CRISTIANE BITENCOURT DIAS
Projetos de Pesquisa
Unidades Organizacionais
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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Agora exibindo 1 - 10 de 19
- Schistosoma mansoni and membranous nephropathy(2016) NEVES, Precil D. M. M.; BEZERRA, Kalyanna S.; SILVEIRA, Marcelo A. D.; YU, Luis; WORONIK, Viktoria; JORGE, Lecticia B.; TESTAGROSSA, Leonardo A.; MALHEIROS, Denise M. A. Costa; DIAS, Cristiane B.
- The immunohistological profile of membranous nephropathy associated with chronic Schistosoma mansoni infection reveals a glomerulopathy with primary features(2019) ARAUJO, Stanley de Almeida; NEVES, Precil Diego Miranda de Menezes; WANDERLEY, David Campos; REIS, Marlene Antonia dos; DIAS, Cristiane Bitencourt; MALHEIROS, Denise Maria Avancini Costa; ONUCHIC, Luiz Fernando
- Role of renal expression of CD68 in the long-term prognosis of proliferative lupus nephritis(2017) DIAS, Cristiane B.; MALAFRONTE, Patricia; LEE, Jin; RESENDE, Aline; JORGE, Lecticia; PINHEIRO, Cilene C.; MALHEIROS, Denise; WORONIK, ViktoriaIntroduction Renal histology of proliferative lupus nephritis (LN) shows increased macrophage infiltration, but its association with renal outcome is a matter of debate. Here, we investigate the potential relationship that macrophage expression has with renal prognosis in patients with proliferative LN. Methods Fifty patients newly diagnosed with proliferative LN were followed for a median of 8 years. Laboratory testing was conducted at diagnosis, after induction therapy and at the final follow-up evaluation. Renal biopsies were obtained at diagnosis and underwent immunohistochemical analysis with anti-CD68 and monocyte chemoattractant protein 1 monoclonal antibodies. Patients were stratified at final follow-up evaluation into glomerular filtration rate (GFR) > 60 ml/min/1.73 m(2) (non-progressor group; n = 24) and GFR <= 60 ml/min/1.73 m(2) (progressor group; n = 26). All patients were treated with prednisone and six pulses of cyclophosphamide on induction therapy. Conventional maintenance therapy was administered in both groups. Results Compared to progressors, the non-progressor group showed a lower chronicity index (p = 0.01) and fewer CD68-positive cells in the renal tubules (p = 0.01) and particularly in the renal interstitium (p = 0.0003). Baseline and final serum creatinine correlated positively with the chronicity index (r = 0.3, p = 0.01 and r = 0.3, p = 0.04, respectively), and final serum creatinine correlated positively with interstitial expression of CD68 (r = 0.4, p = 0.0006). Conclusion Renal expression of CD68 and the chronicity index are associated with progression to chronic kidney disease in patients with proliferative LN.
conferenceObject IMMUNOGLOBULIN DEPOSITS IN GLOMERULI OF LUPUS MEMBRANOUS NEPHROPATHIES(2015) CARNEIRO FILHO, Eduardo Jorge Duque de Sa; PIRES, Alcino Gama; TESTAGROSSA, Leonardo; MALHEIROS, Denise Mac; YU, Luis; DIAS, Cristiane Bitencourt; JORGE, Lectcia Barbosa; WORONIK, ViktoriabookPart Glomerulopatia membranosa(2022) DIAS, Cristiane Bitencourt; MALHEIROS, Denise Maria Avancini CostabookPart Glomerulonefrite membranoproliferativa(2022) DIAS, Cristiane Bitencourt; JORGE, Lecticia Barbosa; MALHEIROS, Denise Maria Avancini Costa- Nephrotic syndrome in the elderly: epidemiological aspects, clinical data, and renal biopsy findings(2022) SOARES, L. R.; PANTOJA JUNIOR, J. M. S.; JORGE, L. B.; YU, L.; CAVALCANTE, L. B.; MALHEIROS, D. M. A. C.; WORONIK, V; DIAS, C. B.Nephrotic syndrome is the most common clinical presentation of glomerular disease in elderly patients, and renal biopsy is an important diagnostic resource. The aim of this study was to describe nephrotic syndrome among elderly patients in Brazil, focusing on tubulointerstitial and vascular involvement. This was a retrospective study of patients over 65 years of age with nephrotic syndrome who underwent renal biopsy between January 2012 and December 2019. Of the 123 renal biopsies that occurred during the study period, 44 (35.8%) were performed for the investigation of nephrotic syndrome. Among those 44 cases, the main etiologies were membranous nephropathy in 13 cases (29.5%), amyloidosis in ten (22.7%), non-collapsing focal segmental glomerulosclerosis (FSGS) in four (9.1%), and collapsing FSGS in four (9.1%). Patients with minimal change disease (MCD) had the lowest degree of interstitial fibrosis compared with the other glomerulopathies, and histological signs of acute tubular necrosis (ATN) were less common among those with amyloidosis than among those with membranous nephropathy, FSGS, or MCD (P=0.0077). Of the patients with ATN, the frequency of acute kidney injury (AKI) was highest in those with MCD (P <0.001). All patients had some degree of vascular involvement, regardless of the type of glomerulopathy. In conclusion, the second most common cause of nephrotic syndrome in this population was amyloidosis, and acute interstitial tubule involvement was more marked in MCD. Vascular involvement is something that cannot be dissociated from the age of the patient and is not only due to the underlying glomerulopathy.
- Methimazole-Induced ANCA Vasculitis: A Case Report(2021) NEVES, Precil Diego Miranda de Menezes; MOTA, Lucas Braga; DIAS, Cristiane Bitencourt; YU, Luis; WORONIK, Viktoria; CAVALCANTE, Livia Barreira; MALHEIROS, Denise Maria Avancini Costa; JORGE, Lecticia BarbosaRapidly progressive glomerulonephritis (RPGN) is a syndrome which presents rapid loss of renal function. Vasculitis represents one of the major causes, often related to anti-neutrophil cytoplasmic antibodies (ANCA). Herein, we report a case of methimazole-induced ANCA-associated vasculitis. A 35-year-old woman complained of weight loss and fatigue for 2 weeks and attended the emergency room with alveolar hemorrhage. She had been diagnosed with Graves' disease and had been taking methimazole in the past 6 months. Her physical examination showed pulmonary wheezing, hypertension and signs of respiratory failure. Laboratory tests revealed urea 72 mg/dL, creatinine 2.65 mg/dL (eGFR CKD-EPI: 20 mL/min/1.73 m(2)), urine analysis with >100 red blood cells per high-power field, 24 h-proteinuria: 1.3 g, hemoglobin 6.6 g/dL, white-cell count 7700/mm(3), platelets 238,000/mm(3), complement within the normal range, negative viral serological tests and ANCA positive 1:80 myeloperoxidase pattern. Chest tomography showed bilateral and diffuse ground-glass opacities, and bronchial washing confirming alveolar hemorrhage. A renal biopsy using light microscopy identified 27 glomeruli (11 with cellular crescentic lesions), focal disruption in glomerular basement membrane and fibrinoid necrosis areas, tubulitis and mild interstitial fibrosis. Immunofluorescence microscopy showed IgG +2/+3, C3 +3/+3 and Fibrinogen +3/+3 in fibrinoid necrosis sites. She was subsequently diagnosed with crescentic pauci-immune glomerulonephritis, mixed class, in the setting of a methimazole-induced ANCA vasculitis. The patient was treated with methimazole withdrawal and immunosuppressed with steroids and cyclophosphamide. Four years after the initial diagnosis, she is currently being treated with azathioprine, and her exams show creatinine 1.30 mg/dL (eGFR CKD-EPI: 52 mL/min/1.73 m(2)) and negative p-ANCA.
- Atypical presentation of acute post-infectious glomerulonephritis in patients with sickle cell disease: report of two cases(2020) NEVES, Precil Diego Miranda de Menezes; REICHERT, Bernardo Vergara; BRIDI, Ramaiane Aparecida; YU, Luis; DIAS, Cristiane Bitencourt; PINHEIRO, Rafaela Brito Bezerra; TESTAGROSSA, Leonardo de Abreu; CAVALCANTE, Livia Barreira; MALHEIROS, Denise Maria Avancini Costa; JORGE, Lecticia Barbosa; WORONIK, ViktoriaBackgroundSickle 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 presentationCase 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 6.1g/dl; leucocytes 18,820 cells/mm(3); and creatinine 0.49mg/dl. A urine sample evidenced leucocyturia and haematuria. The 24-h proteinuria was 8.99g, serum albumin level was 1.2g/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 0.48mg/dl. A urine sample evidenced leukocyturia and haematuria. The 24-h proteinuria was 12.5g, and the serum albumin level was 2.6g/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.ConclusionsThe 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.
- Glomeruloesclerose segmentar e focal (GESF) colapsante associada ao parvovírus B19: relato de caso(2015) FREITAS, Geraldo Rubens Ramos de; PRAXEDES, Marcel Rodrigues Gurgel; MALHEIROS, Denise; TESTAGROSSA, Leonardo; DIAS, Cristiane Bitencourt; WORONIK, ViktoriaObjective: To describe the clinical and laboratory profile of focal segmental glomerulosclerosis (FSGS) of the collapsing subtype in association with infection by parvovirus B19 (PVB19). Case report: Female patient, 37 years old, mulatto, developed pharyngalgia and fever with partial improvement after penicillin. After one week we observed reduced urinary output and lower limb edema. Smoker, family and personal history negative for hypertension, diabetes or kidney disease. Patient presented with olyguria, hypertension and edema, also hypochromic microcytic hypoproliferative anemia, nephritic range proteinuria, microscopic hematuria and renal dysfunction. All rheumatologic investigation, HIV and hepatitis serology were negative. Unremarkable renal ultrasound. PCR positive for PVB19 in bone marrow aspirate and blood and renal biopsy conclusive of collapsing FSGS subtype. Spontaneous remission occurred within two weeks of the profile. The blood PVB19 PCR was repeated within a month and resulted negative. This finding demonstrated PVB19 acute infection or viral reactivation in association with collapsing FSGS. Conclusion: There is demonstrated the temporal association of PVB19 viremia and collapsing FSGS, due primary infection or viral reactivation. The association of collapsing FSGS and PVB19 is described in the literature, demonstrating virus presence in kidney tissue, but the real relationship of virus in the pathogenesis of this glomerulopathy remains unclear.