Navegando por Palavras-chave "Kidney diseases"
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- ItemAcesso aberto (Open Access)Análise morfológica dos fígados e rins no binômio materno-fetal após tratamento de ratas prenhes com Ritonavir durante toda a prenhez(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2007-07-01) Carvalho, Adelino Moreira De; Simões, Ricardo Santos [UNIFESP]; Oliveira, Fábio Hideo Martins; Simões, Manuel de Jesus [UNIFESP]; Oliveira-filho, Ricardo Martins; Nakamura, Mary Uchiyama [UNIFESP]; Kulay Júnior, Luiz [UNIFESP]; Universidade José do Rosário Vellano Faculdade de Ciências Médicas; Universidade Federal de São Paulo (UNIFESP); Irmandade da Santa Casa de Misericórdia de São Paulo Faculdade de Ciências Médicas Departamento de Obstetrícia; Universidade de São Paulo (USP)PURPOSE: to evaluate the effect of the chronic administration of three different doses of Ritonavir in the liver and kidneys of pregnant albino rats and their concepts from a morphological standpoint. METHODS: forty pregnant albino EPM-1 Wistar rats were randomly divided into four groups: Contr (vehicle control), and three experimental groups, Exp20, Exp60, Exp180, which received daily 20, 60 or 180 mg/kg of Ritonavir, respectively. The drug and the vehicle (propyleneglycol) were orally administered by gavage, from the first up to the 20th day of pregnancy. At the last experimental day, all the animals were sacrificed under deep anesthesia, and fragments from the maternal and fetal liver and kidneys were taken and prepared for histological analysis by light microscope. RESULTS: no morphological changes were identified in Exp20 and control group. In the Exp60 group, we found hepatocytes with signs of atrophy and apoptosis (eosinophilic cytoplasm and picnotic nuclei) and marked sinusoid capillary vasodilation (congestion). The proximal convoluted tubules of maternal kidneys and liver showed eosinophilic areas and hyperchromatic nuclei, as well as signs of vasodilation. The maternal kidneys and livers of the Exp180 rats presented more prominent morphological changes than the ones of Exp60. Regarding the fetal organs, no histomorphological abnormalities were observed in all the groups. CONCLUSIONS: our results show that the administration of Ritonavir to pregnant rats, in higher than conventional doses causes morphological changes in the maternal liver and kidneys. On the other hand, the lack of abnormalities in the fetal organs may be due to the protective role of glycoprotein P.
- ItemAcesso aberto (Open Access)Análise renal de ultramaratonista em prova de 75 km(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2009-01-01) Lopes, Thiago Ribeiro [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To identify urinary abnormalities, indicative of renal involvement, in 75 km ultra-marathon racer and pacer (cyclist that gives support to the racer). METHODS: Renal analysis consisted of urine dipstick tests in four different times and anthropometric measures. RESULTS: Both the racer and the pacer were in eutrophic conditions. There was an association between the capacity for maximum physical effort and detection of urinary abnormalities determined by the presence of hematuria and/or proteinuria. CONCLUSION: Renal analysis allowed the identification of transitory renal involvement in both healthy individuals during intense exercise.
- ItemAcesso aberto (Open Access)Divergences in antihypertensive therapy in special situations in nephrology(Associação Paulista de Medicina - APM, 2008-01-01) Lemos, Marcelo Montebello [UNIFESP]; Pedrosa, Alessandra Coelho [UNIFESP]; Tavares, Alze Pereira [UNIFESP]; Góes, Miguel Ângelo [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: The choice of an antihypertensive drug is based on several criteria and specific situations give rise to doubt and controversy. The aim here was to evaluate physicians approaches towards treatment with antihypertensive agents in specific situations. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo (UNIFESP), São Paulo. METHODS: A questionnaire was applied during a nephrology meeting to evaluate individual approaches towards each hypothetical clinical situation. The questionnaire consisted of five multiple-choice questions (clinical cases) concerning controversial aspects of antihypertensive therapy. RESULTS: A total of 165 questionnaires were analyzed. Most participants were nephrologists (93.2%). There was a preference for angiotensin-converting enzyme (ACE) inhibitors in at least two of the cases. Only 57.2% of the physicians were correct in choosing beta-blockers as the first-line drugs for patients with ischemic coronary disease. Moreover, 66.2% chose ACE inhibitors as the first-line drugs for patients with chronic kidney disease and proteinuria. About 5% of the physicians did not follow the current recommendations for the use of ACE inhibitors in diabetic patients with microalbuminuria. The most controversial question concerned the first-line drug for advanced chronic kidney disease. Most physicians were correct in choosing calcium channel blockers and avoiding ACE inhibitors in renovascular hypertension in the case of a patient with a single functioning kidney. CONCLUSIONS: Most physicians adopted the correct approach, but some had an alternative strategy for the same situations that was not based on evidence.
- ItemAcesso aberto (Open Access)Doença renal crônica: frequente e grave, mas também prevenível e tratável(Associação Médica Brasileira, 2010-01-01) Bastos, Marcus Gomes; Bregman, Rachel; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de Juiz de Fora Pesquisas e Tratamento em Nefrologia Núcleo Interdisciplinar de Estudos; Universidade do Estado do Rio de Janeiro Nefrologia; Universidade Federal de São Paulo (UNIFESP)Chronic kidney disease (CKD) is a public health problem worldwide. In Brazil incidence and prevalence of end stage renal failure are increasing; prognosis is still poor and costs of disease treatment are very high. Regardless of the etiology, main outcomes in patients with CKD are its complications (anemia, metabolic acidosis, malnutrition and alteration in mineral metabolism), death (mainly due to cardiovascular causes) and loss of renal function. Recent studies indicate that these outcomes may be postponed with specific treatment if the CKD is diagnosed early and renoprotective and cardioprotective measures are implemented early in the course of the disease. The current definition and staging of CKD, as well as the discussion of the main preventive measures are addressed in this review.
- ItemAcesso aberto (Open Access)O eletrocardiograma no diagnóstico da hipertrofia ventricular de pacientes com doença renal crônica(Sociedade Brasileira de Cardiologia - SBC, 2009-10-01) Costa, Francisco de Assis [UNIFESP]; Rivera, Ivan Romero; Vasconcelos, Mirian Lira Castro de; Costa, André Falcão Pedrosa; Póvoa, Rui Manuel dos Santos [UNIFESP]; Bombig, Maria Teresa Nogueira [UNIFESP]; Luna Filho, Bráulio [UNIFESP]; Lima, Valter Correia de [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE: To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS: Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 ± 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearson's linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION: ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.
- ItemAcesso aberto (Open Access)Estudo do eixo intestino-rim: as alterações na microbiota intestinal em um modelo experimental de nefropatia induzida pela adriamicina(Universidade Federal de São Paulo (UNIFESP), 2018-04-28) Silva, Denis Goncalves [UNIFESP]; Camara, Niels Olsen Saraiva [UNIFESP]; http://lattes.cnpq.br/8098379714093877; http://lattes.cnpq.br/1625763026411693Introduction: Kidney diseases are a global epidemic, with a high economic burden for global health systems. Recently, the gut-kidney axis is gaining strength as organs that influence each other, however little is known on how glomerulopathies, as Focal segmental glomerulosclerosis (FSGS), can modify and affect the composition of the gut microbiota and metabolites. The progressive loss of podocytes is a major cause of chronic kidney disease (CKD), with a high prevalence rate and limited current etiological knowledge. Objective: Explore the interrelationship between the renal injury caused by glomerular dysfunction and changes in gut microbiota. Methods: Wild type Balb/c mice were chemically-induced to develop glomerulopathy (Adriamycin, ADR) and were evaluated for 30 days. In parallel, 14 days before receiving ADR, a group of Balb/c mice underwent microbiota depletion, administering broad spectrum antibiotics (ampicillin, metronidazole, neomycin, vancomycin) in autoclaved drinking water and then they were induced the same way to develop glomerulopathy. Results: ADR caused renal histopathological lesions, such as glomerular collapse, decreased number of podocytes per glomerulus, glomerular barrier dysfunction and uremia. In addition, ADR-induced animals showed histological changes in gut colon, with increased levels in amorphous cell mass and a decrease in claudin-1 expression. Structural changes in intestinal colon were also associated with gut microbiota dysbiosis, with reduced Bacteroidetes phylum and less gut mucus. Disease-induced animals that had previously depleted gut microbiota exhibited better glomerular barrier function, with lower levels of protein and albumin in the urine. Conclusion: Our results shows, for the first time in literature, that the development of ADR-induced glomerulopathy promotes changes in the structure of the colon and in the proportion of gut bacterial phyla. Interestingly, initial results showed that depletion of gut microbiota conferred protection to the loss of glomerular barrier function.
- ItemAcesso aberto (Open Access)Extracellular vesicles: structure, function, and potential clinical uses in renal diseases(Assoc Bras Divulg Cientifica, 2013-10-01) Borges, Fernanda Teixeira [UNIFESP]; Reis, L. A. [UNIFESP]; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Cruzeiro SulInterest in the role of extracellular vesicles in various diseases including cancer has been increasing. Extracellular vesicles include microvesicles, exosomes, apoptotic bodies, and argosomes, and are classified by size, content, synthesis, and function. Currently, the best characterized are exosomes and microvesicles. Exosomes are small vesicles (40- 100 nm) involved in intercellular communication regardless of the distance between them. They are found in various biological fluids such as plasma, serum, and breast milk, and are formed from multivesicular bodies through the inward budding of the endosome membrane. Microvesicles are 100-1000 nm vesicles released from the cell by the outward budding of the plasma membrane. the therapeutic potential of extracellular vesicles is very broad, with applications including a route of drug delivery and as biomarkers for diagnosis. Extracellular vesicles extracted from stem cells may be used for treatment of many diseases including kidney diseases. This review highlights mechanisms of synthesis and function, and the potential uses of wellcharacterized extracellular vesicles, mainly exosomes, with a special focus on renal functions and diseases.
- ItemAcesso aberto (Open Access)Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico(Sociedade Brasileira de Cardiologia - SBC, 2012-12-01) Gomes, Vitor O.; Lasevitch, Ricardo; Lima, Valter C. [UNIFESP]; Brito Jr., Fábio S.; Perez-alva, Juan Carlos; Moulin, Bruno; Arruda, Airton; Oliveira, Denise; Caramori, Paulo; PUCRS Hospital São Lucas; Universidade Federal de São Paulo (UNIFESP); Hospital São Camilo; Hospital General de Puebla; Hospital da Unimed; Hospital Intercath Meridional; UFRGSBACKGROUND: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN) in patients undergoing cardiac catheterization. OBJECTIVE: The present study was aimed at determining whether sodium bicarbonate is superior to hydration with saline to prevent nephropathy in patients at risk undergoing cardiac catheterization. METHODS: Three hundred and one patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > 1.2mg/dL or glomerular filtration rate (GFR) < 50ml/min were randomized to receive hydration with sodium bicarbonate starting 1 hour before the procedure and 6 hours after the procedure, or hydration with 0.9% saline. CIN was defined as an increase of 0.5mg/dL in creatinine in 48h RESULTS: Eighteen patients (5.9%) developed contrast induced nephropathy: 9 patients in the bicarbonate group (6.1%) and 9 patients in the saline group (6.0%), p = 0.97. The change in serum creatinine was similar in both groups, 0.01 ± 0.26 mg/dL in the bicarbonate group and 0.01 ± 0.35 mg/dL in the saline group, p = 0.9. No statistical difference was observed between the change in glomerular filtration rate (0.89 ± 9 ml/min vs. 2.29 ± 10 ml/min, p = 0.2 bicarbonate group and saline group, respectively). CONCLUSION: Hydration with sodium bicarbonate was not superior to saline to prevent contrast media induced nephropathy in patients at risk undergoing cardiac catheterization.
- ItemAcesso aberto (Open Access)Perfil epidemiológico dos pacientes em lista de espera para o transplante renal(Univ Fed Sao Paulo, Dept Enfermagen, 2017) Batista, Camilla Maria Mesquita [UNIFESP]; Moreira, Rita Simone Lopes [UNIFESP]; Pessoa, João Luis Erbs; Ferraz, Agenor Spallini; Roza, Bartira de Aguiar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To identify and describe the profile of patients placed on a single waiting list for renal transplantation in the state of Sao Paulo. Methods: Cross-sectional epidemiological study of quantitative approach to identify and describe the profile of patients placed on a single waiting list for renal transplantation. In the period from 2009 to 2015, a survey was conducted in the databases of the Notification, Collection and Distribution Center of Organs of the Single Technical Registry, and the following characteristics were established as variables: clinical, demographic and information related to the convocation result. The sample included 12,415 patients undergoing hemodialysis who were simultaneously registered for renal transplantation. The Chi-Square and Student's t-test were used for descriptive statistical analysis and the Kaplan-Meier estimate was used for significance. Results: A total of 12,415 patients were included, mean age was 50 years, male gender (59.6%), white color (63.1%), blood type O (48.9%), metropolitan region of Sao Paulo (73.82%), unspecified diagnosis (34.5%), did not undergo transplantation (77.2%), and without clinical conditions to perform the transplant (99.8%). Conclusion: Knowing the profile of patients with chronic kidney disease on the single waiting list allows the development of new health care strategies for reducing mainly morbidity and mortality rates. There is lack in meeting the care demands and high rates of refusal.
- ItemAcesso aberto (Open Access)Síndrome hipertensiva induzida pela gravidez : risco futuro de desenvolver doenças renal crônica e cardiovascular(Universidade Federal de São Paulo (UNIFESP), 2017-09-29) Facca, Thais Alquezar [UNIFESP]; Sass, Nelson [UNIFESP]; Kirsztajn, Gianna Mastroianni [UNIFESP]; http://lattes.cnpq.br/5744106277657588; http://lattes.cnpq.br/6079546404174722; http://lattes.cnpq.br/3999486113967328; Universidade Federal de São Paulo (UNIFESP)Objectives: Long-term postpartum assessment of the clinical, anthropometric, epidemiological, laboratory profile, risk stratification of CKD and CVD, angiogenic factors and podocyturia in women with a history of pregnancy-induced hypertensive syndrome, comparing them with women who had normal gestation. Methods: This is a retrospective cohort study. The clinical, anthropometric and epidemiological profile were investigated, laboratory tests were performed for metabolic and renal evaluation, risk stratification of CKD/CVD, podocyturia and serum angiogenic factors. Statistical analysis was performed using Pearson's Chi-square test, Fisher's exact test, or its extension, Student's t-test, Mann-Whitney test, Pearson's linear correlation coefficient, 1-factor ANOVA and Kruskall-Wallis test, with significance level α equal to 5%. Results: Total of 85 women divided into case (n=25) and control group (n=60). The case group presented a higher incidence of chronic arterial hypertension (p=0.003), a shorter time between its diagnosis and the end of gestation (p<0.001) and also a lower age of diagnosis (p=0.033); higher weight (p<0.001), body mass index (p<0.001), waist to height ratio (p=0.001), brachial (p=0.001), abdominal (p<0.001) and hip circumferences (p<0.001); higher fat percentage (p=0.004) and metabolic rate (p<0.001) and lower weight percent (p=0.003); lower estimated glomerular filtration rate by CKD EPI (p=0.021) and MDRD (p=0.003), greater difference between actual age and estimated vascular age according to Framingham RS (2008) (p=0.008) and higher frequency of metabolic syndrome (p<0.001). No significant difference was found between the groups in podocyturia and serum angiogenic factors. Conclusion: Women who had pregnancy-induced hypertension syndrome were more obese, mainly by central obesity, higher incidence of metabolic syndrome and chronic arterial hypertension after pregnancy, with earlier onset after delivery. These findings reinforce the importance of investigating the history of hypertensive syndrome in pregnancy at postpartum follow-up.