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Daher EDF, Zuñiga PJD, Pequeno MGC, Meneses GC, Silva HF, Lima DB, Martins AMC, Bezerra da Silva Junior G. SP111NOVEL BIOMARKERS OF SUBCLINICAL KIDNEY INJURY AMONG PATIENTS WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Oliveira Neves FM, Araújo CB, de Freitas DF, Arruda BFT, de Macêdo Filho LJM, Salles VB, Meneses GC, Martins AMC, Libório AB. Fibroblast growth factor 23, endothelium biomarkers and acute kidney injury in critically-ill patients. J Transl Med 2019; 17:121. [PMID: 30971270 PMCID: PMC6458699 DOI: 10.1186/s12967-019-1875-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibroblast growth factor 23 (FGF23) and endothelium-related biomarkers have been related to AKI in critically-ill patients. Also, FGF23 is associated with endothelial dysfunction. In this study, we investigated if elevated FGF23 association with severe AKI is mediated by several endothelial/glycocalyx-related biomarkers. METHODS Prospective cohort study with critically-ill patients. Blood samples were collected within the first 24 h after ICU admission. Severe AKI (defined according to KDIGO stage 2/3) was the analyzed outcome. RESULTS 265 patients were enrolled and 82 (30.9%) developed severe AKI-defined according to KDIGO stage 2/3. Blood samples to biomarkers measurement were collected within the first 24 h after ICU admission. After adjustment for several variables, FGF23, vascular cell adhesion protein 1 (VCAM-1), angiopoietin 2 (AGPT2), syndecan-1 and intercellular adhesion molecule-1 (ICAM-1) were associated with severe AKI. The individual indirect effects of VCAM-1, AGPT2 and syndecan-1 explained 23%, 31%, and 32% of the total observed effect of FGF23 on severe AKI, respectively. ICAM-1 showed no statistically significant mediation. When all three endothelium-related biomarkers were included in a directed acyclic graph (DAG), the Bayesian network learning suggested the following causal association pathway FGF-23 → syndecan-1 → VCAM-1 → AGPT2 → severe AKI. CONCLUSIONS The association between FGF23 and AKI are mediated by endothelium-related biomarkers, mainly VCAM-1, AGPT2 and syndecan-1. Moreover, the statistical models show that syndecan-1, a biomarker of endothelial glycocalyx dysfunction, seems to be the initial mediator between FGF23 and severe AKI.
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Affiliation(s)
- Fernanda Macedo de Oliveira Neves
- Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceará, CEP 60165-082, Brazil
| | - Camila Barbosa Araújo
- Medical Sciences Postgraduate Program, Universidade de Fortaleza-UNIFOR, Fortaleza, Ceara, Brazil
| | | | | | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceará, CEP 60165-082, Brazil
| | - Alice Maria Costa Martins
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceará, CEP 60165-082, Brazil. .,Medical Sciences Postgraduate Program, Universidade de Fortaleza-UNIFOR, Fortaleza, Ceara, Brazil.
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Araújo CB, de Oliveira Neves FM, de Freitas DF, Arruda BFT, de Macêdo Filho LJM, Salles VB, Meneses GC, Martins AMC, Libório AB. Angiopoietin-2 as a predictor of acute kidney injury in critically ill patients and association with ARDS. Respirology 2019; 24:345-351. [PMID: 30654408 DOI: 10.1111/resp.13464] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Angiopoietin-2 (AGPT2) has been proposed as a key mediator of organ dysfunction, mainly in acute respiratory distress syndrome (ARDS). It has also been associated with acute kidney injury (AKI). We aimed to investigate the role of AGPT2 in patients with and without ARDS. METHODS In a cohort study with critically ill patients, AGPT1 and AGPT2 were assayed in plasma collected within the first 24 h after admission to intensive care unit (ICU). Severe AKI and the need for dialysis were outcome measures from comparative analysis with clinical characteristics useful for AKI risk stratification. RESULTS Among 283 patients (50.2% males), 109 (38.5%) had ARDS. AGPT2 levels at admission were higher in patients with ARDS. Although overall AGPT2 and AGPT2/AGPT1 levels were associated with severe AKI, this association was not significant in patients without ARDS; however, it remained strongly significant in ARDS patients. In patients without ARDS, AGPT2 showed only a weak discriminatory capacity to predict severe AKI (area under the curve (AUC): 0.64 vs 0.81 in the ARDS group). The continuous net reclassification improvement (NRI) in the ARDS group resulting from AGPT2 inclusion was 64.1% (P < 0.001) and the integrated discrimination improvement (IDI) index was 0.057 (P = 0.003). There was no significant difference in NRI in the no-ARDS group. CONCLUSION AGPT2 and AGPT2/AGPT1 ratio are associated with severe AKI and there was only a need of renal replacement therapy (RRT) in patients with or at risk of ARDS, not in other critically ill patients. Adding AGPT2 to a clinical model resulted in a significant improvement in the capacity to predict severe AKI specifically in ARDS patients.
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Affiliation(s)
- Camila Barbosa Araújo
- Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil
| | | | | | | | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Alice Maria Costa Martins
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.,Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
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Macedo ÊS, Parente Filho SLA, Pro JDZ, Rolim VDM, Primo GDAS, Brunetta DM, Silva HFD, Meneses GC, Barroso-Duarte F, Daher EDF. Renal involvement in paroxysmal nocturnal haemoglobinuria: a brief review of the literature. Rev Assoc Med Bras (1992) 2018; 64:1139-1146. [DOI: 10.1590/1806-9282.64.12.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 12/26/2022] Open
Abstract
SUMMARY INTRODUCTION: Paroxysmal Nocturnal Haemoglobinuria (PNH) is an acquired genetic disorder characterized by complement-mediated haemolysis, thrombosis and variable cytopenias. Renal involvement may occur and causes significant morbidity to these patients. OBJECTIVE: To review the literature about pathophysiology and provide recommendations on diagnosis and management of renal involvement in PNH. METHODS: Online research in the Medline database with compilation of the most relevant 26 studies found. RESULTS: PNH may present with acute kidney injury caused by massive haemolysis, which is usually very severe. In the chronic setting, PNH may develop insidious decline in renal function caused by tubular deposits of hemosiderin, renal micro-infarcts and interstitial fibrosis. Although hematopoietic stem cell transplantation remains the only curative treatment for PNH, the drug Eculizumab, a humanized anti-C5 monoclonal antibody is capable of improving renal function, among other outcomes, by inhibiting C5 cleavage with the subsequent inhibition of the terminal complement pathway which would ultimately give rise to the assembly of the membrane attack complex. CONCLUSION: There is a lack of information in literature regarding renal involvement in PNH, albeit it is possible to state that the pathophysiological mechanisms of acute and chronic impairment differ. Despite not being a curative therapy, Eculizumab is able to ease kidney lesions in these patients.
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Ferrer NMB, de Melo Bezerra Cavalcante CT, Branco KMC, Júnior VCP, Meneses GC, de Oliveira Neves FM, de Souza NMG, LourençoPenaforte K, Martins AMC, Libório AB. Urinary Syndecan-1 and acute kidney injury after pediatric cardiac surgery. Clin Chim Acta 2018; 485:205-209. [DOI: 10.1016/j.cca.2018.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/06/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
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Cavalcante Cezar L, Bezerra da Silva Junior G, Lima Mont'Alverne Rangel M, Fernandes CR, Alves Maciel D, dos Santos Garcez J, Cavalcante Meneses G, De Francesco Daher E, Parente Garcia JH. FP259NOVEL BIOMARKERS OF ACUTE KIDNEY INJURY AND ENDOTHELIAL DYSFUNCTION AFTER LIVER TRANSPLANTATION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lemos Moura Moreira Albuquerque P, Cavalcante Meneses G, Pantoja BL, Pinto Custodio M, Costa Martins AM, Bezerra da Silva Junior G, Buckley N, De Francesco Daher E. SP222PERFORMANCE OF URINARY MONOCYTE CHEMOATTRACTANT PROTEIN-1 (MCP-1) TO DIAGNOSE ACUTE KIDNEY INJURY IN SNAKEBITE ENVENOMATION DUE TO BOTHROPS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Bruna Luiza Pantoja
- Medical Sciences Graduate Program, Federal University of Ceara, Fortaleza, Brazil
| | | | | | | | - Nicholas Buckley
- Clinical Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
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Gomes Junior RM, Cezar LC, Meneses GC, Silva Junior GBD, Garcia JHP, Daher EDF. PREOPERATIVE RISK FACTORS FOR ACUTE KIDNEY INJURY AFTER LIVER TRANSPLANTATION: RESULTS FROM A CROSS-SECTIONAL STUDY IN NORTHEAST OF BRAZIL. Arq Gastroenterol 2018; 55:18-22. [PMID: 29561970 DOI: 10.1590/s0004-2803.201800000-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/04/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication in the immediate postoperative period of patients undergoing liver transplantation. OBJECTIVE The aim of this study was to evaluate preoperative risk factors for AKI after liver transplantation. METHODS A cross-sectional study was conducted with adults submitted to orthotopic liver transplantation at a reference hospital in Fortaleza, Northeast of Brazil, from January to December 2016. Preoperative risk factors were evaluated for AKI development in the immediate postoperative period. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. RESULTS A total of 40 patients were included in the study. AKI was found in 85% of patients in the first 24 hours after transplantation, most of them (40%) classified in KDIGO stage 1. Preoperative data indicate that serum albumin levels were lower in the KDIGO stage 3 group compared to the non-AKI group, as well as the hematocrit levels. Direct bilirubin (DB) was higher in the KDIGO stage 3 group compared to the group without AKI, as well as alkaline phosphatase (AP) and gamma-glutamiltransferase (GGT). In a logistic regression analysis independent risk factors for AKI were increase levels of AP, GGT and DB and decrease level of serum albumin. CONCLUSION Low levels of serum albumin, and elevated levels of DB, AP and GGT in the preoperative period are risk factors for AKI development after liver transplantation.
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Affiliation(s)
- Raimundo Martins Gomes Junior
- Divisão de Anestesiologia, Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Lia Cavalcante Cezar
- Divisão de Anestesiologia, Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Gdayllon Cavalcante Meneses
- Programa de Pós-Graduação em Farmacologia, Departamento de Fisiologia e Farmacologia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Geraldo Bezerra da Silva Junior
- Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Centro de Ciências da Saúde, Universidade de Fortaleza, CE, Brasil
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Campos NG, Marizeiro DF, Florêncio ACL, Silva ÍC, Meneses GC, Bezerra GF, Martins AMC, Libório AB. Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial. Respir Med 2018; 134:103-109. [DOI: 10.1016/j.rmed.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
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Meneses GC, Cavalcante MG, da Silva Junior GB, Martins AMC, Neto RDJP, Libório AB, De Francesco Daher E. Endothelial Glycocalyx Damage and Renal Dysfunction in HIV Patients Receiving Combined Antiretroviral Therapy. AIDS Res Hum Retroviruses 2017; 33:703-710. [PMID: 28260391 DOI: 10.1089/aid.2016.0284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Widespread use of combined antiretroviral therapy (cART) increased HIV patients' life expectancy, however, favored the development of kidney and cardiovascular diseases. The aim of this study was to investigate endothelial glycocalyx (eGC) damage and its association with renal function in HIV patients receiving cART. This is a cross-sectional study with HIV-infected patients with no renal and cardiovascular disease, recruited in public health centers in Brazil. Clinical and laboratory parameters of HIV patients were compared according to cART use and with a healthy control group. Blood ICAM-1 and syndecan-1 levels were quantified by ELISA kit. Estimated glomerular filtration rate (eGFR) was evaluated. A total of 69 HIV patients were included, with mean age of 33.4 ± 8.9 years, and 77.3% were male. Serum urea, creatinine, and eGFR were similar in all groups. No HIV patient had decreased GFR <60 ml/min. All HIV patients had higher systemic syndecan-1 compared with healthy controls (71.8 ± 25.4 ng/ml vs. 36.5 ± 14.3 ng/ml, p < .001). Syndecan-1 showed a significant positive correlation with serum creatinine (r = 0.437, p = .001), serum urea levels (r = 0.352, p = .006), and a negative correlation with eGFR (r = -0.315, p = .015) in HIV patients. Syndecan-1 remained independently associated with serum creatinine and reduced GFR even after we forced variables related with HIV infection status, tenofovir use, treatment time, dyslipidemia, and others in a multivariate analysis. HIV patients using cART with no clinical renal and cardiovascular disease presented eGC damage and it is associated with clinical markers of kidney dysfunction. Syndecan-1 may be a useful early biomarker to monitoring renal dysfunction in HIV patients in chronic use of cART. Further research is needed to evaluate this applicability.
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Affiliation(s)
- Gdayllon Cavalcante Meneses
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Malena Gadelha Cavalcante
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará. Fortaleza, Brazil
| | | | - Alice Maria Costa Martins
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Roberto da Justa Pires Neto
- Public Health Postgraduate Program, Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, School of Medicine, University of Fortaleza, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará. Fortaleza, Brazil
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De Francesco Daher E, Lemos Moura Moreira Albuquerque P, Cavalcante Meneses G, Queiroz Frota T, Timbó Rocha AM, Sombra Olinda B, Martins Moura CT, Costa Martins AM, Bezerra da Silva Junior G. MP291SERUM NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN PREDICTS ACUTE KIDNEY INJURY AND NEED FOR DIALYSIS IN VICTIMS OF SNAKEBITES ENVENOMATION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx167.mp291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Francesco Daher E, Palácio Duarte Fernandes PH, Cavalcante Meneses G, Costa Martins AM, Bezerra da Silva Junior G. MP326INVESTIGATION OF NOVEL KIDNEY INJURY BIOMARKERS AMONG BODYBUILDERS USING ANABOLIC ANDROGENIC STEROIDS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx168.mp326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Francesco Daher E, Morais Andrade N, Cavalcante Meneses G, Freire Bezerra G, Costa Martins AM, Delgado Barros Pereira E, Bezerra da Silva Junior G. MP322CIRCULATING GALECTIN-3 LEVELS ARE ASSOCIATED WITH RESPIRATORY AND RENAL DYSFUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx168.mp322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Luna LDS, Soares DDS, Junior GBDS, Cavalcante MG, Malveira LRC, Meneses GC, Pereira EDB, Daher EDF. CLINICAL CHARACTERISTICS, OUTCOMES AND RISK FACTORS FOR DEATH AMONG CRITICALLY ILL PATIENTS WITH HIV-RELATED ACUTE KIDNEY INJURY. Rev Inst Med Trop Sao Paulo 2017; 58:52. [PMID: 27410912 PMCID: PMC4964321 DOI: 10.1590/s1678-9946201658052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/15/2016] [Indexed: 12/23/2022] Open
Abstract
Background: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death.
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Affiliation(s)
- Leonardo Duarte Sobreira Luna
- Federal University of Ceará, School of Medicine, Division of Nephrology, Department of Internal Medicine. Fortaleza, CE, Brazil. E-mails: ; ; ;
| | - Douglas de Sousa Soares
- Federal University of Ceará, School of Medicine, Division of Nephrology, Department of Internal Medicine. Fortaleza, CE, Brazil. E-mails: ; ; ;
| | | | - Malena Gadelha Cavalcante
- Federal University of Ceará, School of Medicine, Medical Sciences and Pharmacology Graduate Program. Fortaleza, CE, Brazil. E-mails: ;
| | - Lara Raissa Cavalcante Malveira
- Federal University of Ceará, School of Medicine, Division of Nephrology, Department of Internal Medicine. Fortaleza, CE, Brazil. E-mails: ; ; ;
| | - Gdayllon Cavalcante Meneses
- Federal University of Ceará, School of Medicine, Medical Sciences and Pharmacology Graduate Program. Fortaleza, CE, Brazil. E-mails: ;
| | - Eanes Delgado Barros Pereira
- University of Fortaleza, School of Medicine, Public Health Graduate Program. Fortaleza, CE, Brazil. E-mails: ; ;
| | - Elizabeth De Francesco Daher
- Federal University of Ceará, School of Medicine, Division of Nephrology, Department of Internal Medicine. Fortaleza, CE, Brazil. E-mails: ; ; ; .,University of Fortaleza, School of Medicine, Public Health Graduate Program. Fortaleza, CE, Brazil. E-mails: ; ;
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Daher EDF, Soares DDS, Filho SLAP, Meneses GC, Freitas TVDS, Leite TT, da Silva Junior GB. Hyponatremia and risk factors for death in human visceral leishmaniasis: new insights from a cross-sectional study in Brazil. BMC Infect Dis 2017; 17:168. [PMID: 28231825 PMCID: PMC5322621 DOI: 10.1186/s12879-017-2257-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background Visceral leishmaniasis (VL) is an important and potentially fatal neglected tropical disease. The aim of this study was to investigate hyponatremia and risk factors for death among VL patients. Methods This is a cross-sectional study with VL patients admitted to a tertiary hospital in Northeast Brazil, from 2002 to 2009. Patients were divided into two groups: non-survivors and survivors. Hyponatremia was defined as serum sodium < 135 mEq/L. A logistic regression model was done to investigate risk factors for death. Results A total of 285 VL patients were included, with mean age 37 ± 15 years, and 74% were males. Thirty-four patients died (11.9%). Non-survivors had a significantly higher prevalence of dyspnea (38.2 vs. 16.7%, p = 0.003), pulmonary crackles (11.8 vs. 4.0%, p = 0.049), dehydration (23.5 vs. 10.8%, p = 0.033), oliguria (8.8 vs. 0.8%, p = 0.001) and jaundice (47.1 vs. 14.3%, p < 0.001). They also presented higher prevalence of hyponatremia (41.9 vs. 24.1%, p = 0.035), thrombocytopenia (91.2 vs. 65.3%, p = 0.002) and severe hypoalbuminemia (78.3 vs. 35.3%, p < 0.001). In multivariate analysis, moderate/severe hyponatremia (OR = 2.278, 95% CI = 1.046–4.962), thrombocytopenia (OR = 5.482, 95% CI = 1.629–18.443), jaundice (OR = 5.133, 95% CI = 1.793–14.696) and severe hypoalbuminemia (OR = 6.479, 95% CI = 2.124–19.766) were predictors of death. Conclusion Higher prevalence of dehydration, oliguria, pulmonary symptoms and liver involvement was found in non-survivors VL patients. Hypoalbuminemia and hyponatremia were frequent and significantly associated with mortality.
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Affiliation(s)
- Elizabeth De Francesco Daher
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil. .,Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil.
| | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Sérgio Luiz Arruda Parente Filho
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Gdayllon Cavalcante Meneses
- Pharmacology Graduate Program, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Tainá Veras de Sandes Freitas
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Tacyano Tavares Leite
- Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, CE, CEP: 60270-135, Brazil
| | - Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health Graduate Program, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
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Sampaio TL, Menezes RRPPBD, da Costa MFB, Meneses GC, Arrieta MCV, Chaves Filho AJM, de Morais GB, Libório AB, Alves RS, Evangelista JSAM, Martins AMC. Nephroprotective effects of (-)-α-bisabolol against ischemic-reperfusion acute kidney injury. Phytomedicine 2016; 23:1843-1852. [PMID: 27912887 DOI: 10.1016/j.phymed.2016.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/28/2016] [Accepted: 11/10/2016] [Indexed: 05/14/2023]
Abstract
BACKGROUND Ischemia/reperfusion (I/R) in kidney is commonly related to acute kidney injury (AKI), essentially through oxidative stress. (-)-α-Bisabolol is a sesquiterpene isolated from the essential oil of a variety of plants, including chamomile, which has important antioxidant activity. STUDY DESIGN This study intends to evaluate the nephroprotective activity of (-)-α-bisabolol (Bis) in both in vivo and in vitro models of kidney I/R. METHODS Male Wistar rats were submitted to right nephrectomy, followed by ischemia by clamping of the renal artery in the left kidney for 60min. and 48h of reperfusion. The animals were treated orally with Bis (100mg/kg) or vehicle for 24h after reperfusion, and placed in metabolic cages, to evaluate water consumption, diuresis, urinary osmolality, classic biochemical markers and urinary KIM-1 (kidney injury molecule-1). Additionally, the left kidney was collected for histological evaluation and determination of glutathione (GSH) and Thiobarbituric Acid Reactive Substances (TBARS) levels. Tubular epithelial cells LLC-MK2 were used to assess Bis effect on in vitro I/R, by MTT assay. It was performed the cellular respiration tests by flow cytometry: evaluation of the production of cytoplasmic reactive oxygen species by DCFH-DA assay and mitochondrial transmembrane potential analysis with the dye rhodamine 123. RESULTS I/R caused alterations in diuresis, water intake, urinary osmolality, plasmatic creatinine, urea and uric acid, creatinine clearance, proteinuria and microalbuminuria. Treatment with Bis ameliorated all of these parameters. Also, KIM-1 level enhanced by I/R was also diminished in groups treated with Bis. The histological examination showed that Bis attenuated the morphological changes caused by I/R, markedly vascular congestion and intratubular deposits of proteinaceous material. Additionally, Bis was able to reduce the changes observed in TBARS and GSH levels in kidney tissue. In in vitro assay, Bis was capable to partially protect the cell lineage against cell damage induced by I/R. CONCLUSION (-)-α-Bisabolol has a nephroprotective effect in kidney I/R, with antioxidant effect. Moreover, this result seems to be associated to a direct protective effect on tubular epithelia.
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Affiliation(s)
- Tiago Lima Sampaio
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Ceará, Brazil
| | | | | | | | | | | | | | - Alexandre Braga Libório
- Department of Clinical Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceara, Brazil
| | - Renata Sousa Alves
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Alice Maria Costa Martins
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
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de Melo Bezerra Cavalcante CT, Castelo Branco KM, Pinto Júnior VC, Meneses GC, de Oliveira Neves FM, de Souza NMG, Penaforte KL, Martins AMC, Libório AB. Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2016; 152:178-186.e2. [DOI: 10.1016/j.jtcvs.2016.03.079] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/09/2016] [Accepted: 03/27/2016] [Indexed: 12/26/2022]
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Oliveira Filho AMP, Daher EF, Albuquerque PLM, Silva Júnior G, Lopes IS, Veras MSB, Meneses GC, Buckley N. SP192ACUTE KIDNEY INJURY CAUSED BY SNAKEBITES IN PATIENTS ADMITTED TO A REFERENCE TOXICOLOGICAL ASSISTANCE CENTER IN NORTHEAST BRAZIL. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw162.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Francesco Daher ED, Gadelha Cavalcante M, Cavalcante Meneses G, Costa Martins AM, Braga Libório A, Bezerra da Silva Junior G. SP205ENDOTHELIAL GLYCOCALYX DAMAGE AND RENAL DYSFUNCTION IN HIV PATIENTS RECEIVING COMBINED ANTIRETROVIRAL THERAPY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw162.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carvalho Pedrosa D, Macedo de Oliveira Neves F, Cavalcante Meneses G, Pinheiro Gomes Wirtzbiki G, da Costa Moraes CA, Costa Martins AM, Braga Libório A. Urinary KIM-1 in children undergoing nephrotoxic antineoplastic treatment: a prospective cohort study. Pediatr Nephrol 2015; 30:2207-13. [PMID: 26248472 DOI: 10.1007/s00467-015-3178-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/24/2015] [Accepted: 07/21/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a significant complication in patients with cancer, and nephrotoxic drugs are among the most common causes of AKI. To date, there is no study evaluating the potential role of renal biomarkers in children receiving nephrotoxic chemotherapy. METHODS A prospective study was conducted in children receiving methotrexate (MTX) or platinum-based treatment. Urinary kidney injury molecule-1 (KIM-1) was measured 24 h after the initiation of the chemotherapy infusion, and serum creatinine (sCr) was measured prior to drug infusion and at 24, 48, 72, and 96 h, 1 and 2 weeks, and 3 months post-initiation of treatment. RESULTS A total of 64 children were evaluated, of whom 21 (32.8%) developed AKI. The majority had AKI stage 1 (n = 12, 57.1%) and only one developed AKI stage 3. Median values of urinary KIM-1 were higher in patients with AKI than in those without AKI [10.7, interquartile range (IQR) 1.6-17.9 vs. 4.3 (IQR 1.3-6.1) ng/mg creatinine; p < 0.01]. Urinary KIM-1 showed good discrimination for AKI in patients receiving nephrotoxic chemotherapy, with an area under the receiver operator characteristic curve for AKI up to 1 week later of 0.82 (95% confidence interval 0.66-0.95). Even when measured only 24 h after drug infusion, urinary KIM-1 still showed good discrimination to predict persistent renal impairment three months later. CONCLUSION Urinary KIM-1 measured 24 h after the start of drug infusion has the potential to detect early AKI in pediatric patients treated with MTX or platinum-class drugs.
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Affiliation(s)
- Danielle Carvalho Pedrosa
- Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil
| | - Fernanda Macedo de Oliveira Neves
- Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | | | | | - Alice Maria Costa Martins
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Alexandre Braga Libório
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil. .,Medical Sciences Post-graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Avenue Abolição, 4043, Fortaleza, Ceará, Brazil.
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Silva Junior GBD, Daher EDF, Pires Neto RDJ, Pereira EDB, Meneses GC, Araújo SMHA, Barros EJG. Leprosy nephropathy: a review of clinical and histopathological features. Rev Inst Med Trop Sao Paulo 2015; 57:15-20. [PMID: 25651321 PMCID: PMC4325518 DOI: 10.1590/s0036-46652015000100002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/02/2014] [Indexed: 11/22/2022] Open
Abstract
Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.
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Affiliation(s)
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Eanes Delgado Barros Pereira
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Elvino José Guardão Barros
- Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Salmito FTS, de Oliveira Neves FM, Meneses GC, de Almeida Leitão R, Martins AMC, Libório AB. Glycocalyx injury in adults with nephrotic syndrome: Association with endothelial function. Clin Chim Acta 2015; 447:55-8. [DOI: 10.1016/j.cca.2015.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/31/2022]
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Neves FMDO, Meneses GC, Sousa NEA, Pessoa Bezerra de Menezes RRP, Parahyba MC, Martins AMC, Libório AB. Syndecan-1 in Acute Decompensated Heart Failure – Association With Renal Function and Mortality –. Circ J 2015; 79:1511-1519. [DOI: 10.1253/circj.cj-14-1195] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Duarte DB, Vanderlei LA, de Azevêdo Bispo RK, Pinheiro ME, da Silva Junior GB, Martins AMC, Meneses GC, De Francesco Daher E. Renal function in hepatosplenic schistosomiasis--an assessment of renal tubular disorders. PLoS One 2014; 9:e115197. [PMID: 25531759 PMCID: PMC4274079 DOI: 10.1371/journal.pone.0115197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/19/2014] [Indexed: 01/07/2023] Open
Abstract
Background Renal involvement in Schistosoma mansoni infection is not well studied. The aim of this study is to investigate the occurrence of renal abnormalities in patients with hepatosplenic schistosomiasis (HSS), especially renal tubular disorders. Methods This is a cross-sectional study with 20 consecutive patients with HSS followed in a medical center in Maceió, Alagoas, Brazil. Urinary acidification and concentration tests were performed using calcium chloride (CaCl2) after a 12-h period of water and food deprivation. The biomarker monocyte chemoattractant protein 1 (MCP-1) was quantified in urine. Fractional excretion of sodium (FENa+), transtubular potassium gradient (TTKG) and solute-free water reabsorption (TcH2O) were calculated. The HSS group was compared to a group of 17 healthy volunteers. Results Patients' mean age and gender were similar to controls. Urinary acidification deficit was found in 45% of HSS patients. Urinary osmolality was significantly lower in HSS patients (588±112 vs. 764±165 mOsm/kg, p = 0,001) after a 12-h period of water deprivation. TcH2O was lower in HSS patients (0.72±0.5 vs. 1.1±0.3, p = 0.04). Urinary concentration deficit was found in 85% of HSS patients. The values of MCP-1 were higher in HSS group than in control group (122±134 vs. 40±28 pg/mg-Cr, p = 0.01) and positively correlated with the values of microalbuminuria and proteinuria. Conclusions HSS is associated with important kidney dysfunction. The main abnormalities found were urinary concentrating ability and incomplete distal acidification defect, demonstrating the occurrence of tubular dysfunction. There was also an increase in urinary MCP-1, which appears to be a more sensitive marker of renal damage than urinary albumin excretion rate.
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Affiliation(s)
- Daniella Bezerra Duarte
- Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil
- Department of Internal Medicine, Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lucas Alexandre Vanderlei
- Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil
| | | | - Maria Eliete Pinheiro
- Department of Internal Medicine, School of Medicine, Federal University of Alagoas, Maceió, AL, Brazil
| | - Geraldo Bezerra da Silva Junior
- School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, CE, Brazil
| | | | | | - Elizabeth De Francesco Daher
- Department of Internal Medicine, Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
- * E-mail:
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Meneses GC, Libório AB, de Daher EF, da Silva GB, da Costa MFB, Pontes MAA, Martins AMC. Urinary monocyte chemotactic protein-1 (MCP-1) in leprosy patients: increased risk for kidney damage. BMC Infect Dis 2014; 14:451. [PMID: 25142123 PMCID: PMC4158081 DOI: 10.1186/1471-2334-14-451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/12/2014] [Indexed: 11/19/2022] Open
Abstract
Background We aimed to evaluate urinary MCP-1 and oxidative stress through urinary malondialdehyde (MDA) in leprosy and correlate them with traditional, but less sensitive markers of renal disease. Methods This is a cross-sectional study of 44 patients with diagnosis of leprosy and no previous treatment. Skin smear was assessed through a bacteriological index - from 0 to 6+. Glomerular filtration rate (GFR), protein excretion rate, microalbuminuria, urinary oxidative stress, malondialdehyde (MDA) and urinary MCP-1 were measured. Also, high- sensitivity C-reactive protein (hs-CRP) was measured in the blood. Fifteen healthy subjects composed a control group. Results Age and gender were similar between leprosy patients and control groups. No patient had a GFR < 60 mL/min/1.73 m2 or albumin excretion rate greater than 30 mg/g-Cr. Leprosy patients had higher urinary protein excretion (97.6 ± 69.2 vs. 6.5 ± 4.3 mg/g-Cr, p < 0.001), urinary MCP-1 (101.0 ± 79.8 vs. 34.5 ± 14.9 mg/g-Cr, p = 0.006) and urinary MDA levels (1.77 ± 1.31 vs. 1.27 ± 0.66 mmol/g-Cr, p = 0.0372) than healthy controls. There was a positive correlation between urinary MCP-1 and bacteriological index in skin smears (r = 0.322, p = 0.035), urinary protein excretion (r = 0.547, p < 0.001), albumin excretion rate (r = 0.414, p = 0.006) and urinary MDA (r = 0.453, p = 0.002). After adjusting for hs-CRP, urinary MCP-1 remained correlated with albumin excretion rate (rpartial = 0.483, p = 0.007) and MDA levels (rpartial = 0.555, p = 0.001). Conclusion Leprosy patients with no clinical kidney disease have increased urinary MCP-1 mainly in lepromatous polar form. Inflammatory (MCP-1) and oxidative stress markers suggest leprosy patients are at high risk of developing kidney disease. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-451) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Alexandre Braga Libório
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceara, Brazil.
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