SESARAM - Nef - Nefrologia
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- RabdomiólisePublication . Rodrigues, Fernando; Araújo, José AugustoINTRODUÇÃO A rabdomiólise é definida como uma síndrome clínico--laboratorial que decorre da lise das células musculares esqueléticas, com a libertação de substâncias intracelulares para a circulação. A maioria dos casos de rabdomiólise está relacionada com o consumo de álcool, actividade convulsiva e compressão muscular, por imobilização prolongada e depressão do estado de consciência1. O crush syndrome é outra causa importante de miólise. Neste caso, a destruição muscular decorre da compressão traumática e sobretudo da lesão de reperfusão, no contexto de acidentes de viação ou grandes catástrofes naturais (e.g. terramotos). O diagnóstico e a terapêutica precoces são fundamentais para evitar a progressão para insuficiência renal aguda RA) oligúrica e a necessidade de terapêutica dialítica que se associa a morbilidade e custos não desprezíveis
- Fungal peritonitis in peritoneal dialysis patients: is previous antibiotic therapy an essential condition?Publication . Guimarães Rosa, Nuno; Silva, Sónia; Lopes, José António; Branco, Patrícia; de Almeida, Edgar; Ribeiro, Carlos; Abreu, Fernando; Barbas, José; Martins Prata, M.The aim of this study was to analyse the clinical and microbiological features of fungal peritonitis, in chronic peritoneal dialysis patients, focusing on non-traditional risk factors for this feared complication. From 2001 to 2004, five episodes of fungal peritonitis were diagnosed in five different patients, accounting for 4.5% of all peritonitis cases seen during this period. Candida spp. were the most frequent isolates. In all cases, peritoneal dialysis catheter removal and switching to haemodialysis were necessary. In these five cases of fungal peritonitis only one was preceded by antibiotic use, within the previous 3 months, the classical risk factor for fungal peritonitis. Identifying predisposing factors usually not taken into account, may lead to an early diagnosis and to a better understanding of fungal peritonitis pathogenesis.
- Iliac artery false aneurysm twelve years after allograft nephrectomyPublication . Guimarães Rosa, Nuno; Silva, Sónia; Jorge, Sofia; Branco, Patricia; Inácio, João; Barbas, José; Gomes da Costa, A; Martins Prata, MWe report a case of a non-infected right external iliac artery false aneurysm. The patient was a 44 year-old woman on chronic peritoneal dialysis had had an allograft nephrectomy 12 years before and who presented with acute abdominal pain. Ultrasound and CT-scan showed a saccular aneurysm arising from the right external iliac artery. A large false aneurysm was identified during surgery, from donor arterial vessel remaining in situ after graft nephrectomy. Resection of the false aneurysm, with ligation of the right external iliac artery and interposition of a femorofemoral graft was successfully performed, with an uneventful post-operative recovery. False aneurysms after renal allograft nephrectomy are very rare. To our knowledge, this is the longest reported period of time between na nephrectomy and clinical evidence of a false aneurysm.
- Homozygous C677T mutation of the 5,10-methylenetetrahydrofolate reductase gene with hyperhomocysteinaemia associated with lupus anticoagulant in a chronic peritoneal dialysis patient with cerebral venous thrombosis- Case ReportPublication . Guimaraes, Nuno; Silva, Sónia; Branco, Patrícia; Almeida, Edgar de; Canhão, Patrícia; Barbas, José; Gomes da Costa, A.; Prata, M. MartinsWe report a case of a cerebral venous thrombosis (CVT) in a chronic kidney disease patient with three CVT predisposing conditions. A 53 year-old woman on chronic peritoneal dialysis presented to the emergency department with acute headache and vertigo. The neurological examination and head CT scan performed at the emergency department were normal but, three days later, a lateral gait deviation and a horizontal nystagmus were identified. A brain MRI and MRI-venogram confirmed a left lateral sinus thrombosis. Hormonal replacement therapy (HRT), a positive lupus anticoagulante and a homozygous mutation on the methylenetetrahydrofolate reductase gene, with hyperhomocysteinaemia, were the three well-known prothrombotic conditions identified in this patient. HRT was discontinued, the patient started anticoagulation with warfarin and folic acid supplementation and was discharged, 10 days after admission, complaining of a mild vertigo. After six months of therapy the patient had vertigo improvement and maintained a positive lupus anticoagulant. The head MRI and MRI-venography showed a thrombus reduction.
- Main Determinants of PON1 Activity in Hemodialysis PatientsPublication . Ribeiro, Sandra; do Sameiro Faria, Maria; Mascarenhas-Melo, Filipa; Freitas, Isabel; Mendonca, Maria Isabel; Nascimento, Henrique; Rocha-Pereira, Petronila; Miranda, Vasco; Mendonça, Denisa; Quintanilha, Alexandre; Belo, Luís; Costa, Elísio; Reis, Flávio; Santos-Silva, AliceCardiovascular diseases are the major cause of morbidity and mortality in hemodialysis (HD) patients. These patients present reduced paraoxonase 1 (PON1) activity that depends on genetic and non-genetic factors; however, how these factors influence PON1 activity in HD patients is poorly clarified. Our aim was to evaluate the influence of two polymorphisms and non-genetic factors on PON1 activity in HD patients.
- 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.
- Metabolic Profile and Cardiovascular Risk in a Population of Renal transplant recipientsPublication . Gonçalves, M; Vieira, P; Resende, L; Durães, J; Rosa, N; Teixeira, JA; Silva, GIntroduction. Cardiovascular disease is more common in renal transplant recipients (RTRs) than in the general population, and is the major cause of both graft loss and patient death in RTRs. Objectives. This study aimed to characterize the cardiovascular risk factors, calculate the 7-year risk for major adverse cardiac events and the 7-year risk for death in a population of RTRs using a cardiovascular risk calculator, and determine the main cardiovascular risk factors associated with increased prediction of major adverse cardiac event (MACE) and death. Patients. This is a retrospective review of clinical data from 121 RTRs who are in follow-up programs at our institution, and who had a functioning and stable graft for longer than 6 months. Results. Among 121 adult patients followed at our institution (59.5% males, mean age of 49.6 13.8 years, mean times for functioning grafts were 105 73.5 mo), 86.8% had hypertension, 19.8% had diabetes, 24.8% were current or former smokers, 61.9% had increased body mass index, and 71% had dyslipidemia. The 7-year risk for MACE was more than 10% in 38 (31.4%) patients with age, diabetes, and smoke being independent risk predictors. The 7-year risk for death was more than 10% in 56 (46.3%) patients with age, diabetes, blood pressure, smoking, and male gender being independent risk predictors. Conclusion. There is a high prevalence of cardiovascular risk factors in a population of RTRs, and there is increased risk for MACE and death. Accurate risk prediction is important for physician decision support and patient education, promoting improved cardiovascular health of RTRs, and thus prolonging the survival of both patients and graft.
- Blood pressure and phosphate level in diabetic and non-diabetic kidney disease: Results of the cross-sectional "Low Clearance Consultation" studyPublication . Mendes, Margarida; Resende, Luis; Teixeira, Alves; Correia, João; Silva, GilA statistically significant and moderate positive correlation was verified between systolic blood pressure and plasma phosphate concentration in the whole sample (diabetic and non-diabetic), due to the diabetic chronic kidney disease group.A statistically significant and moderate positive correlation was verified between the diastolic blood pressure and plasma phosphate concentration in the whole sample (diabetic and non-diabetic), due to the diabetic chronic kidney disease group.A statistically significant and strong negative correlation was found between diastolic blood pressure and estimated glomerular filtration rate in the diabetic chronic kidney disease group, but there was no statistically significant correlation in the whole sample (diabetic and non-diabetic).
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