RESUMO
Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR. METHODS: A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m2), slow progressors (> -1 and < -5 mL/min/1.73 m2), and fast progressors (< -5 mL/min/1.73 m2). Percentage of achievement of KDIGO target was also analyzed. RESULTS: The mean GFR was 62.5 mL/min/1.73 m2. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m2), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]). CONCLUSIONS: High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.
Assuntos
Taxa de Filtração Glomerular/fisiologia , Transplante de Rim , Sobrepeso/complicações , Insuficiência Renal Crônica/etiologia , Adulto , Idoso , Índice de Massa Corporal , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Ácido Úrico/sangueRESUMO
Highly virulent strains of Trypanosoma cruzi are frequently used as murine models of Chagas' disease. However, these strains do not fully represent the spectrum of parasites involved in the human infection. In this paper, we analysed parasitaemia, mortality, tissue pathology and parasite-specific IgG serum levels in immune-deficient mice infected with Sylvio X10/4 parasites, a T. cruzi derived from a chagasic patient that yields very low parasitaemias and in C3H/HePAS mice induces a chronic cardiopathy resembling the human disease. IFN-gamma was identified as a crucial element for parasite control as its absence determined a drastic increase in parasitaemia, tissue parasitism, leukocyte infiltrates at the heart and striated muscles and mortality. The lack of IFN-gamma or IL-12p40, a molecule shared by IL-12 and IL-23, also resulted in spinal cord lesions and a progressive paralysis syndrome. Whereas IgG2a was the main Ig isotype in infected C57BL/6 mice, IL-12p40-KO mice produced IgG2a and IgG1 and IFN-gamma-KO mice produced only IgG1. The IFN-gamma-protective effect was not essentially mediated by nitric oxide (NO), inasmuch as infected iNOS-KO mice showed no parasitaemia and low tissue damage. Mice deficient in CD4(+) or CD8(+) T cells showed an intermediate phenotype with increased mortality and tissue pathology but no parasitaemia. Interestingly, CD28-KO mice were unable to produce anti-T. cruzi IgG antibodies but presented moderate tissue pathology and managed to control the infection. Thus, differently from infections with high virulence parasites, neither IgG, NO nor CD28-mediated signalling are essential for the non-sterile control of Sylvio X10/4 parasites.
Assuntos
Especificidade de Anticorpos , Cardiomiopatia Chagásica/imunologia , Imunoglobulina G , Interferon gama/fisiologia , Óxido Nítrico , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/patogenicidade , Animais , Linhagem Celular , Cardiomiopatia Chagásica/genética , Cardiomiopatia Chagásica/metabolismo , Modelos Animais de Doenças , Feminino , Imunoglobulina G/fisiologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Nus , Óxido Nítrico/fisiologia , Virulência/genética , Virulência/imunologiaRESUMO
This study examines patterns of growth and nutritional status of indigenous Tsimane' children under 9 years of age (n = 199 boys and 210 girls), based on a cross-sectional sample from 58 villages from the Beni Deparment of lowland Bolivia. Compared with US children, Tsimane' children are quite short, with linear growth tracking at or below the US 5th centile in both sexes. The prevalence of low height-for-age ("stunting;" HA Z-scores =-2) is 52% in boys and 43% in girls. In contrast, weight-for-height in Tsimane' children approximates the US median, with the prevalence of low weight-for-height ("wasting"; WH Z-scores =-2) being only 4% and 6% in boys and girls, respectively. Tsimane' boys and girls are leaner than their US peers, but their levels of body fatness are not so low as to indicate severe energy stress. Arm muscularity of Tsimane' children is similar to that of their US age peers, and this suggests that they are not experiencing acute protein malnutrition. Variation in measures of nutritional status of Tsimane' children is modestly correlated with village-level differences. Degree of isolation, as measured by distance to urban centers or to primary forest, was not a strong predictor of children's anthropometric status. Rather, in both boys and girls, nutritional status was most strongly associated with number of teachers in the village, a measure of access to education. Comparative analyses indicate that high levels of statural growth stunting are common among indigenous populations throughout lowland South America. This problem appears to be largely attributable to poor dietary quality (diets low in key micronutrients) and high disease loads. Further research is needed to identify the specific causes and potential interventions for the high rates of childhood growth stunting in this region.
Assuntos
Tamanho Corporal/etnologia , Tamanho Corporal/fisiologia , Desenvolvimento Infantil/fisiologia , Fenômenos Fisiológicos da Nutrição Infantil/fisiologia , Indígenas Sul-Americanos/estatística & dados numéricos , Distribuição por Idade , Bolívia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Avaliação Nutricional , Estado Nutricional , Prevalência , Distribuição por Sexo , Magreza/epidemiologiaRESUMO
Los presentes documentos correpondientes a la consultoría sobre el plan quinquenal del PAI 2001-2005, constituye constituye un plan de acción realizado para los nueve departamentos de Bolivia con el fin de lograr mayor cobertura de inmunización a nivel nacional, brindando estrategias para mejorar la cobertura de vacunación, además se añade a estos documentos el inventario de cadena de frío también realizado en los nueve departamentos