RESUMO
BACKGROUND: Renal transplantation is considered a safe procedure for patients with systemic lupus erythematosus (SLE). However, the recurrence of disease and its impact on graft survival remains controversial. METHODS: To analyze the presence of lupus serology activity during dialysis and its impact on lupus recurrence after transplantation, we performed a retrospective analysis of 23 lupus patients who received 26 kidney transplantations. RESULTS: Twenty-three patients received 26 renal transplantations from 1984 to 2003. Twelve patients presented pretransplant lupus activity (low complement and ANA > 1/40), without correlation with length of dialysis, but associated with proliferative glomerulonephritis (class IV) pretransplant. Among 26 grafts, 6 were lost in the first 6 months posttransplant. Among the remaining 20 functioning grafts, low complement activity occurred in 8, being associated with recurrence of immune deposits in 3 cases. Analysis of lupus activity showed that only one patient with a normal complement level posttransplant presented SLEDAI > 4, associated with persistent proteinuria and a graft biopsy without immune deposits. Graft survival was reduced in the presence of low complement posttransplantation. CONCLUSION: Low complement levels after renal transplantation, in association with proteinuria may be considered to be a risk factor for recurrence of immune deposits, with a negative impact on graft survival.
Assuntos
Proteínas do Sistema Complemento/metabolismo , Sobrevivência de Enxerto/fisiologia , Transplante de Rim/efeitos adversos , Transplante de Rim/fisiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Biomarcadores/sangue , Humanos , Falência Renal Crônica/cirurgia , Recidiva , Fatores de TempoRESUMO
CONTEXT: Renal allograft biopsies have been used as a good method for monitoring the evolution of kidney transplants for at least 20 years. Histological analysis permits differential diagnosis of the causes of allograft dysfunction to be made. OBJECTIVES: To correlate the data of urinalysis and serum creatinine with histological diagnosis of renal graft in a group of renal transplant patients. DESIGN: Accuracy study, retrospective analysis. SETTING: A university terciary referral center. SAMPLE: 339 percutaneous allograft biopsies obtained from 153 patients. Blood and urine samples were obtained before the graft biopsy. MAIN MEASUREMENTS: Laboratory evaluation and hystological analysis (light microscopy, immunofluorescent electronic microscopy). RESULTS: Most of the biopsies (58.9%) were performed during the first month post-transplant. An increase in serum creatinine was associated with acute tubular and/or cortical necrosis. Proteinuria and normal serum creatinine were associated with glomerular lesions. Non-nephrotic range proteinuria and an increase in serum creatinine were associated with chronic rejection. CONCLUSION: Evaluation of serum creatinine and urinalysis can be useful in suggesting the histological graft diagnosis.
Assuntos
Biópsia por Agulha/métodos , Rejeição de Enxerto/diagnóstico , Transplante de Rim/patologia , Creatinina/sangue , Diagnóstico Diferencial , Rejeição de Enxerto/patologia , Humanos , Estudos Retrospectivos , Urina/químicaAssuntos
Injúria Renal Aguda/etiologia , Ciclosporina/efeitos adversos , Síndrome Hemolítico-Urêmica/etiologia , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Adulto , Ciclosporina/uso terapêutico , Diagnóstico Diferencial , Intervalo Livre de Doença , Feminino , Sobrevivência de Enxerto , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/terapia , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , MasculinoRESUMO
We report a case of acute tubulointerstitial nephritis and uveitis (TINU syndrome) in a 47-year-old woman who also was found to have antineutrophil cytoplasmic antibody. The patient developed severe acute renal failure that improved after a high dose (1 mg/kg/d) of corticosteroid therapy. The diagnosis of the disorder is discussed, as well as the finding of antineutrophil cytoplasmic antibody.
Assuntos
Autoanticorpos/imunologia , Nefrite Intersticial/imunologia , Uveíte Anterior/imunologia , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/etiologia , Anticorpos Anticitoplasma de Neutrófilos , Biomarcadores/análise , Feminino , Glucocorticoides/uso terapêutico , Humanos , Túbulos Renais/patologia , Pessoa de Meia-Idade , Nefrite Intersticial/complicações , Nefrite Intersticial/tratamento farmacológico , Nefrite Intersticial/patologia , Prednisona/uso terapêutico , Síndrome , Uveíte Anterior/complicações , Uveíte Anterior/tratamento farmacológicoRESUMO
UNLABELLED: Diabetic nephropathy is a frequent cause of end-stage renal failure in patients admitted for renal replacement therapy. PURPOSE: To evaluate the prevalence of DN, as the underline disease, in patients with ESRF. METHODS: 1,303 [male (M) = 767 and female (F) = 536] patients with ESRF who were on a waiting list for cadaver kidney transplant at Nephrology Unit-University Hospital (HC-UNICAMP), from August/90 to June/93--group 1--and 193 (M = 112 and F = 81) patients admitted for renal replacement therapy in a year period (April/92 to March/93), in the city of Campinas, State of São Paulo, Brazil, were studied. RESULTS: The prevalence of DN was 10.1% in group 1 and 17.6% in group 2 (x2 = 7.15; p = 0.007), being the third cause of ESRF in both groups, and it was preceded by glomerulonephritis and arterial hypertension. In group 1 the reduction of number of patients with increase in duration of dialysis was significantly greater in patients with diabetic nephropathy (x2 = 30.9; p < 0.001). Among patients with DN 35 (26%) in group 1 and 6 (18%) in group 2 had less than 35 years when they were admitted for renal replacement therapy and are likely to be type 1 (insulin-dependent) diabetic patients. CONCLUSION: In our studied groups DN was a frequent cause of ESRF.