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David-Neto E, Nahas W, Sampaio EC, Ianhez LE, Sabbaga E, Arap S. CSA/AZA, in the absence of prednisone, improves linear growth in renal transplanted children. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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2
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Castro LGM, Neto LA, Sabbaga E, Cucé LC. Cutaneous cryptococcosis in a renal transplant patient: Successful treatment with fluconazole. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639109086778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ribeiro-David DS, David-Net E, Castro MCR, Souza NA, Reis M, Saldanha L, Sabbaga E, Nahas WC, Ianhez IE. Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology. Transpl Int 2008. [DOI: 10.1111/j.1432-2277.1998.tb01112.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marmanillo CG, Pecoits-Filho RF, Romão JE, Kakehashi ET, Sabbaga E, Marcondes M, Abensur H. Reciprocal influences between ambulatorial peritoneal dialysis and pulmonary function. Artif Organs 2001; 25:876-81. [PMID: 11903140 DOI: 10.1046/j.1525-1594.2001.06904.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to verify if dialysis solution volumes used in patients on continuous ambulatory peritoneal dialysis (CAPD) interfere with pulmonary function and if the pulmonary volumes interfere with the lymphatic absorption of the peritoneal cavity. We submitted 10 CAPD patients with a mean age of 48 +/- 18 years and on CAPD for 35 +/- 27 months to the following evaluations: first, measurement of the lymphatic absorption from the peritoneal cavity; second, measurement of the hydrostatic intraperitoneal pressure; and third, expirometry with the peritoneal cavity full of dialysis solution and empty. There were no differences between the expirometry results obtained with the peritoneal cavity full and empty of dialysis solution, and the results were in accordance with the prediction for this population. The values did not correlate with the peritoneal lymphatic absorption of the peritoneal cavity. The cumulative lymphatic absorption of the peritoneal cavity after 4 h dialysis solution permanence was 197 +/- 93 ml, and the hydrostatic intraperitoneal pressure was 13.9 +/- 2.8 column centimeters of water. Neither of these correlated with pulmonary volumes. In conclusion, CAPD did not interfere with the pulmonary function, nor did the pulmonary function influence the lymphatic absorption of the peritoneal cavity of these patients.
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Affiliation(s)
- C G Marmanillo
- Nephrology Division, Hospital das Clínicas, Universidade de São Paulo, Brazil
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Romão JE, Luders C, Kahhale S, Pascoal IJ, Abensur H, Sabbaga E, Zugaib M, Marcondes M. Pregnancy in women on chronic dialysis. A single-center experience with 17 cases. Nephron Clin Pract 2000; 78:416-22. [PMID: 9580542 DOI: 10.1159/000044970] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialytic treatment, and the most adequate dialysis therapy in the management of these pregnant patients has not been established. During the period 1988-1995, we studied the outcome of 17 pregnancies in dialyzed females, with an average age of 28.2 +/- 5.9 years (range: 18-38 years). Seven women had adequate urine volume (>800 ml/24 h). Five patients started dialysis after conception and the remaining 12 pregnancies were diagnosed after 6-72 months on dialysis. Fourteen women were maintained on hemodialysis (HD) and 3 on continuous ambulatory peritoneal dialysis (CAPD). The HD schedule was increased to 3 h 5-6 times weekly, and CAPD was increased to six 2-liter exchanges/day. Mean serum urea was 78.6 +/- 27.4 mg/dl (range 45-110); serum creatinine was 6.5 +/- 3.7 mg/dl (3.3-9.8 mg/dl); and hematocrit was 28.9 +/- 3.3 vol% (22-35 vol%). Anemia was partially controlled with rHuEpo in 8 patients. Significant problems were polyhydramnios in 7 cases (5 HD/2 CAPD), oligohydramnios in 1 (HD), gestational diabetes in 2 (CAPD), premature labor with spontaneous abortion at the 19th, 22nd and 28th weeks of gestation (2 HD/1 CAPD), hypertension in 8 (7 HD/1 CAPD), and sterile eosinophilic peritonitis in 1 case (CAPD). Mean gestational age at delivery in 14 successful pregnancies (12 HD/2 CAPD) was 32.3 +/- 2.6 weeks (27-36 weeks) and mean baby weight was 1,400.7 +/- 579.1 g (range 720-2,650 g). No congenital fetal abnormality was observed. Respiratory distress was observed in 6 infants, with 2 deaths (1 HD/1 CAPD) in the first week after delivery. In this study, successful pregnancies were reported in 70.6% of dialyzed women with uremia, with hemodialysis having a rate of fetal survival of 78.6% and CAPD with 33.3%.
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Affiliation(s)
- J E Romão
- Department of Medicine, Hospital das Clínicas, University of São Paulo Medical School, SP, Brazil
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6
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Abstract
PURPOSE Hyperhomocyst(e)inaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(e)inemia in renal transplant recipients. METHODS Total serum homocysteine (by high performance liquid chromatography), creatinine, lipid profile, folic acid (by radioimmunoassay-RIA) and vitamin B12 (by RIA) concentrations were measured in 3 groups. Group I patients (n=20) were under treatment with cyclosporine, azathioprine, and prednisone; group II (n=9) were under treatment with azathioprine and prednisone; and group III (n=7) were composed of renal graft donors for groups I and II. Creatinine, estimated creatinine clearance, cyclosporine trough level, lipid profile, folic acid, and vitamin B12 concentrations and clinical characteristics of patients were assessed with the aim of ascertaining determinants of hyperhomocyst(e)inemia. RESULTS Patient ages were 48.8 +/- 15.1 yr (group I), 43.3 +/- 11.3 yr (group II); and 46.5 +/- 14.8 yr (group III). Mean serum homocyst(e)ine (tHcy) concentrations were 18.07 +/- 8.29 mmol/l in renal transplant recipients; 16.55 +/- 5.6 mmol/l and 21.44 +/- 12.1 mmol/l respectively for group I (with cyclosporine) and group II (without cyclosporine) (NS). In renal donors, tHcy was significantly lower (9.07 +/- 3.06 mmol/l; group I + group II vs. group III, p<0.008). There was an unadjusted correlation (p<0.10) between age (r=0.427; p<0.005) body weight (r=0.412; p<0.05), serum creatinine (r=0.427; p<0.05), estimated creatinine clearance (r=0.316; p<0.10), and tHcy in renal recipients (group I +II). Independent regressors (r2=0.46) identified in the multiple regression model were age (coefficient= 0.253; p=0.009) and serum creatinine (coefficient=8.07; p=0.045). We found no cases of hyperhomocyst(e)inemia in the control group. In contrast, 38% of renal recipients had hyperhomocyst(e)inemia: 7 cases (35%) on cyclosporine and 4 (45%) without cyclosporine, based on serum normal levels. CONCLUSIONS Renal transplant recipients frequently have hyperhomocyst(e)inemia. Hyperhomocyst(e)inemia in renal transplant patients is independent of the scheme of immunosuppression they are taking. The older the patients are and the higher are their serum creatinine levels, the more susceptible they are to hyperhomocyst(e)inemia following renal transplantation.
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Affiliation(s)
- D J Machado
- Division of Urology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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Mazzucchi E, Lucon AM, Nahas WC, Neto ED, de Castro MC, Saldanha LB, Sabbaga E, Ianhez LE, Arap S. Histologic outcome of acute cellular rejection in kidney transplantation after treatment with methylprednisolone. Transplant Proc 2000; 32:784-5. [PMID: 10856584 DOI: 10.1016/s0041-1345(00)00981-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Mazzucchi
- Renal Transplantation Unit, Division of Urology, Cl¿inicas Hospital, University of Såo Paulo Medical School, Såo Paulo, Brazil
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Aranda RA, Romão Júnior JE, Kakehashi E, Domingos W, Sabbaga E, Marcondes M, Abensur H. Intraperitoneal pressure and hernias in children on peritoneal dialysis. Pediatr Nephrol 2000; 14:22-4. [PMID: 10654324 DOI: 10.1007/s004670050005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abdominal wall hernias have been increasingly recognized in patients on continuous ambulatory peritoneal dialysis (CAPD). They are also more frequent in children than in adults. The aim of this study was to determine the influence of intraperitoneal pressure (IPP) on the development of hernias in children on CAPD, and if there was a difference between IPP in children and adults. We studied 14 children aged 11.2 +/- 3.2 years, body weight 31.1 +/- 9.4 kg, who had undergone CAPD for 16.2 +/- 14.4 months. Also, 10 adults were studied, aged 48 +/- 18 years, body weight 62.4 +/- 13.9 kg, on the CAPD program for 35 +/- 27 months. The IPP was measured via a column of dialysate in the peritoneal dialysis line, immediately before the drainage of the peritoneal cavity. The pressure was measured with the patients in the supine position, at the level of the umbilical cicatrix with the zero point located on the mean axillary line. IPP was measured at inspiration and at expiration, and the mean of these two measurements was calculated. The children were divided in two groups: group 1 (n = 7) without hernias and group 2 (n = 7) with hernias (5 umbilical and 2 inguinal). The IPP of all children was 9.5 +/- 2.9 cm H2O. The IPP was 8.1 +/- 2.6 and 10.9 +/- 2.6 cm H2O in groups 1 and 2, respectively (P = 0.003). The instilled volume for test was similar in both groups. The IPP of the adults was 13.8 +/- 2.8 cm H2O, which was significantly greater than that of the children (P = 0.001). In conclusion, hernia is a common complication in children on CAPD and its prevalence is affected by IPP. Other associated factors may be the presence of anatomically weak sites in the abdominal wall of the children, since IPP is lower in children than in adults.
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Affiliation(s)
- R A Aranda
- Nephrology Service, Universidade de São Paulo, Brazil
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Aranda RA, Pecoits-Filho RF, Romão JE, Kakehashi E, Sabbaga E, Marcondes M, Abensur H. Kt/V in children on CAPD: how much is enough? Perit Dial Int 1999; 19:588-90. [PMID: 10641782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- R A Aranda
- Nephrology Division, Hospital das Clínicas da Universidade de São Paulo, Brazil
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David-Neto E, Americo da Fonseca J, Jota de Paula F, Nahas WC, Sabbaga E, Ianhez LE. The impact of azathioprine on chronic viral hepatitis in renal transplantation: a long-term, single-center, prospective study on azathioprine withdrawal. Transplantation 1999; 68:976-80. [PMID: 10532537 DOI: 10.1097/00007890-199910150-00013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In transplanted patients, viral hepatitis progresses to chronic liver disease and patient's death after many years of transplantation. Also, it is well known that azathioprine (AZA) is harmful to the liver of these patients. However, it is unclear whether a low dose of AZA still represents a threat to the viral liver disease. METHODS A total of 79 patients with hepatitis C, B, or both, transplanted between 1973 and 1990, were grouped according to whether they had AZA either withdrawn from the immunosuppressive regimen [group (G) I, n=45] or a dosage reduction only (group II, n=34). The decision to remove or to keep AZA was restricted to the patient's doctor. Patients records were reviewed by April 1997. RESULTS After an equal time of follow-up, after the AZA changing (64+/-26 vs. 58+/-29 months), patients in GI showed a significant decrease in the serum liver parameters when compared to baseline [alanine aminotransferase (ALT): P=0.001; gamma-glutamyl transferase (gamma-GT): P=0.001 and total bilirubin: P=0.002], whereas in GII only ALT decreased (P=0.04) although gamma-GT and total bilirubin did not. Compared to baseline, serum creatinine (SCr) increased only in GI (P=0.001) but, at last follow-up, did not differ from GII. The intention-to-perform liver biopsies was equal in GI and GII (16 vs. 14) but the hystological findings of severe chronic liver disease (either chronic active hepatitis or cirrhosis) were more frequent in GII (P=0.004). Death with a functioning graft was much more frequent in GII than in GI (P=0.001). Infection and cirrhosis were more common as a cause of death in GII than in GI. CONCLUSIONS The use AZA is harmful to renal transplantation patients with both chronic hepatitis C and B and, therefore, should be avoided. AZA withdrawal, but not dose adjustments, diminishes the serum liver enzymes and the progression rate of the chronic viral liver disease as well as the rate of death secondary to infection and cirrhosis.
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Affiliation(s)
- E David-Neto
- Renal Transplantation Unit, Hospital das Clinicas of the University of São Paulo School of Medicine, Brazil
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Moysés RM, Pereira RC, Machado dos Reis L, Sabbaga E, Jorgetti V. Dynamic tests of parathyroid hormone secretion using hemodialysis and calcium infusion cannot be compared. Kidney Int 1999; 56:659-65. [PMID: 10432406 DOI: 10.1046/j.1523-1755.1999.00593.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Extracellular Ca++ concentration [Ca++] and parathormone (PTH) are related by a sigmoidal function. The set point of the control system is the [Ca++] that produces a half-maximal inhibition of PTH secretion. Whether or not this set point is abnormal in patients with chronic renal failure (CRF) and secondary hyperparathyroidism (SHP) is controversial. METHODS We investigated whether the way [Ca++] is varied [hemodialysis (HD) or calcium gluconate/sodium citrate infusions (INF)] and the way the curve is constructed (four-parameter model or adapted four-parameter, created by Felsenfeld) could influence this set point. We performed dynamic tests of PTH secretion in 12 patients with CRF and SHP during either HD or INF. Both the four-parameter model or adapted four-parameter methods were used, creating four combinations: (a) hypocalcemia and hypercalcemia induced during HD, calculated by Brown's formula (HDB); (b) hypocalcemia and hypercalcemia induced during HD, calculated by Felsenfeld's formula (HDF); (c) hypocalcemia and hypercalcemia induced during infusion, calculated by Brown's formula (INFB); and (d) hypocalcemia and hypercalcemia induced during infusion, calculated by Felsenfeld's formula (INFF). RESULTS The set points obtained with HDB correlated perfectly with those obtained with HDF (R2 = 0.999). A similar relationship was found between INFB and INFF (R2 = 0.9997). In contrast, there was no correlation between either HDB and INFB (R2 = 0.0157) or HDF and INFF (R2 = 0.0204). CONCLUSIONS These findings indicate that the calculated [Ca++] set point in patients with CRF and SHP is determined by the way [Ca++] is varied, rather than by the mathematical model used to generate the curves. Further studies are needed to determine the differing physiological mechanisms triggered by HD and INF and the way they influence [Ca++] homeostasis in this setting.
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Affiliation(s)
- R M Moysés
- Nephrology Division, University of São Paulo Medical School, Brazil
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Romão JE, Abensur H, de Castro MC, Ianhez LE, Massola VC, Sabbaga E. Effect of dialyser biocompatibility on recovery from acute renal failure after cadaver renal transplantation. Nephrol Dial Transplant 1999; 14:709-12. [PMID: 10193824 DOI: 10.1093/ndt/14.3.709] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It has been reported that patients with acute renal failure (ARF) requiring haemodialysis show an improved recovery of renal function when the dialysis treatment is performed using a biocompatible membrane rather than a bioincompatible membrane. However, most recent published human trials have not been able to confirm these findings. METHOD Over a 2-year period, we prospectively studied 53 patients with ARF after cadaver renal transplantation who required haemodialysis and randomized them into two treatment groups. One group underwent dialysis with a cuprophane membrane and the other group underwent haemodialysis with a more biocompatible membrane, polysulfone. All patients received an immunosuppressive regimen which included azathioprine, prednisone and cyclosporine. RESULTS There was no difference by patient characteristics or immunosuppressive regimen before acute tubular necrosis (ATN) recovery. In both groups the number of haemodialysis sessions required prior to the recovery of renal function (6.57+/-2.79 vs 6.05+/-2.40), the number of oliguric days (16.25+/-5.14 vs 14.40+/-4.67) and the number of hospital days (33.38+/-12.85 vs 30.10+/-11.00), were not statistically different. There was also no difference in long-term allograft outcome. CONCLUSION Our data demonstrate that the use of a more biocompatible membrane had no influence on the recovery from acute renal failure after renal transplantation.
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Affiliation(s)
- J E Romão
- Division of Nephrology, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil
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Mazzucchi E, Lucon AM, Nahas WC, Neto ED, Saldanha LB, Sabbaga E, Ianhez LE, Arap S. Histological outcome of acute cellular rejection in kidney transplantation after treatment with methylprednisolone. Transplantation 1999; 67:430-4. [PMID: 10030291 DOI: 10.1097/00007890-199902150-00016] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies comparing the response of acute cellular rejection (ACR) episodes to different corticosteroid regimens have been conducted. However, in most of them, the histological evaluation of the infiltrate and its correlation with clinical response was not studied. The clinical and histological outcomes of 37 episodes of ACR treated with methylprednisolone (MP) were studied, with the aim to determine how long the infiltrate takes to be cleared after therapy. METHODS A total of 37 patients with biopsy-proven ACR were treated with 8 or 16 mg of MP/kg/day. Allograft biopsies were repeated at 5 and 10 days after the end of corticotherapy. Clinical and histological outcomes were compared. RESULTS Six patients were excluded; 15 (48.4%) patients responded to therapy; the mean serum creatinine of these patients reached normal levels in the 2 weeks that followed treatment. Nine patients (60%) of this group had signs of ACR on biopsies done 5 days after corticotherapy, and four (26.7%) maintained them on the 10th day. Among 16 patients with no clinical response, none reached normal serum creatinine levels; 15 (93.7%) had signs of rejection 5 days after treatment and maintained them on the 10th day. Histological signs of ACR disappeared in 73.3% of patients with clinical response 10 days after therapy, but in only 6.3% of patients with no response (P=0.001). CONCLUSIONS Biopsies performed 5 days after treatment show a high incidence of features of ACR; such features take on average 10 days to disappear in nearly 75% of cases with successful therapy with MP.
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Affiliation(s)
- E Mazzucchi
- Division of Urology, Clínicas Hospital, University of São Paulo Medical School, Brazil
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14
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David-Neto E, da Fonseca JA, de Paula FJ, Nahas WC, Sabbaga E, Ianhez LE. Is azathioprine harmful to chronic viral hepatitis in renal transplantation? A long-term study on azathioprine withdrawal. Transplant Proc 1999; 31:1149-50. [PMID: 10083514 DOI: 10.1016/s0041-1345(98)01941-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E David-Neto
- Renal Transplantation Unit, Hospital das Clínicas of the University of São Paulo, School of Medicine, Brazil
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15
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Azevedo LS, Romão JE, Malheiros D, Saldanha LB, Ianhez LE, Sabbaga E. Renal transplantation in systemic lupus erythematosus. A case control study of 45 patients. Nephrol Dial Transplant 1998; 13:2894-8. [PMID: 9829497 DOI: 10.1093/ndt/13.11.2894] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Outcome and the issue of recurrence of disease in systemic lupus erythematosus (SLE) renal transplant recipients is still a matter of controversy. There is a lack of comparative studies with non-SLE patients. The aim of this paper is to compare renal transplantation in lupus patients with a similar matched non-SLE group. METHODS Forty-five patients with systemic lupus erythematosus subjected to 48 kidney transplants were studied. For comparative purposes, a case-control population was selected, matched for gender, race, type of donor, age, and time of transplantation. Patients with non-glomerulonephritis diseases were excluded. RESULTS No differences in acute episodes of rejection, causes of kidney loss or patient death were observed. General as well as infectious complications were similar. Pregnancy rates and outcomes were similar with no deleterious effect on patients or grafts. Actuarial 1- and 5-year patient survivals (97.7 and 91.1% for SLE and 95.4 and 87% for controls, respectively) and graft survivals (93.1 and 80.7% for SLE and 88.8 and 70.2% for controls, respectively) were similar. Long-term renal function expressed by serum creatinine was the same. No differences in immunosuppressive drug (azathioprine, prednisone, and cyclosporin) requirements were found. Clinical SLE recurrence was suspected only once (a patient with thrombocytopenia, hypocomplementaemia with low complement levels and positive antiplatelet antibodies). Two SLE patients showed mesangial proliferative glomerulonephritis compatible with recurrence. Both grafts were lost. Two further patients showed membranous glomerulonephritis with an immunofluorescence pattern compatible with recurrence. A fifth patient had necrotizing arteritis which recovered after treatment with cyclophosphamide and another patient showed focal and segmental glomerulosclerosis. Histology of biopsies from five patients in the control group showed signs compatible with recurrence of focal and segmental glomerulosclerosis and membranous glomerulonephritis. There was a wide variation in serum levels of antinuclear antibodies. A wide variation in complement levels was also observed, but with a tendency towards low C4 levels. CONCLUSIONS The safety of renal transplantation in SLE patients is equivalent to a matched case-control group with a similar rate of recurrence of disease.
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Affiliation(s)
- L S Azevedo
- Renal Transplantation Unit, University of São Paulo Medical School, SP, Brazil
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Abstract
To investigate the mechanism of diabetogenic action of cyclosporin A (CsA), 7 male Wistar albino rats received 10 mg/kg/day of the drug for 4 weeks (CsA). The results were compared with controls (C); blood CsA levels measured weekly remained stable throughout the experiment (mean +/- SEM) (X = 2657.9+/-155.1 ng/ml). Intravenous glucose load (0.75 g/kg) performed after 2 weeks of CsA therapy showed glucose intolerance in treated animals as evaluated by the glucose area under the curve (CsA = 409.2+/-17.8 vs. C = 313.3+/-12.6 umol x ml(-1) x min(-1)) (p < 0.05) with insulin levels being similar in the two groups (CsA = 8603.9+/-1645.5 vs. C = 9571.9+/-828.5 pmol x ml(-1) x min(-1)). After 4 weeks of CsA administration, glucose intolerance was maintained (CsA = 398.6+/-35.6 vs. C = 301.7+/-23.0 umol x ml(-1) x min(-1)) (p < 0.05) associated with a significant decrease in insulin secretion (CsA = 4404.9+/-2392.0 vs. C = 10075.9+/-2861.0 pmol x ml(-1) x min(-1) (p < 0.05). These results suggest that CsA induced a state of insulin resistance preceding the failure of insulin secretion. After 4 weeks, the pancreatic insulin content was also decreased (CsA = 0.7+/-0.1 vs. C = 1.4+/-0.5 mU/mg) (p < 0.05). Maximal insulin binding to isolated adipocytes was not affected by CsA (CsA = 7.4+/-2.6 vs. C = 6.4+/-2.0%), although glucose transport and oxidation decreased after CsA treatment (p < 0.05). In conclusion, glucose intolerance induced by CsA in Wistar albino rats is due to decreased insulin production and impaired insulin action by a post-binding mechanism.
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Affiliation(s)
- L A Menegazzo
- Laboratory of Medical Investigation (LIM 18), University of São Paulo Medical School, SP, Brazil
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17
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Ribeiro-David DS, David-Neto E, Castro MC, Souza NA, Reis MM, Saldanha LB, Sabbaga E, Nahas WC, Ianhez IE. Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology. Transpl Int 1998; 11 Suppl 1:S19-25. [PMID: 9664936 DOI: 10.1007/s001470050418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acute rejection is associated with a poor long-term prognosis for renal allografts. Sequential fine-needle aspiration cytology (FNAC) has been used to monitor rejection. However, FNAC diagnoses rejection only when the infiltrating cells are already damaging the graft and, in some borderline cases with a low increment of inflammatory cells in the graft, FNAC lacks the specificity to diagnose rejection. In these cases, the number of inflammatory cells within the graft can decline, stabilize or increase with time. In this study, we sought to determine whether the analysis of the expression of ICAM-I, HLA-DR and IL-2R along with borderline FNAC results increases the specificity to diagnose rejection. Of 117 FNAC samples taken from 24 patients after renal transplantation, 85 (72%) were considered suitable for cytological analysis. Of these patients, 9 (37%) did not suffer an acute cellular rejection (ACR) episode and 15 (63%) had at least one ACR episode. ICAM-1 and IL-2R were studied using an immune-peroxidase technique. The ICAM-1 results are expressed as the percentage of tubular cells in the aspirate stained with this marker and the IL-2R results are expressed as the absolute number of positively stained lymphocytes in the whole cytopreparation. With a total corrected increment (TCI) of > 3 there was a sharp increase in the specificity index for rejection that reached almost 100% at a TCI of > or = 4. Sensitivity for rejection at this level was only 20%. Between a TCI of 2.5 and 2.9 the sensitivity increased to 75%, with specificity for rejection around 75%. There was an upregulation of ICAM-1 and IL-2R when FNAC diagnosed rejection but with a large overlap of the results when compared either to normal graft or acute tubular neurosis. The mean TCI during the week preceding the rejection episode was 2.5 and the TCI reached a mean value of > or = 3 only during rejection. The peak ICAM-1 and IL-2R expression occurred during the week preceding the clinically evident rejection episode. The expression of ICAM-1 by > or = 70% of the tubular cells increased the specificity for rejection of a TCI of > or = 2.5 to 100%. In the same way, the specificity for rejection increased up to 90% when eight to ten IL-2R-positive lymphocytes were seen along with a TCI of > or = 2.5. There was no further increase in specificity after that. A specificity index of 100% for rejection could be obtained for moderate levels of both ICAM-1 (70% or more tubular cells) and IL-2R (eight or more lymphocytes). ICAM-1 expression in 70% or more tubular cells and/or IL-2R expression in eight or more lymphocytes was found in 58% of the FNAC aspirates with a TCI between 2.5 and 2.9. In conclusion, the expression of IL-2R in lymphoid cells and ICAM-1 in tubular cells was upregulated during rejection episodes and the upregulation preceded both the clinical and the routine FNAC diagnosis of rejection by 1 week. The ddition of these markers to the FNAC increased substantially the specificity of the FNAC to diagnose rejection.
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Affiliation(s)
- D S Ribeiro-David
- Renal Transplantation Unit, University of São Paulo Medical School, Brazil
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18
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Castro MC, David DS, Saldanha LB, Sabbaga E, Arap S, Ianhez LE. Acute vascular rejection: a clinical and morphological study. Transpl Int 1998; 11 Suppl 1:S15-8. [PMID: 9664935 DOI: 10.1007/s001470050417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We analyzed one special type of acute vascular rejection (AVR), defined as fibrous thickening of the arterial intimal layer that leads to early renal failure. Twenty-one patients who presented this histological pattern were studied among 339 transplanted over 4 years. Patients were separated into two groups. Thirteen patients have restained their kidneys (Group A, 61.9%) and 8 have lost their grafts (Group B, 38%). Diagnosis was made on average 430. POD in GA and at 49 degrees POD in GB on the 43rd postoperative day in group A and on the 49th postoperative day in group B (NS). In group A, mean serum creatinine is 2.2 mg/dl and follow-up time is 29 months. Oliguria was much more frequent in group B (75% versus 15.3%, P = 0.01). These patients were submitted to 91 renal biopsies always because of non-function. Typical vascular lesions began at arcuate arteries and progressed, as seen in sequential biopsies, to interlobular arteries and arterioles. When only arcuate arteries were affected, 22.5% of renal losses were seen, but when arcuate plus interlobular arteries were compromised, 72.2% of patients lost their kidneys (P = 0.006). We did not identify any difference in immunofluorescent staining from biopsies with or without vascular rejection, or between groups A and B. We concluded that about 2.3% of our patients lost their kidneys because of this kind of AVR, diagnosed near the 43rd postoperative day. The only clinical predictive sign of poor reversibility was oliguria. The attack on arcuate plus interlobular arteries meant a poor prognosis. Immunofluorescent staining did not have a prognostic value.
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Affiliation(s)
- M C Castro
- Renal Transplantation Unit, São Paulo University, Brazil
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de Castro MC, Saldanha LB, Nahas W, David DS, Arap S, David-Neto E, Sabbaga E, Ianhez LE. Post-transplant neutrophilic interstitial nephritis--an important cause of graft dysfunction. Transpl Int 1998; 11 Suppl 1:S144-6. [PMID: 9664965 DOI: 10.1007/s001470050447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Post-transplant neutrophilic interstitial nephritis (NIN) is characterized by an interstitial infiltrate consisting of polymorphonuclear cells that leads frequently to acute graft dysfunction. In 220 graft biopsies performed because of renal dysfunction over 2 years in our unit, 11 (5%) diagnoses of NIN were made. Only two patients had chronic pyelonephritis as original disease. Four patients had urological problems before transplantation. After transplantation, five patients had urinary tract infection, one had urethral stenosis, two had vesicourethral reflux and one patient had a perinephritic abscess. Seven patients had fever (63%). Only in six patients did urine culture lead to microorganism isolation. After 6 months, only two patients had a serum creatinine level < 1.4 mg/dl, five patients had abnormal function, three had lost their grafts, and one patient had died with sepsis. We conclude that 5% of the biopsies performed in our center disclosed NIN, an entity that causes graft dysfunction and progresses frequently to chronic renal failure. In some cases, no infectious etiology could be detected.
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Affiliation(s)
- M C de Castro
- Renal Transplantation Unit, São Paulo University, Brazil
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20
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Abstract
CONTEXT Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN Prospective, cohort study. SETTING Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS The diastolic blood pressure was lower in summer than in fall and winter (95 +/- 8 vs 107 +/- 10 and 101 +/- 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 +/- 8 vs 130 +/- 11 and 124 +/- 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 +/- 1.6 vs 19.5 +/- 3.0 and 15.8 +/- 1.9 degrees C, respectively; p < 0.01). CONCLUSIONS We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.
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Affiliation(s)
- M C de Castro
- Nephrology Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Castro MD, Chocair P, Saldanha L, Nahas W, Arap S, Sabbaga E, Ianhez L. Comparação entre diagnósticos clínicos e histológicos no pós-transplante renal. Rev Assoc Med Bras (1992) 1998. [DOI: 10.1590/s0104-42301998000200017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
There are doubts about the presence of glycosuria and the progress of glomerular disease. Some reports suggest that glycosuria could be an index of a more severe tubulointerstitial lesion. We investigated the presence of glycosuria in 60 patients with primary glomerular diseases: 17 patients (28%) had glycosuria and 43 patients (72%) were glycosuria free. The two groups were similar in age, arterial pressure and sex. Serum creatinine was higher in patients with glycosuria (2.0 +/- 1.7 vs 1.3 +/- 0.9 mg/dl, P < 0.05). The protein excretion rate was 7.5 +/- 3.7 vs 5.3 +/- 4.2 g/day (P > 0.05) in patients with and without glycosuria, respectively, while serum albumin was lower in patients with glycosuria (1.7 +/- 0.6 vs 2.7 +/- 1.0 g/dl, P < 0.05). Several histological forms were present in the group with glycosuria, with membraneous glomerulonephritis being the most frequent. Histological evidence of tubular atrophy and interstitial fibrosis prevailed in patients with glycosuria, suggesting a poor prognosis for these patients. We may conclude that the presence of glycosuria in patients with glomerular disease is associated with more pronounced tubular atrophy and interstitial fibrosis and therefore imply a poorer prognosis.
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Affiliation(s)
- V Woronik
- Departamento de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brasil
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24
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Abstract
OBJECTIVE The aim of the present study was to analyze the long-term evolution of patients submitted to endolymphatic irradiation as a pre-transplant preparation. SETTING Referral center of university hospital. DESIGN Case-control study. MAIN OUTCOMES MEASURES The study was designed to evaluate the incidence of rejection, kidney loss, leukopenia, infection, and graft survival in the group treated (group 1) prior to surgery, compared to a control group (group 2) composed of patients under identical clinical conditions (sex, age, type of donor, immunosuppressive therapy and time of transplant) that did not undergo treatment preparation. PATIENTS Patients were selected from amongst transplantation candidates on a long-term waiting list, some with a high level of antibodies against panel. The control group was chosen from amongst recently transplanted patients. Patients in the treated group received lipoiodine containing 131I with specific activity ranging between 4 and 6 mCu/ml. RESULTS A significant difference between the two groups was found with regard to the incidence of rejection crises (21.0% in group 1 and 73.6% in group 2; P = 0.003), and the maintenance dose of azathioprine (smaller in group 1; P < 0.01). As to kidney graft loss due to rejection, a tendency to significance could be identified (10.5% in group 1 and 42.1% in group 2; P = 0.063); however, the difference was not significant between the two groups in terms of reversibility of rejection episodes during the first 60 post-transplant days. CONCLUSIONS The authors concluded that this method, besides being relatively innocuous (there was no compromising of either the thyroid gland or of gonad function and there was no increase in tumor incidence), has an extended immunosuppressive effect, and can be indicated for cadaveric renal allograft recipients, especially those showing high panel reactivity.
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Affiliation(s)
- M M Galvão
- Renal Transplant Unit, Hospital das Clínicas, Universidade de São Paulo, Brazil
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de Castro MC, Chocair PR, Saldanha LB, Nahas W, Arap S, Sabbaga E, Ianhez LE. [Comparison of clinical and histological diagnosis in kidney post-transplantation period]. Rev Assoc Med Bras (1992) 1998; 44:155-8. [PMID: 9699337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the agreement between clinical and histopathological diagnosis in a renal transplantation center, 40 episodes of acute renal failure were studied. METHODS Kidney biopsies were performed at the moment that a clinical diagnosis was made by the staff. RESULTS Nineteen episodes of acute tubular necrosis (ATN), eighteen episodes of acute cellular rejection (ACR), 2 humoral rejections and 1 acute cyclosporin nephrotoxicity episodes were diagnosed. ATN episodes were confirmed by renal biopsy in 84.21%, ACR episodes in 83.33%, humoral rejections in 100%. Renal biopsy showed ATN in the occurrence of clinical cyclosporin nephrotoxicity. Total agreement was 82.5%. CONCLUSION There is a good relationship between clinical and histopathological diagnosis in the post-transplantation period. Diagnostic mistakes occurred mainly when oliguria was present.
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Affiliation(s)
- M C de Castro
- Unidade de Transplante Renal, Faculdade de Medicina, Universidade de São Paulo
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26
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Abstract
A 13-year-old Brazilian boy with Kimura's disease (eosinophylic lymphoid granuloma) and nephrotic syndrome is reported. Native kidney biopsy showed focal segmental glomerulosclerosis (FSGS). Treatment with prednisolone resulted in partial remission of proteinuria, and he had a progressive loss in renal function, requiring initiation of chronic dialysis, which he underwent for 46 months. After kidney transplantation, the patient developed proteinuria. A renal biopsy showed recurrence of focal segmental glomerulosclerosis, and subsequently he developed renal insufficiency.
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Affiliation(s)
- J E Romão
- Renal Transplantation Unit, Urology Division, Hospital das Cl¿nicas, University of S¿o Paulo Medical School, São Paulo, Brazil.
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27
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Galvão MM, Sotto MN, Kihara SM, Rivitti EA, Sabbaga E. Lymphocyte subsets and Langerhans cells in sun-protected and sun-exposed skin of immunosuppressed renal allograft recipients. J Am Acad Dermatol 1998; 38:38-44. [PMID: 9448203 DOI: 10.1016/s0190-9622(98)70536-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients who have received renal allografts experience early aging of the skin, opportunistic infections, and an increased incidence of skin cancer. OBJECTIVE We compared the density of lymphocyte subsets and Langerhans cells in normal-appearing skin of renal allograft recipients without skin cancer at 5 to 6 years (group 1) and 14 years after transplant (group 2) with a matched normal control group. METHODS Biopsy specimens of sun-protected and exposed areas from 18 white, kidney allograft recipients (10 in group 1 and 8 in group 2) with normal renal function and from 10 healthy volunteers were semiquantitatively analyzed for dermal lymphocyte subsets and Langerhans cells. RESULTS There was a statistically significant decrease in all dermal cell elements in the sun-protected skin of both groups of patients who had received grafts. The sun-exposed skin of group 2 also showed a significant decrease of dermal CD4+ and CD8+ lymphocytes, and group 1 had a significant decrease in dermal CD8+ lymphocytes. The dermal CD1a+ cell population in the sun-exposed skin from both grafted groups did not differ from the control group. CONCLUSION Kidney transplant recipients showed dermal depletion of cells related to immune surveillance against tumors even before skin cancer occurred, and this depletion seemed to become more marked with the duration of immunosuppression.
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Affiliation(s)
- M M Galvão
- Kidney Transplant Unit, University of São Paulo School of Medicine, Brazil
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28
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Carvalhal GF, Machado MG, Pompeo A, Saldanha L, Sabbaga E, Arap S. Mucormycosis presenting as a renal mass in a patient with the human immunodeficiency virus. J Urol 1997; 158:2230-1. [PMID: 9366353 DOI: 10.1016/s0022-5347(01)68208-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G F Carvalhal
- Department of Urology, Hospital das Clínicas de São Paulo, Brazil
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29
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Caballero OL, Menezes CL, Costa MC, Fernandes SC, Anacleto TM, de Oliveira RM, Viotti EA, Távora ER, Vilaça SS, Sabbaga E, de Paula FJ, Távora PF, Villa LL, Simpson AJ. Highly sensitive single-step PCR protocol for diagnosis and monitoring of human cytomegalovirus infection in renal transplant recipients. J Clin Microbiol 1997; 35:3192-7. [PMID: 9399518 PMCID: PMC230146 DOI: 10.1128/jcm.35.12.3192-3197.1997] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A multiplex, single-step PCR protocol for the detection of human cytomegalovirus (HCMV) DNA is described. The protocol amplifies regions of the viral LA and IE genes and employs elevated temperatures for both reagent mixing and primer annealing together with product detection by silver staining on polyacrylamide gels. This assay detects one to five HCMV genomes in clinical samples containing up to 100 ng of human DNA, a level of sensitivity equivalent to that of more complex assays involving either nested PCR or postamplification hybridization. As well as being of importance in clinical situations where high-sensitivity qualitative diagnosis is required, this assay is also applicable to the monitoring of HCMV infection in renal transplant recipients. Due to its multiplex format the assay provides quantitative information, in that samples from which a single target is amplified contain on average sevenfold fewer viral genomes per 10(6) leukocytes than those from which both targets are amplified. When weekly blood leukocyte DNA preparations from renal transplant patients were assayed, findings of three consecutive tests in which both HCMV targets were amplified were highly indicative of patients who had developed very high loads of HCMV (100% sensitivity, 88% specificity). We thus show that the same simple PCR assay which permits highly sensitive HCMV diagnosis can also be used for the efficient identification of transplant recipients at risk of clinically significant infection.
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Affiliation(s)
- O L Caballero
- Ludwig Institute for Cancer Research, Departamento de Bioquímica, Instituto de Química, USP, São Paulo, Brazil
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30
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Daher EF, Abdulkader RC, Motti E, Marcondes M, Sabbaga E, Burdmann EA. Prospective study of tetanus-induced acute renal dysfunction: role of adrenergic overactivity. Am J Trop Med Hyg 1997; 57:610-4. [PMID: 9392604 DOI: 10.4269/ajtmh.1997.57.610] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To assess the mechanisms related to tetanus-induced acute renal failure (ARF), 30 patients with tetanus had their renal function prospectively studied and factors possibly related to renal changes were evaluated during four weeks of hospitalization. Fifty percent of these patients had a glomerular filtration rate (GFR) < or = 50 ml/min in the first or second week of hospitalization (Group I) and 50% had a GFR > 50 ml/min throughout the entire hospitalization period (Group II). Age, gender, tetanus incubation time and tetanus onset time, hospitalization time, use of nephrotoxic drugs, need for mechanical ventilation with intermittent positive pressure, and presence of systemic infection were similar in both groups. None of the patients presented with oliguria. Autonomic nervous system (ANS) overactivity, characterized by intense variations in systolic and diastolic blood pressure, by increased heart rate and elevated urinary metanephrine excretion, was higher in Group I compared with Group II. Plasma renin activity, serum creatinephosphokinase levels, and myoglobinuria were not significantly different between the two groups. These results strongly suggest that tetanus-induced ARF has a high prevalence, is characterized by early onset, and is probably related to ANS overactivity.
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Affiliation(s)
- E F Daher
- Department of Medicine, University of São Paulo Medical School, Brazil
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31
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Galvão MM, Peixinho ZF, Mendes NF, Sabbaga E. Stored blood--an effective immunosuppressive method for transplantation of kidneys from unrelated donors. An 11-year follow-up. Braz J Med Biol Res 1997; 30:727-34. [PMID: 9292109 DOI: 10.1590/s0100-879x1997000600005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Thirty-seven patients were submitted to kidney transplantation after transfusion at 2-week intervals with 4-week stored blood from their potential donors. All patients and donors were typed for HLA-A-B and DR antigens. The patients were also tested for cytotoxic antibodies against donor antigens before each transfusion. The percentage of panel reactive antibodies (PRA) was determined against a selected panel of 30 cell donors before and after the transfusions. The patients were immunosuppressed with azathioprine and prednisone. Rejection crises were treated with methylprednisolone. The control group consisted of 23 patients who received grafts from an unrelated donor but who did not receive donor-specific pretransplant blood transfusion. The incidence and reversibility of rejection episodes, allograft loss caused by rejection, and patient and graft survival rates were determined for both groups. Non-parametric methods (chi-square and Fisher tests) were used for statistical analysis, with the level of significance set at P < 0.05. The incidence and reversibility of rejection crises during the first 60 post-transplant days did not differ significantly between groups. The actuarial graft and patient survival rates at five years were 56% and 77%, respectively, for the treated group and 39.8% and 57.5% for the control group. Graft loss due to rejection was significantly higher in the untreated group (P = 0.0026) which also required more intense immunosuppression (P = 0.0001). We conclude that transfusions using stored blood have the immunosuppressive effect of fresh blood transfusions without the risk of provoking a widespread formation of antibodies. In addition, this method permits a reduction of the immunosuppressive drugs during the process without impairing the adequate functioning of the renal graft.
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Affiliation(s)
- M M Galvão
- Unidade de Transplante Renal, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brasil
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32
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Abstract
Dextran 40 is largely used in clinical medicine as a plasma substitute because of its beneficial effects on the microcirculation and antithrombogenic properties. An unusual adverse reaction of dextran administration is oligoanuric acute renal failure. We report two cases of anuric ARF induced by dextran 40. Diuresis and renal function were quickly resumed after plasma-pheresis treatment. Renal biopsy revealed normal kidneys except for swelling and vacuolation of renal tubules suggestive of osmotic nephrosis.
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Affiliation(s)
- R Ferraboli
- Department of Medicine, Hospital das Clínicas, University of São Paulo Medical School, Brazil
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Teixeira MC, Mazucchi E, Nahas WC, Ianhez LE, Machado MM, Arap S, Sabbaga E, David-Neto E. Peripheral renin activity predicts blood pressure control after bilateral nephrectomy in renal transplant patients. Transplant Proc 1997; 29:220-1. [PMID: 9122969 DOI: 10.1016/s0041-1345(96)00068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M C Teixeira
- Renal Transplantation Unit, Hospital das Clinicas, University of São Paulo, Brazil
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David-Neto E, Abdallah KA, Bassit L, Pereira AN, Alquezar AS, Fonseca JA, Ianhez LE, Sabbaga E. Anti-HCV antibody is sensitive but not sufficient to detect HCV active infection in renal transplanted patients: the role of PCR for HCV-RNA. Transplant Proc 1997; 29:781-2. [PMID: 9123523 DOI: 10.1016/s0041-1345(96)00099-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E David-Neto
- Division of Urology, Hospital das Clínicas, University of São Paulo, Brazil
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35
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Nahas WC, Mazzucchi E, Antonopoulos I, David-Neto E, Ianhez LE, Sabbaga E, Arap S. Kidney transplantation in patients with bladder augmentation: surgical outcome and urodynamic follow-up. Transplant Proc 1997; 29:157-8. [PMID: 9122941 DOI: 10.1016/s0041-1345(96)00047-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- W C Nahas
- Unidade de Transplante Renal, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil
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Româo JE, Fadil MA, Sabbaga E, Marcondes M. Haemodialysis without anticoagulant: haemostasis parameters, fibrinogen kinetic, and dialysis efficiency. Nephrol Dial Transplant 1997; 12:106-10. [PMID: 9027783 DOI: 10.1093/ndt/12.1.106] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Haemodialysis without anticoagulant is an alternative to systemic anticoagulation of patients at high risk of bleeding. However, reports have suggested that heparin-free haemodialysis might results in blood defibrination, and fibrin deposition in dialytic membrane with possible reduction in dialyser efficiency. METHODS Haemostasis parameters, fibrin-fibrinogen kinetic assessed by 125I-fibrinogen (125I-F) turnover and 125I-fibrinogen deposition within the dialyser membranes, and dialytic efficiency were studied in 10 stable chronic uraemic patients. Each patient was dialysed on two consecutive 4-h dialyses, once with each of two dialysis strategies: haemodialysis without anticoagulant and conventional haemodialysis using heparin as anticoagulant. RESULTS No significant changes were seen in mean platelet count, plasma fibrinogen, prothrombin time, and antithrombin III during haemodialysis without anticoagulation, and these parameters were not different from those in patients who underwent conventional haemodialysis. Compared with the predialysis values, a shortening of the mean aPTT from an initial mean value was noted (P < 0.05) in haemodialysis without anticoagulation at 60, 120 and 240 min. Fibrin-fibrinogen degradation products remained unchanged during conventional haemodialysis, but were increased after the 30th minute of haemodialysis without anticoagulation (P < 0.05), although all values were in normal range. The biological half-life of 125I-F in uraemic patients before the haemodialysis was 5.02 +/- 0.43 days (control). There was a significant fall in 125I-F half-life during haemodialysis without anticoagulation (2.56 +/- 0.58 days; P < 0.01) but not during conventional haemodialysis (4.77 +/- 0.97, NS). After use each dialyser was dismantled and 125I-F deposition within the membranes (M#5, M#12 and M#19) was measured. During haemodialysis without anticoagulation mean fibrin deposition in M# (28.74 +/- 10.50 x 10(3) counts), M#12 (26.42 +/- 9.06 x 10(3) counts), and M#19 (21.97 +/- 8.33 x 10(3) counts) was greater (P < 0.001) than that during conventional haemodialysis (1.70 +/- 0.92 x 10(3), 1.33 +/- 0.65 x 10(3), and 1.59 +/- 1.03 x 10(3) counts respectively). However, this greater deposition of fibrin on membranes during haemodialysis without anticoagulation did not change dialyser efficiency as assessed (haemodialysis without anticoagulation vs conventional haemodialysis) by change in serum urea (-53.96 +/- 3.38% vs -51.96 +/- 5.20%, NS), serum creatinine (-48.65 +/- 5.99% vs -49.59 +/- 6.65%, NS), serum potassium (-30.06 +/- 4.46% vs -27.64 +/- 2.81%, NS), serum bicarbonate (+25.91 +/- 1.39% vs +24.89 +/- 2.59%, NS) and haematocrit (+3.20 +/- 3.99% vs 2.15 +/- 2.01%, NS). The mean Kt/V was similar for conventional haemodialysis (0.870 +/- 0.074) and haemodialysis without anticoagulation (0.873 +/- 0.107). CONCLUSION In conclusion, although conventional haemostasis parameters remained unchanged during haemodialysis without anticoagulation, some degree of activation of coagulation system occurs, haemodialysis without anticoagulation was associated with greater decline in 125I-F half-life and greater fibrin deposition on dialyser membranes, but with no change in dialyser efficiency.
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Affiliation(s)
- J E Româo
- Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil
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37
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Albers M, De Luccia N, Nahas W, Sabbaga E, Arap S. Reducing cross-clamping duration in aortoiliac reconstruction after renal transplantation. A case report. Angiology 1996; 47:1181-5. [PMID: 8956672 DOI: 10.1177/000331979604701210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A fifty-two-year-old male renal transplant patient underwent aortoiliac reconstruction with a bifurcated prosthesis for treatment of hypertension and deteriorating allograft function. A modified technique was used that reduced aortic cross-clamping time to twelve minutes. This simple technique is applicable to most patients, reduces warm ischemia to a minimum, and saves time for a careful aortoiliac reconstruction.
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Affiliation(s)
- M Albers
- Department of Surgery, Hospital Das Clínicas, University of São Paulo Medical School, Brazil
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38
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Tzanno-Martins C, Azevedo LS, Tanji M, Tanji MC, Sabbaga E, Marcondes M, Duarte AJ. The role of experimental aluminum intoxication in allogeneic immunoresponse. Transpl Int 1995; 8:396-8. [PMID: 7576023 DOI: 10.1007/bf00337173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To evaluate the immunological properties of aluminum (Al) in experimental Al intoxication in rats, we performed heart transplantation and in vitro experiments. Lewis (Lew) rats were intoxicated with intraperitoneal injections of AlCl3. heart transplants were performed using Brown-Norway (BN) rats as donors. Isotransplants and normal Lew were used as controls. No differences in survival were observed. Unidirectional mixed lymphocyte cultures (MLC) and Concanavalin A (Con A)-stimulated cultures were prepared using spleen cells from normal and Al-intoxicated Lew rats. No differences were found in unidirectional MLC. Intoxicated cells showed a less intense response to con A than did normal cells. In conclusion, we could not detect an immunosuppressive role of Al intoxication in experimental cardiac transplantation or in MLC. However, the depressed Con A blastogenic response of Al-intoxicated cells may reflect an immunological role yet to be defined.
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Affiliation(s)
- C Tzanno-Martins
- Laboratory of Immunogenetics and Experimental Transplantation, University of São Paulo Medical School, Brazil
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39
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Levin AS, Gobara S, Scarpitta CM, Warschauer CL, Sinto SI, Rodrigues E, Mendes CM, Sabbaga E, Boulos M. Electric showers as a control measure for Legionella spp. in a renal transplant unit in São Paulo, Brazil. Legionellosis Study Team. J Hosp Infect 1995; 30:133-7. [PMID: 7673686 DOI: 10.1016/0195-6701(95)90153-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
After an outbreak of legionnaires' disease Legionella pneumophila serogroup 1 in a renal transplant unit in São Paulo, Brazil, periodic hyperchlorination and flushing of pipes were instituted as control measures. These were only partially effective as every two to five months water cultures turned positive or new cases of the disease occurred. In November 1993 the hot water was disconnected from the unit and small, plastic electric showers were installed in each bathroom. Over a period of 12 months water from showers and taps was cultured for Legionella spp. every two weeks. On only one occasion was a water culture positive for L. pneumophila from a sink tap. No water sample obtained from showers was positive during the study period. No cases of legionnaires' disease occurred. We considered the use of electric showers an inexpensive and effective method of controlling the problem of Legionella spp. in the water system of our renal transplant unit.
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Affiliation(s)
- A S Levin
- Hospital Infection Control Group, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
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40
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Azevedo LS, Manrique R, Sabbaga E. [Comparison of the determination of cyclosporin-A in blood samples collected on filter paper and by the ordinary technique]. Rev Assoc Med Bras (1992) 1995; 41:183-6. [PMID: 8574226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Monitoring cyclosporin-A (CsA) blood levels is of utmost importance for the rational use of this drug. Although many centers perform transplants, in Brazil there are few laboratories able to measure CsA blood levels. Therefore making blood samples reach the laboratory emerged as a problem. Collection of blood on filter paper has been a technique used for a long time in special cases. PURPOSE--To confirm the usefulness of measuring CsA blood levels in blood samples collected on filter paper and in the usual way. METHOD--We studied twenty renal cadaver kidney recipients who were receiving CsA, azathioprine and prednisone. Ninety five blood samples were collected and divided into two aliquots. One of them was sent routinely to one laboratory to perform whole blood CsA measurements. From the other aliquot, 20 microliters were pipetted on filter paper. When dried they were mailed to the other laboratory, where, after elution, CsA was measured. In both cases radioimmunoassay with polyclonal antibody was used. RESULTS--Linear correlation between both measurements revealed r = 0.81 with no statistical difference. CONCLUSION--The technique showed to be useful in clinical practice. In countries with continental size, as Brazil, it may be very helpful.
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Affiliation(s)
- L S Azevedo
- Unidade de Transplante Renal, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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41
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Teixeira MC, David-Neto E, Sequeira DM, Mazucchi E, Machado MM, Arap S, Sabbaga E. Enhanced peripheral renin activity identifies high-renin hypertension in renal transplant patients with native kidneys. Transplant Proc 1995; 27:970-1. [PMID: 7879249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M C Teixeira
- Renal Transplantation Unit, Hospital das Clinicas, University of São Paulo, Brazil
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42
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Chocair PR, Duley JA, Cameron JS, Arap S, Ianhez L, Sabbaga E, Simmonds HA. Does low-dose allopurinol, with azathioprine, cyclosporin and prednisolone, improve renal transplant immunosuppression? Adv Exp Med Biol 1995; 370:205-8. [PMID: 7660891 DOI: 10.1007/978-1-4615-2584-4_44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P R Chocair
- Unidade de Transplante Renal, Hospital das Clinicas, Universidade de Sao Paulo, Brazil
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43
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Sabbaga E, Tedesco-Marchesi LM, Lacaz CDS, Cucé LC, Salebian A, Heins-Vaccari EM, Sotto MN, Valente NY, Porto E, Levy Neto M. [Subcutaneous phaeohyphomycose due to Exophiala jeanselmir. Report of 3 cases in patients with a kidney transplant]. Rev Inst Med Trop Sao Paulo 1994; 36:175-83. [PMID: 7997796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report three cases of subcutaneous phaeohyphomycosis due to Exophiala jeanselmei (Langeron) McGinnis et Padhye 1977, in kidney transplant patients. Exophiala jeanselmei is a dematious fungus having also ability to rarely procedure eumycetoma (black grains). According to KWON-CHUNG & BENNETT (1992) such fungus is antigenically very heterogeneous, since so far three serotypes have been identified; each serotype including subgroups. Subcutaneous phaeohyphomycosis is becoming more and more frequent in kidney transplant patients submitted to an immunosuppressive treatment. As Exophiala jeanselmei has already been isolated from the environment it becomes difficult to explain the pathogenicity of these cases by a reactivation of quiescent processes. The authors suggest an occasional fungistatic action of cyclosporine A upon Exophiala jeanselmei.
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Affiliation(s)
- E Sabbaga
- Unidade de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil
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Abstract
A 29-year-old man born with bladder exstrophy presented with end stage renal failure many years after ileal conduit diversion. Bilateral nephrectomy and continent external urinary diversion were performed, and 1.5 months later a cadaveric kidney was grafted into the right iliac fossa. The patient was well at 18 months with a serum creatinine level of 1.2 mg./dl. and he was completely dry with 4 or 5 daily catheterizations. Although followup is still short, renal transplantation with drainage into an external continent urinary diversion permits excellent quality of life and good renal function. Therefore, this alternative is worth consideration whenever other reconstructive alternatives are not possible in candidates for renal transplantation.
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Affiliation(s)
- A M Lucon
- Division of Urology, São Paulo University Medical School, Brazil
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45
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David-Neto E, Ianhez LE, Nahas WC, Krasilcic S, Sabbaga E, Arap S. Do steroids matter in one-haplotype pediatric renal allograft recipients on cyclosporine/azathioprine? Transplant Proc 1994; 26:95-6. [PMID: 8109040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- E David-Neto
- Renal Transplantation Unit, Hospital das Clínicas, University of São Paulo, Brazil
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46
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Nahas WC, Mazzucchi E, Henrique A, Ianhez LE, Saldanha LB, Sabbaga E, Arap S. Percutaneous needle biopsy of the renal allograft using the automated needle system: evaluation of 87 procedures. J Urol 1993; 150:313-5. [PMID: 8326550 DOI: 10.1016/s0022-5347(17)35469-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between April 1991 and February 1992 we obtained 87 percutaneous core needle biopsy specimens from 60 patients with the automatic biopsy gun. In 78 cases (89.7%) enough renal tissue was obtained for histological analysis. Acute rejection was present on 35 biopsies (40.3%) indicating antirejection therapy. No pathological signs of rejection were detected on 43 biopsies (49.4%). In 38 instances (43.7%) biopsy diagnosis differed from clinical presumptive diagnosis, affecting patient management, while in the remainder it was helpful to confirm clinical impressions. The only complication of the procedure was gross hematuria (requiring vesical irrigation in 1 patient). Due to its simplicity and low morbidity rate, renal biopsy with the automated needle system is the procedure of choice for evaluation and management of renal allograft dysfunction.
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Affiliation(s)
- W C Nahas
- Renal Transplantation Service, Hospital das Clinicas, Faculdade de Medicine, Universidade de São Paulo, Brazil
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47
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Abstract
Early rejection can still complicate renal transplantation even with cyclosporin. We added low-dose allopurinol (25 mg on alternative days) to "triple" immunosuppression with cyclosporin, prednisolone, and azathioprine for twelve recipients of cadaver renal grafts. The controls were fifteen patients on triple therapy alone. Only one rejection episode occurred among the allopurinol-treated patients, whereas eleven controls had rejections (seven with more than one episode). Allopurinol may be toxic when combined with azathioprine, yet the bone marrow tolerated the new regimen well. As expected, reduction of the azathioprine dose was necessary in the treated group.
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Affiliation(s)
- P Chocair
- Renal Transplant Unit, Hospital das Clinicas, Universidade de São Paulo, Brazil
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48
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Chocair PR, Duley JA, Sabbaga E, Arap S, Simmonds HA, Cameron JS. Fast and slow methylators: do racial differences influence risk of allograft rejection? Q J Med 1993; 86:359-63. [PMID: 8171183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A catabolic route for azathioprine involving methylation by thiopurine methyltransferase has been directly implicated in the drug's immunosuppressive efficacy. Since ethnic differences in thiopurine methyltransferase activity have been reported in a study of Lapps, this study compared the distribution of thiopurine methyltransferase activity in erythrocyte lysates from 134 healthy, randomly selected subjects living in Brazil, comprising 39 blacks (i.e. Afro-Brazilians), 33 white subjects, 30 mixed-race subjects, and 32 Brazilian-residing Japanese subjects. The results demonstrated bimodality of thiopurine methyltransferase activity compatible with genetic polymorphism in the white, black and mixed-race groups, but not in the Japanese, who were homogeneously 'fast methylators' (high thiopurine methyltransferase activity). Thiopurine methyltransferase activity was generally higher in Brazilian males than females, and some individuals in the black and mixed-race groups had very high activity. Azathioprine-immunosuppressed transplant patients with thiopurine methyltransferase activity above 35 pmol/h/mgHb have previously been shown to have significantly poorer outcomes. Using this thiopurine methyltransferase value as the cut-off point between 'poor responders' and 'good responders' to azathioprine, 65% of the Japanese, 59% of the black subjects, and 63% of the mixed-race subjects fell into the 'poor responder' category, compared with only 42% of the white group. Interestingly, this approximately 20% difference in azathioprine response corresponds to the racial differences seen in allograft survival.
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Affiliation(s)
- P R Chocair
- Unidade de Transplante Renal, Hospital das Clinicas, Sao Paulo, Brazil
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David-Neto E, Ribeiro DS, Ianhez LE, Palomino S, Saldanha LB, Arap S, Sabbaga E. Acute interstitial nephritis of plasma cells: a new cause for renal allograft loss. Transplant Proc 1993; 25:897-9. [PMID: 8442259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- E David-Neto
- Renal Transplantation Unit, University of Sao Paulo, Brazil
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50
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Ianhez LE, Sampaio M, Chocair PR, Fonseca JA, Sabbaga E. [The influence of socio-economic conditions in renal posttransplant infection]. Rev Assoc Med Bras (1992) 1993; 39:33-6. [PMID: 8220504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Two hundred and four patients who underwent renal transplantation were followed up as outpatients with a minimum of four years. They were divided into two socio-economic levels: group I - 104 patients who underwent transplantation in a private hospital and 120 patients (group II) with a lower socio-economic standard, treated in a public hospital. In both groups urinary infections and hepatitis were excluded. The incidence of infection in group I was 24% and in group II, 50% (p = 0.0002). There was no difference in relation to viral infection in either groups. However, bacterial infection and infection by opportunistic agents were significantly higher in group II (p = 0.0001 and p = 0.0282). The number of hospitalizations and the number of infections of patients were higher in group II. There was a tendency for an increase in mortality owing to infection in group II. There was no difference in the two groups as the parameters of: age, sex, type of donor, primary disease, number of rejections crises, level of serum creatinine and number of patients with ciclosporine. On the other hand, the dose of azathioprine and prednisone was mildly higher in those patients of group II. Low level of socio-economic conditions is a risk factor in renal transplant patients.
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Affiliation(s)
- L E Ianhez
- Unidade de Transplante Renal, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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