1
|
de Menezes Neves PDM, Mohrbacher S, Lobato Vasques I, Barreira Cavalcante L, Hamamoto Sato VA, de Souza Oliveira É, Barbosa Pereira LV, Martins Bales A, Martins Frediani M, Renato Chocair P, Cuvello-Neto AL. Renal infarction secondary to Aspergillus spp. embolism following COVID-19. Lancet Infect Dis 2024; 24:e266-e267. [PMID: 38519259 DOI: 10.1016/s1473-3099(23)00780-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Sara Mohrbacher
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | - Victor Augusto Hamamoto Sato
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Érico de Souza Oliveira
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Leonardo Victor Barbosa Pereira
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Alessandra Martins Bales
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Marcella Martins Frediani
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Pedro Renato Chocair
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Américo Lourenço Cuvello-Neto
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| |
Collapse
|
2
|
Campos MAG, Valois TDO, Magalhães LE, Vasques LF, de Medeiros RG, Costa DMDN, Salgado Filho N, Nogueira RMDR, Neves PDMDM, Silva GEB. ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination: a case report and literature review. Front Immunol 2024; 14:1298622. [PMID: 38299140 PMCID: PMC10828972 DOI: 10.3389/fimmu.2023.1298622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
With the coverage of COVID-19 vaccination, it has been possible to observe the potential side effects of SARS-CoV-2 vaccines, with the most common ones being fever, myalgia, headache, and fatigue. However, an association has been observed between new and recurrent kidney injuries, mainly glomerulonephritis and lupus nephritis associated with ANCA, with the Pfizer-BioNTech, Moderna, Sinovac, and AstraZeneca vaccines, although the relationship between them is not clear. We report a case of ANCA-related vasculitis and lupus glomerulonephritis after the second dose of the AstraZeneca vaccine. The elderly patient presented significant worsening of kidney function after immunosuppression and complications after a new onset COVID-19 infection that led to death. We provide a literature review about kidney damage related to ANCA vasculitis after COVID-19 vaccine, aiming for a better understanding of the pathophysiological mechanism of kidney injury, its presentation, and treatment.
Collapse
Affiliation(s)
- Marcos Adriano Garcia Campos
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
| | - Tiago de Oliveira Valois
- Divison of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Luís Eduardo Magalhães
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
| | | | | | - Denise Maria do Nascimento Costa
- Divison of Nephrology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Recife Medical School, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Natalino Salgado Filho
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
| | | | | | - Gyl Eanes Barros Silva
- Clinical Hospital of State University Júlio de Mesquita Filho, State University of São Paulo, Botucatu, São Paulo, Brazil
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
3
|
de Araújo EMC, Campos MAG, Sodré AM, de Holanda MI, Hagemann R, Teixeira Júnior AAL, Salgado Filho N, Neves PDMDM, Silva GEB. Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review. Vaccines (Basel) 2024; 12:62. [PMID: 38250875 PMCID: PMC10821173 DOI: 10.3390/vaccines12010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Large-scale COVID-19 vaccination has been one of the most effective strategies to control the spread of the SARS-CoV-2 virus. However, several cases of glomerular injury related to the COVID-19 vaccine have been described in the literature. We report two cases of a tip lesion variant of focal segmental glomerulosclerosis (FSGS), which presented with significant proteinuria and improved after immunosuppression. In our literature review, the tip lesion variant of FSGS is currently the most frequent variant associated with vaccination against COVID-19. Prognosis is favorable and without significant alterations in the tubulointerstitial or vascular compartments. Adverse effects of vaccines need to be recognized early and will help us to understand the immune and pathological mechanisms of kidney damage.
Collapse
Affiliation(s)
- Emmy Marjorie Carvalho de Araújo
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
| | - Marcos Adriano Garcia Campos
- Clinical Hospital of Botucatu Medical School, São Paulo State University, Professor Mário Rubens Guimarães Montenegro Avenue, Botucatu 18618-687, Brazil;
| | - Andressa Monteiro Sodré
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
| | | | - Rodrigo Hagemann
- Clinical Hospital Complex, Federal University of Paraná, General Carneiro Street, Curitiba 80060-900, Brazil;
| | | | - Natalino Salgado Filho
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
| | | | - Gyl Eanes Barros Silva
- Faculty of Medicine, Federal University of Maranhão, Gonçalves Dias Square, São Luís 65020-240, Brazil; (E.M.C.d.A.); (A.M.S.); (N.S.F.)
- Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, Ribeirão Preto 14040-900, Brazil
| |
Collapse
|
4
|
Cavalcante RN, Nishinari K, Centofanti G, Krutman M, De Fina B, Sato VH, de Oliveira ES, Pereira LVB, Mohrbacher S, Bales AM, Ferreira BMC, Neves PDMDM, Chocair PR, Cuvello Neto AL. The role of vacuum-assisted mechanical thrombectomy in the management of acutely thrombosed arteriovenous fistulas and grafts. J Vasc Access 2024; 25:113-118. [PMID: 35633069 DOI: 10.1177/11297298221099469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts. METHODS A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates. RESULTS Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11-539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis. CONCLUSION In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates.
Collapse
Affiliation(s)
| | - Kenji Nishinari
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | - Guiherme Centofanti
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | - Mariana Krutman
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | - Bruna De Fina
- Hospital Alemão Oswaldo Cruz, Vascular and Endovascular Surgery, São Paulo, Brazil
| | | | | | | | - Sara Mohrbacher
- Hospital Alemão Oswaldo Cruz, Nephrology and Dialysis Center, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
5
|
Nunes RAB, Neves PDMDM, da Costa LMA, Bachour P, Cantarelli MJDC, Oliveira GBDF, Avezum Jr. Á. Five-year cardiovascular outcomes in patients with chronic myeloid leukemia treated with imatinib, dasatinib, or nilotinib: A cohort study using data from a large multinational collaborative network. Front Cardiovasc Med 2023; 10:888366. [PMID: 36824461 PMCID: PMC9941183 DOI: 10.3389/fcvm.2023.888366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background Breakpoint cluster region-Abelson gene (BCR-ABL) tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of patients with chronic myeloid leukemia (CML). However, concern has arisen about the cardiac safety profile of these drugs. Objectives This study aims to compare long-term risks of adverse cardiovascular and cerebrovascular events (ACE), heart failure or left ventricular ejection fraction (LVEF) < 50%, and venous thromboembolic events (VTE) in patients with CML treated with BCR-ABL TKIs, using data from a large multinational network. Methods Patients aged ≥ 18 years with CML treated with imatinib, dasatinib, or nilotinib without prior cardiovascular or cerebrovascular disease were included. We used propensity score matching to balance the cohorts. The 5-year cumulative incidences and hazard ratios were calculated. Results We identified 3,722 patients with CML under treatment with imatinib (n = 1,906), dasatinib (n = 1,269), and nilotinib (n = 547). Patients with imatinib compared to dasatinib showed a higher hazard ratio (HR) for ACE (HR 2,13, 95% CI 1.15-3.94, p = 0.016). Patients with imatinib presented a lower HR than nilotinib for ACE (HR 0.50, 95% CI 0.30-0.83, p = 0.0074). In relation to heart failure or LVEF < 50%, patients with imatinib had a higher HR than dasatinib (HR 9.41, 95% CI 1.22-72.17, p = 0.03), but no significant difference was observed between imatinib and nilotinib (HR 0.48, 95% CI 0.215-1.01, p = 0.064). Conclusion In this retrospective study with a large number of patients with CML, those treated with nilotinib had a higher 5-year ratio of ACE, while patients with dasatinib showed a lower ratio than patients with imatinib. The ratio of heart failure was higher in patients with imatinib than in patients with dasatinib, but not when compared to nilotinib.
Collapse
Affiliation(s)
- Rafael Amorim Belo Nunes
- Department of Cardiology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil,*Correspondence: Rafael Amorim Belo Nunes,
| | | | | | - Philip Bachour
- Department of Hematology and Bone Marrow Transplant, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Álvaro Avezum Jr.
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| |
Collapse
|
6
|
Pereira LJ, Mohrbacher S, Neves PDMDM, Zacchi FFS, Medeiros IUD, Sato VAH, Oliveira ÉS, Pereira LVB, Cuvello-Neto AL, Baiocchi O, Chocair PR. Primary Effusion Lymphoma: A Rare and Challenging Diagnosis for Recurrent Pleural Effusion. Diagnostics (Basel) 2023; 13:diagnostics13030370. [PMID: 36766474 PMCID: PMC9914331 DOI: 10.3390/diagnostics13030370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Primary Effusion Lymphoma is an extremely rare and aggressive subtype of B-cell lymphoma, accounting for only <1% of all cases of this neoplasm. It has a unique clinical presentation because it has a predilection for appearing in body cavities, such as the pleural space, pericardium and peritoneum. It mainly affects immunocompromised individuals and may also affect individuals in the Mediterranean region and in areas endemic for human herpesvirus 8 (HHV-8). Herein, we report the case of an 83-year-old immunocompetent male complaining of coughing, fever and progressive dyspnea for 3 days. His past medical history revealed a recurrent pleural effusion for the last three years, as well as losing weight and malaise. A subsequent investigation revealed a PEL diagnosis of the pleura.
Collapse
Affiliation(s)
| | - Sara Mohrbacher
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| | | | | | | | | | - Érico Souza Oliveira
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| | | | | | - Otávio Baiocchi
- Oncology Center, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| | - Pedro Renato Chocair
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| |
Collapse
|
7
|
Costa DMDN, Gouveia PADC, Silva GEDB, Neves PDMDM, Vajgel G, Cavalcante MAGDM, Oliveira CBLD, Valente LM, Silveira VMD. The relationship between chikungunya virus and the kidneys: A scoping review. Rev Med Virol 2023; 33:e2357. [PMID: 35521644 DOI: 10.1002/rmv.2357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 01/28/2023]
Abstract
Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality. Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.
Collapse
Affiliation(s)
| | | | | | - Precil Diego Miranda de Menezes Neves
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil.,Nephrology and Dialysis Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Gisele Vajgel
- Nephrology Division, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | | |
Collapse
|
8
|
Szor RS, Fernandes F, Lino AMM, Mendonça LO, Seguro FS, Feitosa VA, Castelli JB, Jorge LB, de Oliveira Alves LB, de Menezes Neves PDM, de Oliveira Souza E, Cavalcante LB, Malheiros D, Kalil J, Martinez GA, Rocha V. Systemic amyloidosis journey from diagnosis to outcomes: a twelve-year real-world experience of a single center in a middle-income country. Orphanet J Rare Dis 2022; 17:425. [PMID: 36471404 PMCID: PMC9724300 DOI: 10.1186/s13023-022-02584-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Systemic amyloidosis is caused by the deposition of misfolded protein aggregates in tissues, leading to progressive organ dysfunction and death. Epidemiological studies originate predominantly from high-income countries, with few data from Latin America. Due to the non-specific clinical manifestations, diagnosing amyloidosis is often challenging and patients experience a long journey and delay in diagnosis. This study aimed to assess clinical and laboratory characteristics, the diagnostic journey, and outcomes of patients with biopsy-proven systemic amyloidosis diagnosed between 2009 and 2020 at a university referral center in a middle-income Latin American country. Patients´ medical records were retrospectively reviewed. RESULTS One hundred and forty-three patients were included. The median age at diagnosis was 60 years and 54% were male. Until the diagnosis, most of the patients (52%) were seen by at least 3 specialists, the main ones being: general practitioners (57%), nephrologists (45%), and cardiologists (38%). The most common manifestations were renal (54%) and cardiac (41%) disorders, and cachexia was seen in 36% of patients. In 72% of the cases, ≥ 2 biopsies were required until the final diagnosis. The median time from symptoms onset to diagnosis was 10.9 months, and most patients (75%) had ≥ 2 organs involved. The following subtypes were identified: AL (68%), ATTR (13%), AA (8%), AFib (4%), and inconclusive (7%). Median OS was 74.3 months in the non-AL subgroup and 18.5 months in AL. Among AL patients, those with advanced cardiac stage had the worst outcome [median OS 8.6 months versus 52.3 for stage III versus I-II, respectively (p < 0.001)]. AL subtype, cardiac involvement, and ECOG ≥ 2 were identified as independent risk factors for reduced survival. CONCLUSIONS Systemic amyloidosis is still an underdiagnosed condition and the delay in its recognition leads to poor outcomes. Medical education, better diagnostic tools, improvement in access to therapies, and establishment of referral centers may improve patient outcomes in middle-income countries.
Collapse
Affiliation(s)
- Roberta Shcolnik Szor
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | - Fabio Fernandes
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Angelina Maria Martins Lino
- grid.11899.380000 0004 1937 0722Divisão de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Oliveira Mendonça
- grid.11899.380000 0004 1937 0722Departamento de Imunologia Clínica e Alergia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Salles Seguro
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | - Valkercyo Araujo Feitosa
- grid.11899.380000 0004 1937 0722Divisão de Nefrologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Jussara Bianchi Castelli
- grid.11899.380000 0004 1937 0722Laboratório de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil ,grid.466673.6Grupo Fleury, São Paulo, Brazil
| | - Lecticia Barbosa Jorge
- grid.11899.380000 0004 1937 0722Divisão de Nefrologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Bassolli de Oliveira Alves
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | | | - Evandro de Oliveira Souza
- grid.11899.380000 0004 1937 0722Divisão de Gastroenterologia e Hepatologia Clínica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Livia Barreira Cavalcante
- grid.11899.380000 0004 1937 0722Divisão de Anatomia Patológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Denise Malheiros
- grid.11899.380000 0004 1937 0722Divisão de Anatomia Patológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- grid.11899.380000 0004 1937 0722Departamento de Imunologia Clínica e Alergia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Gracia Aparecida Martinez
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | - Vanderson Rocha
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil ,grid.4991.50000 0004 1936 8948Department of Hematology, Churchill Hospital, Oxford University, Oxford, UK
| |
Collapse
|
9
|
Pacheco ICR, Costa DMDN, Sousa DS, Salgado Filho N, Silva GEB, Neves PDMDM. Kidney injury associated with COVID-19 infection and vaccine: A narrative review. Front Med (Lausanne) 2022; 9:956158. [PMID: 36544502 PMCID: PMC9760714 DOI: 10.3389/fmed.2022.956158] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/11/2022] [Indexed: 12/08/2022] Open
Abstract
The respiratory tract is the main infection site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in many admissions to intensive care centers in several countries. However, in addition to lung involvement, kidney injury caused by the novel coronavirus has proven to be a significant factor related to high morbidity and mortality, alarming experts worldwide. The number of deaths has drastically reduced with the advent of large-scale immunization, highlighting the importance of vaccination as the best way to combat the pandemic. Despite the undeniable efficacy of the vaccine, the renal side effects associated with its use deserve to be highlighted, especially the emergence or reactivation of glomerulopathies mentioned in some case reports. This study aimed to identify the main renal morphological findings correlated with COVID-19 infection and its vaccination, seeking to understand the pathophysiological mechanisms, main clinical features, and outcomes.
Collapse
Affiliation(s)
| | | | - Deborah Serra Sousa
- Division of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Brazil
| | - Natalino Salgado Filho
- Division of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Brazil
| | - Gyl Eanes Barros Silva
- Division of Nephrology, University Hospital of the Federal University of Maranhão, São Luís, Brazil,Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil,*Correspondence: Gyl Eanes Barros Silva,
| | | |
Collapse
|
10
|
Gomes OV, Santana LFE, Duarte RMSDC, Rodrigues MDS, Nicacio JM, Brito DJDA, Muniz MPR, Salgado-Filho N, Neves PDMDM, Silva GEB. Case report: Isolated tubular basement membrane deposits in a patient with systemic lupus erythematosus - A diagnostic challenge. Front Med (Lausanne) 2022; 9:958615. [PMID: 36186813 PMCID: PMC9522906 DOI: 10.3389/fmed.2022.958615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Lupus nephritis is one of the most serious and frequent manifestations of systemic lupus erythematosus. It usually presents in the first years of the disease, which suspicion should be raised in cases of elevated serum creatinine, presence of proteinuria above 500 mg/day or active urinary sediment, in the absence of other apparent causes such as urinary tract infection and use of nephrotoxic drugs. In most cases, it affects the glomerulus, and its presentation is rare in the form of isolated tubulo-interstitial disease. In this report, we describe a case of lupus nephritis diagnosed after 2 years of illness, in the form of atypical isolated tubular disease, characterized by massive deposits in the tubular basement membrane. Clinically, there were altered renal function, subnephrotic proteinuria, and evolution to a complete clinical response after immunosuppressive treatment.
Collapse
Affiliation(s)
- Orlando Vieira Gomes
- University Hospital, Federal University of Vale Do São Francisco (HU-UNIVASF), Petrolina, Brazil
| | | | | | | | - Jandir Mendonça Nicacio
- University Hospital, Federal University of Vale Do São Francisco (HU-UNIVASF), Petrolina, Brazil
| | | | | | | | | | | |
Collapse
|
11
|
Chocair PR, de Menezes Neves PDM, Sato VAH, Mohrbacher S, Oliveira ÉS, Pereira LVB, Bales AM, da Silva FP, Duley JA, Cuvello-Neto AL. Proposal for standardizing normal insulin ranges in Brazilian patients and a new classification of metabolic syndrome. Front Med (Lausanne) 2022; 9:984001. [PMID: 36160146 PMCID: PMC9500149 DOI: 10.3389/fmed.2022.984001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Insulin resistance and/or hyperinsulinemia are closely linked to adiposity, metabolic syndrome (MetS) and prolonged inflammatory processes. Methods We retrospectively analyzed 1,018 adult individuals with a mean age of 46 years (74% male) and classified them as: Metabolically normal: without any of the five criteria of the International Diabetes Federation (IDF) used for the diagnosis of MetS, plus normal fasting insulin (Men < 8 mU/L, Women < 10 mU/L); Level 1 MetS: with one or two IDF criteria, plus hyperinsulinemia (Men: ≥ 8 mU/L), and Women: ≥ 10 mU/L); Level 2 MetS: with three or more IDF criteria, plus hyperinsulinemia. Results The mean values for fasting insulinemia in metabolically normal individuals was 4.6 ± 1.8 mU/L and 5.6 ± 2.3 mU/L, while their means for the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were 1.0 and 1.2 for men and women, respectively. In addition, the mean values for insulin (and HOMA-IR) for individuals with two normal anthropometric parameters (body mass index and waist girth), or two normal anthropometric parameters plus no IDF criteria, were similar to the metabolically normal group. Based on the obtained mean + 2 SD, we established the following insulin (and HOMA-IR) values as diagnostic cut-offs for hyperinsulinemia: Men: ≥ 8 mU/L (≥ 1.5), and Women: ≥ 10 mU/L (≥ 2.0). The mean serum insulin was significantly higher for individuals with Level 1 MetS (approx. 9 mU/L for both genders) compared with metabolically normal individuals, as was the prevalence of hepatic steatosis, which was more evident in men. Thus, the presence of one or two abnormal IDF criteria, combined with hyperinsulinemia and/or raised HOMA-IR, suggests the presence of MetS and insulin resistance. Patients of both genders with Level 2 MetS had higher serum insulin and/or HOMA-IR values than Level 1, as well as a higher prevalence of hypertension and hepatic steatosis, being more pronounced among men. The process was progressive and proportional to the degree of hyperinsulinemia. Conclusion It is proposed that intervention against MetS progression should be started in individuals with Level 1 MetS, rather than waiting for more criteria for diagnostic confirmation, which this should help to reduce the occurrence of known complications such as type 2 diabetes, atherosclerosis, hypertension, and chronic kidney disease, among others.
Collapse
Affiliation(s)
- Pedro Renato Chocair
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
- *Correspondence: Pedro Renato Chocair,
| | | | | | - Sara Mohrbacher
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Érico Souza Oliveira
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | | - John A. Duley
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | | |
Collapse
|
12
|
Chocair PR, Neves PDMDM, Mohrbacher S, Neto MP, Sato VAH, Oliveira ÉS, Barbosa LV, Bales AM, da Silva FP, Cuvello-Neto AL, Duley JA. Case Report: Azathioprine: An Old and Wronged Immunosuppressant. Front Immunol 2022; 13:903012. [PMID: 35757730 PMCID: PMC9226564 DOI: 10.3389/fimmu.2022.903012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
Mycophenolate rapidly substituted azathioprine (AZA) in transplant immunosuppression regimens since the 1990s, when early clinical trials indicated better outcomes, although opposite results were also observed. However, none of these trials used the well-established optimization methods for AZA dosing, namely, thiopurine methyltransferase pharmacogenetics combined with monitoring of the thiopurine metabolites 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP). Resistance to optimize AZA therapy remains today in transplant therapy, despite the fact that thiopurine metabolite testing is being used by other medical disciplines with evident improvement in clinical results. In a previous analysis, we found that active 6-TGN metabolites were not detectable in about 30% of kidney transplant patients under continuous use of apparently adequate azathioprine dosage, which demonstrates the need to monitor these metabolites for therapeutic optimization. Two of four case studies presented here exemplifies this fact. On the other hand, some patients have toxic 6-TGN levels with a theoretically appropriate dose, as seen in the other two case studies in this presentation, constituting one more important reason to monitor the AZA dose administered by its metabolites. This analysis is not intended to prove the superiority of one immunosuppressant over another, but to draw attention to a fact: there are thousands of patients around the world receiving an inadequate dose of azathioprine and, therefore, with inappropriate immunosuppression. This report is also intended to draw attention, to clinicians using thiopurines, that allopurinol co-therapy with AZA is a useful therapeutic pathway for those patients who do not adequately form active thioguanine metabolites.
Collapse
Affiliation(s)
- Pedro R Chocair
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | - Sara Mohrbacher
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | - Victor A H Sato
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Érico S Oliveira
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Leonardo V Barbosa
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Alessandra M Bales
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | - Américo L Cuvello-Neto
- Internal Medicine and Nephrology Service, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - John A Duley
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| |
Collapse
|
13
|
Neves PDMDM, Muniz MPR, Morgantetti GF, Cutrim ÉMM, Macieira CDA, Salgado-Filho N, Lages JS, Brito DJDA, Cunha KDA, Gatto GC, Silva GEB. Membranous Nephropathy Secondary to Graves’ Disease: A Case Report. Front Immunol 2022; 13:824124. [PMID: 35734176 PMCID: PMC9207503 DOI: 10.3389/fimmu.2022.824124] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
Membranous nephropathy (MN) is a form of kidney disease that is idiopathic in 70%–80% of cases. Glomerular involvement in autoimmune thyroiditis can occur in 10%–30% of patients, and MN manifests in association with Hashimoto thyroiditis in up to 20% of the cases with glomerular involvement. Reports of MN associated with Graves’ disease (GD) are extremely rare in the current literature. Herein, we report the case of a 46-year-old man admitted to the hospital with nephrotic syndrome and symptomatic hyperthyroidism due to GD. Kidney biopsy revealed a secondary MN pattern. Immunohistochemical staining for PLA2R was negative, and thyroglobulin showed weak and segmental staining along the glomerular capillary. Anti-thyroid peroxidase (TPO) antibody test was not performed. The patient was treated for GD with methimazole and prednisone, and despite reaching clinical improvement after 8 months, proteinuria remained close to nephrotic levels. In this scenario, the patient was submitted to radioactive iodine, and there was a dramatic reduction in proteinuria levels after treatment. In conclusion, GD association with MN is rare, and when present, diagnosis using PLA2R and immunohistochemistry can be useful in determining association. In addition, radioactive iodine therapy can be an effective treatment modality when preceded with immunosuppressive corticosteroid therapy.
Collapse
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Gyl Eanes Barros Silva
- Pathology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- University Hospital of Federal University of Maranhão, São Luís, Brazil
- *Correspondence: Gyl Eanes Barros Silva,
| |
Collapse
|
14
|
Vaisbich MH, de Andrade LGM, de Menezes Neves PDM, Palma LMP, de Castro MCR, Silva CAB, Barbosa MINDH, Penido MGMG, Neto OÂF, Sobral RML, Miranda SMC, de Almeida Araújo S, Pietrobom IG, Takase HM, Ribeiro C, da Silva RM, de Carvalho CAA, Machado DJB, Silva AMSTE, da Silva AR, Russo ER, Barros FHS, Nasserala JCL, de Oliveira LSC, Sylvestre LDC, Weissheimer R, Nascimento SO, Bianchini G, Barreto FDC, Veloso VSP, Fortes PM, Colares VS, Gomes JG, Leite AFP, Mesquita PGM, Vieira-Neto OM. Baseline characteristics and evolution of Brazilian patients with atypical hemolytic uremic syndrome: first report of The Brazilian aHUS Registry. Clin Kidney J 2022; 15:1601-1611. [PMID: 35892013 PMCID: PMC9308094 DOI: 10.1093/ckj/sfac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background Atypical hemolytic uremic syndrome (aHUS) is an ultra-rare disease. Therefore, studies involving large samples are scarce, making registries powerful tools to evaluate cases. We present herein the first analysis of the Brazilian aHUS Registry (BRaHUS). Methods Analysis of clinical, laboratory, genetic and treatment data from patients inserted in the BRaHUS, from 2017 to 2020, as an initiative of the Rare Diseases Committee of the Brazilian Society of Nephrology. Results The cohort consisted of 75 patients (40 adults and 35 pediatric). There was a predominance of women (56%), median age at diagnosis of 20.7 years and a positive family history in 8% of cases. Renal involvement was observed in all cases and 37% had low C3 levels. In the <2 years of age group, males were predominant. Children presented lower levels of hemoglobin (P = .01) and platelets (P = .003), and higher levels of lactate dehydrogenase (LDH) (P = .004) than adults. Genetic analysis performed in 44% of patients revealed pathogenic variants in 66.6% of them, mainly in CFH and the CFHR1-3 deletion. Plasmapheresis was performed more often in adults (P = .005) and 97.3% of patients were treated with eculizumab and its earlier administration was associated with dialysis-free after 3 months (P = .08). Conclusions The cohort of BRaHUS was predominantly composed of female young adults, with renal involvement in all cases. Pediatric patients had lower hemoglobin and platelet levels and higher LDH levels than adults, and the most common genetic variants were identified in CFH and the CFHR1-3 deletion with no preference of age, a peculiar pattern of Brazilian patients.
Collapse
Affiliation(s)
- Maria Helena Vaisbich
- Pediatric Nephrology Service, Child Institute, University of São Paulo, São Paulo, Brazil
| | | | - Precil Diego Miranda de Menezes Neves
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
- Nephrology and Dialysis Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Cláudia Ribeiro
- Nephrology Center. Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gilson Bianchini
- Nephrology Service. Federal University of Paraná. Curitiba, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lugon JR, Neves PDMDM, Pio-Abreu A, do Nascimento MM, Sesso R. Evaluation of central venous catheter and other risk factors for mortality in chronic hemodialysis patients with COVID-19 in Brazil. Int Urol Nephrol 2022; 54:193-199. [PMID: 34132971 PMCID: PMC8207494 DOI: 10.1007/s11255-021-02920-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. METHODS Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb-Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan-Meier. RESULTS From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease's first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76-82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05-2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22-2.64, P = 0.003), age (HR 1.03, 95% CI 1.01-1.04, P < 0.001), and origin from the North vs. Southeast region (HR 2.60, 95% CI 1.01-6.68, P = 0.047). CONCLUSIONS Hemodialysis patients using a CVC as the vascular access, aside from diabetic and elderly ones, should be closely monitored due to their high risk of death in the course of the COVID-19.
Collapse
Affiliation(s)
| | | | - Andrea Pio-Abreu
- Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP, Brazil
| | | | - Ricardo Sesso
- Division of Nephrology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Botucatu 740, São Paulo, SP, 04023-900, Brazil.
| |
Collapse
|
16
|
Neves PDMDM, Lario FC, Mohrbacher S, Ferreira BMC, Sato VAH, Oliveira ÉS, Pereira LVB, Bales AM, Nardotto LL, Ferreira JN, Cavalcante LB, Chocair PR, Cuvello-Neto AL. Dialysis-related constrictive pericarditis: old enemies may sometimes come back. J Bras Nefrol 2022; 44:602-606. [PMID: 34251389 PMCID: PMC9838677 DOI: 10.1590/2175-8239-jbn-2020-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/02/2021] [Indexed: 01/26/2023] Open
Abstract
Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Several heart conditions have been associated with CKD, including myocardial and pericardial diseases. This paper describes a case of Dialysis-related constrictive pericarditis in a patient diagnosed with sudden hypotension during a hemodialysis session. A 65-year-old man diagnosed with hypertension, diabetes, obesity, and cirrhosis on hemodialysis for two years complained of symptoms during one of his sessions described as malaise, lipothymia, and confusion. The patient had a record of poor compliance with the prescribed diet and missed dialysis sessions. He was sluggish during the physical examination, and presented hypophonetic heart sounds, a blood pressure of 50/30mmHg, and a prolonged capillary refill time. The patient was referred to the intensive care unit and was started on antibiotics and vasoactive drugs. His workup did not show signs of infection, while electrocardiography showed low QRS-wave voltage. His echocardiogram showed signs consistent with a thickened pericardium without pericardial effusion. Cardiac catheterization showed equalization of diastolic pressures in all heart chambers indicative of constrictive pericarditis. The patient underwent a pericardiectomy. Examination of surgical specimens indicated he had marked fibrosis and areas of dystrophic calcification without evidence of infection, consistent with Dialysis-related constrictive pericarditis. Hypotension for unknown causes must be considered in the differential diagnosis of dialysis patients.
Collapse
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Divisão de Nefrologia, São Paulo, SP, Brasil
| | | | - Sara Mohrbacher
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil
| | | | | | - Érico Souza Oliveira
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil
| | | | | | | | | | - Lívia Barreira Cavalcante
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Divisão de Patologia, São Paulo, SP, Brasil
| | - Pedro Renato Chocair
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil
| | | |
Collapse
|
17
|
Coelho Júnior JL, Israel KCP, Machado CEE, Muniz MPR, Gatto GC, Barros FHS, Cunha KDA, de Lacerda MVG, Neves PDMDM, Silva GEB. Thrombotic microangiopathy associated with arboviral infection: Report of 3 cases. PLoS Negl Trop Dis 2021; 15:e0009790. [PMID: 34648498 PMCID: PMC8516303 DOI: 10.1371/journal.pntd.0009790] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Dengue fever and chikungunya are viral diseases that have spread rapidly throughout the world in recent decades. The occurrence of complications is well known, including prerenal acute kidney injury (AKI), which is usually thought to be caused by dehydration and fluid loss. Thrombotic microangiopathy (TMA) is an uncommon aggravation of dengue fever and chikungunya, with only a few cases described in the medical literature. The aim of this study is to present 3 cases of TMA associated with arboviral infection. Three patients with clinical history, laboratory test, and kidney biopsy results compatible with TMA were selected for the study, 2 of whom had a serological diagnosis of dengue fever and 1 of chikungunya. The 3 patients were followed up at the Federal University of Maranhão Hospital’s Nephrology Service in 2018. A targeted gene panel sequencing (TGPS) plus multiple to atypical hemolytic uremic syndrome (aHUS) multiplex ligation–dependent probe amplification (MLPA) was performed in 2 of the patients and revealed in the patient 1 a heterozygous pathogenic variant in the gene THBD, as well as heterozygous deletions in CFH, CFHR1, and CFHR3. In the patient 2, there were heterozygous pathogenic variant in the genes CFI and CFB, in addition to heterozygous deletions in the genes CFHR1 and CFHR3. Both received treatment with eculizumab and undergone recovery of renal function. The third patient had TMA not classified as either aHUS or thrombotic thrombocytopenic purpura (TTP); he abandoned the treatment and returned to the service after 2 years for a dialysis emergency. Patients with arboviral infectious disease and changes that suggest TMA should have appropriate support to establish early diagnosis and useful treatment.
Collapse
Affiliation(s)
- José Luiz Coelho Júnior
- Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil
- * E-mail:
| | | | | | - Monique Pereira Rêgo Muniz
- Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil
| | - Giuseppe Cesare Gatto
- Nephrology Service, University Hospital of Brasilia, University of Brasília (HUB–UNB), Brasília, Brazil
| | | | - Kaile de Araújo Cunha
- Department of Nephrology, University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil
| | | | | | - Gyl Eanes Barros Silva
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo (FM-USP), Ribeirão Preto, Brazil
| |
Collapse
|
18
|
Watanabe A, Guaragna MS, Belangero VMS, Casimiro FMS, Pesquero JB, de Santis Feltran L, Palma LMP, Varela P, de Menezes Neves PDM, Lerario AM, de Souza ML, de Mello MP, de Brito Lutaif ACG, Ferrari CR, Sampson MG, Onuchic LF, Nogueira PCK. APOL1 in an ethnically diverse pediatric population with nephrotic syndrome: implications in focal segmental glomerulosclerosis and other diagnoses. Pediatr Nephrol 2021; 36:2327-2336. [PMID: 33585978 DOI: 10.1007/s00467-021-04960-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/25/2020] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND APOL1 high-risk genotypes (HRG) are associated with increased risk of kidney disease in individuals of African ancestry. We analyzed the effects of APOL1 risk variants on an ethnically diverse Brazilian pediatric nephrotic syndrome (NS) cohort. METHODS Multicenter study including 318 NS patients, categorized as progressors to advanced CKD [estimated glomerular filtration rate (eGFR)] < 30 mL/min/1.73 m2] and slow/non-progressors (eGFR > 30 mL/min/1.73 m2 through the study). We employed Cox regression with progression time as the outcome and APOL1 genotype as the independent variable. We tested this association in the entire cohort and three subgroups; (1) focal segmental glomerulosclerosis (FSGS), (2) steroid-resistant NS (SRNS), and (3) those who underwent kidney biopsy. RESULTS Nineteen patients (6%) had an HRG. Of these, 47% were self-reported White. Patients with HRG manifested NS at older ages and presented higher frequencies of FSGS and SRNS. HRG patients progressed to advanced CKD more often than low-risk-genotype (LRG) children in the whole NS cohort (p = 0.001) and the three subgroups. In SRNS and biopsied patients, a single risk variant was associated with trends of higher CKD progression risk. CONCLUSIONS Novel discoveries include a substantial prevalence of HRG among patients self-reported White, worse kidney outcomes in HRG versus LRG children in the FSGS subgroup, and a trend of higher CKD progression risk associated with a single risk variant in the SRNS cohort. These findings suggest APOL1-associated NS extends beyond patients self-reported non-White, the HRG effect is independent of FSGS, and a single risk variant may have a detrimental impact in children with NS.
Collapse
Affiliation(s)
- Andreia Watanabe
- Department of Pediatrics, University of São Paulo School of Medicine, São Paulo, Brazil
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mara Sanches Guaragna
- Center for Molecular Biology and Genetic Engineering, State University of Campinas, Campinas, Brazil
| | | | - Fernanda Maria Serafim Casimiro
- Center for Diagnosis and Research on Genetic Diseases, Department of Biophysics, Federal University of São Paulo School of Medicine, São Paulo, Brazil
| | - João Bosco Pesquero
- Center for Diagnosis and Research on Genetic Diseases, Department of Biophysics, Federal University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | - Patrícia Varela
- Center for Diagnosis and Research on Genetic Diseases, Department of Biophysics, Federal University of São Paulo School of Medicine, São Paulo, Brazil
| | - Precil Diego Miranda de Menezes Neves
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Marcela Lopes de Souza
- Center for Molecular Biology and Genetic Engineering, State University of Campinas, Campinas, Brazil
| | | | | | | | - Matthew Gordon Sampson
- Division of Pediatric Nephrology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Luiz Fernando Onuchic
- Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | | |
Collapse
|
19
|
da Silveira-Neto JN, de Oliveira Ahn GJ, de Menezes Neves PDM, Baptista VAF, de Almeida Araújo S, Wanderley DC, Watanabe A, Watanabe EH, Murai NM, Bertollo EMG, Vieira-Neto OM, Dantas M, de Antônio SR, Costa RS, Baptista MASF, Moysés-Neto M, Onuchic LF. Lipoprotein glomerulopathy associated with the Osaka/Kurashiki APOE variant: two cases identified in Latin America. Diagn Pathol 2021; 16:65. [PMID: 34311745 PMCID: PMC8314595 DOI: 10.1186/s13000-021-01119-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lipoprotein glomerulopathy (LPG) is a rare autosomal dominant disease caused by mutations in APOE, the gene which encodes apolipoprotein E. LPG mainly affects Asian individuals, however occasional cases have also been described in Americans and Europeans. Herein we report two unrelated Brazilian patients with LPG in whom genetic analyses revealed the APOE-Osaka/Kurashiki variant. Case presentation - case 1 A 29-year-old Caucasian male sought medical attention with complaints of face swelling and foamy urine for the last 3 months. He denied a family history of kidney disease, consanguinity, or Asian ancestry. His tests showed proteinuria of 12.5 g/24 h, hematuria, serum creatinine 0.94 mg/dL, albumin 2.3 g/dl, total cholesterol 284 mg/dL, LDL 200 mg/dL, triglycerides 175 mg/dL, and negative screening for secondary causes of glomerulopathy. A kidney biopsy revealed intraluminal, laminated deposits of hyaline material in glomerular capillaries consistent with lipoprotein thrombi. These findings were confirmed by electron microscopy, establishing the diagnosis of LPG. His apolipoprotein E serum level was 72 mg/dL and genetic analysis revealed the APOE pathogenic variant c.527G > C, p.Arg176Pro in heterozygosis, known as the Osaka/Kurashiki mutation and positioned nearby the LDL receptor binding site. Case 2 A 34-year-old Caucasian man sought medical assessment for renal dysfunction and hypertension. He reported intermittent episodes of lower-limb edema for 3 years and a family history of kidney disease, but denied Asian ancestry. Laboratorial tests showed BUN 99 mg/dL, creatinine 10.7 mg/dL, total cholesterol 155 mg/dL, LDL 79 mg/dL, triglycerides 277 mg/dL, albumin 3.1 g/dL, proteinuria 2.7 g/24 h, and negative screening for secondary causes of glomerulopathy. His kidney biopsy was consistent with advanced chronic nephropathy secondary to LPG. A genetic analysis also revealed the Osaka/Kurashiki variant. He was transplanted a year ago, displaying no signs of disease relapse. Conclusion We report two unrelated cases of Brazilian patients with a diagnosis of lipoprotein glomerulopathy whose genetic assessment identified the APOE-Osaka/Kurashiki pathogenic variant, previously only described in eastern Asians. While this is the second report of LPG in Latin America, the identification of two unrelated cases by our medical team raises the possibility that LPG may be less rare in this part of the world than currently thought, and should definitely be considered when nephrotic syndrome is associated with suggestive kidney biopsy findings.
Collapse
Affiliation(s)
| | | | - Precil Diego Miranda de Menezes Neves
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil.,Division of Molecular Medicine, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | | | - Stanley de Almeida Araújo
- Division of Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Nephropathology Institute, Belo Horizonte, Brazil
| | - David Campos Wanderley
- Division of Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Nephropathology Institute, Belo Horizonte, Brazil
| | - Andréia Watanabe
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil.,Division of Molecular Medicine, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Elieser Hitoshi Watanabe
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil.,Division of Molecular Medicine, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Neide Missae Murai
- Division of Nephrology, Hospital de Base, FAMERP/FUNFARME, São Jose do Rio Preto, Brazil
| | | | - Osvaldo Merege Vieira-Neto
- Nephrology Service of Ribeirão Preto, Ribeirão Preto, Brazil.,Division of Nephrology, Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto, Brazil
| | - Márcio Dantas
- Nephrology Service of Ribeirão Preto, Ribeirão Preto, Brazil.,Division of Nephrology, Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto, Brazil
| | - Sergio Ricardo de Antônio
- Nephrology Service of Ribeirão Preto, Ribeirão Preto, Brazil.,Division of Nephrology, Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto, Brazil
| | - Roberto Silva Costa
- Division of Pathology, Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Alice Sperto Ferreira Baptista
- Division of Nephrology, Hospital de Base, FAMERP/FUNFARME, São Jose do Rio Preto, Brazil.,Division of Renal Pathology, Hospital de Base, FAMERP/FUNFARME, São Jose do Rio Preto, Brazil
| | - Miguel Moysés-Neto
- Nephrology Service of Ribeirão Preto, Ribeirão Preto, Brazil.,Division of Nephrology, Ribeirão Preto School of Medicine - University of São Paulo, Ribeirão Preto, Brazil
| | - Luiz Fernando Onuchic
- Division of Nephrology, University of São Paulo School of Medicine, São Paulo, Brazil. .,Division of Molecular Medicine, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil.
| |
Collapse
|
20
|
Neves PDMDM, Sato VAH, Mohrbacher S, Ferreira BMC, Oliveira ÉS, Pereira LVB, Bales AM, Nardotto LL, Ferreira JN, Machado DJ, Bassi E, Silva-Júnior A, Chocair PR, Cuvello-Neto AL. Acute Kidney Injury Due to COVID-19 in Intensive Care Unit: An Analysis From a Latin-American Center. Front Med (Lausanne) 2021; 8:620050. [PMID: 34150790 PMCID: PMC8211765 DOI: 10.3389/fmed.2021.620050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/16/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: The kidney may be affected by coronavirus (COVID-19) in the setting of acute kidney injury (AKI). Data about AKI in intensive care unit (ICU) patients in Latin America are scarce. We aimed to evaluate the risk of AKI, dialysis (HD), and death in ICU COVID-19 patients in a Brazilian center. Methods: Analysis from medical records of COVID-19 patients in a Brazilian center. Results: A total of 95 patients were analyzed. There was male predominance (64.2%), median age: 64.9 years, and previous history of hypertension and diabetes in 51.6 and 27.4%, respectively. AKI was diagnosed in 54 (56.8%) patients, and 32 (59.2%) of them required HD. Mortality rate was 17.9%. AKI patients when compared with no-AKI were more frequently hypertensive/diabetic and more often needed organ support therapies. Workups depicted more anemia, lymphopenia, and higher levels of inflammatory markers and higher mortality. Comparing patients who had undergone death to survivors, they were older, more frequently diabetic, and had worse SAPS3 and SOFA scores and need for organ support therapies, AKI, and HD. Multinomial logistic regression revealed that hypertension (p = 0.018) and mechanical ventilation (p = 0.002) were associated with AKI; hypertension (p = 0.002), mechanical ventilation (p = 0.008), and use of vasopressor (p = 0.027) to HD patients; and age >65 years (p = 0.03) and AKI (p = 0.04) were risk factors for death. Conclusions: AKI was a common complication of ICU COVID-19 patients, and it was more frequent in patients with hypertension and need of organ support therapies. As well as age >65 years, AKI was an independent risk factor for death.
Collapse
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Sara Mohrbacher
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | - David José Machado
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
- Intensive Care Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Estêvão Bassi
- Intensive Care Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | | |
Collapse
|
21
|
Oi SSP, Muniz MPR, Faria IM, Filho NS, de Brito DJA, Lages JS, Lauande LP, Oliveira TKM, Cunha KDA, Neves PDMDM, Silva GEB. Multisystemic Inflammatory Syndrome and Thrombotic Microangiopathy as Complications of COVID-19 in a Child: A Case Report. Front Pediatr 2021; 9:659069. [PMID: 34150685 PMCID: PMC8212948 DOI: 10.3389/fped.2021.659069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
Clinical presentations of the novel coronavirus (SARS-CoV-2) infection are quite varied, ranging from asymptomatic conditions to potentially fatal disease. The kidney is one of the affected targets of coronavirus disease (COVID-19) complications, and renal dysfunction is a significant prognostic factor for mortality. This report describes a series of clinical complications in a previously healthy child who developed nephritic syndrome with a concomitant SARS-CoV-2 infection. These complications include acute kidney injury that progressed to chronicity, multisystemic inflammatory syndrome, Kawasaki-like syndrome, and thrombotic microangiopathy.
Collapse
Affiliation(s)
| | | | - Igor Murad Faria
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | | | | | - Joyce Santos Lages
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
INTRODUCTION National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. OBJECTIVE To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. METHODS Data collection from dialysis units in the country through a completed online questionnaire for 2019. RESULTS 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. CONCLUSION The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.
Collapse
|
23
|
Wanderley DC, Neves PDMDM, Jorge LB, Onuchic LF, Araujo SA. The immunohistological profile of membranous nephropathy associated with syphilis infection. Clin Kidney J 2021; 14:1857-1858. [PMID: 34221395 PMCID: PMC8243262 DOI: 10.1093/ckj/sfab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Indexed: 01/23/2023] Open
Affiliation(s)
- David Campos Wanderley
- Centro de Microscopia Eletrônica, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Instituto de Nefropatologia, Belo Horizonte, Brazil
| | | | | | | | - Stanley Almeida Araujo
- Centro de Microscopia Eletrônica, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Instituto de Nefropatologia, Belo Horizonte, Brazil
| |
Collapse
|
24
|
Neves PDMDM, Souza RA, Torres FM, Reis FA, Pinheiro RB, Dias CB, Yu L, Woronik V, Furukawa LS, Cavalcante LB, de Almeida Araújo S, Wanderley DC, Malheiros DM, Jorge LB. Evidences of histologic thrombotic microangiopathy and the impact in renal outcomes of patients with IgA nephropathy. PLoS One 2020; 15:e0233199. [PMID: 33147224 PMCID: PMC7641451 DOI: 10.1371/journal.pone.0233199] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. According to the Oxford Classification, changes in the kidney vascular compartment are not related with worse outcomes. This paper aims to assess the impact of thrombotic microangiopathy (TMA) in the outcomes of Brazilian patients with IgAN. MATERIALS AND METHODS Analysis of clinical data and kidney biopsy findings from patients with IgAN to assess the impact of TMA on renal outcomes. RESULTS The majority of the 118 patients included were females (54.3%); mean age of 33 years (25;43); hypertension and hematuria were observed in 67.8% and 89.8%, respectively. Median creatinine: 1.45mg/dL; eGFR: 48.8ml/min/1.73m2; 24-hour proteinuria: 2.01g; low serum C3: 12.5%. Regarding to Oxford Classification: M1: 76.3%; E1: 35.6%; S1: 70.3%; T1/T2: 38.3%; C1/C2: 28.8%. Average follow-up: 65 months. Histologic evidence of TMA were detected in 21 (17.8%) patients and those ones presented more frequently hypertension (100% vs. 61%, p <0.0001), hematuria (100% vs 87.6%, p = 0.0001), worse creatinine levels (3.8 vs. 1.38 mg/dL, p = 0.0001), eGFR (18 vs. 60 ml/min/1.73m2), p = 0.0001), low serum C3 (28.5% vs. 10.4%, p = 0.003), lower hemoglobin levels (10.6 vs. 12.7g/dL, p<0.001) and platelet counts (207,000 vs. 267,000, p = 0.001). Biopsy findings of individuals with TMA revealed only greater proportions of E1 (68% vs. 32%, p = 0.002). Individuals with TMA were followed for less time (7 vs. 65 months, p<0.0001) since they progressed more frequently to chronic kidney disease (CKD) requiring kidney replacement therapy (KRT) (71.4% vs. 21,6%, p<0.0001). Male sex, T1/T2, and TMA were independently associated with progression to CKD-KRT. CONCLUSIONS In this study patients with TMA had worse clinical manifestations and outcomes. In terms of histologic evidence, E1 distinguished patients with TMA from other patients. Further studies are necessary to analyze the impact of vascular lesions on IgAN prognosis.
Collapse
Affiliation(s)
| | - Rafael A. Souza
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Fábio M. Torres
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Fábio A. Reis
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Rafaela B. Pinheiro
- Pathology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Cristiane B. Dias
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Luis Yu
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Viktoria Woronik
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Luzia S. Furukawa
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Lívia B. Cavalcante
- Pathology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Stanley de Almeida Araújo
- Nephropathology Institute, Belo Horizonte, MG, Brazil
- Pathology Division, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - David Campos Wanderley
- Nephropathology Institute, Belo Horizonte, MG, Brazil
- Pathology Division, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Denise M. Malheiros
- Pathology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Lectícia B. Jorge
- Nephrology Division, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| |
Collapse
|
25
|
Pio-Abreu A, do Nascimento MM, Vieira MA, de Menezes Neves PDM, Lugon JR, Sesso R. High mortality of CKD patients on hemodialysis with Covid-19 in Brazil. J Nephrol 2020; 33:875-877. [PMID: 32770522 PMCID: PMC7414252 DOI: 10.1007/s40620-020-00823-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Pio-Abreu
- Nephrology Division, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
26
|
Teixeira Júnior AAL, Neves PDMDM, Lages JS, Cunha KDA, Muniz MPR, Brito DJDA, Watanabe A, Watanabe EH, Onuchic LF, Nunes LLA, Coutinho Filho AF, Barcelos FL, Gatto GC, Monteiro A, Polido DDA, Motta DRMDS, Leite TDO, Guedes FL, Gomes OV, Valente LM, Israel KCSP, Ladchumananandasivam FR, de Farias LCL, Marques IDB, Uliano GL, Maramaldo CEC, Neto LGL, Luchi WM, Wanderley DC, Araújo SDA, Salgado Filho N, Silva GEB. Brazilian Consortium for the Study on Renal Diseases Associated With COVID-19: A Multicentric Effort to Understand SARS-CoV-2-Related Nephropathy. Front Med (Lausanne) 2020; 7:584235. [PMID: 33195337 PMCID: PMC7663765 DOI: 10.3389/fmed.2020.584235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2.
Collapse
Affiliation(s)
- Antonio Augusto Lima Teixeira Júnior
- Postgraduate Program in Genetics, Ribeirão Preto Medical School, University of São Paulo (PGGEN-FMRP-USP), Ribeirão Preto, Brazil
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
- Clinical Research Center (CEPEC), University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | - Precil Diego Miranda de Menezes Neves
- Nephrology Division, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
- Molecular Medicine Discipline, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Joyce Santos Lages
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | - Kaile de Araújo Cunha
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
- Nephrology Service, University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | - Monique Pereira Rêgo Muniz
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
- Nephrology Service, University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | - Dyego José de Araújo Brito
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
- Nephrology Service, University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | - Andréia Watanabe
- Nephrology Division, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
- Molecular Medicine Discipline, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
| | - Elieser Hitoshi Watanabe
- Nephrology Division, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
- Molecular Medicine Discipline, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
| | - Luiz Fernando Onuchic
- Nephrology Division, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
- Molecular Medicine Discipline, Medical School, University of São Paulo (FM-USP), São Paulo, Brazil
| | - Lucas Lobato Acatauassu Nunes
- University Hospital Complex, João de Barros Barreto University Hospital, Federal University of Pará (HUJBB – UFPA), Belém, Brazil
| | | | - Flávia Lara Barcelos
- Nephrology Service, University Hospital of Brasilia, University of Brasília (HUB – UNB), Brasília, Brazil
| | - Giuseppe Cesare Gatto
- Nephrology Service, University Hospital of Brasilia, University of Brasília (HUB – UNB), Brasília, Brazil
| | - Antonio Monteiro
- Maria Aparecida Pedrossian University Hospital, Federal University of Mato Grosso do Sul (HUMAP – UFMS), Campo Grande, Brazil
| | | | | | - Thaísa de Oliveira Leite
- Nephrology Service, University Hospital of Lizard, Federal University of Sergipe (HUL - UFS), Lagarto, Brazil
| | - Felipe Leite Guedes
- Nephrology Service, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte (HUOL-UFRN), Natal, Brazil
| | - Orlando Vieira Gomes
- University Hospital, Federal University of Vale do São Francisco (HU-UNIVASF), Petrolina, Brazil
| | | | | | | | | | | | | | - Carlos Eduardo Campos Maramaldo
- Laboratory of Immunology and Microbiology of Respiratory Infections (LIMIR), Maranhão University Center (CEUMA), São Luís, Brazil
| | - Lídio Gonçalves Lima Neto
- Laboratory of Immunology and Microbiology of Respiratory Infections (LIMIR), Maranhão University Center (CEUMA), São Luís, Brazil
| | - Weverton Machado Luchi
- Nephrology Service, Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo (HUCAM-UFES), Vitória, Brazil
| | - David Campos Wanderley
- Nephropathology Institute, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Natalino Salgado Filho
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
- Nephrology Service, University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| | - Gyl Eanes Barros Silva
- University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
- Nephrology Service, University Hospital, Federal University of Maranhão (HU-UFMA), São Luís, Brazil
| |
Collapse
|
27
|
Araújo SDA, Neves PDMDM, Wanderley DC, Reis MAD, Dias CB, Malheiros DMAC, Onuchic LF. The immunohistological profile of membranous nephropathy associated with chronic Schistosoma mansoni infection reveals a glomerulopathy with primary features. Kidney Int 2020; 96:793-794. [PMID: 31445585 DOI: 10.1016/j.kint.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Stanley de Almeida Araújo
- Centro de Microscopia Eletrônica, Federal University of Minas Gerais, BeloHorizonte, Brazil; Instituto de Nefropatologia, Belo Horizonte, Minas Gerais State, Brazil.
| | | | - David Campos Wanderley
- Centro de Microscopia Eletrônica, Federal University of Minas Gerais, BeloHorizonte, Brazil; Instituto de Nefropatologia, Belo Horizonte, Minas Gerais State, Brazil
| | | | | | | | | |
Collapse
|
28
|
de Menezes Neves PDM, Coelho Ferreira BM, Mohrbacher S, Renato Chocair P, Cuvello-Neto AL. Purple urine bag syndrome: a colourful complication of urinary tract infection. Lancet Infect Dis 2020; 20:1215. [PMID: 32979332 DOI: 10.1016/s1473-3099(20)30323-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil.
| | | | - Sara Mohrbacher
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | |
Collapse
|
29
|
Franco RP, Costa CBS, Sousa CS, Rodrigues AT, Neves PDMDM, Chula DC. Hemodialysis Vascular access maintenance in the Covid-19 pandemic: Positioning paper from the Interventional Nephrology Committee of the Brazilian Society of Nephrology. ACTA ACUST UNITED AC 2020; 42:41-43. [PMID: 32877498 PMCID: PMC7479985 DOI: 10.1590/2175-8239-jbn-2020-s110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Vascular accesses for hemodialysis are considered the patient’s lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.
Collapse
Affiliation(s)
| | - Ciro Bruno Silveira Costa
- Clínica TRS, Nefrologia e Hemodiálise, Goiânia, Goiás, Brazil.,Hospital de Acidentados, Goiânia, Goiás, Brasil
| | | | - Anderson Tavares Rodrigues
- Pró-Renal Centro de Nefrologia, Barbacena, MG, Brasil.,Fundação José Bonifácio Lafayette de Andrada, Faculdade de Medicina de Barbacena, Barbacena, MG, Brazil
| | - Precil Diego Miranda de Menezes Neves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Nefrologia, São Paulo, SP, Brazil.,Hospital Alemão Oswaldo Cruz, Centro Especializado em Nefrologia e Diálise, São Paulo, SP, Brazil
| | - Domingos Candiota Chula
- Fundação Pró-Renal, Centro de Nefrologia Intervencionista, Curitiba, PR, Brazil.,Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brazil
| |
Collapse
|
30
|
Chocair PR, Neves PDMDM, Pereira LVB, Mohrbacher S, Oliveira ES, Nardotto LL, Bales AM, Sato VAH, Ferreira BMC, Cuvello Neto AL. Covid-19 and Metabolic Syndrome. ACTA ACUST UNITED AC 2020; 66:871-875. [PMID: 32844933 DOI: 10.1590/1806-9282.66.7.871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/23/2020] [Indexed: 01/18/2023]
Affiliation(s)
| | | | | | - Sara Mohrbacher
- Serviço de Clínica Médica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | | | | | | | | | | | | |
Collapse
|
31
|
Neves PDMDM, Sesso RDCC, Thomé FS, Lugon JR, Nasicmento MM. Brazilian Dialysis Census: analysis of data from the 2009-2018 decade. J Bras Nefrol 2020; 42:191-200. [PMID: 32459279 PMCID: PMC7427641 DOI: 10.1590/2175-8239-jbn-2019-0234] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/30/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION National data on chronic dialysis treatment are essential for the development of health policies that aim to improve patient treatment. OBJECTIVE To present data from the Brazilian Society of Nephrology on patients with chronic dialysis for kidney disease in July 2018, making a comparative analysis of the past 10 years. METHODS Data collection from dialysis units, with filling in an online questionnaire for 2018. Data from 2009, 2013 and 2018 were compared. RESULTS 288 (36.6%) centers answered the questionnaire. In July 2018, the estimated total number of patients on dialysis was 133,464. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 640 and 204, respectively, with average annual increases of 23.5 pmp and 6 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 19.5%. Of the prevalent patients, 92.3% were on hemodialysis and 7.7% on peritoneal dialysis, with 29,545 (22.1%) on the waiting list for transplantation. Median bicarbonate concentration in the hemodialysis bath was 32 mEq/L. Venous catheters were used as access in 23.6% of the hemodialysis patients. The prevalence rate of positive serology for hepatitis C showed a progressive reduction (3.2%). CONCLUSION The absolute number of patients and rates of incidence and prevalence in dialysis in the country increased substantially in the period, although there are considerable differences in rates by state. There has been a persistent increase in the use of venous catheters as an access for dialysis; and reduction in the number of patients with positive serology for hepatitis C.
Collapse
|
32
|
Neves PDMDM, Pinheiro RBB, Dias CB, Yu L, Testagrossa LDA, Cavalcante LB, Malheiros DMAC, Jorge LB, Woronik V. Renal Outcomes in Brazilian Patients with Immunoglobulin A Nephropathy and Cellular Crescentic Lesions. Kidney Blood Press Res 2020; 45:431-441. [PMID: 32299081 DOI: 10.1159/000507251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy. The Oxford classification was recently updated to include crescents as markers of poor prognosis. The aim of this study was to evaluate the impact of cellular crescents on the prognosis of patients with IgAN in Brazil. METHODS This was a single-centre retrospective analysis of medical records and renal biopsies in patients with IgAN. The renal biopsy findings were classified according to the revised Oxford classification: mesangial hypercellularity, endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy or interstitial fibrosis (T), and crescent formation (C). We evaluated a composite outcome (progression to end-stage renal disease or creatinine doubling). We performed analyses between the patients with crescents in the renal biopsy specimen (C1/C2 group) and those without such crescents (C0 group). RESULTS We evaluated 111 patients, of whom 72 (65.0%) were women, 80 (72.0%) self-identified as White, 73 (65.6%) were hypertensive, and 95 (85.6%) had haematuria. The distribution of patients according to cellular crescentic lesions was: C0, 80 (72%); C1, 27 (24.4%); C2, 4 (3.6%). The composite outcome was observed in 33 (29.72%) of the 111 patients. In comparison with the C0 group, the C1/C2 group had higher proportions of patients with hypertension (p = 0.04), haematuria (p = 0.03), worse serum creatinine (p = 0.0007), and worse estimated glomerular filtration rate (p = 0.0007). The C1/C2 group also had higher proportions of patients in whom the biopsy specimen was classified as E1 (p = 0.009), S1 (p = 0.001), or T1/T2 (p = 0.03), In addition, the mean follow-up period was shorter in the C1/C2 group (p < 0.0001). Furthermore, the composite outcome was observed in a greater proportion of patients and in a shorter length of time in the C1/C2 group than in the C0 group (p = 0.002 and p = 0.0014, respectively). In a Cox regression analysis, the independent risk factors for the composite outcome had Oxford classifications of S1, T1/T2, and C1/C2. CONCLUSION Oxford classification findings of S1, T1/T2, or C1/C2 were independent risk factors for the composite outcome, corroborating previous studies.
Collapse
Affiliation(s)
| | | | | | - Luis Yu
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | | | - Viktoria Woronik
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| |
Collapse
|
33
|
de Menezes Neves PDM, Reichert BV, Bridi RA, Yu L, Dias CB, Pinheiro RBB, de Abreu Testagrossa L, Cavalcante LB, Malheiros DMAC, Jorge LB, Woronik V. Atypical presentation of acute post-infectious glomerulonephritis in patients with sickle cell disease: report of two cases. BMC Nephrol 2020; 21:56. [PMID: 32093686 PMCID: PMC7038555 DOI: 10.1186/s12882-020-01715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a highly prevalent genetic disease worldwide. In the natural evolution of SCD, glomerular lesions can develop, presenting histopathological patterns of segmental or focal membranoproliferative glomerulosclerosis, with or without thrombotic microangiopathy. We report two cases of acute post-infectious glomerulonephritis (APIGN), with atypical presentations, in patients with SCD. CASE PRESENTATION Case 1: An 18-year-old female with SCD presented with a 21-day history of progressive oedema, accompanied by dyspnoea, productive cough, fever, and chest pain. Blood tests showed the following: haemoglobin 6.1 g/dl; leucocytes 18,820 cells/mm3; and creatinine 0.49 mg/dl. A urine sample evidenced leucocyturia and haematuria. The 24-h proteinuria was 8.99 g, serum albumin level was 1.2 g/dl, low serum C3 levels and high levels of anti-streptolysin O. Renal biopsy was consistent with APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving to reversal of the renal alterations. Case 2: A 12-year-old male with SCD presented with a 20-day history of a non-productive cough and progressive oedema, together with hypertension. The serum creatinine concentration was 0.48 mg/dl. A urine sample evidenced leukocyturia and haematuria. The 24-h proteinuria was 12.5 g, and the serum albumin level was 2.6 g/dl. The levels of C3 and C4 were normal. Renal biopsy revealed APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving reversal of the renal alterations. CONCLUSIONS The presentation of the two cases reported here are not typical of SCD-related kidney injury. Analysis of the renal biopsy specimens elucidated the diagnosis, affecting the prognosis, because that of APIGN is highly favourable, unlike that of nephrotic syndrome associated with SCD glomerulopathy.
Collapse
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil.
| | - Bernardo Vergara Reichert
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Ramaiane Aparecida Bridi
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Luis Yu
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Cristiane Bitencourt Dias
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | | | | | | | | | - Lectícia Barbosa Jorge
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Viktoria Woronik
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| |
Collapse
|
34
|
Onuchic L, Sato VAH, de Menezes Neves PDM, Balbo BEP, Portela-Neto AA, Ferreira FT, Watanabe EH, Watanabe A, de Almeida MCS, de Abreu Testagrossa L, Chocair PR, Onuchic LF. Two cases of fungal cyst infection in ADPKD: is this really a rare complication? BMC Infect Dis 2019; 19:911. [PMID: 31664917 PMCID: PMC6819534 DOI: 10.1186/s12879-019-4444-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cyst infection is a prevalent complication in autosomal dominant polycystic kidney disease (ADPKD) patients, however therapeutic and diagnostic approaches towards this condition remain unclear. The confirmation of a likely episode of cyst infection by isolating the pathogenic microorganism in a clinical scenario is possible only in the minority of cases. The available antimicrobial treatment guidelines, therefore, might not be appropriate to some patients. Case presentation We describe two unique cases of kidney cyst infection by Candida albicans, a condition that has not been previously described in literature. Both cases presented clear risk factors for Candida spp. infection. However, since there was no initial indication of cyst aspiration and culture, antifungal therapy was not immediately started and empirical treatment was initiated as recommended by the current guidelines. Antifungal treatment was instituted in both cases along the clinical course, according to their specificities. Conclusion Our report highlights the possibility of Candida spp. cyst infection. Failure of clinical improvement with antibiotics should raise the suspicion of a fungal infection. Identification of infected cysts should be pursued in such cases, particularly with PET-CT, and when technically possible followed by cyst aspiration and culture to guide treatment. Risk factors for this condition, such as Candida spp. colonization, previous antimicrobial therapy, hemodialysis, necrotizing pancreatitis, gastrointestinal/hepatobiliary surgical procedure, central venous catheter, total parenteral nutrition, diabetes mellitus and immunodeficiency (neutropenia < 500 neutrophils/mL, hematologic malignancy, chemotherapy, immunosuppressant drugs), should be also considered accepted criteria for empirical antifungal therapy.
Collapse
Affiliation(s)
- Laura Onuchic
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | | | - Precil Diego Miranda de Menezes Neves
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Bruno Eduardo Pedroso Balbo
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Antônio Abel Portela-Neto
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Fernanda Trani Ferreira
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Elieser Hitoshi Watanabe
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | - Andreia Watanabe
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil
| | | | | | - Pedro Renato Chocair
- Nephrology and Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Luiz Fernando Onuchic
- Department of Medicine, Division of Nephrology, University of São Paulo School of Medicine, Avenida Doutor Arnaldo, 455 - Sala 4304, São Paulo, SP, 01246-903, Brazil.
| |
Collapse
|
35
|
Dos Reis Monteiro MLG, Custódio FB, de Menezes Neves PDM, Ferreira FM, Watanabe EH, Lerário AM, de Araújo LS, Balbo BEP, Pinto VCD, Barbosa LMG, de Paiva Marques V, Machado JR, Reis MA, Onuchic LF. A novel single amino acid deletion impairs fibronectin function and causes familial glomerulopathy with fibronectin deposits: case report of a family. BMC Nephrol 2019; 20:322. [PMID: 31419955 PMCID: PMC6697944 DOI: 10.1186/s12882-019-1507-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background Glomerulopathy with fibronectin deposits is an autosomal dominant disease associated with proteinuria, hematuria, hypertension and renal function decline. Forty percent of the cases are caused by mutations in FN1, the gene that encodes fibronectin. Case presentation This report describes two cases of Glomerulopathy with fibronectin deposits, involving a 47-year-old father and a 14-year-old son. The renal biopsies showed glomeruli with endocapillary hypercellularity and large amounts of mesangial and subendothelial eosinophilic deposits. Immunohistochemistry for fibronectin was markedly positive. Whole exome sequencing identified a novel FN1 mutation that leads to an amino-acid deletion in both patients (Ile1988del), a variant that required primary amino-acid sequence analysis for assessment of pathogenicity. Our primary sequence analyses revealed that Ile1988 is very highly conserved among relative sequences and is positioned in a C-terminal FN3 domain containing heparin- and fibulin-1-binding sites. This mutation was predicted as deleterious and molecular mechanics simulations support that it can change the tertiary structure and affect the complex folding and its molecular functionality. Conclusion The current report not only documents the occurrence of two GFND cases in an affected family and deeply characterizes its anatomopathological features but also identifies a novel pathogenic mutation in FN1, analyzes its structural and functional implications, and supports its pathogenicity.
Collapse
Affiliation(s)
| | | | | | | | - Elieser Hitoshi Watanabe
- Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | | | - Liliane Silvano de Araújo
- Nephropathology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330 - Bairro Abadia, Uberaba, MG, 38015-050, Brazil
| | - Bruno Eduardo Pedroso Balbo
- Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | | | - Lívia Maria Gruli Barbosa
- Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | | | - Juliana Reis Machado
- Nephropathology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330 - Bairro Abadia, Uberaba, MG, 38015-050, Brazil
| | - Marlene Antônia Reis
- Nephropathology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330 - Bairro Abadia, Uberaba, MG, 38015-050, Brazil.
| | - Luiz Fernando Onuchic
- Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| |
Collapse
|
36
|
de Menezes Neves PDM, Balbo BEP, Watanabe EH, Rocha-Santos V, Andraus W, D'Albuquerque LAC, Onuchic LF. Functional Budd-Chiari Syndrome Associated With Severe Polycystic Liver Disease. Clin Med Insights Gastroenterol 2017; 10:1179552217713003. [PMID: 28611533 PMCID: PMC5466357 DOI: 10.1177/1179552217713003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022]
Abstract
A 50-year-old woman with end-stage renal disease secondary to autosomal dominant polycystic kidney disease was referred to a quaternary care center due to significantly increased abdominal girth. Her physical examination revealed tense ascites and abdominal collateral veins. A 10-L paracentesis improved abdominal discomfort and disclosed a transudate, suggestive of portal hypertension. A computed tomographic scan revealed massive hepatomegaly caused by multiple cysts of variable sizes, distributed throughout all hepatic segments. Contrast-enhanced imaging uncovered extrinsic compression of hepatic and portal veins, resulting in functional Budd-Chiari syndrome and portal hypertension. Although image-guided drainage followed by sclerosis of dominant cysts could potentially lead to alleviation of the extrinsic compression, the associated significant risk of cyst hemorrhage and infection precluded this procedure. In this scenario, the decision was to submit the patient to a liver-kidney transplantation. After 1 year of this procedure, the patient maintains normal liver and kidney function and refers significant improvement in quality of life.
Collapse
Affiliation(s)
| | - Bruno Eduardo Pedroso Balbo
- Divisions of Nephrology and Molecular Medicine, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elieser Hitoshi Watanabe
- Divisions of Nephrology and Molecular Medicine, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wellington Andraus
- Liver Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Fernando Onuchic
- Divisions of Nephrology and Molecular Medicine, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
37
|
de Menezes Neves PDM, Machado JR, Custódio FB, Dos Reis Monteiro MLG, Iwamoto S, Freire M, Ferreira MF, Dos Reis MA. Ultrastructural deposits appearing as "zebra bodies" in renal biopsy: Fabry disease?- comparative case reports. BMC Nephrol 2017; 18:157. [PMID: 28499424 PMCID: PMC5427530 DOI: 10.1186/s12882-017-0571-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 05/03/2017] [Indexed: 12/12/2022] Open
Abstract
Background Fabry Disease (FD) is a genetic disorder caused by alpha-galactosidase A deficiency. Certain drugs, such as hydroxychloroquine, can produce renal deposits that mimic morphological findings seen in FD, characterizing a type of drug-induced renal phospholipidosis. Case presentation Case 1: A 28-year-old female patient with systemic lupus erythematosus who had been using hydroxychloroquine for 14 months presented subnephrotic proteinuria. Renal biopsy showed deposits compatible with FD. Neither activity analysis of alpha-galactosidase A nor genetic analysis were available and were not performed. These deposits were not detected in a subsequent renal biopsy three years after withdrawal of the medication, characterizing a possible hydroxychloroquine-induced renal phospholipidosis. Case 2: A 29-year-old male patient presented with acroparesthesia, angiokeratomas, cornea verticillata and subnephrotic proteinuria. Deposits compatible with FD were detected upon renal biopsy. The evaluation of alpha-galactosidase A showed no activity in both blood and leukocytes. Genetic analysis identified an M284 T mutation in exon 6, and such mutation was also found in other family members. Conclusion Clinical investigation is necessary in suspected cases of Fabry Disease upon renal biopsy in order to confirm diagnosis. Drug-induced renal phospholipidosis should be considered in differential diagnosis in cases with intracellular osmiophilic, lamellar inclusions in electron microscopy.
Collapse
Affiliation(s)
| | - Juliana Reis Machado
- Nephropathology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Uberaba, MG, CEP: 38015-050, Brazil
| | - Fabiano Bichuette Custódio
- Nephropathology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Uberaba, MG, CEP: 38015-050, Brazil
| | | | - Shigueo Iwamoto
- Renal Therapy Unit, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Uberaba, MG, CEP: 38015-050, Brazil
| | - Marlene Freire
- Rheumatology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Uberaba, MG, CEP: 38015-050, Brazil
| | - Marisa França Ferreira
- Nephrology Service, Felício Rocho Hospital, Rua Uberaba, 500, Belo Horizonte, MG, CEP: 30180-080, Brazil
| | - Marlene Antônia Dos Reis
- Nephropathology Service, Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Uberaba, MG, CEP: 38015-050, Brazil.
| |
Collapse
|
38
|
Paula FJD, Neves PDMDM, Bridi RA, Song ATW, David-Neto E. First Report of Granulicatella sp. Endocarditis in a Kidney Transplant
Patient. J Bras Nefrol 2017; 39:341-344. [DOI: 10.5935/0101-2800.20170059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/16/2017] [Indexed: 11/20/2022] Open
|
39
|
de Menezes Neves PDM, Machado JR, Dos Reis MA, de Paiva Marques V. Primary renal lymphoma: an uncommon diagnosis for acute kidney failure. Clin Kidney J 2015; 5:476-7. [PMID: 26019832 PMCID: PMC4432422 DOI: 10.1093/ckj/sfs113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/22/2012] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Juliana Reis Machado
- Nephropathology Service, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | | |
Collapse
|
40
|
Abstract
UNLABELLED Association between severe hypothyroidism and acute kidney injury (AKI) is rare. A 40-year-old woman presented with 15 days history of generalised muscle pain, weakness, weight gain and oedema. MEDICAL HISTORY hypertension and hypothyroidism. PHYSICAL EXAMINATION dry skin, peripheral/periorbital oedema, slow thought and speaking, thyroid increased. Laboratory examinations: high levels of creatine kinase , creatinine, uric acid and lactate dehydrogenase. Free T4 was very low (<0.3 ng/dL) and thyroid-stimulating hormone was high (21.7 µIU/mL). Urinalysis showed haem pigment without haematuria. We performed the diagnosis of AKI secondary to hypothyroidism-induced rhabdomyolysis. Intravenous fluids were started, urinary alkalisation and increased l-thyroxine dose replacement. On the day after admission, forced diuresis with furosemide was introduced leading to a progressive improvement of symptoms. Although hypothyroidism and AKI is unusual, it should be suspected in patients presenting decrease of renal function and high creatine kinase in the absence of other causes of rhabdomyolysis.
Collapse
|
41
|
Machado JR, Silva MVD, Neves PDMDM, Oliveira FAD, Corrêa RRM, Rodrigues WVD, Benson M, Reis MAD. Fibrinogen A alpha-chain amyloidosis: report of the first case in Latin America. Amyloid 2013; 20:52-5. [PMID: 23343498 DOI: 10.3109/13506129.2012.763029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hereditary fibrinogen A alpha-chain (AFib) amyloidosis affects different organs, especially the kidneys. No case of this disease has been reported in Latin America. CASE REPORT A 52-year-old previously healthy Brazilian woman presented with a seven-month history of proteinuria in the absence of hematuria. The patient had normal blood pressure and reported no other symptoms. A renal biopsy was obtained and light microscopy revealed the presence of Congo red positive deposits (apple-green birefringence under polarized light) only in the glomerular compartment. These deposits were strongly immunoreactive to fibrinogen in all glomeruli. Electron microscopy showed the presence of organized deposits compatible with AFib. The diagnosis was confirmed by DNA analysis of the AFib gene, which demonstrated a Glu526Val mutation in one allele. CONCLUSION This first description of hereditary AFib amyloidosis in Latin America highlights the need to include this type of amyloidosis in the differential diagnosis, especially in Brazil where the degree of miscegenation is high.
Collapse
Affiliation(s)
- Juliana Reis Machado
- Nephropathology Service, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Neves PDMDM, Oliveira AADOE, Oliveira MCDOE, Machado JR, Reis MAD, Mendonça HM, Resende LAPRD, Marques VDP. Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis. J Bras Nefrol 2012; 34:243-50. [PMID: 23099829 DOI: 10.5935/0101-2800.20120005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 04/30/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The detection of the renal artery stenosis in hypertensive patients can be a signal of systemic arterial atherosclerosis. AIMS To identify and characterize clinical-epidemiologically the hypertensive patients with renal artery stenosis, evaluating factors of cardiovascular risk and presence of symptomatic multiarterial atherosclerotic. METHOD Were selected the hypertensive patients who were assisted at the Nephrological Clinic of Universidade Federal do Triângulo Mineiro (UFTM) between 2000-2010, with diagnosis of renal artery stenosis of atherosclerotic etiology. Epidemiological data were evaluated (gender, age, ethnicity), factors of cardiovascular risk (diabetes, hypercholesterolemia, hypertriglyceridemia, tabagism, metabolic syndrome), information on hypertension (time of diagnosis, family report, number of used medicines), previous cardiovascular events (acute myocardial infarctation, ischemic stroke, peripheral arterial disease). Blood pressure levels, global cardiovascular risk and Score Framingham were stratified. RESULTS Casuistry of 30 patients, feminine majority (73.3%), average of 66 year-old age, 86.67% white, medium time of hypertension of 19.94 years, 89.92 without family report, 13.8 with diabetes, 65.51% smoking, 17.25% hypertriglyredemia, 62.06% with hypercholesterolemia and 66.7% with metabolic syndrome. Average number of medicines in use: 3.26. Dominant right-sided renal artery stenosis separately (46.7%) and in proximal third (56.7%). High creatinine levels in 40% of the patients. As for the hypertension phase, majority phase 2 (47%) and 73.3% with high global cardiovascular risk. Average Framingham Score of 13%. 66.7% presented atherosclerotic disease in another place, being infarctation the main one (53.3%). CONCLUSION The most common correlation was with acute myocardial infarctation, what implicates in the search of the coronary compromising to the diagnosis of renal artery stenosis in hypertensive patients to try avoid future damages to the patient.
Collapse
|
43
|
Neves PDMDM, Machado JR, Silva MVD, Abate DTDRES, Rodrigues DBR, Faleiros ACG, Reis MAD. [IgA nephropathy: histological analysis and clinicomorfological correlation in patients from Minas Gerais State]. ACTA ACUST UNITED AC 2012; 34:101-8. [PMID: 22850910 DOI: 10.1590/s0101-28002012000200001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 03/20/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION IgA nephropathy (IgAN) is the most common primary glomerulopathy. OBJECTIVE Classify IgAN according to the new Oxford's classification. METHODS We analyzed the renal biopsies from the Nephropathology Service of UFTM, among 1996 to 2010, with a diagnosis of IgAN. We assessed gender, age, presence of hematuria, patterns/intensity of the lesions, deposition of IgA, IgG, IgM, Kappa, Lambda, C3, C1q and fibrinogen. Based on the histological alterations, the biopsies were characterized according to the Oxford Classification, and the clinicomorfological correlation was made. Significative results for p < 0,05. RESULTS A total of 164 cases biopsies, predominantly male (53.7%) and adults (93.3%). We characterized the patients according Oxford Classification, there was a predominance of the pattern M0 (85,3%), S1 (53,1%), E0 (65,2%) e T0 (70,1%). About the clinicomorfological correlation, we observed more severe proteinuria comparing M1 to M0 (p < 0,008), low estimated GFR (p < 0,001) and more frequent hypertension (p < 0,001) comparing T0, T1 e T2. On immunofluorescence, there is a predominance of IgA (100% of cases), with co-deposition of C3 (99.37% of cases), Kappa (96.25%), Lambda (91.25%) and IgM (76.92%). Correlation was found between IgA intensity and C3, Kappa and Lambda. CONCLUSION In this study, IgA nephropathy was predominant in males, the more frequent patterns were the M0, S1, E0 and T0, with more severe proteinuria and the enhance of mesangial hypercellularity, besides larger prevalence of hypertension/worse kidney function according the tubulo-interstitial injuries.
Collapse
|
44
|
Rocha MM, Neves PDMDM, Rodrigues CCM, Carrara GFA, Simões FF, Etchebehere RM, dos Santos JPV, Fatureto MC. Invasive thymoma in a child: a rare case report. J Pediatr Surg 2012; 47:e23-5. [PMID: 22325416 DOI: 10.1016/j.jpedsurg.2011.11.006] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 11/17/2022]
Abstract
Thymomas are neoplasms of the anterior mediastinum and generally occur between the fourth and sixth decades of life. In children, they are rare, with few reported cases. We describe a 9-year-old boy with invasive thymoma treated successfully by surgery alone. The patient was previously healthy and under treatment for a community-acquired pneumonia. A chest radiograph showed an opacity at the left lung base, and thoracic computed tomographic scan showed a mass with thick walls and liquid content situated in the lingula with no cleavage plane with the mediastinum. The patient underwent a left anterolateral thoracotomy, which showed a mass extending from the anterior mediastinum, infiltrating the left upper lobe of lung, phrenic nerve, and pericardium. A left upper lobectomy and resection of the mediastinal mass and lymph nodes were carried out. The pathologic analysis showed it to be a type B3 fusiform-cell thymoma, infiltrating the left upper lobe and 1 peribronchial lymph node. A multidisciplined tumor group decided to observe the patient and followed with thoracic computed tomographic scans every 3 months. After 2 years of follow-up, the patient has no evidence of recurrent disease.
Collapse
Affiliation(s)
- Mauricio Murce Rocha
- Surgery Department, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Marques VDP, Neves PDMDM, Mendonça HM, Fugikaha I, Fernandes EL. Glomerulonefrite aguda após infecção de vias aéreas superiores ou pele: análise descritiva de 82 pacientes entre 14 e 64 anos de idade. J Bras Nefrol 2010. [DOI: 10.1590/s0101-28002010000300003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
46
|
Marques VDP, Neves PDMDM, Mendonça HM, Fugikaha I, Fernandes EL. Acute glomerulonephritis after upper airway or skin infection: descriptive analysis of 82 cases between 14 and 64 years-old. J Bras Nefrol 2010; 32:237-241. [PMID: 21103685] [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] [Received: 05/06/2010] [Accepted: 07/10/2010] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Acute glomerulonephritis (AGN) after infection of the upper airways or skin is a kidney disease usually caused by streptococcal nephritogenic strains and may present with sudden onset of gross hematuria, hypertension, edema and, occasionally, acute renal failure, is common in childhood and little incident in adults and younger individuals. OBJECTIVE To analyze, in a descriptive way, data from the initial presentation of GNA after infection of the upper airways or skin in patients over 14 years of age, with emphasis on its epidemiological and clinical aspects. PATIENTS AND METHODS We reviewed the clinical data of 82 patients treated at our department during the period 1972-2001, divided into three groups: group 1, with individuals between 14 and 20 years (n = 52), group 2, between 21 and 30 years (n = 19) and group 3, aged ≥; 31 years (n = 11). RESULTS There was a predominance of the table among younger patients (group 1), male and white, mostly preceded by infection of the skin, appearing most commonly on lower extremity edema and/or face. In some cases, even with nephrotic syndrome, and hypertension, especially in adults over 30 years (group 3), being the least frequent finding of gross hematuria, and rarely, acute renal failure. CONCLUSION Our findings underscore the importance of studying the AGN after infection of the upper airways or skin in younger individuals and adults, seeking to better characterize its clinical, mainly because it is a group of patients where the disease is less incident.
Collapse
Affiliation(s)
- Vilmar de Paiva Marques
- Universidade Federal do Triângulo Mineiro, Universidade de Uberaba, Institute of Hemodialysis and Kidney Transplantation of the city of Uberaba, Brazil.
| | | | | | | | | |
Collapse
|