Percorrer por autor "Vieira, Pedro"
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- Celiac Disease as a Rare Cause of Membranous Nephropathy: A Case ReportPublication . Pestana, Nicole; Vida, Carlota; Durães, José; Silva, Gil; Vieira, PedroMembranous nephropathy is the most common cause of nephrotic syndrome in adults. A non-negligible number of cases are associated with systemic conditions. We report a case of a 50-year-old man who presented with nephrotic syndrome six months after being diagnosed with celiac disease. Although the patient showed disappearance of circulating immunoglobulin A (IgA) anti-tissue transglutaminase antibodies following a gluten-free diet, he had a sudden onset of nephrotic syndrome presenting with severe hypoalbuminemia. Other secondary causes were promptly excluded leading to the assumption of celiac disease-associated membranous nephropathy with remission after treatment with angiotensin system blockade and a gluten-free diet. The goal of this case report is to alert the clinic towards this rare association aiming for an early diagnosis and adequate selection of long-term therapy.
- Crescent-like lesions as an early signature of nephropathy in a rat model of prediabetes induced by a hypercaloric dietPublication . Nunes, Sara; Alves, André; Preguiça, Inês; Barbosa, Adelaide; Vieira, Pedro; Mendes, Fernando; Martins, Diana; Viana, Sofia; Reis, FlávioDiabetic nephropathy (DN) is a major microvascular complication of diabetes. Obesity and hyperlipidemia, fueled by unhealthy food habits, are risk factors to glomerular filtration rate (GFR) decline and DN progression. Several studies recommend that diabetic patients should be screened early (in prediabetes) for kidney disease, in order to prevent advanced stages, for whom the current interventions are clearly inefficient. This ambition greatly depends on the existence of accurate early biomarkers and novel molecular targets, which only may arise with a more thorough knowledge of disease pathophysiology. We used a rat model of prediabetes induced by 23 weeks of high-sugar/high-fat (HSuHF) diet to characterize the phenotype of early renal dysfunction and injury. When compared with the control animals, HSuHF-treated rats displayed a metabolic phenotype compatible with obese prediabetes, displaying impaired glucose tolerance and insulin sensitivity, along with hypertriglyceridemia, and lipid peroxidation. Despite unchanged creatinine levels, the prediabetic animals presented glomerular crescent-like lesions, accompanied by increased kidney Oil-Red-O staining, triglycerides content and mRNA expression of IL-6 and iNOS. This model of HSuHF-induced prediabetes can be a useful tool to study early features of DN, namely crescent-like lesions, an early signature that deserves in-depth elucidation.
- Echocardiography and cardiovascular risk:The relationship in the renal transplant recipientPublication . Neto, Micaela; Gonçalves, Miguel; Resende, Luis; Vieira, Pedro; Gomes, Susana; Durães, José; Rosa, Nuno; Teixeira, José Alves; Silva, GilIntroduction: Cardiovascular disease (CVD) is the major cause of death among renal transplant recipientes (RTR). It is not known whether echocardiographic abnormalities are useful to identify RTR at high risk of CVD. Methods: Retrospective review of RTR with functioning and stable graft and an echocardiography performed in the last year. Risk of major adverse cardiac events (MACE) and death using a risk calculator specific for RTR. Results: Among 107 patients (57.9% males, 50.4±13.9 years), 7-year risk of MACE was >10% in 30.9% of patients and 7-year risk of death >10% in 56.1%. Left ventricular hypertrophy (LVH) was found in 55.1%, diastolic dysfunction in 39.3%, dilated left atrium (LA) in 53.3%, high pulmonary artery systolic pressure (PASP) in 9.0%, valvular calcifications in 22.4% and moderate to severe mitral regurgitation (MR) in 3.7%. Mean Ejection fraction was 68.36±6.87%. Univariate analysis showed an increased risk of MACE and death in patients with LVH, diastolic dysfunction, dilated LA, high PASP, valvular calcifications and MR. Multivariate analysis identified an independente association between the risk of MACE >10% and valvular calcifications and high PASP. Risk of death>10% in multivariate analysis had an independent association with diastolic dysfunction and elevated PASP. Conclusion: Echocardiographic abnormalities identify RTR at increased risk of MACE and death. Valvular calcifications and high PASP are predictors of MACE whereas diastolic dysfunction and high PASP predict death.
- A FENITOÍNA COMO TERAPÊUTICA NA SÍNDROME DE SECREÇÃO INADEQUADA DE HORMONA ANTIDIURÉTICAPublication . Correia, Maria Inês; Vieira, Pedro; Correia, Luís Marote; Santos, Dina; Lélis, Manuela; Brazão, Maria Da Luz
- IgA dominant glomerulonephritis associated to staphylococcus infection: a peculiar case reportPublication . Pestana, Nicole; Vieira, Pedro; Silva, Francisca; Figueira, José Ricardo; Silva, Gil; Durães, JoséIgA dominant glomerulonephritis associated to Staphylococcus infection is a rare clinical entity that has been described mainly in case reports. Biopsy features can resemble other disease entities mainly IgA nephropathy and Henoch‑Schönlein purpura nephritis. Treatment of IgA dominant glomerulonephritis associated to staphylococcal infection is based on antibiotics for the underlying infection, controlling hypertension and edema and may resort to concomitant use of steroids in selected cases. Prognosis markers such as hypertension, diabetes and interstitial fibrosis may influence treatment as they are associated with poor renal outcomes. We report a case of a 63‑year‑old man with known hypertension, pre‑diabetes and recent history of methicillin‐sensitive staphylococcus aureus bacteremia associated to prostatitis, who presented with a one‑month history of edema, arthralgia and foamy urine. Over this period he progressed to anasarca and nephrotic range proteinuria with concomitant rise in creatinine levels being documented. The renal biopsy showed segmental endocapillary proliferation and IgA segmental dominant staining associated to C3 and lambda in minor distribution. On completion of two months of steroid therapy the patient partially recovered his renal function and proteinuria. After nine months of tapering steroids, he presented with acute inflammatory arthritis supporting an inflammatory background disease. To our knowledge this case describes an unusual entity such as IgA dominant glomerulonephritis associated to staphylococcal infection co‑presenting with an associated reactive arthritis.
- A new millennium for women and kidney diseasePublication . Pestana, Nicole; Vieira, Pedro; Silva, GilIntroduction: Taking advantage of this year’s synergy, as World Kidney Day (WKD) and International Women’s Day fall on the same day, the theme chosen for WKD 2018 was “Kidneys and Women’s health”, drawing the attention of the nephrology community to the special features of diseases of the kidney as they affect women. When focusing on this subject, we come to see the major gaps in this area of knowledge. On one hand, it is now comprehensively accepted that there are unique biological and behavioral differences resulting in sex/gender variances, albeit mostly in favour of women. However, on the other, despite mounting evidence in multiple medical disciplines, these disparities have not been so well explored in nephrology, and so we try, in this editorial, to review current knowledge n this field.
- Rare aetiology of obstructive kidney injury: Bilateral ureteral endometriosisPublication . Correia, Maria Inês; Vieira, Pedro; Gonçalves, Miguel; Durães, José M; Santos, Dina; Rosa, Nuno G; Silva, GilEndometriosis is highly prevalent in women at the reproductive age, ranging from 6-10%, though ureteral involvement is rare, only seen in 0.1% of the cases, but may lead to urinary tract obstruction with potential renal function loss. As endometriosis has a non-specific symptomology, diagnosis may be elusive, though it must be considered in order to prevent irreversible kidney injury and resultant morbidity. Here we present a 29-year-old Caucasian female with a past medical history of infertility and dysmenorrhoea who presented with a stage II acute kidney injury. On initial diagnostic approach, moderate bilateral ureterohydronephrosis was detected by ultrasound, assuming extrinsic compression, but no specific cause was recognizable. In order to diagnose the obstruction’s aetiology, Magnetic Resonance Imaging was used. This did not reveal an objective cause. Given the circumstances, workup ended in an explorative laparotomy, revealing a “frozen pelvis” due to endometriosis, confirmed histologically. Due to difficult ressecability, a conservative approach was taken through hormonal reatment and bilateral ureteral pigtail placement, given the necessity to salvage renal function and decrease disease burden.
- Renal Disease in Madera Islands: twenty years experience of native kidney biopsiesPublication . Vieira, Pedro; Goncalves, Miguel; Durães, José; Rosa, Nuno; Resende, Luís; Silva, Gil; Teixeira, Alves; Rodrigues, Fernando; Galvão, Maria; Brinca, Ana; Viana, Helena; Carvalho, Fernanda; Araújo, JoséRenal biopsy plays an essential role either in the diagnosis or in the prognosis of patients with renal disease. In order to assess its epidemiology and evolution in Madeira Islands, we analysed twenty-seven years of native kidney biopsies. Methods: We performed a retrospective analysis of clinical records, including histological revision from 1986 to 2012, totalling 315 native kidney biopsies. They were assessed regarding the temporal evolution both for the quality/indications for renal biopsy and for the patterns of kidney disease. Results: A total of 315 native kidney biopsies were analysed. The patients’ mean age was of 40.8 ± 18.4 years and 50.5%(n = 159) were males. The most common indications for renal biopsy were nephrotic syndrome (36.2%, n = 114) and acute kidney injury (20.0%, n = 63). Among primary glomerular diseases (41.5%, n = 115) the most common were IgA nephropathy (26.1%, n = 30) and focal-segmental glomerulosclerosis (17.4%, n = 20) and among secondary glomerular diseases (31.4%, n = 87), lupus nephritis (51.7%, n = 45) and amyloidosis (20.7%, n = 18). Statistical analysis revealed significant correlation between gender and major pathological diagnosis (Fisher’s exact test, p <.01) and between indications for renal biopsy and major pathological diagnosis (χ2, p <.01). Regarding the temporal evolution, no statistically significant differences were found in the number of renal biopsies (χ2, p =.193), number of glomeruli per sample (Fisher’s exact test, p =.669), age (Kruskal-Wallis, p =.216), indications for renal biopsy (χ2, p =.106) or major pathological diagnosis groups (χ2, =.649). However, considering the specific clinico-pathological diagnoses and their temporal variation, a statistically significant difference (Fisher’s exact test, p <.05) was found for lupus nephritis and membranous nephropathy with an increasing incidence and for amyloidosis with an opposite tendency. Discussion: The review of the native kidney biopsies from a population with particular characteristics, geographically isolated, such as those from Madeira Islands, showed parallel between epidemiological numbers referring to other
- Situs ambiguous and absence of the inferior vena cava: an extremely rare cause of femoral hemodialysis catheter dysfunctionPublication . Vieira, Pedro; Rosa, Nuno G.; Castanha, Guida; Silva, GilHemodialysis catheter dysfunction (CDys) has been defined by Kidney Disease utcomes Quality Initiative (K/DOQI) guidelines as “failure to maintain an extracorporeal blood flow sufficient to perform hemodialysis without significantly lengthening the hemodialysis treatment” [1], influencing stage 5 chronic kidney disease (CKD) patients’ morbidity and mortality [2]. Among the causes of CDys, those occurring within the first 2 weeks of placement are defined as early dysfunction commonly resulting from mechanical problems, which include inadequate positioning, kinking, or constriction, while late dysfunction usually results from thrombus formation [1]. However, this case report demonstrates that one must also consider other causes of CDys.
- The first ABO-incompatible kidney transplantation performed in PortugalPublication . Barreto, Patrícia; Vieira, Pedro; Dias, Leonidio; Almeida, Manuela; Pedroso, Sofia; Martins, La Salete; Henriques, António Castro; BINI ANTUNES, MARIKAKidney transplantation is the optimal treatment of end -stage renal disease (ESRD) improving survival and quality of life for most recipients. In our country, potential living donors have been refused due to the ABO incompatibility barrier. However, ABO -incompatible living donor kidney transplant is presently common practice in several countries with good outcomes. The authors describe a case of a 49 -year -old female patient, with chronic kidney disease due to autosomal dominant polycystic kidney disease, who had started haemodialysis 10 months before and with blood group O. The living donor was a 53 -year -old sister with blood group B. The desensitization protocol was based on rituximab and plasmapheresis. The induction protocol used was basiliximab, tacrolimus, mofetil mycophenolate and metilprednisolone. Five days post -transplant she presented a normal graft function that remained during the eight months follow -up. This case reveals the first ABO incompatible living donor kidney transplant performed in Portugal with excellent outcome.