The mortality rate of chronic kidney disease (CKD) patients that have undergone renal replacement therapy is very high due to cardiovascular diseases (CVD). Some studies have indicated that cyclosporine A, a drug used to prevent transplant rejection, is associated with bone loss following transplantation. Furthermore, it has an oxidative effect on circulating lipids. Its prooxidant effect on cell membranes causes calcium release. This study aimed to examine whether or not renal transplantation result in improvement in oxidative stress and to assess the association between oxidized LDL (ox-LDL) and some variables in the prediction of CVD risk in Renal Transplantation (RT) patients that were compared with the control group.
A total number of 30 CKD patients were recruited to evaluate time dependent changes in biomarker of OS before and after RT. The ox-LDL, lipid metabolism parameters, CsA, creatinine, calcium and phosphate were assessed both before RT, 10 days and 6 months after RT in comparison with the control group (n = 30).
Over 6 months, ox-LDL concentration changed from 79.7 ± 9.7 to 72 ± 7 mU/mL
The findings indicated that restoring renal function by transplantation, improves uremia induced oxidative stress. calcium phosphate product, as an independent risk factor for CVD, correlates with ox-LDL before RT and 6 months after RT. Calcium phosphate product correlates with cyclosporine in the RT group, too.
Keywords: calcium phosphates; cardiovascular diseases; kidney transplantation; oxidative stress;
We investigate the
PCS was synthesized by PC sulfatation. VSMC were extracted by enzymatic digestion of umbilical cord vein and characterized by immunofluorescence against α-actin antibody. The cells were treated with PC and PCS at their normal (n), uremic (u) and maximum uremic concentrations (m). Cell viability was assessed by MTT. MCP-1 expression was investigated by ELISA in cells supernatants after toxins treatment with or without the NF-κB p65 inhibitor.
There was no significant difference in cell viability after toxins treatment
for all concentrations tested. There was a significant increase in MCP-1
expression in cells treated with PCu and PCm (
VSMC are involved in atherosclerosis lesion formation and production of MCP-1, which contributes to the inflammatory response initiation. Our results suggest that PC mediates MCP-1 production in VSMC, probably through NF-κB p65 pathway, although we hypothesize that PCS acts through a different subunit pathway since NF-κB p65 inhibitor was not able to inhibit MCP-1 production.
Keywords: chemokines; chronic kidney disease; NF-kappa B; uremia;
Priming is the mechanism of protection induced by a previous exposition of a cell or organ to low or equal concentrations of a toxic substance.
Objective: To analyze the mechanism of priming induced by the previous exposition to gentamicin in human proximal tubular cells and nephrotoxic acute renal failure (ARF).
Wistar rats and tubular cells were exposed to gentamicin 2mM during 24h or 40 mg/kg during 3 days and after one rest week were exposed to the same concentration during 24h in cells and additional ten days in rats. The primed animals were compared to control rats receiving vehicle and GENTA animals treated with the gentamicin during the same period. Biochemical parameters were analyzed. The oxidative stress was analyzed by urinary hydroperoxides and carbonylated protein while antioxidant defense was studied by antioxidant activity of the plasma (FRAP), catalase, superoxide dismutase, heme-oxygenase 1 (HO-1) immunostaining and enzymatic activity in kidney. Necrosis, apoptosis, proliferation, endothelin 1 (ET-1) and HO-1 expression were studied in cells.
Priming of the animals inhibited the increase in creatinine, urea, sodium excretion and urinary protein induced by gentamicin. Bosentan, ET-1 receptor antagonist, and hemin, HO-1 inducer, potentiate the inhibition. The mechanism of protection was mediated by induction of the antioxidant enzymes HO-1, catalase and SOD activity and oxidative stress reduction. Priming inhibited cell death and induced proliferation through ET-1 production.
Priming is a persistent and multifactorial mechanism, the stimulation of the antioxidant defense could mimics partially the priming process and prevent the ARF.
Keywords: acute renal failure; antioxidants; gentamicins; oxidative stress; repetition priming;
Vitamin D reduces albuminuria in patients with chronic kidney disease (CKD) but its effects on glomerular podocytes are not entirely understood.
To evaluate if cholecalciferol supplementation reduces the levels of podocyte-associated urine mRNAs in patients with CKD.
A total of 27 patients with stages 2 to 4 CKD and suboptimal serum vitamin D [25(OH)D] levels were treated with cholecalciferol for 6 months. Serum 25(OH)D level, estimated glomerular filtration rate (eGFR), proteinuria, and urine mRNA of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6, vascular endothelial growth factor A, and transforming growth factor beta were assessed before and after intervention.
eGFR declined at an average rate of -4.71 mL/min/1.73 m2
Six months of cholecalciferol supplementation had no effect on urine podocyte-associated mRNA profile of patients with advanced CKD. The protective effect of vitamin D or its analogues on the glomerular podocyte should be investigated in early stages of CKD with a longer treatment period.
Keywords: podocytes, renal insufficiency, chronic; transforming growth factor beta1; vascular endothelial growth factor A; vitamin D;
Hyperparathyroidism is a frequent complication of chronic kidney disease (CKD). Total parathyroidectomy (PTX) with parathyroid tissue autotransplantation (AT) is a treatment option in those individuals that do not respond to clinical management.
To evaluate grafted parathyroid tissue response during induced hypocalcemia among CKD patients who underwent total PTX with AT.
Eighteen patients with renal hyperparathyroidism were submitted to total PTX with parathyroid AT selected by stereomicroscopy between April and October 2008. Eleven (eight with successful kidney transplantation, 2 in peritoneal dialysis and 1 in hemodialysis) were clinically stable and eligible for testing. Hypocalcemia was induced using sodium bicarbonate infusion in 5 healthy controls and in patients 6-12 months after surgery.
Among controls, hypocalcemia elicited a major rise in intact PTH (iPTH)
levels 4 minutes after bicarbonate infusion. In patients, a significant
decrease in ionized calcium concentration was observed [from 1.17 ±
0.12 to 1.09 ± 0.11 mean (± SE) mmol/L] in the 4th
Among CKD patients tested 6-12 months after surgery, grafted parathyroid tissue revealed a blunted secretory capacity during bicarbonate induced hypocalcemia with no changes in iPTH levels
Keywords: hyperparathyroidism; hypocalcemia; parathyroid hormone; parathyroidectomy; renal insufficiency, chronic.;
Renal involvement in pregnant women with chronic hypertension is not widely known.
1- To describe the epidemiological profile of pregnant women with chronic hypertension; 2- To evaluate urinary abnormalities (by urinalysis), renal function (serum creatinine and cystatin C, and estimated glomerular filtration rate (eGFR); 3- To evaluate the pregnancy outcome in chronic hypertension.
103 pregnant women with chronic hypertension (blood pressure over 140/90 mmHg, detected previously to pregnancy or until the 20th week) were submitted to clinical and laboratorial evaluation.
Pregnant women were 21-45 (mean: 34) years-old. Protein/creatinine ratio in
random urine was elevated in 5.2% (0.0-6.4g/g), serum creatinine in 19.6%
and cystatin C in 14.7% of them. It was observed that characteristics of
pregnant patients and their newborns (
Renal abnormalities were detected by proteinuria, determinations of serum creatinine and cystatin C in 5.2, 19.6 and 14.7% of the cases. The results suggest that the formulas CKD-EPI and MDRD can have applicability in assessing renal function in pregnant women. It was also shown a high frequency of preterm birth or with < 2500g at birth or small for gestational age, as well as of superimposed preeclampsia-eclampsia (24.7%) in pregnant women with chronic hypertension.
Keywords: creatinine; cystatin C; glomerular filtration rate; high-risk; hypertension; pregnancy; proteinuria;
Years before the progression to
This paper discusses the frequency of microalbuminuria in non-diabetic population, but with increased metabolic risk, and attempts to assess whether there is any correlation of microalbuminuria with data from glucose metabolism.
A total of 132 nondiabetic patients who presented one or more risk factors for changes in glucose metabolism were included in the study: arterial hypertension; obesity; first-degree relatives with diabetes; individuals of Hispanic-American, Asian and African-American ethnicities; mothers of newborns who are large for gestational age (LGA) or who had gestational diabetes; serum measurements in fasting HDL cholesterol 250 mg/dL.
The results showed a frequency of abnormal microalbuminuria for the method in 16% of this population, and the presence of lower levels of HDL-cholesterol and creatinine clearance in this population. There was a positive correlation between microalbuminury and serum creatinine and uric acid.
Our study suggests that microalbuminuria be evaluated as a marker of incipient nephropathy in non-diabetic population with increased metabolic risk.
Keywords: diabetes mellitus; prediabetic state; chronic kidney disease; albuminuria;
The use of ultrasonography (US) by non-radiologists has increased due to the need of physicians to integrate "new" clinical information into the diagnostic process. A defined and validated ultrasound training program has not been established in Nephrology. This study aimed to present the results of assessment of the development of skills to utilize point-of-care ultrasonography (POCUS) in Nephrology practice.
Nine residents, four from Nephrology and five from internal medicine program, attended a 16-hour course that covered theoretical and practical aspects of ultrasonography. The course addressed topics related to urinary tract, lung, heart, and blood vessel ultrasonography and use of ultrasound to guide kidney biopsy and central venous catheter insertion. The resident evaluation consisted of cognitive tests (CT) with multiple-choice questions and image association tests, before and after the course, and assessment of skills in generating ultrasound images and performing procedures using the Objective Structured Clinical Examination (OSCE).
All residents completed the course. A significant improvement in knowledge
was observed by comparing the residents' scores obtained on the CT
A 16-hour nephrology POCUS training course that was not limited to topics involving the urinary tract enabled the development of skills to obtain images and perform Nephrology procedures. The program developed can be used as a model for learning POCUS in Nephrology.
Keywords: clinical competence; competency-based education; nephrology; ultrasonography;
Among the dialysis modalities, there is a prevalence of hemodialysis (HD).
To verify who chooses the dialysis modality and which variables reflect the perception of patients and health care team about treatment.
The study was conducted at three clinics of HD and peritoneal dialysis (PD). Two hundred and twenty patients participated in the study, of whom 69.5% were on HD and 30.5% on PD. Included voluntary patients on treatment from 90 days to 2 years, with. Of the 54 health workers, 18.5% were doctors, 20.4% nurses and 61.1% nurse technicians: Two questionnaires were applied: one for professionals and one for patients.
Most patients had their modality of dialysis chosen by doctors: 76.3%. Most
patients rejected a change of treatment in both HD (83%) and PD (92.5%).
There was a significant association by PD patients of their modality with
greater safety (
The choice of dialysis modality was a decision solely of doctors in 76.3% of cases. PD was considered by the health care team as the best modality therapy with regard to quality of life, clinical and psychosocial well-being
Keywords: kidney failure, chronic; nursing; peritoneal dialysis, continuous ambulatory; physicians; renal dialysis;
Kidney transplant recipients from HLA-identical living donor have lower risk of acute rejection and greater graft survival compared to other types of kidney transplantation. Immunosuppressive regimens without calcineurin inhibitors (CNI) can further improve these results by reducing cardiovascular, metabolic and toxic events related to this drug class.
This study aimed to evaluate efficacy and safety of a new immunosuppressive regimen with planned suspension of CNI.
This was a prospective, single center and single treatment arm study to evaluate HLA-identical kidney transplant recipients receiving everolimus (EVR), tacrolimus (TAC) and corticosteroids, followed by TAC discontinuation 30 days after transplantation. TAC discontinuation was later postponed to the third month after an interim efficacy analysis.
Thirty-nine patients were included. Although mean TAC and EVR blood concentrations have remained within the proposed therapeutic ranges, five patients had biopsy-proven acute rejection and one patient had an episode of C4D-positive glomerulitis. This result led to the end of the inclusions. Interestingly, the proportion of patients with proteinuria greater than 0.5 g/L has not reached more than 22% of patients in any visit. Adverse events related to EVR use were the most incident in this population: oral ulcers, dyslipidemia and peripheral edema.
The proposed scheme was not effective for this population, particularly due to a high incidence of acute rejection. Safety profile showed that prolonged exposure to a high concentration of blood EVR increases the incidence of adverse events related to this drug.
Keywords: immunosuppression; kidney transplantation; living donors;
Lower urinary tract dysfunction (LUTD) are voiding dysfunctions without anatomical or neurological defects. The diagnosis is primarily clinical, with symptoms standardized by the International Children's Continence Society. Few studies relate quality of life of patients with cognitive and school performance.
To evaluate milestones of bladder control, daily problems, quality of life (QoL), cognitive function and school performance of children with LUTD.
Case series of patients followed in the Pediatric Nephrology tertiary hospital with assessment of QoL (Pediatric Quality of Life Inventory - PedsQoL version 4), School Performance Test (TDE) and Raven Progressive Matrices test.
Girls of lower social class were (90.9%) of eligible children. The mean age was 9.1 ± 4.8 years old. The most common symptoms were urge incontinence (81%), holding maneuvers (77.3%) and enuresis (59.1%) associated with the elimination disorder syndrome (63.6%). Caregivers considered volunteers urinary losses and/ or symptoms, and fought and/or beat the child. Children had been subjected to embarrassing situations such as warnings of teachers, they hid symptoms and/or the dirty clothes. Mean score of QoL was 71.0 ± 12.6 with the lowest mean score on the school dimension. In TDE 55% had lower performance and in Raven Matrices 60% were intellectually in the medium level. It was observed lower QoL scores in the medium and lower level of TDE and average intellectual capacity/below average in Raven matrices.
LUTD may negatively affect family and social relationships, school performance and QoL of children with the dysfunction.
Keywords: cognitive science; constipation; lower urinary tract symptoms; pediatrics; psychomotor performance; quality of life; underachievement; urinary incontinence;
Every cell in the human body has globotriaosylceramide accumulation (Gb3) in Fabry disease due to the mutation in gene of the enzyme α-galactosidase A. It is a disease linked to sex. The main clinical features are: cutaneous angiokeratomas; acroparestesias and early strokes; decreased sweating and heat intolerance; ocular changes; myocardial hypertrophy, arrhythmias; gastrointestinal disorders and renal involvement. Renal involvement occurs due to Gb3 accumulation in all types of renal cells. Therefore, patients may present glomerular and tubular function disorders. Podocytes are particularly affected, with pedicels effacement and development of proteinuria. The diagnosis is made by detection of reduced plasma or leukocyte α-galactosidase activity and genetic study for detecting the α-galactosidase gene mutation. Treatment with enzyme replacement contributes to delay the progression of kidney disease, especially if initiated early.
Keywords: enzyme replacement therapy; Fabry disease; podocytes;
Gemcitabine is a medication used to treat various types of malignant neoplasms. Its association with hemolytic uremic syndrome (HUS) has been described in few cases, although these cases have resulted in mortality rates of at least 50%. We report on the case of a 25-year-old patient with cholangiocarcinoma in remission who developed microangiopathic hemolytic anemia with acute anuric renal failure after receiving 5 cycles of gemcitabine chemotherapy; this condition was consistent with HUS caused by the side effects of this drug. The administration of gemcitabine was stopped, and hemodialysis, blood transfusions, plasma exchanges, steroids, doxycycline, and rituximab were used to treat the patient. A favorable outcome was achieved; in particular, hemolysis was controlled, and renal function was completely recovered.
Keywords: acute kidney injury; cholangiocarcinoma; hemolytic-uremic syndrome; thrombotic microangiopathies;
IgG4-related disease (IgG4RD) is a recent inflammatory process of supposed
autoimmune etiology, which is characterized by elevated serum IgG4 levels, dense
lymphoplasmacytic infiltration rich in IgG4-positive plasma cells and storiform
fibrosis. Tubulointerstitial nephritis is the most common renal manifestation,
with different degrees of kidney dysfunction and variable clinical findings.
Herein, the authors describe a new case of IgG4 tubulointerstitial nephritis
(IgG4TN), and discuss clinic and pathologic criteria. Male patient, 72
years-old, was admitted on hospital service with clinical complaint of asthenia,
loss of strength, emaciation, and anosmia. Previous history included type 2
Keywords: diagnosis; immunity; kidney; pathology;
To describe a case of Posterior Reversible Encephalopathy Syndrome diagnosed in pregnant women with late-eclampsia, as well as its clinical management.
A 34 years old patient in her third pregnancy had started with high blood pressure levels during labor; after eleven days postpartum, she presented a decreased right visual acuity; subsequently one episode of seizure followed by partial loss of vision in the right eye. After conducting tests and ruled out stroke, the patient was diagnosed as Posterior Reversible Encephalopathy Syndrome (PRES). Established the clinical management of seizures and hypertensive crisis, there was complete remission of symptoms and reversal of the initial clinical picture.
Once properly diagnosed and treated, the Posterior Reversible Encephalopathy Syndrome can present satisfactory progress, especially when associated with an acutely triggered factor, as eclampsia.
Keywords: brain edema; disease models, animal; eclampsia; hemianopsia; pre-eclampsia; hypertension; pregnancy complications;
A 60 year-old man was submitted to kidney transplantation in 2013 due to chronic renal insufficiency caused by hypertension. He had recurrent episodes of urinary tract infection and came to the hospital due to a 4 day-long fever, abdominal pain, burning urination and nausea. Routine urinalysis revealed a picture of infection (> 50 leucocytes/high power field associated to massive bacteriuria). The urine sediment revealed elongated like elements with an enlarged part in the middle of the structure body.
Keywords: bacteriuria; infection; klebsiella pneumoniae; kidney transplantation; laboratory test; nephrology; transplantation; urinary tract infections;