Navegando por Palavras-chave "Chronic allograft nephropathy"
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- ItemSomente MetadadadosAssociation of high post-transplant soluble CD30 serum levels with, chronic allograft nephropathy(Elsevier B.V., 2013-12-01) Grenzi, Patricia C. [UNIFESP]; Campos, Erika F. [UNIFESP]; Tedesco-Silva, Helio; Felipe, Claudia R.; Franco, Marcello F. [UNIFESP]; Soares, Maria Fernanda Sanches [UNIFESP]; Medina-Pestana, Jose Osmar [UNIFESP]; Gerbase-DeLima, Maria [UNIFESP]; AFIP; Universidade Federal de São Paulo (UNIFESP); Hosp Rim & Hipertensao; Univ Fed ParanaThe purpose of this study was to evaluate the association of post-transplant soluble CD30 (sCD30) levels, isolated or in combination with of anti-HLA class II antibodies and of serum creatinine levels, with kidney graft loss due to chronic allograft nephropathy (CAN), and type of lesions in graft biopsies for cause. the study comprised 511 first kidney graft recipients, transplanted at a single center, with a graft functioning for at least 2.8 years. A single blood sample was collected from each patient sCD30 levels were determined by ELISA, and HIA antibodies by Luminex assay. the minimum follow-up after testing was 93 years. High sCD30 levels, set at sCD30 >= 3.415 ng/mL, the presence of HLA class II antibodies, and serum creatinine >= 1.9 mg/dL were independently associated with CAN-graft loss (P values <0.0001, 0.05, <0.0001, respectively), and the combined hazard ratio for CAN-graft loss was 20.2. Analyses of 166 biopsies for cause showed that high sCD30 levels and creatinine were independently associated with interstitial lesions. Post-transplant sCD30 serum levels, especially in conjunction with information regarding HLA class II antibodies and serum creatinine levels, provide valuable information regarding graft outcome and could be useful for the management of kidney transplant recipients. (C) 2013 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosFunctional and morphologic evaluation of kidney proximal tubuli and correlation with renal allograft prognosis(Wiley-Blackwell, 2010-05-01) Matos, Ana Cristina Carvalho de [UNIFESP]; Camara, Niels Olsen Saraiva [UNIFESP]; Oliveira, Ana Francisca Franco de [UNIFESP]; Franco, Marcello Fabiano de [UNIFESP]; Moura, Luiz Antonio Ribeiro de [UNIFESP]; Nishida, Sonia Kiyomi [UNIFESP]; Pereira, Aparecido Bernardo [UNIFESP]; Pacheco-Silva, Alvaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Albert Einstein Hosp; Universidade de São Paulo (USP); Univ Jose Rosario VellanoP>Renal transplant patients with stable graft function and proximal tubular dysfunction (PTD) have an increased risk for chronic allograft nephropathy (CAN). in this study, we investigated the histologic pattern associated with PTD and its correlation with graft outcome. Forty-nine transplant patients with stable graft function were submitted to a biopsy. Simultaneously, urinary retinol-binding protein (uRBP) was measured and creatinine clearance was also determined. Banff's score and semi-quantitative histologic analyses were performed to assess tubulointerstitial alterations. Patients were followed for 24.0 +/- 7.8 months. At biopsy time, mean serum creatinine was 1.43 +/- 0.33 mg/dl. Twelve patients (24.5%) had uRBP >= 1 mg/l, indicating PTD and 67% of biopsies had some degree of tubulointerstitial injury. At the end of the study period, 18 (36.7%) patients had lost renal function. uRBP levels were not associated with morphologic findings of interstitial fibrosis and tubular atrophy (IF/TA), interstitial fibrosis measured by Sirius red or tubulointerstitial damage. However, in multivariate analysis, the only variable associated with the loss of renal function was uRBP level >= 1 mg/l, determining a risk of 5.290 of loss of renal function (P = 0.003). Renal transplant patients who present PTD have functional alteration, which is not associated with morphologic alteration. This functional alteration is associated to progressive decrease in renal function.
- ItemAcesso aberto (Open Access)Glomerular damage as a predictor of renal allograft loss(Associação Brasileira de Divulgação Científica, 2010-06-01) Moscoso-Solorzano, Grace Tamara [UNIFESP]; Câmara, Niels Olsen Saraiva [UNIFESP]; Franco, Marcello Fabiano de [UNIFESP]; Araújo, Sergio [UNIFESP]; Ortega, Francisco Gabriel; Pacheco-Silva, Alvaro [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Universitario Central de Asturias Servicio de Nefrología; Fundación Renal Iñigo Alvarez de Toledo Y Fundación Carolina-BBVA; Universidade de São Paulo (USP)Interstitial fibrosis and tubular atrophy (IF/TA) are the most common cause of renal graft failure. Chronic transplant glomerulopathy (CTG) is present in approximately 1.5-3.0% of all renal grafts. We retrospectively studied the contribution of CTG and recurrent post-transplant glomerulopathies (RGN) to graft loss. We analyzed 123 patients with chronic renal allograft dysfunction and divided them into three groups: CTG (N = 37), RGN (N = 21), and IF/TA (N = 65). Demographic data were analyzed and the variables related to graft function identified by statistical methods. CTG had a significantly lower allograft survival than IF/TA. In a multivariate analysis, protective factors for allograft outcomes were: use of angiotensin-converting enzyme inhibitor (ACEI; hazard ratio (HR) = 0.12, P = 0.001), mycophenolate mofetil (MMF; HR = 0.17, P = 0.026), hepatitis C virus (HR = 7.29, P = 0.003), delayed graft function (HR = 5.32, P = 0.016), serum creatinine ≥1.5 mg/dL at the 1st year post-transplant (HR = 0.20, P = 0.011), and proteinuria ≥0.5 g/24 h at the 1st year post-transplant (HR = 0.14, P = 0.004). The presence of glomerular damage is a risk factor for allograft loss (HR = 4.55, P = 0.015). The presence of some degree of chronic glomerular damage in addition to the diagnosis of IF/TA was the most important risk factor associated with allograft loss since it could indicate chronic active antibody-mediated rejection. ACEI and MMF were associated with better outcomes, indicating that they might improve graft survival.
- ItemAcesso aberto (Open Access)Patologia do transplante renal: achados morfológicos principais e como laudar as biópsias(Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2008-08-01) Sementilli, Angelo; David, Daisa Ribeiro; Malheiros, Denise; Visona, Iria [UNIFESP]; Pegas, Karla Laís; Franco, Marcello Fabiano de [UNIFESP]; Soares, Maria Fernanda Sanches [UNIFESP]; Edelweiss, Maria Isabel Albano; Caldas, Maria Lúcia; Araújo, Sérgio [UNIFESP]; Universidade Metropolitana de Santos; Centro Universitário Lusíadas; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Irmandade da Santa Casa de Misericórdia de Porto Alegre; Salomão & Zoppi Medicina Diagnóstica; Universidade Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Patologia; Universidade Federal Fluminense Faculdade de Medicina Centro de Ciências MédicasRenal transplant has reached remarkable and growing rates of success since its introduction; nowadays it is a widely used replacement therapy. Renal allograft biopsies are increasingly more frequent in the routine of pathology laboratories, whose histological findings are varied. This paper results from the expertise of the members of the Kidney Club of Sociedade Brasileira de Patologia, and presents a general overview of renal allograft pathology, focusing on the current Banff classification, its main categories and cases of difficult diagnosis.
- ItemAcesso aberto (Open Access)Proximal tubular dysfunction as an indicator of chronic graft dysfunction(Associação Brasileira de Divulgação Científica, 2009-03-01) Câmara, Niels Olsen Saraiva [UNIFESP]; Williams Jr., W.w.; Pacheco-Silva, Alvaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Harvard University Massachusetts General Hospital; Instituto Israelita de Ensino e Pesquisa Hospital Albert Einstein Unidade de Transplante RenalNew strategies are being devised to limit the impact of renal sclerosis on graft function. Individualization of immunosuppression, specifically the interruption of calcineurin-inhibitors has been tried in order to promote better graft survival once chronic graft dysfunction has been established. However, the long-term impact of these approaches is still not totally clear. Nevertheless, patients at higher risk for tubular atrophy and interstitial fibrosis (TA/IF) development should be carefully monitored for tubular function as well as glomerular performance. Since tubular-interstitial impairment is an early event in TA/IF pathogenesis and associated with graft function, it seems reasonable that strategies directed at assessing tubular structural integrity and function would yield important functional and prognostic data. The measurement of small proteins in urine such as α-1-microglobulin, N-acetyl-beta-D-glucosaminidase, alpha/pi S-glutathione transferases, β-2 microglobulin, and retinol binding protein is associated with proximal tubular cell dysfunction. Therefore, its straightforward assessment could provide a powerful tool in patient monitoring and ongoing clinical assessment of graft function, ultimately helping to facilitate longer patient and graft survival associated with good graft function.
- ItemSomente MetadadadosToll-like receptors-related genes in kidney transplant patients with chronic allograft nephropathy and acute rejection(Elsevier B.V., 2009-06-01) Nogueira, Eliana; Ponciano, Viviane Campos; Naka, Erika L.; Marques, Georgia D. M.; Cenedeze, Marcos A.; Saraiva Camara, Niels Olsen; Pacheco-Silva, Alvaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Introduction: Toll-like receptors (TLR) comprehend an emerging family of receptors that recognize pathogen-associated molecular patterns and promote the activation of leukocytes. Surgical trauma and ischemia-reperfusion injury are likely to provide exposure to endogenous ligands for TLR in virtually all kidney transplant recipients.Methods: Macroarray (GEArray OHS-018.2 Series-Superarray) analyses of 128 genes involved in TLR signaling pathway were performed in nephrectomy samples of patients with chronic allograft nephropathy (CAN) and acute rejection (AR, vascular and non vascular). the analysis of each membrane was performed by GEArray Expression Analysis Suite 2.0.Results: Macroarray profile identified a gene expression signature that could discriminate CAN and AR. Three genes were significantly expressed between CAN and vascular AR: Pellino 2; IL 8 and UBE2V1. in relation to vascular and non-vascular AR, there were only two genes with statistical significance: IL-6 and IRAK-3.Conclusion: Vascular and non-vascular AR and CAN showed different expression of a few genes in TLR pathway. the analysis of nephrectomy showed that activation of TLR pathway is present in AR and CAN. (C) 2008 Elsevier B.V. All rights reserved.