that pregnancy after SPK under LCPT is feasible. Further studies are needed to expand the empirical knowledge surrounding tacrolimus.


Assuntos
Transplante de Rim , Transplante de Pâncreas , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Sobrevivência de Enxerto , Terapia de Imunossupressão , Rim/fisiologia , Pâncreas , Tacrolimo/uso terapêutico
19.
Lakartidningen ; 1192022 11 15.
Artigo em Sueco | MEDLINE | ID: mdl-36377978

RESUMO

Janusmed Renal Function is a clinical decision support system (CDSS) that provides evidence-based dosage recommendations for adult patients with renal impairment. Dosage recommendations are presented for each drug/active substance in relation to four stages of chronic kidney disease (CKD). In addition, substances that are nephrotoxic are labelled with a warning. The web version is available with free access for all caregivers in Sweden, and there is also a version available for integration in electronic health record (EHR) systems. A questionnaire distributed among users who already use a health record integrated version of the CDSS showed that physicians have good support from the system and perceive it as useful.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Insuficiência Renal , Humanos , Sistemas Computadorizados de Registros Médicos , Prescrições , Rim/fisiologia
20.
World J Urol ; 40(12): 3091-3097, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36348070

RESUMO

PURPOSE: To explore the impact of ileal conduit (IC), orthotopic ileal neobladder, and MAINZ Pouch I on renal function (RF) over time. METHODS: We performed a retrospective, cohort study including consecutive patients who underwent open radical cystectomy due to bladder cancer from November 2013 to June 2022. RF deterioration was calculated based on the estimated glomerular filtration rate (eGFR) through the CKD-EPI creatinine equation. A linear mixed-effects model was constructed, adjusting for multiple risk factors. The probability of achieving an eGFR reduction greater than 25% compared to baseline among different urinary diversion techniques was assessed using a Kaplan-Meier curve. RESULTS: Overall, 107 patients received IC, 28 neobladder, and 20 MAINZ Pouch I. Those receiving IC were older and displayed more comorbidities. At follow-up, eGFR was lower by 0.09 mL/min/1.73m2 (confidence interval - 5.87 to 5.69, p = 0.975) in patients receiving neobladder compared to those receiving IC. Similarly, eGFR was higher by 4.64 mL/min/1.73m2 (confidence interval - 1.57 to 10.85, p = 0.143) in patients receiving pouch compared to those receiving IC. Accordingly, patients with higher preoperative eGFR (p < 0.001), lower age (p = 0.048), non-T4 histological tumor (p = 0.027) and absence of septicemia at follow-up (p = 0.002) presented higher eGFR values at follow-up. The three UD techniques did not differ significantly in the time-to-event analysis (log-rank test = 0.29). CONCLUSIONS: A substantial proportion of patients undergoing urinary diversion with IC, orthotopic ileal neobladder, or MAINZ Pouch I develop RF deterioration at follow-up. No significant differences were observed among the three UD techniques in terms of eGFR decline in the long-term.


Assuntos
Neoplasias da Bexiga Urinária , Derivação Urinária , Coletores de Urina , Humanos , Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/patologia , Estudos Retrospectivos , Estudos de Coortes , Derivação Urinária/métodos , Rim/fisiologia , Rim/patologia
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