RESUMO
INTRODUCTION: Renal histology of proliferative lupus nephritis (LN) shows increased macrophage infiltration, but its association with renal outcome is a matter of debate. Here, we investigate the potential relationship that macrophage expression has with renal prognosis in patients with proliferative LN. METHODS: Fifty patients newly diagnosed with proliferative LN were followed for a median of 8 years. Laboratory testing was conducted at diagnosis, after induction therapy and at the final follow-up evaluation. Renal biopsies were obtained at diagnosis and underwent immunohistochemical analysis with anti-CD68 and monocyte chemoattractant protein 1 monoclonal antibodies. Patients were stratified at final follow-up evaluation into glomerular filtration rate (GFR) >60 ml/min/1.73 m2 (non-progressor group; n = 24) and GFR ≤60 ml/min/1.73 m2 (progressor group; n = 26). All patients were treated with prednisone and six pulses of cyclophosphamide on induction therapy. Conventional maintenance therapy was administered in both groups. RESULTS: Compared to progressors, the non-progressor group showed a lower chronicity index (p = 0.01) and fewer CD68-positive cells in the renal tubules (p = 0.01) and particularly in the renal interstitium (p = 0.0003). Baseline and final serum creatinine correlated positively with the chronicity index (r = 0.3, p = 0.01 and r = 0.3, p = 0.04, respectively), and final serum creatinine correlated positively with interstitial expression of CD68 (r = 0.4, p = 0.0006). CONCLUSION: Renal expression of CD68 and the chronicity index are associated with progression to chronic kidney disease in patients with proliferative LN.
Assuntos
Antígenos CD/fisiologia , Antígenos de Diferenciação Mielomonocítica/fisiologia , Rim/fisiologia , Nefrite Lúpica/complicações , Insuficiência Renal Crônica/etiologia , Adulto , Quimiocina CCL2/fisiologia , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Macrófagos/fisiologia , Masculino , PrognósticoRESUMO
High prevalence of hypovitaminosis D has been observed in patients with chronic kidney disease. However, there is not much data about its prevalence in kidney transplant recipients (KTRs). The study included 83 adult KTRs at a single center to calculate the prevalence of hypovitaminosis D. Among the 83 patients, those with incomplete data were excluded leaving 22 patients available for study. The demographic and biochemical data were analyzed retrospectively. Serum concentrations of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), phosphorus, calcium, and creatinine were evaluated. The 22 selected patients were divided into two groups: (1) those who received 10,000 IU of cholecalciferol orally per week, and (2) those who received 10,000-20,000 IU/week. The Vitamin D level rate was calculated to evaluate the time necessary to reach serum values ≥30 ng/mL. Hypovitaminosis D was present in 80.7% (67/83) of the patients. Eleven patients received 10,000 IU/week of cholecalciferol, and the other 11 patients received 10,000-20,000 IU/week (approximately 64,000 IU/month). The calcium, phosphorus, and PTH values did not show any differences between the two groups. We estimate that a dose of approximately 64,000 IU/month of cholecalciferol was sufficient to reach values of ≥30 ng/mL of 25(OH)D in approximately 2.1 months in the insufficient and 4.3 months in Vitamin D-deficient patients. The prevalence of hypovitaminosis D was high among Brazilian KTR, and low-level doses of cholecalciferol (approximately 64,000 IU/month) were sufficient to control hypovitaminosis D.
Assuntos
Deficiência de Vitamina D , Brasil , Cálcio , Colecalciferol , Humanos , Transplante de Rim , Hormônio Paratireóideo , Prevalência , Vitamina DRESUMO
BACKGROUND: The long-term prognosis of renal transplant recipients with systemic lupus erythematosus is still controversial. The outcome of these patients depends on the population studied, race/ethnicity, socioeconomic conditions, donor-related factors and recurrent lupus nephritis (LN), among other factors. OBJECTIVE: This study was conducted to evaluate kidney transplantation outcomes for adult Brazilian patients with LN at a single center. SUBJECTS AND METHOD: The archival records of all patients with LN who had received a kidney transplant at Santa Casa of Sao Paulo Hospítal were reviewed. Kaplan-Meier method was used to determine the survival rate. RESULTS: We identified 18 patients with LN subjected to 22 kidney transplants during the 20-year interval. Two patients received three renal grafts. The majority of the patients were female, with 33.7 ± 10 years at the time of the transplantation, and half of them were African descendants or mixed. Sixteen transplants were performed from deceased donors and six from living-related donors. The patient survival rate was 90%, and graft survival was 68% at 10 years. Chronic allograft nephropathy was the major cause of graft loss. Two patients developed extra-renal manifestations of lupus. There was no clinical or histological evidence of recurrent LN. CONCLUSION: Renal transplantation is a method which can provide a long-term survival for patients with SLE and end-stage renal disease.
Assuntos
Transplante de Rim , Nefrite Lúpica/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
MYH9 polymorphisms have been described to be associated with the risk of CKD in non-diabetic nephropathy, HIV nephropathy and FSGS. Predominating in black descendants, MHY9 genetic variants could partially explain the excess risk of CKD associated with African ancestry. However, recent data suggests that APOL1 gene co-segregate with MYH9, and could be the gene truly associated with CKD risk. In this study, we evaluated the role of MYH9 and APOL1 gene polymorphisms in the risk of CKD in Brazilian patients with lupus nephritis (LN). A retrospective analysis of 196 LN patients was done. MYH9 rs4821480, rs2032487, rs4821481 and rs3752462, APOL 1rs73885319, rs16996616, rs60910145, rs71785313, and APOL3 rs11089781 gene polymorphisms were determined. Genetic ancestry was ascertained both by autossomal ancestry and mitochondrial haplogroup. Primary outcome was defined as doubling of serum creatinine (DC) or end stage renal disease (ESRD). Sixty-two patients presented the PO. In our population, MYH9 and APOL1 were not in LD. None APOL polymorphism was associated with the PO, whereas rs3752462 MYH9 polymorphism showed a positive association (HR3.72, 95%CI 1.47-9.38, pâ=â0.005). When we analyzed the MYH9 E1 haplotype, the GCCT carriers (1 or 2 alelles present in 29.7% in the PO group vs. 18.5% in controls) showed a significant association to the risk of PO, even after adjustments for baseline estimated creatinine clearance and autossomal ancestry (HR 2.0, 95%CI 1.2-3.4, pâ=â0.01). Our results show that in our population MYH9, but not APOL1, gene polymorphisms confer an increased risk of CKD in LN patients, independently of race.
Assuntos
Apolipoproteínas/genética , Lipoproteínas HDL/genética , Nefrite Lúpica/genética , Proteínas Motores Moleculares/genética , Cadeias Pesadas de Miosina/genética , Polimorfismo Genético , Insuficiência Renal Crônica/genética , Adulto , Apolipoproteína L1 , Brasil , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Desequilíbrio de Ligação , Nefrite Lúpica/complicações , Insuficiência Renal Crônica/complicaçõesRESUMO
BACKGROUND: Renal failure patients submitted to chronic hemodialysis can present with cryoglobulinemia. There are few studies on cryoglobulins in chronic hemodialysis patients. The aim of the present study was to determine the prevalence and to identify the components of cryoglobulins in chronic hemodialysis patients. METHODS: Fifty-four patients on chronic hemodialysis were evaluated for the presence of cryoglobulins, after inclusion and exclusion criteria. The components of the cryoprecipitate were analyzed. RESULTS: Cryoglobulins were detected in 83% (45/54) of the patients on chronic hemodialysis. The cryoprecipitate was constituted by IgG, IgM, IgA, and complement fractions C3 and C4. CONCLUSION: We concluded that there was a high prevalence of cryoglobulins in chronic hemodialysis patients, and the cryoprecipitate was constituted by IgG, IgM, IgA, and complement fractions C3 and C4.
Assuntos
Crioglobulinemia/epidemiologia , Diálise Renal , Adulto , Crioglobulinemia/etiologia , Feminino , Hepatite C Crônica/complicações , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
OBJECTIVE: To evaluate whether the A/G polymorphism at position -2518 in the regulatory region of the monocyte chemoattractant protein-1 (MCP-1) or the V/I polymorphism at position -64 of the receptor, CCR2, are associated with lupus nephritis (LN) or any clinical characteristics of the disease or with renal survival in a patient population. METHODS: We selected 197 patients with lupus nephritis and 220 matched healthy controls for study. MCP-1 and CCR2 genotyping was performed by polymerase chain reaction. Clinical and laboratory data were compiled from patients' charts over followup that ranged from 6 months to 10 years. RESULTS: The G/G genotype of MCP-1 was more common in LN patients (p = 0.019), while the A allele was associated with healthy controls (p = 0.007) as was the V allele of CCR2 (p = 0.046) compared to LN patients. Clinical index measures [SLE Disease Activity Index (SLEDAI)], immunological markers, renal histology, renal function at enrollment, and renal survival were not influenced by these polymorphisms. A less aggressive renal disease, measured by renal SLEDAI index, was associated with the V allele of the CCR2 gene polymorphism. CONCLUSION: These findings support that MCP-1 -2518 G/G is associated with LN but there was no association of this genotype with renal function or renal survival. When studying CCR2 -64 V/I polymorphism we showed a positive association of the V allele with healthy controls but no association of the genotype with LN patients.
Assuntos
Quimiocina CCL2/genética , Nefrite Lúpica/genética , Polimorfismo de Nucleotídeo Único/genética , Receptores CCR2/genética , Adulto , Alelos , Análise de Variância , Creatinina/sangue , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Humanos , Rim/fisiopatologia , Testes de Função Renal , Nefrite Lúpica/sangue , Nefrite Lúpica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Reação em Cadeia da Polimerase , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
BACKGROUND: The Paulista Registry of Glomerulopathies was created in May 1999 and comprises several centres of São Paulo, the most populous Brazilian State, that concentrates people from all regions of the country who look for health care. METHODS: This report includes data from 2086 patients from Brazil submitted to renal biopsy due to the presumed diagnosis of glomerular diseases, registered prospectively since May 1999 until January 2005. Data were collected by the integrants of the 11 centres involved, utilizing a standardized questionnaire. RESULTS: The mean age of the patients was 34.5+/-14.6 years. Primary glomerular diseases were more frequent in males (55.1%) than in females; on the other hand, secondary glomerular diseases were more frequent in females (71.8%). The most common clinical presentation was nephrotic syndrome and the frequency of hypertension, at this time, was 55.5%. There was a predominance of indication of biopsies in the third, fourth and fifth decades of life. The most common primary glomerular diseases were focal and segmental glomerulosclerosis (29.7%), followed by membranous nephropathy (20.7%), IgA nephropathy (17.8%), minimal change disease (9.1%), membranoproliferative glomerulonephritis (7%), crescentic glomerulonephritis (4.1%), advanced chronic glomerulopathy (4%), non-IgA mesangial glomerulonephritis (3.8%), diffuse proliferative glomerulonephritis (2.5%), focal segmental proliferative glomerulonephritis (1%) and others (0.3%). The most frequent secondary glomerular disease was lupus nephritis, corresponding to 66.2% of the cases, followed by post-infectious glomerulonephritis (12.5%), diabetic nephropathy (6.2%), diseases associated to paraproteinaemia (4.9%), hereditary diseases (4.6%), vasculitis (3.2%), malignancies (0.9.%), secondary focal segmental glomerulosclerosis (0.6%) and others (0.9%). CONCLUSION: Focal segmental glomerulosclerosis was the most frequent primary glomerular disease, followed by membranous nephropathy and IgA nephropathy. Lupus nephritis predominated over all the other secondary glomerular diseases.
Assuntos
Glomerulonefrite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Feminino , Glomerulonefrite/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Objetivo :As glomerulopatias têm sido diagnosticadas com mais freqüência em indivíduos idoso,o que tem motivado os estudos nesta faixa etária. Nesta série de casos, apresentamos os diagnósticos histológicos e clínicos mais comuns entre os pacientes idosos submetidos a biópsia renal no HC-FMUSP.Métodos :Foi avaliada retrospectivamente uma série de casos de 65 pacientes com 60 anos ou mais, submetidos a biópsia renal no HC-FMUSP, de 1989 a 1999, com suspeita clínica de glomerulopatia. Os dados demográficos e clínicos foram extraídos de revisão de prontuários. Proteinúria nefrática foi definida como proteinúria de 24 horas maior ou igual a 3,5 g e insuficiência renal como dosagem de creatinina sérica maior do que 1,4 mgldf. Os dados são descritos em freqüências simples e a comparação entre proporções foi realizada através do qui-quadrado. As médias de variáveis contínuas foram analisadas através do teste t de Student. O valor de p<0,05 foi considerado como limite para significância estatística. Resultados :Insuficiência renal foi diagnosticada em 69(por cento) (45/65) dos pacientes e em 6(por cento) (39165) havia proteinúria nefrática no momento da biópsia. A glomerulonefrite membranosa (18 por cento) foi a lesão mais encontrada no HC-FMUSP, seguida de amifoidose (14 por cento), doença de lesões mínimas (14por cento) e vasculite pauci-imune (11por cento). Nos pacientes com GP, a creatinina média no momento do exame foi 2,5±1,0 mg/di e a proteinúria 6,2±5,4 gl dia. Nos portadores de amiloidose, creatinina média foi 2,7±2,4 mg/di e a proteinúria 9,1 ± 4,6 g/dia. Nos pacientes com vasculite pauci-imune, a creatinina sérica inicial foi 4,8 ± 2,0 mgldl e a proteinúria 0,810 ± 0,26 ao dia. Estavam em programa de diálise no momento da biópsia 14 por cento dos pacientes e 34 por cento daqueles sem indicação de diálise evoluíram com perda de função renal. Conclusões: A glomerulonefrite membranosa foi a lesão mais encontrada, seguida de amiloidose, doença de lesões mínimas e vasculite pauci-imune. Nas glomerulopatias primárias e amiloidose, predominou quadro clínico nefrótico e nas vasculites, a perda de função renal. A maioria dos pacientes tinha acometimento renal em grau avançado, o que pode estar refletindo viés de seleção, por conduta conservadora na indicação de biópsias renais em pacientes idosos.