RESUMO
PURPOSE: To evaluate and the long term course of patients with lupus nephritis, METHOD: Thirty seven patients with lupus nephritis followed in a referral, tertiary care center of a developing country (Brazil) were studied. The length of follow up was 52.4 + 13.3 months and mean age was 26.05 + 11.12 years. 84% of the patients were females and class IV nephritis was found to be the most frequent (80%). RESULTS: At the time of renal biopsy mean serum creatinine was 1.74 + 1.15 mg/dl, and 24 h-proteinuria was 2.62 + 2.89 g. Fifty one per cent of the patients with elevated serum creatinine showed a decrease in these values. Of the variables studied (age, sex, proteinuria, presence of hypertension and serum creatinine at biopsy), serum creatinine elevation was the only one to be associated with poorer prognosis. Remission of the nephrotic syndrome occurred in 65% of the patients. Actuarial survival rate was 96% at 1 year, 82% at 5 years, 70% at 10 years and 70% at 12 years. Five patients developed end stage renal failure and 7 died. Infection was the most frequent(57%) cause of death. CONCLUSION: Among several factors studied the only which has been associated with chronic renal failure was elevated serum creatinine at the time of biopsy. Infections were the main cause of death.
Assuntos
Nefrite Lúpica/fisiopatologia , Adolescente , Adulto , Criança , Creatinina/sangue , Feminino , Seguimentos , Humanos , Falência Renal Crônica/etiologia , Nefrite Lúpica/sangue , Nefrite Lúpica/complicações , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/etiologia , Prognóstico , Proteinúria/sangue , Estudos Retrospectivos , Análise de Sobrevida , Fatores de TempoRESUMO
OBJETIVO: Estudar a apresentação clínica e a evolução de pacientes portadores de glomerulonefrite lúpica. CASUÍSTICA E MÉTODOS: Foram estudados 37 pacientes portadores de glomerulonefrite lúpica, atendidos pela Disciplina de Nefrologia - Faculdade de Medicina de Botucatu, com seguimento médio de 52,4 + ou - 13,3 meses. Os dados foram obtidos através do levantamento retrospectivo dos prontuários. RESULTADOS: A idade média foi de 26,05 + ou - 11,12 anos, com predomínio do sexo feminino (84 por cento) sendo que a glomerulonefrite classe IV foi a mais freqüente (80 por cento). No início do seguimento a média da creatinina sérica foi de 1,74 + ou - 1,15 mg/dl, e a da proteinúria de 24h foi de 2,62 + ou - 2.89 g. Cinqüenta e um porcento dos pacientes com creatinina sérica elevada apresentaram, durante o seguimento, diminuição desses valores. Dentre diferentes variáveis estudadas, à época da biopsia renal, (idade, sexo, proteinúria, presença de hipertensão arterial e creatinina sérica) a única que se associou com pior prognóstico foi a elevação da creatinina sérica. Remissão da síndrome nefrótica ocorreu em 65 por cento das vezes. A sobrevida atuarial foi de 96 por cento, 82 por cento, 70 por cento e 70 por cento em 1, 5, 10 e 12 anos. Cinco pacientes desenvolveram insuficiência renal crônica terminal e sete morreram, sendo infecção a principal causa de óbito (57 por cento) CONCLUSÃO: Em pacientes com nefropatia lúpica, o aumento da creatinina sérica, à época da biópsia, se associou com o desenvolvimento de insuficiência renal crônica ao fim do seguimento e a principal causa de óbito foi processo infeccioso.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Nefrite Lúpica/fisiopatologia , Prognóstico , Proteinúria/sangue , Fatores de Tempo , Nefrite Lúpica/complicações , Análise de Sobrevida , Estudos Retrospectivos , Seguimentos , Creatinina/sangue , Falência Renal Crônica/etiologia , Síndrome Nefrótica/etiologiaRESUMO
The effect of ticlopidine on rats with adriamycin nephropathy was observed during 26 weeks. In the ticlopidine-treated nephrotic animals (TNG), proteinuria was less than in the untreated nephrotic animals (NG), but this difference was significant only at week 6 (TNG = 47.27 +/- 16.52 versus NG = 100.08 +/- 13.83 mg/24 h, p < 0.01) and week 26 (TNG = 157.00 +/- 28.73 versus NG = 217.00 +/- 21.73 mg/24 h, p < 0.01) after ADR injection. NG presented severe tubulointerstitial abnormalities with a tubulointerstitial lesion index of 3+. No difference in glomerular lesions was observed among the groups (NG median = 6%, TNG median = 4% and TCG median = 2%). The tubulointerstitial lesion index of TNG was less intense (median = 2+) but not different from those of the control groups (CG median = 1+; TCG median = 0+) nor NG (median = 3+). We concluded that the treatment with ticlopidine produced some partially beneficial effects but did not prevent the development of adriamycin-induced nephropathy.
Assuntos
Nefrose/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/uso terapêutico , Animais , Antibióticos Antineoplásicos , Doxorrubicina , Avaliação Pré-Clínica de Medicamentos , Rim/efeitos dos fármacos , Rim/patologia , Masculino , Nefrose/induzido quimicamente , Nefrose/patologia , Proteinúria/induzido quimicamente , Proteinúria/tratamento farmacológico , Ratos , Ratos Wistar , Estatísticas não Paramétricas , Fatores de TempoRESUMO
The role of superoxide in adriamycin-induced nephropathy (single dose; i.v. 3 mg/kg) has been studied by blocking superoxide synthesis through the administration of allopurinol (500 mg/L in drinking water). In Experiment I (EI), allopurinol administration was started 3 days prior to nephropathy induction and continued until day 14. In Experiment II (EII) allopurinol administration was started 2 weeks after nephropathy induction and was maintained until the end of the experiment (26 weeks). Affected glomeruli frequency and tubulointerstitial lesion index (TILI) were determined at Weeks 2 and 4 (EI) and Week 26 (EII). In EI, the 24 h mean proteinuria in the nephrotic control group (NCG-I) differed from that of the treated nephrotic group (TNG-I) at Week 1 (TNG = 33.3 +/- 6.39 mg/24 h; NCG = 59.8 +/- 6.3 mg/24 h; p < 0.05) and 2 (NCG-I = 80.0 +/- 17.5 mg/24 h; TNG-I = 49.1 +/- 8.4 mg/24 h; p < 0.05). No glomerular alterations were observed and TILI medians were not different in both nephrotic groups at week 2 (NCG-I = 1+: TNG = 1+) and 4 (NCG = 4+; TNG = 4+). In EII, NCG-II and TNG-II presented different 24 h proteinuria values only at Week 6, (136.91 +/- 22.23 mg/24 h and 72.66 +/- 10.72 mg/24 h, respectively; p < 0.05). Between nephrotic groups, there was no statistical difference in the median of affected glomeruli (CNG-II = 56%; TNG-II = 48%) and TILI (NCG-II = 8+; TNG-II = 9+). Thus, allopurinol was associated with a transient reduction in proteinuria and it did not alter the progression of the nephropathy.
Assuntos
Alopurinol/farmacologia , Antineoplásicos/toxicidade , Doxorrubicina/toxicidade , Sequestradores de Radicais Livres/farmacologia , Nefrite Intersticial/tratamento farmacológico , Animais , Biópsia , Modelos Animais de Doenças , Progressão da Doença , Seguimentos , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/metabolismo , Glomerulosclerose Segmentar e Focal/patologia , Glomérulos Renais/diagnóstico por imagem , Glomérulos Renais/efeitos dos fármacos , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/ultraestrutura , Masculino , Nefrite Intersticial/induzido quimicamente , Nefrite Intersticial/patologia , Proteinúria/etiologia , Proteinúria/urina , Distribuição Aleatória , Ratos , Ratos Wistar , UltrassonografiaRESUMO
Rats treated with two injections of adriamycin (week 0 and week 12) developed glomerusclerosis and severe tubulointerstitial lesions as described in the literature. In addition, a number of glomerular alterations were present. These included capillary loop dilation, insudation of eosinophilic material, necrosis, duplication of the glomerular basement membrane, severe mesangiolysis with disruption of the mesangial matrix and segmental double-contours. The renal arterioles and interlobular arteries showed endothelial cell swelling. The subendothelial space was infiltrated by fibrinoid material and there was intensive fibrinoid necrosis of the wall of both arteries and arterioles extending into the glomerular tuft. These alterations were very similar to those observed in the hemolytic uremic syndrome. This observation suggests that the two injections of adriamycin, with a long interval in between them, might induce renal lesions similar to those observed in the hemolytic uremic syndrome.
Assuntos
Antineoplásicos , Doxorrubicina , Glomerulonefrite/induzido quimicamente , Síndrome Hemolítico-Urêmica/etiologia , Nefrite Intersticial/induzido quimicamente , Animais , Antineoplásicos/administração & dosagem , Doxorrubicina/administração & dosagem , Glomerulonefrite/complicações , Glomerulonefrite/patologia , Síndrome Hemolítico-Urêmica/patologia , Glomérulos Renais/efeitos dos fármacos , Glomérulos Renais/patologia , Masculino , Nefrite Intersticial/complicações , Nefrite Intersticial/patologia , Ratos , Ratos Wistar , Fatores de TempoRESUMO
Trypanosoma cruzi, the causative agent of Chagas' disease assumes two distinct forms in vertebrate hosts: circulating trypomastigote and tissular amastigote. This latter form infects predominantly the myocardium, smooth and skeletal muscle, and central nervous system. The present work describes for the first time the detection of amastigote forms of T. cruzi in the renal parenchyma of a kidney graft recipient one month after transplantation. The patient was serologically negative for Chagas' disease and received no blood transfusion prior to transplant. The cadaver donor was from an endemic area for Chagas' disease. The recipient developed the acute form of the disease with detection of amastigote forms of T. cruzi in the renal allograft biopsy and circulating trypomastigote forms. The present report demonstrates that T. cruzi can infect the renal parenchyma. This mode of transmission warrants in endemic areas of Chagas' disease.
Assuntos
Doença de Chagas/transmissão , Transplante de Rim , Rim/parasitologia , Trypanosoma cruzi/isolamento & purificação , Adulto , Animais , Humanos , MasculinoRESUMO
Acute renal failure (ARF) is a frequent complication in hospitalized patients and is strongly related to increase in mortality. In order to analyze the clinical outcome and the prognostic factors in hospital-acquired ARF, a prospective study was performed. Data from 200 patients with established ARF during the period of January 1987 through July 1990 were collected. The incidence of ARF was 4.9/1000 admissions. Renal ischemia (50%) and nephrotoxic drugs (21%) were the main etiologic factors. The histologic study done in 43 patients showed: acute tubular necrosis (53%), tubular hydropic degeneration (16%), glomerulopathies (16%), and other lesions (15%). Dialysis therapy was performed in 101 patients. The mortality rate was 46.5% and the most important causes of death were: sepsis (38%), respiratory failure (19%), and multiple organ failure (11%). Higher mortality was observed in oliguric patients (62.9%) than nonoliguric (34.5%) (p < 0.05) and in ischemic renal failure (56.7%) when compared to nephrotoxic renal failure (14.7%) (p < 0.05). As primary cause of death was not associated to the acute renal failure, we conclude that acute renal failure is an important marker of the gravity of the underlying disease and not the cause of death.
Assuntos
Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Causas de Morte , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Adulto , Idoso , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Progressão da Doença , Feminino , Humanos , Isquemia/complicações , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Oligúria/complicações , Estudos Prospectivos , Diálise Renal , Fatores de Risco , Resultado do TratamentoRESUMO
In order to evaluate the role of underlying disease in the high mortality observed in acute renal failure (ARF) and risk factors related to the development of oliguric ARF in renal allograft recipients, two groups were selected: 34 patients with native kidneys, aged 16 and 57 years, and presenting ischemic ARF caused by cardiovascular collapse, with no signs of infection at the time of diagnosis; and 34 renal allograft recipients who developed ARF immediately after transplantation, without rejection. ARF was defined either as 30% increase of basal plasmatic creatinine in patients with native kidneys or nonnormalization of plasmatic creatinine at day 5 after transplantation in renal allograft recipients; oliguria as diuresis < or = 400 mL/24 h. There were no differences in age, male frequency, oliguria presence and duration, need for dialysis, and infection episodes for renal allograft recipients and patients with native kidneys. The development of sepsis (3% and 41%) and death rate (3% and 44%) were higher in patients with native kidneys (p < 0.01). The renal allograft recipients with both oliguric (n = 18) and nonoliguric (n = 16) ARF were evaluated and no difference was observed in the recipient's age, donor's age, cold ischemia time, time elapsed until plasmatic creatinine normalization, donor's plasmatic creatinine or urea, and mean arterial pressure. No differences were observed between the groups regarding frequency of infection episodes during ARF and frequency of death. In conclusion, renal allograft recipients presented a lower death rate and were less susceptible to sepsis. Cold ischemia time, age, and hemodynamic characteristics of the donor did not affect the development of oliguria.