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1.
J Intern Med ; 289(1): 69-83, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32613703

RESUMO

BACKGROUND: Hypertensive nephrosclerosis is the presumed underlying cause in many end-stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy. OBJECTIVE: To evaluate and improve the diagnostic process for nephrosclerosis patients. METHODS: We included adults from the population-based HUNT study (n = 50 552), Norwegian CKD patients referred for kidney biopsy 1988-2012 (n = 7261), and unselected nephrology clinic patients (n = 193) used for matching. Decision tree analysis and ROC curve-based methods of optimal cut-offs were used to improve clinical nephrosclerosis criteria. RESULTS: Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney-related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy-verified arterionephrosclerosis. A new optimized diagnostic algorithm based on proteinuria (<0.75 g d-1 ), systolic blood pressure (>155 mm Hg) and age (>75 years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false-positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk-tolerant ones (harm:benefit ratio < 1:4) should consider kidney biopsy. CONCLUSION: Further improvements of the current clinical criteria seem difficult, so risks and benefits of kidney biopsy could be more actively discussed with selected patients to reduce misclassification and direct treatment.


Assuntos
Hipertensão Renal/patologia , Rim/patologia , Nefrite/patologia , Nefroesclerose/patologia , Biópsia , Árvores de Decisões , Taxa de Filtração Glomerular , Humanos , Hipertensão Renal/complicações , Hipertensão Renal/diagnóstico , Hipertensão Renal/epidemiologia , Falência Renal Crônica/etiologia , Pessoa de Meia-Idade , Nefrite/complicações , Nefrite/diagnóstico , Nefrite/epidemiologia , Nefroesclerose/complicações , Nefroesclerose/diagnóstico , Nefroesclerose/epidemiologia , Noruega/epidemiologia , Prevalência , Prognóstico , Curva ROC , Sensibilidade e Especificidade , Análise de Sobrevida
2.
Clin Exp Nephrol ; 25(11): 1255-1265, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34129132

RESUMO

BACKGROUND: The majority of active tuberculosis (TB) cases develop from latent tuberculosis infection (LTBI). Since the risk of TB in hemodialysis (HD) patients is particularly high, interferon-gamma release assay (IGRA) for LTBI screening in HD patients is considered important. However, the prevalence and characteristics of LTBI in Japanese HD patients remain obscure. METHODS: We performed an observational cross-sectional study of LTBI using IGRA QFT-3G tests in 118 HD outpatients enrolled at 3 hospitals of varying location and function. RESULTS: Of the 118 patients, 96 were QFT negative, 7 were QFT indeterminate, 14 were QFT positive, and 1 was QFT judgment impossible. No patient had active TB. Confirmed (QFT positive) and possible (QFT positive + indeterminate) LTBI patients totaled 14 (11.9%) and 21 (17.8%), respectively. The LTBI possible group was significantly older and had a significantly higher rate of nephrosclerosis versus the QFT-negative group. The indeterminate group had a significantly longer HD period. The QFT results were not remarkably affected by other clinical data, including hospital characteristics. The possible LTBI rate increased age-dependently, with higher values from 60 years of age. CONCLUSIONS: The prevalence of LTBI is high in Japanese HD patients, especially from the age of 60 years. Older age was a significant risk factor for LTBI, with prediction difficult using other clinical data. Extended HD may mask IGRA results. Therefore, aggressive screening for LTBI is advised in all HD patients regardless of hospital region or type, especially in patients over 60 years of age or newly commencing HD.


Assuntos
Tuberculose Latente/epidemiologia , Diálise Renal , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Testes de Liberação de Interferon-gama , Japão/epidemiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Tuberculose Latente/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefroesclerose/epidemiologia , Prevalência , Fatores de Risco
3.
J Am Soc Nephrol ; 29(7): 1960-1969, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29789431

RESUMO

Background Glomerular volume increases when demand exceeds nephron supply, which may lead to glomerulosclerosis. It is unclear if determinants of glomerular volume are consistent between populations that differ by severity of comorbidities.Methods We studied kidney biopsy specimens from living kidney donors (n=2453) and patients who underwent radical nephrectomy for a renal tumor (n=780). We scanned specimen sections into high-resolution digital images, manually traced glomerular profiles, and calculated mean glomerular volumes using the Weibel-Gomez stereologic formula (separately for nonsclerosed glomeruli and globally sclerosed glomeruli). We then assessed the relationship of glomerular volume with age, clinical characteristics, and nephrosclerosis on biopsy specimen.Results Compared with kidney donors, patients with tumors were older and more frequently men, obese, diabetic, or hypertensive, had more glomerulosclerosis and interstitial fibrosis on biopsy specimen, and had 12% larger nonsclerosed glomeruli (P<0.001). In both populations, male sex, taller height, obesity, hypertension, and proteinuria associated with larger nonsclerosed glomeruli to a similar extent. In patients with tumors, diabetes, glomerulosclerosis >25%, and interstitial fibrosis >25% also associated with larger nonsclerosed glomeruli. Independent clinical predictors of larger nonsclerotic glomeruli were family history of ESRD, male sex, taller height, obesity, diabetes, and proteinuria. After adjustment for these characteristics, nonsclerotic glomerular volume did not differ between populations and was stable up to age 75 years, after which it decreased with age. Many of these findings were also evident with globally sclerotic glomerular volume.Conclusions Characteristics associated with glomerular volume are consistent between patient populations with low and high levels of comorbidity.


Assuntos
Glomérulos Renais/patologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Nefroesclerose/epidemiologia , Nefroesclerose/patologia , Adulto , Fatores Etários , Idoso , Estatura , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Fibrose , Humanos , Hipertensão/epidemiologia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Tamanho do Órgão/genética , Proteinúria/epidemiologia , Fatores de Risco , Doadores de Tecidos , Estados Unidos/epidemiologia
4.
Ren Fail ; 41(1): 893-898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31557071

RESUMO

Background: Two types of global glomerulosclerosis, glomerular obsolescence and solidification, have been identified. A clinicopathological correlation between these glomerular changes and hypertensive nephrosclerosis has been reported; however, clinicopathological correlations with other kidney diseases are unknown. The aim of this study was to evaluate the correlation between the two glomerulosclerosis types and the clinical IgA nephropathy presentation. Methods: A single center, cross-sectional study of patients with IgA nephropathy was performed. Correlations between glomerulosclerosis and body mass index, mean blood pressure, creatinine-based estimated glomerular filtration rate (eGFR), total cholesterol, urinary protein corrected by urinary creatinine, and anti-hypertensive agent use were investigated using univariate and multivariate analyses. Results: Overall, 116 patients were enrolled (male/female, 59/57; mean age, 40.5 ± 15.0 years). Separate analyses were performed for solidification and obsolescence glomerulosclerosis. Univariate analysis demonstrated a significant correlation between the percentage of solidification glomerulosclerosis and patient age, mean blood pressure, eGFR, and use of antihypertensive drugs. Multivariate analysis showed that only eGFR and use of antihypertensive drugs maintained their independent predictive value. The amount of urinary protein emerged as a significant factor based on the multivariate analysis. However, although the univariate analysis demonstrated a statistically significant correlation between the percentage of obsolescence and eGFR for obsolescence glomerulosclerosis, a multivariate analysis indicated that none of the factors maintained their independent predictive value. Conclusions: The incidence of solidification was better correlated with some nephritis-related clinical parameters compared with the incidence of obsolescence. The emergence of solidification may influence the clinical activities that are associated with IgA nephropathy.


Assuntos
Taxa de Filtração Glomerular , Glomerulonefrite por IGA/complicações , Glomérulos Renais/patologia , Nefroesclerose/epidemiologia , Adulto , Fatores Etários , Biópsia , Pressão Sanguínea/fisiologia , Estudos Transversais , Feminino , Glomerulonefrite por IGA/patologia , Glomerulonefrite por IGA/fisiopatologia , Humanos , Incidência , Glomérulos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefroesclerose/etiologia , Nefroesclerose/patologia , Fatores de Risco
5.
Harefuah ; 155(3): 158-62, 196, 2016 Mar.
Artigo em Hebraico | MEDLINE | ID: mdl-27305749

RESUMO

BACKGROUND: Kidney biopsies are not routinely performed for diabetic patients with chronic kidney disease. However in some cases, a biopsy is carried out to exclude other treatable Prolonged duration of diabetes, insulin therapies and presence of diabetic retinopathy were associated with a greater likelihood of DN. The high prevalence of NDRD in our population emphasizes the judicious use of kidney biopsy in diabetic patients. e renal diseases. The prevalence and the nature of non diabetic renal disease (NDRD) among diabetic patients in Israel have not yet been evaluated. OBJECTIVE: To assess pathological findings of kidney biopsies conducted in patients with diabetes mellitus. METHODS: A total of 200 native kidney biopsies were performed during the study period. Patients who had a diagnosis of diabetes mellitus were included in the study. Clinical data and pathological findings were retrospectively collected and analyzed. RESULTS: The cohort included 34 patients, median age 61.8 years. The male to female ratio was 25:9; mean serum creatinine was 1.8 ± 1.2 mg/dl The duration of diabetes was significantly shorter in patients with NDRD (6.8 ± 7.1 years vs. 13.0 ± 9.6 years in diabetic nephropathy (DN) or combined), whereas insulin therapy was significantly more common in patients with DN (72% vs 5% in NDRD). Diabetic retinopathy was documented in 57% of patients with diabetic nephropathy but wasn't documented in any patient with NDRD. Prevalence of NDRD, DN and combined pathology was 58.8%, 32.4% and 8.8% respectively. Neither the level of proteinuria nor the rate of renal function deterioration could predict pathological findings in the biopsy. The most common NDRD disease was nephrosclerosis. CONCLUSIONS: Non-diabetic renal disease was common. Prolonged duration of diabetes, insulin therapies and presence of diabetic retinopathy were associated with a greater likelihood of DN. The high prevalence of NDRD in our population emphasizes the judicious use of kidney biopsy in diabetic patients.


Assuntos
Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Nefropatias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/patologia , Feminino , Humanos , Insulina/administração & dosagem , Israel , Nefropatias/diagnóstico , Nefropatias/patologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Nefroesclerose/diagnóstico , Nefroesclerose/epidemiologia , Prevalência , Proteinúria/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
6.
Clin Exp Nephrol ; 18(3): 461-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23832327

RESUMO

BACKGROUND: Nephrosclerosis/ischemic nephropathy (NS/IN) ranks third among renal diseases requiring dialysis in Japan. Although it is an important renal disease in terms of frequency, its prevalence, new incidence, and risk factors are not fully elucidated. METHODS: We analyzed the prevalence, incidence, concurrent diseases, and risk factors of NS/IN by using data from specific health checkups of Kumamoto citizens between 2008 and 2010. RESULTS: Although the prevalence of NS/IN was 1-2 % in people in their 40s, it increased sharply with age, reaching 17.6 % in people aged 70-74 years. The incidence of new NS/IN was 0.4-0.5 % per year. In multivariate logistic regression analysis, factors such as age, male gender, body mass index (BMI), hyperuricemia, hypertension, and dyslipidemia correlated with NS/IN. When risk factors associated with NS/IN progress were evaluated by multivariate logistic regression analysis, four factors-male gender, hypertension, BMI, and current smoking-significantly correlated. CONCLUSION: The analysis of Kumamoto citizens aged 40-74 years receiving specific health checkups showed that in addition to hypertension and age that were considered important, male gender and obesity are also risk factors for NS/IS independent from hypertension.


Assuntos
Hipertensão/complicações , Isquemia/epidemiologia , Rim/irrigação sanguínea , Nefroesclerose/epidemiologia , Obesidade/complicações , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
7.
BMC Nephrol ; 15: 153, 2014 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-25233856

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is public health concern even in Asian countries. TRK-100STP, a sustained release tablet of an orally-active prostacyclin analogue, beraprost sodium, is suggested to suppress worsening of some parameters of renal filtration function, containing in slope of 1/serum creatinine (1/SCr) vs. time in a phase II clinical trial. METHODS/DESIGN: We describe the design of the phase IIb/III trial of TRK-100STP, CASSIOPEIR (CRF Asian Study with Oral PGI2 derivative for Evaluating Improvement of Renal function) conducted in approximately 160 centers in China, Hong Kong, Japan, Malaysia, Republic of Korea, Taiwan, and Thailand. A total of 750 patients (n = 250 per group) with primary glomerular disease or nephrosclerosis were planned to be enrolled. Patients were randomized into one of three treatment groups in a double-bind, placebo-controlled manner: TRK-100STP 60 µg b.i.d.; TRK-100STP 120 µg b.i.d.; or placebo. The treatment period is planned to last 2 to 4 years. The primary efficacy endpoint is the renal composite endpoint including doubling of SCr and ESRD (dialysis induction, renal transplantation, or increase in SCr to ≥ 6.0 mg/dL). DISCUSSION: This trial targeting CKD patients is designed to (a) demonstrate the superiority of TRK-100STP over placebo using renal composite endpoints, (b) determine the recommended clinical dose, and (c) assess the safety of TRK-100STP in this population and setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01090037.


Assuntos
Epoprostenol/análogos & derivados , Epoprostenol/administração & dosagem , Glomérulos Renais/efeitos dos fármacos , Nefroesclerose/tratamento farmacológico , Nefroesclerose/epidemiologia , Administração Oral , Adulto , Idoso , Método Duplo-Cego , Epoprostenol/química , Feminino , Seguimentos , Humanos , Internacionalidade , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefroesclerose/diagnóstico , Adulto Jovem
8.
Diabetes Res Clin Pract ; 212: 111682, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38677368

RESUMO

AIMS: It is unclear whether the effect of proteinuria on rapid kidney function decline is equivalent among diabetic kidney disease (DKD), non-DKD with diabetes (NDKD+DM), and nephrosclerosis without diabetes (NS-DM), particularly in advanced chronic kidney disease patients. METHODS: In total, 1038 chronic kidney disease patients who participated in the BRIGHTEN study were included in the present study. A linear mixed effect model was applied to estimate the annual estimated glomerular filtration rate decline in each disease group. RESULTS: The prevalence of rapid decliners (rapid kidney function decline, defined as an eGFR loss of > 5 mL/min/1.73 m2/year) in the DKD group (44.6 %) was significantly higher compared with the NDKD+DM (27.9 %) and NS-DM (27.0 %) groups. By contrast, the prevalence of rapid decliners in different urine total protein to creatinine ratio (UPCR) categories (<0.5, 0.5 to < 1.0, 1.0 to < 3.5, and ≥ 3.5 g/g) were equivalent between the DKD and NS-DM groups. Moreover, the prevalence of a UPCR < 1.0 g/g in rapid decliners of the NS-DM group was more than double than in those of the DKD and NDKD+DM groups. CONCLUSIONS: The risk of rapid kidney function decline in NS-DM patients with low levels of proteinuria may be greater than initially predicted.


Assuntos
Nefropatias Diabéticas , Taxa de Filtração Glomerular , Proteinúria , Insuficiência Renal Crônica , Humanos , Proteinúria/epidemiologia , Proteinúria/fisiopatologia , Masculino , Feminino , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/epidemiologia , Pessoa de Meia-Idade , Taxa de Filtração Glomerular/fisiologia , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/epidemiologia , Idoso , Progressão da Doença , Adulto , Rim/fisiopatologia , Creatinina/urina , Nefroesclerose/fisiopatologia , Nefroesclerose/epidemiologia , Prevalência
13.
Lik Sprava ; (7-8): 106-10, 2011.
Artigo em Russo | MEDLINE | ID: mdl-22768748

RESUMO

It was modified the instant method of Caplan-Meiyer (worked out for the characteristic of the patients revealing) for calculation of a new criterion--preservation of the patient in the condition pre terminal chronic renal insufficiency (CRI). It was determined 102,5; 112,5; 122,5; 132,5; 142,5; 152,5; 162,5; 172,5; 182,5; 192,5; 202,5; 212,5; 222,5; 232.5; 242,5-monthly preservation of the patient in the condition pre terminal CRI, which was formed: (98.0 +/- 1.1)%, (92.8 +/- 1.8)%, (85.6 +/- 2.1)%, (75.9 +/- 2.4)%, (62.8 +/- 2.7)%, (51.0 +/- 2.5)%, (39.9 +/- 2.4)%, (30.7 +/- 2.1)%, (22.9 +/- 1.9)%, (17.0 +/- 1.6)%, (11.8 +/- 1.5)%, (7.9 +/- 1.3)%, (4.6 +/- 1.1)%, (1.9 +/- 0.6)%. It was shown that size of this parameter changed considerably subject to the initial reason of CRI the patient sex, adequateness of the medical providing, from harmful habits (smoking) and the presence of accompanying pathologies (comorbidity coefficient).


Assuntos
Glomerulonefrite/fisiopatologia , Nefroesclerose/fisiopatologia , Qualidade da Assistência à Saúde , Insuficiência Renal Crônica/fisiopatologia , Azerbaijão/epidemiologia , Doença Crônica , Comorbidade , Feminino , Glomerulonefrite/epidemiologia , Glomerulonefrite/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Nefroesclerose/epidemiologia , Nefroesclerose/mortalidade , Probabilidade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/mortalidade , Fatores de Risco , Fatores Sexuais , Fumar
14.
Medicine (Baltimore) ; 100(51): e28318, 2021 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-34941129

RESUMO

ABSTRACT: Equations to estimate glomerular filtration rate (eGFR) are useful for monitoring tje renal status of benign hypertensive nephrosclerosis (BHN). This study aimed to compare the applicability of 6 equations (Cockcroft-Gault [CG] adjusted for body surface area, original modification of diet in renal disease [MDRD], American abbreviated MDRD, Chinese modified MDRD, Chinese abbreviated MDRD, and Chronic Kidney Disease Epidemiology [CKD-EPI]) to estimate GFR in a Chinese BHN population. A total of 179 patients diagnosed with BHN were enrolled. The GFR estimated by each equation was compared to the reference GFR (rGFR) measured using the dual plasma sampling technetium-labeled diethylenetriaminepentaacetic acid method. The Chinese modified and Chinese abbreviated MDRD equations overestimated the rGFR, while the CG, CG adjusted for body surface area, original MDRD, American abbreviated MDRD, and CKD-EPI equations underestimated the rGFR. The difference in performance between estimated GFR (eGFR) based on the American abbreviated MDRD equation and the rGFR was not statistically significant (P = .191), while differences in the others were statistically significant (P < .05). Furthermore, the advantages in deviation, absolute deviation, deviation degree, precision, and accuracy were also significantly different from those of the other equations. Our findings suggest that eGFR based on the American abbreviated MDRD equation is suitable for the Chinese BHN population.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Hipertensão/etnologia , Nefroesclerose/etnologia , Insuficiência Renal Crônica/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão Renal , Masculino , Pessoa de Meia-Idade , Nefrite , Nefroesclerose/epidemiologia , Insuficiência Renal Crônica/etnologia , Pentetato de Tecnécio Tc 99m , Tomografia Computadorizada de Emissão de Fóton Único/métodos
15.
Nefrologia ; 30(3): 304-9, 2010.
Artigo em Espanhol | MEDLINE | ID: mdl-20414328

RESUMO

OBJECTIVE: Hypertensive nephropathy is the second most common cause for starting renal replacement therapy in Spain with a steady incidence since 1997. Data on incidence of hypertensive nephropathy previously to dialysis are scanty because there are not registries similar to those used for renal replacement therapy. DESIGN AND METHODS: Retrospectively we studied the records of our hospital Nephrology outpatients clinic from January, 1991 to December, 2007. Diagnosis was commonly made using clinical criteria in most of cases. There were 60 cases with proteinuria higher than 1 g/day and so that renal biopsies were performed. RESULTS: During this time 479 (44.0 pmp) patients were diagnosed of hypertensive nephropathy (mean age 66.6 +/- 12.1 years and 43.0% were women). Incidence increased from 33.3 pmp (1991) to 76.2 pmp (2006). There was a steady trend to increase incidence since 16.7 pmp in 1991 up to 89.5 pmp in 2007. Mean incidence was 31.8 pmp between 1991 and 1995, 32.1 pmp in the period 1996-2000; and 54.4 pmp from 2001 to 2006. The mean age of incident patients showed a J curve. 53 subjects (11.6%) have started renal replacement therapy. Survival before starting renal replacement therapy was 96.0 at first year, 85.9% at five years and 81.6% after seven years of follow-up. CONCLUSIONS: Incidence of hypertensive nephropathy seems to have increased last years specially in spite of therapeutic improvements the prognosis is still unfavourable. Less restricted age criteria for submitting patients may have influenced these results.


Assuntos
Hipertensão/epidemiologia , Falência Renal Crônica/etiologia , Nefroesclerose/etiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia , Nefropatias Diabéticas/epidemiologia , Progressão da Doença , Feminino , Humanos , Hipertensão/complicações , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Estimativa de Kaplan-Meier , Rim/irrigação sanguínea , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefroesclerose/epidemiologia , Obesidade/epidemiologia , Prognóstico , Proteinúria/etiologia , Proteinúria/patologia , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos
16.
Nefrologia ; 30(6): 687-97, 2010.
Artigo em Espanhol | MEDLINE | ID: mdl-21113220

RESUMO

BACKGROUND: Hypertensive nephrosclerosis is a chronic kidney disease (CKD) associated with essential hypertension. The lack of correlation between hypertension control and progression to end-stage CKD suggests an intrinsic and primitive disease. New evidence suggests that MYH9 gene alterations are associated with polymorphisms in African Americans. The aim of this study is to investigate whether a polymorphism of MYH9 in Caucasians is linked to essential hypertension and nephrosclerosis. The secondary objective is to identify the clinical risk factors of progression to end-stage CKD. This is a retrospective study that will compare patients with nephrosclerosis and essential hypertensives without renal disease, and also patients with nephrosclerosis and impaired renal function with those that are stable. METHOD: Between October 2009 and October 2010, 500 patients with stages 3-5 CKD attributed to nephrosclerosis according to usual clinical criteria, and 300 essential hypertensives (eGFR>60 mL/min/1.73 m2; microalbuminuria <300 mg/g) are to be recruited. A total of 200 healthy controls from the general population are also to be included for the genetic study. There are two study sections, being the first and final visits to the clinic (for stage 5 cases, the start of replacement therapy will be the end of follow-up). Clinical and laboratory data will be recorded, and blood samples will be collected. DISCUSSION: Our study will aim to determine if there is a relationship between the diagnosis of nephrosclerosis and the MYH9 gene in Caucasians, and to study possible risk factors for progression to end-stage CKD, on both clinical and genetic bases.


Assuntos
Hipertensão/genética , Proteínas Motores Moleculares/genética , Estudos Multicêntricos como Assunto/métodos , Cadeias Pesadas de Miosina/genética , Nefroesclerose/genética , Adulto , Idoso , Comorbidade , Progressão da Doença , Feminino , Predisposição Genética para Doença , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/etnologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto/economia , Nefroesclerose/epidemiologia , Nefroesclerose/etnologia , Nefroesclerose/etiologia , Apoio à Pesquisa como Assunto , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , População Branca/genética
17.
Semin Nephrol ; 40(1): 69-75, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32130968

RESUMO

As early detection and advances in the treatment for renal cell carcinoma continue to lead to excellent oncologic outcomes, the preservation of renal function in kidney cancer patients has emerged as an increasingly important clinical objective. Given that diabetes, hypertension, obesity, cigarette smoking, and aging are independent risk factors for renal cell carcinoma, the corresponding non-neoplastic kidney diseases frequently are present, but often undiagnosed. In addition, the subsequent clinical management of the ensuing chronic kidney disease historically has not included nephrologists. Awareness of these practice gaps remain low among nephrologists, surgeons, and pathologists. This article discusses the common non-neoplastic kidney diseases that are encountered in cancer nephrectomy specimens. The accurate and timely diagnosis of these disorders will result in additional gains in clinical outcomes. There is a unique opportunity for the nephrology community to play a central role in the management of chronic kidney disease that often is present in kidney cancer patients.


Assuntos
Arteriosclerose/epidemiologia , Carcinoma de Células Renais/epidemiologia , Nefropatias Diabéticas/epidemiologia , Neoplasias Renais/epidemiologia , Nefrectomia , Nefroesclerose/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Amiloidose/epidemiologia , Amiloidose/patologia , Arteriosclerose/patologia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Nefropatias Diabéticas/patologia , Glomerulonefrite/epidemiologia , Glomerulonefrite/patologia , Glomerulonefrite Membranosa/epidemiologia , Glomerulonefrite Membranosa/patologia , Glomerulosclerose Segmentar e Focal/epidemiologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefroesclerose/patologia , Insuficiência Renal Crônica/patologia , Fatores de Risco , Microangiopatias Trombóticas/epidemiologia , Doenças não Diagnosticadas
18.
Med Arch ; 73(2): 87-91, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391693

RESUMO

INTRODUCTION: In patients with diabetes mellitus (DM), non-diabetic renal disease (NDRD) can also occurs, as well as diabetic nephropathy. NDRD is most accurately diagnosed using kidney biopsy. AIM: The aim of the study was to investigate the incidence and type of NDRD diagnosed by kidney biopsy in patients with type 2 DM and the correlation of clinical and laboratory findings with histopathological diagnosis. MATERIAL AND METHODS: From April 2007 to October 2018, 290 kidney biopsies were performed at the Department of Nephrology, Internal Medicine Clinic in Banja Luka, out of which 18 patients (males 9, mean age 59.8 years) were with type 2 DM. The US-guided (ultrasound device: Toshiba Famio 5) kidney biopsy was performed using an automatic biopsy instrument FAST-GUN® with needle 16G. Kidney tissue samples were analyzed by light microscopy and immunofluorescence. RESULTS: In 18 patients with type 2 DM, the average duration of the disease was 5.9 years, 5 patients had a retinopathy, and 16 patients had hypertension. Biopsy indications were: nephrotic syndrome in 11 patients, asymptomatic urinary abnormalities in 3 patients, and rapid chronic renal failure progression. Unsatisfactory quality sample for pathohistological analysis was obtained in one patient, and out of the other 17, 6 (35.3%) had NDRD, 3 (17.6%) had NDRD superimposed with the diabetic nephropathy, and 8 (47.1%) had diabetic nephropathy. Of the patients who had NDRD, 3 had membranous glomerulonephritis, 1 had focal segmental glomerulosclerosis, and two had hypertensive nephroangiosclerosis. Out of patients with coexisting NDRD and diabetic nephropathy, 2 had hypertensive nephroangiosclerosis and one diabetic nephropathy and lupus nephritis. CONCLUSION: NDRD was diagnosed using kidney biopsy in 9/17 patients with type 2 DM, which confirms the significance of the kidney biopsy in patients with DM with properly indications. Accurate diagnosis provides disease specific treatment and thus significantly improves the long-term prognosis of the patient.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Glomerulonefrite Membranosa/epidemiologia , Glomerulosclerose Segmentar e Focal/epidemiologia , Nefrite Lúpica/epidemiologia , Nefroesclerose/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Comorbidade , Nefropatias Diabéticas/patologia , Feminino , Glomerulonefrite Membranosa/patologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Biópsia Guiada por Imagem , Nefrite Lúpica/patologia , Masculino , Pessoa de Meia-Idade , Nefroesclerose/patologia , Insuficiência Renal Crônica/patologia , Ultrassonografia
19.
Nephrol Dial Transplant ; 23(8): 2576-85, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18308771

RESUMO

BACKGROUND: Low glomerular number and large glomerular volume are hypothesized to be risk factors for hypertensive renal disease in adult life. Reports of human glomerular number are based on studies from developed nations and have found single kidney mean values of approximately 900 000 per kidney with a roughly 8-fold range matched by a similar range in glomerular volume. Glomerular number and volume have never been investigated in people from a developing country. METHODS: This study analysed the pathology of 81 autopsy kidneys from Dakar, Senegal, and determined total glomerular number and mean glomerular volume in 28 of these kidneys using the physical disector/fractionator method. RESULTS: Total glomerular number ranged 2.6-fold from 536 171 to 1 394 010, with a mean of 925 485 nephrons. The mean glomerular volume was 5.74 microm(3) x 10(6) with a 2.5-fold variation that was strongly and inversely correlated with total glomerular number. Glomerular number was inversely correlated with age, and age-associated increases in arteriosclerosis, cortical fibrosis and glomerulosclerosis were observed. Arteriolar nephrosclerosis was observed in 34% of adults. Mean glomerular number in this Dakar population was similar to that previously reported for people from developed nations, while the range of glomerular number and mean glomerular volume was much narrower. CONCLUSIONS: The frequency of arteriolar nephrosclerosis in these Senegalese adults was high (34%), suggesting that hypertensive kidney disease could contribute to a large burden of future chronic kidney disease in this population. Unusually low glomerular number or large glomerular volume do not appear to provide a basis for this potential burden of kidney disease.


Assuntos
Rim/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Arteriosclerose/patologia , Criança , Pré-Escolar , Feminino , Fibrose , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Córtex Renal/patologia , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefroesclerose/epidemiologia , Nefroesclerose/patologia , Senegal/epidemiologia , População Urbana
20.
Am J Kidney Dis ; 46(5): 863-70, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16253726

RESUMO

BACKGROUND: Mortality rates in patients with chronic renal failure (CRF) are high both before and after start of renal replacement therapy (RRT). However, few studies of mortality and progression have been performed in an unselected CRF population. METHODS: We followed up a population-based inception cohort of 920 men and women aged 18 to 74 years who had CRF (serum creatinine level > 3.4 mg/dL [>300 micromol/L] for men and >2.8 mg/dL [>250 micromol/L] for women) for 55 to 79 months. Relationships between the outcomes (death and start of RRT) and independent variables under study (age, sex, primary renal disease, body mass index [BMI], and glomerular filtration rate [GFR] at entry) were explored by using Cox regression models. RESULTS: Seven hundred thirty-nine patients (80%) started RRT during the follow-up period. As expected, GFR at entry was clearly linked to the incidence of RRT (P < 0.0001). Age was related inversely to incidence of RRT (adjusted relative risk for patients > or =65 years relative to patients <45 years, 0.72; 95% confidence interval, 0.57 to 0.90). Men progressed to RRT more often than women (adjusted relative risk, 1.59; 95% confidence interval, 1.35 to 1.88). BMI was unrelated to RRT incidence. By the end of follow-up, 389 patients with CRF (42%) had died, 89 of them (10%) before the start of RRT. The most common primary cause of death was cardiovascular disease (37.5%). Characteristics significantly related to a greater mortality rate included older age, diagnoses of diabetic nephropathy and nephrosclerosis, and low BMI. CONCLUSION: Preuremic characteristics (age, sex, primary renal diagnosis, BMI, and GFR) are predictive of prognosis in unselected patients with CRF.


Assuntos
Falência Renal Crônica/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Estudos de Casos e Controles , Causas de Morte , Comorbidade , Creatinina/sangue , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Progressão da Doença , Feminino , Seguimentos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Mortalidade , Nefroesclerose/epidemiologia , Terapia de Substituição Renal , Risco , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologia
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