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Aragão NL, Zaranza MDS, Meneses GC, Lázaro APP, Guimarães ÁR, Martins AMC, Aragão NLP, Beliero AM, da Silva Júnior GB, Mota SMB, Albuquerque PLMM, Daher EDF, De Bruin VMS, de Bruin PFC. Syndecan-1 levels predict septic shock in critically ill patients with COVID-19. Trans R Soc Trop Med Hyg 2024; 118:160-169. [PMID: 37897240 DOI: 10.1093/trstmh/trad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The clinical picture of coronavirus disease 2019 (COVID-19)-associated sepsis is similar to that of sepsis of other aetiologies. The present study aims to analyse the role of syndecan-1 (SDC-1) as a potential predictor of septic shock in critically ill patients with COVID-19. METHODS This is a prospective study of 86 critically ill patients due to COVID-19 infection. Patients were followed until day 28 of hospitalization. Vascular biomarkers, such as vascular cell adhesion protein-1, SDC-1, angiopoietin-1 and angiopoietin-2, were quantified upon admission and associated with the need for vasopressors in the first 7 d of hospitalization. RESULTS A total of 86 patients with COVID-19 (mean age 60±16 y; 51 men [59%]) were evaluated. Thirty-six (42%) patients died during hospitalization and 50 (58%) survived. The group receiving vasopressors had higher levels of D-dimer (2.46 ng/ml [interquartile range {IQR} 0.6-6.1] vs 1.01 ng/ml [IQR 0.62-2.6], p=0.019) and lactate dehydrogenase (929±382 U/l vs 766±312 U/l, p=0.048). The frequency of deaths during hospitalization was higher in the group that received vasoactive amines in the first 24 h in the intensive care unit (70% vs 30%, p=0.002). SDC-1 levels were independently associated with the need for vasoactive amines, and admission values >269 ng/ml (95% CI 0.524 to 0.758, p=0.024) were able to predict the need for vasopressors during the 7 d following admission. CONCLUSIONS Syndecan-1 levels predict septic shock in critically ill patients with COVID-19.
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Affiliation(s)
- Nilcyeli Linhares Aragão
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
- Instituto José Frota Hospital, Fortaleza, Ceará, Brazil
| | - Marza de Sousa Zaranza
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
- Instituto José Frota Hospital, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - Ana Paula Pires Lázaro
- Public Health Postgraduate Program, School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Álvaro Rolim Guimarães
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | - Geraldo Bezerra da Silva Júnior
- Public Health Postgraduate Program, School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Sandra Mara Brasileiro Mota
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
- Instituto José Frota Hospital, Fortaleza, Ceará, Brazil
| | | | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - Veralice Meireles Sales De Bruin
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - Pedro Felipe Carvalhedo de Bruin
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
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Salmito FTS, Mota SMB, Holanda FMT, Libório Santos L, Silveira de Andrade L, Meneses GC, Lopes NC, de Araújo LM, Martins AMC, Libório AB. Endothelium-related biomarkers enhanced prediction of kidney support therapy in critically ill patients with non-oliguric acute kidney injury. Sci Rep 2024; 14:4280. [PMID: 38383765 PMCID: PMC10881963 DOI: 10.1038/s41598-024-54926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/18/2024] [Indexed: 02/23/2024] Open
Abstract
Acute kidney injury (AKI) is a common condition in hospitalized patients who often requires kidney support therapy (KST). However, predicting the need for KST in critically ill patients remains challenging. This study aimed to analyze endothelium-related biomarkers as predictors of KST need in critically ill patients with stage 2 AKI. A prospective observational study was conducted on 127 adult ICU patients with stage 2 AKI by serum creatinine only. Endothelium-related biomarkers, including vascular cell adhesion protein-1 (VCAM-1), angiopoietin (AGPT) 1 and 2, and syndecan-1, were measured. Clinical parameters and outcomes were recorded. Logistic regression models, receiver operating characteristic (ROC) curves, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used for analysis. Among the patients, 22 (17.2%) required KST within 72 h. AGPT2 and syndecan-1 levels were significantly greater in patients who progressed to the KST. Multivariate analysis revealed that AGPT2 and syndecan-1 were independently associated with the need for KST. The area under the ROC curve (AUC-ROC) for AGPT2 and syndecan-1 performed better than did the constructed clinical model in predicting KST. The combination of AGPT2 and syndecan-1 improved the discrimination capacity of predicting KST beyond that of the clinical model alone. Additionally, this combination improved the classification accuracy of the NRI and IDI. AGPT2 and syndecan-1 demonstrated predictive value for the need for KST in critically ill patients with stage 2 AKI. The combination of AGPT2 and syndecan-1 alone enhanced the predictive capacity of predicting KST beyond clinical variables alone. These findings may contribute to the early identification of patients who will benefit from KST and aid in the management of AKI in critically ill patients.
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Affiliation(s)
| | | | | | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Internal Medicine, Medical School, Federal University of Ceará, Fortaleza, Brazil
| | - Nicole Coelho Lopes
- Pharmacology Postgraduate Program, Department of Physiology and Pharmacology, Medical School, Federal University of Ceará, Fortaleza, Brazil
| | - Leticia Machado de Araújo
- Pharmacology Postgraduate Program, Department of Physiology and Pharmacology, Medical School, Federal University of Ceará, Fortaleza, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza- UNIFOR, Fortaleza, Ceará, Brazil.
- Medical Course, Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil.
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Beliero AM, Lázaro APP, Zaranza MDS, Lima GMC, Guimarães ÁR, Aragão NL, Meneses GC, Holanda MA, Albuquerque PLMM, da Silva GB, Fernandes PFCBC. ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome. J Bras Pneumol 2024; 49:e20230227. [PMID: 38232252 PMCID: PMC10769475 DOI: 10.36416/1806-3756/e20230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.
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Affiliation(s)
- Andréa Mazza Beliero
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Fortaleza (CE) Brasil
| | - Ana Paula Pires Lázaro
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Marza de Sousa Zaranza
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Giovanna Mazza Cruz Lima
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Álvaro Rolim Guimarães
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Nilcyeli Linhares Aragão
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Gdayllon Cavalcante Meneses
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Marcelo Alcantara Holanda
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
- . Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Polianna Lemos Moura Moreira Albuquerque
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Geraldo Bezerra da Silva
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
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Zaranza MDS, Meneses GC, Oriá RB, Martins AMC, Aragão NLP, Aragão NL, de Andrade SRR, Lopes NC, de Araújo LM, Santos RSDS, Guimarães ÁR, Lázaro APP, Beliero AM, Dantas MMP, Mota SMB, da Silva Júnior GB, Albuquerque PLMM, Daher EDF. Endothelial Biomarkers in Critically Ill COVID-19 Patients: Potential Predictors of the Need for Dialysis. Kidney Blood Press Res 2023; 49:27-37. [PMID: 38016435 DOI: 10.1159/000535035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The aim of this was to evaluate the function of vascular biomarkers to predict the need for hemodialysis in critically ill patients with COVID-19. METHODS This is a prospective study with 58 critically ill patients due to COVID-19 infection. Laboratory tests in general and vascular biomarkers, such as VCAM-1, syndecan-1, angiopoietin-1, and angiopoietin-2, were quantified on intensive care unit (ICU) admission. RESULTS There was a 40% death rate. VCAM and Ang-2/Ang-1 ratio on ICU admission were associated with the need for hemodialysis. Vascular biomarkers (VCAM-1, syndecan-1, angiopoietin-2/angiopoietin-1 ratio) were predictors of death and their cutoff values were useful to stratify patients with a worse prognosis. In the multivariate cox regression analysis with adjusted models, VCAM-1 (OR 1.13 [CI 95%: 1.01-1.27]; p = 0.034) and Ang-2/Ang-1 ratio (OR 4.87 [CI 95%: 1.732-13.719]; p = 0.003) were associated with the need for dialysis. CONCLUSION Vascular biomarkers, mostly VCAM-1 and Ang-2/Ang-1 ratio, showed better efficiency to predict the need for hemodialysis in critically ill COVID-19 patients.
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Affiliation(s)
- Marza de Sousa Zaranza
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Instituto José Frota (IJF) Hospital, Fortaleza, Brazil
| | - Gdayllon Cavalcante Meneses
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Reinaldo Barreto Oriá
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | | | - Nilcyeli Linhares Aragão
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Instituto José Frota (IJF) Hospital, Fortaleza, Brazil
| | - Saskya Roberta Rodrigues de Andrade
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Nicole Coelho Lopes
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Letícia Machado de Araújo
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Ana Paula Pires Lázaro
- Public Health Postgraduate Program, School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Brazil,
- School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Brazil,
| | | | - Márcia Maria Pinheiro Dantas
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Instituto José Frota (IJF) Hospital, Fortaleza, Brazil
| | - Sandra Mara Brasileiro Mota
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Instituto José Frota (IJF) Hospital, Fortaleza, Brazil
| | - Geraldo Bezerra da Silva Júnior
- Public Health Postgraduate Program, School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Brazil
- School of Medicine, Health Sciences Center, Universidade de Fortaleza, Fortaleza, Brazil
| | | | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
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Medina Néri AK, Silva RP, Meneses GC, Costa Martins AM, Portela Lima AO, Callou Filho CR, Cavalcante Vidal FD, de Oliveira Lima JM, Rocha EA, da Silva Júnior GB. Association between endothelial biomarkers and lipid and glycemic levels: a cross-sectional study with diabetic patients. Biomark Med 2023; 17:935-946. [PMID: 38230971 DOI: 10.2217/bmm-2023-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Background: Biomarkers can help understand the impact of achieving therapeutic goals in developing vascular diseases in diabetics. Aim: To assess the association between lipid and glycemic profiles and endothelial biomarkers in diabetics. Methods: Cross-sectional study that evaluated lipid and glycemic levels and biomarkers (VCAM-1, Sdc-1, FGF-23 and KIM-1 in diabetics. Results: Higher VCAM-1 levels were associated with higher low-density lipoprotein cholesterol and non-high-density lipoprotein (HDL) cholesterol levels (in the group with inadequate glycohemoglobin A1c [HbA1c] levels), with higher glycemic levels (in the group with inadequate HDL cholesterol levels) and with lower HDL cholesterol levels (both groups). VCAM-1 was independently associated with not achieving adequate HbA1c levels. Conclusion: In uncontrolled diabetics, VCAM-1 was independently associated with having inadequate HbA1c levels, suggesting they may already have endothelial damage.
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Affiliation(s)
- Ane Karoline Medina Néri
- University of Fortaleza, Health Sciences Center, Postgraduate Program in Collective Health, Fortaleza, 60811-905, Brazil
| | - Ricardo Pereira Silva
- Federal University of Ceará, Walter Cantídio Teaching Hospital, Cardiology Service, Fortaleza, 60430-372, Brazil
| | - Gdayllon Cavalcante Meneses
- Federal University of Ceará, Federal University of Ceará, Medical Sciences Post-Graduate Program, Fortaleza, 60430-140, Brazil
| | - Alice Maria Costa Martins
- Federal University of Ceará, Clinical and Toxicological Analysis Department, School of Pharmacy, Fortaleza, 60430-160, Brazil
| | - Ana Ofélia Portela Lima
- University of Fortaleza, Health Sciences Center, Postgraduate Program in Collective Health, Fortaleza, 60811-905, Brazil
| | - Cesário Rui Callou Filho
- University of Fortaleza, Health Sciences Center, Postgraduate Program in Collective Health, Fortaleza, 60811-905, Brazil
| | | | - Jeruza Mara de Oliveira Lima
- Federal University of Ceará, Walter Cantídio Teaching Hospital, Cardiology Service, Fortaleza, 60430-372, Brazil
| | - Eduardo Arrais Rocha
- Federal University of Ceará, Walter Cantídio Teaching Hospital, Cardiology Service, Fortaleza, 60430-372, Brazil
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Cavalcante MG, Gomes PEADC, Parente MDSR, Meneses GC, Silva Junior GBD, Neto RDJP, Martins AMC, Daher EDF. Monitoring Renal Function in HIV Patients Without Kidney Disease Using Endothelial Biomarkers: A Prospective Pilot Study. AIDS Res Hum Retroviruses 2023; 39:468-474. [PMID: 36924277 DOI: 10.1089/aid.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
This study aimed to investigate the association between novel biomarkers and renal injury in people with HIV (PWH). A cohort study was carried out with PWH under chronic use of antiretroviral therapy (ART), followed at a public outpatient service. Clinical and laboratory parameters of the patients were evaluated year by year, from 2015 [at baseline (year 1, Y1)] to 2019 [year 5 (Y5)]. At baseline, biomarkers of renal damage (e.g., neutrophil gelatinase-associated lipocalin-NGAL, monocyte chemoattractant protein-1-MCP-1, and kidney injury molecule-1-KIM-1) and endothelial activation or glycocalyx damage [e.g., intercellular adhesion molecule 1 (ICAM-1), E-selectin, and syndecan-1] were quantified using enzyme-linked immunosorbent assays and their levels were used to classify patients into different groups. However, only syndecan-1 showed a significant correlation with serum creatinine (p < .001) and glomerular filtration rate (GFR) (p = .003) over the years. Moreover, both serum creatinine and GFR in almost 5 years were significantly associated with serum levels of syndecan-1 at baseline. The multivariate linear regression with confounders showed a significant and independent association between GFR and levels of syndecan-1 and CD4 cell count in the beginning of the study, as well as age in Y5. The data reinforce the screening for kidney diseases with novel biomarkers, especially syndecan-1, as an important strategy for a timely diagnostic and therapeutic approach.
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Nunes JCC, Camurça DS, Rocha GA, de Oliveira ABT, Marinho GCP, Santos SGM, Pereira DCBHG, Meneses GC, Daher EDF. Chronic kidney disease prevention campaign: relationship between proteinuria and elderly people. J Bras Nefrol 2023; 45:162-168. [PMID: 36354245 PMCID: PMC10627140 DOI: 10.1590/2175-8239-jbn-2022-0028en] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/20/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To verify the relationship between the presence of proteinuria as a renal injury marker in elderly without history of systemic arterial hypertension and cardiovascular diseases. A cross-sectional study was developed from January 2014 to December 2019, through kidney disease prevention campaigns promoted by the Federal University of Ceará in the city of Fortaleza. METHODS The sample consisted of 417 elderlies. A questionnaire was used to characterize individuals and assess previous diseases, and urinalysis reagent strips were used to assess proteinuria. RESULTS Statistically significant differences (p < 0.05) and moderate effect sizes were found for blood pressure levels (CI 0.53-0.93), systolic blood pressure, and diastolic blood pressure (CI 0.21-0.61). Significant differences in capillary glycemia were also found between groups (p = 0.033), but with a low effect size (0.02-0.42). The group with comorbidities was 2.94 times more likely to have proteinuria than those without comorbidities (OR 2.94, CI 1.55-4.01; p < 0.05). In the group without cardiovascular disease/high blood pressure, a statistically significant association was found for previous diabetes and proteinuria (p = 0.037), presenting 2.68 times higher risk of proteinuria in those with diabetes mellitus (OR 2.68, CI 1.05-6.85). Significant association was also found between age groups, with the older group having 2.69 times higher risk of developing proteinuria (75 to 90 compared to 60 to 74 years) (CI 1.01-7.16; p = 0.045). CONCLUSION Even without systemic arterial hypertension or cardiovascular disease, diabetes and older age can be considered high risk factors for proteinuria.
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Affiliation(s)
- Júlio César Chaves Nunes
- Universidade Federal do Ceará, Departamento de Medicina Clínica,
Programa de Pós-Graduação em Ciências Médicas, Fortaleza, CE, Brazil
| | - David Silva Camurça
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Fortaleza, CE, Brazil
| | - Gabriel Alves Rocha
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Fortaleza, CE, Brazil
| | | | | | | | | | - Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Departamento de Medicina Clínica,
Programa de Pós-Graduação em Ciências Médicas, Fortaleza, CE, Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Departamento de Medicina Clínica,
Programa de Pós-Graduação em Ciências Médicas, Fortaleza, CE, Brazil
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de Araújo ÉMR, Meneses GC, Carioca AAF, Martins AMC, Daher EDF, da Silva GB. Use of probiotics in patients with chronic kidney disease on hemodialysis: a randomized clinical trial. J Bras Nefrol 2023; 45:152-161. [PMID: 36112723 PMCID: PMC10627128 DOI: 10.1590/2175-8239-jbn-2022-0021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/12/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Supplementation with probiotics for patients with chronic kidney disease (CKD) may be associated with decreased systemic inflammation. OBJECTIVE To assess the impact of oral supplementation with probiotics for patients with CKD on hemodialysis. METHOD This double-blind randomized clinical trial included 70 patients on hemodialysis; 32 were given oral supplementation with probiotics and 38 were in the placebo group. Blood samples were collected at the start of the study and patients were given oral supplementation with probiotics or placebo for three months. The probiotic supplement comprised four strains of encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium longum A101. Patients were given one capsule per day for 3 months. Blood samples were taken throughout the study to check for inflammatory biomarkers. Non-traditional biomarkers Syndecan-1, IFN-y, NGAL, and cystatin C were measured using an ELISA kit, along with biochemical parameters CRP, calcium, phosphorus, potassium, PTH, GPT, hematocrit, hemoglobin, glucose, and urea. RESULTS Patients given supplementation with probiotics had significant decreases in serum levels of syndecan-1 (239 ± 113 to 184 ± 106 ng/mL, p = 0.005); blood glucose levels also decreased significantly (162 ± 112 to 146 ± 74 mg/dL, p = 0.02). CONCLUSION Administration of probiotics to patients with advanced CKD was associated with decreases in syndecan-1 and blood glucose levels, indicating potential improvements in metabolism and decreased systemic inflammation.
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Affiliation(s)
| | | | | | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Programas de Pós-Graduação em
Farmacologia e Ciências Farmacêuticas, Fortaleza, CE, Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de
Pós-graduação em Ciências Médicas, Departamento de Medicina Clínica, Fortaleza, CE,
Brazil
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Programa de Pós-Graduação em Ciências
Médicas, Fortaleza, CE, Brazil
- Universidade Federal do Ceará, Faculdade de Medicina, Programa de
Pós-graduação em Ciências Médicas, Departamento de Medicina Clínica, Fortaleza, CE,
Brazil
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Galdino GS, de Sandes-Freitas TV, de Andrade LGM, Adamian CMC, Meneses GC, da Silva Junior GB, de Francesco Daher E. Development and validation of a simple machine learning tool to predict mortality in leptospirosis. Sci Rep 2023; 13:4506. [PMID: 36934135 PMCID: PMC10024714 DOI: 10.1038/s41598-023-31707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/16/2023] [Indexed: 03/20/2023] Open
Abstract
Predicting risk factors for death in leptospirosis is challenging, and identifying high-risk patients is crucial as it might expedite the start of life-saving supportive care. Admission data of 295 leptospirosis patients were enrolled, and a machine-learning approach was used to fit models in a derivation cohort. The comparison of accuracy metrics was performed with two previous models-SPIRO score and quick SOFA score. A Lasso regression analysis was the selected model, demonstrating the best accuracy to predict mortality in leptospirosis [area under the curve (AUC-ROC) = 0.776]. A score-based prediction was carried out with the coefficients of this model and named LeptoScore. Then, to simplify the predictive tool, a new score was built by attributing points to the predictors with importance values higher than 1. The simplified score, named QuickLepto, has five variables (age > 40 years; lethargy; pulmonary symptom; mean arterial pressure < 80 mmHg and hematocrit < 30%) and good predictive accuracy (AUC-ROC = 0.788). LeptoScore and QuickLepto had better accuracy to predict mortality in patients with leptospirosis when compared to SPIRO score (AUC-ROC = 0.500) and quick SOFA score (AUC-ROC = 0.782). The main result is a new scoring system, the QuickLepto, that is a simple and useful tool to predict death in leptospirosis patients at hospital admission.
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Affiliation(s)
- Gabriela Studart Galdino
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil.
- Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Tainá Veras de Sandes-Freitas
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
- Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceara, Brazil
| | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
| | - Geraldo Bezerra da Silva Junior
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
- Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil
- School of Medicine, Medical Sciences and Public Health Postgraduate Programs, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Elizabeth de Francesco Daher
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
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de Moura ACN, Mota SMB, Holanda FMT, Meneses GC, Bezerra GF, Martins AMC, Libório AB. Syndecan-1 predicts hemodynamic instability in critically ill patients under intermittent hemodialysis. Clin Kidney J 2023. [DOI: 10.1093/ckj/sfad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Abstract
Introduction
Up to 70% of intermittent haemodialysis (IHD) sessions in critically ill patients are complicated by hemodynamic instability. Although several clinical characteristics have been associated with hemodynamic instability during IHD, the discriminatory capacity of predicting such events during IHD sessions is less defined. In the present study, we aimed to analyse endothelium-related biomarkers collected before IHD sessions and their capacity to predict hemodynamic instability related to IHD in critically ill patients.
Methods
In this prospective observational study, we enrolled adult critically ill patients with acute kidney injury who required fluid removal with IHD. We screened each included patient daily for IHD sessions. Thirty minutes before each IHD session, each patient had a 5-ml blood collection for measurement of endothelial biomarkers - vascular cell adhesion protein-1 (VCAM-1), angiopoietin-1 and 2 (AGPT 1 and AGPT2) and syndecan-1. Hemodynamic instability during IHD was the main outcome. Analyses were adjusted for variables already known to be associated with hemodynamic instability during IHD.
Results
Plasma syndecan-1 was the only endothelium-related biomarker independently associated with hemodynamic instability. The accuracy of syndecan-1 for predicting hemodynamic instability during IHD was moderate (area under the receiver operating characteristic curve, 0.78 - 95% CI 0.68-0.89). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.67 to 0.82 (P < 0.001) and improved risk prediction, as measured by net reclassification improvement.
Conclusion
Syndecan-1 is associated with hemodynamic instability during IHD in critically ii patients. It may be useful to identify patients who are at increased risk for such events and suggest that endothelial glycocalyx derangement is involved in the pathophysiology of IHD-related hemodynamic instability.
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Affiliation(s)
| | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Internal Medicine, Medical School, Federal University of Ceará , Brazil
| | - Gabriela Freire Bezerra
- Pharmacology Postgraduate Program, Department of Physiology and Pharmacology, Medical School, Federal University of Ceará . Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará , Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza- UNIFOR , Fortaleza , Ceará, Brazil
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Sousa MS, Meneses GC, van Dam GJ, Corstjens PLAM, Galvão RLDF, Pinheiro MCC, Martins AMC, Daher EDF, Bezerra FSDM. Subclinical signs of podocyte injury associated with Circulating Anodic Antigen (CAA) in Schistosoma mansoni-infected patients in Brazil. Rev Soc Bras Med Trop 2023; 56:e0341. [PMID: 36820657 PMCID: PMC9957141 DOI: 10.1590/0037-8682-0341-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The long-term effects of schistosomiasis on the glomerulus may contribute to the development of chronic kidney disease. This study aimed to investigate baseline Schistosoma mansoni-Circulating Anodic Antigen (CAA) levels and their association with kidney biomarkers related to podocyte injury and inflammation in long-term follow-up after praziquantel (PZQ) treatment. METHODS Schistosoma infection was diagnosed by detecting CAA in urine using a quantitative assay based on lateral flow using luminescent up-converting phosphor reporter particles. A cutoff threshold of 0.1 pg/mL CAA was used to diagnose Schistosoma infection (baseline) in a low-prevalence area in Ceará, Northeast, Brazil. Two groups were included: CAA-positive and CAA-negative individuals, both of which received a single dose of PZQ at baseline. Urinary samples from 55 individuals were evaluated before (baseline) and at 1, 2, and 3 years after PZQ treatment. At all time points, kidney biomarkers were quantified in urine and adjusted for urinary creatinine levels. RESULTS CAA-positive patients had increased baseline albuminuria and proteinuria and showed greater associations between kidney biomarkers. CAA levels correlated only with Vascular Endothelial Growth Factor (VEGF) (podocyte injury) levels. Increasing trends were observed for malondialdehyde (oxidative stress), monocyte chemoattractant protein-1 (inflammation marker), and VEGF. In the follow-up analysis, no relevant differences were observed in kidney biomarkers between the groups and different periods. CONCLUSIONS S. mansoni-infected individuals presented subclinical signs of glomerular damage that may reflect podocyte injury. However, no causal effect on long-term renal function was observed after PZQ treatment.
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Affiliation(s)
- Mariana Silva Sousa
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil.
| | - Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil.
| | - Govert Jan van Dam
- Leiden University Medical Centre, Department of Parasitology, Leiden, The Netherlands.
| | | | - Rosangela Lima de Freitas Galvão
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Patologia, Fortaleza, CE, Brasil.
| | - Marta Cristhiany Cunha Pinheiro
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil.
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Farmacêuticas, Fortaleza, CE, Brasil.
| | - Elizabeth de Francesco Daher
- Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil.
| | - Fernando Schemelzer de Moraes Bezerra
- Universidade Federal do Ceará, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Pesquisa em Parasitologia e Biologia de Moluscos, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Ciências Médicas, Fortaleza, CE, Brasil. , Universidade Federal do Ceará, Programa de Pós-graduação stricto senso em Patologia, Fortaleza, CE, Brasil.
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Nunes Filho JCC, Camurça DS, Rocha GA, Oliveira ABTD, Marinho GCP, Santos SGM, Pereira DCBHG, Meneses GC, Daher EDF. Campanha de prevenção de doença renal crônica: relação entre proteinúria e idosos. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0028pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumo Objetivo: Verificar a relação entre a presença de proteinúria como marcador de lesão renal em idosos sem histórico de hipertensão arterial sistêmica e doenças cardiovasculares. Um estudo transversal foi desenvolvido de Janeiro de 2014 a Dezembro de 2019, por meio de campanhas de prevenção a doenças renais promovidas pela Universidade Federal do Ceará, na cidade de Fortaleza. Métodos: A amostra foi composta por 417 idosos. Um questionário foi usado para caracterizar indivíduos e avaliar doenças prévias, e foram utilizadas tiras reagentes de urinálise para avaliar proteinúria. Resultados: Diferenças estatisticamente significativas (p < 0,05) e tamanhos de efeito moderados foram encontrados para níveis de pressão arterial (IC 0,53-0,93), pressão arterial sistólica e pressão arterial diastólica (IC 0,21-0,61). Também foram encontradas diferenças significativas na glicemia capilar entre grupos (p = 0,033), mas com um tamanho de efeito baixo (0,02–0,42). O grupo com comorbidades apresentou 2,94 vezes mais probabilidade de ter proteinúria do que aqueles sem comorbidades (OR 2,94; IC 1,55-4,01; p < 0,05). No grupo sem doença cardiovascular/hipertensão, foi encontrada uma associação estatisticamente significativa para diabetes anterior e proteinúria (p = 0,037), apresentando risco 2,68 vezes maior de proteinúria naqueles com diabetes mellitus (OR 2,68; IC 1,05-6,85). Também foi encontrada uma associação significativa entre faixas etárias, com o grupo mais velho apresentando risco 2,69 vezes maior de desenvolver proteinúria (75 a 90 em comparação com 60 a 74 anos) (IC 1,01-7,16; p = 0,045). Conclusão: Mesmo sem hipertensão arterial sistêmica ou doença cardiovascular, o diabetes e a idade avançada podem ser considerados fatores de alto risco para proteinúria.
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de Araújo ÉMR, Meneses GC, Carioca AAF, Martins AMC, Daher EDF, da Silva Junior GB. Uso de probióticos em pacientes com doença renal crônica em hemodiálise: um ensaio clínico randomizado. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0021pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: A suplementação com probióticos na doença renal crônica (DRC) pode estar associada à redução do processo inflamatório sistêmico. Objetivo: Avaliar a suplementação oral com probióticos em pacientes com DRC em hemodiálise. Método: Ensaio clínico, duplo cego, randomizado com 70 pacientes em hemodiálise, sendo 32 do grupo que recebeu o suplemento de probióticos e 38 do grupo placebo. Inicialmente ocorreu a coleta de sangue e suplementação oral com probióticos ou placebo durante três meses. O suplemento probiótico foi composto pela combinação de 4 cepas de bactérias Gram-positivas encapsuladas: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 e Bifidobacterium longum A101, sendo 1 cápsula do suplemento ao dia, durante 3 meses. Após esse período foram feitas novas coletas de sangue para dosagem dos biomarcadores inflamatórios. Foram analisados os biomarcadores não tradicionais: Syndecan-1, IFN-y, NGAL e cistatina C pelo método ELISA, e os seguintes parâmetros bioquímicos: PCR, cálcio, fósforo, potássio, PTH, TGP, hematócrito, hemoglobina, glicose e ureia. Resultados: Os pacientes que receberam suplemento tiveram diminuição significativa dos níveis séricos de syndecan-1 (de 239 ± 113 para 184 ± 106 ng/mL, p = 0,005). Outro parâmetro que diminuiu significativamente nos pacientes que receberam suplemento foi a glicemia (de 162 ± 112 para 146 ± 74 mg/dL, p = 0,02). Conclusão: O uso de probióticos na DRC avançada esteve associado à redução dos níveis de syndecan-1 e glicemia, sinalizando possível melhora no metabolismo e redução do processo inflamatório sistêmico.
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Malveira GLS, Santos SAAR, de Oliveira Leite G, Meneses GC, Campos AR. Topiramate in an Experimental Model of Epilepsy - Similarity between Generic, Similar and Reference Drugs. J Epilepsy Res 2022; 12:1-5. [PMID: 35910324 PMCID: PMC9289377 DOI: 10.14581/jer.22001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose The literature is still controversial in relation to therapeutic differences between innovative, generic, and similar anti-seizures medications (ASM). Topiramate (TPM) is an ASM used in the treatment of various seizure types and in different epileptic syndromes, as well as in other groups of morbidities, and it is available in many generic and similar forms, besides the innovator. The aim of this translational work was to compare different brands of TPM by using animal models of seizures induced by pentylenetetrazole (PTZ). Methods Five brands of TPM (one reference, two similar and two generics) were tested in mice. Animals were previously treated with TPM (n=6/brand) and latencies from PTZ injection to onset of manifestations, first seizure and death were measured and compared between groups. Experiment was conducted in two settings: acute seizure model (PTZ 80 mg/kg) and kindling model (PTZ 20, 30, and 40 mg/kg in 8 alternate days). Results The experiment did not demonstrate significant differences between the TPM brands regarding the protective effect in the acute seizure and kindling models. Conclusions In conclusion, results can be explained by true therapeutic equivalence or insufficiency of the PTZ model to reveal differences among brands.
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Affiliation(s)
- George Linard Silva Malveira
- Experimental Biology Center, University of Fortaleza, Fortaleza, Brazil
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza, Brazil
| | | | | | | | - Adriana Rolim Campos
- Experimental Biology Center, University of Fortaleza, Fortaleza, Brazil
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza, Brazil
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Meneses GC, de Carvalho Gomes PEA, Galdino GS, Bezerra GF, de Souza Santos RS, Martins AMC, da Silva Junior GB, Libório AB, da Justa Pires Neto R, Daher EDF. Endothelial biomarkers as predictors for hemodialysis need in severe leptospirosis patients (Weil's disease). Trop Med Int Health 2022; 27:727-734. [PMID: 35761507 DOI: 10.1111/tmi.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prediction ability of vascular injury biomarkers for hemodialysis requirement in patients with severe leptospirosis. METHODS Prospective study with severe leptospirosis patients hospitalized in Fortaleza, Brazil. Blood samples were collected at hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to hemodialysis requirement during hospital stay. RESULTS 27 patients were included, with a mean age of 39 ± 18 years. 88.9% were males. 53.8% needed hemodialysis and 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). Syndecan-1 showed significant correlation with creatinine (r = 0.546; p = 0.05) and total bilirubin levels (r = 0.534; p = 0.013) at hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r = 0.513; p = 0.009) at hospital admission and the number of hemodialysis sessions (r = 0.406; p = 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict hemodialysis need in patients with severe leptospirosis (AUC-ROC= 0.744 [CI 95%: 0.545 - 0.943] p=0.035). CONCLUSION Syndecan-1 and angiopoietin-2 were associated with hemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Roberto da Justa Pires Neto
- Public Health Post-Graduate Program, Department of Community Health, School of Medicine, Federal University of Ceara, Fortaleza, Brazil.,Sao Jose Hospital of Infectious Diseases, Fortaleza, Brazil
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Lima Chagas GC, Rangel AR, Noronha LM, Veloso FCS, Kassar SB, Oliveira MJC, Meneses GC, da Silva Junior GB, Daher EDF. Risk Factors for Mortality in Patients with Dengue: A Systematic Review and Meta-Analysis. Trop Med Int Health 2022; 27:656-668. [PMID: 35761748 DOI: 10.1111/tmi.13797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/27/2022]
Abstract
OBJECTIVE To investigate risk factors for mortality in dengue. METHODS Systematic review and meta-analysis searching MEDLINE, Embase, SciELO, LILACS Bireme, and OpenGrey to identify eligible observational studies of patients with dengue, of both genders, aged 14 years or older, that analyzed risk factors associated with mortality and reported adjusted risk measures with their respective confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs with a DerSimonian and Laird random-effects model. Methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS Of 1,170 citations reviewed, 18 papers, with a total of 25,851 patients, were included in the systematic review and 12 in the meta-analysis. Severe hepatitis (OR 29.222, 95% CI: 3.876-220.314), dengue shock syndrome (OR 23.575, 95% CI 3.664-151.702), altered mental status (OR 3.76, 95% CI 1.67-8.42), diabetes mellitus (OR 3.698, 95% CI 1.196-11.433), and higher pulse rate (OR 1.039, 95% CI 1.011-1.067) are associated with mortality in patients with dengue. All studies included were classified as having a high quality. CONCLUSIONS Proper identification and management of these risk factors should be considered to improve patient outcomes and reduce the hidden burden of this neglected tropical disease. Future well-designed studies are needed to investigate the association of other clinical, radiological, and laboratorial findings with mortality in dengue, as well as to develop prognostic models based on the risk factors found in our study.
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Affiliation(s)
- Gabriel Cavalcante Lima Chagas
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Amanda Ribeiro Rangel
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Luísa Macambira Noronha
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Felipe Camilo Santiago Veloso
- Federal University of Alagoas, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Maceió, Brazil
| | - Samir Buainain Kassar
- Federal University of Alagoas, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Maceió, Brazil
| | | | - Gdayllon Cavalcante Meneses
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Geraldo Bezerra da Silva Junior
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil.,University of Fortaleza, School of Medicine, Health Sciences, Public Health and Medical Sciences Graduate Programs, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
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Lázaro APP, Albuquerque PLMM, Meneses GC, Zaranza MDS, Batista AB, Aragão NLP, Beliero AM, Guimarães ÁR, Aragão NL, Leitão AMM, de Carvalho MCF, Cavalcante MIDA, Mota FAX, Daher EDF, Martins AMC, da Silva Junior GB. Critically ill COVID-19 patients in northeast Brazil: mortality predictors during the first and second waves including SAPS 3. Trans R Soc Trop Med Hyg 2022; 116:1054-1062. [PMID: 35598042 PMCID: PMC9129229 DOI: 10.1093/trstmh/trac046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/19/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Simplified Acute Physiology Score (SAPS) 3 is a reliable score to predict mortality. This study aims to investigate the predictive values of SAPS 3 and other clinical parameters for death in critically ill coronavirus disease 2019 (COVID-19) patients. METHODS This is a prospective study in a tertiary hospital for patients who required intensive care due to COVID-19 infection in northeast Brazil. Two distinct groups were constructed according to the epidemiological data: first wave and second wave. The severity of patients admitted was estimated using the SAPS 3 score. RESULTS A total of 767 patients were included: 290 were enrolled in the first wave and 477 in the second wave. Patients in the first wave had more comorbidities, were put on mechanical ventilation and required dialysis and vasopressors more frequently (p<0.05). During the second wave, non-invasive ventilation was more often required (p<0.05). In both periods, older patients and higher SAPS 3 scores on admission were associated with death (p<0.05). Non-invasive ventilation use showed a negative association with death only in the second wave period. In the first wave, the SAPS 3 score was more useful (area under the curve [AUC] 0.897) in predicting death in critically ill COVID-19 patients than in the second wave (AUC 0.810). CONCLUSION The SAPS 3 showed very reliable predictive values for death during the waves of the COVID-19 pandemic, mostly together with kidney and pulmonary dysfunction.
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Affiliation(s)
| | - Polianna Lemos Moura Moreira Albuquerque
- University of Fortaleza, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil,Instituto Doutor Jose Frota Hospital, R. Barão do Rio Branco, 1816, Fortaleza, CE, 60025-061, Brazil
| | - Gdayllon Cavalcante Meneses
- Post-Graduate Program in Medical Sciences, Federal University of Ceara, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil
| | - Marza de Sousa Zaranza
- Instituto Doutor Jose Frota Hospital, R. Barão do Rio Branco, 1816, Fortaleza, CE, 60025-061, Brazil,Post-Graduate Program in Medical Sciences, Federal University of Ceara, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil
| | - Ana Beatriz Batista
- Instituto Doutor Jose Frota Hospital, R. Barão do Rio Branco, 1816, Fortaleza, CE, 60025-061, Brazil
| | | | - Andrea Mazza Beliero
- Instituto Doutor Jose Frota Hospital, R. Barão do Rio Branco, 1816, Fortaleza, CE, 60025-061, Brazil
| | - Álvaro Rolim Guimarães
- Federal University of Ceara, Av. da Universidade, 2853, Fortaleza, CE, 60020-181, Brazil
| | - Nilcyeli Linhares Aragão
- Post-Graduate Program in Medical Sciences, Federal University of Ceara, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil
| | | | | | | | | | - Elizabeth De Francesco Daher
- Post-Graduate Program in Medical Sciences, Federal University of Ceara, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil
| | - Alice Maria Costa Martins
- Post-Graduate Program in Pharmaceutical Sciences, Federal University of Ceara, Rua Capitão Francisco Pedro, 1210 , Fortaleza, CE, 60.430-370, Brazil
| | - Geraldo Bezerra da Silva Junior
- University of Fortaleza, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil,Post-Graduate Program in Public Health, University of Fortaleza, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil,Post-Graduate Program in Medical Sciences, University of Fortaleza, Av. Washington Soares, 1321, Fortaleza, CE, 60811-905, Brazil
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Gadelha Cavalcante M, Cavalcante Meneses G, Bezerra G, Maria Costa Martins A, Gondim Lima Oliveira M, Gabriel Monteiro Santos S, Alaíde Andrade Do Vale V, De Francesco Daher E. MO410: Early Endothelial Glycocalyx Injury Damage Associated With Further Kidney Dysfunction in Hiv Patients: Five Years Follow-Up. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac070.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
HIV patients have an increased risk of chronic kidney disease (CKD) development. Endothelial dysfunction was previously associated with kidney dysfunction markers. This study aims to investigate the association between renal markers and renal dysfunction biomarkers among outpatient HIV patients.
METHOD
Cohort study carried out with HIV patients in chronic use of Antiretroviral therapy followed up at a public outpatient service located in northeastern Brazil. Clinical and laboratory parameters of HIV patients were evaluated annually between 5 years: 2015 and 2019. Kidney dysfunction markers were blood creatinine and estimated glomerular filtration rate (GFR). Urinary kidney biomarkers NGAL, MCP-1, KIM-1 and serum endothelial biomarkers Syndecan-1 (glycocalyx), ICAM-1 and E-selectin were quantified in first-year using ELISA assays.
RESULTS
In total 66 patients completed the follow-up. Most patients were male (77.3%), of mixed race/color (57.6%), aged 39.33 ± 9.04 years. No patient had CKD development. However, Syndecan-1 showed a significant correlation with maximum creatinine (P < 0.001) and minimum GFR (P 0.003) over the years. Moreover, both creatinine and GFR in the last year had a significant association with syndecan-1 levels quantified 4 years ago. Multivariate linear regression with confounders showed a significant and independent association of syndecan-1 levels, current age and CD4 + count with minimum GFR.
CONCLUSION
HIV patients in chronic use of Antiretroviral therapy and glycocalyx injury may have an increased risk for long-term impacts on renal tissue. These data reinforce that endothelial impacts evaluation using biomarkers is a way to optimize the diagnosis and prognosis of kidney diseases, promoting the prevention of complications.
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Affiliation(s)
| | | | - Geraldo Bezerra
- Federal University of Ceará, School of Pharmacy, Fortaleza, Brazil
- University of Fortaleza, School of Medicine, Fortaleza, Brazil
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19
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Da Silva Barbosa J, Cavalcante Meneses G, Rebouças Castelo L, Bezerra Da Silva Junior G, Maria Costa Martins A, De Francesco Daher E, Lima Sampaio T, Coelho Lopes N, de Oliveira Gomes A, Beatriz Timbó de Oliveira A, Daniel Alves Albuquerque F, Pinheiro Gonçalves Lemes R. MO1027: Kidney Tubular Damage Associated with Early Sepsis and Longer Hospital Stay in Newborns with Neonatal Infection. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac089.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The aim of the study was to evaluate the early association of urinary cystatin-C (uCysC) (proximal tubular injury biomarkers) with sepsis and longer hospital stay in premature newborns (NBs) with neonatal infection.
METHOD
This is a prospective study with NBs from Neonatal Intensive Care Unit (nUTI), between August 2019 and September 2020. Three groups were constructed: healthy NBs, NBs with neonatal infection without sepsis and NBs with sepsis. Premature newborns with kidney disease, renal malformation, insufficient data in the medical record, or samples with scarce volume were excluded. Urine samples were collected for biomarkers measurements. Urinary cystatin-C was quantified in the urine and expressed with or without ratio by urinary creatinine to investigate the urinary concentration bias.
RESULTS
In total, 62 NBs were included: 27 healthy, 24 with neonatal infection without sepsis and 11 with sepsis. No acute kidney injury (AKI) was found in NBs and 22 (63%) had longer hospital stay (˃ 30 days). Higher levels of urinary cystatin-C, both adjusted for urinary creatinine, were elevated in NBs's sepsis group. Moreover, in NBs with a longer hospital stay, there was an elevated level of urinary cystatin-C, which was capable to predict the need for ˃ 30 days of hospital stay (AUC-ROC = 0.783, P = .01).
CONCLUSION
Our study demonstrated that kidney tubular damage biomarker, such as uCysC, was associated with early sepsis in premature NBs and was useful to prognosis evaluation.
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Affiliation(s)
| | | | | | | | | | | | - Tiago Lima Sampaio
- Federal University of Ceará, Department of Clinical and Toxicological Analysis, Fortaleza, Brazil
| | - Nicole Coelho Lopes
- Federal University of Ceara, Postgraduate Program in Medical Sciences, Fortaleza, Brazil
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20
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Cesar Chaves Nunes Filho J, Castelo Branco Holanda Gadelha Pereira D, Salviano de Matos R, Vieira Pinto D, de Olveira Vilar Neto J, Cavalcante Meneses G, Maria Costa Martins A, Silva Camurça D, Helen Barreto Melo A, De Francesco Daher E. MO146: Effects of High-Intensity Exercise on Renal and Endothelial Function of Crossfit Athletes. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac066.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
High-intensity exercise modalities such as Crossfit have increased the number of practitioners due to the benefits such as weight loss. However, high-intensity exercise can induce renal and endothelial damage. The objective was to verify the main acute effects of high-intensity exercise on renal and endothelial function of Crossfit athletes.
METHOD
The study was conducted by evaluating 10 high-performance Crossfit athletes, performing pre- and 24-h post-competition test collection. The athletes were evaluated using biomarkers for kidney injury, such as lipocalin associated with neutrophil gelatinase (NGAL), creatine kinase (CK), albumin, creatinine and estimated glomerular filtration rate (eGFR). Endothelial damage was evaluated using serum enzymatic markers, intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1) and Syndecan-1. In addition, athletes' physical and social evaluation questionnaires measuring body composition data and socioeconomic conditions were used. Statistical analysis was performed with Shapiro-Wilk and Student t test for parametric values and Wilcoxon for non-parametric data. Pearson and Spearman tests were used for data with normality and non-normality, respectively.
RESULTS
There was a significant increase in creatinine (1.03 ± 0.24 versus 1.36 ± 0.34 mg/ dL, P = .001) and CK [median 302.40 (115.75–474.00) versus 2048.80 (542.75–3391.25) U/L, P = .005] 24 h after the activity, and reduced eGFR (91.55 ± 21.15 versus 66.45 ± 20.6 mL/min/1.73 m², P = .000). The values of ICAM-1, VCAM-1, Syndecan-1 and NGAL did not show statistically significant variations. There was a strong positive correlation between syndecan-1 and CK (P = .000, r = 0.953).
CONCLUSION
The study showed that high performance exercise performed by athletes does not cause significant acute changes in renal function, but its intensity was able to cause muscle damage and endothelial changes in the participants.
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21
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Adamian CMC, de Lima Mota MA, Martins AAF, Aragão MC, Carvalho MS, Meneses GC, Silva Júnior GBD, Leitão TDMJS, De Francesco Daher E. Progressive disseminated histoplasmosis in HIV-positive patients. Int J STD AIDS 2022; 33:544-553. [PMID: 35343333 DOI: 10.1177/09564624221076605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/01/2023]
Abstract
BACKGROUND Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection. PURPOSE Describe general aspects and challenges of this disease and its association with HIV. RESEARCH DESIGN Review of literature. STUDY SAMPLE Articles found using different combinations of terms including "disseminated histoplasmosis" and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database. ANALYSIS We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients. RESULTS Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus encountered throughout the world, mainly in soil enriched with bat and bird excreta. Progressive disseminated histoplasmosis is the main presentation of this mycosis in people living with advanced HIV and is fatal if left untreated. Symptoms include a systemic disease characterized by fever, weight loss, night sweats, skin manifestations, hepatomegaly, splenomegaly, and septic shock. Diagnostic tests include culture, visualization of H. capsulatum by direct and histopathological examination, serology, antigen, molecular, and skin testing. Patients with disseminated disease require aggressive and prolonged treatment to eradicate the pathogen and include amphotericin B and itraconazole. In many low income countries of endemic regions, histoplasmosis in HIV-positive patients is often undiagnosed or misdiagnosed as another opportunistic infection, due to the similarity in clinical manifestations and to the paucity of better diagnostic tests. CONCLUSION Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.
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Affiliation(s)
- Caio Manuel Caetano Adamian
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Matheus Alves de Lima Mota
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil.,School of Medicine, 28128University of Fortaleza, Fortaleza, Brazil
| | - Augusto Adler Freire Martins
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Matheus Cardoso Aragão
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Marina Santos Carvalho
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | - Elizabeth De Francesco Daher
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
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22
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Bezerra GF, Meneses GC, Jacinto VN, Lima DB, Magalhães EP, Lima LAL, da Rocha TP, de Azevedo IEP, da Silva Jr. GB, Daher EDF, Martins AMC. Preliminary Study for New Markers of Early Tubuloglomerular Injury and Renal Inflammation in Patients with Visceral Leishmaniasis Receiving Liposomal Amphotericin B Treatment. Am J Trop Med Hyg 2022; 106:1191-1195. [PMID: 35189590 PMCID: PMC8991337 DOI: 10.4269/ajtmh.21-0978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/18/2021] [Indexed: 11/07/2022] Open
Abstract
Visceral leishmaniasis is treated with liposomal amphotericin B (L-AMB), which is associated with nephrotoxicity. Thus, we aimed to investigate nephrotoxicity through novel renal biomarkers in patients with visceral leishmaniasis during L-AMB use. Ours was a prospective study with 17 patients with visceral leishmaniasis treated with L-AMB during their hospital stay. Laboratory tests, renal parameters, urinary biomarkers (urinary kidney injury molecule 1, urinary monocyte chemoattractant protein 1 [uMCP-1], sodium-potassium-2 chloride cotransporter [NKCC2], sodium-hydrogen exchanger 3) [NHE3], aquaporin 2 [AQP2], tumor susceptibility gene 101 [TSH 101], and serum inflammatory biomarkers (MCP-1, interferon-γ, and IL-6) were evaluated in two periods: before and during L-AMB use. Glomerular filtration rate, creatinine, proteinuria, and albuminuria were similar before and during L-AMB use. IL-6 levels, AQT2, and NHE3 expression decreased, whereas uMCP-1 and urinary kidney injury molecule 1 levels increased during L-AMB treatment. In patients who developed acute kidney injury, uMCP-1 showed higher levels. L-AMB aggravated tubuloglomerular lesions, inflammation, and renal tubular disorders. Thus, patients treated with L-AMB need to be monitored for inflammatory and electrolyte disturbances to prevent acute kidney injury, longer length of hospital stay, higher public costs, and mortality.
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Affiliation(s)
- Gabriela Freire Bezerra
- Pharmacology Postgraduate Program, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Vittória Nobre Jacinto
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Danya Bandeira Lima
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Emanuel Paula Magalhães
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Lana Andrade Lucena Lima
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Thaiany Pereira da Rocha
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Geraldo Bezerra da Silva Jr.
- Collective Health Graduate Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alice Maria Costa Martins
- Pharmacology Postgraduate Program, Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
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23
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Galvão RLDF, Meneses GC, Pinheiro MCC, Martins AMC, Daher EDF, Bezerra FSM. Kidney injury biomarkers and parasitic loads of Schistosoma mansoni in a highly endemic area in northeastern Brazil. Acta Trop 2022; 228:106311. [PMID: 35038425 DOI: 10.1016/j.actatropica.2022.106311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 01/20/2023]
Abstract
Schistosomiasis affects approximately 240 million people worldwide. In Brazil, it is estimated that 1.5 million people are infected with Schistosoma mansoni and up to 15% of diagnosed individuals develop kidney damage. Renal involvement in schistosomiasis mansoni is characterized by glomerular lesions, with a high incidence, especially in chronically infected patients living in areas of high endemicity. Renal damage occurs slowly and is often asymptomatic, with a long-term manifestation of chronic kidney disease, with progressive loss of kidney functions, and early detection of subclinical kidney disease is of great importance. The aim of this study was to investigate kidney damage in patients infected with S. mansoni through urinary biomarkers of kidney injury and their association with the different parasite loads found. The patients were divided into two groups based on the diagnosis of infection by S. mansoni by the Kato-Katz and IgG-ELISA-SEA method: group of individuals infected by S. mansoni, Kato-Katz positive (PG); and group of individuals not infected by S. mansoni, Kato-Katz-negative (NG). Urinary creatinine and albuminuria were determined by immunoturbidimetry and proteinuria by the colorimetric method. The urinary biomarkers of podocyte injury (VEGF and Nephrin) and glomerular inflammation (MCP-1) were quantified by immunoassay and expressed by the urinary creatinine ratio. Urinary VEGF showed significantly higher levels in PG compared to NG (p = 0.004), increasing at all intensities of infection including low parasite load (p = 0.020). Our results show increased signs of podocyte damage in patients with schistosomiasis mansoni regardless of the parasite load, evidenced by increased urinary VEGF levels. However, further studies are needed since data related to schistosomiasis glomerulopathy and its association with new urinary biomarkers of kidney injury are scarce in the literature.
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24
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de Oliveira AAA, de Oliveira TA, de Oliveira LA, Meneses GC, Bezerra GF, Martins AMC, Libório AB. Association between angiopoietin-2 and functional cardiac remodeling in hemodialysis patients with normal left ventricular ejection. J Clin Hypertens (Greenwich) 2022; 24:502-512. [PMID: 35297166 PMCID: PMC8989752 DOI: 10.1111/jch.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/22/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
Cardiac remodeling is the initial process in heart failure development. The aim of this study is to evaluate the association between endothelium-related biomarkers and cardiac remodeling in hemodialysis (HD) patients and how the presence of high blood pressure and diabetes mellitus modulates these associations. This was a cross-sectional study with adult HD and normal left ventricular (LV) ejection fraction-LVEF-patients. The authors correlated several endothelium-related biomarkers with echocardiographic indices-LV mass index (LVMi), LVEF, global longitudinal strain, mitral E/e', and aortic root diameter. Seventy-one patients were included, with 37 women (52.1%) and mean age of 54.3 ± 16.8 years. Angiopoietin-2 (AGPT2) was inversely correlated with global longitudinal strain (r = -.374, p = .001) and directly with E/e' (r = .265, p = .025). After adjustment, only AGPT2 was significantly associated with global longitudinal strain. blood pressure and diabetes mellitus were independent moderators for the AGPT2 and global longitudinal strain association. The conditional association was significant only when the mean pre-HD blood pressure was above 97.5 mmHg or in diabetes mellitus patients. Finally, there was an interaction between diabetes mellitus and blood pressure when moderating the conditional effect of AGPT2 on global longitudinal strain. While in non-diabetic patients, the association between AGPT2 with global longitudinal strain was significant only with pre-HD blood pressure levels as high as 110 mmHg, in diabetic patients, this association was significant with pre-HD blood pressure as low as 90 mmHg. Higher levels of AGPT2 were associated with worse cardiac function as determined by lower global longitudinal strain values. This association was moderated by blood pressure and diabetes mellitus, suggesting that the effects of AGPT2 on cardiac remodeling is dependent of such circumstances.
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Affiliation(s)
- Ana Aécia Alexandrino de Oliveira
- Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Ceará, Brazil.,Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Department of Internal Medicine, Medical school, Federal University of Ceará, Ceará, Brazil
| | - Gabriela Freire Bezerra
- Pharmacology Postgraduate Program, Department of Physiology and Pharmacology, Medical school, Federal University of Ceará, Ceará, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Ceará, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Ceará, Brazil.,Medical Course, Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil
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25
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Meneses RRC, Damasceno NRT, Cartolano FDC, Verde SMML, Lira LG, Dantas MB, Viana GDA, Silva MED, Sousa ELHD, Meneses GC, Ferreira JM, Sampaio TL, Queiroz MGRD. Hypertriglyceridemia promotes dysfunctions in high-density lipoprotein increasing the cardiovascular risk. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20488] [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: 01/17/2023] Open
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brasil
| | - Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento de Análises Clínicas e Toxicológicas, Fortaleza, CE, Brasil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento de Análises Clínicas e Toxicológicas, Fortaleza, CE, Brasil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento de Análises Clínicas e Toxicológicas, Fortaleza, CE, Brasil
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27
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Cícero Abdon Malheiro Gomes
- Medical Sciences Postgraduate Program, Universidade de Fortaleza, UNIFOR, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceara, 60165-082, Brazil
| | | | | | | | - Paula Roberta de Lima
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alice Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, Universidade de Fortaleza, UNIFOR, Avenida Abolição, 4043 Ap 1203, Fortaleza, Ceara, 60165-082, Brazil.
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28
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Louise Donadello Tessarolo
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
| | - Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Gabriela Freire Bezerra
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Fisiologia e Farmacologia, Programa de Pós-Graduação em Farmacologia, Fortaleza,
Ceará, Brazil
| | - Thaiany Pereira da Rocha
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
| | - Isabella Evelyn Prado de Azevedo
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
| | - Geraldo Bezerra Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Faculdade de
Medicina, Programa de Pós-Graduação de Saúde Coletiva, Fortaleza, Ceará,
Brazil
| | | | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Departamento
de Análises Clínicas e Toxicológicas, Programa de Pós-Graduação em Ciências
Farmacêuticas, Fortaleza, Ceará, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | | | | | - Geraldo Bezerra da Silva Junior
- University of Fortaleza, School of Medicine, Post-Graduation Programs in Public Health and Medical Sciences, Fortaleza, Brazil
| | - Nicole Coelho Lopes
- Federal University of Ceará, Medical Sciences Post-Graduate Program, Fortaleza, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | | | | | - Geraldo Bezerra da Silva Junior
- University of Fortaleza, School of Medicine, Post-Graduation Programs in Public Health and Medical Sciences, Fortaleza, Brazil
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33
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | | | | | | | - Geraldo Bezerra da Silva Júnior
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza, Curso de Medicina, Fortaleza, Ceará, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Sandra Mara Brasileiro Mota
- Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, 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
| | - Elizabeth De Francesco Daher
- Medical Sciences Graduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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35
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | | | - Bruno Gabriele Costa
- Department of Internal Medicine, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil
| | - Vinicius Farina Sartori
- Department of Physiology and Pharmacology, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Gabriela Freire Bezerra
- Department of Physiology and Pharmacology, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alexandre Braga Libório
- Department of Internal Medicine, Medical School, Federal University of Ceará, Fortaleza, Ceará, Brazil.,Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil
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36
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Ítalo Caldas Silva
- Medical Sciences Program, Universidade Federal Do Ceará- UFC, Brazil; Inspirafisio Research Group, Universidade Federal Do Ceará- UFC, Brazil.
| | - Débora Fortes Marizeiro
- Medical Sciences Program, Universidade Federal Do Ceará- UFC, Brazil; Inspirafisio Research Group, Universidade Federal Do Ceará- UFC, Brazil.
| | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences, Department of Clinical and Toxicological Analyses, Universidade Federal Do Ceará- UFC, Brazil.
| | - Gabriela Freire Bezerra
- Pharmacology, Department of Clinical and Toxicological Analyses, Universidade Federal Do Ceará- UFC, Brazil
| | | | | | - Nataly Gurgel Campos
- Ph.D. in Medical Sciences, Professor of Physical Therapy Course, Department of Physical Therapy, Universidade Federal Do Ceará- UFC, Brazil; Inspirafisio Research Group, Universidade Federal Do Ceará- UFC, Brazil.
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37
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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. Rev Bras Saude Mater Infant 2021. [DOI: 10.1590/1806-9304202100s200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Daniella Bezerra Duarte
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará, Fortaleza, Brazil.,School of Medicine, Federal University of Alagoas, Maceió, Brazil.,School of Medicine, Tiradentes University Center, Maceió, Brazil.,School of Medicine, CESMAC University Center, Maceió, Brazil
| | - Gdayllon Cavalcante Meneses
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Dânya Bandeira Lima
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Alice Maria Costa Martins
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | | | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará, Fortaleza, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- José de Oliveira Vilar Neto
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil.,Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Carlos Alberto da Silva
- Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Gdayllon Cavalcante Meneses
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil.,Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Daniel Vieira Pinto
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil
| | - Luciana Catunda Brito
- Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Said Goncalves da Cruz Fonseca
- Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Renata de Sousa Alves
- Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Alice Maria Costa Martins
- Department of Pharmacy and Clinical Analysis, Federal University of Ceará, Pastor Samuel Munguba street, 1210 Rodolfo Teófilo, Fortaleza 60430-372, CE, Brazil
| | - Cláudio de Oliveira Assumpção
- Physical Education and Sports Institute, Federal University of Ceará, Mister Hull Avenue, Sports Park, Block 320, Pici Ccampus, Fortaleza 60455-760, CE, Brazil
| | - Elizabeth De Francesco Daher
- Post-Graduate Program in Medical Sciences, Federal University of Ceará, Alexandre Baraúna street, 949-Rodolfo Teófilo, Fortaleza 60430-160, CE, Brazil
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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] [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: 01/15/2020] [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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Affiliation(s)
- Polianna Lemos Moura Moreira Albuquerque
- University of Fortaleza (Unifor), Fortaleza, Ceará, Brazil
- Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza, Ceará, Brazil
| | | | - Alice Maria Costa Martins
- Graduate Program in Pharmaceutical Sciences, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | | | - Geraldo Bezerra da Silva
- Public Health and Medical Sciences Graduate Programs, School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | | | - Danya Bandeira Lima
- Federal University of Ceará, School of Medicine and Pharmacy, Fortaleza, Brazil
| | - Geraldo Bezerra da Silva Junior
- Federal University of Ceará, School of Medicine and Pharmacy, Fortaleza, Brazil
- Universidade de Fortaleza, Public Health and Medical Sciences Graduate Programs, Fortaleza, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | - Debora Fortes Marizeiro
- Federal University of Ceará, School of Medicine, Farmacy and Physical Therapy, Fortaleza, Brazil
| | | | | | | | | | - Geraldo Bezerra da Silva Junior
- Federal University of Ceará, School of Medicine, Farmacy and Physical Therapy, Fortaleza, Brazil
- Universidade de Fortaleza, Public Health and Medical Sciences Graduate Programs, Fortaleza, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | | | | | | | | | - Geraldo Bezerra da Silva Junior
- Federal University of Ceará, School of Medicine and Farmacy, Fortaleza, Brazil
- Universidade de Fortaleza, Public Health and Medical Sciences Graduate Programs, Fortaleza, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Paulo Pacelli Bezerra Filizola Tôrres
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Valeska Queiroz de Castro
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Renata Lima Lopes
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- D O C Lino
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil.,Serviço de Emergência Cardiológica, Hospital Dr. Carlos Alberto Studart Gomes, Secretaria da Saúde do Estado do Ceará, Fortaleza, CE, Brasil
| | - I A Freitas
- Serviço de Emergência Cardiológica, Hospital Dr. Carlos Alberto Studart Gomes, Secretaria da Saúde do Estado do Ceará, Fortaleza, CE, Brasil
| | - G C Meneses
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - A M C Martins
- Departamento de Fisiologia e Farmacologia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - E F Daher
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - J H C Rocha
- Serviço de Emergência Cardiológica, Hospital Dr. Carlos Alberto Studart Gomes, Secretaria da Saúde do Estado do Ceará, Fortaleza, CE, Brasil
| | - G B Silva Junior
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza, CE, Brasil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Sérgio Luiz Arruda Parente Filho
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Guilherme Aguiar Forte
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Laio Ladislau Lopes Lima
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Gdayllon Cavalcante Meneses
- 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
| | - Elizabeth De Francesco Daher
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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