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Barbosa JDS, da Silva GB, Meneses GC, Martins AMC, Daher EDF, Machado RPG, Lemes RPG. Use of non-conventional biomarkers in the early diagnosis of acute kidney injury in preterm newborns with sepsis. J Bras Nefrol 2022; 44:97-108. [PMID: 34846061 PMCID: PMC8943868 DOI: 10.1590/2175-8239-jbn-2020-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
Acute kidney injury (AKI) is a common finding in Neotatal Intensive Care Units (NICU). Sepsis is one the main causes of AKI in preterm newborns. AKI has been associated with significant death rates. Early detection of the condition is the first step to improving prevention, treatment, and outcomes, while decreasing length of hospitalization, care costs, and morbimortality. AKI may progress to chronic kidney disease (CKD), a condition linked with dialysis and greater risk of cardiovascular disease. This review article aims to discuss cases of AKI in preterm newborns with sepsis, the use of biomarkers in lab workup, and the use of non-conventional biomarkers for the early identification of AKI.
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Gomes CAM, de Carvalho Borges BM, Lemos LO, de Medeiros CMMF, de Lima PR, Meneses GC, Martins AC, de Melo Bezerra Cavalcante CT, Cavalcante MB, Libório AB. Baseline endothelial-related biomarkers in hemodialysis patients and risk of developing severe SARS-Cov-2 infection. J Nephrol 2021; 34:971-974. [PMID: 34279811 PMCID: PMC8287842 DOI: 10.1007/s40620-021-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
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Tessarolo LD, Meneses GC, Bezerra GF, da Rocha TP, de Azevedo IEP, Silva GB, Pontes MAA, Daher EDF, Martins AMC. Endothelial activation is associated with albuminuria in multibacillary leprosy. Rev Inst Med Trop Sao Paulo 2021; 63:e44. [PMID: 34161550 PMCID: PMC8216693 DOI: 10.1590/s1678-9946202163044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022] Open
Abstract
Leprosy may present kidney and endothelial abnormalities, being a risk factor for complications. However, the involvement of renal and vascular endothelia has been poorly investigated. We aimed to investigate if the levels of systemic endothelial biomarkers are associated with kidney abnormalities and the clinical forms of leprosy. This is a cross-sectional study with leprosy patients enrolled in January 2017 to December 2018, before the initiation of the multidrug therapy. Leprosy-associated clinical and epidemiological data were collected. Two groups were investigated: Paucibacillary (PB) and Multibacillary (MB) infections, for the comparisons. Serum and urine samples were obtained for laboratory analysis. In serum samples, were evaluated the endothelial biomarkers VCAM-1 and ICAM-1. In total, 101 leprosy patients were included, the mean age was 48±١٥ years and 71 (70%) were male. The multibacillary form occurred in 81 cases (80%), among which 22 had the Virchowian form. Serum creatinine was more elevated in the MB group than in PB patients. In addition, VCAM-1 was elevated in the MB group and was correlated with the bacteriological index (rho = 0.372, p <0.01), the duration of disease symptoms (rho = 0.234, p = 0.04), and the number of skin lesions (rho = 0.468, p <0.001). Moreover, in MB patients who presented albuminuria >15 mg/g of creatinine, VCAM-1 showed a significant correlation with increased albuminuria and improved the correlation with the number of skin lesions (rho= 0.563, p=0.010). In conclusion, higher systemic VCAM-1 levels were associated with the multibacillary clinical form of leprosy and with increased albuminuria. Prospective studies are necessary to establish a cause-effect and evaluate the preventive role of these biomarkers to improve the clinical care.
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Cavalcante Meneses G, Andrade de Carvalho Gomes PE, Studart Galdino G, Bezerra da Silva Junior G, Coelho Lopes N, Costa Martins AM, Brasil Gadelha Farias LA, De Francesco Daher E. MO157HYPONATREMIA AND DISEASE SEVERITY IN LEPTOSPIROSIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Hyponatremia is associated with severe complication in tropical diseases and may be associated with higher mortality. The aim of this study was to investigate the association between hyponatremia and disease severity in patients with leptospirosis.
Method
This is a retrospective study including patients with confirmed diagnosis of leptospirosis admitted to three reference hospitals in Fortaleza, northeast Brazil, in the period from 1985 to 2018. Demographic, clinical and laboratory data were analyzed, and the incidence of unfavorable outcomes were investigated: acute kidney injury (AKI) – defined according to KDIGO criteria, hemodialysis need and death. Patients were divided in groups according to the levels of sodium at hospital admission (< or ≥135mEq/L). Statistical analysis was done with the SPSS program version 23.0.
Results
A total of 319 patients were included. Hyponatremia was found in 163 cases (51%) at hospital admission. Patients’ mean age was 37±15 years, and 84% were male. The group with hyponatremia had higher frequency of some symptoms and signs, such as disorientation (8.1% vs 1.3%, p=0.047) and jaundice (76% vs 54%, p<0.001). Higher levels of urea (130±80 vs 94±34mg/dL, p<0.001) and creatinine (4.3±2.7 vs 3.0±2.6mg/dL, p<0.001) were observed at hospital admission, as well as maximum levels of bilirubins, in the group with hyponatremia (p<0,05). Median lower levels of platelets during hospital stay were observed in the group of hyponatremia (45 [26 – 110] vs 73 [42 – 157] x103/µL p=0.001). A higher frequency of complications was also observed in the group with hyponatremia: hemodialysis need (38% vs 20%, p<0.001) and AKI stage 3 (71% vs 46%, p=0.002). There was no difference regarding mortality rate between the two groups (14.1% vs 10.1%, p=0.281).
Conclusion
Hyponatremia in patients with leptospirosis, at hospital admission, is associated with worse prognosis and can be an important parameter to guide clinical care in this group of patients.
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Brasileiro Mota SM, Lemos Moura Moreira Albuquerque P, Cavalcante Meneses G, Tavares Holanda FM, Oliveira Brizeno M, Rolim Guimaraes A, Costa Martins AM, Bezerra da Silva Junior G, De Francesco Daher E. MO396NOVEL ENDOTHELIAL INFLAMMATION BIOMARKERS IN SNAKEBITES-ASSOCIATED ACUTE KIDNEY INJURY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab082.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Acute kidney injury (AKI) is a frequent and potentially fatal complications of snakebites. Coagulation disturbances are observed and have a high probability to be involved in AKI pathogenesis. Novel endothelial inflammation biomarkers are capable of predicting disease severity and could be used in the setting of snakebites.
Method
This is a prospective study conducted at the Instituto Dr. José Frota, a reference hospital for toxicological assistance in Fortaleza, Northeast Brazil. Blood and urine samples were collected from patients admitted after snakebite accident, without comorbidities, in 3 different time-points post-bite: on admission (until 8h post-bite), 12 to 16h, and 24-48h. The samples were stored in microtubes, frozen in a freezer (-80ºC) until performance of the laboratory tests. To measure the novel biomarkers the following ELISA kits were used: Angiopoietin-1 (R&D Systems–Duoset DY623), Angiopoietin-2 (R&D Systems–Duoset DY623) and Vascular cell adhesion protein 1 (VCAM-1) (Abcam–ab47355). All procedures were conducted according to the manufacturer’s guidelines. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were divided in 2 groups: with and without AKI.
Results
A total of 26 patients were included in the study:23 (88.5%) victims of Bothrops accident and 3 (11.5%) Crotalus accidents. AKI was observed in 11 cases. The 2 groups did not differ in age, gender, electrolytes levels, creatine kinase (CK), hemoglobin and hematocrit levels. There were significant differences regarding the levels of angiopoietin 1 (16.39±8.1 vs 4.35±7.36; p=0.0054) and VCAM-1 (1293±528 vs 811.3±234; p=0.0175), both in the second sample (12-16h after bite). The analysis of ROC curve revealed that angiopoietin 1 (AUC: 0.8182, 95% CI0.63–0.99, p=0.0064) and VCAM-1 (AUC: 0.77, 95% CI0.57–0.97, p=0.0182) presented good accuracy for AKI prediction in the studied population.
Conclusion
Endothelial inflammation biomarkers (VCAM-1 and angiopoietin 1) have good accuracy for snakebites-associated AKI diagnosis. The time 12-16h after the bite had the best result in predicting AKI in this setting.
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Cavalcante Meneses G, Freire Bezerra G, Andrade Lucena Lima L, Justino Bandeira IC, Coelho Lopes N, Pinheiro Dantas MM, Brasileiro Mota SM, Lemos Moura Moreira Albuquerque P, Costa Martins AM, De Francesco Daher E, Bezerra da Silva Junior G. MO365URINARY BIOMARKERS AND POOR OUTCOMES IN PATIENTS WITH COVID-19 ADMITTED TO A REFERENCE HOSPITAL IN NORTHEAST BRAZIL. Nephrol Dial Transplant 2021. [PMCID: PMC8194930 DOI: 10.1093/ndt/gfab082.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Aims Kidney biomarkers improve early and specific AKI detection and also poor outcomes in different clinical contexts. Kidney disease is an important risk factor for poor outcomes in COVID-19. The aim of this study was to evaluate association of early levels of kidney biomarkers with poor outcomes in hospitalized patients with COVID-19. Method This is a prospective study conducted at the Instituto Dr. Jose Frota Hospital, an important public reference hospital for COVID-19 in northeast Brazil. Medical records with clinical, epidemiologic, laboratory and outcomes were collected. The urinary NGAL, KIM-1, MCP-1 and nephrin were the kidney biomarkers quantified at hospital admission. ELISA assays were used for analysis and biomarkers urinary concentrations were adjusted for urinary creatinine. Data were expressed as mean± standard deviation or median. Results A total of 69 patients collected urine and were included in this study. Male gender was predominant (65%) and mean age was 56±19 years. Regarding outcomes, the group had 62% of death, 92% of ICU admission and 65% of invasive respiratory support in ICU. Urinary NGAL and MCP-1 were significantly elevated in patients that needed invasive respiratory support in comparison with non-invasive support: uNGAL (median=104 [IQR=74-153] vs 71 [31-79] ng/mg-Cr, p=0.013), and uMCP-1 (3055 [1127-5008] vs 1315 [574-2127] pg/mg-Cr, p=0.027). Urinary nephrin and KIM-1 was also elevated, however with no statistical significance. Moreover, all urinary biomarkers were higher in ICU admission group and death group, but with p>0.05. In ROC curve analysis for prediction of invasive respiratory support, uNGAL had AUC=0.696 (0.565-0.827),p=0.012 and cut-off=78 ng/mg-Cr; uMCP-1 had AUC=0.676 (0.539-0.813), p=0.023 and cut-off=1354 pg/mg-Cr. In survival analysis, patients with uNGAL >78 ng/mg-Cr had worse prognosis and died more quickly (19 vs 48 days, log-rank test; p=0.01). In patients with uMCP-1 >1354 pg/mg-Cr, they also died more quickly, but with no significance (25 vs 48 days, log-rank test; p=0.08). Conclusion Urinary biomarkers NGAL and MCP-1 quantified at hospital admission were associated with poor outcomes, mostly with needed of invasive respiratory support in ICU. Prediction cut-off values for invasive respiratory support was useful to determine the survival prognosis.
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Donadello Tessarolo L, Cavalcante Meneses G, Freire Bezerra G, Bezerra da Silva Junior G, De Francesco Daher E, Costa Martins AM. MO224VCAM-1 LEVELS ASSOCIATED WITH ALBUMINURIA IN MULTIBACILLARY LEPROSY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab092.00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Leprosy may present important renal and endothelial abnormalities, and this can worse patients’ prognosis. However, renal and vascular involvement in these patients has been poor investigated. The aim of this study was to investigate if higher systemic endothelial biomarkers levels are associated with renal abnormalities and clinical aspects of leprosy.
Method
This is a cross-sectional study with leprosy patients before initiation of multidrug therapy enrolled in January 2017 to December 2018 in Fortaleza, northeast Brazil. Leprosy-associated clinical and epidemiological data were collected. Two groups were constructed: Paucibacillary (PB) and Multibacillary (MB) for comparisons. Serum and urine samples were obtained for laboratory analysis. In urine the following parameters were evaluated: creatinine, proteinuria and albuminuria. In serum the endothelial biomarkers were evaluated: VCAM-1 and ICAM-1, using ELISA assay.
Results
A total of 101 leprosy patients were included, with mean age of 48±15 years, and 71 (70%) were male. The multibacillary form occurred in 81 cases (80%), where 22 had a Virchowian form. VCAM-1 was elevated in MB group and was correlated with the bacteriological index (skin smear) (r = 0.372, p <0.01), duration of disease symptoms (r = 0.234, p = 0.04), and number of skin lesions ( r = 0.331, p <0.001). Moreover, in MB patients who presented albuminuria >15 mg/g of creatinine, VCAM-1 showed a significant correlation (r = 0.341, p <0.05) with increased albuminuria and improve the correlation with number of skin lesions (r = 0.653, p=0.003).
Conclusion
Multibacillary leprosy patients present high systemic levels of VCAM-1, associated with leprosy clinical features and increased albuminuria, an important marker of kidney disease progression. Further prospective studies are necessary to establish a cause-effect relation and evaluate the preventive role of these biomarkers, aiming to improve clinical care.
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Cavalcante MG, Parente MDSR, Gomes PEADC, Meneses GC, Silva Júnior GBD, Pires Neto RDJ, Daher EDF. Death-related factors in HIV/AIDS patients undergoing hemodialysis in an intensive care unit. Rev Inst Med Trop Sao Paulo 2021; 63:e33. [PMID: 33909847 PMCID: PMC8075620 DOI: 10.1590/s1678-9946202163033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 12/25/2022] Open
Abstract
HIV-infected patients are at high risk for developing critical diseases,
including opportunistic infections (OI), with consequent admission in intensive
care units (ICU). Renal disfunctions are risk factors for death in HIV/AIDS
patients, and survival rates in patients undergoing hemodialysis are smaller
than the ones observed in the general population. In this context, this study
aimed to investigate death-related factors in HIV/AIDS patients in an intensive
care setting. This is a retrospective cross-sectional study performed through
the analysis of medical records from 271 HIV/AIDS-diagnosed patients
hospitalized in an intensive care unit of an infectious disease hospital, in
Fortaleza, Ceara State, Brazil. Patients were divided into two groups: those who
underwent dialysis during hospitalization and those who did not. Clinical and
demographic parameters that could be associated with death were evaluated.
Results indicated a prevalence of death of 19.1% (CI 95%: 14.8-24.3). The median
age of patients was 47 years, with a male predominance (71.3%). The main causes
of admission were pulmonary tuberculosis (16.9%), followed by neurotoxoplasmosis
(14.9%). In the bivariate analysis, for those that did not undergo dialysis,
age, fever, dyspnea, oliguria, disorientation, kidney injury, use of lamivudine
and efavirenz, length of hospitalization, CD4 count, WBC count, platelet count,
urea, sodium and LDH levels were the associated variables. In those who needed
dialysis, the use of stavudine, abacavir and ritonavir, and the length of
hospitalization were associated factors. Renal toxicity by the antiretroviral
agents and length of hospitalization increased the risk of death among HIV
patients under dialysis.
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Mota SMB, Albuquerque PLMM, Meneses GC, da Silva Junior GB, Martins AMC, De Francesco Daher E. Role of endothelial biomarkers in predicting acute kidney injury in Bothrops envenoming. Toxicol Lett 2021; 345:61-66. [PMID: 33872748 DOI: 10.1016/j.toxlet.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 01/06/2023]
Abstract
Acute kidney injury (AKI) is a frequent and potentially fatal complication of snakebites. In the setting of snakebites, endothelial biomarkers may be used to predict disease severity and can play a major role in AKI pathophysiology. The aim of this study was to investigate the potential role of endothelial biomarkers in predicting AKI in Bothrops envenoming. Therefore, blood and urine samples were collected from 26 patients admitted to the emergency department after Bothrops envenoming at 3 different post-bite points in time: on admission (up to 8 h post-bite), 12-16 h, and 24-28 h post-bite, to investigate the time course of endothelial biomarkers in AKI following Bothrops snakebites. The diagnostic performance of injury biomarkers in Bothrops envenomation was evaluated. AKI was diagnosed using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. There was an association between endothelial injury and increased risk for AKI in bothropic envenoming. Angiopoietin- 1 (Ang-1) and Vascular cell adhesion protein-1 (VCAM-1) were useful biomarkers to predict mild AKI [AUC-ROC: Ang-1 0.82, VCAM-1 0.76] within the interval of 8-16 h post Bothrops snakebites. The use of endothelial biomarkers VCAM-1 e Ang-1 within 12-16 h post-bite may be useful in the early stage of mild AKI related to Bothrops envenoming and might have an effect on the early intervention for renal protection in less severe Bothrops-related AKI.
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Freire de Medeiros CMM, Diógenes da Silva BR, Costa BG, Sartori VF, Meneses GC, Bezerra GF, Martins AMC, Libório AB. Cognitive impairment, endothelial biomarkers and mortality in maintenance haemodialysis patients: a prospective cohort study. Nephrol Dial Transplant 2021; 35:1779-1785. [PMID: 32379316 DOI: 10.1093/ndt/gfaa040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Haemodialysis (HD) patients have a high prevalence of cardiovascular disease risk factors as well as cognitive impairment. The objective of the present study was to evaluate the interrelationship between cognitive impairment, endothelium-related biomarkers and cardiovascular/non-cardiovascular mortality. METHODS A total of 216 outpatients were recruited from three centres in a dialysis network in Brazil between June 2016 and June 2019. Sociodemographic and clinical data were obtained by applying a patient questionnaire, reviewing medical records data and conducting patient interviews. Cognitive function was assessed using the Cambridge Cognitive Examination. Plasma endothelium-related biomarkers [syndecan-1, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1) and angiopoietin-2 (AGPT2)] were measured. Patients were followed for 30 months. Cox proportional hazards regression models were used to assess the associations of the cognitive function scores and each endothelium-related biomarker with cardiovascular/non-cardiovascular mortality. RESULTS Cognitive function was associated with cardiovascular mortality {each standard deviation [SD] better cognitive score was associated with a 69% lower risk for cardiovascular mortality [hazard ratio (HR) 0.31 [95% confidence interval (CI) 0.17-0.58]} but not with non-cardiovascular mortality. Moreover, cognitive function was also correlated with all endothelial-related biomarkers, except VCAM-1. ICAM-1, AGPT2 and syndecan-1 were also associated with cardiovascular mortality. The association between cognitive function and cardiovascular mortality remained significant with no HR value attenuation [fully adjusted HR 0.32 (95% CI 0.16-0.59)] after individually including each endothelial-related biomarker in the Cox model. CONCLUSIONS In conclusion, cognitive impairment was associated with several endothelium-related biomarkers. Moreover, cognitive impairment was associated with cardiovascular mortality but not with non-cardiovascular mortality, and the association between cognitive impairment and cardiovascular mortality in HD patients was not explained by any of the endothelial-related biomarkers.
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Silva ÍC, Marizeiro DF, De Francesco Daher E, Veras de Sandes-Freitas T, Meneses GC, Bezerra GF, Libório AB, Costa Martins AM, Campos NG. Correlation between functional capacity and oxidative stress and inflammation in hemodialysis patients. J Bodyw Mov Ther 2021; 27:339-343. [PMID: 34391254 DOI: 10.1016/j.jbmt.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) may present impaired functional capacity due to peripheral muscle involvement. Oxidative stress and inflammation are probably involved in this pathophysiology. This study aimed to evaluate the association between functional capacity and biomarkers of oxidative stress as well as biomarkers of inflammation in patients under chronic hemodialysis therapy. METHOD Cross-sectional study including 41 patients from a single hemodialysis center. Functional capacity was assessed through the 6-min walk test (6MWT). The assessed blood biomarkers were: malondialdehyde (MDA) (oxidative stress, TBARS method) and angiopoietin-2 (Ang-2) (inflammation, ELISA). The influence of gender on impairment of functional capacity was further explored. RESULTS There was an inversely proportional correlation between the 6MWD and MDA (r = -,322 and p = 0.040) and Ang-2 (r = -, 376 and p = 0.016) values. 6MWD was 370.9 ± 101.2 m and 391.4 ± 108.2 m in women and men, respectively (p < 0.001), which means 29.3% and 34.3% reduction of the expected values for healthy individuals from the same age range. CONCLUSION Patients with CKD under hemodialysis, regardless of gender, presented impaired performance in 6MWT and this impairment was associated with oxidative stress and inflammation.
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Chagas GCL, Rangel AR, Noronha LM, da Silva Jr. GB, Meneses GC, Martins AMC, Daher EDF. COVID-19 and Kidney: a narrative review. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-9304202100s200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract COVID-19 is a pandemic associated with systemic clinical manifestations. In this study, we aimed to present a narrative review on kidney involvement in COVID-19. Kidney involvement could be derived from direct cytopathic effects, immunological mechanisms, indirect effects on renal tissue through other mediators, and dysfunction or injury of other organs. The evolution of COVID-19 may be complicated with acute kidney injury (AKI) in a significant percentage of patients, and renal dysfunction seems to be associated with worse prognosis. Patients with chronic kidney disease (CKD) seem to be more susceptible to the severe forms of COVID-19. Patients with renal replacement therapy (RRT) are also a vulnerable population as consequence of their advanced age, underlying comorbidities, impaired immune response, and clustering in hemodialysis centers, with requirements for frequent contact with healthcare services. Kidney transplant patients may be at high-risk due to long-term immunosuppression and comorbidities, hence, managing immunosuppression is imperative. Lastly, renal replacement therapy may be required during COVID-19, and different modalities are discussed based on clinical findings and laboratorial aspects. Therefore, COVID-19 seems to affect kidney by different mechanisms, which contributes for AKI development and increases the severity of the disease. Also, patients with CKD and kidney transplant recipients are at higher risk for COVID-19 and mortality.
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Duarte DB, Meneses GC, Lima DB, Martins AMC, da Silva Júnior GB, Daher EDF. Aquaporin-2 and NKCC2 expression pattern in patients with hepatosplenic schistosomiasis. Trop Med Int Health 2020; 25:1140-1144. [PMID: 32632995 DOI: 10.1111/tmi.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Schistosoma mansoni infection is considered a public health problem. Glomerular involvement in schistosomiasis is a well-documented complication, especially in hepatosplenic schistosomiasis (HSS). However, renal tubular function is poorly understood. The aim of this study was to investigate, through urinary exosomes, tubular transporters functionally in HSS patients. METHODS Cross-sectional study of 20 HSS patients who had isolated exosomes from urine samples. Protease inhibitor was added in the urine samples who were immediately frozen at -80 °C for further exosomes isolation. After urine had thawed, urinary exosomes were obtained using extensive vortexing, centrifugation and ultracentrifugation steps of urine. Urinary transporters expression from exosomes was evaluated by western blot, including NHE3, AQP2 and NKCC2. Charge amounts for gel electrophoresis were adjusted by urinary creatinine concentration of each patient to avoid urinary concentration bias. All protein expression of HSS patients was relative to healthy controls. RESULTS The expression of aquaporin-2 (AQP2) was lower in HSS patients than in controls (46.8 ± 40.7 vs. 100 ± 70.2%, P = 0.03) and the expression of the NKCC2 co-transporter was higher (191.7 ± 248.6 vs. 100 ± 43.6%, P = 0.02). CONCLUSIONS The decrease of AQP2 and the increase of NKCC2 expression in HSS patients seem to be involved with the inability of urinary concentration in these patients. These data show renal tubular abnormalities in HSS patients without manifest clinical disease.
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de Oliveira Vilar Neto J, da Silva CA, Meneses GC, Pinto DV, Brito LC, da Cruz Fonseca SG, de Sousa Alves R, Martins AMC, de Oliveira Assumpção C, De Francesco Daher E. Novel renal biomarkers show that creatine supplementation is safe: a double-blind, placebo-controlled randomized clinical trial. Toxicol Res (Camb) 2020; 9:263-270. [PMID: 32670557 DOI: 10.1093/toxres/tfaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to evaluate the impact of creatine supplementation (CS) on renal function in young, healthy, and active subjects. We used a randomized, double-blind, placebo-controlled clinical trial as the study design. Thirty-six healthy male university students were recruited and divided into three groups: group placebo, group G3 (3 g/day of CS), and group G5 (5 g/day of CS). To assess renal function, new kidney biomarkers, kidney injury molecule-1 (KIM-1) and monocyte chemoattractant protein-1 (MCP-1), were quantified. Serum albumin, serum creatinine, serum urea, estimated glomerular filtration rate (eGFR), proteinuria, and albuminuria were also measured. All groups were evaluated at two times: prior CS or placebo (pre) and after 35 days on CS or placebo (post). After 35 days of intervention, all characteristics were maintained without significant difference (P > 0.05) between the groups, including serum creatinine, eGFR, and more sensitive kidney biomarker concentrations (KIM-1 and MCP-1). The paired analysis showed that the supplemented groups (G3 and 5G) had increased serum creatinine and decreased eGFR levels (P < 0.05). However, the values were still within the normal reference range. In conclusion, the results of renal function evaluation did not show any difference between the evaluated groups. Increased serum creatinine and decreased eGFR levels in CS groups can be explained by increased creatine stores and metabolism, since creatinine is a by-product of creatine metabolism. These findings indicate that the use of CS at doses of 3 g and 5 g/day for a short period (35 days) is safe and did not impair the kidneys or renal function in young healthy subjects.
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Albuquerque PLMM, Paiva JHHGL, Martins AMC, Meneses GC, da Silva GB, Buckley N, Daher EDF. Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20190076. [PMID: 32704246 PMCID: PMC7359628 DOI: 10.1590/1678-9199-jvatitd-2019-0076] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.
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Cavalcante JEA, de Sousa ELH, de Oliveira Rodrigues R, de Almeida Viana G, Duarte Gadelha D, de Carvalho MMD, Sousa DL, Silva AJX, Filho RRBX, Fernandes VO, Montenegro Júnior RM, de Sousa Alves R, Meneses GC, Sampaio TL, Queiroz MGR. Interleukin-18 promoter −137 G/C polymorphism (rs187238) is associated with biochemical markers of renal function and cardiovascular disease in type 2 diabetes patients. Clin Biochem 2020; 80:1-7. [DOI: 10.1016/j.clinbiochem.2020.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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Freire Bezerra G, Cavalcante Meneses G, Bandeira Lima D, Bezerra da Silva Junior G, Nobre Jacinto V, Paula Magalhães E, Pereira da Rocha T, Prado de Azevedo IE, De Francesco Daher E, Costa Martins AM. P0634RISK OF HYDROELECTROLYTIC AND ACID-BASE DISORDERS INDUCED BY LIPOSOMAL AMPHOTERICIN B USE IN VISCERAL LEISHMANIASIS PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Visceral leishmaniasis (VL) is a serious illness if untreated. Liposomal Amphotericin B (L-AMB) is the more effectiveness treatment against LV and less nephrotoxic formulation. We aim to evaluate expression of kidney transporters in VL patients before and during L-AMB use.
Method
This is a prospective study with 9 selected VL patients that used only L-AMB during hospital stay. Renal transporter analyzes were from before and during the treatment and compared with a control group composed by healthy people. The urine transporters (AQP2, aquaporin 2; NKCC2, Na-K-2Cl cotransporter; NHE3, Na/H exchanger) and a constitutive exosome marker (TSG 101) expressions were measured after urinary exosomes isolation.
Results
No significant increase of TSG 101 was observed in all comparisons, including between both times and vs healthy controls. Additionally, were observed increased urinary protein expression in VL patients in both times (before and after L-AMB use) in comparison with healthy controls of the AQP2: (105.32 (22.90 – 140.27) vs 1362.97 (627.93-2620.09) or 846,20(552.60-1249.14) %, p<0.01); NHE3: (74.81 (57.17 – 126.33) vs 3373.36 (282.69-6877.97) or 462.67 (123.80-7280.21) %, p<0.01); and NKCC2: (90.98 (79.07 – 120.30) vs 634.45 (345.18-1588.41) or 545.74 (284.34-2183.87) %, p=0.03). Moreover, the patients treated with L-AMB showed a significant decrease in AQT2 (P=0.023) and NHE3 (P=0.008) expression.
Conclusion
We suggest that despite less nephrotoxic, the L-AMB use may be monitored to investigate patients at risk of hydroelectrolytic and acid-base disorders.
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De Francesco Daher E, Fortes Marizeiro D, Gardano Bucharles Mont'alverne D, Cavalcante Meneses G, Veras de Sandes Freitas T, Costa Martins AM, Bezerra da Silva Junior G. P0663RELATIONSHIP BETWEEN ENDOTHELIAL LESION AND PULMONARY DYSFUNCTION AMONG HEMODIALYTIC CHRONIC KIDNEY DISEASE PATIENTS WITH AND WITHOUT DIABETES MELLITUS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Patients with Chronic Kidney Disease (CKD) on dialysis and Diabetes Mellitus type 2 (DM2) may develop dysfunction in several systems, including the respiratory system. The aim of this study is to investigate if there is a relationship between endothelial lesion and pulmonary dysfunction in patients with CKD in hemodialysis with and without DM2.
Method
This is a cross-sectional study, from October 2017 to August 2018, including 60 patients divided into three groups: patients on hemodialysis (HD) without DM2 (HD in NDM = 30); HD with DM2 (HD in DM = 15); Non-hemodialysis with DM2 (DM without HD = 15) aged 40 to 60 years, regardless of gender. Analyzed pulmonary function were: maximal inspiratory and expiratory pressures (MIP and MEP) and measures of lung capacities and volumes: Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1).
Results
In the DM group in HD: MIP, MEP, FVC and FEV1 showed significant differences (p = 0.008; and p = 0.000; p = 0.000; p = 0.000), respectively. In the HD without NDM group: only the MIP parameter showed no significant difference (p = 0.256), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.001; p = 0.000; p = 0.000), respectively. In the DM group without HD: only MIP showed no statistically significant difference (p = 0.491), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.000; p = 0.008; p = 0.000), respectively when compared to their predicted value. Significant difference was detected between the groups regarding VCAM-1 only between DM in HD and DM without HD (p = 0.040). Syndecan-1 and Angiopoietin-2 plasma levels were statistically different when compared between the groups (p = 0.000) for the two biomarkers, this difference was observed only between the dialysis groups and the diabetic group without dialysis. In the multivariate regression analysis, when the fact that the individual had DM was also added, there was a greater association of VCAM-1 with the fact that the patient did not reach the predicted MEP, this value increased to OR = 8.762 (CI = 2.317 - 33.136) times of chance of not achieving the expected (p = 0.001). However, no statistically significant difference was found when the fact that the patient underwent hemodialysis was included (p = 0.885). Regarding Spearman correlation between MIP and VCAM-1 / Syndecan-1 / angiopoietin-2 there was no significant difference. However, in the correlation between MEP and endothelial lesion biomarkers, there was a significant difference only when compared with VCAM-1 (r = -0.287, p = 0.036). The FEV1 and FVC parameters obtained statistically significant results when correlated only with angiopoietin-2 (r = -0.309; -0.361), respectively.
Conclusion
Inspiratory muscle strength is reduced only when DM and HD are present when compared to their predicted. Expiratory muscle strength is reduced in all three groups and this parameter is most affected in diabetic individuals undergoing hemodialysis. Pulmonary function is compromised in all three groups equally. Endothelial glycocalyx lesion biomarkers (Angiopoietin-2 and Syndecan-1) are increased mainly in subjects on hemodialysis. Endothelial dysfunction is evidenced in HD group DM by increased VCAM-1 levels. There is a relationship between the lack of expected expiratory muscle strength with high values of VCAM-1 and when added the fact of having DM this relationship increases, however when added the fact of being dialytic there is no significant relationship. There is an inversely proportional correlation between expiratory muscle strength with the adhesion molecule marker (VCAM-1) and between pulmonary function with the endothelial lesion marker (Angiopoietin-2).
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De Francesco Daher E, Andrade de Carvalho Gomes PE, Studart Galdino G, Cavalcante Meneses G, Costa Martins AM, Bezerra da Silva Junior G. P0604IDENTIFICATION OF NOVEL ENDOTHELIAL ACTIVATION BIOMARKERS IN PATIENTS WITH LEPTOSPIROSIS AND ITS ASSOCIATION WITH ACUTE KIDNEY INJURY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Leptospirosis has a broad clinical spectrum. Many patients present a severe disease, with potentially fatal outcomes. Novel biomarkers of endothelial activation are being studied in order to predict the severity of disease and to establish early assistance to the patients.
Method
For the analysis of biomarkers, blood samples were collected at hospital admission, in proper material for serum isolation. Aliquots were frozen at -80 ºC until the analysis was done. To quantify the biomarkers, ELISA kits were used: Syndecan-1 (Abcam–ab47352), ICAM-1 (Abcam–ab47349) e VCAM-1 (Abcam–ab47355), Angiopoietin-2 (R&D Systems–Duoset DY623) e FGF-23 (R&D Systems–Duoset DY2604).
Results
A group of 27 patients was evaluated. 24 (88.9%) were males and 3 (11.1%) were females. Mean age was 39.1 ± 17.6 years. 14 (53.8%) required dialysis. Patients who required dialysis presented higher levels of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/mL; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/mL; p = 0.01), and FGF-23 (291 [56-2,031] vs. 10 [10-806] pg/mL; p = 0.021). There were no significant differences in the levels of VCAM-1 and ICAM-1 between the two groups. Syndecan-1 showed significant correlation with the levels of creatinine at hospital admission (r = 0.546; p = 0.05) and total bilirubin at hospital admission (r = 0.534; p = 0.013). Angiopoietin-2 showed significant correlation with the levels of creatinine at hospital admission (r = 0.513; p = 0.009) and the number of hemodialysis sessions (r = 0.406; p = 0.049). No correlation was shown concerning FGF-23.
Conclusion
Novel biomarkers revealed leptospirosis-associated endothelial activation and were significantly increased in patients with renal involvement. Therefore, they may be useful for establishing early identification and assistance in those patients.
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Meneses GC, da Silva GB, Tôrres PPBF, de Castro VQ, Lopes RL, Martins AMC, Daher EDF. Novel kidney injury biomarkers in tropical infections: a review of the literature. Rev Inst Med Trop Sao Paulo 2020; 62:e14. [PMID: 32074217 PMCID: PMC7032010 DOI: 10.1590/s1678-9946202062014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 12/29/2022] Open
Abstract
Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.
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Lino DOC, Freitas IA, Meneses GC, Martins AMC, Daher EF, Rocha JHC, Silva Junior GB. Interleukin-6 and adhesion molecules VCAM-1 and ICAM-1 as biomarkers of post-acute myocardial infarction heart failure. ACTA ACUST UNITED AC 2019; 52:e8658. [PMID: 31778438 PMCID: PMC6886400 DOI: 10.1590/1414-431x20198658] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022]
Abstract
Acute coronary syndromes are associated with a high prevalence of complications including heart failure (HF). The aim of this study was to investigate the association of novel biomarkers with the occurrence of post-acute myocardial infarction (AMI) HF. A prospective study was conducted with patients admitted to the emergency department with ST-segment elevation myocardial infarction (STEMI). Blood and urine samples were collected for analysis of traditional and novel biomarkers, including interleukin-6, vascular cell adhesion molecule 1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1). We compared the levels of these biomarkers between patients with and without post-STEMI HF. A total of 48 patients were assessed, with a prevalence of males. Fifteen patients (31.2%) had post-STEMI HF. Patients with HF had higher mean values of IL-6, VCAM-1, and ICAM-1 compared to those who did not develop HF (57.06 vs 14.03 pg/mL, P=0.001; 1719.58 vs 1304.34 ng/mL, P=0.001; and 1594.20 vs 1158.74 ng/mL, P<0.001, respectively). The three biomarkers were shown to be good predictors of post-STEMI HF (IL-6: AUC 0.786, P=0.002; VCAM-1: AUC 0.797, P=0.001; and ICAM-1: AUC 0.825, P<0.0001), with the respective cutoff points being calculated based on the best sensitivity and specificity indexes (IL-6: 8.67 pg/mL; VCAM-1: 1501.42 ng/mL; and ICAM-1: 1262.38 ng/mL). Of the three biomarkers, only VCAM-1 and ICAM-1 had a direct linear association between them (r=0.470, P<0.0001). IL-6, VCAM-1, and ICAM-1 were associated with the development of new post-AMI HF symptoms, but only VCAM-1 and ICAM-1 correlated with each other, possibly because they have the same pathophysiological mechanism of action.
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Parente Filho SLA, Gomes PEADC, Forte GA, Lima LLL, Silva Júnior GBD, Meneses GC, Martins AMC, Daher EDF. Kidney disease associated with androgenic-anabolic steroids and vitamin supplements abuse: Be aware! Nefrologia 2019; 40:26-31. [PMID: 31585781 DOI: 10.1016/j.nefro.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 01/06/2023] Open
Abstract
The excessive chase for beauty standards and the rise of muscle dysmorphia have ultimately led to an increase in androgenic-anabolic steroids (AAS) and intramuscular injections of vitamins A, D and E (ADE) abuse, which is associated with several adverse effects and has become a public health issue. This review of literature discusses kidney injury associated with the use of AAS and ADE, highlighting the mechanisms of acute and chronic renal lesion, such as direct renal toxicity, glomerular hyperfiltration and hypercalcemia. Future perspectives regarding evaluation and early diagnosis of kidney injury in these patients are also discussed.
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Lima EGGR, Bandeira Lima D, Sampaio TL, Menezes RRPPB, Meneses GC, Azevedo IEP, Teixeira AC, de Francesco Daher E, Bezerra da Silva Junior G, Martins AMC. FP305CONTRAST-INDUCED NEPHROPATHY: INFLUENCE OF REDUCTION IN THE ADMINISTERED VOLUME OF CONTRAST. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bezerra GF, Daher EDF, Meneses GC, Bezerra da Silva Junior G, Donadello TL, Rocha TP, Azevedo IEP, Pequeno MGC, Lima DB, Jacinto VN, Martins AMC. SP127ASSOCIATION OF URINARY MCP-1 WITH THE NEPHROTOXICITY OF LIPOSOMAL ANFOTERICIN B IN PATIENTS WITH VISCERAL LEISHMANIOSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Donadello TL, Daher EDF, Bezerra GF, Meneses GC, Rocha TP, Bezerra da Silva Junior G, Pequeno MGC, Lima DB, Martins AMC. SP103ENDOTHELIAL DYSFUNCTION AND NOVEL KIDNEY INJURY BIOMARKERS IN MULTIBACILARY LEPROSY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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