RESUMO
The aim of this study was to assess the presence of cryoglobulins, the constitution of the cryoprecipitate, as well as the possible etiology and clinical features in kidney transplant recipients. We excluded patients with clinical or laboratory evidence of autoimmune, liver or neoplasm disease, infections, blood transfusions or immunizations in the previous 3 months. Detection of cryoglobulins was obtained from the peripheral venous blood. In cases of cryoprecipitate formation it was analyzed using anti-IgG, anti-IgM, anti-IgA, anti-C3, and anti-C4 antibodies. The hepatitis C virus (HCV) was detected by the polymerase chain reaction. Thirty-nine patients were selected, of whom 23 were men and the overall mean age was 40.6 +/- 12.7 years. Cryoprecipitate was detected in 74.4% (29/39) patients. Among patients with or without cryoprecipitate formation, the serum creatinine values, the percentage of patients with proteinuria, and the posttransplantation times were similar. In patients with cryoglobulins, 37.9% (11/29) were HCV positive. The etiology was not determined for the other patients. The IgG, IgM, and IgA immunoglobulins and the complement fractions C3 and C4 were found in the cryoprecipitate. Their compositions were similar among patients with or without HCV. Few clinical features were associated with the presence of cryoglobulins, including deep venous thrombosis, cutaneous purpura and peripheral neuropathy. In conclusion, cryoglobulinemia was prevalent in kidney transplant recipients, but appeared to not affect graft function. HCV infection was the most frequently associated etiology and clinical features were infrequent.
Assuntos
Crioglobulinemia/sangue , Crioglobulinas/análise , Transplante de Rim/efeitos adversos , Adulto , Proteínas do Sistema Complemento/imunologia , Feminino , Seguimentos , Hepatite B/sangue , Hepatite B/complicações , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Fatores de TempoRESUMO
Los portadores asintomáticos constituyen reservorios importantes del virus de la hepatitis B, a pesar de lo cual no se han reportado hasta el momento ensayos terapéuticos en estos grupos. Por constituir, además, un modelo que permite evaluar las bondades de los antivirales junto a los antecedentes del empleo de la vía intraperitoneal en trabajos anteriores realizados en nuestro medio, hemos empleado esta vía para administrar IFN en concentraciones crecientes a 15 portadores asintomáticos a los que no se les detectó actividad de IFN circulante antes de iniciar la experiencia. Se estudiaron el número total de partículas, partículas de Dane, antígeno de superficie del virus de la hepatitis B (HBsAg) y antígeno "e" (HBeAg). Las variaciones encontradas en estos indicadores denotan que se alcanzó el estado antiviral con los tres esquemas empleados. A pesar de las limitaciones del tamaño de la muestra, se observaron las mayores modificaciones al mes postratamiento en el grupo al cual se administró la dosis más elevada, pudiendo clasificarse la evolución de algunos de los tratados como de tipo II. La ausencia de toxicidad y complicaciones validan el fármaco y la vía empleada para nuevos ensayos tendientes a lograr un esquema terapéutico racional, determinante dosis, periodicidad y duración del tratamiento