RESUMO
BACKGROUND: The renal manifestations of IgA nephropathy are wide, including patients with asymptomatic disease. The probability of developing advanced renal disease after 20 years of diagnosis varies. The prevalence of mesangial deposits of IgA in otherwise healthy people has been studied previously and there are only 2 reports in which the diagnosis is made by time-zero renal biopsy (TO-RBx). MATERIAL AND METHODS: We compared clinical characteristics (baseline and at followup) of renal donors with IgA nephropathy diagnosed by TO-RBx compared with 20 donors with normal TO-RBx. RESULTS: From 1999 to 2006 151 T0-RBx were analyzed. Of these 10 cases (6.62%) had IgA nephropathy. There were two patients with stage II and 8 with stage I according to HASS classification of IgA nephropathy. All donors in both groups (n=30) had normal urinary tests, however urinary protein excretion was significantly higher in the IgA nephropathy group compared with the normal group from baseline to the end of follow-up (three years). The glomerular filtration rate at three years of follow-up was significantly higher in the normal group (80 +/- 14 vs. 65 +/- 8 mL/min, p = 0.001). CONCLUSIONS: Donors with IgA nephropathy on TO-RBx had no urinary abnormalities during pre donation screening. At three years of follow-up patients with IgA nephropathy showed a greater loss of renal function as well as increased urinary protein excretion.
Assuntos
Glomerulonefrite por IGA/diagnóstico , Transplante de Rim , Doadores Vivos , Nefrectomia , Complicações Pós-Operatórias/diagnóstico , Adulto , Biópsia , Colesterol/sangue , Diagnóstico Tardio , Diagnóstico Precoce , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mesângio Glomerular/imunologia , Mesângio Glomerular/patologia , Glomerulonefrite por IGA/imunologia , Glomerulonefrite por IGA/metabolismo , Glomerulonefrite por IGA/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/patologia , Prevalência , Proteinúria/etiologia , Índice de Gravidade de Doença , Triglicerídeos/sangueRESUMO
BACKGROUND: In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300-500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP). METHODS: This prospective study included 72 patients with catheter Group 1 (G1), 1877 treatments and 35 arterio-venous (AV) fistulae Group 2 (G2), 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250 mmHg. We measured ionic clearance (IK: mL/min), access recirculation, DALP (mmHg) and Qb (mL/min). Six prescription zones were identified: from an optimal A zone (Qb > 400, DALP -200 to -250) to zones with lower Qb E (Qb < 300, DALP -200 to -250) and F (Qb < 300, DALP > -199). RESULTS: Treatments distribution in A was 695 (37%) in G1 vs. 704 (37.7%) in G2 (P = 0.7). In B 150 (8%) in G1 vs. 458 (24.5%) in G2 (P < 0.0001). Recirculation in A was 10.0% (Inter quartile rank, IQR 6.5, 14.2) in G1 vs. 9.8% (IQR 7.5, 14.1) in G2 (P = 0.62). IK in A was 214 +/- 34 (G1) vs. 213 +/- 35 (G2) (P = 0.65). IK Anova between G2 zones was: A vs. C and D (P < 0.000001). Staff prescription adherence was 81.3% (G1) vs. 84.1% (G2) (P = 0.02). CONCLUSION: In conclusion, an optimal Qb can de prescribed with DALP of -200 mmHg. Staff adherence to DLAP treatment prescription could be reached up to 81.3% in catheters and 84.1% in AV fistulae.
Assuntos
Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Falência Renal Crônica/reabilitação , Diálise Renal/métodos , Terapia Assistida por Computador/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
HD and HDF as hemodialytic therapies normally alter patient's haemodynamic stability, due to the inflammatory response to extracorporeal blood circuit, producing increment of the core temperature (+1.0 degrees C). However, such increase in temperature could be controlled by lowering dialysate's temperature using two main modalities techniques (isothermic and thermoneural) with different patient's thermal balance consequences, not yet well studied. In this work, energy expenditure (EE) was measured by indirect calorimetry in a group of 12 patients waiting kidney transplant. In each patient, EE was assessed (as a power generation) during isothermic and thermoneutral modalities as a manner of cross and prospective study (a) at before therapy, (b) during therapy and (c) at the end of the HDF therapy. Wheraeas, power extraction was measured by a BTM (Blood Temperature Monitor from Fresenius Inc) in order to determine power balance in a thermodynamic model of the extracorporeal circuit. The results showed significant differences in the power balance when EE at during therapy was subtracted from the EE at before therapy. Then, EE increments were 32 Kcal/4-hours during isothermic and 3.6 Kcal/4-hours during thermoneutral HDF sessions (p<0.05). While, BTM totals power extraction was 91 and 16.1 Kcal/4-hours (p<0.05), respectively. Additionally, it was estimated a 12% of EE/day increment during HDF-isothermic at during therapy stage compared with none significative EE increment during thermoneutral modality. The statistical evidence confirmed the expected hypothesis that both modalities affect in different manner the patient's EE. Also, we conclude there is no satisfactory data interpretation when the thermodynamic model was applied expecting null balance between EE increment and BTM power extraction. Therefore, these findings force to think there is need of different BTM design and measurement setting with ability to follow dynamic patient's EE changes with the purpose to achieve a better power balance.