Repositório Institucional - Unifesp :: Navegando por Palavras-chave "kidney"

Navegando por Palavras-chave "kidney"

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Antenatal Diagnosis of Renal Duplication by Ultrasonography: Report on Four Cases at a Referral Center
(Urol & Nephrol Res Ctr-unrc, 2013-09-01) Queiroga Junior, Edward Eneas D.; Martins, Marilia G.; Rios, Livia T.; Araujo Junior, Edward [UNIFESP]; Oliveira, Ricardo V.; Nardozza, Luciano M. [UNIFESP]; Moron, Antonio F. [UNIFESP]; Fed Univ Maranhao UFMA; Universidade Federal de São Paulo (UNIFESP)
Duplication of the renal collecting system is the commonest major congenital malformation of the urinary tract, with an incidence of 1% among live births. Antenatal diagnosing of renal duplication and an associated ureterocele is infrequent. We report four cases of prenatally diagnosed unilateral duplication of the renal collecting system. In two of them, the renal duplication was associated with an ectopic ureterocele.
Acesso aberto (Open Access)
Assessment of stage T1 (TNM 1997) for renal cell carcinoma: is recommended the subdivision in T1a and T1b?
(Sociedade Brasileira de Urologia, 2003-04-01) Dall Oglio, Marcos Francisco [UNIFESP]; Srougi, Miguel [UNIFESP]; Mangini, Marcelo; Ribeiro, Eduardo [UNIFESP]; Ferraz, Márcio [UNIFESP]; Sañudo, Adriana [UNIFESP]; Leite, Kátia Ramos Moreira [UNIFESP]; Nesrallah, Luciano [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
INTRODUCTION: Classification TNM 1997 defines renal cell carcinoma smaller than 7 cm and confined to the kidney as stage T1. Our goal is to discuss if tumors smaller than 4 cm have the same behavior characteristics then tumors between 4 and 7 cm, to compose the same stage of the disease. MATERIALS AND METHODS: Retrospective assessment of 138 patients in stage T1 (TNM - 97), divided into 2 groups; group-1: composed of 65 patients (47%) with tumors < 4 cm, and group-2: composed of 73 patients (53%) with tumors between 4 and 7 cm. The following prognostic factors were assessed in the recurrence of the disease and survival of patients: nuclear degree, microvascular invasion, sarcomatous degeneration, and involved lymph nodes. Statistical evaluation has been accomplished through the log rank test, chi-square test, and Fishers exact text. RESULTS: Average tumor size was 2.5 cm for group-1, and 5.3 cm for group-2. In group-2, there was the predominance of worse prognostic factors, with high-grade tumors (p = 0.01) and presence of microvascular invasion (p = 0.001). Sarcomatous tumors and involvement of lymph nodes did only happen in group-2. Disease-free survival for group-1, analyzed in the median period of 36 months, was 100%, and for group 2, in the median period of 31 months, was 81% (p = 0.008). CONCLUSION: The results obtained allow the conclusion that the present stage T1 for renal cell carcinoma gathers tumors of different evolution, being therefore recommendable the stratification in T1a for tumors smaller than 4 cm, and T1b for tumors between 4 and 7 cm.
Acesso aberto (Open Access)
Association of somatic and N-domain angiotensinconverting enzymes from Wistar rat tissue with renal dysfunction in diabetes mellitus
(J R A A S Ltd, 2007-03-01) Roncbi, Fernanda Aparecida [UNIFESP]; Irigoyen, Maria Claudia [UNIFESP]; Casarini, Dulce E. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
Diabetes mellitus (DM) is characterised by alterations in the intrarenal renin-angiotensin system (RAS). Insulin treatment may reverse these changes by an unknown mechanism. We aimed to verify the association between somatic ACE with 136 kDa (sACE) and N-domain ACE with 69 kDa (nACE) from Wistar (W) rat tissue with DM. Three groups were studied: control (CT), insulin treated diabetic (DT) and untreated (D). ACE activity was determined using Hippuryl-His-Leu and Z-Phe-His-Leu as substrates. in D group, urine ACE activity increased for both substrates when compared with CT and DT, despite the decreased activity of renal tissues. Immunostaining of renal tissue demonstrated that ACE is more strongly expressed in the proximal-tubule of D than in the same nephron portion in the other groups. Angiotensin (Ang) 1-7 and Ang II are less expressed in DT group when compared with CT and D. Ang II levels decreased in the D and DT groups showed when compared to the control. Ang 1-7 was detected in all studied groups with low levels in DT. the modulation of angiotensin peptides suggests that sACE, nACE, ACE 2 and NEP could have important functions in renal RAS regulation through a counter-regulatory mechanism to protect the kidney in diabetes mellitus.
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Brown spider dermonecrotic toxin directly induces nephrotoxicity
(Elsevier B.V., 2006-02-15) Chaim, O. M.; Sade, Y. B.; Silveira, R. B. da; Toma, L.; Kalapothakis, E.; Chavez-Olortegui, C.; Mangili, O. C.; Gremski, W.; von Dietrich, C. P.; Nader, H. B.; Veiga, S. S.; Univ Fed Parana; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Minas Gerais (UFMG); Catholic Univ parana
Brown spider (Loxosceles genus) venom can induce dermonecrotic lesions at the bite site and systemic manifestations including fever, vomiting, convulsions, disseminated intravascular coagulation, hemolytic anemia and acute renal failure. the venom is composed of a mixture of proteins with several molecules biochemically and biologically well characterized. the mechanism by which the venom induces renal damage is unknown. By using mice exposed to Loxosceles intermedia recombinant dermonecrotic toxin (LiRecDT), we showed direct induction of renal injuries. Microscopic analysis of renal biopsies from dermonecrotic toxin-treated mice showed histological alterations including glomerular edema and tubular necrosis. Hyalinization of tubules with deposition of proteinaceous material in the tubule lumen, tubule epithelial cell vacuoles, tubular edema and epithelial cell lysis was also observed. Leukocytic infiltration was neither observed in the glomerulus nor the tubules. Renal vessels showed no sign of inflammatory response. Additionally, biochemical analyses showed such toxin-induced changes in renal function as urine alkalinization, hematuria and azotemia with elevation of blood urea nitrogen levels. Immunofluorescence with dermonecrotic toxin antibodies and confocal microscopy analysis showed deposition and direct binding of this toxin to renal intrinsic structures. By immunoblotting with a hyperimmune dermonecrotic toxin antiserum on renal lysates from toxin-treated mice, we detected a positive signal at the region of 33-35 kDa, which strengthens the idea that renal failure is directly induced by dermonecrotic toxin. Immunofluorescence reaction with dermonecrotic toxin antibodies revealed deposition and binding of this toxin directly in MDCK epithelial cells in culture. similarly, dermonecrotic toxin treatment caused morphological alterations of MDCK cells including cytoplasmic vacuoles, blebs, evoked impaired spreading and detached cells from each other and from culture substratum. in addition, dermonecrotic toxin treatment of MDCK cells changed their viability evaluated by XTT and Neutral-Red Uptake methodologies. the present results point to brown spider dermonecrotic toxin cytotoxicity upon renal structures in vivo and renal cells in vitro and provide experimental evidence that this brown spider toxin is directly involved in nephrotoxicity evoked during Loxosceles spider venom accidents. (c) 2005 Elsevier Inc. All rights reserved.
Acesso aberto (Open Access)
Cake kidney drained by single ureter
(Sociedade Brasileira de Urologia, 2004-08-01) Calado, Adriano A. [UNIFESP]; Macedo Jr., Antonio [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Cake kidney is a rare congenital anomaly of the urogenital tract, with a few more than 20 cases described in the literature. It can be diagnosed at any age range. Normally, drainage is achieved by 2 ureters, and there are only 5 reports in the literature of cake kidney drained by a single ureter. The authors describe one more case of this rare malformation of the urinary tract.
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Changes in cat urinary glycosaminoglycans with age and in feline urologic syndrome
(Elsevier B.V., 2004-04-07) Pereira, D. A.; Aguiar, JAK; Hagiwara, M. K.; Michelacci, Y. M.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
The aim of the present study was to characterize the urinary excretion of glycosaminoglycaris in kittens and adult healthy cats, as well as in cats with a low urinary tract disease, the feline urologic syndrome (FUS). the main urinary glycosamitioglycan in cats was found to be chondroitin sulfate, with smaller amounts of dermatan sulfate and heparan sulfate. There was no difference in the urinary glycosaminoglycan concentration with sex, but a marked decrease occurred with age, due to chondroitin sulfate. Trace amounts of keratan sulfate were also detected in the urine of kittens, but not of healthy adult cats. Dermatan sulfate and heparan sulfate were the only glycosaminoglycans found in the urinary tract and kidney, and chondroitin sulfate was the only glycosaminoglycan found in the plasma. These data suggest that the main urinary glycosaminoglycan chondroitin sulfate is of systemic origin and filtered in the kidney, while the minor components dermatan sulfate and heparan sulfate may come from the urinary tract. the urinary glycosaminoglycan concentration was greatly decreased in animals with FUS, as compared to normal adults. We hypothesize that these low glycosaminoglycan levels reflect a damage to the bladder surface, resulting in absorption and/or degradation of the endogenous urinary glycosaminoglycans. (C) 2004 Elsevier B.V. All rights reserved.
Acesso aberto (Open Access)
Efeito do tratamento da aloe vera no diabetes: estudo por análise proteômica da expressão de proteínas no rim
(Universidade Federal de São Paulo (UNIFESP), 2016-09-27) Santos, Lilian dos [UNIFESP]; Arita, Danielle Yuri [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Diabetes mellitus (DM) is a metabolic syndrome characterized by chronic hyperglycemia, with diabetic nephropathy (ND) as its complication. Several studies have demonstrated that Aloe vera (A. vera) has beneficial effects on DM and its consequences. Proteomic analysis is a tool that systematically studies the set of proteins expressed in a given situation. Therefore, the aim of this study was to evaluate the effect of DM1 on the kidney through proteomic analysis, comparing with animals without DM, besides evaluating the effect of insulin treatment and the buthanolic fraction of A. vera (FB) in order to elucidate the protective mechanism of this plant in renal injury induced by this pathology. The streptozotocin-induced diabetic model was used in male Wistar rats. We observed a hypoglycemic effect of FB, which was able to reduce glycemia lasting up to 6 hours after treatment. There was a statistically significant increase in serum creatinine in the untreated (D) and insulin treated (INS) groups compared to the control group (C). On the other hand, there was no difference in relation to urinary creatinine and creatinine clearance. All groups presented increased 24h proteinuria in relation to the C group. The D group presented some alterations in the histological analysis, with dilated tubules and hyperfiltrant glomeruli. The diabetic group treated with FB presented a discrete but not significant improvement. Proteomic analysis identified 93 proteins with statistical differences between the C and D groups, being 36 proteins related to diabetes, and were grouped into: proteins related to mitochondrial dysfunction, arginine metabolic process, eicosanoic acid eicosatrienoic acid, lactate production, glycolysis/pentoses pathway, lipid metabolism, stress, inflammation, calcium influx, transport and others. In addition, 5 exclusive proteins of group D were found, being 2 proteins related to this syndrome. FB treatment was shown to have a beneficial effect, altering the expression of 11 of these proteins, besides presenting two exclusive proteins. Thus, A. vera may be a promising ally in the treatment of diabetes and kidney damage prevention.
Acesso aberto (Open Access)
Effect of shock wave reapplication on urinary n-acetyl-beta-glucosaminidase in canine kidney
(Sociedade Brasileira de Urologia, 2004-04-01) Fortes, Marco A.q.r. [UNIFESP]; Andriolo, Adagmar [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: Renal tubular damage can be assessed with the aid of urinary dosing of N-acetyl-beta-glucosaminidase (NAG) and it is possible to demonstrate a significant correlation between shock wave and damage to renal parenchyma. The objective of this study was to assess the effect of shock wave reapplication over urinary NAG in canine kidney. MATERIALS AND METHODS: The authors submitted 10 crossbred dogs to 2 applications of 2000 shock waves in a 24-hour interval in order to assess urinary NAG values after 12, 24, 36 and 48 hours. RESULTS: Twelve hours following the first shockwave application there was an increase in NAG of 6.47 ± 5.44 u/g creatinine (p < 0.05). Twelve hours and 24 h following the second application there was no increase in the urinary enzyme, - 2.56 ± - 7.36 u/g creatinine and 2.89 ± - 7.27 u/g creatinine, respectively (p > 0.05). CONCLUSION: Shock wave reapplication with a 24-hour interval did not cause any increase in urinary NAG.
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Effects of chronic stavudine exposure on liver, pancreas and kidneys of pregnant rats and their fetuses: Morphological and biochemical aspects
(Elsevier B.V., 2006-09-01) Barreto, Regina Lucia Braga; Soares, Jose Maria; Simoes, Ricardo Santos; Maciel, Gustavo Arantes Rosa; Jesus Simoes, Manuel de; Kulay, Luiz; Universidade Federal de São Paulo (UNIFESP)
Objective: To study the morphological and biochemical effects on liver, pancreas and kidney of pregnant rats and their fetuses subjected to stavudine treatment.Methods: Forty animals were distributed in four groups E1, E2, E3, and C (control) and received by gavage once a day 1, 3 or 9 mg/kg of stavudine in 2 mL distilled water, from days 1 to 20 of pregnancy. After this period, the animals were sacrificed; blood samples were collected for further determinations of AST, ALT, creatinine, urea, glucose and amylase. Samples of liver, kidneys and pancreas of every rat and of the corresponding fetuses were taken and examined under light microscopy.Results: the maternal livers of groups E1, E2 and E3 displayed progressive morphological alterations without corresponding changes in serum AST and ALT activity. Maternal kidney histology and function were similar in all groups. Maternal pancreas of groups E2 and E3 evidenced moderate and progressive signs of tissue damage without functional repercussion. All fetal livers, kidneys and pancreas presented normal morphology.Conclusions: High doses of stavudine produced signs of mild to moderate maternal hepatic and pancreatic toxicity at the morphological level. This was not followed by changes in biochemical parameters, most conceivably due to the functional reserve of these organs. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
Acesso aberto (Open Access)
Effects of repeated extracorporeal shock wave on kidney apoptosis of normal and diabetic rat
(Sociedade Brasileira de Urologia, 2008-02-01) Kira, Vicente Massaji [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Bandeira, César Orlando Peralta [UNIFESP]; Kaufman, Oskar [UNIFESP]; Fagundes, Anna T. N. [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To assess the effect of repeated extracorporeal shock waves (ESW) on the apoptosis of renal parenchyma in normal and diabetic rats by the caspase-3 expression. MATERIALS AND METHODS: 80 rats were assigned for ESW (Direx Tripter X1® - 14 KVA) to one of three groups with 50% rats with diabetes (A) and 50% normal (B) in each: G1 (n = 40): no ESW; G2 (n = 20): one ESW; G3 (n = 20): two ESWin an interval of 14 days. The animals were sacrificed 3 days after the ESW and samples of the renal parenchyma were histologically prepared, stained by the caspase-3 cleavage immunohistochemical method, and the apoptotic index (ApIn) was calculated by computer program Image Pro-Plus V 4,5,1 Media Cybernetics® ( ApIn = number of apoptotic cells in the microscopic section / total cells in the microscopic section). RESULTS: There was no statistical difference in ApIn of normal rats with one ESW (8.4 + 0.2) or two ESW (9.1 + 0.3) and both were similar to the control group with no ESW (7.9 + 0.2). The ApIn of diabetic rats with one ESW (7.4 + 0.3) was similar to the normal rats with one or two ESW. On the other hand, the ApIn was statistically higher in diabetic rats with two ESW (11.9 + 0.4) than in diabetic rats with one ESW (7.4 + 0.3). CONCLUSIONS: The ApIn of normal rats with a single (2,000 SW) or repeated ESW (4,000 SW) was similar to the control animals without any ESW. In diabetic rats, the repeated ESW (4,000 SW) may result in an additional risk of tissue damage expressed by the higher ApIn.
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The final stage of the laparoscopic procedure: exploring final steps
(Brazilian Soc Urol, 2012-01-01) Natalin, Ricardo [UNIFESP]; Lima, Fabio S. [UNIFESP]; Pinheiro, Thome [UNIFESP]; Vicari, Eugenio [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Andreoni, Cassio [UNIFESP]; Landman, Jaime; Columbia Univ; Universidade Federal de São Paulo (UNIFESP)
Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the end of the procedure. During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the end of the procedure be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.
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Gastro cystoplasty and chronic renal failure: An acid-base metabolism study
(Lippincott Williams & Wilkins, 2001-07-01) Freitas, L. G. de; Carnevale, J.; Leao, JQS; Schor, N.; Ortiz, V; Universidade Federal de São Paulo (UNIFESP)
Purpose: To verify in an experimental model whether gastrocystoplasty may protect patients with chronic renal failure from acid loading associated acidosis a wedge-shaped portion of the middle stomach was used to improve bladder capacity in animals with chronic renal failure.Materials and Methods: An experimental model was used to study 112 adult female Wistar rats (EPM-1) weighing between 156 and 259 gm. the animals were randomly assigned to groups, including 41 controls, 24 undergoing five-sixths nephrectomy to create chronic renal failure, 26 undergoing gastrocystoplasty and 21 undergoing gastrocystoplasty and five-sixths nephrectomy to create renal failure. To provide an acid overload a 5% NH4Cl diet was administered to a subgroup of each group. Two months after surgery 24-hour urine was collected, and volume and pH were measured as well as the amount of bicarbonate, ammonium, titratable acidity and chloride. the animals were then exsanguinated through an abdominal aorta puncture. the blood was used for blood gas analysis and to measure sodium, potassium, chloride, ionized calcium and creatinine.Results: When undergoing an acid overload, the animals with gastrocystoplasty had no acidosis since acid radicals were eliminating in the urine as NH4Cl. When given the same acid overload, metabolic acidosis developed in the animals with gastrocystoplasty and chronic renal failure.Conclusions: Gastrocystoplasty protected healthy rats from acidosis when they were given an acid overload but failed to protect the rats with chronic renal failure under the same conditions.
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Homocysteine-Lowering and Cardiovascular Disease Outcomes in Kidney Transplant Recipients Primary Results From the Folic Acid for Vascular Outcome Reduction in Transplantation Trial
(Lippincott Williams & Wilkins, 2011-04-26) Bostom, Andrew G.; Carpenter, Myra A.; Kusek, John W.; Levey, Andrew S.; Hunsicker, Lawrence; Pfeffer, Marc A.; Selhub, Jacob; Jacques, Paul F.; Cole, Edward; Gravens-Mueller, Lisa; House, Andrew A.; Kew, Clifton; McKenney, Joyce L.; Pacheco-Silva, Alvaro [UNIFESP]; Pesavento, Todd; Pirsch, John; Smith, Stephen; Solomon, Scott; Weir, Matthew; FAVORIT Study Investigators; Rhode Isl Hosp; Univ N Carolina; NIDDK; Tufts Med Ctr; Univ Iowa; Brigham & Womens Hosp; Jean Mayer Human Nutr Res Ctr Aging; Univ Toronto; London Hlth Sci Ctr; Univ Alabama; Universidade Federal de São Paulo (UNIFESP); Ohio State Univ; Univ Wisconsin; Duke Univ; Univ Maryland
Background-Kidney transplant recipients, like other patients with chronic kidney disease, experience excess risk of cardiovascular disease and elevated total homocysteine concentrations. Observational studies of patients with chronic kidney disease suggest increased homocysteine is a risk factor for cardiovascular disease. the impact of lowering total homocysteine levels in kidney transplant recipients is unknown.Methods and Results-In a double-blind controlled trial, we randomized 4110 stable kidney transplant recipients to a multivitamin that included either a high dose (n=2056) or low dose (n=2054) of folic acid, vitamin B6, and vitamin B12 to determine whether decreasing total homocysteine concentrations reduced the rate of the primary composite arteriosclerotic cardiovascular disease outcome (myocardial infarction, stroke, cardiovascular disease death, resuscitated sudden death, coronary artery or renal artery revascularization, lower-extremity arterial disease, carotid endarterectomy or angioplasty, or abdominal aortic aneurysm repair). Mean follow-up was 4.0 years. Treatment with the high-dose multivitamin reduced homocysteine but did not reduce the rates of the primary outcome (n=547 total events; hazards ratio [95% confidence interval]=0.99 [0.84 to 1.17]), secondary outcomes of all-cause mortality (n=431 deaths; 1.04 [0.86 to 1.26]), or dialysis-dependent kidney failure (n=343 events; 1.15 [0.93 to 1.43]) compared to the low-dose multivitamin.Conclusions-Treatment with a high-dose folic acid, B6, and B12 multivitamin in kidney transplant recipients did not reduce a composite cardiovascular disease outcome, all-cause mortality, or dialysis-dependent kidney failure despite significant reduction in homocysteine level.
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Leptin as a link between the immune system and kidney-related diseases: leading actor or just a coadjuvant?
(Wiley-Blackwell, 2012-08-01) Moraes-Vieira, P. M. M.; Bassi, E. J.; Araujo, R. C. [UNIFESP]; Camara, N. O. S.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
Food intake and nutritional status modify the physiological responses of the immune system to illness and infection and regulate the development of chronic inflammatory processes, such as kidney disease. Adipose tissue secretes immune-related proteins called adipokines that have pleiotropic effects on both the immune and neuroendocrine systems, linking metabolism and immune physiology. Leptin, an adipose tissue-derived adipokine, displays a variety of immune and physiological functions, and participates in several immune responses. Here, we review the current literature on the role of leptin in kidney diseases, linking adipose tissue and the immune system with kidney-related disorders. the modulation of this adipose hormone may have a major impact on the treatment of several immune- and metabolic-related kidney diseases.
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Low clinical stage renal cell carcinoma: Relevance of microvascular tumor invasion as a prognostic parameter
(Lippincott Williams & Wilkins, 2004-08-01) Goncalves, P. D.; Srougi, M.; Dall'Oglio, M. F.; Leite, KRM; Ortiz, V; Hering, F.; Universidade Federal de São Paulo (UNIFESP); Hosp Sirio Libanes
Purpose: Renal cell carcinoma is a tumor with unpredictable behavior and defining reliable prognostic factors would be extremely valuable in the clinical setting. Tumor stage, nuclear grade and tumor cell type are the main prognostic clinical parameters available. in this study we evaluated the role of microvascular involvement in the primary lesion for predicting tumor behavior in patients with low stage clinical disease.Materials and Methods: A total of 95 patients with clinically localized renal cell carcinoma (stages T-1-T-2 N-x M-0) underwent radical nephrectomy and/or nephron sparing surgery, and were followed for a median of 45 months. the impact of microvascular tumor invasion on disease progression and its correlation with known pathological outcomes (tumor size, nuclear grade and cell type) were studied.Results: Microvascular tumor invasion was observed in 24 patients (25%), of whom 50% had disease recurrence. of the 71 patients without microvascular invasion only 4 (6%) showed tumor recurrence. When microvascular invasion was correlated with other histological parameters, a significant statistical association was noted with tumor diameter, perirenal fat invasion, macroscopic extension to the renal vein, nuclear grade, lymph node metastasis and sarcomatous elements in the tumor. Multivariate analysis showed that microvascular invasion and the involvement of regional lymph nodes were independent predictors of disease recurrence. Concerning cancer specific survival, microvascular invasion and perirenal fat infiltration were the only factors related to death.Conclusions: Microvascular invasion is an independent and relevant clinical prognostic parameter for low clinical stage renal cell carcinoma.
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Neutral endopeptidase expression in mesangial cells
(J R A A S Ltd, 2003-12-01) Ebihara, Fabiana [UNIFESP]; Di Marco, Giovana Seno [UNIFESP]; Juliano, Maria Aparecida [UNIFESP]; Casarini, Dulce Elena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
In the kidney, neutral endopeptidase (NEP) is implicated in the metabolism of several peptides involved in blood pressure and sodium homeostasis control, such as the atrial natriuretic peptide, bradykinin and angiotensin I. Due to its physiological importance in the modulation of pressor responses, the presence of NEP in mouse mesangial cells has been investigated, since these cells control glomerular function and are able to synthesise components of the renin-angiotensin system. A NEP-like activity (NEP-like) that cleaves the fluorogenic substrates Abz-BKQ-EDDnp and AbZ-DRRL-EDDnp was purified from mesangial cell lysate by ion-exchange, followed by gel filtration chromatography. The enzyme was able to hydrolyse bradykinin at the G(4)-F-5 peptide bond and was inhibited by thiorphan. A pH study established that enzyme activity was maximal at pH 7.5 and the determined K-m was 4.86 muM using AbZ-DRRL-EDDnp as substrate. NEP-like was recognised by monoclonal anti-NEP and had a molecular mass of 95 kDa. The purified enzyme was sequenced and showed similarity with human, rat, mouse and rabbit NEPs. We isolated, for the first time, NEP-like from mesangial cells. This enzyme could have an important role in the renal physiology by its action upon different peptides that are able to alter renal haemodynamics.
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A Phase III Study of Belatacept Versus Cyclosporine in Kidney Transplants from Extended Criteria Donors (BENEFIT-EXT Study)
(Wiley-Blackwell, 2010-03-01) Durrbach, A.; Pestana, Jose Osmar Medina [UNIFESP]; Pearson, T.; Vincenti, F.; Garcia, V. D.; Campistol, J.; del Carmen Rial, M.; Florman, S.; Block, A.; Di Russo, G.; Xing, J.; Garg, P.; Grinyo, J.; Univ Paris 11; Universidade Federal de São Paulo (UNIFESP); Emory Univ; Univ Calif San Francisco; Complexo Hosp Santa Casa; Univ Barcelona; Inst Nefrol; Tulane Sch Med; Bristol Myers Squibb Co; Univ Hosp Bellvitge
Recipients of extended criteria donor (ECD) kidneys are at increased risk for graft dysfunction/loss, and may benefit from immunosuppression that avoids calcineurin inhibitor (CNI) nephrotoxicity. Belatacept, a selective costimulation blocker, may preserve renal function and improve long-term outcomes versus CNIs. BENEFIT-EXT (Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial-EXTended criteria donors) is a 3-year, Phase III study that assessed a more (MI) or less intensive (LI) regimen of belatacept versus cyclosporine in adult ECD kidney transplant recipients. the coprimary endpoints at 12 months were composite patient/graft survival and a composite renal impairment endpoint. Patient/graft survival with belatacept was similar to cyclosporine (86% MI, 89% LI, 85% cyclosporine) at 12 months. Fewer belatacept patients reached the composite renal impairment endpoint versus cyclosporine (71% MI, 77% LI, 85% cyclosporine; p = 0.002 MI vs. cyclosporine; p = 0.06 LI vs. cyclosporine). the mean measured glomerular filtration rate was 4-7 mL/min higher on belatacept versus cyclosporine (p = 0.008 MI vs. cyclosporine; p = 0.1039 LI vs. cyclosporine), and the overall cardiovascular/metabolic profile was better on belatacept versus cyclosporine. the incidence of acute rejection was similar across groups (18% MI; 18% LI; 14% cyclosporine). Overall rates of infection and malignancy were similar between groups; however, more cases of posttransplant lymphoproliferative disorder (PTLD) occurred in the CNS on belatacept. ECD kidney transplant recipients treated with belatacept-based immunosuppression achieved similar patient/graft survival, better renal function, had an increased incidence of PTLD, and exhibited improvement in the cardiovascular/metabolic risk profile versus cyclosporine-treated patients.
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Purification and characterization of the active form of tyrosine hydroxylase from mesangial cells in culture
(Wiley-Blackwell, 2002-01-01) Arita, D. Y.; Di Marco, G. S.; Schor, N.; Casarini, D. E.; Universidade Federal de São Paulo (UNIFESP)
The capacity of mesangial cells (MC) to produce catecholamines (CAs) has been investigated in our laboratory. To study the CA cascade, it is necessary to examine some steps in their metabolic pathway. Tyrosine hydroxylase (TH) catalyzes the rate-limiting step in the biosynthesis of these biogenic amines (dopamine (DA), norepinephrine (NE), and epinephrine (EPI)). Since the glomerular mesangium is their target in the regulation of renal sodium transport and renin secretion, the aim of the study was to determine the presence of TH in those cells in culture. the CA levels were detected in immortalized MC by high-performance liquid chromatography with electrochemical detection. the following concentrations were found in the intracellular region and in the medium, respectively: NE=284 +/- 31 and 134 +/- 22, EPI = 75 +/- 14 and 22 +/- 5, and DA=42 +/- 14, 40 +/- 20 pg/mg cell protein. the enzymatic activity of the cell lysate and medium was measured based on L-dopa formation. in the presence of o-phenanthroline, both samples presented 39% inhibition. the biopterin was detected in the intracellular and in the medium (64.87 and 631.99 pmol/mg protein, respectively) using high-performance liquid chromatography with ultraviolet detection. the cell lysate was submitted to a DEAE-Sephacel column, followed by gel filtration, and Heparin-Sepharose. TH was purified 613.16-fold with a specific activity of 466.0 pg/mg cell protein. Immunoblotting using monoclonal antibody revealed the presence of TH in the different purification steps. Purified TH was sequenced, presenting an alignment with amino-terminal sequence of mouse enzyme. Our results demonstrated the presence of active TH in MC, suggesting that these cells are able to produce CA in vivo, and establishing a convenient purification method for TH that can be applied to the study of the molecular properties of the enzyme modified in vivo by different physiological and pathophysiological stimuli.
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A rare case of TFE-related pigmented renal tumor with overlapping features between melanotic Xp11 translocation renal cancer and Xp11 renal cell carcinoma with melanotic features
(Wiley, 2017) Cardili, Leonardo [UNIFESP]; Pereira, Gregorio Wrublevsky; Viana, Cristiano Ribeiro
In recent years, an increasing number of TFE3 rearrangement-associated tumors with melanotic features have been reported as primary neoplasm in different anatomical sites, including the kidney. Melanotic Xp11 translocation renal cancer (MXTRC) and Xp11 renal cell carcinoma with melanotic features (XRCCM) have been proposed to be main categories for pigmented lesions in the microophthalmia-associated transcription factor (MiTF/TFE3) family of renal tumors that may show variable degrees of melanocytic differentiation. Herein we report a rare case of TFE3-related pigmented renal tumor showing unusual immunoexpression of cytokeratins (AE1/AE3) and renal cell carcinoma markers (RCC, CD10). Cathepsin-K and Vimentin were diffusely positive whereas melanocytic markers (HMB-45 and Melan-A) displayed weak and patchy expression. We found no labelling for PAX-8, muscle markers (desmin, smooth muscle actin, muscle-specific actin and caldesmon) and S-100. TFE3 fusion was confirmed by break-apart fluorescence in situ hybridization (FISH). This case corroborates previous evidence for overlap in the TFE3-associated cancer family and illustrates that it may not be possible to set a clear cutoff between epithelial (XRCCM) and mesenchymal (MXTRC) subgroups.
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Renal and urinary glycosaminoglycans in an experimental model of chronic renal failure in rats
(Karger, 2001-01-01) Michelacci, Yara Maria [UNIFESP]; Cadaval, Ricardo Augusto de Miranda [UNIFESP]; Rovigatti, R. M.; Kohlmann Junior, Osvaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The present paper reports the glomerular and renal individual glycosaminoglycan levels in an experimental model of chronic renal failure (CRF) that was induced in Wistar rats by five-sixths mass ablation. Glycemia, body weight, blood systolic pressure and urinary excretions of creatinine, albumin and glycosaminoglycans were measured for 12 weeks. At the end of the experiment, the weight and the glycosaminoglycan composition of the kidneys were determined. In control rats, heparan sulfate was the main glycosaminoglycan found both in whole kidney and isolated glomeruli, with trace amounts of dermatan sulfate. Isolated glomeruli presented higher heparan sulfate concentrations than whole kidney (expressed as mg/g dry weight). In CRF rats, albuminuria appeared from the 2 week on, and dermatan sulfate and chondroitin sulfate contents of the kidney increased, whereas heparan sulfate levels remained unaltered. Changes in urine glycosaminoglycans (heparan sulfate, chondroitin sulfate and dermatan sulfate) were not statistically significant. The increase in glomerular dermatan sulfate and chondroitin sulfate observed in this experimental model could be related to the mechanisms involved in the glomerulosclerosis and proteinuria that occur in CRF. Copyright (C) 2000 S. Karger AG, Basel.

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