RESUMO
BACKGROUND: There are few studies about the functional tubular disturbances in human Kala-azar. The aim of this study was to investigate alterations in tubular reabsorption of urinary proteins, sodium, potassium, chloride, glucose, uric acid, inorganic phosphate and amino acids in patients with the chronic form of kala-azar. PATIENTS AND METHODS: This is a cross-sectional study of 55 patients with visceral leishmaniasis (Kala-azar). The laboratorial investigation was: creatinine clearance and daily urinary excretion of total proteins, albumin, IgG, beta2-microglobulin, sodium, potassium, chloride, calcium, inorganic phosphate, uric acid and glucose. Plasma and urinary protein electrophoresis were performed in agarose gel. Urinary light chains were determined by the nephelometric method and amino acids by chromatography. All data were compared to those of a control group. RESULTS: Hypoalbuminemia, hypergammaglobulinemia as well as increased plasma levels of both IgG and beta2-microglobulins were found in all patients with Kala-azar. The mean urinary protein excretion was 277 +/- 66 mg/day. Increased albumin excretion was observed in 44% of patients accounting for 17% of the total urinary protein excretion. Proteinuria consisted predominantly of low molecular weight protein fractions that migrated with alpha1, alpha2, beta and especially gamma globulins. Urinary beta2-microglobulin excretion was elevated in all patients. Immune electrophoresis showed increased urinary excretion rates of kappa (27%) and lambda (42%) light chains. The Bence-Jones test was positive in 20% of patients. Immunofixation was negative for monoclonal peak. The principal alterations were hyponatremia 94.6%, hypokalemia 26%, hypochloremia 27.2%, hypocalcemia 32%, hypomagnesemia 41.8%, hypouricemia 14.3%, Increased urinary excretion fraction were: sodium 15%, potassium 26%, chloride 33.3%, calcium 32%, inorganic phosphate 27.2%, magnesium 100% with hypermagnesiuria, uric acid 44%. Glucosuria was found in one third of patients. CONCLUSION: There was evidence of renal proximal tubular damage with alterations in the reabsorption of proteins and light chains with characteristics of a tubular proteinuria, Disturbances of tubular reabsorption of uric acid, calcium, phosphate, glucose and magnesium were also observed.
Assuntos
Acidose Tubular Renal/etiologia , Taxa de Filtração Glomerular/fisiologia , Túbulos Renais/metabolismo , Leishmaniose Visceral/complicações , Acidose Tubular Renal/metabolismo , Acidose Tubular Renal/fisiopatologia , Adolescente , Adulto , Cálcio/sangue , Cálcio/urina , Estudos Transversais , Progressão da Doença , Feminino , Fluorometria , Seguimentos , Humanos , Imunoglobulina G/urina , Túbulos Renais/patologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fosfatos/urina , Prognóstico , Estudos Prospectivos , Sódio/sangue , Sódio/urina , Espectrofotometria , Ácido Úrico/sangue , Ácido Úrico/urina , Adulto Jovem , Microglobulina beta-2/metabolismoRESUMO
OBJECTIVES: The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue infection were studied. DESIGN: Serum, saliva, and urine samples were collected from 22 patients with clinical and confirmed dengue 3 virus infection during the outbreak in Havana City in 2001. They were tested by capture IgM (MAC-ELISA), IgA (AAC-ELISA), and IgE (EAC-ELISA) and IgG ELISA inhibition method (EIM) to detect specific dengue antibodies. RESULTS: Similar kinetics were observed in IgM, IgA, and IgG antibodies in saliva and IgA and IgG in urine samples from secondary cases compared with kinetics in serum samples, although the values were lower. No IgG antibody was detected in saliva and urine samples in primary cases and IgM antibody was not detected in urine samples from either primary or secondary infection. All secondary cases were positive for IgG in saliva and urine samples at day 7. The kinetics of specific IgE antibodies in primary and secondary cases were different. CONCLUSIONS: The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue 3 virus infection were studied for the first time, showing its behavior and usefulness in dengue virus diagnosis. The specific IgE could play a role as a serological marker in secondary infections.
Assuntos
Anticorpos Antivirais/análise , Vírus da Dengue/imunologia , Dengue/diagnóstico , Dengue/imunologia , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/urina , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina E/análise , Imunoglobulina E/sangue , Imunoglobulina E/urina , Imunoglobulina G/análise , Imunoglobulina G/sangue , Imunoglobulina G/urina , Imunoglobulina M/análise , Imunoglobulina M/sangue , Imunoglobulina M/urina , Cinética , Masculino , Pessoa de Meia-Idade , Saliva/imunologiaRESUMO
OBJECTIVE: To evaluate the accuracy of a urine-based enzyme-linked immunosorbent assay (ELISA) kit for anti-Helicobacter pylori immunoglobulin G antibody (urine-HpELISA) in children, we compared its sensitivity and specificity in reference to (13)C-urea-breath test (UBT) and H pylori stool antigen test (HpSA). STUDY DESIGN: Japanese children without significant upper abdominal symptoms were included (n=100; mean age, 7.0 years; range, 2 to 15). UBT, HpSA, and urine-HpELISA were performed. RESULTS: Of 100 children, 36 and 64 were judged H pylori-positive and H pylori-negative, respectively, by UBT and HpSA. Thirty-four of 36 positive children were positive by urine-HpELISA, and 62 out of 64 negative children were negative by urine-HpELISA. Thus, the urine-HpELISA had 94.4% sensitivity and 96.9% specificity, with accuracy of 96.0%. CONCLUSIONS: The urine-HpELISA is a rapid, inexpensive, reliable, and easy-to-perform method for the diagnosis of H pylori infection in children. It may be useful not only for diagnosis but also for mass screening for epidemiological studies in pediatric population.
Assuntos
Anticorpos Antibacterianos/urina , Ensaio de Imunoadsorção Enzimática/métodos , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/imunologia , Imunoglobulina G/urina , Adolescente , Antígenos de Bactérias/análise , Testes Respiratórios , Criança , Pré-Escolar , Reações Falso-Negativas , Reações Falso-Positivas , Fezes/microbiologia , Feminino , Humanos , Imunoglobulina G/imunologia , Japão , Masculino , Sensibilidade e Especificidade , UreiaRESUMO
PURPOSE: Having observed a decrease in antiphospholipid antibodies (aPL) upon the development of nephrotic syndrome, as well as a negative association between nephrotic syndrome and secondary antiphospholipid syndrome, in patients with systemic lupus erythematosus (SLE), we sought to determine if this could be due to urinary loss of aPL and/or other factors. SUBJECTS AND METHODS: IgG and IgM aPL as well as other autoantibodies were studied by enzyme-linked immunosorbent assay with cardiolipin as antigen in serum and urine from six patients with SLE who had elevated serum aPL levels and developed nephrotic syndrome (cases). For controls, we studied: (1) three SLE patients with nephrotic syndrome but low aPL levels; (2) three patients with non-SLE nephrotic syndrome; (3) three SLE patients with high-titer aPL but no proteinuria; and (4) 10 healthy volunteers. RESULTS: We found urinary IgG, but no IgM, aPL in all cases and in one control from Group 2. Serum IgG aPL had gradually decreased after the development of nephrotic syndrome and had become normal. IgM aPL had also decreased in the four patients who had elevated levels, having reached normal levels at the time of the study in two. There was an apparent correlation between serum and urine IgG aPL levels but not between urinary IgG aPL and total proteinuria. By Farr's method, we found no urinary anti-DNA despite high serum titers in three cases. The two cases and one of the controls in Group 1 who had serum antibodies to extractable antigens also had these antibodies in the urine. CONCLUSION: Urinary loss of IgG aPL during nephrotic syndrome does not completely explain the reduction in serum aPL, since IgM also decreases. There could also be decreased synthesis and/or increased catabolism of immunoglobulins.
Assuntos
Autoanticorpos/análise , Imunoglobulina G/urina , Lúpus Eritematoso Sistêmico/imunologia , Síndrome Nefrótica/imunologia , Fosfolipídeos/imunologia , Adulto , Sangue , Feminino , Seguimentos , Humanos , Imunoglobulina G/análise , Isotipos de Imunoglobulinas/análise , Isotipos de Imunoglobulinas/urina , Imunoglobulina M/análise , Imunoglobulina M/urina , Lúpus Eritematoso Sistêmico/urina , Síndrome Nefrótica/patologia , Síndrome Nefrótica/urina , Proteinúria/imunologia , Proteinúria/urinaAssuntos
Síndrome da Imunodeficiência Adquirida/urina , Antígenos de Protozoários/urina , Imunoglobulina G/urina , Toxoplasma/imunologia , Toxoplasmose Cerebral/urina , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Testes de Aglutinação/métodos , Animais , Feminino , Humanos , Camundongos , Toxoplasmose Cerebral/complicações , Toxoplasmose Cerebral/diagnósticoRESUMO
The relationship of early retinal changes and subclinical proteinuria to duration and metabolic regulation of insulin-dependent diabetes was studied in 67 children. Retinopathy was found in 25 patients and occurred almost exclusively (96%) in those with duration of disease longer than five years. Glomerular filtration rate was normal or increased in all patients. Urinary excretion of beta 2-microglobulin, albumin, transferrin, and IgG was significantly increased in patients, as compared with controls, whereas serum concentrations of these proteins were generally normal. The mechanisms responsible for the hyperexcretion of both large and small proteins are unclear but probably involve both glomerular and tubular dysfunction. Increased urinary protein excretion occurred independently of duration of disease. Retinopathy but not microproteinuria was more common in patients with glycosylated hemoglobin greater than 11% and in those with duration of disease longer than five years. Although a significant association was found between retinopathy and the hyperexcretion of one or more of the large molecular weight proteins, the weight of the evidence suggests that these two sequelae of diabetes differ in their pathogenesis. Long-term follow-up of these patients may provide insight as to their risk of developing more serious retinopathy or nephropathy, and whether good glycemic control may protect against these complications of insulin-dependent diabetes.