RESUMEN
Chronic renal allograft injury is reflected by interstitial fibrosis and tubular atrophy (IF/TA) and by the accumulation of extracellular matrix (ECM). Metalloproteinases (MMPs) are renal physiologic regulators of ECM degradation. Changes in MMPs expression or activity may disturb ECM turnover leading to glomerular scarring and worsening renal function. Our goal was to investigate intragraft MMP2 and MMP9 activities and their correlation with renal dysfunction. Plasma MMP2 and MMP9 activities were analyzed as noninvasive markers of renal allograft deterioration. Transplanted patients were biopsied and histopathologically characterized as IF/TA+ or IF/TA-. Renal function was evaluated by serum creatinine, glomerular filtration rate (GFR) estimated by Modification of Diet in Renal Disease equation and urinary protein/creatinine ratio. Kidney and plasma MMP2 and MMP9 activities were analyzed by zymography. A significant renal dysfunction was observed in IF/TA+ patients. Intragraft proMMP9 showed a significant higher activity in IF/TA+ than in IF/TA- samples and was inversely correlated with the GFR. Intragraft proMMP2 activity tended to increase in IF/TA+ samples, although no statistic significance was reached. Circulating proMMP2 and proMMP9 activities did not show significant differences between groups. Our data provide evidence that correlates intragraft proMMP9 activity with the fibrotic changes and renal dysfunction observed in IF/TA.
Asunto(s)
Fibrosis/fisiopatología , Trasplante de Riñón , Túbulos Renales/patología , Riñón/fisiopatología , Adulto , Atrofia/cirugía , Biopsia , Estudios de Cohortes , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/terapia , Dieta , Femenino , Fibrosis/cirugía , Tasa de Filtración Glomerular , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Hipertensión Renal/complicaciones , Hipertensión Renal/terapia , Riñón/metabolismo , Riñón/cirugía , Pruebas de Función Renal , Masculino , Metaloproteinasa 2 de la Matriz/sangre , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/sangre , Metaloproteinasa 9 de la Matriz/metabolismo , Persona de Mediana Edad , Nefritis/complicaciones , Nefritis/terapiaRESUMEN
BACKGROUND/AIM: Chronic kidney disease (CKD) is an increasing major public health problem worldwide. The sympathetic nervous system and nitric oxide play an important role in the pathogenesis of CKD. Traditional Chinese medicine has accumulated thousands of years of therapeutic experiences. Electroacupuncture (EA) and moxibustion (MO) are two such therapeutic strategies. The aim of this study was to investigate the renal and hemodynamic effects of EA-MO in an experimental model of a CKD. METHODS: Male Wistar rats submitted to 5/6th nephrectomy (5/6 NX) were studied for 8 weeks. There were four groups: (1) control, normal rats; (2) NX, 5/6 NX only; (3) NX-AS, 5/6 NX and EA-MO session using sham points, and (4) NX-AM, 5/6 NX and EA-MO session using real acupoints. Biochemical and blood pressure studies, renal sympathetic nerve activity measurements, nitric oxide levels and the histopathological indices were assessed. RESULTS: The EA- and MO-treated group presented significant improvement in all measured functional and histopathological parameters. CONCLUSION: These findings suggest that EA-MO had beneficial effects on CKD. This effect was probably achieved by the modulation of the renal sympathetic nerve activity and nitric oxide levels, leading to decreased blood pressure, which is associated with less proteinuria.
Asunto(s)
Electroacupuntura/métodos , Moxibustión/métodos , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia , Sistema Nervioso Simpático/fisiología , Animales , Presión Sanguínea/fisiología , Creatinina/sangre , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Glomeruloesclerosis Focal y Segmentaria/fisiopatología , Glomeruloesclerosis Focal y Segmentaria/terapia , Hipertensión Renal/fisiopatología , Hipertensión Renal/terapia , Riñón/inervación , Riñón/fisiología , Masculino , Nefrectomía , Óxido Nítrico/metabolismo , Proteinuria/fisiopatología , Proteinuria/terapia , Ratas , Ratas Wistar , Urea/sangre , OrinaRESUMEN
The purpose of this retrospective cohort study was to describe the outcome of 107 patients with chronic kidney disease (CKD) admitted to a pre-dialysis interdisciplinary management program from 1990 to 2006. The events of interest were progression to CKD stage 5 (renal survival), patient survival, hypertension, and somatic growth. Survival was studied by the Kaplan-Meier method. Patients were classified into four groups according to their primary renal disease: congenital nephro-uropathies; glomerular diseases; cystic disease, and miscellaneous. Median follow-up time was 94 months [Interquartile (IQ) range 38-145]. The probability of reaching CKD stage 5 was estimated to be 36% by 5 years after admission. As a whole, the mean estimated glomerular filtration rate (GFR) decrease per year was 5.8 ml/min per 1.73 m(2) body surface area [standard deviation (SD) 12.4]. The glomerular diseases group showed a median rate of GFR deterioration of 10 ml/min per 1.73 m(2) per year (IQ range -24 to -5.7), whereas the median rate of GFR deterioration for the groups with cystic diseases, congenital nephro-uropathies, and miscellanea were 2.5 ml/min (IQ range -10 to +0.34), 2.2 ml/min (IQ range -5.0 to -0.52), and 0.36 ml/min (IQ range -2.5 to +2.6), respectively (P < 0.001). The results of this study support the view that children and adolescents with glomerular diseases present a faster deterioration of renal function. Therefore, patients with glomerular diseases need to be referred early to a pediatric nephrology center so that suboptimal pre-dialysis care might possibly be avoided.
Asunto(s)
Proteinuria/mortalidad , Proteinuria/terapia , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/terapia , Adolescente , Niño , Preescolar , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Glomerulonefritis/mortalidad , Glomerulonefritis/terapia , Humanos , Hipertensión Renal/mortalidad , Hipertensión Renal/terapia , Estimación de Kaplan-Meier , Masculino , Grupo de Atención al Paciente , Diálisis Renal , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
El infarto renal puede definirse como la muerte de tejido renal debido a interferencia con su circulación sanguínea. Se presenta el caso de un paciente masculino, de nueve años de edad, con cefalea universal, vómitos de contenido gástrico y una tensión arterial (TA) de 140/100 mmHg. Su renina plasmática periférica fue de 7.4 ng/mL/h (normal hasta 2.5 ng/mL/h). La arteriografía renal indicó infarto parenquimatoso en polo superior de riñón derecho. Actualmente, está controlado con una tensión arterial de 110/70 mmHg, para lo cual recibe 1 mg/kg/día de captopril complementado con dieta hiposódica.
Asunto(s)
Niño , Humanos , Masculino , Enfermedades Vasculares/fisiopatología , Captopril/uso terapéutico , Insuficiencia Renal/sangre , Hidralazina/uso terapéutico , Necrosis de la Corteza Renal/fisiopatología , Enfermedades Renales/terapia , Dieta Hiposódica/métodos , Hipertensión Renal/terapia , Riñón/patologíaAsunto(s)
Humanos , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/prevención & control , Donantes de Tejidos , Donadores Vivos , Riñón , Trasplante de Riñón/normas , Anemia/etiología , Anemia/terapia , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/terapia , Hipertensión Renal/terapia , Diálisis/normasAsunto(s)
Humanos , Insuficiencia Renal Crónica/tratamiento farmacológico , Anemia/etiología , Anemia/terapia , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/terapia , Diálisis/normas , Hipertensión Renal/terapia , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/prevención & control , Riñón , Donadores Vivos , Donantes de Tejidos , Trasplante de Riñón/normasAsunto(s)
Espacio Extracelular/fisiología , Hipertensión Renal/fisiopatología , Fallo Renal Crónico/fisiopatología , Sistema Renina-Angiotensina , Adolescente , Adulto , Captopril/uso terapéutico , Dieta Hiposódica , Femenino , Humanos , Hipertensión Renal/terapia , Indometacina/uso terapéutico , Masculino , Diálisis RenalRESUMEN
A 34 year old patient with prolonged unstable angina pectoris who did not respond to medical treatment is presented. In the course of three days he developed acute subendocardial infarction complicated by severe ventricular arrhythmias and cardiac arrest. Previously renovascular arterial hypertension due to important stenosis of the right renal artery had been diagnosed by renal arteriography. The precordial pain did not disappear with acute myocardial infarction. He presented acute postinfarction angina which required the use of vasodilator and beta-adrenergic blocking agents which did not alleviate his symptoms completely. Coronary arteriography performed a month after acute myocardial infarction demonstrated 99% stenosis of the left main coronary artery and 70% stenosis of the left anterior descending artery. During three days before surgery intraaortic ballon pumping was employed and the patient did not present precordial pain. The patient became asymptomatic after placing two aortocoronary vein grafts to the left anterior descending and circumflex arteries, and three months later blood pressure fell to normal after placing a right aorto renal graft. The poor prognosis of critical stenosis of the main left branch, its medical treatment and better evolution after surgery is discussed. The indications for intra-aortic ballon pumping in this type of patients and its use before surgery so as to be able to suspend beta-adrenergic blocking agents without risks are specified. Finally the surgical indications for renovascular hypertension are discussed.