Uma Avaliação Prospectiva do Transplante Renal Versus Hemodiálise: na Perspectiva Social, Qual a Melhor Modalidade Terapêutica?

Background: Economic evaluations help health authorities facing budget constraints. This study compares the health-related quality of life (HRQOL) and costs in patient subgroups on haemodialysis (HD) and renal transplantation (KT). Methods: In a prospective study with follow-up of 1-3 years, we performed a costutility analysis of KT vs. HD, adopting a lifetime horizon. A societal perspective was taken. Costs for organ procurement, KT eligibility, transplant surgery and follow-up of living donors were included. Key clinical events were recorded. HRQOL was assessed using the EuroQol instrument. Results: The HRQOL remained stable on HD patients. After KT, mean utility score improved at 3 months while mean EQ-VAS scores showed a sustained improvement. Mean annual cost for HD was 32,567.57€. Mean annual costs for KT in the year-1 and in subsequent years were, 60,210.09€ and 12,956.77€ respectively. Cost for initial hospitalization averaged 18,740.74€. HLA-mismatches increased costs by 75% for initial hospitalization (p < 0.001) and 41% in the year-1 (p < 0.05), and duplicate the risk of readmission in the year-1 (p < 0.05). The incremental costutility ratio was 5,534.46€/QALY, increasing 35% when costs for organ procurement were added. KT costs were 41,541.63€ more but provided additional 7.51 QALY. Conclusions: The KT is cost-effective compared with HD. Public funding should reflect the value created by the intervention and adapt to the organ demand

Calcifilaxia: Revisão da Literatura a Propósito de 2 Casos Clínicos

Calciphylaxis is a rare and devastating obliterative vasculopathy, leading to ischemia and subcutaneous necrosis. In most cases it affects patients with renal disease and is associated with high morbidity and mortality. We present two case reports followed recently in our department, and a literature review on this topic. Case one refers to an 80 -year -old Caucasian woman with chronic kidney disease stage 5 and primary hyperparathyroidism with secondary brown tumour and calciphylaxis. Case two refers to a 59 -year -old Caucasian woman admitted with severe nephrotic syndrome associated with amyloidosis, that developed a catastrophic picture of calciphylaxis, ending in the patient’s death. There is a critical need to understand the pathogenesis of calciphylaxis. Its comprehension is the only way to improve the survival of these patients, and may help to elucidate the pathophysiology of vascular calcification in general. Educating physicians in the prevention and early detection of calciphylaxis is crucial. Only by increasing the knowledge about risk factors, pathophysiology, response to treatment and outcome, will we be able to improve prophylaxis and therapy of patients with calciphylaxis, decreasing the high mortality of this entity

Anticoagulant-Related Nephropathy in a Patient with IgA Nephropathy

Anticoagulant-related nephropathy is a type of acute kidney injury caused by overcoagulation. We describe a case of an 84-year-old man with arterial hypertension, coronary heart disease and atrial fibrillation treated with acenocoumarol, who presented with haematoproteinuria and acute kidney injury during a phase of excessive anticoagulation. In addition to IgA nephropathy, renal biopsy also revealed acute tubular necrosis, red blood cell casts and positive iron staining in tubular cells. After this acute episode, renal function improved and proteinuria decreased below the nephrotic range.info:eu-repo/semantics/publishedVersio

Variability of a portion of RNA 3 containing the coat protein gene of Citrus variegation virus (CVV) using single-strand conformation polymorphism (SSCP)

A portion of RNA 3 of Citrus variegation virus (CVV), comprising part of the intergenic region and the coat protein (CP) gene from eight viral isolates, was amplified by RT-PCR and cloned. The clones were compared for intra and inter-isolate variations by single-strand conformation polymorphism analysis. Some of the results were compared with sequence data previously obtained. The test discriminated between clones differing in as little as 3.2% of the nucleotides. Most isolates included several variants, in some cases with a predominant pattern, which, however, could no longer be recognised in new RT-PCR products obtained 13 months later. This procedure can there-fore be used to identify and detect variations between CVV isolates. It is rapid, inexpensive and may reduce the amount of sequencing needed for comparing viral isolates

New-Onset Seizures 15 Years After Renal Transplant

info:eu-repo/semantics/publishedVersio

Rare Diagnosis in a Patient with Diabetes with Nephrotic Proteinuria

We report a 63-year-old man with well-controlled type 2 diabetes mellitus and hypertension, who presented with new onset nephrotic proteinuria and rapid deterioration in renal function. The atypical clinical presentation prompted us to consider a non-diabetic and non-hypertensive cause and to perform a renal biopsy. A diagnosis of fibrillarglomerulonephritis (FGn) was made based on electronic microscopy. Proteinuria remained in nephrotic range despite treatment with prednisolone, and renal function deteriorated. We suggest that other causes of proteinuria should be considered in patients with diabetes who present with the nephrotic syndrome when there is no other evidence of microvascular disease. We review the spectrum of fibrillar glomerulopathies including FGn, primary and secondary amyloidosis and immunotactoid glomerulonephritis.info:eu-repo/semantics/publishedVersio

Variabilidad en la concentración y composición de los tocoferoles en el aceite de híbridos de girasol tradicionales y “alto oleico” en Argentina

Tocopherols are natural antioxidants that increase the stability of food fat and fulfill an important biological requirement in humans. There are no previous studies on the variability of tocopherol concentration and composition in the oil of sunflower traditional hybrids (TH) and high oleic sunflower hybrids (HOH) from different environments in Argentina. The objective of this work was to detect and  examine that variability. Seed samples were obtained from i) seven TH grown in four locations (Experiment I) and, ii) five hybrids (three HOH and two traditional ones) grown in three locations (Experiment II). Concentrations of total tocopherol in oil ranged from 634 to 1054 μg g oil–1. α-tocopherol accounted for 90.8 to 97% of the total tocopherols. Total and α-tocopherol concentrations were highly genetically determined (more than 80%). In Experiment I, a significant, although low in value, interaction between hybrid and location was found for total and α-tocopherol concentrations. In Experiment II, mean values for total tocopherol concentration in HOH and in each environment were larger than in TH. Significant differences for total and α-tocopherol concentration were not found among HOH and environments. The variation of tocopherol concentration for each hybrid across environments was higher than the variation among hybrids in the same environment. To obtain oil with high tocopherol concentration, both hybrid and environment must be selected.Los tocoferoles son antioxidantes naturales que aumentan la estabilidad de los aceites y cumplen una importante actividad biológica en humanos. No son conocidos estudios sobre la variabilidad del contenido y composición de tocoferoles en el aceite de híbridos de girasol tradicionales (HT) y “alto oleico” (HAO) sembrados en diferentes ambientes en Argentina. El objetivo de este trabajo fue detectar y examinar esa variabilidad. Las semillas fueron obtenidas de a) 7 HT sembrados en 4 localidades (Experimento I), y, b) 5 híbridos ( 3 HAO y 2 HT) sembrados en 3 localidades (Experimento II). La concentración de tocoferoles totales varió entre 634 y 1054 μg g aceite–1. El α-tocoferol aportó con el 90.8 a 97.0% del contenido total de tocoferol. Las concentraciones de α-tocoferol y tocoferol total estuvieron genéticamente determinadas (más del 80%). Para ambas variables, la interacción híbrido x localidad en el Experimento I fue significativa aunque de pequeño valor. La concentración media de tocoferoles totales entre ambientes y en cada ambiente fue mayor en los HAO que en los HT en el Experimento II, mientras que no hubo diferencias significativas entre HAO ni entre ambientes para esta variable, ni para α-tocoferol. En ambos experimentos, la variabilidad en la concentración de tocoferoles para cada híbrido a través de los ambientes fue más alta que la ocurrida entre híbridos en un mismo ambiente. Para obtener aceite de girasol con alta concentración de tocoferoles deben seleccionarse tanto el genotipo como el ambiente