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Biomedical subjects

E Sabbaga

Publications and source records attributed to E Sabbaga.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Hyperhomocyst(e)inemia in chronic stable renal transplant patients.

PURPOSE: Hyperhomocyst(e)inaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(e)inemia in renal transplant recipients. METHODS: Total serum homocysteine (by high performance liquid chromatography), creatinine, lipid profile, folic acid (by radioimmunoassay-RIA) and vitamin B12 (by RIA) concentrations were measured in 3 groups. Group I patients (n=20) were under treatment with cyclosporine, azathioprine, and prednisone; group II (n=9) were under treatment with azathioprine and prednisone; and group III (n=7) were composed of renal graft donors for groups I and II. Creatinine, estimated creatinine clearance, cyclosporine trough level, lipid profile, folic acid, and vitamin B12 concentrations and clinical characteristics of patients were assessed with the aim of ascertaining determinants of hyperhomocyst(e)inemia. RESULTS: Patient ages were 48.8 +/- 15.1 yr (group I), 43.3 +/- 11.3 yr (group II); and 46.5 +/- 14.8 yr (group III). Mean serum homocyst(e)ine (tHcy) concentrations were 18.07 +/- 8.29 mmol/l in renal transplant recipients; 16.55 +/- 5.6 mmol/l and 21.44 +/- 12.1 mmol/l respectively for group I (with cyclosporine) and group II (without cyclosporine) (NS). In renal donors, tHcy was significantly lower (9.07 +/- 3.06 mmol/l; group I + group II vs. group III, p<0.008). There was an unadjusted correlation (p<0.10) between age (r=0.427; p<0.005) body weight (r=0.412; p<0.05), serum creatinine (r=0.427; p<0.05), estimated creatinine clearance (r=0.316; p<0.10), and tHcy in renal recipients (group I +II). Independent regressors (r2=0.46) identified in the multiple regression model were age (coefficient= 0.253; p=0.009) and serum creatinine (coefficient=8.07; p=0.045). We found no cases of hyperhomocyst(e)inemia in the control group. In contrast, 38% of renal recipients had hyperhomocyst(e)inemia: 7 cases (35%) on cyclosporine and 4 (45%) without cyclosporine, based on serum normal levels. CONCLUSIONS: Renal transplant recipients frequently have hyperhomocyst(e)inemia. Hyperhomocyst(e)inemia in renal transplant patients is independent of the scheme of immunosuppression they are taking. The older the patients are and the higher are their serum creatinine levels, the more susceptible they are to hyperhomocyst(e)inemia following renal transplantation.

Adult↗
PubMedDate not supplied

Endolymphatic irradiation in preparation for renal transplantation: a 26-year's follow-up.

OBJECTIVE: The aim of the present study was to analyze the long-term evolution of patients submitted to endolymphatic irradiation as a pre-transplant preparation. SETTING: Referral center of university hospital. DESIGN: Case-control study. MAIN OUTCOMES MEASURES: The study was designed to evaluate the incidence of rejection, kidney loss, leukopenia, infection, and graft survival in the group treated (group 1) prior to surgery, compared to a control group (group 2) composed of patients under identical clinical conditions (sex, age, type of donor, immunosuppressive therapy and time of transplant) that did not undergo treatment preparation. PATIENTS: Patients were selected from amongst transplantation candidates on a long-term waiting list, some with a high level of antibodies against panel. The control group was chosen from amongst recently transplanted patients. Patients in the treated group received lipoiodine containing 131I with specific activity ranging between 4 and 6 mCu/ml. RESULTS: A significant difference between the two groups was found with regard to the incidence of rejection crises (21.0% in group 1 and 73.6% in group 2; P = 0.003), and the maintenance dose of azathioprine (smaller in group 1; P < 0.01). As to kidney graft loss due to rejection, a tendency to significance could be identified (10.5% in group 1 and 42.1% in group 2; P = 0.063); however, the difference was not significant between the two groups in terms of reversibility of rejection episodes during the first 60 post-transplant days. CONCLUSIONS: The authors concluded that this method, besides being relatively innocuous (there was no compromising of either the thyroid gland or of gonad function and there was no increase in tumor incidence), has an extended immunosuppressive effect, and can be indicated for cadaveric renal allograft recipients, especially those showing high panel reactivity.

Actuarial Analysis↗
PubMedDate not supplied

Seasonal variation of blood pressure in maintenance hemodialysis.

CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 +/- 8 vs 107 +/- 10 and 101 +/- 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 +/- 8 vs 130 +/- 11 and 124 +/- 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 +/- 1.6 vs 19.5 +/- 3.0 and 15.8 +/- 1.9 degrees C, respectively; p < 0.01). CONCLUSIONS: We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.

Adult↗
PubMedDate not supplied

[Use of recombinant human erythropoietin in the treatment of anemia in hemodialyzed patients: a multicentric study].

Recombinant human erythropoietin (rHu-EPO) therapy was given to 25 patients undergoing long-term hemodialysis, for 12 weeks, in 5 Brazilian dialysis centers. The dose of rHu-EPO was given intravenously thrice weekly, initially at 50 Units/kg/dose. If the target hemoglobin concentration (10g/dL) was not achieved by four weeks the dose was increased to 75 and 100 Units/kg/dose. After 4 weeks hemoglobin concentration had achieved 10g/dL in only one patient, and, after 8 weeks, 10 patients (40% of all cases) had hemoglobin levels higher than the target concentration. After 12 weeks, the hemoglobin increased from 7.1 +/- 1.1 to 9.6 +/- 1.2 g/dL, the target hemoglobin concentration was achieved in 15 patients (60% of all cases). There was a significant (p < 0.05) increase in hematocrit (from 22 +/- 4 to 31 +/- 4 vol%), in body weight (from 55.03 +/- 12.24 to 56.16 +/- 12.86kg), and in serum phosphorus (from 5.85 +/- 2.02 to 6.82 +/- 2.34 mg/dL). There were no significant changes in blood pressure, serum levels of creatinine, of potassium, and of transferrin. Increase in blood pressure (in 3 patients), fever (in 2 patients), increase in the heparin dose needs (in 2 cases), and vascular access thrombosis (in 1 patient) were the most important adverse effects observed during rHu-EPO therapy. Thus, the anemia of chronic renal failure may be easily corrected with adequate amounts of recombinant human erythropoietin. Attention must be paid to some adverse effects during reversal of anemia.

Adolescent↗
PubMedDate not supplied

[Urinary citrate determination in normal persons and in patients with recurrent urinary calculi].

The presence of citric acid in urine and its ability to bind calcium ions forming a soluble complex are well recognized and has led to the suggestion that citric acid may play an important role in preventing renal calcium stone disease. In this study the 24-hour urinary excretion was measured with a specific enzymatic method in 48 normal subjects and in a group of 46 non selected patients with recurrent urolithiasis. Hypocitraturia was detected in 18/46 patients (39.1%) and was the unique metabolic abnormality in 6 (13%).

Adult↗
PubMedDate not supplied

[Survival analysis of 487 patients with kidney transplantation].

The causes of graft loss were analysed in a group of 487 kidney transplants, of which 252 (51.46%) concerned related donors, 139 (28.5%) cadaver donors and 96 (19.7%) non-related donors. A total of 74 kidneys were lost in the first 3 months after transplantation (15.19%). In 34 cases the loss was due to immunological factors (45.9%) in 21 cases (28.3%) to the death of the patients and in 19 cases (25.7%) to the technical causes. From 34 losses by immunological problems, 32 were rejections with humoral character (acute vascular rejection in 11 cases, late humoral rejection in 11 cases, immediate humoral rejection in 9 cases, ABO incompatibility in one case) and recurrence of original disease in one case. Acute cellular rejection was observed in only one patient. None of the patients died from immunological loss of the graft. The most frequent cause of death were sepsis (13 out of 21 patients) and the most common focus of infection was pulmonary (5 patients). It occurred most frequently with cadaveric donor, (10.07%). Death related to cardiovascular causes occurred in four patients, digestive in two and in consequence of arterial bleeding in two. Among the 23 losses by technical factors renal artery thrombosis was the most frequent (11 cases); renal rupture occurred in three cases, renal vein thrombosis in two rupture of arterial anastomosis in one and inviable kidney in another one. The technical loss was most frequent with cadaver donors (8.63%), followed by non-related donors (4.16%) and related donors (2.77%). Four patients died from causes directly related to technical factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Brazil↗
PubMedDate not supplied

Immunosuppressive effect of intra-lymphatic irradiation.

The effect of intra-lymphatic administration of Lipiodol-l131 on the number of T and B lymphocytes, and on the in vivo response to common antigens and to DNCB, was investigated in uremic patients in the pre-transplant period. T lymphocytes have been detected by rosette formation with sheep erythrocytes (E) and B lymphocytes by rosette formation with erythrocytes sensitized with antibody and complement (EAC). After irradiation it was observed a lymphopenia due to a statistically significant decrease in the number of both T and B peripheral blood lymphocytes and a depletion of these cells in the irradiated lymph nodes. Their ability to give delayed hypersensitivity response to common antigens in vivo was lost after intralymphatic irradiation. Two patients were able to develop sensitization to DNCB and this reaction was supressed in one of them by irradiation. These effects of intralymphatic irradiation on the immune system favours further study of this method in clinical renal transplantation.

B-Lymphocytes↗
PubMedDate not supplied

[Recurrence of segmental and focal glomerulosclerosis in transplanted kidneys].

The course of 16 patients with segmental and focal glomerulosclerosis (SFGS) with kidney transplantation is reported. Ten out of 16 (group I) had the diagnosis histologically confirmed in their native kidneys. In 6 (group II) the diagnosis was suggested by the early development of SFGS in the graft and was considered a recurrence of the baseline disease. The recurrence (in group I) was 40% and the main clinical parameter was proteinuria, in nephrotic level, with early development in all cases (less than 60 days). In those patients who had an early development of the baseline disease (less than 4 years) the recurrence was greater, observed in 5 out of 8 grafts with 3 grafts lost due to the recurrence of focal glomerulosclerosis. On the other hand, the patients whose baseline disease had a longer period of development presented a better course of the recurrent glomerulosclerosis and no grafts were lost in this cases. We believe that renal transplantation of a live donor must be avoided in those patients with quick developing SFGS.

Adolescent↗
PubMedDate not supplied

[Rice bran in the treatment of idiopathic hypercalciuria in patients with urinary calculosis].

Ten patients with recurrent nephrolithiasis and hypercalciuria were given rice bran during 60 days. Hypercalciuria was reduced in all patients in an average of 40%. Urinary magnesium was reduced in 28% and oxalate excretion was increased in 28%. The rate of decrease of urinary calcium was 65% in the absorptive type and 33% in the renal type of hypercalciuria.

Adult↗
PubMedDate not supplied

[Prevalence of anti-HIV antibodies in dialysis patients].

Patients treated with chronic dialysis have a high risk of acquiring viral infections and blood transfusions are commonly considered to be the vehicle of transmission. In Brazil this source is implicated in infection of 15 percent of patients developing acquired immunodeficiency syndrome (AIDS). So, we evaluated the relative risk of our patients in dialysis becoming infected with human immunodeficiency virus (HIV), the virus associated with the AIDS. An enzyme immunoassay showed 6 of 104 patients on dialysis to have antibodies to HIV. In five infection with HIV was confirmed by Western blot tests. Investigation of other risk factors for AIDS showed that blood transfusion was the most likely cause of contamination. There was no correlation between HIV and HBV infections. Only one patient had leucopenia and low OKT4/T8 ratio and she died 90 days after sorologic diagnosis of HIV infection; the cause of death was encephalopathy and sepsis. Two patients died after 4 and 16 months victims of cardiocirculatory problems (non-AIDS related causes). Three patients remain asymptomatic on chronic hemodialysis 20, 36 and 37 months after diagnosis of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Peritonitis in intermittent peritoneal dialysis: microbiological aspects and the antibiogram].

Peritonitis is the most frequent complication in patients on peritoneal dialysis and bacteria are the major causative agents. Initial antibiotic therapy may be "blind" but the antimicrobial agent used should be related to the infecting organism and its sensitivities. This study was initiated in order to evaluate the microbiological characteristics and sensitivity of bacteria isolated from pre and post peritoneal dialysis effluents. Positive growth of microorganisms was observed in 52 out of 503 cultures. Staphylococcus aureus and Staphylococcus epidermidis were identified most frequently (29 per cent each). Antibiograms showed high sensitivity to aminoglycosides (netilmicin and amikacin) and to second and third generation cephalosporin. Vancomycin and netilmicin were the best choices for Staphylococcal infection. A high bacterial resistance to ampicillin, co-trimoxazole, cephalothin and gentamicin was verified. Characteristics of organisms causing peritonitis in patients on intermittent peritoneal dialysis is very important, for selection of the initial antibiotic therapy.

Anti-Bacterial Agents↗