Hepatice C em portadores de insuficiência renal crônica em tratamento hemodialítico: estudo clínico, epidemiológico e laboratorial

Exportado OPUSMade available in DSpace on 2019-08-10T12:48:10Z (GMT). No. of bitstreams: 1 tese_k_tia_de_paula_farah.pdf: 10620908 bytes, checksum: 99c201d5c7dc43b7a62c6760c7a3247c (MD5) Previous issue date: 13O interesse em conhecer o comportamento da infecção pelo vírus dahepatite C (VHC) em portadores de insuficiência renal crônica (IRC) é recente e crescente. No presente estudo, avaliou-se: 1) a prevalência da infecção pelo VHC entre os portadores de IRC; 2) as características sócio-demográficas, epidemiológicas e clínicas da infecção pelo VHC; 3) a detecção do RNA do VHC no plasma e no tecido hepático e seu perfil genotípico; 4) as alterações ultra-sonográficas; e, 5) as alterações histopatológicas à biópsia hepática. Realizou-se estudo de corte transversal em portadores de insuficiência renal crônica (IRC) em hemodiálise (grupo I) e candidatos à doação de sangue (grupo II), todos com ELISA anti-VHC-3.0 reativos. Foram avaliados 76 portadores de IRC e 77 pacientes candidatos à doação de sangue. Identificou-se o RNA-VHC no plasma e no fragmento de tecido hepático através da técnica da reação em cadeia da poiimerase transcriptase reversa (RT-PCR-aninhado) e por seqüenciamento. Realizou-se a genotipagem para o VHC pela técnica de fragmento de restrição da extensão do polimorfismo (RFLP) e por seqüenciamento. Todos os pacientes submeteram-se á biópsia hepática. A idade média foi de 43 e 40 anos nos grupos I e II, respectivamente. A elevação de laninoaminotransferase (ALT) ocorreu em 44,7% dos pacientes portadores de IRC e em 63,6% dos candidatos à doação de sangue (p=0,019). Houve maior exposição prévia ao vírus da hepatite B (VHB) e ao uso de drogas hepatotóxicas no grupo I, e o alcoolismo mostrou-se mais prevalente no grupo II. Ao ultra-som, a textura ecográfica do parênquima hepático mostrou-se homogênea em 86,8% e 80,5% dos pacientes do grupo 1 e II, respectivamente (p=0,290). Obteve-se a detecção plasmática do RNA viral em 72 pacientes (94,7%) do grupo I e em 65 pacientes (84,4%) do grupo II (p=0,022). Houve predomínio do genótipo 1 nos dois grupos. O genótipo 3 foi o segundo maisprevalente no grupo II (p=0,001). Identificou-se o genótipo 2 em oito pacientes (10,5%) do grupo I e em apenas um paciente (1,3%) do grupo II (p=0,016). Dentre os 96 pacientes que realizaram a pesquisa do RNA-VHC no plasma e tecido hepático, seis (6,3%) apresentaram RT-PCR negativo no plasma e positivo no tecido hepático. A histologia hepática avaliada pelos critérios do METAVIR não evidenciou diferença estatística significativa com relação à atividade inflamatória e fibrose nos dois grupos avaliados, sendo a esteatose hepática e a siderose mais prevalentes no grupo I. Portanto, no presente estudo, observou-se o predomínio do genótipo 1, seguido pelo genótipo 2, nos portadores de IRC. Não houve diferença significativa com relação à carga viralnos dois grupos. A siderose kupfferiana e hepatocitária observada com maior freqüência no grupo I (IRC) pode ter agravado a fibrose hepática neste grupo. As complicações decorrentes da biópsia hepática foram graves e ocorreram apenas nos portadores de IRC.There has been, lately, an increasing interest in studying the behavior of the hepatitis C infection in patients with terminal renal failure. In the present study, the following aspects of the disease were evaluated: 1) the prevalence of hepatitis C in patients with renal failure; 2) clinical and epidemiological aspects of the infection; 3) the detection of HCV-RNA in plasma and liver tissue and the identification of the genotypes; 4) ultrasonographic alterations of the liver; and, 5) histological alterations in fragments of liver obtained by needle biopsy. This is a study of coorte comparing patients with chronic renal failure (Group I) with blood donor candidates (Group II). All tested positive for hepatitis C infection byan ELISA technique. 76 patients in Group I and 77 volunteers in Group II have been selected for the study. The RNA for HCV was sought in liver and plasma using the nested polymerase chain reaction-reverse transcriptase (RT-PCR) and genomic sequencing. Genotyping was performed using the restriction fragment length polymorphism (RFLP) technique and genomic sequencing. All patients underwent liver biopsy. The middle ages for Groups I and II were 43 and 40, respectively. Elevated serum levels of ALT were described in 44.7% of Group I patients and 63.6% of Group II individuals (p=0.019). Serum markers of cured hepatitis B infection and the use of hepatotoxic drugs were moreprevalent in Group I and alcohol abuse in Group II. On ultrasound a normal liver texture was noticed in 86.8% and 80.5% in Groups I and II, respectively (p=0.290). Hepatits C viral RNA was identified in the sera of 72 patients (94.7%) in Group I and in 65 volunteers in Group II (p=0.022). The genotype 1 was the most common genotype found in both groups. Genotype 3 was more prevalent in Group II (p=0.001), and genotype 2 was described in 8 patients in Group I (10.5%) and in one individual of Group II (1.3%)(p=0.016). In six out of 96 129 patients (6.3%) the RT-PCR was found to be negative in sera and positive In the liver. Liver histology, classified according to METAVIR, showed no statistical difference in inflammation and fibrosis, when groups I and II were compared;liver steatosis and siderosis, though, were more frequently reported in Group I. Summing up, in the present study, genotype 1 of hepatitis C predominated, followed by genotype 2 in patients with chronic renal failure. There was no ignificant difference in viral load for both groups. Siderosis (in Kuppfer cells and in hepatocytes) was more frequently observed in Group I and this may have increased the frequency of liver fibrosis in Group I. Severe complications of liver biopsy were observed only in patients with renal failure

Gender in the allocation of organs in kidney transplants: meta-analysis

OBJECTIVE To analyze whether gender influence survival results of kidney transplant grafts and patients.METHODS Systematic review with meta-analysis of cohort studies available on Medline (PubMed), LILACS, CENTRAL, and Embase databases, including manual searching and in the grey literature. The selection of studies and the collection of data were conducted twice by independent reviewers, and disagreements were settled by a third reviewer. Graft and patient survival rates were evaluated as effectiveness measurements. Meta-analysis was conducted with the Review Manager® 5.2 software, through the application of a random effects model. Recipient, donor, and donor-recipient gender comparisons were evaluated.RESULTS : Twenty-nine studies involving 765,753 patients were included. Regarding graft survival, those from male donors were observed to have longer survival rates as compared to the ones from female donors, only regarding a 10-year follow-up period. Comparison between recipient genders was not found to have significant differences on any evaluated follow-up periods. In the evaluation between donor-recipient genders, male donor-male recipient transplants were favored in a statistically significant way. No statistically significant differences were observed in regards to patient survival for gender comparisons in all follow-up periods evaluated.CONCLUSIONS The quantitative analysis of the studies suggests that donor or recipient genders, when evaluated isolatedly, do not influence patient or graft survival rates. However, the combination between donor-recipient genders may be a determining factor for graft survival

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo