Artigos e Materiais de Revistas Científicas - LIM/16

URI Permanente para esta coleção

https://observatorio.fm.usp.br/handle/OPI/3659

A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

Navegar

Agora exibindo 1 - 20 de 368

Mixed uremic osteodystrophy: an ill-described common bone pathology in patients with chronic kidney disease
(2023) ELKHOULI, Ekbal; NAGY, Eman; SANTOS, Cassia Gomes S.; BARRETO, Fellype Carvalho; CHAER, Juliana; JORGETTI, Vanda; EL-HUSSEINI, Amr
Renal osteodystrophy (ROD) starts early and progresses with further loss of kidney function in patients with chronic kidney disease (CKD). There are four distinct types of ROD based on undecalcified bone biopsy results. Adynamic bone disease and osteomalacia are the predominant forms of low bone turnover, while hyperparathyroid bone disease and mixed uremic osteodystrophy (MUO) are typically associated with high bone turnover. MUO is a prevalent but poorly described pathology that demonstrates evidence of osteomalacia on top of the high bone formation/resorption. The prevalence of MUO ranges from 5 to 63% among different studies. The pathogenesis of MUO is multi-factorial. Altered phosphate homeostasis, hypocalcemia, vitamin D deficiency, increased FGF-23, interleukins 1 and 6, TNF-& alpha;, amyloid, and heavy metal accumulation are the main inducers of MUO. The clinical findings of MUO are usually non-specific. The use of non-invasive testing such as bone turnover markers and imaging techniques might help to suspect MUO. However, it is usually impossible to precisely diagnose this condition without performing bone biopsy. The principal management of MUO is to control the maladaptive hyperparathyroidism along with correcting any nutritional mineral deficiencies that may induce mineralization defect. MUO is a common but still poorly understood bone pathology category; it demonstrates the complexity and difficulty in understanding ROD. A large prospective bone biopsy-based studies are needed for better identification as proper diagnosis and management would improve the outcome of patients with MUO.
Evaluation of glomerular sirtuin-1 and claudin-1 in the pathophysiology of nondiabetic focal segmental glomerulosclerosis
(2023) LOPES-GONCALVES, Guilherme; COSTA-PESSOA, Juliana Martins; PIMENTA, Ruan; TOSTES, Ana Flavia; SILVA, Eloisa Martins da; LEDESMA, Felipe Lourenco; MALHEIROS, Denise Maria Avancini Costa; ZATZ, Roberto; THIEME, Karina; CAMARA, Niels Olsen Saraiva; OLIVEIRA-SOUZA, Maria
Focal segmental glomerulosclerosis (FSGS) is the leading cause of nephrotic syndrome, which is characterized by podocyte injury. Given that the pathophysiology of nondiabetic glomerulosclerosis is poorly understood and targeted therapies to prevent glomerular disease are lacking, we decided to investigate the tight junction protein claudin-1 and the histone deacetylase sirtuin-1 (SIRT1), which are known to be involved in podocyte injury. For this purpose, we first examined SIRT1, claudin-1 and podocin expression in kidney biopsies from patients diagnosed with nondiabetic FSGS and found that upregulation of glomerular claudin-1 accompanies a significant reduction in glomerular SIRT1 and podocin levels. From this, we investigated whether a small molecule activator of SIRT1, SRT1720, could delay the onset of FSGS in an animal model of adriamycin (ADR)-induced nephropathy; 14 days of treatment with SRT1720 attenuated glomerulosclerosis progression and albuminuria, prevented transcription factor Wilms tumor 1 (WT1) downregulation and increased glomerular claudin-1 in the ADR + SRT1720 group. Thus, we evaluated the effect of ADR and/or SRT1720 in cultured mouse podocytes. The results showed that ADR [1 mu M] triggered an increase in claudin-1 expression after 30 min, and this effect was attenuated by pretreatment of podocytes with SRT1720 [5 mu M]. ADR [1 mu M] also led to changes in the localization of SIRT1 and claudin-1 in these cells, which could be associated with podocyte injury. Although the use of specific agonists such as SRT1720 presents some benefits in glomerular function, their underlying mechanisms still need to be further explored for therapeutic use. Taken together, our data indicate that SIRT1 and claudin-1 are relevant for the pathophysiology of nondiabetic FSGS.
Remote vs. face-to-face activities in the teaching of renal pathophysiology in the context of social isolation during the early phase of the COVID-19 pandemic
(2023) HAYDAR, Ahmed; SANTOS, Itamar Souza; ARCON, Luis Carlos; MARTINS, Milton de Arruda; TEMPSKI, Patricia Zen; ZATZ, Roberto
The advent of the COVID-19 pandemic forced medical schools around the world to adopt emergency remote learning as a resort to avoid interruption of courses. However, the effectiveness of online classes as an educational strategy has been questioned by medical educators and students. In a prospective observational study design, students enrolled in a renal physiology and pathophysiology course were exposed to either face-to-face or remote synchronous classes. Students taught online obtained significantly higher mean scores than the group who had in-person classes, both groups assessed with identical exams. Appropriate screening tests suggested that fraud is unlikely to have significantly influenced these results and that the observed differences in performance reflected increased learning by the remote group. These observations suggest that online classes can help to maintain the continuity of physiology and pathophysiology courses during periods of social isolation and may contribute to improving learning under normal conditions.
Effects of nutritional supplementation stabilizing muscle mass loss in older patients on hemodiafiltration
(2023) SILVA, Luana Cristina A. de; CORREIA, Marilia A. de; GOUVEIA, Renata Daniel; SOUZA, Mayara S.; JR, Carlos P. Isaac; PARRILLO, Fernando; MOYSES, Rosa M. A.; DALBONI, Maria Aparecida; ELIAS, Rosilene M.
Background & aims: Malnutrition is common in older individuals with end-stage renal disease on maintenance dialysis. Whether nutritional supplementation may improve skeletal muscle mass (SMM) and survival rate in this population is uncertain. We aimed to analyze the effect of a year of nutritional supplementation on muscle mass and survival rate in older patients on hemodiafiltration.Methods: In this observational study, older patient (>= 65 years old) on maintenance hemodiafiltration were selected to receive nutritional counselling + nutritional supplementation (N = 85, Supp+) or nutritional counselling alone (N = 47, Supp-) and followed for 1 year. The outcomes were a change in SMM and sarcopenia diagnosis. The secondary outcome was 1-year mortality rate. Nutritional parameters included calf circumference, body mass index, anthropometric measurements, subjective global assessment, and handgrip strength (HGS). Data were evaluated using GLM for repeated measures with adjustment for covariates (age and diabetes).Results: Malnutrition was found in 50.8% of patients. At baseline, patients from the Supp+ group were older and had worse nutritional parameters including hand grip strength, calf circumference, anthro-pometric findings and sarcopenia (all p values < 0.05). During the follow-up, there was no significant change in sarcopenia (from 50.8% to 58.3%, p = 0.108), and there was a more pronounced decrease in the SMM index in the Supp-group (p = 0.049), with a significant intervention interaction (p = 0.030). Twenty deaths occurred, 7 (35%) in the Supp-and 13 (65%) in the Supp+ group (p = 0.540). SMM index (relative risk 0.90, p = 0.030) and age (relative risk 1.07, p = 0.046) were independently associated with higher mortality rates. Conclusion: Nutritional supplementation in older and malnourished individuals undergoing hemodia-filtration mitigates the loss of the SMM index and benefits survival rate.(c) 2023 European Society for Clinical Nutrition and Metabolism.
Older patients are less prone to fast decline of renal function: a propensity-matched study
(2023) PINA, Paula M. R.; ARCON, Luis Carlos; ZATZ, Roberto; MOYSES, Rosa M. A.; ELIAS, Rosilene M.
PurposeDespite CKD is common among older patients, and although factors associated with CKD progression have been explored over decades, little is known about the decline of renal function specifically in older individuals.MethodsWe included adult patients with CKD on conservative management in a propensity-score matched study 1:1 older (> 65 year) and young (<= 65 yr). Factors associated with the slope of the decline of eGFR such as proteinuria, initial eGFR, diabetes, sex, and use of angiotensin-converting enzyme inhibitor/angiotensin receptor block (ACEI/ARB) were analyzed. Inclusion criteria were at least two consultations in the service and an initial eGFR lower than 45 ml/min/m(2), in the period between January 2012 and December 2017.ResultsCrude analysis of eGFR decline shows a slower progression of older patients when compared to younger patients in both absolute change [- 2.0 (- 4.5, - 1.0) vs. -3.0 (- 7.0, - 1.0) ml/min/1.73m(2), p < 0.001] and slope of eGFR reduction [- 2.2 (- 4.4, - 1.0) vs. 3.1 (- 6.7, - 1.2)) ml/min/1.73m(2), p < 0.001]. Patients considered fast progressors (> 5 ml/min/1.73 m(2)/year decline in eGFR) were less likely to be older (35.2% young vs. 22.0% older, p < 0.001). Adjusted logistic multivariate regression confirmed that older patients had less odds ratio of eGFR decline, independently of the presence of proteinuria, diabetes, ACEI/ARB use, sex, baseline eGFR, baseline phosphate and baseline 25(OH) vitamin D.ConclusionOlder patients present slower CKD progression even after multiple adjustments. This information should be taken into consideration while treating these patients on conservative management and should be kept in mind while planning dialysis start.
Effect of aluminum accumulation on bone and cardiovascular risk in the current era
(2023) CARBONARA, Cinthia E. M.; ROZA, Noemi A. V.; QUADROS, Kelcia R. S.; FRANCA, Renata A.; ESTEVES, Andre B. A.; PAVAN, Celia R.; BARRETO, Joaquim; REIS, Luciane M. dos; JORGETTI, Vanda; SPOSITO, Andrei C.; OLIVEIRA, Rodrigo Bueno
BackgroundThe prevalence of aluminum (Al) intoxication has declined over the past 3 decades. However, different groups still report on the diagnosis of Al in bone. Prolonged and low-intensity exposures to Al may not be captured by serum Al measurements, preventing its proper diagnosis. We hypothesize that bone Al accumulation may be related to bone and cardiovascular events in the current Era. AimsTo detect the diagnosis of bone Al accumulation; to explore bone and cardiovascular consequences of Al accumulation. MethodsThis is a sub-analysis of The Brazilian Registry of Bone Biopsy, a prospective, multicentre cohort, with a mean follow-up of 3.4 years, including patients with CKD undergoing bone biopsy; bone fracture and major cardiovascular events (MACE) were adjudicated; Al accumulation was identified by solochrome-azurine staining; history of previous Al accumulation was registered based on information provided by the nephrologist who performed the bone biopsy; bone histomorphometry parameters, clinical data, and general biochemistry were registered. Results275 individuals were considered; 96 (35%) patients have diagnosed with bone Al accumulation and were younger [50 (41-56) vs. 55 (43-61) years; p = 0.026], had lower body mass index [23.5 (21.6-25.5) vs. 24.3 (22.1-27.8) kg/m(2); p = 0.017], higher dialysis vintage [108 (48-183) vs. 71 (28-132) months; p = 0.002], presented pruritus [23 (24%) vs. 20 (11%); p = 0.005], tendon rupture [7 (7%) vs. 3 (2%); p = 0.03) and bone pain [2 (0-3) vs. 0 (0-3) units; p = 0.02]. Logistic regression reveals that prior bone Al accumulation [OR: 4.517 (CI: 1.176-17.353); p = 0.03] and dialysis vintage [OR: 1.003 (CI: 1.000-1.007); p = 0.046] as independent determinants of bone Al accumulation; minor perturbations in dynamic bone parameters and no differences in bone fractures rate were noted; MACE was more prevalent in patients with bone Al accumulation [21 (34%) vs. 23 (18%) events; p = 0.016]. Cox regression shows the actual/prior diagnosis of bone Al accumulation and diabetes mellitus as independent predictors for MACE: [HR = 3.129 (CI: 1.439-6.804; p = 0.004) and HR = 2.785 (CI: 1.120-6.928; p = 0.028]. ConclusionsAn elevated proportion of patients have bone Al accumulation, associated with a greater prevalence of bone pain, tendon rupture, and pruritus; bone Al accumulation was associated with minor perturbations in renal osteodystrophy; actual/prior diagnosis of bone Al accumulation and diabetes mellitus were independent predictors for MACE.
Overview of renal osteodystrophy in Brazil: a cross-sectional study
(2023) CARBONARA, Cinthia E. M.; ROZA, Noemi A. V.; REIS, Luciene M. dos; CARVALHO, Aluizio B.; JORGETTI, Vanda; OLIVEIRA, Rodrigo Bueno de
Introduction: The epidemiologic profile of renal osteodystrophy (ROD) is changing over time and cross-sectional studies provide essential information to improve care and health policies. The Brazilian Registry of Bone Biopsy (REBRABO) is a prospective, nationalmulticenter cohort that includes patients with chronic kidney disease (CKD) undergoing bone biopsy. REBRABO aims to provide clinical information on ROD. The main objective of this subanalysis was to describe the profile of ROD, including clinically relevant associations. Methods: From Aug/2015 to Dec/2021, 511 patients with CKD who performed bone biopsy were included in the REBRABO platform. Patients with no bone biopsy report (N = 40), GFR > 90 mL/min (N = 28), without asigned consent (N = 24), bone fragments inadequate for diagnosis (N = 23), bone biopsy indicated by a specialty other than nephrology (N = 6), and < 18 years old (N = 4) were excluded. Clinical-demographic data (e.g., age, sex, ethnicity, CKD etiology, dialysis vintage, comorbidities, symptoms, and complications related to ROD), laboratory (e.g., serum levels of total calcium, phosphate, parathormone, alkaline phosphatase, 25-hydroxyvitamin D, and hemoglobin), and ROD (e.g., histological diagnosis) were analyzed. Results: Data from 386 individuals were considered in this subanalysis of REBRABO. Mean age was 52 (42-60) years; 198 (51%) were male; 315 (82%) were on hemodialysis. Osteitis fibrosa (OF) [163 (42%)], adynamic bone disease (ABD) [96 (25%)] and mixed uremic osteodystrophy (MUO) [83 (21%)] were the most frequent diagnosis of ROD in our sample; 203 (54%) had the diagnosis of osteoporosis, 82 (56%) vascular calcification; 138 (36%) bone aluminum accumulation, and 137 (36%) iron intoxication; patients with high turnover were prone to present a higher frequency of symptoms. Conclusions: A high proportion of patients were diagnosed with OF and ABD, as well as osteoporosis, vascular calcification and clinical symptoms.
International Perspectives on GFR Estimation and Race-Based Adjustments
(2023) EL-KHOURY, Joe M.; KARGER, Amy B.; CAVALIER, Etienne; KALYESUBULA, Robert; TEO, Boon Wee; SILVA, Veronica T. Costa e; INKER, Lesley A.
Chronic environmental hypoxia attenuates innate immunity activation and renal injury in two CKD models
(2023) ZAMBOM, Fernanda Florencia Fregnan; ALBINO, Amanda Helen; TESSARO, Helena Mendonca; FORESTO-NETO, Orestes; MALHEIROS, Denise Maria Avancini Costa; CAMARA, Niels Olsen Saraiva; ZATZ, Roberto
Tissue hypoxia has been pointed out as a major pathogenic factor in chronic kidney disease (CKD). However, epidemiological and experimental evidence inconsistent with this notion has been described. We have previously reported that chronic exposure to low ambient Po-2 promoted no renal injury in normal rats and in rats with 5/6 renal ablation (Nx) unexpectedly attenuated renal injury. In the present study, we investigated whether chronic exposure to low ambient Po-2 would also be renoprotective in two additional models of CKD: adenine (ADE) excess and chronic nitric oxide (NO) inhibition. In both models, normobaric ambient hypoxia attenuated the development of renal injury and inflammation. In addition, renal hypoxia limited the activation of NF-?B and NOD-like receptor family pyrin domain containing 3 inflammasome cascades as well as oxidative stress and intrarenal infiltration by angiotensin II-positive cells. Renal activation of hypoxia-inducible factor (HIF)-2a, along with other adaptive mechanisms to hypoxia, may have contributed to these renoprotective effects. The present findings may contribute to unravel the pathogenesis of CKD and to the development of innovative strategies to arrest its progression.
Bevacizumab-Associated Thrombotic Microangiopathy Treated with Eculizumab: A Case Report
(2023) PADILHA, Wallace Stwart Carvalho; CESAR, Bruno Nogueira; PACHECO, Samara Theodoro; SOUSA, Alessandra Alves De; LEDESMA, Felipe Lourenco; MALHEIROS, Denise Maria Avancini Costa; TEIXEIRA, Marcela Crosara Alves
Patient: Female, 64-year-old Final Diagnosis: Bevacizumab-associated thrombotic microangiopathy Symptoms: Microangiopathic hemolytic anemia and acute kidney injury Clinical Procedure: - Specialty: Nephrology Objective: Rare disease Background: Bevacizumab is an approved targeted therapy for metastatic cancer treatment. It can have adverse effects on multiple organs. Despite its low incidence, thrombotic microangiopathy (TMA) is the most severe complication. TMA has been associated with complement dysregulation, and treatment with eculizumab can be effective, despite the paucity of literature on eculizumab therapy for bevacizumab-associated TMA. To date, 10 cases have been reported, with less than half of them including a kidney biopsy. We present a new case of bevacizumab-associated TMA successfully treated with eculizumab, along with kidney biopsy records and an overview of mechanisms underlying TMA development in bevacizumab-treated patients. Case Report: A female patient diagnosed with metastatic breast cancer who was treated with bevacizumab in conjunction with chemotherapy was admitted to the hospital for acute kidney injury requiring hemodialysis, microangiopathic hemolytic anemia, and thrombocytopenia. TMA was diagnosed and was later confirmed by a kidney biopsy. Primary causes for TMA, such as ADAMTS13 deficiency and shiga toxin associated hemolytic-uremic syndrome, were ruled out, and the patient's condition was ultimately found to be triggered by exposure to bevacizumab. After discontinuing bevacizumab and receiving 4 weekly doses of eculizumab, kidney function and hematological parameters improved. Conclusions: Bevacizumab-associated TMA can be reversed or attenuated in some patients with the use of eculizumab (inhibiting complement system overactivation), possibly reducing time to recovery, with fewer long-term sequelae. This additional case encourages future clinical trials to evaluate the safety and efficacy of eculizumab in cases of TMA associated with bevacizumab.
A Prospective Cross-Sectional Study on the Performance of the 2021 CKD-EPI Equations Without Race in a Multiracial Population of Adults With Solid Tumors in Brazil
(2023) SILVA, Veronica T. Costa e; JR, Luiz A. Gil; INKER, Lesley A.; CAIRES, Renato A.; COSTALONGA, Elerson; COURA-FILHO, George; SAPIENZA, Marcelo T.; JR, Gilberto Castro; ESTEVEZ-DIZ, Maria D. P.; ZANETTA, Dirce Maria T.; ANTONANGELO, Leila; MARCAL, Lia; TIGHIOUART, Hocine; MIAO, Shiyuan; MATHEW, Paul; LEVEY, Andrew S.; BURDMANN, Emmanuel A.
In memoriam: Professor Gerhard Malnic
(2023) REBOUCAS, Nancy Amaral; ZATZ, Roberto; HELOU, Claudia Maria de Barros
Transcription factor HNF4 & alpha;2 promotes osteogenesis and prevents bone abnormalities in mice with renal osteodystrophy
(2023) MARTINEZ-CALLE, Marta; COURBON, Guillaume; HUNT-TOBEY, Bridget; FRANCIS, Connor; SPINDLER, Jadeah; WANG, Xueyan; REIS, Luciene M. dos; MARTINS, Carolina S. W.; SALUSKY, Isidro B.; MALLUCHE, Hartmut; NICKOLAS, Thomas L.; MOYSES, Rosa M. A.; DAVID, Valentin; MARTIN, Aline
Renal osteodystrophy (ROD) is a disorder of bone metabolism that affects virtually all patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes including fractures, cardiovascular events, and death. In this study, we showed that hepatocyte nuclear factor 4 & alpha; (HNF4 & alpha;), a transcription factor mostly expressed in the liver, is also expressed in bone, and that osseous HNF4 & alpha; expression was dramatically reduced in patients and mice with ROD. Osteoblast-specific deletion of Hnf4 & alpha; resulted in impaired osteogenesis in cells and mice. Using multi-omics analyses of bones and cells lacking or overexpressing Hnf4 & alpha;1 and Hnf4 & alpha;2, we showed that HNF4 & alpha;2 is the main osseous Hnf4 & alpha; isoform that regulates osteogenesis, cell metabolism, and cell death. As a result, osteoblast-specific overexpression of Hnf4 & alpha;2 prevented bone loss in mice with CKD. Our results showed that HNF4 & alpha;2 is a transcriptional regulator of osteogenesis, implicated in the development of ROD.
Calf Circumference Predicts Falls in Older Adults on Hemodialysis
(2023) RODRIGUES, Renata G.; DALBONI, Maria Aparecida; CORREIA, Marilia de A.; REIS, Luciene M. dos; MOYSES, Rosa M. A.; ELIAS, Rosilene M.
Objective: Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. Methods: This is a prospective study that enrolled patients aged >= 65 years on conventional hemodialysis, followed for 6 months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34 cm for men and <33 cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). Results: Ninety-one patients were included (age 73.7 +/- 5.4 years, 69.2% men, 56% with diabetes). Mean CC was 32.6 +/- 3.7 cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P = .017 and P = .025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27 kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.1353.86, P = .037), higher age (HR 1.19, CI: 1.04-1.36, P = .011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P = .003) were independently associated with falls in a fully adjusted model. Conclusion: CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.
Skeletal muscle changes in older patients undergoing online hemodiafiltration
(2023) GONCALVES, Thiago J. M.; SILVA, Luana C. A.; DALBONI, Maria A.; PIRES JUNIOR, Carlos I.; SILVEIRA JUNIOR, Sergio A. D.; ELIAS, Rosilene M.
Background & aims: Skeletal muscle mass (SMM) and function are negatively affected in chronic kidney disease (CKD). SMM and the assessment of muscle strength and functionality are indicators of clinical and nutritional status. We aimed to evaluate older patients undergoing online hemodiafiltration (OLHDF), using muscle ultrasound (US) to monitor the SMM, correlating findings with strength and physical performance.Methods: This is a prospective cohort that included patients on OL-HDF, evaluated at admission (T0), 6 months (T1), and 12 months (T2) by anthropometric data, calf circumference (CC) measurement, muscle strength measured by handgrip (HGS) and functionality by gait speed. Muscle US was used for serial assessment of the quantity and quality of SMM during the 12-month follow-up. The main outcome was change in the following muscle parameters: quadriceps muscle thickness (QT), rectus femoris crosssectional area (RF-CSA), pennation angle (PA) and muscle echogenicity, evaluated by the US. Results: Thirty subjects were included (75.9 +/- 7.8 years, 76.7% men). Over time, there was a significant reduction in CC (p < 0.01) in both sexes and gait speed only in men (p < 0.01). The reduction of SMM was observed in both sexes by the assessment of QT and RF-CSA (p < 0.01). There was an increased muscle echogenicity in both men (p < 0.01) and women (p = 0.01). The percentage of SMM loss of the RF-CSA in 12 months was -19.3 +/- 6.9% (95% CI: 15.2-23.2; p < 0.01) in men and -23.0 +/- 8.2% (95% CI: 12.8-31.1; p < 0.01) in women.Conclusion: Muscle US, a bedside, non-invasive, accessible, and inexpensive tool, can be applied for assessment of the accelerated loss of SMM in older patients with CKD on dialysis.(c) 2023 European Society for Clinical Nutrition and Metabolism.
Rosa Maria Rodrigues Pereira (1958-2022) IN MEMORIAM
(2023) JORGETTI, Vanda; PD, Sampaio-Barros; SK, Shinjo; BONFA, Eloisa
Longitudinal changes in blood pressure are preceded by changes in albuminuria and accelerated by increasing dietary sodium intake
(2023) KATAYAMA, Isis Akemi; HUANG, Yuefei; GARZA, Amanda E.; BROOKS, Danielle L.; WILLIAMS, Jonathan S.; NASCIMENTO, Mariana M.; HEIMANN, Joel C.; POJOGA, Luminita H.
Background: Dietary sodium is a well-known risk factor for cardiovascular and renal disease; however, direct evidence of the longitudinal changes that occur with aging, and the influence of dietary sodium on the age-associated alterations are scarce. Methods: C57BL/6 mice were maintained for 13 months on a low (LS, 0.02 % Na+), normal (NS, 0.3 % Na+) or high (HS, 1.6 % Na+) salt diet. We assessed 1) the longitudinal trajectories for two markers of cardiovascular and renal dysfunction (blood pressure (BP) and albuminuria), as well as hormonal changes, and 2) end-of-study cardiac and renal parameters. Results: The effect of aging on BP and kidney damage did not reach significance levels in the LS group; however, relative to baseline, there were significant increases in these parameters for animals maintained on NS and HS diets, starting as early as month 7 and month 5, respectively. Furthermore, changes in albuminuria preceded the changes in BP relative to baseline, irrespective of the diet. Circulating aldosterone and plasma renin activity displayed the expected decreasing trends with age and dietary sodium loading. As compared to LS - higher dietary sodium consumption associated with increasing trends in left ventricular mass and volume indices, consistent with an eccentric dilated phenotype. Functional and molecular markers of kidney dysfunction dis-played similar trends with increasing long-term sodium levels: higher renovascular resistance, increased glomerular volumes, as well as higher levels of renal angiotensin II type 1 and mineralocorticoid receptors, and lower renal Klotho levels. Conclusion: Our study provides a timeline for the development of cardiorenal dysfunction with aging, and doc-uments that increasing dietary salt accelerates the age-induced phenotypes. In addition, we propose albuminuria as a prognostic biomarker for the future development of hypertension. Last, we identified functional and mo-lecular markers of renal dysfunction that associate with long-term dietary salt loading.
Self-reported and objective sleep duration in patients with CKD: are they telling the same story?
(2023) CARVALHO, Kalyanna S. Bezerra de; LAUAR, Julia C.; DRAGER, Luciano F.; MOYSES, Rosa M.A.; ELIAS, Rosilene M.
Abstract Introduction: There is disagreement between data on sleep duration obtained from questionnaires and objective measurements. Whether this is also true for individuals with CKD is unknown. Here we compared self-reported sleep duration with sleep duration obtained by actigraphy. Methods: This prospective study included adult individuals with stage 3 CKD recruited between September/2016 and February/2019. We evaluated subjective sleep duration by asking the following question: “How many hours of actual sleep did you get at night?” Results: Patients (N=34) were relatively young (51 ± 13 years). Self-reported and measured sleep duration were 7.1 ± 1.7 and 6.9 ± 1.6 hours, respectively, with no correlation between them (p=0.165). Although the mean difference between measurements was 0.21 h, the limits of agreement ranged from -3.7 to 4.1 h. Conclusion: Patients with CKD who are not on dialysis have an erroneous sleep perception. Data on sleep duration should be preferentially obtained from objective measurements in patients with CKD.
COVID-19: Understanding the impact of anti-hypertensive drugs and hydroxychloroquine on the ACE1 and ACE2 in lung and adipose tissue in SHR and WKY rats
(2023) CORREA, Beatriz Santos Geoffroy; BARROS, Silvana de; VAZ, Julia Braga; PERES, Maria Angelica; UCHIYAMA, Mayara Klimuk; SILVA, Alexandre Alves da; FURUKAWA, Luzia Naoko Shinohara
Hypertensive individuals taking anti-hypertensive drugs from renin-angiotensin system inhibitors may exhibit a more severe evolution of the disease when contracting the SARS-CoV-2 virus (COVID-19 disease) due to potential increases in ACE2 expression. The study investigated ACE1 and ACE2 axes and hydroxychloroquine in the lungs and adipose tissue of male and female normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHRs). SHRs were treated with losartan (10 mg/kg/day) or captopril (10 mg/kg/day) for 14 days or 7 days with hydroxychloroquine (200 mg/kg/day) in drinking water. WKY rats were also treated for 7 days with hydroxychloroquine. Blood pressure (BP), protein, and mRNA expression of ACE1 and ACE2 were analyzed in serum, adipose, and lung tissues. Losartan and captopril reduced BP in both sexes in SHR, whereas hydroxychloroquine increased BP in WKY rats. Losartan reduced ACE2 in serum and lungs in both sexes and in adipose tissue of male SHRs. Captopril decreased ACE2 protein in the lung of females and in adipose tissue in both sexes of SHRs. Hydroxychloroquine decreased ACE1 and ACE2 proteins in the lungs in both sexes and adipose tissue in male SHRs. In female WKY rats, ACE2 protein was lower only in the lungs and adipose tissue. Losartan effectively inhibited ACE2 in male and captopril in female SHRs. Hydroxychloroquine inhibited ACE2 in male SHRs and female WKY rats. These results further our understanding of the ACE2 mechanism in patients under renin-angiotensin anti-hypertensive therapy and in many trials using hydroxychloroquine for COVID-19 treatment and potential sex differences in response to drug treatment.
Advanced Glycation End Products and Bone Metabolism in Patients with Chronic Kidney Disease
(2023) QUADROS, Kelcia R. S.; ROZA, Noemi A. V.; FRANCA, Renata A.; ESTEVES, Andre B. A.; BARRETO, Joaquim; DOMINGUEZ, Wagner V.; FURUKAWA, Luzia N. S.; CARAMORI, Jacqueline Teixeira; SPOSITO, Andrei C.; OLIVEIRA, Rodrigo Bueno de
Advanced glycation end products (AGEs) accumulation may be involved in the progression of CKD-bone disorders. We sought to determine the relationship between AGEs measured in the blood, skin, and bone with histomorphometry parameters, bone protein, gene expression, and serum biomarkers of bone metabolism in patients with CKD stages 3 to 5D patients. Serum levels of AGEs were estimated by pentosidine, glycated hemoglobin (A1c), and N-carboxymethyl lysine (CML). The accumulation of AGEs in the skin was estimated from skin autofluorescence (SAF). Bone AGEs accumulation and multiligand receptor for AGEs (RAGEs) expression were evaluated by immunohistochemistry; bone samples were used to evaluate protein and gene expression and histomorphometric analysis. Data are from 86 patients (age: 51 +/- 13 years; 60 [70%] on dialysis). Median serum levels of pentosidine, CML, A1c, and SAF were 71.6 pmol/mL, 15.2 ng/mL, 5.4%, and 3.05 arbitrary units, respectively. AGEs covered 3.92% of trabecular bone and 5.42% of the cortical bone surface, whereas RAGEs were expressed in 0.7% and 0.83% of trabecular and cortical bone surfaces, respectively. AGEs accumulation in bone was inversely related to serum receptor activator of NF-KB ligand/parathyroid hormone (PTH) ratio (R = -0.25; p = 0.03), and RAGE expression was negatively related to serum tartrate-resistant acid phosphatase-5b/PTH (R = -0.31; p = 0.01). Patients with higher AGEs accumulation presented decreased bone protein expression (sclerostin [1.96 (0.11-40.3) vs. 89.3 (2.88-401) ng/mg; p = 0.004]; Dickkopf-related protein 1 [0.064 (0.03-0.46) vs. 1.36 (0.39-5.87) ng/mg; p = 0.0001]; FGF-23 [1.07 (0.4-32.6) vs. 44.1 (6-162) ng/mg; p = 0.01]; and osteoprotegerin [0.16 (0.08-2.4) vs. 6.5 (1.1-23.7) ng/mg; p = 0.001]), upregulation of the p53 gene, and downregulation of Dickkopf-1 gene expression. Patients with high serum A1c levels presented greater cortical porosity and Mlt and reduced osteoblast surface/bone surface, eroded surface/bone surface, osteoclast surface/bone surface, mineral apposition rate, and adjusted area. Cortical thickness was negatively correlated with serum A1c (R = -0.28; p = 0.02) and pentosidine levels (R = -0.27; p = 0.02). AGEs accumulation in the bone of CKD patients was related to decreased bone protein expression, gene expression changes, and increased skeletal resistance to PTH; A1c and pentosidine levels were related to decreased cortical thickness; and A1c levels were related to increased cortical porosity and Mlt.

Navegar

Submissões Recentes