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2.
Kidney Int Suppl ; (108): S145-51, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18379538

RESUMO

The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) was launched in December 2004 aiming to collect data monthly and continuously from a representative cohort, allowing for a continuous snapshot of the peritoneal dialysis (PD) reality in the country. This is an observational study of PD patients comprising follow-up from December 2004 to February 2007 (mean follow-up of 13.6 months-ranging from 1 to 26 months) in 114 Brazilian centers. All centers report data through a central web-based database. After an initial baseline retrospective data collection, all patients are followed prospectively every month until they drop out from the PD program. Total number of patients recruited until February 2007 was 3226 (2094 incident patients). Mean age was 54+/-19 years (37% above 65 years old), with 55% females and 64% Caucasians. The more frequent causes of renal failure were diabetic nephropathy (34%), renal vascular disease associated with hypertension (26%), and glomerulopathies (13%). The most common comorbidities were hypertension (76%), diabetes (36%), and ischemic heart disease (23%). Automated PD (APD) was the modality utilized in 53%. The estimated overall peritonitis rate was 1 episode per 30 patient-months (most frequently due to Staphylococcus aureus). The total dropout rate was 33%, mainly due to deaths, whereas 20% of dropouts were due to renal transplant. The gross mortality was 17.6% and the main causes of mortality were cardiovascular diseases (40%) and infections (15%). The initial results of this first Brazilian PD registry provide a unique opportunity to develop future clinical studies addressing specific PD questions in the Brazilian reality and context.


Assuntos
Diálise Peritoneal/métodos , Insuficiência Renal/terapia , Adulto , Idoso , Brasil , Estudos de Coortes , Escolaridade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Qualidade de Vida , Insuficiência Renal/mortalidade , Estudos Retrospectivos
3.
Transplant Proc ; 40(5): 1435-8, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18589124

RESUMO

Gingival overgrowth (GO) is a common side effect of chronic cyclosporine use. The average prevalence of GO is about 30%, ranging from 10% to 85% in various series, due to diverse aggravating risk factors: drug interactions with calcium channel blockers, age, cyclosporine dose, bacterial plaque, and genetic predisposition. Recent studies have demonstrated elevated levels of specific cytokines particularly transforming growth factor-beta (TGF-beta) in hyperplastic gingival tissue, suggesting that this growth factor plays a role in the accumulation of the extracellular matrix. Until recently treatment for this complication was only surgical. Nowadays, several studies have been performed to evaluate the effects of antibiotic treatment on the regression of GO. In the present study, we used roxithromycin, a macrolide antibiotic that has inhibitory effect on TGF-beta production by inflammatory cells. The results suggested that roxithromycin may be an important therapeutic tool to reduce cyclosporine-induced GO.


Assuntos
Ciclosporina/efeitos adversos , Hiperplasia Gengival/prevenção & controle , Transplante de Rim/imunologia , Roxitromicina/uso terapêutico , Adulto , Idoso , Antibacterianos/uso terapêutico , Azatioprina/uso terapêutico , Feminino , Hiperplasia Gengival/induzido quimicamente , Hiperplasia Gengival/patologia , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico
4.
Transplant Proc ; 38(10): 3476-8, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17175309

RESUMO

We performed a retrospective study to evaluate the safety, incidence, and management of proteinuria in 31 renal transplant recipients converted to Rapamycin (RAPA). All patients received RAPA immediately after the cessation of the calcineurin inhibitor or the antiproliferative drug. No acute rejection episodes were seen after this regimen. Chronic allograft nephropathy (58.1%) and calcineurin inhibitor toxicity (51.6%), both biopsy-proven, were the major reasons to introduce RAPA. Post-RAPA proteinuria was defined as the appearance of urine protein excretion >300 mg/d or any further increase in protein among those who showed previously elevated levels. We observed an elevated incidence of proteinuria of 48.4%. It started at 5.3 +/- 2.5 months after the conversion and 60% occurred within 6 months. The proteinuria increased from a median of 200 mg/d to 1466 mg/d (P < .001). Age, gender, race, HLA mismatches, time to onset of RAPA, level of previous proteinuria, glomerular filtration rate, use of renin-angiotensin blockers, and etiology of chronic kidney disease were similar between the groups with or without proteinuria. Once it appeared, we suspended the drug in only 4 patients (26.7%), initiated or augmented the dosage of renin-angiotensin blockers in 26.7%, adjusted the RAPA dose in 20.1%, and did not perform a specific measure in 40% (6 of 15). At 15.6 +/- 12.7 months, 91% showed no further increase or reduction in proteinuria. We observed a high prevalence of proteinuria among renal transplant recipients converted to RAPA (48.4%). In addition, RAPA was suspended in only 4 patients and the proteinuria showed a tendency to stabilize or reduce over time.


Assuntos
Imunossupressores/uso terapêutico , Transplante de Rim/patologia , Proteinúria/induzido quimicamente , Sirolimo/efeitos adversos , Sirolimo/uso terapêutico , Adulto , Biópsia , Feminino , Taxa de Filtração Glomerular , Teste de Histocompatibilidade , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/imunologia , Transplante de Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Proteinúria/epidemiologia , Proteinúria/terapia , Estudos Retrospectivos
5.
Transplantation ; 49(6): 1150-4, 1990 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2141742

RESUMO

Although anti-CD3 mAb therapy is used extensively in clinical transplantation, the dose-related effects and mechanisms of action are not clearly defined. We have examined the dose-related effects of an antimurine CD3 mAb, 145-2C11, in pancreatic islet cell allograft and the delayed type hypersensitivity reaction models of T-cell-dependent immunity. Low-dose anti-CD3 therapy (0.5 micrograms/day) administered over several days mediated superficially equal, effective clinical immunosuppression as a single high-dose intravenous injection (400 micrograms). T cells harvested from animals treated with high-dose anti-CD3 were unresponsive to in vitro restimulation. In contrast, T cells isolated from low-dose treated animals retained in vitro proliferative capacity when restimulated with polyvalent anti-CD3 mAb. The terminal complement components were not required to support in vivo immunosuppression mediated by anti-CD3 mAb as C5 deficient mice were immunosuppressed by the administration of this mAb. In some pancreatic islet cell allograft recipients, permanent engraftment, but not tolerance, was achieved. Replacement of donor leukocytes produced acute rejection in hosts bearing long-term, well-accepted grafts. Prolonged anti-CD3 mAb treatment may provide sufficient time for replacement or inactivation of donor leukocytes.


Assuntos
Anticorpos Monoclonais/imunologia , Antígenos de Diferenciação de Linfócitos T/imunologia , Sobrevivência de Enxerto/imunologia , Hipersensibilidade/imunologia , Terapia de Imunossupressão , Transplante das Ilhotas Pancreáticas , Receptores de Antígenos de Linfócitos T/imunologia , Animais , Anticorpos Monoclonais/uso terapêutico , Complexo CD3 , Relação Dose-Resposta Imunológica , Hipersensibilidade/terapia , Masculino , Camundongos , Camundongos Endogâmicos , Especificidade da Espécie , Baço/patologia
6.
Rev Saude Publica ; 33(3): 219-29, 1999 Jun.
Artigo em Português | MEDLINE | ID: mdl-10456994

RESUMO

In Brazil, in recent years, as a result of the increasing participation of county authorities in health care, a need for tools which would contribute to the better preparation of local administrators, complementary to the activities of a more academic nature, has been recognized. One of the possible alternatives is the exploitation of experiences, regarded as successful, in local health care planning and administration, by using them as material for "case studies" in activities with selected groups of health care administrators thus, stimulating the identification of those elements which contributed to the favorable results attained, and their interactions, in the quest for analogies which would facilitate the identification of new perspectives for their own situations. In this article an experience of a "case studies" development, in response to a demand from UNICEF, based on 8 counties in from the North and Northeast, which were successful in using a "focus approach" in their organization of data and their utilisation in a seminar with 21 local managers from both regions, is presented. During the seminar the local health managers attained greater knowledge of the strategies implemented and identified feasible intervention alternatives. The methodological proposition of teaching on the basis of case studies, using a conceptual strategy of grouping experiences according to specific dimensions enabled local health managers to learn from their practical experiences.


Assuntos
Administradores de Instituições de Saúde/educação , Administração de Serviços de Saúde , Capacitação em Serviço/métodos , Brasil , Currículo , Humanos , Técnicas de Planejamento
7.
Rev Assoc Med Bras (1992) ; 42(1): 11-5, 1996.
Artigo em Português | MEDLINE | ID: mdl-8935669

RESUMO

BACKGROUND: We evaluated the occurrence of low-trait genital infection and cervical epithelial dysplasia in women from a South-american indian tribe in the Brazilian Amazonia. METHODS: Cross-sectional study of women older than 10 years from two indian settlements of the Parakanã tribe: Paranatinga and Maroxewara. Demographic data and information about sexual behavior as well as obstetric/gynaecological history were recorded. Two gynecologists examined 80 patients (89.9%), and collected vaginal and cervical specimens of 69 indians for further laboratory analysis, by Gram stain and Papanicolaou method. Fourteen (20.3%) women resulted to be pregnant. RESULTS: Parakanã women begin sexual activity early, after menarche; they have multiple sexual partners; are multiparous. Some of his partners already had intercourse with women of our society. In Paranatinga, vaginal discharges were a very frequent sign and not age-related, and women presented high frequency of disturbances on lactobacilli flora, greater than among inhabitants of Maroxewara. Pap smears in 91.5% of all patients showed inflammatory pattern. When found an possible etiologic agent (61.3%), in 63.4% it was Gardnerella vaginalis, in 7.3% Trichomonas vaginalis and in 4.9% Candida sp. In 23.2% of smears cythophatic signs related to infection by human papillomavirus were identified. One case had morphological changes compatible with cervical intraepithelial neoplasia grade I, another with CIN II and, in a 48 year old indian, cervical cancer. CONCLUSIONS: Near all women had some grade of cervical disease. Measure HPV-infection prevalence among Parakanã indians with adequate methods may improve our understanding about worldwide occurrence of HPV infections. Established risk factors for cancer of the cervix and sexually transmitted diseases were common in this tribe.


Assuntos
Neoplasias do Colo do Útero/prevenção & controle , Cervicite Uterina/diagnóstico , Vaginite/diagnóstico , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Criança , Estudos Transversais , Feminino , Humanos , Indígenas Sul-Americanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Lesões Pré-Cancerosas , Gravidez , Fatores de Risco , Coloração e Rotulagem , Cervicite Uterina/etnologia , Esfregaço Vaginal , Vaginite/etnologia
8.
Transplant Proc ; 46(6): 1695-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25131015

RESUMO

BACKGROUND: The pretransplantation period is characterized by many stressful events that can result in symptoms of anxiety and stress and ultimately can have a negative impact on graft outcome. Our objective was to evaluate the association between symptoms of anxiety and stress in patients awaiting kidney transplantation. METHODS: This was a transversal study describing 50 randomly selected patients undergoing hemodialysis and waitlisted for kidney transplantation. We collected social and demographic data, and adopted the Beck Anxiety Inventory and the Lipp Stress Symptoms for Adults Inventory to respectively evaluate anxiety and stress. RESULTS: The mean age was 50.2 ± 11.7 years, 54% of patients were female, time on dialysis was 6.5 ± 4.5 years, and transplant waitlist time was 5.9 ± 4.4 years. Forty-six percent of patients were married or had a stable relationship, 50% were illiterate or had only finished primary school, and 64% were pensioners. Stress was documented in 60% of patients, of which 30% had severe stress, whereas 56% of patients showed symptoms of anxiety. The presence of stress was associated with longer waitlist time (P = .006) and longer time on dialysis (P = .052). Less severe stress was associated with higher education level (P = .031), whereas patients in more advanced phases of stress showed higher levels of anxiety. After a multivariate analysis, stress was 3.6 times (CI 1.34 to 9.89) more frequent among individuals with anxiety. CONCLUSIONS: Stress and anxiety were prevalent in patients on a waitlist and were associated with social and chronic kidney disease-related patterns. This observation can stimulate the adoption of strategies for the prevention of stress and anxiety, avoiding posttransplantation complications, such as nonadherence to treatment.


Assuntos
Ansiedade/epidemiologia , Transplante de Rim/psicologia , Estresse Psicológico/epidemiologia , Listas de Espera , Adulto , Feminino , Humanos , Rim/cirurgia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Diálise Renal/psicologia , Adulto Jovem
9.
Transplant Proc ; 46(6): 1750-2, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25131027

RESUMO

INTRODUCTION: Kidney transplant recipients (KTR) experience better appetite, partly due to the use of steroids, and are subjected to less severe dietetic restrictions, hence they tend to increase the uptake of calories, which favors weight gain posttransplantation. In this study, we evaluate the profile of body mass index (BMI) in the first year posttransplantation. METHODS: This was a retrospective study including 131 patients who received transplants between 1991 and 2011. We collected demographic and clinical data such as body weight and height, and calculated BMI pretransplantation and at 6 and 12 months posttransplantation. RESULTS: Mean age was 47.1 ± 13.1 years, 64.9% were male, and 29% of patients were diabetic. Pretransplantation mean BMI was 23.04 ± 4.08 kg/m(2), and at 6 and 12 months posttransplantation it increased to 24.55 ± 4.2 kg/m(2) and 24.65 ± 4.16 kg/m(2), respectively (P < .001). At 6 months, this significant weight gain occurred in all patients, even those malnourished, eutrophic, overweight, and obese at pretransplantation. Looking at pretransplantation malnourished patients, 30.8% remained malnourished 1 year after transplantation. Otherwise, 28.6% of pretransplantation overweight patients and 100% of pretransplantation obese patients could be classified as obese at 1 year posttransplantation. CONCLUSIONS: Increase in BMI is common in obese and nonobese KTR. This study highlights the importance of identifying subjects at risk for excessive weight gain posttransplantation, thus allowing an early nutritional intervention to prevent its complications.


Assuntos
Índice de Massa Corporal , Transplante de Rim , Sobrepeso/etiologia , Complicações Pós-Operatórias , Magreza/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/etiologia , Sobrepeso/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Magreza/diagnóstico , Aumento de Peso
10.
Transplant Proc ; 44(8): 2341-3, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23026588

RESUMO

BACKGROUND: The relationship between socioeconomic status and clinical outcome in health and disease is complex and multifactorial. An association between low socioeconomic status and shorter patient survival in renal replacement therapy, dialysis, and transplantation, has been reported, implicating individual and environmental factors. We sought to analyze the socioeconomic and demographic characteristics of chronic kidney disease (CKD) patients in preparation for living kidney transplantation. METHODS: We evaluated 60 patients with CKD-V, on hemodialysis or peritoneal dialysis and who were being prepared in our public service between July 2008 and January 2010. Socioeconomic data were collected from the records. RESULTS: The mean age was 44.8 ± 13.3 years and 51% were male. Sixty-three percent were married, most of them with children, with a family size of 3.5 ± 1.45 members. They were taken a mean of 5.8 ± 2.8 drugs; only half of them were dispensed by public health insurance. Almost all--93%--did not work regularly, and the majority reported some limitation in daily activities. The mean monthly income was US $1,535.70 and 76.2% reported a monthly income ≤ US $1,810.60. The mean of school years was 7.91 ± 4.19. CONCLUSION: Low-income patients are gaining access to preparing for renal transplantation; we believe that is inherent to the universal structure of Brazil's public health system. Besides the low income, this population showed a considerable educational level, suggesting this characteristic made the patient more active to search the living transplant as an alternative for their CKD treatment. Knowledge about social status is essential for design strategies in minimizing its potential undesirable effects after transplantation.


Assuntos
Transplante de Rim , Doadores Vivos , Insuficiência Renal Crônica/cirurgia , Fatores Socioeconômicos , Adulto , Brasil , Estudos Transversais , Escolaridade , Emprego , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Diálise Peritoneal , Diálise Renal , Insuficiência Renal Crônica/psicologia , Classe Social
11.
Transplant Proc ; 44(8): 2381-3, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23026599

RESUMO

BACKGROUND: Death with a functioning graft is currently one of the main causes of kidney graft loss. A large proportion of cases is attributed to infectious complications that can be related to overimmunosuppression. We retrospectively studied 80 kidney transplant patients, grafted from January 2005 to December 2009, to assess the prevalence of excessive immunosuppression, and its possible correlation with infections and infection-related death. METHODS: Excessive immunosuppression was defined by a prescribed dosage above the expected to the time point or an elevated drug blood level according to the Kidney Disease: Improving Global Outcomes (2009) recommendations at 1, 3, 6, and 12 months, and then annually. RESULTS: Death with a functioning graft accounted for 76.5% of losses. Overall, 53.8% of deaths were from infections, and 38.5% from cardiovascular causes. Acute rejection episodes were noted in 8.8% of patients. Only 10% of patients had adequate immunosuppression throughout the follow-up. Seventy-two percent of patients showed adequate immunosuppression at least half of the 18 evaluated points, although 50% showed between 1 and 3 drugs administered above recommended dosages during the whole period. Infections were recorded in 78.8% patients, with a median of 3 episodes per patient. Any level of excessive immunosuppression was associated with infections (odds ratio, 11.2; P < .001), but not with death caused thereby. CONCLUSION: Excessive immunosuppression among this cohort was associated with a greater incidence of infections, but not with death from this cause.


Assuntos
Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Doença Aguda , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Transmissíveis/epidemiologia , Estudos Transversais , Monitoramento de Medicamentos , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Imunossupressores/sangue , Incidência , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/mortalidade , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
12.
Braz J Med Biol Res ; 44(3): 258-62, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21344138

RESUMO

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4%). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4%) at the baseline period of the study than after 1 year of the study (26.8%). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22%) was lower than the percentage of non-adherent patients who became adherent (50%). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.


Assuntos
Anti-Hipertensivos/uso terapêutico , Diuréticos/uso terapêutico , Falência Renal Crônica/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Brasil , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Autorrelato , Fatores Socioeconômicos
13.
Transplant Proc ; 42(2): 486-7, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20304172

RESUMO

Urinary tract infection (UTI) is a common complication among kidney transplant patients. UTI caused by multi-resistant extended-spectrum beta-lactamase producing bacteria (ESBL) have largely increased among the hospitalized patient population and especially kidney transplant recipients. We retrospectively studied 83 kidney transplant patients to evaluate the incidence and possible causative conditions of ESBL-related UTI over the last 6 years. ESBL production was determined by the antibiotic susceptibility profile of urine cultures. We compared the incidence in two 3-year periods, 2003-2005 (period 1) and 2006-2008 (period 2). An high incidence of ESBL-related UTI (16.8%) was observed in the posttransplant period performing 31% of the overall UTI incidence, with an increase over the last 3 years from 23.8% to 37.5%. ESBL-related UTI was related to previous episodes of UTI (78.6% vs 29.0%; P < .01) and reoperations (50.0% vs 12.9%; P < .05). We observed a progressively increasing incidence of 13%, 38%, and 45% of ESBL-related UTI among first, second, and third episodes, respectively. Age, gender, HLA mismatches, etiology of chronic kidney disease, diabetes mellitus, acute rejection, induction treatment, and type/level of immunosuppressants were similiar between the groups with or without ESBL-related UTI. We observed a high increased incidence of ESBL-related UTI among kidney transplant recipients, and particularly patients with recurrent UTI.


Assuntos
Antibacterianos/uso terapêutico , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/microbiologia , Infecções Urinárias/microbiologia , Adulto , Cefazolina/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Glomerulonefrite/complicações , Rejeição de Enxerto/epidemiologia , Teste de Histocompatibilidade , Humanos , Transplante de Rim/imunologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , beta-Lactamases/biossíntese
14.
Braz J Med Biol Res ; 43(6): 528-36, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20464341

RESUMO

Chronic kidney disease (CKD) is a world-wide public health problem, with adverse outcomes of kidney failure, cardiovascular disease, and premature death. This finding has led to the hypothesis that earlier recognition of kidney disease and successful intervention may improve outcome. The National Kidney Foundation, through its Kidney Disease Outcomes Quality Initiative (K/DOQI), and other National institutions recommend glomerular filtration rate (GFR) for the definition, classification, screening, and monitoring of CKD. Blood creatinine clearance, the most widely used clinical marker of kidney function, is now recognized as an unreliable measure of GFR because serum creatinine is affected by age, weight, muscle mass, race, various medications, and extra-glomerular elimination. Cystatin C concentration is a new and promising marker for kidney dysfunction in both native and transplanted kidneys. Because of its low molecular weight, cystatin C is freely filtered at the glomerulus and is almost completely reabsorbed and catabolized, but not secreted, by tubular cells. Given these characteristics, cystatin C concentration may be superior to creatinine concentration in detecting chronic kidney disease. This review aims to evaluate from recent literature the clinical efficiency and relevance of these GFR markers in terms of screening CKD.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Nefropatias/diagnóstico , Biomarcadores/sangue , Doença Crônica , Humanos , Nefropatias/sangue , Nefropatias/fisiopatologia
16.
Braz. j. med. biol. res ; 44(3): 258-262, Mar. 2011. ilus, tab
Artigo em Inglês | LILACS | ID: lil-576069

RESUMO

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4 percent). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4 percent) at the baseline period of the study than after 1 year of the study (26.8 percent). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22 percent) was lower than the percentage of non-adherent patients who became adherent (50 percent). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Diuréticos/uso terapêutico , Falência Renal Crônica/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Brasil , Estudos de Coortes , Análise Multivariada , Estudos Prospectivos , Autorrelato , Fatores Socioeconômicos
17.
Braz. j. med. biol. res ; 43(6): 528-536, June 2010. tab
Artigo em Inglês | LILACS | ID: lil-548270

RESUMO

Chronic kidney disease (CKD) is a wrld-wide public health problem, with adverse outcomes of kidney failure, cardiovascular disease, and premature death. This finding has led to the hypothesis that earlier recognition of kidney disease and successful intervention may improve outcome. The National Kidney Foundation, through its Kidney Disease Outcomes Quality Initiative (K/DOQI), and other National institutions recommend glomerular filtration rate (GFR) for the definition, classification, screening, and monitoring of CKD. Blood creatinine clearance, the most widely used clinical marker of kidney function, is now recognized as an unreliable measure of GFR because serum creatinine is affected by age, weight, muscle mass, race, various medications, and extra-glomerular elimination. Cystatin C concentration is a new and promising marker for kidney dysfunction in both native and transplanted kidneys. Because of its low molecular weight, cystatin C is freely filtered at the glomerulus and is almost completely reabsorbed and catabolized, but not secreted, by tubular cells. Given these characteristics, cystatin C concentration may be superior to creatinine concentration in detecting chronic kidney disease. This review aims to evaluate from recent literature the clinical efficiency and relevance of these GFR markers in terms of screening CKD.


Assuntos
Humanos , Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Nefropatias/diagnóstico , Biomarcadores/sangue , Doença Crônica , Nefropatias/sangue , Nefropatias/fisiopatologia
18.
J Immunol ; 145(11): 3535-9, 1990 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-2147194

RESUMO

During the proliferative burst after Ag recognition, T cells express cell-surface, high-affinity IL-2R. The importance of IL-2R+ T cells in supporting/mediating tissue injury has been documented by the ability of mAb anti-IL2R therapies to prevent allograft rejection and autoimmunity. The delayed-type hypersensitivity (DTH) response, an experimental model of T-dependent immunity, offers the possibility of studying responses mounted against defined Ag. We previously reported that the chimeric IL-2 toxin (DAB486-IL-2) prevents DTH responses and selectively eliminates activated IL-2R bearing CD4 and CD8 T cells from lymph nodes draining the site of inflammation. We have examined the duration of immunosuppression and relative specificity of action of DAB486-IL-2 and anti-CD3 mAb for Ag-activated clones in a murine model of DTH using two different noncross-reacting haptens. Treatment with DAB486-IL-2 generates a state of selective unresponsiveness to subsequent challenge with the hapten introduced during the therapeutic period. Immediately after cessation of DAB486-IL-2 therapy, immunization with an unrelated hapten induces a normal vigorous immune response. By comparison, anti-CD3 mAb treatment causes a broad immunosuppression because unrelated haptens introduced after anti-CD3 therapy do not evoke a vigorous immune response. After cessation of DAB486-IL-2 toxin treatment response to the hapten is eventually restored probably by cells trafficking from the thymus, because thymectomized hosts remain unresponsive to the hapten. Taken together these data reinforce the role of the IL-2R as an important target for immunosuppression in T cell-mediated immune reactions. DAB-486-IL-2 treatment confers highly selective immunosuppression.


Assuntos
Antígenos/imunologia , Haptenos/imunologia , Imunotoxinas/farmacologia , Interleucina-2/farmacologia , Ativação Linfocitária , Linfócitos T/imunologia , Animais , Anticorpos Monoclonais/imunologia , Antígenos de Diferenciação de Linfócitos T/imunologia , Complexo CD3 , Células Clonais , Toxina Diftérica/farmacologia , Tolerância Imunológica , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Receptores de Antígenos de Linfócitos T/imunologia , Receptores de Interleucina-2/fisiologia , Linfócitos T/efeitos dos fármacos
19.
Eur J Immunol ; 22(3): 697-702, 1992 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-1547815

RESUMO

Insulin-dependent diabetes mellitus (IDDM) is strikingly similar in the non-obese diabetic (NOD) mouse and humans. In IDDM, the systematic autoimmune destruction of insulin-producing beta cells within the pancreas is dependent on autoreactive T cells. This autoimmune process can be accelerated by transferring spleen cells from diabetic donors into irradiated syngeneic NOD mice. In a previous study we established that interleukin 2 receptor (IL 2R)-bearing cells propagated from pre-diabetic NOD mice promote IDDM. Therefore, we reasoned that specific elimination of IL 2R+ T cells should abort the diabetogenic process. T cell expressing IL 2R can be selectively destroyed with a diphtheria toxin-related IL 2 fusion protein (DAB486-IL-2). We set DAB486-IL-2 the challenging task of preventing fulminant IDDM accelerated by the adoptive transfer of diabetic spleen cells. Eight weeks after the adoptive transfer only 10% and 20% of NOD mice treated with 10 and 5 micrograms/day of DAB486-IL-2, respectively, became diabetic while 100% control mice (vehicle buffer) became diabetic within 5 weeks. A dose of 1 microgram/day of DAB486-IL-2 had no protective effect. Although the protection conferred by DAB486-IL-2 is not permanent, it is maintained for at least 4 weeks following cessation of treatment. Furthermore, even though these NOD mice do eventually become diabetic, the tempo of expression and severity of diabetes, as assessed by the level of hyperglycemia, is dramatically reduced. Although histologic examination of pancreas revealed minimal degree of mononuclear infiltrate within the islets in both groups, the vehicle control mice had fewer islets per section indicating many islets had already been destroyed. In addition, spleen cells from diabetic NOD mice which were pre-treated with DAB486-IL-2 (10 micrograms/day) for 1 week lost their ability to transfer disease. Taken together, these studies strongly support the concept that IL 2R-bearing T cells are essential for the induction of IDDM and suggest that DAB486-IL-2 would be a promising therapeutic approach in the treatment of human IDDM.


Assuntos
Autoimunidade/efeitos dos fármacos , Diabetes Mellitus Tipo 1/imunologia , Toxina Diftérica/farmacologia , Interleucina-2/farmacologia , Receptores de Interleucina-2/análise , Proteínas Recombinantes de Fusão/farmacologia , Animais , Diabetes Mellitus Tipo 1/tratamento farmacológico , Toxina Diftérica/uso terapêutico , Imunoterapia Adotiva , Interleucina-2/uso terapêutico , Camundongos , Camundongos Endogâmicos NOD
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