Navegando por Palavras-chave "glomerulonephritis"
Agora exibindo 1 - 11 de 11
Resultados por página
Opções de Ordenação
- ItemAcesso aberto (Open Access)Achados histopatológicos renais em idosos(Sociedade Brasileira de Nefrologia, 2010-09-01) Carmo, Priscylla Aparecida Vieira do; Mastroianni Kirsztajn, Gianna [UNIFESP]; Carmo, Wander Barros do; Franco, Marcello Fabiano de [UNIFESP]; Bastos, Marcus Gomes; Fundação IMEPEN; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Juiz de Fora Faculdade de MedicinaINTRODUCTION: The elderly population has significantly increased worldwide and recent studies have evidenced a 10-year increase in Brazilian life expectancy. Similarly to other comorbidities, glomerular diseases are also observed in the elderly, and, in that age group, kidney biopsy emerges as a fundamental diagnostic tool to help disease management, preventing unnecessary therapies. OBJECTIVE: To establish the frequency of histological diagnoses in the elderly undergoing kidney biopsy, with an emphasis on glomerulopathies (GPs), at two Brazilian universities. METHODS: Retrospective assessment of kidney biopsy reports of the Department of Pathology of UNIFESP (patients aged 60 years or above, from 01/01/1996 to 12/31/2003) and of the outpatient clinic of GPs of NIEPEN. The studies of transplanted kidneys and nephrectomies were excluded. The following data were analyzed: age; sex; clinical syndrome at presentation; and histological diagnosis (light microscopy and immunofluorescence). Nephropathies were classified as primary GPs, secondary kidney diseases, nonglomerular diseases, and others. RESULTS: One hundred and thirteen biopsies were assessed, the mean age of patients was 66.0 ± 6.0 years, and the male sex prevailed (54.8%). The most common clinical presentation was nephrotic syndrome (32.7%), followed by acute and chronic kidney failure (18.6%, each). Glomerular diseases were as follows: membranous nephropathy (MN), 15%; hypertensive nephrosclerosis, 11.5%; focal segmental glomerulosclerosis and vasculitis/crescentic GN, 9.7% each; amyloidosis, chronic glomerulonephritis, and minimal change disease, 7.1% each; diffuse proliferative GN, 4.4%; IgA nephropathy and lupus nephritis, 2.7% each. Primary GPs predominated (45.2%) as compared with other nephropathies. CONCLUSION: Nephrotic syndrome was the major indication for kidney biopsy. Regarding the kidney histological diagnoses, glomerular diseases predominated, in particular MN and hypertensive nephrosclerosis, findings compatible with previous studies in the area, but rarely assessed among us. It is clear that the diversity of diagnoses and differentiated treatments justify kidney biopsy for decision making in that group of patients.
- ItemAcesso aberto (Open Access)Ansiedade, depressão e qualidade de vida em pacientes com glomerulonefrite familiar ou doença renal policística autossômica dominante(Sociedade Brasileira de Nefrologia, 2011-06-01) Barros, Bruna Paes de [UNIFESP]; Nishiura, José Luiz [UNIFESP]; Heilberg, Ita Pfeferman [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Psychological aspects and quality of life are often evaluated in patients under renal replacement therapy, but studies about anxiety, de>pression, and quality of life in familial renal diseases are lacking. OBJECTIVES: To evaluate the frequency of anxiety, depression, and quality of life (QOL) and their eventual associations with the main laboratory, clinical, socioeconomic, and cultural parameters in familial glomerulonephritis (GN) or autosomal dominant polycystic kidney disease (ADPKD). METHODS: Ninety adult patients (52 familial GN and 38 ADPKD) completed the questionaires of State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and QOL-Short-Form SF-36, and were also submitted to a short interview. RESULTS: Moderate anxiety was detected in both groups. Depression was found in 34.6% of familial GN and 60.5% of ADPKD patients. Anxiety and depression were more associated with female gender in familial GN, and with poorer schooling in ADPKD. Patients of both groups presented two quality of life unfavorable dimensions: emotional role function and general health perception. In addition, quality of life was worse among females, unmarried, and Caucasian subjects, and those individuals with a poorer educational level. CONCLUSION: The use of these instruments allows one to appreciate the frequency and levels of anxiety, depression, and quality of life in patients with familial renal diseases that could affect their compliance to treatment. These findings can contribute to planning a better multidisciplinary assistance to such groups of patients.
- ItemSomente MetadadadosAre urinary levels of high mobility group box 1 markers of active nephritis in anti-neutrophil cytoplasmic antibody-associated vasculitis?(Wiley-Blackwell, 2014-11-01) Souza, A. W. S. de [UNIFESP]; Abdulahad, W. H.; Sosicka, P.; Bijzet, J.; Limburg, P. C.; Stegeman, C. A.; Bijl, M.; Westra, J.; Kallenberg, C. G. M.; Univ Groningen; Martini Hosp; Universidade Federal de São Paulo (UNIFESP); Univ WroclawThe objective of this study is to evaluate urinary high mobility group box 1 (HMGB1) levels as markers for active nephritis in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in comparison with urinary CD4(+) effector memory T cells and urinary monocyte chemoattractant protein-1 (MCP-1). Twenty-four AAV patients with active nephritis and 12 healthy controls (HC) were evaluated. in nine patients, samples were also obtained during remission. Urinary levels of HMGB1 were measured by Western blot. CD4(+) T cells and CD4(+) effector memory T cells (CD4(+)CD45RO(+)CCR7(-)) were determined in urine and whole blood by flow cytometry. Measurement of urinary levels of MCP-1 and serum HMGB1 levels were performed by enzyme-linked immunosorbent assay (ELISA). AAV patients with active nephritis had higher median intensity of HMGB1 in urine than HC [10.3 (7.05-18.50) versus 5.8 (4.48-7.01); P = 0.004]. Both urinary HMGB1 and MCP-1 levels decreased significantly from active nephritis to remission. the urinary MCP-1/creatinine ratio correlated with Birmingham Vasculitis Activity Score (BVAS) (P = 0.042). No correlation was found between the HMGB1/creatinine ratio and 24-h proteinuria, estimated glomerular filtration rate (eGFR), MCP-1/creatinine ratio, BVAS and serum HMGB1. A positive correlation was found between urinary HMGB1/creatinine ratio and CD4(+) T cells/creatinine ratio (P = 0.028) and effector memory T cells/creatinine ratio (P = 0.039) in urine. Urinary HMGB1 levels are increased in AAV patients with active nephritis when compared with HC and patients in remission, and urinary HMGB1 levels are associated with CD4(+) T cells and CD4(+) effector memory T cells in urine. Measurement of urinary HMGB1 may be of additional value in identifying active glomerulonephritis in AAV patients.
- ItemSomente MetadadadosAutoimmune lymphoproliferative syndrome presenting with glomerulonephritis(Springer, 2003-05-01) Kanegane, H.; Vilela, MMD; Wang, Y.; Futatani, T.; Matsukura, H.; Miyawaki, T.; Toyama Med & Pharmaceut Univ; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)Autoimmune lymphoproliferative syndrome (ALPS) is characterized clinically by chronic non-malignant lymphoproliferation and autoimmunity and is caused by a genetic defect in programmed cell death (apoptosis). Most patients with ALPS have heterozygous mutations in the Fas gene. We describe an 11-year-old Brazilian boy with hepatosplenomegaly, lymphadenopathy, hemolytic anemia, and hypergammaglobulinemia since early infancy. T cell lines from the patient were defective in Fas-mediated apoptosis. He was diagnosed as having ALPS and found to have a novel Fas gene mutation (IVS4+1G>A). in addition, he presented with glomerulonephritis in infancy. An aunt and uncle who had the same Fas mutations also had histories of glomerulonephritis. Although glomerulonephritis is common in Fas-deficient mice, it is infrequent in human ALPS. Corticosteroid therapy ameliorated the glomerulonephritis in our patient, as well as his lymphoproliferation, anemia, and hypergammaglobulinemia. This study suggests that glomerulonephritis is one of the characteristic features of ALPS.
- ItemAcesso aberto (Open Access)CD4(+) T helper cells and regulatory T cells in active lupus nephritis: an imbalance towards a predominant Th1 response?(Wiley, 2018) Mesquita, D., Jr.; Mastroianni Kirsztajn, G.; Franco, M. F. [UNIFESP]; Reis, L. A.; Perazzio, S. F.; Mesquita, F. V.; da Silva Ferreira, V.; Coelho Andrade, L. E.; Silva de Souza, A. W.The objective of this study was to evaluate the frequency of CD4(+) T cell subsets in peripheral blood mononuclear cells (PBMC), urine and renal tissue from patients with lupus nephritis (LN). PBMC and urinary cells were collected from 17 patients with active LN, 20 disease controls (DC) with primary glomerulonephritis and 10 healthy controls (HC) and were analysed by flow cytometry with markers for T helper type 1 (Th1), Th2, Th17 and regulatory T cells (T-reg) cells. T cell subsets were assessed by immunohistochemistry from LN biopsy specimens from 12 LN patients. T cell subtypes in PBMC were re-evaluated at 6 months of therapy. CD4(+) T cells were decreased in PBMC in LN compared with DC and HC (P=00001). No differences were observed in urinary CD4(+) T cell subsets between LN and DC. The frequency of urinary Th17 cells was higher in patients with non-proliferative than in proliferative LN (P=0041). CD3(+) and T-box 21 ( Tbet+) cells were found in glomeruli and interstitium of LN patients, while forkhead box protein 3 (FoxP3), retinoid-related orphan receptor gamma (ROR-) and GATA binding protein 3 (GATA-3) were present only in glomeruli. Th1 cells in PBMC were correlated negatively with urinary Th1 cells (Rho=-0531
- ItemSomente MetadadadosThe classification of glomerulonephritis in systemic lupus erythematosus revisited(Blackwell Publishing Inc, 2004-02-01) Weening, Jan J.; D'Agati, Vivette D.; Schwartz, Melvin M.; Seshan, Surya V.; Alpers, Charles E.; Appel, Gerald B.; Balow, James E.; Bruijn, Jan A.; Cook, Terence; Ferrario, Franco; Fogo, Agnes B.; Ginzler, Ellen M.; Hebert, Lee; Hill, Gary; Hill, Prue; Jennette, J. Charles; Kong, Norella C.; Lesavre, Philippe; Lockshin, Michael; Looi, Lai-Meng; Makino, Hirofumi; Moura, Luiz A. [UNIFESP]; Nagata, Michio; Int Soc Nephrology; Renal Soc Working Grp Classificati; Univ Amsterdam; Columbia Univ; Rush Med Coll; Cornell Univ; Univ Washington; Columbia Presbyterian Med Ctr; NIH; Leiden Univ; Imperial Coll Med Sch; San Carlo Borromeo Hosp; Vanderbilt Univ; SUNY Hlth Sci Ctr; Ohio State Univ; Georges Pompidou European Hosp; St Vincents Hosp; Univ N Carolina; Univ Kebangsaan Malaysia; Hop Necker Enfants Malad; Univ Malaya; Okayama Univ; Universidade Federal de São Paulo (UNIFESP); Univ TsukubaThe currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving < 50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving 50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivisions for active and sclerotic lesions; class V for membranous lupus nephritis; and class VI for advanced sclerosing lesions. Combinations of membranous and proliferative glomerulonephritis(i.e., class III and V or class IV and V) should be reported individually in the diagnostic line. the diagnosis should also include entries for any concomitant vascular or tubulointerstitial lesions. One of the main advantages of the current revised classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and lending a basis for further clinicopathologic studies. We hope that this revision, which evolved under the auspices of the International Society of Nephrology and the Renal Pathology Society, will contribute to further advancement of the WHO classification.
- ItemAcesso aberto (Open Access)Detecção de podocitúria em pacientes com nefrite lúpica(Sociedade Brasileira de Nefrologia, 2013-12-01) Sabino, Amelia Rodrigues Pereira [UNIFESP]; Teixeira, Vicente de Paulo Castro [UNIFESP]; Nishida, Sonia Kiyomi [UNIFESP]; Sass, Nelson [UNIFESP]; Mansur, Juliana Busato [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: The podocyturia has been detected in glomerular diseases, such as lupus nephritis (LN), in which proteinuria is an important manifestation, and its occurrence seems to be limited to the active phase of the disease. OBJECTIVE: To evaluate podocyturia in LN patients, and the possible association with clinical disease activity. METHODS: We evaluated 56 patients with LN, that were classified in three groups according to the degree of clinical activity: Group B, no activity (n = 17), Group C with mild (n = 29) and Group D, moderate to severe activity (n = 10). The control group was composed by 29 healthy subjects (Group A). The podocyturia was studied by indirect immunofluorescence using primary antibodies to podocyte: anti-podocin, nephrin and synaptopodin, and a secondary antibody conjugated with FITC. We also evaluated serum creatinine levels, urinary protein/creatinine (P/C) ratio, hematuria and leucocituria. RESULTS: The podocyturia with anti-podocin and anti-sinaptopodin correlated statistically with the P/C ratio (p = 0.001 and p = 0.013, respectively). The podocyturia with anti-podocin, as well as the P/C ratio showed significant correlation (p < 0.001) with the degree of lupus disease activity, unlike the other two antibodies, anti-nephrin and anti-synaptopodin. CONCLUSION: Our findings show that podocyturia with anti-podocin could be useful in monitoring disease activity in LN patients.
- ItemSomente MetadadadosNPHS2 mutations in adult patients with primary focal segmental glomerulosclerosis(Wichtig Editore, 2006-05-01) Monteiro, Eduardo Jose Bellotto; Pereira, Alexandre C.; Pereira, Aparecido B.; Krieger, Jose E.; Mastroianni-Kirsztajn, Gianna; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Background. Mutations in the NPHS2 gene encoding the protein podocin have recently been found in a recessive form of steroid-resistant nephrotic syndrome. Focal segmental glomerulosclerosis (FSGS) was the histologic diagnosis in many of the patients harboring these mutations. FSGS is a heterogeneous glomerular lesion with diverse origins and outcomes. Although mutational analysis in children permits the identification of an unresponsive group before initiating treatment, there is not much information on adult-onset patients with FSGS.Methods: We performed NPHS2 gene mutational analysis in 39 adult Brazilian patients with primary FSGS, and evaluated the clinical course of the disease and response to treatment; in addition, we performed urinary screening in 44 relatives of these patients.Results: In this group, only 1 patient (with familial FSGS) had a mutation in the NPHS2 gene with double heterozygosity. The absence of mutations in all other patients evaluated suggests its rarity in sporadic cases of adult-onset (steroid sensitive or resistant) FSGS in our population.Conclusions: Our results suggest that the analysis of the NPHS2 gene mutation is not indicated as a routine diagnostic procedure in our population for adult-onset patients with FSGS.
- ItemSomente MetadadadosPrevalence of hepatitis C virus antibodies in primary glomerulonephritis in Brazil(Karger, 1998-11-01) Lopes, LMV; Lopes, EPA; Silva, E.; Kirsztajn, G. M.; Pereira, A. B.; Sesso, R. C.; Ferraz, M. L.; Universidade Federal de São Paulo (UNIFESP)The association between hepatitis B virus and membranous glomerulonephritis and membranoproliferative glomerulonephritis (MPGN) was first described in 1971. Recently, a similar association between hepatitis C virus (HCV) and glomerulonephritis (CN) has been reported. We investigated the prevalence of hepatitis C serum antibodies (anti-HCV) in patients with primary GN followed up at our Nephrology Outpatient Clinic between March 1993 and November 1995. the diagnosis of primary GN was established after excluding the presence of connective tissue disease, diabetes, infectious disease, and malignancy. Anti-HCV antibodies were detected by a second-generation enzyme immunosorbent assay and HCV RNA by polymerase chain reaction. of 81 patients with primary GN, 24 had membranous glomerulonephritis, 17 MPGN, 15 minimal-change disease, 12 focal-segmental glomerulosclerosis, 9 diffuse proliferative GN, and 4 IgA nephropathy. Anti-HCV were detected in 2 cases (2.5 %), both were HCV RNA positive and had a polyclonal mixed cryoglobulinemia (IgM-IgG). These 2 cases both came from the group of 17 patients with MPGN. Biochemical investigation in these patients revealed persistent elevation of serum aminotransferase activity, and a liver biopsy specimen in 1 of them showed evidence of chronic active hepatitis. We conclude that in our setting the prevalence of anti-HCV among patients with primary GN is low, being higher (11.8 %) only if we consider the patients with MPGN as the reference group. Further studies are necessary to clarify this association and to determine appropriate therapy for these patients.
- ItemAcesso aberto (Open Access)Short-term effects of soy protein diet in patients with proteinuric glomerulopathies(Sociedade Brasileira de Nefrologia, 2011-06-01) Ahmed, Marion Souza [UNIFESP]; Baxmann, Alessandra Calábria [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); SBN Department of Epidemiology and Kidney Diseases PreventionINTRODUCTION: It has been suggested that soy protein can slow renal disease progression by decreasing plasma cholesterol and proteinuria in patients with nephropathies. This study was designed to evaluate the effect of soy protein on proteinuria and dyslipidemia, in patients with proteinuric glomerulopathies. PATIENTS AND METHODS: Patients were divided into three groups: Control Group (n = 9) received diet with 0.8 g/kg/day of animal protein; Study Group 1 (n = 9), 0.8 g/kg/day of soy protein; and Group 2 (n = 9), 0.8 g/kg/day of soy protein plus fibers. The study period corresponded to eight weeks. During the baseline period and by the end of the study, patients were submitted to laboratorial and anthropometric evaluation. RESULTS: There was no statistically significant difference between baseline and post-diet periods among the three groups in anthropometric parameters or body composition, neither in proteinuria levels (Control: 0.7 ± 0.6 versus 0.8 ± 0.6; Group 1: 2.0 ± 1.7 versus 1.9 ± 1.8; Group 2: 2.0 ± 1.4 versus 2.1 ± 2.0). However, a slight decrease in triglycerides (244.8 ± 275.9 versus 200.5 ± 34.0), total (234.0 ± 59.4 versus 181.2 ± 110.3) and LDL (136.0 ± 59.1 versus 104.1 ± 39.4) cholesterol in Group 1 was observed, although not significant. CONCLUSION: We have not observed beneficial effects when using soy protein instead of animal protein with the aim of attenuating proteinuria and hyperlipidemia, but we have shown that soy protein has not caused deleterious changes in body composition, ensuring an adequate nutritional state.
- ItemSomente MetadadadosShould adolescents with glomerulopathies be treated as children or adults?(Karger, 2008-01-01) Requiao-Moura, Lucio R. [UNIFESP]; Freitas, Taina Veras de S. [UNIFESP]; Franco, Marcello F. [UNIFESP]; Pereira, Aparecido B. [UNIFESP]; Mastroianni-Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Glomerular diseases are an important cause of end-stage renal disease, especially among young adults. However, clinical and epidemiological surveys involving adolescent populations are scarce. Aim: To determine the pattern of glomerulopathies (GP) in adolescents submitted to renal biopsy.Methods: A retrospective study of patients' records of the Glomerulopathy Section, UNIFESP (Brazil), was performed.Results: Among 72 adolescents (12-18 years) with GP, 15.6 +/- 1.5 years, 58.3% females, the most frequent clinical manifestation was nephrotic syndrome (NS, 71%) and focal segmental glomerulosclerosis (FSGS) was the main histological pattern (24%), followed by minimal change disease (MCD, 19.5%). After comparing the main causes of NS in adolescents with those of adults, we found no statistically significant differences in clinical presentation or outcome. Renal failure-free survival of 1 and 5 years for all GP corresponded to 87.9 and 73.6%, respectively (88.5 and 76.3% for NS).Conclusions: NS was the main manifestation; FSGS and MCD were the most common histological diagnoses. Our data suggest the GP and particularly the NS pattern in adolescents is similar to that of adults, pointing to the need for an adaptation in diagnostic and treatment protocols for this age group, a pattern which corresponds more closely to that of adults. Copyright (c) 2008 S. Karger AG, Basel.