RESUMO
This is longitudinal retrospective observational cohort study that evaluated anthropometric and biochemical variables of children and adolescents admitted to a Predialysis Interdisciplinary Management Program (PDIMP) responsible for the follow-up of children and adolescents at stages 2 to 4 of chronic kidney disease (CKD) at a tertiary center. One hundred thirty-eight patients with CKD on predialysis treatment with median age at admission of 9 years and the median follow-up time of 5 years were evaluated. Seventy-four (53%) had CKD stage 3 at admission and 70 (51%) reached CKD stage 5 at the end of the follow-up. There was no significant difference between the mean initial and final hemoglobin and serum albumin. However, the final serum bicarbonate presented a significant improvement. Analyses stratified according to clinical variables of interest showed a significant improvement in body mass index (BMI) Z score, especially in the subgroup of children admitted under two years of age. In relation to stature-for-age Z score, data show a significant improvement in stature SD at the end of the study. In conclusion, the present study showed improvement of nutritional status of CKD patients and that the deterioration of renal function was not correlated with BMI-for-age Z score.
Assuntos
Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Adolescente , Fatores Etários , Índice de Massa Corporal , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Feminino , Taxa de Filtração Glomerular , Hemoglobinas/análise , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Albumina Sérica/análise , Adulto JovemRESUMO
Low-level laser therapy (LLLT) controls bronchial hyperresponsiveness (BHR) associated with increased RhoA expression as well as pro-inflammatory mediators associated with NF-kB in acute lung inflammation. Herein, we explore if LLLT can reduce both BHR and Th2 cytokines in allergic asthma. Mice were studied for bronchial reactivity and lung inflammation after antigen challenge. BHR was measured through dose-response curves to acetylcholine. Some animals were pretreated with a RhoA inhibitor before the antigen. LLLT (660 nm, 30 mW and 5.4 J) was applied on the skin over the right upper bronchus and two irradiation protocols were used. Reduction of BHR post LLLT coincided with lower RhoA expression in bronchial muscle as well as reduction in eosinophils and eotaxin. LLLT also diminished ICAM expression and Th2 cytokines as well as signal transducer and activator of transduction 6 (STAT6) levels in lungs from challenged mice. Our results demonstrated that LLLT reduced BHR via RhoA and lessened allergic lung inflammation via STAT6.
Assuntos
Remodelação das Vias Aéreas/efeitos da radiação , Asma/radioterapia , Broncoconstrição/efeitos da radiação , Citocinas/metabolismo , Hipersensibilidade/radioterapia , Terapia com Luz de Baixa Intensidade , Remodelação das Vias Aéreas/efeitos dos fármacos , Remodelação das Vias Aéreas/fisiologia , Amidas/farmacologia , Animais , Asma/tratamento farmacológico , Asma/fisiopatologia , Brônquios/efeitos dos fármacos , Brônquios/fisiopatologia , Brônquios/efeitos da radiação , Hiper-Reatividade Brônquica/tratamento farmacológico , Hiper-Reatividade Brônquica/fisiopatologia , Hiper-Reatividade Brônquica/radioterapia , Broncoconstrição/efeitos dos fármacos , Broncoconstrição/fisiologia , Inibidores Enzimáticos/farmacologia , Hipersensibilidade/tratamento farmacológico , Hipersensibilidade/fisiopatologia , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Pulmão/efeitos da radiação , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiopatologia , Músculo Liso/efeitos da radiação , Ovalbumina/efeitos adversos , Pneumonia/tratamento farmacológico , Pneumonia/fisiopatologia , Pneumonia/radioterapia , Piridinas/farmacologia , Fator de Transcrição STAT6/metabolismo , Proteínas rho de Ligação ao GTP/antagonistas & inibidores , Proteínas rho de Ligação ao GTP/metabolismo , Proteína rhoA de Ligação ao GTPRESUMO
BACKGROUND AND OBJECTIVES: The incidence of ESRD in children has increased over the last two decades. Nevertheless, there are still limited data on risk factors related to the emergence of ESRD among patients with CKD. The aim of this study was to develop a model of prediction of ESRD in children and adolescents with CKD (stages 2-4) enrolled in a predialysis interdisciplinary management program. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective cohort study, 147 patients with CKD admitted from 1990 to 2008 were systematically followed up at a tertiary pediatric nephrology unit for a median of about 4.5 years. The primary outcome was the progression to CKD stage 5. A predictive model was developed using Cox proportional hazards model and evaluated by c statistics. RESULTS: The median renal survival was estimated at 98.7 months (95% confidence interval [95% CI], 68.7 to 129.6 months). The probability of reaching CKD stage 5 was estimated as 52% in 10 years. The most accurate model included eGFR, proteinuria at admission, and primary renal disease. Risk score ranged from 0 to 13 points (median, 4 points). The accuracy of the score applied to the sample was high, with c statistics of 0.865 (95% CI, 0.80 to 0.93) and 0.837 (95% CI, 0.76 to 0.91) at follow-up of 2 and 5 years, respectively. By survival analysis, it was estimated that at 10 years after admission, the probability of renal survival was about 63% for patients in the low-risk group and 43% for the medium-risk group; all patients assigned to the high-risk group had CKD stage 5 (P<0.001). CONCLUSION: The predictive model of progression of CKD might contribute to early identification of a subgroup of patients at high risk for accelerated renal failure.
Assuntos
Falência Renal Crônica/etiologia , Insuficiência Renal Crônica/complicações , Adolescente , Fatores Etários , Criança , Pré-Escolar , Progressão da Doença , Diagnóstico Precoce , Feminino , Taxa de Filtração Glomerular , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Rim/fisiopatologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Proteinúria/etiologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária , Fatores de TempoRESUMO
A doença renal crônica (DRC) é uma síndrome clínica decorrente da lesão renal progressiva, de etiologia diversificada. Estudos internacionais indicam que a incidência anual de doença renal crônica terminal (DRCT) nas crianças esteja entre 5 e 15 pacientes por milhão de população infantil e a sua prevalência entre 22 e 62 pacientes por milhão de população infantil. Apesar de a DRC ser menos freqüente na infância, este grupo representa um desafio, por apresentar manifestações da doença durante as fases de crescimento, desenvolvimento neurológico e psicossocial. Desta forma, a abordagem da DRC na infância exige a participação de uma equipe interdisciplinar. Neste contexto, o objetivo desta artigo é revisar conceitos básicos da DRC na infância (definições, aspectos epidemiológicos, etiologia) e discutir a abordagem pré-diálitica desses pacientes.
Chronic kidney disease (CKD) is a clinical syndrome due to a progressive renal damage of varied etiologies. International studies indicate that the annual incidency of end stage renal disease (ESRD) in children is between 5 to 15 patients per million of children and its prevalence is between 22 to 62 per million of children. Despite the lower frenquency of DRC in childhood, this group represents a challenge due to the occurrence of disease manisfestations during stages of growth, neurological and psicosocial development. Therefore, the approach of CKD in childhood requires the participation of an interdisciplinary team. In this context, the aim of this article is to revise basic concepts of CKD in childhood (definitions, epidemiological aspects, etiology) and to discuss the pre-dialitic management of these patients.