RESUMO
Most children with hepatoblastoma manifest, at the time of LT, a decrease in renal function due to chemotherapy that could be further deteriorated by the use of calcineurin inhibitors. The purpose of this work was to examine the long-term follow-up of renal function in a cohort of children transplanted for unresectable hepatoblastoma. We present a retrospective observational study of 10 pediatric patients who received a LT for unresectable hepatoblastoma between 1996 and 2016. All patients included in this study were followed up on a regular basis and were assessed for GFR before transplantation and at least once a year during follow-up. All patients received standardized chemotherapy treatment for hepatoblastoma and immunosuppression according to hospital protocols. There was a marked decrease in GFR at the time of the LT in five patients presenting renal complications during the pretransplant cycles of chemotherapy. Three patients, one of them with prior kidney involvement, presented complications after LT, namely acute kidney failure and decrease in GFR. Those patients who presented with the lowest GFR at the time of LT eventually recovered renal function at levels similar to the rest of the group on follow-up. Chemotherapy-induced nephrotoxicity is a concern in patients treated for hepatoblastoma. Some individuals will develop low GFR after chemotherapy; therefore, strict follow-up is recommended, as low GFR may affect the doses of subsequent chemotherapy and immunosuppression. Stabilization of GFR levels and occasional improvement can be observed in the post-transplant period.
Assuntos
Taxa de Filtração Glomerular , Hepatoblastoma/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Antineoplásicos/farmacologia , Inibidores de Calcineurina/uso terapêutico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Terapia de Imunossupressão , Imunossupressores/uso terapêutico , Lactente , Rim/fisiopatologia , Masculino , Insuficiência Renal/fisiopatologia , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: Severe ischemia-reperfusion injury (SIRI) seems to be the key factor that can significantly affect the function of both native kidneys and renal allografts. Therefore, the development of a successful strategy is of a paramount importance in both basic and clinical research. METHODS: To determine the effects of SIRI on the native kidney function, a murine model was planned as follows: group 1 (n = 6) mice underwent to nephrectomy plus ischemia-reperfusion injury for 30 minutes; group 2 (n = 6) mice underwent to nephrectomy without ischemia-reperfusion injury and thus served as sham controls for SIRI. The results of serum creatinine (SCr) were analyzed using Mann-Whitney U tests to calculate the significance between mean values. Survival between groups was measured by Kaplan-Meier test. RESULTS: To reliably achieve an elevation of SCr levels animals were exposed to a SIRI. The values of SCr increased from 0.35 (SD, 0.09) mg/dL to about 2-fold within 2 days and 3-fold within the following 5 days. Under these given conditions the mice displayed signs and histologic findings of severe kidney damage. The survival rate was about 83% of the animals within a week, and they showed no capacity of complete spontaneous self-regeneration. CONCLUSIONS: In this study, we aim to establish a murine model with extensive structural kidney damage and significant elevation of SCr levels, which could be used in basic and translational research of transplantation and regenerative therapies.
Assuntos
Modelos Animais de Doenças , Transplante de Rim , Insuficiência Renal/etiologia , Traumatismo por Reperfusão/complicações , Animais , Creatinina/sangue , Rim/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologiaRESUMO
Tumor lysis syndrome (SLT) is a rare and potentially fatal entity. It represents an oncological emergency. It can be diagnosed by its clinical presentation and also by laboratory results. In most cases it is presented as a complication of the chemotherapeutic treatment of oncohematological diseases with large tumor mass. Less frequently, a syndrome of spontaneous tumor lysis has been described, or secondary to the use of corticosteroids, hydroxyurea and radiotherapy. In its most severe forms it may require hospitalization in intensive care units and invasive therapeutic measures such as hemodialysis. We report four cases of SLT with unusual presentation characteristics admitted to our Medical Research Institute.
El síndrome de lisis tumoral (SLT) es una entidad poco frecuente y potencialmente fatal. Representa una emergencia oncológica. Puede diagnosticarse por su forma de presentación clínica y también por los resultados de laboratorio. En la mayoría de los casos se presenta como complicación del tratamiento quimioterapéutico de enfermedades oncohematológicas con gran masa tumoral. Con menor frecuencia se ha descrito un síndrome de lisis tumoral espontáneo, o secundario al uso de corticoides, hidroxiurea y radioterapia. En sus formas más graves puede requerir internación en unidades de terapia intensiva y medidas terapéuticas invasivas como la hemodiálisis. Comunicamos cuatro casos de SLT con características de presentación inusual internados en nuestro Instituto de Investigaciones Médicas.
Assuntos
Síndrome de Lise Tumoral/patologia , Adulto , Idoso , Antineoplásicos/efeitos adversos , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/fisiopatologiaRESUMO
Abstract Introduction: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. Objective: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). Methodology: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. Results: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. Conclusion: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.
Resumo Introdução: Não se sabe ao certo se a função renal residual (FRR) de pacientes dialíticos pode atenuar o impacto metabólico do maior intervalo interdialítico (MII) de 68 horas, no qual ocorre acúmulo de volume, ácidos e eletrólitos. Objetivo: Avaliar os níveis séricos de eletrólitos, balanço hídrico e status ácido-básico de pacientes dialíticos com e sem FRR ao longo do MII. Metodologia: Tratou-se de estudo unicêntrico, transversal e analítico, que comparou pacientes com e sem FRR, definida como diurese acima de 200 mL em 24 horas. Para tal, os pacientes foram pesados e submetidos à coleta de amostras séricas para análise bioquímica e gasométrica no início e fim do MII. Resultados: Foram avaliados 27 e 24 pacientes com e sem FRR, respectivamente. Pacientes sem FRR apresentaram maior aumento de potássio sérico durante o MII (2,67 x 1,14 mEq/L, p < 0,001) atingindo valores mais elevados no fim (6,8 x 5,72 mEq/L, p < 0,001); menor valor de pH no início do intervalo (7,40 x 7,43, p = 0,018), maior proporção de pacientes com bicarbonato sérico < 18 mEq/L (50 x 14,8 %, p = 0,007) e distúrbio ácido-básico misto (70,8 x 42,3 %, p = 0,042), além de maior ganho de peso interdialítico (14,67 x 8,87 mL/kg/h, p < 0,001) e menor natremia (137 x 139 mEq/L, p = 0,02) no fim do intervalo. A calcemia e fosfatemia não foram diferentes entre os grupos. Conclusão: Pacientes com FRR apresentaram melhor controle dos níveis séricos de potássio, sódio, status ácido-básico e da volemia ao longo do MII.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Equilíbrio Hidroeletrolítico/fisiologia , Diálise Renal/efeitos adversos , Insuficiência Renal/sangue , Rim/fisiopatologia , Fosfatos/sangue , Potássio/sangue , Sódio/sangue , Desequilíbrio Ácido-Base/fisiopatologia , Bicarbonatos/sangue , Aumento de Peso , Cálcio/sangue , Estudos Transversais , Progressão da Doença , Insuficiência Renal/fisiopatologia , Insuficiência Renal/urina , Insuficiência Renal/terapia , Rim/metabolismo , Rim/química , Testes de Função Renal/métodosRESUMO
El síndrome de lisis tumoral (SLT) es una entidad poco frecuente y potencialmente fatal. Representa una emergencia oncológica. Puede diagnosticarse por su forma de presentación clínica y también por los resultados de laboratorio. En la mayoría de los casos se presenta como complicación del tratamiento quimioterapéutico de enfermedades oncohematológicas con gran masa tumoral. Con menor frecuencia se ha descrito un síndrome de lisis tumoral espontáneo, o secundario al uso de corticoides, hidroxiurea y radioterapia. En sus formas más graves puede requerir internación en unidades de terapia intensiva y medidas terapéuticas invasivas como la hemodiálisis. Comunicamos cuatro casos de SLT con características de presentación inusual internados en nuestro Instituto de Investigaciones Médicas.
Tumor lysis syndrome (SLT) is a rare and potentially fatal entity. It represents an oncological emergency. It can be diagnosed by its clinical presentation and also by laboratory results. In most cases it is presented as a complication of the chemotherapeutic treatment of oncohematological diseases with large tumor mass. Less frequently, a syndrome of spontaneous tumor lysis has been described, or secondary to the use of corticosteroids, hydroxyurea and radiotherapy. In its most severe forms it may require hospitalization in intensive care units and invasive therapeutic measures such as hemodialysis. We report four cases of SLT with unusual presentation characteristics admitted to our Medical Research Institute.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Síndrome de Lise Tumoral/patologia , Síndrome de Lise Tumoral/etiologia , Síndrome de Lise Tumoral/fisiopatologia , Evolução Fatal , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Antineoplásicos/efeitos adversosRESUMO
PURPOSE: To analyze the muscle changes with high-intensity aerobic training (HIAT) in an animal model of renal disease (RD). METHODS: Twenty one adult Wistar rats were divided into 3 groups: healthy sedentary (HS), RD sedentary (RDS), RD aerobic training (RDAT). RDS and RDAT were subjected to unilateral renal ischemia-reperfusion (10 min) and 21days after that, RDAT was subjected to 6 weeks HIAT (swimming). Serum creatinine (Cr) and muscle morphometry (cross-sectional area = CSA) of gastrocnemius were analyzed. RESULTS: Cr was higher (p = 0.0053) in RDS (0.82 ± 0.04) than in the others (RDAT 0.55 ± 0.04; HS 0.55 ± 0.04). Morphometric analysis (class interval of CSA in µm2/absolute frequency of muscle fibers in each class) indicated that 50th percentile occurred in: HS 7th class (3000.00-3499.00/515), RDS, 8th class (3500.00-3999.00/484), RDAT 5th class (2000.00-2499.00/856). CSA of largest fibers in RDS, RDAT, HS was 9953.00 µm2, 9969.00 µm2,11228.00 µm2, respectively. High frequency of fibers with lower CSA occurred in 4th, 5th, 6th and 7th class in RDA, absence of fibers into 22nd, 23rd classes (RDS and RDAT). CONCLUSION: HIAT in an animal model of RD resulted in increased the number of muscle fibers with smaller CSA.
Assuntos
Músculo Esquelético/fisiopatologia , Condicionamento Físico Animal/fisiologia , Insuficiência Renal/fisiopatologia , Animais , Peso Corporal/fisiologia , Creatinina/sangue , Modelos Animais de Doenças , Rim/irrigação sanguínea , Rim/fisiopatologia , Fibras Musculares Esqueléticas/fisiologia , Ratos Wistar , Valores de Referência , Traumatismo por Reperfusão/fisiopatologia , Reprodutibilidade dos Testes , Comportamento Sedentário , Natação/fisiologiaRESUMO
INTRODUCTION: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. OBJECTIVE: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). METHODOLOGY: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. RESULTS: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. CONCLUSION: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.
Assuntos
Rim/fisiopatologia , Diálise Renal/efeitos adversos , Insuficiência Renal/sangue , Equilíbrio Hidroeletrolítico/fisiologia , Desequilíbrio Ácido-Base/fisiopatologia , Adulto , Idoso , Bicarbonatos/sangue , Cálcio/sangue , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Rim/química , Rim/metabolismo , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Fosfatos/sangue , Potássio/sangue , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Insuficiência Renal/urina , Sódio/sangue , Aumento de PesoRESUMO
INTRODUCTION: This study aimed to identify the prevalence of urodynamic changes with an associated risk of developing upper urinary tract damage in neuroschistosomiasis patients. METHODS: A prospective study was conducted, wherein68 patients were admitted for analysis of urodynamics, urea and creatinine levels, and uroculture. RESULTS: Blood test results did not indicate kidney failure. There were cases of asymptomatic bacteriuria. Common symptoms were frequent nocturia and detrusor overactivity. Results of low compliance and low cystometric capacity were both statistically significant (p = 0.001 and p = 0.002, respectively). CONCLUSIONS: A high prevalence of negative urodynamic changes were found in neuroschistosomiasis patients.
Assuntos
Neuroesquistossomose/complicações , Insuficiência Renal/etiologia , Bexiga Urinária Hiperativa/etiologia , Urodinâmica/fisiologia , Adulto , Idoso , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/fisiopatologia , Prevalência , Estudos Prospectivos , Insuficiência Renal/fisiopatologia , Fatores de Risco , Ureia/sangue , Bexiga Urinária Hiperativa/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: Advanced glycation end products (AGEs) are elevated in patients with renal failure and may potentially affect skeletal muscle. The aim of this study was to evaluate whether serum concentrations of AGEs are associated with muscle strength in hemodialysis (HD) patients, since this association is not clear in the literature. METHODS: This research has a cross-sectional design and included 96 patients on hemodialysis treatment (20-69 years). Serum AGEs (ELISA), three-day dietary records, anthropometric and bioimpedance variables and handgrip strength (HGS) were analysed. Serum AGEs were analyzed by ELISA test. RESULTS: Men's HGS were significantly higher than women's (p < 0.001). Serum AGEs of the individuals of the highest HGS quartile versus the lowest quartile were 11.27 ± 2.52 and 9.06 ± 2.14 (µg/mL), respectively (p = 0.02). After adjustment for potential confounders, the correlation between serum AGEs and HGS lost statistical significance. The main factors that were associated to muscle strength were aging, BMI, percentage of fat-free mass and serum albumin. CONCLUSION: Contrary to our hypothesis, serum AGEs were not associated with muscular strength in HD patients. These results suggest that serum AGE is not a good indicator of muscle strength in this population and others factors related to the disease may be more important and significant in reducing muscle strength than the serum concentrations of AGEs alone.
Assuntos
Produtos Finais de Glicação Avançada/sangue , Força Muscular/fisiologia , Diálise Renal , Insuficiência Renal/sangue , Adulto , Antropometria , Estudos Transversais , Registros de Dieta , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Adulto JovemRESUMO
PURPOSE: Adjusting the antibiotic dose based on an estimation of the glomerular filtration rate (eGFR) may result in subdosing, which may actually be significantly more problematic for intensive care unit (ICU) patients than not adjusting the dose. The aim of this study was to assess the outcomes of antibiotic dose adjustment in ICU patients with renal impairment. METHODS: A retrospective cohort study was conducted in adult patients admitted to an ICU of a Brazilian hospital from January 2014 to December 2015. The eGFR was determined using Cockcroft-Gault and Modified Diet in Renal Disease equations for each day of hospitalization. Treatment failure was defined based on the clinical, laboratory, and radiological criteria. RESULTS: A total of 126 patients were assessed to meet the inclusion criteria and subsequently enrolled in the study (19.9% of patients admitted to the ICU during the study period). Of the 168 opportunities for dose adjustment, 99 (58.9%) adjustments were made. The mean eGFR in the group with dose adjustment was lower than that in the group without dose adjustment (38.5 vs. 40.7 mL/min/1.73 m2, respectively). The treatment failure rate among patients with dose adjustment and those treated with the usual dose was 59.3 and 38.9%, respectively (p = 0.023), and the mortality rates in the respective groups were 74.1 and 55.5% (p = 0.033). An association between dose adjustment and treatment failure/mortality rates was also observed in the multivariate analysis including the prognostic score. CONCLUSIONS: In ICU patients with renal impairment, adjustments in antibiotic dose based on eGFR, significantly increased the risk of treatment failure and death.