RUI TOLEDO BARROS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject KIDNEY BIOPSIES IN HIV PATIENTS: A FIFTEEN-YEAR SINGLE CENTER EXPERIENCE IN BRAZIL(2012) CALDIN, Bruno; HUNG, James; REPIZO, Liliany; MALHEIROS, Denise M.; BARROS, Rui; WORONIK, ViktoriaIntroduction and Aims: Human Immunodeficiency Virus (HIV) is associated to many kidney pathologies, like glomerular, vascular and tubule-interstitial alterations. Few data on renal biopsies in HIV patients are available in Brazil. Our objective is to reveal the prevalence and outcomes related to the different diagnosis concerning kidney pathology in a single brazilian reference center. Methods: From 1985 to 2010, we performed 69 kidney biopsies in HIV-positive patients at the Hospital das Clínicas, University of São Paulo. We correlated clinical and laboratorial data to the results of kidney biopsies from these patients and established clinical outcomes depending on the kind of glomerular lesion. Eight biopsies were excluded from analysis due to incomplete data. Results: Mean age of this population was 39,6 ± 11,3 years (range: 15 to 65 years) and 66% were men. Only 3 patients were not under antiretroviral therapy. Main indications for biopsy were: nephrotic syndrome (47%), loss of renal function (37%) and hematuria (31%). The most prevalent glomerulopathy (GP) was focal and segmental glomerulosclerosis (FSGS), which was found in 24 patients (39%), followed by membranoproliferative glomerulonephritis (MPGN) (10 patients, 16% of the total). Six patients (10%) were diagnosed as membranous glomerulonephritis. Vascular disease (atherosclerosis, nephrosclerosis) and acute tubular necrosis were found in three patients each, representing 10% of the population. IgA nephropathy and diabetic GP were diagnosed in two patients each. Other diagnosis, like chronic and acute interstitial nephritis and mesangial glomerulonephritis were made, but represented only 5% of the population. In three patients, diagnosis was not conclusive. To evaluate whether the pattern of glomerular injury has somehow impact under renal prognosis, we divided the patients into two subgroups: FSGS and non-FSGS GP (24 vs 22 biopsies). Clinical and laboratorial aspects are depicted in table 1. Table 1 Clinical and laboratorial characteristics of the study populaton Follow-up between these two groups was slightly different: 22,8 ± 17 months for FSGS group vs 40,7 ± 31,6 months for non-FSGS GP group (p = 0,047). Only hematuria was more prevalent in the non-FSGS GP group. Composite outcome defined as hemodialysis or duplication of serum creatinine resulted in no differences between these groups (p = 0,71) during the follow up (7 patients out of 21 in FSGS group vs 5 patients out of 18 in non-FSGS GP group), as shown in figure 1. Figure 1. Composite outcome in FSGS group vs non-FGSG group FSGS was also compared to a combined group of MPGN and crioglobulinemia (12 patients). Again, only hematuria was different between these groups (22% vs 75%, p = 0,01). Nevertheless, coinfection with HCV was more prevalent in the latter group (50% of the patients, against 16% in the FSGS group, p = 0,027). Conclusions: The main indication for kidney biopsy in HIV-positive patients in our center is nephrotic syndrome and FSGS was the single most prevalent GP. MPGN was the second most prevalent diagnosis and is strongly associated to coinfection with HCV. Our composite outcome showed that the kind of GP found in kidney biopsy does not correlate to renal prognosis.conferenceObject CD68 POSITIVE CELLS IN RENAL BIOPSY PREDICT LONG TERM PROGNOSIS IN PROLIFERATIVE LUPUS NEPHRITIS(2013) DIAS, Cristiane Bitencourt; LEE, Jin; JORGE, Leticia; MALHEIRO, Denise; BARROS, Rui Toledo; WORONIK, ViktoriaIntroduction and Aims:Studies in proliferative lupus nephritis (LN) showed that in more severe clinical forms the renal histology showed increase macrophages detected by immunohistochemistry. However no long-term assessment of this data is known. The aim of this study was to describe any relations of renal outcomes with tecidual macrophages (CD68+) expressed in renal biopsy specimens obtained on the diagnosis. Methods:Forty six newly diagnosed patients with proliferative LN were prospectively followed-up during 3.5 (3.2 - 4.0) years. Conventional laboratory tests were collected on diagnosis and on last follow-up. Renal biopsy was done on diagnosis and immunohistochemical study was performed with monoclonal antibody anti-CD68 (DAKO) and macrophages MCP-1 (R&D), and results expressed as cells/microscopic fields. Patients were stratified in two groups according to renal outcome: GFR ≤ 60 mL/min/1.73m2at the end of follow-up (n=24) and GFR > 60mL/min/1.73m2(n=22). Considering treatment, all patients received prednisone and 6 pulses of cyclophosphamide (CYA) on induction. Maintenance treatment was conventional and applied in both groups. Results: Considering all patients (n=46) tubule and interstitial CD68+cells showed negative correlation with final MDRD (r= - 0.3, p=0.01 and r= -0.45, p=0.001). Macrophages MCP-1 interstitial had positive correlation with chronicity index (r=0.4, p=0.0031). Conclusions:Tubule and interstitial CD68+cells expression on renal biopsies may predict long term GFR in proliferative lupus nephritis.