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Excessive fructose consumption has been associated with hypertension and metabolic disorders and can alter physiological adaptations during pregnancy, with long-term detrimental consequences. This study evaluated in post-weaning mothers the effects of increased fructose consumption during pregnancy and lactation on blood pressure and renal function. Female Wistar rats were assigned to one of four experimental groups: non-pregnant control (NPC); pregnant control (PC); non-pregnant fructose (NPF), and pregnant fructose (PF). Control rats had free access to food and water, while the fructose groups had free access to food and to a 20% fructose solution, over the time period of the experiment. The systolic BP and renal function parameters were measured at the end of the experimental period, one week after weaning (28 days after delivery). The results were presented as means ± standard error. Higher values of BP were observed in both pregnant and non-pregnant rats treated with fructose compared to control. Creatinine clearance was reduced only in the PF group; however, both the PF and NPF groups had reduced Na+ and K+ excretions. In the PF group, there was also glomerular enlargement and changes in the media/lumen (M/L) ratio of interlobular arteries. Additionally, the PF group showed increased macrophage infiltration and expression of alpha-SM-actin and reduced expression of nitric-oxide-synthase endothelial in renal tissue. These findings suggest that the association of high fructose intake with pregnancy aggravated kidney changes that persisted for up to four weeks after delivery, which may represent a risk factor for maternal health.
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Actinas , Efeitos Tardios da Exposição Pré-Natal , Animais , Creatinina , Feminino , Frutose , Humanos , Rim/metabolismo , Lactação , Óxidos/farmacologia , Gravidez , Ratos , Ratos Wistar , ÁguaRESUMO
The arthrogryposis, renal dysfunction, and cholestasis syndrome (ARCS) is an autosomal recessive multisystem disease caused by variants in VPS33B or VIPAS39. The classical presentation includes congenital joint contractures, renal tubular dysfunction, cholestasis, and early death. Additional features include ichthyosis, central nervous system malformations, platelet dysfunction, and severe failure to thrive. We studied three patients with cholestasis, increased aminotransferases, normal gamma-glutamyl transferase, and developmental and language delay. Whole exome sequencing analysis identified VPS33B variants in all patients: patients 1 and 2 presented a novel homozygous variant at position c.1148T>A. p.(Ile383Asn), and patient 3 was compound heterozygous for the same c.1148T>A. variant, in addition to the c.940-2A>G. variant. ARCS is compatible with the symptomatology presented by the studied patients. However, most patients that have been described in the literature with ARCS had severe failure to thrive and died in the first 6 months of life. The three patients studied here have a mild ARCS phenotype with prolonged survival. Consequently, we believe that the molecular analysis of the VPS33B and VIPAS39 should be considered in patients with normal gamma-glutamyl transferase cholestasis.
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BACKGROUND: Platelet α-granule biogenesis in precursor megakaryocytes is critically dependent on VPS33B and VPS16B, as demonstrated by the platelet α-granule deficiency seen in the rare multisystem disorder arthrogryposis, renal dysfunction, and cholestasis (ARC) syndrome associated with biallelic pathogenic variants in VPS33B and VIPAS39 (encoding VPS16B). VPS33B and VPS16B are ubiquitously expressed proteins that are known to interact and play key roles in protein sorting and trafficking between subcellular locations. However, there remain significant gaps in our knowledge of the nature of these interactions in primary cells from patients with ARC syndrome. OBJECTIVES: To use primary cells from patients with ARC syndrome to better understand the interactions and roles of VPS33B and VPS16B in platelets and precursor megakaryocytes. PATIENTS/METHODS: The proband and his male sibling were clinically suspected to have ARC syndrome. Confirmatory genetic testing and platelet phenotyping, including electron microscopy and protein expression analysis, was performed with consent in a research setting. RESULTS: We describe the first case of ARC syndrome identified in Costa Rica, associated with a novel homozygous nonsense VPS33B variant that is linked with loss of expression of both VPS33B and VPS16B in platelets. CONCLUSION: These results indicate that stable expression of VPS16B in platelets, their precursor megakaryocytes, and other cells is dependent on VPS33B. We suggest that systematic evaluation of primary cells from patients with a range of VPS33B and VIPAS39 variants would help to elucidate the interactions and functions of these proteins.
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Artrogripose , Colestase , Artrogripose/diagnóstico , Artrogripose/genética , Artrogripose/metabolismo , Plaquetas/metabolismo , Colestase/diagnóstico , Colestase/genética , Colestase/metabolismo , Humanos , Masculino , Insuficiência Renal , Irmãos , Proteínas de Transporte Vesicular/genética , Proteínas de Transporte Vesicular/metabolismoRESUMO
This study was conducted to evaluate the protective role of extracted natural antioxidants from black rice and their effect on kidney failure and renal cirrhosis caused by ethanol-induced toxicity. Antioxidant activity in terms of total phenol content, flavonoid compounds and anthocyanin, as well as antioxidant capacity, was determined in an extract of black rice. The findings noted that the black rice extract contained high amounts of antioxidant activity and capacity. Total phenolic compounds from black rice extract were fractionated using HPLC and the results showed that ferulic, sinapic, ascorbic, salicylic and coumaric acids were the highest in the extract. Biological experiments were performed on male albino adult rats (40 animals, 10 rats for each group), divided into four groups. After five weeks, kidney functions and protein fractions were assessed. In addition, superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) enzyme activities were determined in all groups. The results found that kidney function, total protein, albumin and globulin were affected by renal dysfunction and renal fibrosis in the positive control (PC), whereas groups 3 and 4 noted an improvement in renal function nearly or equal to the healthy rats which were fed on a basal diet. Furthermore, the PC group showed significantly decreased levels of enzymatic antioxidants, namely SOD and GSH with a concomitant elevated MDA level compared with those in the negative rats fed on a basal diet. Groups 3 and 4 also reported improvements in enzyme activity. These results were further supported by histopathological findings which revealed a curative effect in groups 3 and 4, which avoided renal dysfunction and renal fibrosis from ethanol-induced toxicity. From the results, it can be said that the black rice extract with the highest amounts of antioxidants led to improvements in all parameters, especially kidney function, total protein, albumin, and globulin, in addition to enzyme activity. Therefore, black rice can be recommended as a benefit to general health.
Este estudo foi conduzido para avaliar o papel protetor dos antioxidantes naturais extraídos do arroz-preto e seu efeito na insuficiência renal e cirrose renal causada pela toxicidade induzida pelo etanol. A atividade antioxidante em termos de teor de fenóis totais, compostos flavonoides e antocianinas, bem como a capacidade antioxidante, foi determinada em um extrato de arroz-preto. As descobertas observaram que o extrato de arroz-preto continha grandes quantidades de atividade e capacidade antioxidante. Os compostos fenólicos totais do extrato de arroz-preto foram fracionados por HPLC e os resultados mostraram que os ácidos ferúlico, sinápico, ascórbico, salicílico e cumárico foram os mais elevados no extrato. Experimentos biológicos foram realizados em ratos adultos albinos machos (40 animais, 10 ratos para cada grupo), divididos em quatro grupos. Após cinco semanas, as funções renais e frações proteicas foram avaliadas. Além disso, as atividades das enzimas superóxido dismutase (SOD), glutationa (GSH) e malondialdeído (MDA) foram determinadas em todos os grupos. Os resultados mostraram que a função renal, proteína total, albumina e globulina foram afetadas por disfunção renal e fibrose renal no controle positivo (CP), enquanto os grupos 3 e 4 observaram uma melhora na função renal quase ou igual aos ratos saudáveis ââque foram alimentados em uma dieta básica. Além disso, o grupo PC apresentou níveis significativamente diminuídos de antioxidantes enzimáticos, ou seja, SOD e GSH com um nível concomitante de MDA elevado em comparação com aqueles nos ratos negativos alimentados com uma dieta basal. Os grupos 3 e 4 também relataram melhorias na atividade enzimática. Esses resultados foram ainda apoiados por achados histopatológicos que revelaram um efeito curativo nos grupos 3 e 4, que evitou a disfunção renal e fibrose renal por toxicidade induzida pelo etanol. A partir dos resultados, pode-se dizer que o extrato de arroz-preto com maior quantidade de antioxidantes levou a melhorias em todos os parâmetros, principalmente função renal, proteína total, albumina e globulina, além da atividade enzimática. Portanto, o arroz-preto pode ser recomendado como um benefício para a saúde geral.
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Ratos , Oryza , Fibrose , Etanol , Insuficiência Renal , AntioxidantesRESUMO
INTRODUCTION AND OBJECTIVES: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. MATERIALS AND METHODS: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver-kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998-2002, nâ¯=â¯488), era-2 (2003-2007, nâ¯=â¯889), era-3 (2008-2012, nâ¯=â¯703) and era-4 (2013-2018, nâ¯=â¯791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5â¯mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. RESULTS: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (Pâ¯<â¯0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (Pâ¯<â¯0.005) but not in era-3 or era-4 (Pâ¯=â¯0.13 and Pâ¯=â¯0.08, respectively). Multivariate analysis demonstrated the lack of independent effect of pre-LT renal dysfunction on post-LT mortality in era-3 and era-4. A separate analysis using eGFR <60â¯mL/min/1.73â¯m2 at LT to define renal dysfunction showed similar results. CONCLUSIONS: Pre-LT renal dysfunction had less impact on post-LT survival in the contemporary transplant era.
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Hepatopatias/complicações , Hepatopatias/mortalidade , Transplante de Fígado , Insuficiência Renal/complicações , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Estimativa de Kaplan-Meier , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: It becomes increasingly evident that the SARS-CoV-2 infection is not limited to the respiratory system. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease. METHODS: Data was obtained by a comprehensive and non-systematic search in the PubMed, Cochrane, Scopus and SciELO databases, using mainly the terms "SARS-CoV-2", "COVID-19", "chronic kidney disease", "renal transplantation", acute kidney injury" and "renal dysfunction" Discussion: The membrane-bound angiotensin-converting enzyme 2 is the receptor for SARS-CoV- -2, and this interaction may lead to an imbalance of the Renin-Angiotensin System (RAS), associated with worse clinical presentations of COVID-19, including acute pulmonary injury, hyperinflammatory state and hematological alterations. In the framework of renal diseases, the development of acute kidney injury is associated mostly with immune alterations and direct cytopathic lesions by the virus, leading to higher mortality. As for chronic kidney disease, the patients at a non-terminal stage have a worse prognosis, while the hemodialysis patients appear to have mild courses of COVID-19, probably due to lower chances of being affected by the cytokine storm. Furthermore, the current scenario is unfavorable to kidney donation and transplantation. The relationship between COVID-19 and immunosuppression in kidney transplantation recipients has been greatly discussed to determine whether it increases mortality and how it interacts with immunosuppressive medications. CONCLUSION: The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection, and more research is required to have a complete understanding of the repercussions caused by COVID-19 in renal diseases.
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COVID-19/complicações , Nefropatias , COVID-19/mortalidade , COVID-19/prevenção & controle , COVID-19/virologia , Bases de Dados Factuais , Humanos , Nefropatias/complicações , Nefropatias/mortalidade , Nefropatias/cirurgia , Nefropatias/virologia , Transplante de Rim , Sistema Renina-Angiotensina , SARS-CoV-2RESUMO
Autoantibodies are frequently reported in patients with malaria, but whether they contribute to protection or to pathology is an issue of debate. A large body of evidence indicates that antibodies against host-self components are associated to malaria clinical outcomes such as cerebral malaria, renal dysfunction and anemia. Nonetheless, self-reactive immunoglobulins induced during an infection can also mediate protection. In light of these controversies, we summarize here the latest findings in our understanding of autoimmune responses in malaria, focusing on Plasmodium falciparum and Plasmodium vivax. We review the main targets of self-antibody responses in malaria as well as the current, but still limited, knowledge of their role in disease pathogenesis or protection.
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Malária Falciparum , Malária Vivax , Autoanticorpos , Humanos , Plasmodium falciparum , Plasmodium vivaxRESUMO
BACKGROUND: Pruritus is a major health-related quality-of-life burden in progressive familial intrahepatic cholestasis (PFIC) and other childhood cholestatic liver diseases. Several nontransplant surgical techniques were developed in an attempt to ameliorate symptoms and slow disease progression. Very few case-series have been published on a particular intervention, ileal exclusion (IE), which has been considered to be inferior to the other approaches. METHODS: We conducted a single-center retrospective chart-review case-series of patients submitted to IE as the first-line surgical treatment at our institution from 1995 to 2018. The primary goal was pruritus relief, followed by survival with the native liver and improvement in biochemical parameters. RESULTS: Eleven patients were submitted to IE, with a mean follow-up of 60â¯months. Complete resolution or significant reduction of pruritus was obtained in 72.7% (nâ¯=â¯8) of patients. One patient (9.1%) had a major postoperative complication that required surgery. No other morbidities were reported. Two cases progressed to end-stage liver disease (ESLD) within the short-term and one year after surgery. CONCLUSIONS: This case series study shows that IE provided excellent results in pruritus control and permitted survival with the native liver. We believe IE is a safe procedure, with few associated morbidities, and should be considered more often as primary surgical treatment for PFIC and other cholestasis. LEVEL OF EVIDENCE: IV.
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Procedimentos Cirúrgicos do Sistema Biliar , Colestase Intra-Hepática , Íleo/cirurgia , Prurido , Criança , Colestase/complicações , Colestase/cirurgia , Colestase Intra-Hepática/complicações , Colestase Intra-Hepática/cirurgia , Humanos , Prurido/etiologia , Prurido/cirurgia , Estudos RetrospectivosRESUMO
Ophiopogonin D (OP-D) is the principal pharmacologically active ingredient from Ophiopogon japonicas, which has been demonstrated to have numerous pharmacological activities. However, its protective effect against renal damage in streptozotocin (STZ)-induced diabetic nephropathy (DN) rats remains unclear. The present study was performed to investigate the protective effect of OP-D in the STZ-induced DN rat model. DN rats showed renal dysfunction, as evidenced by decreased serum albumin and creatinine clearance, along with increases in serum creatinine, blood urea nitrogen, TGF-β1, and kidney hypertrophy, and these were reversed by OP-D. In addition, STZ induced oxidative damage and inflammatory response in diabetic kidney tissue. These abnormalities were reversed by OP-D treatment. The findings obtained in the present study indicated that OP-D might possess the potential to be a therapeutic agent against DN via inhibiting renal inflammation and oxidative stress.
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Animais , Masculino , Ratos , Saponinas/uso terapêutico , Estresse Oxidativo/efeitos dos fármacos , Ophiopogon/química , Diabetes Mellitus Experimental/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Inflamação/prevenção & controle , Espirostanos/uso terapêutico , Ratos Sprague-Dawley , EstreptozocinaRESUMO
OBJECTIVE: The effect of dual renin-angiotensin system (RAS) inhibition in heart failure (HF) is still controversial. Systematic reviews have shown that dual RAS blockade may reduce mortality and hospitalizations, yet it has been associated with the increased risk of renal dysfunction (RD). Surprisingly, although RD in patients with HF is frequent, the effect of combining RAS inhibitors in HF patients with RD has never been studied in a meta-analysis. METHODS: A systematic review and meta-analysis of randomized clinical trials involving HF patients with RD who received dual blockade analyzing death, cardiovascular (CV) death or HF hospitalization, and adverse events. RESULTS: Out of 2258 screened articles, 12 studies were included (34,131 patients). Compared with monotherapy, dual RAS inhibition reduced hazard ratio of death to 0.94 (p=0.07) and significantly reduced CV death or HF hospitalization to 0.89 (p=0.0006) in all individuals, and to 0.86 (p=0.005) in patients with RD and to 0.91 (p=0.04) without RD. Nevertheless, dual RAS blockade significantly increased the risk of renal impairment (40%), hyperkalemia (44%), and hypotension (42%), although discontinuation of treatment occurs only in 3.68% versus 2.19% (p=0.00001). CONCLUSIONS: Dual RAS inhibition therapy reduces the risk of CV death or HF hospitalization. However, cautions monitoring for specific adverse events may be warranted.
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Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Insuficiência Renal Crônica/induzido quimicamenteRESUMO
BACKGROUND: Increased mortality due to type 2 diabetes mellitus (T2DM) has been associated with renal and/or cardiovascular dysfunction. Dipeptidyl dipeptidase-4 inhibitors (iDPP-4s) may exert cardioprotective effects through their pleiotropic actions via glucagon-like peptide 1-dependent mechanisms. In this study, the pharmacological profile of a new iDPP-4 (LASSBio-2124) was investigated in rats with cardiac and renal dysfunction induced by T2DM. METHODS: T2DM was induced in rats by 2 weeks of a high-fat diet followed by intravenous injection of streptozotocin. Metabolic disturbance and cardiac, vascular, and renal dysfunction were analyzed in the experimental groups. RESULTS: Sitagliptin and LASSBio-2124 administration after T2DM induction reduced elevated glucose levels to 319.8⯱â¯13.2 and 279.7⯱â¯17.8â¯mg/dL, respectively (pâ¯<â¯0.05). LASSBio-2124 also lowered the cholesterol and triglyceride levels from 76.8⯱â¯8.0 to 42.7⯱â¯3.2â¯mg/dL and from 229.7⯱â¯25.4 to 100.7⯱â¯17.1â¯mg/dL, in diabetic rats. Sitagliptin and LASSBio-2124 reversed the reduction of the plasma insulin level. LASSBio-2124 recovered the increased urinary flow in diabetic animals and reduced 24-h proteinuria from 23.7⯱â¯1.5 to 13.3⯱â¯2.8 mg (pâ¯<â¯0.05). It also reduced systolic and diastolic left-ventricular dysfunction in hearts from diabetic rats. CONCLUSION: The effects of LASSBio-2124 were superior to those of sitagliptin in the cardiovascular systems of T2DM rats. This new prototype showed promise for the avoidance of comorbidities in a T2DM experimental model, and thus may constitute an innovative therapeutic agent for the treatment of these conditions in the clinical field in future.
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Dipeptidil Peptidase 4/metabolismo , Inibidores da Dipeptidil Peptidase IV/farmacologia , Coração/efeitos dos fármacos , Nefropatias/tratamento farmacológico , Animais , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Nefropatias/metabolismo , Masculino , Ratos , Ratos Wistar , Fosfato de Sitagliptina/farmacologia , Estreptozocina/farmacologia , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/metabolismoRESUMO
Herein, we aimed to evaluate the occurrence of impaired renal function after cancer treatment with potentially nephrotoxic chemotherapy in children. A cross-sectional study was performed in 41 cancer survivors after chemotherapy with potentially nephrotoxic drugs. 26 (63.4%) children were detected with glomerular hyperfiltration, and urinary levels of ß-2 microglobulin (B2MG) were higher than reference range in all patients. Levels of B2MG were positively correlated with plasma creatinine and negatively correlated with glomerular filtration rate. Plasma creatinine, systolic blood pressure and cholesterol were independently associated with B2MG values. The final multivariate model for glomerular hyperfiltration risk included plasma levels of urea and of magnesium. Urinary levels of B2MG and glomerular hyperfiltration may emerge as potential biomarkers of early renal dysfunction in childhood cancer survivors.
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Studies have shown that adult offspring of mothers fed a protein-restricted diet during pregnancy present a pronounced reduction of nephron number associated with decreased fractional urinary sodium excretion and arterial hypertension. Additionally, recent advances in our understanding of the molecular pathways that govern the association of gestational nutritional restriction, intrauterine growth retardation and inflammation with impaired nephrogenesis, nephron underdosing and kidney fibrosis point to the epithelial to mesenchymal transition (EMT) as a common factor. In the current study, protein and sodium urinary excretion rates were evaluated in rats, and immunohistochemistry and western blot techniques were used to characterize kidney structure changes in 16 week old male offspring of mothers fed a low-protein diet during pregnancy (LP group) compared with age-matched (NP) controls. We also verified the expression of miRNA, mRNA and protein markers of fibrosis and the EMT in whole kidney prepared from LP offspring. We found, surprisingly, that arterial hypertension and long-term hyperfiltration, manifest by proteinuria, were associated with increased renal miR-192 and miR-200 family expression in 16 week old LP relative to age-matched NP rats. Measurement of kidney fibrosis and EMT-related protein markers, by histochemistry and immunoblot techniques, showed a significant rise of TGF-ß1 and type-I collagen content in glomeruli and tubulointerstitial areas, accompanied by enhanced fibronectin and ZEB1 and decreased E-cadherin immunoreactivity in 16 week old LP offspring. The results were partially confirmed by increased gene (mRNA) expression of collagen 1α1, collagen 1α2 and ZEB1 in LP whole kidneys compared with those of age-matched NP offspring. In view of the presumed functional overload in the remaining nephrons, we suggest that hypertension and proteinuria development following maternal protein restriction may be a preponderant factor for EMT and structural kidney changes in LP offspring. However, our study was not wholly able to establish the precise role of miRNAs in LP kidney disorders. Thus, further studies will be required to assess the contribution of the miR family to renal injury in a gestational protein-restricted model of fetal programming.
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Transição Epitelial-Mesenquimal , Rim/patologia , MicroRNAs/genética , Fenômenos Fisiológicos da Nutrição Pré-Natal , Animais , Dieta com Restrição de Proteínas/efeitos adversos , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Hipertensão/etiologia , Rim/crescimento & desenvolvimento , Masculino , MicroRNAs/metabolismo , Gravidez , Proteinúria/etiologia , Ratos Wistar , Sódio/urinaRESUMO
BACKGROUND: Cryptococcosis is the second most common cause of invasive fungal infections in renal transplant recipients in many countries, and data on graft outcome after treatment for this infection is lacking in less-resourced health care settings. METHODS: Data from 47 renal transplant recipients were retrospectively collected at a single institution during a period of 13 years. Graft dysfunction, graft loss, and mortality rates were evaluated. Predictors of mortality and graft loss were estimated. RESULTS: A total of 38 (97.4%) patients treated with amphotericin B deoxycholate (AMBd) showed graft dysfunction after antifungal initiation and 8 (18.2%) had kidney graft loss. Graft loss within 30 days after cryptococcosis onset was significantly associated with disseminated infection, greater baseline creatinine levels, and graft dysfunction concomitant to AMBd therapy and an additional nephrotoxic condition. The 30-day mortality rate was 19.2% and it was significantly associated with disseminated and pulmonary infections, somnolence at admission, high CSF opening pressure, positive CSF India ink, creatinine levels greater than 2.0 mg/dL at admission, graft dysfunction in patients treated with AMBd and an additional nephrotoxic condition and graft loss within 30 days. CONCLUSION: Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMBd. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients.
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Antifúngicos/efeitos adversos , Criptococose/mortalidade , Rejeição de Enxerto/epidemiologia , Infecções Fúngicas Invasivas/mortalidade , Transplante de Rim/efeitos adversos , Adulto , Idoso , Aloenxertos/efeitos dos fármacos , Aloenxertos/fisiopatologia , Anfotericina B/efeitos adversos , Brasil/epidemiologia , Criptococose/tratamento farmacológico , Criptococose/imunologia , Criptococose/microbiologia , Ácido Desoxicólico/efeitos adversos , Combinação de Medicamentos , Feminino , Rejeição de Enxerto/microbiologia , Rejeição de Enxerto/fisiopatologia , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/imunologia , Infecções Fúngicas Invasivas/microbiologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplantados , Adulto JovemRESUMO
BACKGROUND: Neuropathy is one of the major complications of type 2 diabetes mellitus. Our first aim was to determine the clinical characteristics of a population of diabetic patients with different types of neuropathy. Our next goal was to characterize the cytokine profile (IL-6 and IL-10), nerve growth factor (NGF) and circulating cell-adhesion molecules in these patients. Finally, we aimed to compare the renal function among the groups of neuropathic patients. METHODS: In a cross-sectional study, we included 217 diabetic patients classified in three groups: sensory polyneuropathy with hypoesthesia (DShP) or hyperesthesia (DSHP), and motor neuropathy (DMN). Two control groups were included: one of 26 diabetic non-neuropathic patients (DNN), and the other of 375 non-diabetic (ND) healthy subjects. The participants were attending to the Mexican Institute of Social Security. RESULTS: The circulating levels of NGF were significantly lower in diabetic patients, compared to healthy subjects. The range of IL-6 and IL-10 levels in neuropathic patients was higher than the control groups; however, several samples yielded null measurements. Neuropathic patients also showed increased circulating levels of the adhesion molecules ICAM, VCAM, and E-Selectin, compared to the ND group. Moreover, neuropathic patients showed reduced glomerular filtration rates compared to healthy subjects (82-103 ml/min per 1.73 m2, data as range from 25th-75th percentiles), especially in the group with DMN (45-76 ml/min per 1.73 m2). CONCLUSIONS: Some particular alterations in neuropathic patients included -but were not limited to- changes in circulating NGF, cell adhesion molecules, inflammation, and the worsening of the renal function. This study supports the need for further clinical surveillance and interventions considering a neuropathy-related basis.
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Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Indígenas Norte-Americanos/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/epidemiologia , Humanos , Interleucina-10/sangue , Interleucina-6/sangue , México , Fator de Crescimento Neural/sangueRESUMO
Resumen Dentro de los grandes problemas que se tienen en falla cardiaca, el manejo del volumen en algunos de los pacientes resulta muy difícil y ocasionalmente puede producir grandes alteraciones renales, por lo cual ha sido una de las principales preocupaciones dentro de las estrategias terapéuticas. La diálisis peritoneal ha surgido como una estrategia en algunos pacientes con presencia de disfunción ventricular y de disfunción renal; sin embargo, hay un grupo de pacientes en los cuales el deterioro de la función renal no es severo, pero hay imposibilidad para el manejo óptimo con diuréticos a dosis más altas y hay necesidad de mayor manejo de volumen. La diálisis peritoneal ha evidenciado beneficios clínicos, entre los cuales se encuentra la posibilidad de manejo ambulatorio, el cambio de su clase funcional de III/IV a I/II, la mejoría de la calidad de vida, la reducción en los días de hospitalización o el aumento de la función renal. Se ha realizado una revisión de este escenario específico con presentación de los primeros casos que se han dispuesto con esta finalidad en la clínica de falla cardíaca de la Fundación Cardiovascular de Colombia.
Abstract Within the great problems of heart failure, the management of volume in some of the patients is a difficult task and could occasionally produce severe renal alterations, thus becoming one of the main worries when it comes to therapeutic strategies. Peritoneal dialysis has emerged as a strategy in some patients with ventricular dysfunction and renal dysfunction; however, there is a group of patients where the deterioration of renal function is not severe, but there is an impossibility of optimal management with diuretics at higher doses and there is a need for a greater volume management. Peritoneal dialysis has evidenced clinical benefits, among which there is the possibility of outpatient management, the change from functional class III/IV to I/II, the improvement in quality of life, the decrease of hospitalization days or the increase in renal function. A review of this specific scenario with the presentation of the first cases that have been managed with this motivation in the heart failure clinic of the Cardiovascular Foundation of Colombia is conducted.
Assuntos
Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Diálise Peritoneal , Insuficiência Cardíaca , Doenças Cardiovasculares , Diuréticos , Insuficiência RenalRESUMO
BACKGROUND: The combined use of renal biochemistry and ultrasonographic imaging may improve the correct management of renal disease. Although renal disease is frequently observed in nonhuman primates, renal function markers have not yet been studied in Squirrel monkeys (Saimiri collinsi). OBJECTIVES: The aim of this study was to establish normal renal biochemistry variables and ultrasonographic features in Squirrel monkeys. MATERIAL AND METHODS: Renal biochemistry variables and ultrasonographic images were documented in 29 healthy Squirrel monkeys (15 males and 14 females). Urea, serum creatinine (SCr), and uric acid (UA) concentrations were measured by kinetic assay. Cystatin C (CysC) was analyzed by immunonephelometry. A multiple frequency linear array probe (5-12 MHz) was used for ultrasonographic imaging. The studied indicators of renal function were related to sex, age, and body mass. RESULTS: Serum creatinine was influenced by sex and body mass. Serum concentration of urea, UA, and CysC were not influenced by sex, age, and body mass. Ultrasonographic images provided accurate and comprehensive data for making clinical decisions for Squirrel monkeys. The total renal volume was only influenced by the body mass nested in sex and was positively correlated to body mass. Right renal volume was bigger than the left one. CONCLUSION: Normative standards for the renal evaluation, including biochemistry and ultrasonography, in the Squirrel monkey have been established correlated to age, sex, and body mass.
Assuntos
Cistatina C/análise , Animais , Biomarcadores/análise , Feminino , Rim/química , Rim/diagnóstico por imagem , Masculino , Saimiri , Ultrassonografia/veterináriaRESUMO
El síndrome de nefritis tubulointersticial y uveítis es una causa infrecuente de disfunción renal aguda en los adultos. El diagnóstico puede hacerse difícil, pues con frecuencia no coinciden temporalmente los síntomas oculares y renales. Se presentaron dos casos de síndrome de nefritis tubulointersticial y uveítis en adultos, con evolución favorable con tratamiento esteroideo sistémico(AU)
Tubulointerstitial nephritis syndrome and uveitis is an uncommon cause of acute renal dysfunction in adults. The diagnosis can be difficult, as ocular and renal symptoms often do not coincide temporarily. Two cases of tubulointerstitial nephritis syndrome and uveitis in adults, with favorable evolution with systemic steroid treatment are presented in this paper(AU)
Assuntos
Humanos , Nefrite Intersticial/complicações , Uveíte/tratamento farmacológico , Insuficiência Renal/diagnósticoRESUMO
El síndrome de nefritis tubulointersticial y uveítis es una causa infrecuente de disfunción renal aguda en los adultos. El diagnóstico puede hacerse difícil, pues con frecuencia no coinciden temporalmente los síntomas oculares y renales. Se presentaron dos casos de síndrome de nefritis tubulointersticial y uveítis en adultos, con evolución favorable con tratamiento esteroideo sistémico(AU)
Tubulointerstitial nephritis syndrome and uveitis is an uncommon cause of acute renal dysfunction in adults. The diagnosis can be difficult, as ocular and renal symptoms often do not coincide temporarily. Two cases of tubulointerstitial nephritis syndrome and uveitis in adults, with favorable evolution with systemic steroid treatment are presented in this paper(AU)