ANNA RITA MORAES DE SOUZA AGUIRRE MAZO
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- Protective measures against ultrafiltration failure in peritoneal dialysis patients(2011) AGUIRRE, Anna Rita; ABENSUR, HugoUltrafiltration failure in patients undergoing peritoneal dialysis is a condition with an incidence that increases over time. It is related to increased cardiovascular morbidity and mortality and is a major cause of the abandonment of the treatment technique. Because the number of patients undergoing renal replacement therapy is increasing with society aging and because approximately 10% of this population is treated with peritoneal dialysis, this matter is becoming more common in everyday practice for clinicians involved in the care of patients with chronic renal failure. In this review, we summarize the available measures used to prevent and treat ultrafiltration failure and the current state of research in the field, both in the experimental and clinical settings, focusing on the possible clinical applications of recent findings.
- Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation(2014) RAMALHO, J.; MARQUES, I. D. Bacelar; AGUIRRE, A. R.; PIERROTTI, L. C.; PAULA, F. J. de; NAHAS, W. C.; DAVID-NETO, E.Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25-dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.
conferenceObject DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION THROUGH EARLY PROTOCOL BIOPSIES IN SENSITIZED PATIENTS(2013) SOUZA, Patricia S.; MACHADO, David; AGUIRRE, Anna Rita; DAVID, Daisa; BARBOSA, Erick; PAULA, Flavio Jota de; NAHAS, Willian; DAVID-NETO, Elias; CASTRO, Maria Cristina R.conferenceObject Graft Survival in Sensitized and Non-Sensitized Patients: Role of the Combination of Donor-Specific Antibodies and Acute Rejection(2016) SOUZA, P.; AGUIRRE, A.; BEZERRA, G.; RODRIGUES, H.; AGENA, F.; DAVID, D.; PAULA, F. de; DAVID-NETO, E.; CASTRO, M.- Nebivolol, a β1-adrenergic blocker, protects from peritoneal membrane damage induced during peritoneal dialysis (vol 7, pg 30133, 2016)(2017) LIAPPAS, Georgios; GONZALEZ-MATEO, Guadalupe; AGUIRRE, Anna Rita; ABENSUR, Hugo; ALBAR-VIZCAINO, Patricia; PARRA, Emilio Gonzalez; SANDOVAL, Pilar; RAMIREZ, Laura Garcia; PESO, Gloria del; ACEDO, Juan Manuel; BAJO, Maria A.; SELGAS, Rafael; TOMERO, Jose A. Sanchez; LOPEZ-CABRERA, Manuel; AGUILERA, Abelardo
- Nebivolol, a beta(1)-adrenergic blocker, protects from peritoneal membrane damage induced during peritoneal dialysis(2016) LIAPPAS, Georgios; GONZALEZ-MATEO, Guadalupe; AGUIRRE, Anna Rita; ABENSUR, Hugo; ALBAR-VIZCAINO, Patricia; PARRA, Emilio Gonzalez; SANDOVAL, Pilar; RAMIREZ, Laura Garcia; PESO, Gloria del; ACEDO, Juan Manuel; BAJO, Maria A.; SELGAS, Rafael; TOMERO, Jose A. Sanchez; LOPEZ-CABRERA, Manuel; AGUILERA, AbelardoPeritoneal dialysis (PD) is a form of renal replacement treatment, which employs the peritoneal membrane (PM) to eliminate toxins that cannot be removed by the kidney. The procedure itself, however, contributes to the loss of the PM ultrafiltration capacity (UFC), leading consequently to the technique malfunction. beta-blockers have been considered deleterious for PM due to their association with loss of UFC and induction of fibrosis. Herein we analyzed the effects of Nebivolol, a new generation of beta(1)-blocker, on PM alterations induced by PD fluids (PDF). In vitro: We found that mesothelial cells (MCs) express beta(1)-adrenergic receptor. MCs were treated with TGF-beta to induce mesothelial-to-mesenchymal transition (MMT) and co-treated with Nebivolol. Nebivolol reversed the TGF-beta effects, decreasing extracellular matrix synthesis, and improved the fibrinolytic capacity, decreasing plasminogen activator inhibitor-1 (PAI-1) and increasing tissue-type plasminogen activator (tPA) supernatant levels. Moreover, Nebivolol partially inhibited MMT and decreased vascular endothelial growth factor (VEGF) and IL-6 levels in supernatants. In vivo: Twenty-one C57BL/6 mice were divided into 3 groups. Control group carried a catheter without PDF infusion. Study group received intraperitoneally PDF and oral Nebivolol during 30 days. PDF group received PDF alone. Nebivolol maintained the UFC and reduced PM thickness, MMT and angiogenesis promoted by PDF. It also improved the fibrinolytic capacity in PD effluents decreasing PAI-1 and IL-8 and increased tPA levels. Conclusion: Nebivolol protects PM from PDF-induced damage, promoting antifibrotic, anti-angiogenic, anti-inflammatory and pro-fibrinolytic effects.
- Fisiologia do transporte de fluidos e solutos atraves da membrana peritoneal(2014) AGUIRRE, Anna Rita; ABENSUR, HugoIn this review, phenomena involved in fluid and solute exchange through the peritoneal membrane, both in the physiologic and in the peritoneal dialysis settings, are explained. For that purpose, mathematical models developed for the study of molecule transport through the membrane, such as the ""Pore Model"" and the ""Distributive Model"" are used. Scientific accomplishments in the field are described and areas that require additional research are also cited. Knowledge about the physiologic mechanisms involved in this renal replacement therapy modality, concerning events directly related to the peritoneal membrane itself, is synthesized in this manuscript.
conferenceObject Characterization of Peripheral Blood T and B Cells of Sensitized Kidney Transplant Recipients With Long Term Stable Graft Function(2015) GALANTE, N.; FERNANDES, M.; AGENA, F.; TRIBONI, A.; FREITAS, G.; AGUIRRE, A.; NAHAS, W.; COELHO, V.; DAVID-NETO, E.- Rapamycin Protects from Type-I Peritoneal Membrane Failure Inhibiting the Angiogenesis, Lymphangiogenesis, and Endo-MT(2015) GONZALEZ-MATEO, Guadalupe Tirma; AGUIRRE, Anna Rita; LOUREIRO, Jess; ABENSUR, Hugo; SANDOVAL, Pilar; SANCHEZ-TOMERO, Jose Antonio; PESO, Gloria del; JIMENEZ-HEFFERNAN, Jose Antonio; RUIZ-CARPIO, Vicente; SELGAS, Rafael; LOPEZ-CABRERA, Manuel; AGUILERA, Abelardo; LIAPPAS, GeorgiosPreservation of peritoneal membrane (PM) is essential for long-term survival in peritoneal dialysis (PD). Continuous presence of PD fluids (PDF) in the peritoneal cavity generates chronic inflammation and promotes changes of the PM, such as fibrosis, angiogenesis, and lymphangiogenesis. Mesothelial-to-mesenchymal transition (MMT) and endothelial-to-mesenchymal transition (Endo-MT) seem to play a central role in this pathogenesis. We speculated that Rapamycin, a potent immunosuppressor, could be beneficial by regulating blood and lymphatic vessels proliferation. We demonstrate that mice undergoing a combined PD and Rapamycin treatment (PDF + Rapa group) presented a reduced PM thickness and lower number of submesothelial blood and lymphatic vessels, as well as decreased MMT and Endo-MT, comparing with their counterparts exposed to PD alone (PDF group). Peritonealwater transport in the PDF + Rapa group remained at control level, whereas PD effluent levels of VEGF, TGF-beta andTNF-alpha were lower than in the PDF group. Moreover, the treatment of mesothelial cells with Rapamycin in vitro significantly decreased VEGF synthesis and selectively inhibited the VEGF-C and VEGF-D release when compared with control cells. Thus, Rapamycin has a protective effect on PM in PD through an antifibrotic and antiproliferative effect on blood and lymphatic vessels. Moreover, it inhibits Endo-MT and, at least partially, MMT.
bookPart Destino dos pacientes sensibilizados em lista e após o transplante renal(2016) AGUIRRE, Anna Rita; CASTRO, Maria Cristina Ribeiro de