RESUMO
Cardiovascular abnormalities, such as left ventricular hypertrophy and valvular disorders, particularly mitral valve prolapse, have been described as highly prevalent among adult patients with autosomal dominant polycystic kidney disease (ADPKD). The present study aimed to assess echocardiographic parameters in a large sample of both normotensive and hypertensive ADPKD patients, regardless of kidney function level, and evaluate their association with clinical and laboratorial parameters. A retrospective study consisted of the analysis of clinical, laboratorial, and transthoracic echocardiograms data retrieved from the medical records of young adult ADPKD outpatients. A total of 294 patients (120 M/174 F, 41.0 ± 13.8 years old, 199 hypertensive and 95 normotensive) with a median estimated glomerular filtration rate (eGFR) of 75.5 mL/min/1.73 m2 were included. The hypertensive group (67.6%) was significantly older and exhibited significantly lower eGFR than the normotensive one. Increased left ventricular mass index (LVMI) was seen in 2.0%, mitral valve prolapse was observed in 3.4%, mitral valve regurgitation in 15.3%, tricuspid valve regurgitation in 16.0%, and aortic valve regurgitation in 4.8% of the whole sample. The present study suggested that the prevalence of mitral valve prolapse was much lower than previously reported, and increased LVMI was not seen in most adult ADPKD patients.
RESUMO
Background and Objectives: A high body mass index (BMI) is associated with the progression of autosomal dominant polycystic kidney disease (ADPKD). However, body fat (BF), which is another adiposity marker, has not yet been studied. Excessive weight may promote elevation in the endogenous synthesis of organic acid (OA) anions. Accordingly, we aimed to investigate the possible association of the aforementioned markers with kidney volume and renal function in patients with ADPKD. Materials and Methods: We conducted a retrospective cohort study of adult ADPKD outpatients involving clinical, serum, and urinary laboratorial data and body composition assessments retrieved from their medical records. BF was estimated by skinfold thickness (mm) on the non-dominant arm and was considered as normal or high for each sex. Total kidney volume (TKV) and height-adjusted volume (htTKV) were measured by magnetic resonance imaging. The annual estimated glomerular filtration rate (eGFR) slope was analyzed during a median follow-up time of 6 (5.0-7.0) years to calculate rapid progression (decline in renal function ≥2.5 mL/min/year over 5 years). Results: A total of 104 patients were included (41.9 ± 11.9 years old, 38.5% men), with 62.5% of the patients classified as high BF. The High BF group presented higher levels of OA, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), 24 h urinary sodium (UNa), and htTKV, and lower eGFR than those with a normal BF. In the multivariate linear regression, the associated variables with TKV were high BF, OA and BMI (std. ß 0.47, p < 0.05; std. ß 0.36, p = 0.001; std. ß 0.25, p = 0.01, respectively). In the binary logistic regression, when adjusted for potential confounders, UNa was the only parameter associated with an increased risk of eGFR decline ≥2.5 mL/min/year (OR 1.02, 95% CI 1.01-1.03, p = 0.02). Conclusions: Increased body fat and endogenous production of organic acid anions are associated with larger kidney size in ADPKD but not with a decline in renal function.
Assuntos
Rim Policístico Autossômico Dominante , Tecido Adiposo , Adulto , Ânions , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Rim Policístico Autossômico Dominante/complicações , Rim Policístico Autossômico Dominante/diagnóstico por imagem , Rim Policístico Autossômico Dominante/patologia , Estudos RetrospectivosRESUMO
Low urinary citrate and crystal deposition accelerated cystogenesis in an experimental model of polycystic kidney disease (PKD).Hypocitraturia, frequently observed in patients with autosomal dominant PKD (ADPKD) could contribute to disease progression.Present findings suggest lower urinary citrate in early PKD was associated with faster eGFR decline and worse kidney survival.
Assuntos
Calcinose , Rim Policístico Autossômico Dominante , Humanos , Ácido Cítrico , Rim , Rim Policístico Autossômico Dominante/complicações , Progressão da Doença , Calcinose/complicaçõesRESUMO
INTRODUCTION: Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR). OBJECTIVE: To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage. PATIENTS AND METHODS: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2500 g) and small (SGA), adequate (AGA) and large (LGA) for GA, defined as having a value below, between or beyond the ± 1.28 z/GA score, the usual clinical cut-off to demarcate the 10th and 90th percentiles. RESULTS: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%, 13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were: PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL: 6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA cases. A concomitant presence of, at least, two SGA dimensions in the same fetus was frequent. CONCLUSIONS: The proportions of preterm birth and low birth weight were higher than the local and Brazilian prevalence and a trend was observed for higher proportions of SGA fetal dimensions than the expected population distribution in this small casuistry of newborn from the HIV-infected, low income, antiretroviral users, and publicly assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal dimensions was also observed in infants born to mothers with AIDS compared to HIV-infected mothers without AIDS.
Assuntos
Retardo do Crescimento Fetal/etiologia , Infecções por HIV/complicações , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/etiologia , Adulto , Brasil/epidemiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
Introduction: Maternal HIV infection and related co-morbidities may have two outstanding consequences to fetal health: mother-to-child transmission (MTCT) and adverse perinatal outcomes. After Brazilian success in reducing MTCT, the attention must now be diverted to the potentially increased risk for preterm birth (PTB) and intrauterine fetal growth restriction (IUGR). Objective: To determine the prevalence of PTB and IUGR in low income, antiretroviral users, publicly assisted, HIV-infected women and to verify its relation to the HIV infection stage. Patients and Methods: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary public university hospital in the city of Vitória, state of Espírito Santo, Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were selected for study, with ultrasound validated gestational age (GA) and data on birth dimensions: fetal weight (FW), birth length (BL), head and abdominal circumferences (HC, AC). The data were extracted from clinical and pathological records, and the outcomes summarized as proportions of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2500g) and small (SGA), adequate (AGA) and large (LGA) for GA, defined as having a value below, between or beyond the ±1.28 z/GA score, the usual clinical cut-off to demarcate the 10th and 90th percentiles. Results: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%, 13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were: PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL: 6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA cases. A concomitant presence of, at least, two SGA dimensions in the same fetus was frequent. Conclusions: ...
Introdução: A infecção materna pelo HIV e comorbidades associadas podem ter duas consequências para a saúde fetal, a transmissão vertical e o desfecho perinatal adverso. Após o sucesso em reduzir a transmissão vertical, deve-se dar atenção ao risco potencial de nascimento pretermo (PRT) e de restrição de crescimento fetal (RCF). Objetivo: Determinar a prevalência de PRT e RCF em gestantes de baixa renda, infectadas pelo HIV, usuárias de terapia antirretroviral atendidas em hospital público terciário e verificar sua relação com o estágio da infecção viral. Casuística e métodos: Dentre os 250 partos de gestantes infectadas pelo HIV, ocorridos em um hospital universitário na cidade de Vitória, estado do Espírito Santo, Sudeste do Brasil, entre novembro de 2001 e maio de 2012, foram selecionadas 74 gestações não-gemelares, com idade gestacional confirmada por ultrassonografia e as dimensões neonatais: peso ao nascer (PN), comprimento (CN) e perímetros cefálico (PC) e abdominal (PA). Os dados foram extraídos dos prontuários clínicos e laboratoriais e o desfecho sumarizado como nascimento pretermo (PRT < 37 semanas), baixo peso ao nascer (BPN < 2500g) e como pequeno (PIG), adequado (AIG) e grande (GIG) para a IG, definido como tendo um menor valor, entre e maior que ± 1.28 z/IG escore, o critério clínico usual para demarcar os percentis 10 e 90. Resultados: PRT foi observado em 17,5%, BPN em 20,2% e PN, CN, PC e PA PIG em 16,2%, 19,1%, 13,8% e 17,4%, respectivamente. As respectivas proporções observadas nos casos de HIV e AIDS foram: PRT: 5,9 versus 27,5%, BPN: 14,7% versus 25,0%, PFN PIG: 17,6% versus 15,0%, CN: 6,0% versus 30,0%, PC: 9,0% versus 17,9% e PA: 13,3% versus 21,2%; somente a diferença de CN PIG foi estatisticamente significativa. Dentre 15 neonatos com BPN, oito (53,3%) eram somente PRT, quatro (26,7%) PIG somente e três (20,0%) PRT e PIG. Concomitância no mesmo caso de pelo menos duas dimensões PIG foi observada frequentemente. ...