RESUMEN
AIM: The role of post-reperfusion biopsy findings as a predictor of early and long-term graft function and survival is still a target of research. METHODS: We analyzed data from 136 post-reperfusion biopsies performed in deceased donor renal transplanted patients from November 2008 to May 2012. We analyzed the presence of acute tubular necrosis (ATN), arteriolar hyalinosis (AH), intimal thickness (IT), interstitial fibrosis (IF) and glomerulosclerosis (GS). We also analyzed the impact of donor features on the following outcomes: delayed graft function (DGF) and chronic allograft dysfunction defined as eGFR < 60 mL/min at 1 year. RESULTS: The mean donor age was 41 years, 26% of whom were extended criteria donors (ECD), 33% had hypertension and 50% had cerebral vascular accident (CVA) as the cause of death. ATN was present in 87% of these biopsies, AH in 31%, IF in 21%, IT in 27% and GS in 32%. DGF occurred in 80% and chronic allograft dysfunction was present in 53%. AH was the only histological finding associated with DGF and chronic allograft dysfunction at 1 year. Patients with AH had a lower eGFR at 1 year than patients without it (49.8 mL/min × 64.5 mL/min, P = 0.02). In the multivariate analysis, risk variables for development of chronic graft dysfunction were male sex (odds ratio [OR] = 3.159 [CI: 1.22-8.16]; P = 0.018), acute rejection (OR = 8.91 [CI: 2.21-35.92]; P = 0.002), donor hypertension (OR = 2.94 [CI: 1.10-7.84]; P = 0.031), AH (OR = 3.96 [CI: 1.46-10.70]; P = 0.007) and eGFR at discharge (OR = 0.96 [CI: 0.93-0.98]; P = 0.005). In multivariate analysis, risk factors for AH were donor age ≥ 50 years (OR = 2.46 [CI: 1.10-5.44]; P = 0.027) and CVA as the cause of donor death (OR = 2.33 [CI: 1.05-5.15]; P = 0.007). CONCLUSION: The presence of AH in post-reperfusion biopsies is a marker of ageing and vascular disease and was associated with DGF and a one year poorer renal function. AH in donor biopsies superimposed to long ischaemic time is a predictor of renal function. The management of immunosuppression based on the presence of AH in post-reperfusion biopsy could be useful to improve long term graft function.
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Arterioloesclerosis , Funcionamiento Retardado del Injerto , Necrosis Tubular Aguda , Adulto , Arterioloesclerosis/metabolismo , Arterioloesclerosis/patología , Biopsia/métodos , Funcionamiento Retardado del Injerto/etiología , Funcionamiento Retardado del Injerto/patología , Funcionamiento Retardado del Injerto/fisiopatología , Funcionamiento Retardado del Injerto/prevención & control , Femenino , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Hialina/metabolismo , Terapia de Inmunosupresión/métodos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Necrosis Tubular Aguda/complicaciones , Necrosis Tubular Aguda/patología , Necrosis Tubular Aguda/fisiopatología , Masculino , Daño por Reperfusión/fisiopatología , Daño por Reperfusión/prevención & control , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Venom-induced acute kidney injury (AKI) is a frequent complication of Bothrops snakebite with relevant morbidity and mortality. The aim of this study was to assess the effects of Schizolobium parahyba (SP) extract, a natural medicine with presumed anti-Bothrops venom effects, in an experimental model of Bothrops jararaca venom (BV)-induced AKI. METHODOLOGY: Groups of 8 to 10 rats received infusions of 0.9% saline (control, C), SP 2 mg/kg, BV 0.25 mg/kg and BV immediately followed by SP (treatment, T) in the doses already described. After the respective infusions, animals were assessed for their glomerular filtration rate (GFR, inulin clearance), renal blood flow (RBF, Doppler), blood pressure (BP, intra-arterial transducer), renal vascular resistance (RVR), urinary osmolality (UO, freezing point), urinary neutrophil gelatinase-associated lipocalin (NGAL, enzyme-linked immunosorbent assay [ELISA]), lactate dehydrogenase (LDH, kinetic method), hematocrit (Hct, microhematocrit), fibrinogen (Fi, Klauss modified) and blinded renal histology (acute tubular necrosis score). PRINCIPAL FINDINGS: BV caused significant decreases in GFR, RBF, UO, HcT and Fi; significant increases in RVR, NGAL and LDH; and acute tubular necrosis. SP did not prevent these changes; instead, it caused a significant decrease in GFR when used alone. CONCLUSION: SP administered simultaneously with BV, in an approximate 10â¶1 concentration, did not prevent BV-induced AKI, hemolysis and fibrinogen consumption. SP used alone caused a decrease in GFR.
Asunto(s)
Lesión Renal Aguda/tratamiento farmacológico , Bothrops/metabolismo , Fabaceae/química , Extractos Vegetales/uso terapéutico , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/orina , Proteínas de Fase Aguda/orina , Animales , Biomarcadores/orina , Moléculas de Adhesión Celular/orina , Venenos de Crotálidos , Hematócrito , Hemodinámica/efectos de los fármacos , Pruebas de Función Renal , Necrosis Tubular Aguda/complicaciones , Necrosis Tubular Aguda/patología , Necrosis Tubular Aguda/fisiopatología , Necrosis Tubular Aguda/orina , Lipocalina 2 , Lipocalinas/orina , Masculino , Fitoterapia , Extractos Vegetales/farmacología , Proteínas Proto-Oncogénicas/orina , Ratas , Ratas WistarRESUMEN
A insuficiência renal aguda é comum em pacientes com síndrome nefrótica, podendo requerer terapia de substituição renal e ser irreversível. A insuficiência renal aguda nesses pacientes pode ser precipitada por processos infecciosos, hipovolemia, drogas nefrotóxicas; entretanto na maioria dos casos a etiologia não é identificada e a insuficiência renal aguda é considerada idiopática. A necrose tubular aguda foi associada à insuficiência renal aguda em adultos com lesão mínima. O objetivo deste estudo é avaliar a correlação entre a necrose tubular aguda definida histologicamente com insuficiência renal aguda em pacientes com doença glomerular. Biópsias renais de pacientes com glomerulopatia foram analisadas quanto à intensidade da necrose tubular aguda e esses dados correlacionados com os dados clínicos e presença de insuficiência renal aguda. A análise foi realizada em duas amostras e a intensidade de necrose tubular aguda graduada de duas formas: na primeira amostra a intensidade de necrose tubular aguda foi graduada em cinco níveis de intensidade; na segunda amostra foi feita uma estimativa em percentual da área da cortical acometida. A acurácia da análise semiquantitativa na primeira amostra foi avaliada por meio da correlação com análise morfométrica relativa ao número de túbulos com características necróticas por área de cortical (Spearman r=0,88, P<0,0001) e ao percentual de área da cortical com necrose tubular aguda (Spearman r=0,93, P<0,0001). A reprodutibilidade da análise intraobservador foi regular (kappa=0,53, P<0,0001). A primeira amostra constou de 149 casos com idade média de 21±16 anos. A síndrome nefrótica esteve presente em 104 (72%) pacientes e os principais diagnósticos foram: doenças do espectro Lesão Mínima Glomeruesclerose Segmentar e Focal (45%). Necrose tubular aguda foi observada em 114 (77%) pacientes. insuficiência renal aguda foi diagnosticada em 43 (42%) pacientes. Houve correlação positiva entre a intensidade da necrose tubular aguda e a presença de insuficiência renal (gamma=0,70, P<0,0001). A segunda amostra foi composta por 80 pacientes com idade média 32 ± 18 anos. Síndrome nefrótica foi diagnosticada em 72 (90%) casos e os principais diagnósticos foram as doenças do espectro lesão mínima-Glomeruloesclerose segmentar e focal (54, 68%). Necrose tubular aguda foi observada em 60 (75%) pacientes e insuficiência renal aguda foi diagnosticada em 28 (35%) casos. A intensidade de necrose tubular aguda foi maior nos pacientes com (29,1 ± 27,7) que nos pacientes sem insuficiência renal aguda (5.4 ± 5.1, P<0,0001). A presença de necrose tubular aguda apresentou alta especificidade para diagnóstico de insuficiência renal aguda quando estimada em 10% da cortical representada (especificidade 96,1%, curva ROC [AUC=0,832, P<0,0001]). Não houve diferença entre os grupos com e sem insuficiência renal aguda em relação ao sexo, proteinúria, doença renal e albumina sérica, colesterol e triglicérides. A freqüência de hipertensão arterial sistêmica foi maior no grupo com insuficiência renal aguda com idade mais elevada (P=0,015).
Asunto(s)
Humanos , Adolescente , Histología , Lesión Renal Aguda/patología , Necrosis Tubular Aguda/fisiopatología , Síndrome Nefrótico/metabolismoRESUMEN
BACKGROUND: The differentiation between acute interstitial nephritis (AIN) and acute tubular necrosis (ATN) is crucial in patients with acute kidney injury. Gallium-67 citrate (Ga-67) has been used clinically in the differential diagnosis between these entities, but its efficacy is disputed. The aim of this study was to evaluate Ga-67 scintigraphy efficacy in the differentiation between experimental models of drug-induced AIN and ATN. METHODS: Animals were divided into three groups: AIN (n = 8), ATN (n = 8) and control (NL, n = 10). The AIN group received intraperitoneal puromycin aminonucleoside (single dose, 150 mg/kg). The ATN group received a single intraperitoneal injection of cisplatin (6 mg/kg). The NL group did not receive active drugs. All of the animals were submitted to Ga-67 scintigraphy, serum creatinine (Cr) and urinary osmolality assessment, and blinded renal histology evaluation. RESULTS: Renal Ga-67 uptake was strikingly more intense in the AIN group when compared to the ATN (P < 0.0001) and NL (P < 0.001) groups. The ATN group had increased Cr when compared to the NL group (P < 0.001) and lower urinary osmolality vs the NL (P < 0.001) and AIN (P < 0.01) groups. Renal histology showed severe acute tubular injury in the ATN group and intense interstitial inflammation in the AIN group, and was normal in control animals. CONCLUSION: Ga-67 scintigraphy was extremely effective in the differentiation between experimental drug-induced ATN and AIN.
Asunto(s)
Radioisótopos de Galio , Necrosis Tubular Aguda/diagnóstico por imagen , Nefritis Intersticial/diagnóstico por imagen , Enfermedad Aguda , Lesión Renal Aguda/diagnóstico por imagen , Animales , Diagnóstico Diferencial , Riñón/patología , Riñón/fisiopatología , Necrosis Tubular Aguda/fisiopatología , Masculino , Nefritis Intersticial/fisiopatología , Cintigrafía , Ratas , Ratas WistarRESUMEN
Relationship between cirrhosis and renal dysfunction is not yet fully understood. A model of cirrhosis with acute hepatic and renal damage (RF), produced by CCl4 in rats, with hemodynamic and renal functional alterations, similar to those observed in decompensated cirrhosis (DC) in man, was used to study chemical nephrotoxicity in animals. We performed in male Wistar rats hepatic and renal functional and hemodynamic studies in control, cirrhotic and decompensated cirrhotic (DC) groups. Cirrhosis was induced with carbon tetrachloride by chronic administration. Association between liver and renal functional alterations was detected in rats with decompensated cirrhosis, showing fall in mean arterial pressure and reduction of glomerular filtration rate and filtration fraction. Renal hemodynamics did not change in cirrhotic rats, similarly to what occurs in compensated cirrhotic patients. However, DC rats exhibited increased sodium, glucose and phosphate urinary excretions and decreased ATP in renal cortex. DC animals had severe hypoglycemia. There was an extensive liver fibrosis. Glomeruli had hypercellularity and tubules showed extensive vacuolization in cirrhotic and DC rats. The present study suggests that in this model, damage typical of acute tubular necrosis ensues in cirrhotic rats. We describe functional and morphological damage in liver and kidney in a model of cirrhosis that might predispose to the development of acute renal failure when an individual with hepatic damage is exposed in acute way to chemical toxicants.
Asunto(s)
Lesión Renal Aguda/fisiopatología , Tetracloruro de Carbono/toxicidad , Riñón/efectos de los fármacos , Cirrosis Hepática Experimental/fisiopatología , Hígado/efectos de los fármacos , Lesión Renal Aguda/etiología , Adenosina Trifosfato/análisis , Animales , Intoxicación por Tetracloruro de Carbono/fisiopatología , Tasa de Filtración Glomerular , Humanos , Riñón/irrigación sanguínea , Riñón/patología , Riñón/fisiopatología , Necrosis Tubular Aguda/etiología , Necrosis Tubular Aguda/fisiopatología , Túbulos Renales/patología , Túbulos Renales/fisiopatología , Hígado/irrigación sanguínea , Hígado/patología , Hígado/fisiopatología , Cirrosis Hepática Experimental/complicaciones , Masculino , Ratas , Ratas Wistar , Circulación RenalRESUMEN
Renal ischemia-reperfusion (IR) injury is the major cause of acute renal failure in native and transplanted kidneys. Mononuclear leukocytes have been reported in renal tissue as part of the innate and adaptive responses triggered by IR. We investigated the participation of CD4+ T lymphocytes in the pathogenesis of renal IR injury. Male mice (C57BL/6, 8 to 12 weeks old) were submitted to 45 min of ischemia by renal pedicle clamping followed by reperfusion. We evaluated the role of CD4+ T cells using a monoclonal depleting antibody against CD4 (GK1.5, 50 micro, ip), and class II-major histocompatibility complex molecule knockout mice. Both CD4-depleted groups showed a marked improvement in renal function compared to the ischemic group, despite the fact that GK1.5 mAb treatment promoted a profound CD4 depletion (to less than 5% compared to normal controls) only within the first 24 h after IR. CD4-depleted groups presented a significant improvement in 5-day survival (84 vs 80 vs 39%; antibody treated, knockout mice and non-depleted groups, respectively) and also a significant reduction in the tubular necrosis area with an early tubular regeneration pattern. The peak of CD4-positive cell infiltration occurred on day 2, coinciding with the high expression of betaC mRNA and increased urea levels. CD4 depletion did not alter the CD11b infiltrate or the IFN-gamma and granzyme-B mRNA expression in renal tissue. These data indicate that a CD4+ subset of T lymphocytes may be implicated as key mediators of very early inflammatory responses after renal IR injury and that targeting CD4+ T lymphocytes may yield novel therapies.
Asunto(s)
Lesión Renal Aguda/inmunología , Lesión Renal Aguda/fisiopatología , Linfocitos T CD4-Positivos/inmunología , Daño por Reperfusión/inmunología , Daño por Reperfusión/fisiopatología , Animales , Adhesión Celular/inmunología , Movimiento Celular/inmunología , Modelos Animales de Enfermedad , Hipoxia/inmunología , Hipoxia/fisiopatología , Riñón/irrigación sanguínea , Riñón/fisiología , Necrosis Tubular Aguda/inmunología , Necrosis Tubular Aguda/fisiopatología , Masculino , Ratones , Ratones Endogámicos C57BLRESUMEN
Renal ischemia-reperfusion (IR) injury is the major cause of acute renal failure in native and transplanted kidneys. Mononuclear leukocytes have been reported in renal tissue as part of the innate and adaptive responses triggered by IR. We investigated the participation of CD4+ T lymphocytes in the pathogenesis of renal IR injury. Male mice (C57BL/6, 8 to 12 weeks old) were submitted to 45 min of ischemia by renal pedicle clamping followed by reperfusion. We evaluated the role of CD4+ T cells using a monoclonal depleting antibody against CD4 (GK1.5, 50 æ, ip), and class II-major histocompatibility complex molecule knockout mice. Both CD4-depleted groups showed a marked improvement in renal function compared to the ischemic group, despite the fact that GK1.5 mAb treatment promoted a profound CD4 depletion (to less than 5 percent compared to normal controls) only within the first 24 h after IR. CD4-depleted groups presented a significant improvement in 5-day survival (84 vs 80 vs 39 percent; antibody treated, knockout mice and non-depleted groups, respectively) and also a significant reduction in the tubular necrosis area with an early tubular regeneration pattern. The peak of CD4-positive cell infiltration occurred on day 2, coinciding with the high expression of ßC mRNA and increased urea levels. CD4 depletion did not alter the CD11b infiltrate or the IFN-g and granzyme-B mRNA expression in renal tissue. These data indicate that a CD4+ subset of T lymphocytes may be implicated as key mediators of very early inflammatory responses after renal IR injury and that targeting CD4+ T lymphocytes may yield novel therapies.
Asunto(s)
Animales , Masculino , Ratones , Lesión Renal Aguda , /inmunología , Daño por Reperfusión/inmunología , Daño por Reperfusión/fisiopatología , Hipoxia/inmunología , Hipoxia/fisiopatología , Adhesión Celular/inmunología , Movimiento Celular/inmunología , Modelos Animales de Enfermedad , Necrosis Tubular Aguda/inmunología , Necrosis Tubular Aguda/fisiopatología , Riñón/irrigación sanguínea , Riñón/fisiologíaRESUMEN
INTRODUCTION: Acute tubular necrosis (ATN) is usually studied as a single entity, without distinguishing between ischaemic, nephrotoxic and mixed aetiologies. In the present study we evaluated the characteristics and outcomes of patients with ATN by aetiological group. METHOD: We conducted a retrospective comparison of clinical features, mortality rates and risk factors for mortality for the three types of ATN in patients admitted to the general intensive care unit of a university hospital between 1997 and 2000. RESULTS: Of 593 patients with acute renal failure, 524 (88%) were classified as having ATN. Their mean age was 58 years, 68% were male and 52% were surgical patients. The overall mortality rate was 62%. A total of 265 patients (51%) had ischaemic ATN, 201 (38%) had mixed ATN, and 58 (11%) had nephrotoxic ATN. There were no differences among groups in terms of age, sex, APACHE II score and reason for ICU admission. Multiple organ failure was more frequent among patients with ischaemic (46%) and mixed ATN (55%) than in those with nephrotoxic ATN (7%; P < 0.0001). The complications of acute renal failure (such as, gastrointestinal bleeding, acidosis, oliguria and hypervolaemia) were more prevalent in ischaemic and mixed ATN patients. Mortality was higher for ischaemic (66%; P = 0.001) and mixed ATN (63%; P = 0.0001) than for nephrotoxic ATN (38%). When ischaemic ATN patients, mixed ATN patients and all patients combined were analyzed by multivariate logistic regression, the independent factors for mortality identified were different except for oliguria, which was the only variable universally associated with death (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.64-5.49 [P = 0.0003] for ischaemic ATN; OR 1.96, 95% CI 1.04-3.68 [P = 0.036] for mixed ATN; and OR 2.53, 95% CI 1.60-3.76 [P < 0.001] for all patients combined]). CONCLUSION: The frequency of isolated nephrotoxic ATN was low, with ischaemic and mixed ATN accounting for almost 90% of cases. The three forms of ATN exhibited different clinical characteristics. Mortality was strikingly higher in ischaemic and mixed ATN than in nephrotoxic ATN. Although the type of ATN was not an independent predictor of death, the independent factors related to mortality were different for ischaemic, mixed and all patients combined. These data indicate that the three types of ATN represent different patient populations, which should be taken into consideration in future studies.
Asunto(s)
Unidades de Cuidados Intensivos , Isquemia/clasificación , Isquemia/epidemiología , Necrosis Tubular Aguda/clasificación , Necrosis Tubular Aguda/epidemiología , Riñón/irrigación sanguínea , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Isquemia/fisiopatología , Riñón/fisiología , Necrosis Tubular Aguda/fisiopatología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Late structural changes such as interstitial fibrosis in the renal cortex and tubular atrophy have been detected after severe acute tubular necrosis (ATN). The aim of this study was to investigate the expression of fibronectin, alpha-smooth muscle actin and macrophages during the evolution of the ATN induced by glycerol and their relationship with the late structural changes observed in the kidneys of these animals. Forty-nine male Wistar rats were injected with a 50% glycerol solution, 8 mL/kg (4 mL/kg applied i.m. to each hind leg) and 14 with 0.15 m NaCl solution. Before glycerol injection on day 1, water was removed for 17 h. Blood and urine samples were collected 1 day after the injection to quantify sodium and creatinine. The animals were killed 5, 30 and 60 days after the injections and the kidneys removed for histological and immunohistochemical studies. The results of the histological and immunohistochemical studies were scored according to the extent of lesion or staining in the cortical tubulointerstitium, respectively. The percentage of tubulointerstitial lesions was determined by morphometry. Glycerol-injected rats presented a transitory increase in plasma creatinine levels and in fractional sodium excretion. The immunohistochemical studies showed increased fibronectin, alpha-smooth muscle actin (alpha-SM-actin), TGF-beta and ED-1 (macrophages) staining in the renal cortex from rats killed 5, 30 and 60 days after glycerol injection (P < 0.05) compared to control. The animals killed on day 30 and 60 also presented chronic lesions (fibrosis, tubular dilatation and atrophy) in the renal cortex, despite the recovery of renal function. Macrophages, TGF-beta and myofibroblasts may have contributed to the development of renal fibrosis in these rats.
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Fibroblastos/fisiología , Glicerol/efectos adversos , Necrosis Tubular Aguda/inducido químicamente , Macrófagos/fisiología , Animales , Presión Sanguínea/fisiología , Tasa de Filtración Glomerular/fisiología , Inmunohistoquímica/métodos , Necrosis Tubular Aguda/fisiopatología , Masculino , Ratas , Ratas WistarRESUMEN
Aminoglycosides are widely used in the treatment of gram-negative bacterial infections. Gentamicin (GE) acts mainly in proximal tubular cells, where it is uptake via organic anion transport system and it induces a high incidence of nephrotoxicity, which is characterized by tubular necrosis leading to acute renal failure in 10 to 50% of patients. Gram-negative bacteria have lipopolysaccharide (LPS) which is an endotoxin that causes renal damage. Moreover, many patients are undergone exams using radiologic contrast, which is a risk factor to induce a hemodynamic change in the kidney and to develop acute renal failure. Intracellular calcium [Ca2+]i is involved in renal cellular injury and maybe mediate the effects provoked by these drugs. This study was performed to evaluate necrosis, apoptosis and intracellular calcium levels ([Ca2+]i) in LLC-PK1 (epithelial cell line from pig kidney) induced by GE associated with LPS and a low-osmolality media, Hexabrix (HE).
Asunto(s)
Antibacterianos/efectos adversos , Apoptosis/efectos de los fármacos , Medios de Contraste/efectos adversos , Gentamicinas/efectos adversos , Ácido Yoxáglico/efectos adversos , Necrosis Tubular Aguda/inducido químicamente , Túbulos Renales Proximales/efectos de los fármacos , Lipopolisacáridos/efectos adversos , Animales , Apoptosis/fisiología , Calcio/análisis , Modelos Animales de Enfermedad , Etiquetado Corte-Fin in Situ , Técnicas In Vitro , Necrosis Tubular Aguda/patología , Necrosis Tubular Aguda/fisiopatología , Túbulos Renales Proximales/patología , Túbulos Renales Proximales/fisiopatología , Células LLC-PK1/efectos de los fármacos , Células LLC-PK1/patología , Células LLC-PK1/fisiología , PorcinosRESUMEN
La insuficiencia renal aguda (IRA) es uno de los trastornos fisiopatológicos frecuentes en el paciente crítico y a menudo se presenta formando parte del síndrome de disfunción múltiple de órganos. La presencia de IRA aumenta la mortalidad, aunque la causa de muerte no dependa directamente de la insuficiencia renal. Por estas razones, se han hecho múltiples intentos por evitar la aparición de este trastorno, a fin de mejorar la evolución de los pacientes críticos. El patrón patogénico inicial de la IRA en cualquiera de sus formas se caracteriza por un intenso y sostenido aumento de las resistencias vasculares renales, ya sea como consecuencia de cambios en la hemodinamia sistémica o intrarrenal. La modificación de este perfil constituye la base teórica de cualquier estrategia de prevención de la IRA causada por necrosis tubular aguda. En tal sentido, se han ensayado diversos fármacos que han demostrado, a nivel experimental o en sujetos sanos, efectos positivos sobre el flujo sanguíneo renal, la tasa de filtrado glomerular o la eliminación de sodio y agua. Los diuréticos de asa y la dopamina son los fármacos que han generado mayor entusiasmo y un uso muy extendido, sobre todo en las unidades de cuidado intensivo. Lamentablemente, revisiones cuidadosas de los estudios realizados en pacientes en riesgo de IRA o en las etapas tempranas de la misma, no han mostrado evidencia suficiente que sustente el uso de estos fármacos en este contexto y por el contrario, se han demostrado posibles efectos secundarios perjudiciales que los hacen potencialmente riesgosos. El restablecimiento de una adecuada perfusión renal con expansión de volumen y eventualmente noradrenalina en los pacientes sépticos, junto con la restricción de fármacos nefrotóxicos, son las únicas medidas con efectividad demostrada hasta el momento (AU)
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Humanos , Riñón/irrigación sanguínea , Isquemia , Lesión Renal Aguda/prevención & control , Lesión Renal Aguda/tratamiento farmacológico , Necrosis Tubular Aguda/fisiopatología , Necrosis Tubular Aguda/prevención & control , Diuréticos/uso terapéutico , Dopamina/uso terapéutico , Manitol/uso terapéutico , Fenoldopam/uso terapéutico , Norepinefrina/uso terapéutico , Lesión Renal Aguda/etiología , Necrosis Tubular Aguda/complicacionesRESUMEN
Immunohistochemistry was applied to identify the nature of the nucleated cells that accumulate in the vasa rectae of the corticomedullary junction in acute tubular necrosis. In all 6 cases studied, there were intravascular cells that reacted with monoclonal antibodies to erythroblast, macrophages, myeloid cells, T and B lymphocytes and rare megakaryocytes. The findings are consistent with the occurrence of intravascular haematopoiesis in the renal medulla in acute tubular necrosis.
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Hematopoyesis Extramedular , Médula Renal/irrigación sanguínea , Necrosis Tubular Aguda/patología , Necrosis Tubular Aguda/fisiopatología , Adulto , Anciano , Arteriolas/patología , Femenino , Humanos , Técnicas para Inmunoenzimas , Médula Renal/patología , Persona de Mediana EdadAsunto(s)
Humanos , Diálisis/fisiopatología , Diálisis/clasificación , Diálisis/terapia , Rabdomiólisis/etiología , Rabdomiólisis/prevención & control , Necrosis Tubular Aguda/complicaciones , Necrosis Tubular Aguda/fisiopatología , Necrosis Tubular Aguda/terapia , Diálisis Renal/métodos , Insuficiencia Multiorgánica/complicaciones , PronósticoAsunto(s)
Humanos , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/clasificación , Lesión Renal Aguda/terapia , Rabdomiólisis/etiología , Rabdomiólisis/prevención & control , Necrosis Tubular Aguda/complicaciones , Necrosis Tubular Aguda/fisiopatología , Necrosis Tubular Aguda/terapia , Diálisis Renal/métodos , Insuficiencia Multiorgánica/complicaciones , PronósticoAsunto(s)
Humanos , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/clasificación , Lesión Renal Aguda/terapia , Necrosis Tubular Aguda/complicaciones , Necrosis Tubular Aguda/fisiopatología , Necrosis Tubular Aguda/terapia , Insuficiencia Multiorgánica/complicaciones , Diálisis Renal/métodos , Pronóstico , Rabdomiólisis/etiología , Rabdomiólisis/prevención & controlRESUMEN
Fourteen patients were studied 2 to 36 months after acute tubular necrosis. It was observed that 43% of the patients had decreased glomerular filtration rate. These patients were older and had lower urinary excretion of ammonium and titratable acidity. Proteinuria greater than 150 mg/day, without reaching a nephrotic level, was found in 92% of the patients. The presence of oliguria, the demand of dialysis, and the acute tubular necrosis etiology were not statistically different among the patients who recovered their glomerular filtration rate either totally or partially.
Asunto(s)
Necrosis Tubular Aguda/diagnóstico , Adulto , Anciano , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Capacidad de Concentración Renal , Necrosis Tubular Aguda/fisiopatología , Masculino , Persona de Mediana Edad , Proteinuria/diagnóstico , Factores de TiempoRESUMEN
Foram estudados dezesseis pacientes nas fases inicial, intermediária e tardia de recuperaçäo de necrose tubular aguda, respectivamente até cerca de um mês, seis e depois de seis meses a partir do início da moléstia, sendo a avaliaçäo mais tardia feita no 26§ mês. A excreçäo ácida urinária após a sobrecarga acidificante foi avaliada em 15 pacientes (26 testes) e a capacidade de concentraçäo em 13 (22 testes); em 12, ambos os testes foram efetuados concomitantemente (20 observaçöes pareadas). Os valores médios de o pH urinário foram significativamente mais altos e aqueles de a excreçäo de amônio e de relaçäo UNH4+V/UTAV mais baixos que os normais em todas as fases; a excreçäo média resultante de ácido foi significativamente menor que a normal nas fases inicial e intermediária. A excreçäo média de acidez titulável foi significativamente menor que a normal na fase inicial, sendo semelhante e maior, respectivamente nas fases intermediária e tardia. O índice de clearance de hidrogênio médio (HCI) foi sempre subnormal, mas as relaçöes HCI/Cc exibiram valores normais, com exceçäo de 22% e 33% das observaçöes, respectivamente nas duas últimas fases; o clearance de creatinina e a excreçäo resultante de ácido apresentaram correlaçäo significativa e positiva. Portanto, os dados sugerem que dois mecanismos podem afetar a excreçäo ácida urinária: uma menor populaçäo néfrica funcionante e um defeito tubular específico. Em 22% das observaçöes na fase intermediária e em 25% das mesmas na fase tardia foi encontrada capacidade de concentraçäo urinária normal. Foi verificada a presença de correlaçäo significativa e positiva entre Cc e a osmolalidade urinária máxima, sugerindo algum grau de diurese osmótica por um menor número de néfrons...