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2.
Turk J Ophthalmol ; 51(4): 231-242, 2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34461710

RESUMO

Immunomodulatory agents are often used in the systemic treatment of non-infectious uveitis. These drugs consist of corticosteroids, conventional immunosuppressives, and biological agents. As it is known that they suppress the immune system, the most important concern associated with immunomodulatory therapy (IMT) is the increased risk of infection. The World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although severe acute respiratory distress syndrome secondary to SARS-CoV-2 infection may develop in all people, patients who receive IMT may be at higher risk in terms of both the transmission of the infection and more severe disease course. Therefore, guidelines on the management of patients receiving IMT due to uveitis during the pandemic are needed. In this review, we examined the immunomodulatory drugs used in the treatment of uveitis in terms of infectious complications and the data of patients who received IMT during the COVID-19 pandemic and discussed recommendations for the use of these drugs. According to the latest information, patients who receive IMT may continue their treatment as long as there are no disruptions in regular complete blood count (especially white blood cell count >4,000/µL) and liver and kidney function tests. Patients diagnosed with COVID-19 should be managed with a multidisciplinary approach.


Assuntos
COVID-19/epidemiologia , Glucocorticoides/uso terapêutico , Imunomodulação , Imunossupressores/uso terapêutico , SARS-CoV-2 , Uveíte/tratamento farmacológico , COVID-19/transmissão , Tomada de Decisão Clínica , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Testes de Função Renal , Contagem de Leucócitos , Testes de Função Hepática , Oftalmologia , Medição de Risco
3.
Nutrients ; 13(8)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34444907

RESUMO

Background-Some data suggest favorable effects of a high potassium intake on kidney function. The present population-based study investigated cross-sectional and longitudinal relations of urinary potassium with kidney function. Methods-Study cohort included 2027 Gubbio Study examinees (56.9% women) with age ≥ 18 years at exam-1 and with complete data on selected variables at exam-1 (1983-1985), exam-2 (1989-1992), and exam-3 (2001-2007). Urinary potassium as urinary potassium/creatinine ratio was measured in daytime spot samples at exam-1 and in overnight timed collections at exam-2. Estimated glomerular filtration rate (eGFR) was measured at all exams. Covariates in analyses included demographics, anthropometry, blood pressure, drug treatments, diabetes, smoking, alcohol intake, and urinary markers of dietary sodium and protein. Results-In multivariable regression, urinary potassium/creatinine ratio cross-sectionally related to eGFR neither at exam-1 (standardized coefficient and 95%CI = 0.020 and -0.059/0.019) nor at exam-2 (0.024 and -0.013/0.056). Exam-1 urinary potassium/creatinine ratio related to eGFR change from exam-1 to exam-2 (0.051 and 0.018/0.084). Exam-2 urinary potassium/creatinine ratio related to eGFR change from exam-2 to exam-3 (0.048 and 0.005/0.091). Mean of urinary potassium/creatinine ratio at exam-1 and exam-2 related to eGFR change from exam-1 to exam-3 (0.056 and 0.027/0.087) and to incidence of eGFR < 60 mL/min per 1.73 m2 from exam-1 to exam-3 (odds ratio and 95%CI = 0.78 and 0.61/0.98). Conclusion-In the population, urinary potassium did not relate cross-sectionally to eGFR but related to eGFR decline over time. Data support the existence of favorable effects of potassium intake on ageing-associated decline in kidney function.


Assuntos
Envelhecimento/urina , Saúde da População/estatística & dados numéricos , Potássio/urina , Adolescente , Adulto , Idoso , Creatinina/urina , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Testes de Função Renal , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Adulto Jovem
4.
Diabetes ; 70(8): 1754-1766, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34285121

RESUMO

Half of the mortality in diabetes is seen in individuals <50 years of age and commonly predicted by the early onset of diabetic kidney disease (DKD). In type 1 diabetes, increased urinary albumin-to-creatinine ratio (uACR) during adolescence defines this risk, but the pathological factors responsible remain unknown. We postulated that early in diabetes, glucose variations contribute to kidney injury molecule-1 (KIM-1) release from circulating T cells, elevating uACR and DKD risk. DKD risk was assigned in youth with type 1 diabetes (n = 100; 20.0 ± 2.8 years; males/females, 54:46; HbA1c 66.1 [12.3] mmol/mol; diabetes duration 10.7 ± 5.2 years; and BMI 24.5 [5.3] kg/m2) and 10-year historical uACR, HbA1c, and random blood glucose concentrations collected retrospectively. Glucose fluctuations in the absence of diabetes were also compared with streptozotocin diabetes in apolipoprotein E -/- mice. Kidney biopsies were used to examine infiltration of KIM-1-expressing T cells in DKD and compared with other chronic kidney disease. Individuals at high risk for DKD had persistent elevations in uACR defined by area under the curve (AUC; uACRAUC0-10yrs, 29.7 ± 8.8 vs. 4.5 ± 0.5; P < 0.01 vs. low risk) and early kidney dysfunction, including ∼8.3 mL/min/1.73 m2 higher estimated glomerular filtration rates (modified Schwartz equation; Padj < 0.031 vs. low risk) and plasma KIM-1 concentrations (∼15% higher vs. low risk; P < 0.034). High-risk individuals had greater glycemic variability and increased peripheral blood T-cell KIM-1 expression, particularly on CD8+ T cells. These findings were confirmed in a murine model of glycemic variability both in the presence and absence of diabetes. KIM-1+ T cells were also infiltrating kidney biopsies from individuals with DKD. Healthy primary human proximal tubule epithelial cells exposed to plasma from high-risk youth with diabetes showed elevated collagen IV and sodium-glucose cotransporter 2 expression, alleviated with KIM-1 blockade. Taken together, these studies suggest that glycemic variations confer risk for DKD in diabetes via increased CD8+ T-cell production of KIM-1.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Nefropatias Diabéticas/sangue , Receptor Celular 1 do Vírus da Hepatite A/sangue , Rim/patologia , Adolescente , Adulto , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 1/fisiopatologia , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/fisiopatologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Rim/fisiopatologia , Testes de Função Renal , Masculino , Estudos Retrospectivos , Adulto Jovem
5.
Eur J Radiol ; 142: 109864, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303151

RESUMO

PURPOSE: The evaluation process of potential living kidney donors focusses on renal anatomy and split renal function. This study aimed to evaluate a magnetic resonance imaging (MRI)-based approach for simultaneous evaluation of both and its impact on clinical decision making. METHOD: Over a 3-year period, 65 potential living kidney donors were consecutively enrolled. The MRI protocol was extended by MR-nephrography to measure split renal function. Standard DTPA-scintigraphy was used for functional comparison. RESULTS: Split renal function showed no systematic bias between the two methods (mean difference 0.3%, p = 0.08). Both methods would have yielded the same clinical decision for donor nephrectomy in 75% of the patients. In 25 % of the patients, one method indicated a relevant side difference while the other did not, and a different clinical decision could have been made based on split renal function alone. CONCLUSIONS: MRI proved eligible for comprehensive living kidney donor evaluation and non-inferior to scintigraphy for determining split renal function. In clinical decision making, these two methods would have resulted in the same side for donor nephrectomy in a large proportion of potential donors. Whether MRN will be implemented in clinical practice depends on transplant centre infrastructure and policy.


Assuntos
Transplante de Rim , Humanos , Rim/diagnóstico por imagem , Rim/fisiologia , Testes de Função Renal , Doadores Vivos , Imageamento por Ressonância Magnética , Nefrectomia
6.
Medicina (Kaunas) ; 57(6)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207077

RESUMO

Background and Objectives: Urinary levels of dickkopf-3 (DKK-3) are associated with poor renal survival in patients with non-dialytic chronic kidney disease. However, it remains unknown whether urinary DKK-3 levels can predict residual renal function (RRF) decline in patients undergoing peritoneal dialysis (PD). Therefore, we investigated the correlation between urinary levels of DKK-3 and the subsequent rate of RRF decline in PD patients. Materials and Methods: This study included 36 PD patients who underwent multiple peritoneal equivalent tests during 2011-2021. The relationship between baseline clinical characteristics and the subsequent annual rate of Kt/V decline was investigated. Results: The annual rate of renal Kt/V decline was 0.29 (range: 0.05-0.48), which correlated with renal Kt/V (r = 0.55, p = 0.0005) and 24 h urinary DKK-3 excretion (r = 0.61, p < 0.0001). Similarly, 24 h urinary DKK-3 excretion (ß = 0.44, p = 0.0015) and renal Kt/V (ß = 0.38, p = 0.0059) were independently associated with the annual rate of renal Kt/V decline in multivariate analyses. Conclusions: Urinary DKK-3 assessment may help identify PD patients at a high risk of RRF decline.


Assuntos
Diálise Peritoneal , Insuficiência Renal Crônica , Progressão da Doença , Humanos , Rim , Testes de Função Renal
7.
Int J Mol Sci ; 22(13)2021 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-34199069

RESUMO

Acute kidney injury (AKI) is a common yet complicated clinical entity with high morbidity and mortality. An essential strategy to improve AKI patients' prognoses is finding optimal biomarkers to identify AKI in a timely manner. Procalcitonin (PCT), a well-recognized biomarker for diagnosing infection and guiding antibiotics therapy, has been proposed to predict AKI development and recovery in many clinical settings. The current review provides comprehensive and updated information from relevant studies to evaluate PCT's AKI-predictive ability and the influence of infection on this predictive ability. PCT has demonstrated optimal predictive ability for AKI in various populations irrespective of infection. However, the predictive ability seems to be blunted by infection since infection and inflammation have a more potent influence than AKI on PCT elevation. We furthermore explain the complicated association between elevated PCT levels and AKI in infection and inflammation situations and recommend directions for further investigations to clarify the essential issue. In conclusion, although conflicting data exist, serum PCT level is a potential biomarker for predicting AKI in many clinical settings regardless of infection. Nevertheless, further studies are warranted to clarify the association between PCT, infection, and AKI and to confirm the utilization of PCT for AKI prediction.


Assuntos
Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Biomarcadores , Pró-Calcitonina/sangue , Injúria Renal Aguda/etiologia , Suscetibilidade a Doenças , Humanos , Testes de Função Renal , Prognóstico , Sepse/sangue
8.
Ren Fail ; 43(1): 1104-1114, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34238117

RESUMO

BACKGROUND: The clinical use of serum creatine (sCr) and cystatin C (CysC) in kidney function evaluation of critically ill patients has been in continuous discussion. The difference between estimated glomerular filtration rate calculated by sCr (eGFRcr) and CysC (eGFRcysc) of critically ill COVID-19 patients were investigated in this study. METHODS: This is a retrospective, single-center study of critically ill patients with COVID-19 admitted in intensive care unit (ICU) at Wuhan, China. Control cases were moderate COVID-19 patients matched in age and sex at a ratio of 1:1. The eGFRcr and eGFRcysc were compared. The association between eGFR and death were analyzed in critically ill cases. The potential factors influencing the divergence between eGFRcr and eGFRcysc were explored. RESULTS: A total of 76 critically ill COVID-19 patients were concluded. The mean age was 64.5 ± 9.3 years. The eGFRcr (85.45 (IQR 60.58-99.23) ml/min/1.73m2) were much higher than eGFRcysc (60.6 (IQR 34.75-79.06) ml/min/1.73m2) at ICU admission. About 50 % of them showed eGFRcysc < 60 ml/min/1.73 m2 while 25% showed eGFRcr < 60 ml/min/1.73 m2 (χ2 = 10.133, p = 0.001). This divergence was not observed in moderate group. The potential factors influencing the divergence included serum interleukin-6 (IL-6), tumor necrosis factor (TNF-α) level as well as APACHEII, SOFA scores. Reduced eGFRcr (<60 mL/min/1.73 m2) was associated with death (HR = 1.939, 95%CI 1.078-3.489, p = 0.027). CONCLUSIONS: The eGFRcr was generally higher than eGFRcysc in critically ill COVID-19 cases with severe inflammatory state. The divergence might be affected by inflammatory condition and illness severity. Reduced eGFRcr predicted in-hospital death. In these patients, we advocate for caution when using eGFRcysc.


Assuntos
COVID-19/fisiopatologia , Creatina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/diagnóstico , Idoso , Biomarcadores/sangue , COVID-19/complicações , COVID-19/mortalidade , China/epidemiologia , Estado Terminal/terapia , Feminino , Mortalidade Hospitalar , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Análise de Sobrevida
9.
Life Sci ; 279: 119674, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34081992

RESUMO

One of the global alarming prevalent metabolic diseases is Type 2 diabetes mellitus (T2DM) than other diabetes and sustains a substantial burden on public and healthcare systems. This study attempts to endeavor the beneficial effect of chitosan stabilized nanoparticles Ch-SeNPs on combating diabetic nephropathy (DN) after induction of T2DM in rats (DN.STZ-induced T2D). High-fat diet (HFD) and STZ were used for the induction of T2DM in rats, and then they were treated with either metformin alone (MEF) (500 mg/kg b.wt.) or combined with (Ch-SeNPs) (2 mg Se/kg b.wt.) for eight weeks. The microvascular complications in renal tissue of diabetic rats were pronounced by the prevalence of microalbuminuria and elevated levels of urea, creatinine, and BUN. Pronounced oxidative stress with enhanced inflammatory response. In the urine of diabetic rats, a marked increase in Kim 1, ß2-microglobulin, and urinary albumin. Renal morphological alterations were observed in all groups upon induction of T2DM, except for the Ch-SeNPs/MEF group showed noticeable improvements. The expression levels of Aldo-keto reductase AKr1B1, profibrotic protein transforming growth factor-ß1 (TGF-ß1), nestin, desmin, and vimentin, were up-regulated in the diabetic group. Significant down-regulation of their expression and restored antioxidant capacity was observed in the combined-treated group than single treated ones. Ch-SeNPs helped limit the prevalence of TNF-α, IL-6, and IL-1ß while used after T2DM induction by STZ and HFD. Ch-SeNPs/MEF co-therapy could effectively guard the kidneys and reduce the renal tissue injury via inhibiting oxidative stress and restoring glucose hemostasis, which indicates a promising line for treating T2DM nephropathy.


Assuntos
Aldeído Redutase/metabolismo , Quitosana/química , Diabetes Mellitus Experimental/complicações , Nefropatias Diabéticas/tratamento farmacológico , Rim/efeitos dos fármacos , Nanopartículas/administração & dosagem , Selênio/química , Aldeído Redutase/genética , Animais , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/patologia , Regulação da Expressão Gênica , Rim/lesões , Rim/metabolismo , Rim/patologia , Testes de Função Renal , Masculino , Nanopartículas/química , Ratos , Ratos Sprague-Dawley
10.
Medicine (Baltimore) ; 100(22): e25991, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087843

RESUMO

BACKGROUND: Several studies have reported good results for angiotensin II receptor blockers (ARB) combined with tripterygium glycosides (TGs) in the treatment of diabetic nephropathy (DN). However, because a small number of cases were included in each study, the statistical power was limited. Therefore, we performed a protocol for meta-analysis to further evaluate the clinical efficacy and safety of combined ARB and TGs in treatment of DN. METHODS: The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, Science Direct up to April 2021. Outcome measures were 24-h urinary total protein, urinary albumin excretion rate, serum creatinine, blood urea nitrogen, albumin, hemoglobin A1c, ß2-microglobulin and serum glutamic pyruvic transaminase. The risk of bias assessment of the included studies was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We performed meta-analysis using STATA 11.0. RESULTS: The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. CONCLUSION: The findings will provide helpful evidence for the application of combined ARB and TGs in the treatment of DN. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/ARGE3.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Nefropatias Diabéticas/tratamento farmacológico , Glicosídeos/uso terapêutico , Tripterygium , Antagonistas de Receptores de Angiotensina/administração & dosagem , Antagonistas de Receptores de Angiotensina/efeitos adversos , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Quimioterapia Combinada , Glicosídeos/administração & dosagem , Glicosídeos/efeitos adversos , Humanos , Testes de Função Renal , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
11.
Medicine (Baltimore) ; 100(22): e26003, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087846

RESUMO

ABSTRACT: Assessing renal function accurately is important for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recommended three equations to calculate estimated glomerular filtration rate (eGFR). There is evidence that eGFR based on the combination of serum creatinine and cystatin C is the most accurate of the three equations. But there is limited data on the comparison of three CKD-EPI equations in Chinese HIV/AIDS patients. The aim of our study was to compare the three CKD-EPI equations in Chinese HIV/AIDS population and assess renal function.Cross-sectional, single center, prospective study.One hundred seventy two Chinese adult HIV/AIDS patients were enrolled, including 145 (84.3%) males and 27 (15.7%) females. Mean age was 40(±12) years old. Overall mean eGFR based on serum creatinine, cystatin C and the combination of the 2 markers was 112.6(±19.0) mL/min/1.73 m2, 92.0(±24.2)mL/min/1.73 m2, and 101.7(±21.8)mL/min/1.73 m2, respectively (P = .000). The eGFR calculated by serum creatinine alone is higher than eGFR calculated by combination of serum creatinine and cystatin C, and eGFR calculated by cystatin C individual is lower than eGFR calculated by combination of the 2 markers.Of the 3 CKD-EPI equations, the CKD-EPIscr-cys equation may have the most accuracy in evaluating renal function in Chinese HIV/AIDS patients while the CKD-EPIscr equation may overestimate renal function and the CKD-EPIcys equation may underestimate renal function.


Assuntos
Taxa de Filtração Glomerular , Infecções por HIV/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , China , Creatinina/sangue , Estudos Transversais , Cistatina C/sangue , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Expert Rev Clin Pharmacol ; 14(9): 1173-1182, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34181499

RESUMO

Background: Arsenic trioxide (ATO) was successfully applied to treat acute promyelocytic leukemia (APL).Methods: Inorganic arsenic (iAs), monomethylarsonic acid (MMAV) and dimethyarsinic acid (DMAV) in plasma of 143 APL patients with different renal function were determined. Arsenic methylation capacity was evaluated by iAs%, MMAV%, DMAV%, primary methylation index (PMI, MMAV/iAs), and secondary methylated index (SMI, DMAV/MMAV). Arsenic accumulation with administration frequency were explored. Moreover, safety assessments were performed.Results: Compared with normal renal function, MMAV and DMAV concentrations increased 1.5-4 fold in moderate and severe renal impairment groups, iAs increased 1.3-1.7 fold. APL patients with renal impairment showed lower iAs%, but higher DMAV% and PMI in plasma than those with normal renal function (P < 0.05). MMAV, DMAV, and tAs apparently accumulated with administration frequency in moderate and severe renal dysfunction groups. The incidence of QTc interval prolongation and liver injury increased with the increasing severity of renal impairment.Conclusion: Renal dysfunction may increase exposure to arsenic and arsenic accumulation and affect methylation capacity, then the clinical safety in APL patients treated with ATO. Arsenic-level monitoring and dosing regimen adjustment should be considered in APL patients with moderate and severe renal dysfunction.


Assuntos
Antineoplásicos/administração & dosagem , Trióxido de Arsênio/administração & dosagem , Nefropatias/fisiopatologia , Leucemia Promielocítica Aguda/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Trióxido de Arsênio/efeitos adversos , Trióxido de Arsênio/farmacocinética , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Feminino , Humanos , Testes de Função Renal , Síndrome do QT Longo/induzido quimicamente , Masculino , Metilação , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
14.
J Cardiothorac Surg ; 16(1): 161, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090464

RESUMO

BACKGROUND: This study aimed to compare the effects of N-acetyl cysteine on renal function after coronary artery bypass graft surgery. METHODS: In this randomized clinical trial conducted in Golestan Hospital, Ahvaz, Iran, 60 candidates for coronary artery bypass graft surgery were selected and divided into two N-acetyl cysteine and control groups (30 people each). Patients received 3 (2 intraoperative and 1 postoperative) doses of IV N-acetyl cysteine (100 mg/kg) (n = 30) or placebo (n = 30) over 24 h. Prescription times were as follows: after induction of anesthesia, in the Next 4 h, and in the 16 h after on. Primary outcomes were serum levels of BUN and Cr, at baseline,4 and 48 h after surgery. And also need renal replacement therapy (RRT). Secondary outcomes included the hemodynamic variables, Blood products transfusion. RESULTS: There were significant differences in BUN between groups at 4 h (P = 0.02) and 48 h after surgery (P = 0.001) There were significant differences in Cr level between groups at 4 h (P < 0.001) and 48 h after surgery (P = 0.001). MAP at different times (at 4 h p = 0.002 and 48 h after surgery P < 0.001) were significantly different between the two groups. There was a significant difference between the two groups in terms of the unit of Packed cell transfusion (P = 0.002) and FFP transfusion (P < 0.001). CONCLUSION: In the present study, we found that administration of N-acetyl cysteine can reduce the incidence of acute kidney injury in patients undergoing coronary artery bypass graft surgery and improved kidney functions. TRIAL REGISTRY: IRCT20190506043492N3 Registered at 2020.06.07.


Assuntos
Acetilcisteína/uso terapêutico , Injúria Renal Aguda/prevenção & controle , Antioxidantes/uso terapêutico , Ponte de Artéria Coronária , Complicações Pós-Operatórias/prevenção & controle , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Adulto , Idoso , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Injeções Intravenosas , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 100(26): e26581, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190202

RESUMO

BACKGROUND: To investigate the clinical application and effect of laparoscopic partial nephrectomy with renal artery branch occlusion in the treatment of early renal tumors. METHODS: A retrospective analysis was conducted on the clinical data of 15 cases of renal tumor patients who underwent partial nephrectomy by laparoscopic selective renal artery branch occlusion in our department from January 2017 to January 2018. Nine male patients and 6 female patients were aged 46 to 65 years, with an average age of 54.3 ±â€Š7.2 years. The diameters of tumors were 2.2 to 4.0 cm, with an average of 3.3 ±â€Š0.7 cm. There are 10 tumors locating on the left side and 5 on the right side. Preoperative renal glomerular filtration rate (GFR) were 77.3 to 61.9 mL/min with an average of 47.6 ±â€Š7.5 mL/min. All patients' diseased kidneys underwent renal computer tomography angiography examination before surgery. And the diseased kidney underwent reexamination of renal GFR. The operation time, renal artery branch occlusion time, intraoperative blood loss, postoperative hospital stay, changes of renal function, and complications were evaluated. RESULTS: All surgery were completed successfully, the surgery time was 136.7 ±â€Š15.2 min, intraoperative renal artery branch occlusion time was 21.3 ±â€Š4.5 min, the intraoperative blood loss was 223.3 ±â€Š69.5 mL, the postoperative hospital stay was 6.5 ±â€Š1.7 days, and the postoperative 1-month GFR was 49.5 ±â€Š6.6 mL/min. There was no significant difference between the renal GFR before and after surgery (P > .05). There was no blood transfusion and transfer open surgery cases. The patients were followed up for 3 to 15 months without complications. CONCLUSIONS: Partial nephrectomy with selective renal artery branch occlusion by laparoscopy is a safe, feasible, and effective method for the treatment of early renal cancer. It makes good use of the technical advantages of clear operation field and fine operation of laparoscopic surgery, avoids the heat ischemia process of the whole kidney, and can better protect the renal function.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Renais , Laparoscopia , Nefrectomia , Artéria Renal , China/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Intervenção Médica Precoce/métodos , Feminino , Humanos , Testes de Função Renal/métodos , Neoplasias Renais/irrigação sanguínea , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/métodos , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Carga Tumoral
16.
Int J Clin Pract ; 75(8): e14542, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34137140

RESUMO

INTRODUCTION: Human immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. MATERIAL AND METHODS: A total of 127 HIV-positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as group 1; those who received Dolutegravir/Abacavir/Lamivudine combination as group 2; those who received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as group 3; those who received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as group 4; and those who received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. RESULTS: At the 24th month of therapy, a significant difference was observed between the estimated glomerular filtration rate (eGFR) levels of the study groups (P < .001). eGFR level was significantly higher in group 4 compared with groups 1, 2 and 3 (P = .009, P < .001, P < .001, respectively), whereas it was significantly lower in group 5 than groups 1, 2 and 3 (P = .005, P < .001, P < .001, respectively). No significant eGFR difference was found between group 4 and group 5 (P > .05). Serum creatinine level was significantly higher in groups 4 and 5 compared with the other groups (P < .001). CONCLUSION: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Adenina/efeitos adversos , Fármacos Anti-HIV/efeitos adversos , Emtricitabina/efeitos adversos , Infecções por HIV/tratamento farmacológico , Humanos , Testes de Função Renal , Tenofovir/efeitos adversos
17.
Int J Mol Sci ; 22(11)2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34072329

RESUMO

At the onset of diabetes, the kidney grows large and the glomerular filtration rate becomes abnormally high. These structural and hemodynamics changes affect kidney function and may contribute to the development of chronic kidney disease. The goal of this study is to analyze how kidney function is altered in patients with diabetes and the renal effects of an anti-hyperglyceamic therapy that inhibits the sodium-glucose cotransporter 2 (SGLT2) in the proximal convoluted tubules. To accomplish that goal, we have developed a computational model of kidney function in a patient with diabetes and conducted simulations to study the effects of diabetes and SGLT2 inhibition on solute and water transport along the nephrons. Simulation results indicate that diabetes-induced hyperfiltration and tubular hypertrophy enhances Na+ transport, especially along the proximal tubules and thick ascending limbs. These simulations suggest that SGLT2 inhibition may attenuate glomerular hyperfiltration by limiting Na+-glucose transport, raising luminal [Cl-] at the macula densa, restoring the tubuloglomerular feedback signal, thereby reducing single-nephron glomerular filtration rate.


Assuntos
Diabetes Mellitus/metabolismo , Suscetibilidade a Doenças , Rim/metabolismo , Rim/fisiopatologia , Modelos Biológicos , Animais , Transporte Biológico/efeitos dos fármacos , Biomarcadores , Diabetes Mellitus/etiologia , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/patologia , Humanos , Rim/efeitos dos fármacos , Testes de Função Renal , Glomérulos Renais/efeitos dos fármacos , Glomérulos Renais/metabolismo , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/metabolismo , Transportador 2 de Glucose-Sódio/metabolismo , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia
18.
Isr Med Assoc J ; 23(6): 353-358, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34155848

RESUMO

BACKGROUND: Real-world information regarding the use of direct oral anticoagulants therapy and the outcome in patients with renal dysfunction is limited. OBJECTIVES: To evaluate the clinical characteristics and outcomes of patients with atrial fibrillation (AF) and severe renal dysfunction who are treated with apixaban. METHODS: A sub-analysis was conducted within a multicenter prospective cohort study. The study included consecutive eligible apixaban- or warfarin-treated patients with non-valvular AF and renal impairment (estimated glomerular filtration rate [eGFR] modification of diet in renal disease [MDRD] < 60 ml/min/BSA) were registered. All patients were prospectively followed for clinical events and over a mean period of 1 year. Our sub-analysis included the patients with 15 < eGFR MDRD < 30 ml/min/BSA. The primary outcomes at 1 year were recorded. They included mortality, stroke or systemic embolism, major bleeding, and myocardial infarction as well as their composite occurrence. RESULTS: The sub-analysis included 155 warfarin-treated patients and 97 apixaban-treated ones. All had 15 < eGFR MDRD < 30 ml/min/BSA. When comparing outcomes for propensity matched groups (n=76 per group) of patients treated by reduced dose apixaban or warfarin, the rates of the 1-year composite endpoint as well as mortality alone were higher among the warfarin group (30 [39.5%] vs. 14 [18.4%], P = 0.007 and 28 [36.8%] vs.12 [15.8%], P = 0.006), respectively. There was no significant difference in the rates of stroke, systemic embolism, or major bleeding. CONCLUSIONS: Apixaban might be a reasonable alternative to warfarin in patients with severe renal impairment.


Assuntos
Fibrilação Atrial , Hemorragia , Infarto do Miocárdio , Insuficiência Renal , Acidente Vascular Cerebral , Varfarina , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/mortalidade , Estudos de Coortes , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Israel/epidemiologia , Testes de Função Renal/métodos , Testes de Função Renal/estatística & dados numéricos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Avaliação de Resultados em Cuidados de Saúde , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Insuficiência Renal/complicações , Insuficiência Renal/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Análise de Sobrevida , Varfarina/administração & dosagem , Varfarina/efeitos adversos
19.
Postgrad Med ; 133(6): 701-706, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34030596

RESUMO

OBJECTIVE: As age-related diseases, chronic kidney disease and hearing impairment (HI) cause a serious socioeconomic burden. Due to structural similarities, there is a certain connection between kidney function and hearing, but there has been no large-scale epidemiological study in China that further explored this connection. Thus, this study aimed to explore the association between indicator levels of kidney function and hearing impairment among middle-aged and elderly individuals in Tianjin, China. METHOD: In 2020, 1539 participants aged 45 years or older from Tianjin, China, were recruited into this study. All participants completed questionnaire surveys and underwent physical examinations, laboratory examinations, and hearing tests. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine (Cre) levels. HI was measured using pure-tone audiometry, and audiologists determined the final diagnoses. RESULT: The prevalence of HI was 49.97%. With each 1-mL/min/1.73 m2 increase in eGFR, the overall odds of HI increased by 1.3%; the risk increased by 2.4% and 1.6% for men and people aged 45-65 years, respectively. In contrast, in women, the odds of HI increased as Cre levels increased. Moreover, with each 1-mL/min/1.73 m2 increase in eGFR, the overall odds of a one-degree increase in hearing loss increased by 1.7%; the odds increased by 2.3% and 1.5% for men and people aged 45-65 years, respectively. However, in women and people aged ≥65 years, the odds of a one-grade increase in hearing loss increased by 2.1% and 1.5%, respectively, with each 1-µmol/L increase in Cre. In addition, there were no significant relationships between blood urea nitrogen and hearing loss in multivariate analysis (all P > 0.05). CONCLUSIONS: These findings suggest that eGFR and serum Cre are effective predictors of hearing loss. Thus, to decrease the burden of HI, hearing should be carefully monitored for people aged ≥45 years with elevated serum Cre and eGFR.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular , Perda Auditiva , Insuficiência Renal Crônica , Fatores Etários , Idoso , Audiometria de Tons Puros/métodos , Audiometria de Tons Puros/estatística & dados numéricos , China/epidemiologia , Correlação de Dados , Estudos Transversais , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Humanos , Testes de Função Renal/métodos , Testes de Função Renal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Fatores Sexuais
20.
Expert Opin Drug Saf ; 20(8): 959-963, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34030570

RESUMO

Background: Azithromycin maintenance therapy is widely used in cystic fibrosis (CF), but little is known about its long-term safety. We investigated whether chronic azithromycin use is safe regarding renal function, hepatic cell toxicity and QTc-interval prolongation.Methods: Adult CF patients (72 patients using azithromycin for a cumulative period of 364.8 years and 19 controls, 108.8 years) from two CF-centers in the Netherlands with azithromycin (non)-use for at least three uninterrupted years were studied retrospectively.Results: There was no difference in mean decline of estimated glomerular filtration rate (eGFR), nor in occurrence of eGFR-events. No drug-induced liver injury could be attributed to azithromycin. Of the 39 azithromycin users of whom an ECG was available, 4/39 (10.3%) had borderline and 4/39 (10.3%) prolonged QTc-intervals, with 7/8 patients using other QTc-prolonging medication. Of the control patients 1/6 (16.7%) had a borderline QTc-interval, without using other QTc-prolonging medication. No cardiac arrhythmias were observed.Conclusion: We observed no renal or hepatic toxicity, nor cardiac arrythmias during azithromycin use in CF patients for a mean study duration of more than 5 years. One should be aware of possible QTc-interval prolongation, in particular in patients using other QTc-interval prolonging medication.


Assuntos
Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Fibrose Cística/tratamento farmacológico , Adulto , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Biomarcadores/metabolismo , Estudos de Coortes , Eletrocardiografia , Feminino , Humanos , Testes de Função Renal , Testes de Função Hepática , Síndrome do QT Longo/induzido quimicamente , Masculino , Países Baixos , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
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