The frequency of HLA-DRB1 polymorphisms in Brazilian Plasmodium vivax malaria patients and in blood donors from the Amazon Region

We evaluated the frequency of different HLA-DRB1 alleles in Plasmodium vivax-infected individuals and in healthy blood donors from malaria endemic areas of Brazil. Low-resolution human leukocyte antigen-DRB1 genotyping was performed for 73 malaria patients and 29 healthy blood donors. The most frequent alleles in individuals from northern Brazil were human leukocyte antigen-DRB1*04, *08, *07 and *13. The frequency of human leukocyte antigen-DRB1*07 was higher in malaria-infected individuals than in the control group, which reinforces the theory that this allele plays an important role in susceptibility to malaria. This study offers new information about a potential susceptibility factor for P. vivax malaria in a Brazilian population that is naturally exposed to malaria.

The long-term outcome after acute kidney injury: a narrative review

This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.

Diferentes esquemas de indução para transplante renal com doador vivo

Abstract Introduction: Indications for induction therapy is not consensual in living donors. Objective: The objective of this study was compare no induction with thymoglobulin and basiliximab induction in the incidence of acute rejection in kidney transplantation with living donor. Methods: We select all cases of renal transplantation with living donor performed in Hospital das Clínicas de Botucatu da UNESP during the period of January 2010 to December 2013. The group was divided by the type of medication used for induction. Results: A total of 90 patients were evaluated. There were no differences in baseline characteristics of age and underlying disease. The rate of biopsy-proven acute rejection was higher in the group without induction (42.9%) compared to basiliximab group (20%) and Thymoglobulin (16.7%), p = 0.04. The rejection by compatibility shows that the identical had the lower rejection rate (10%). The haploidentical group without induction had the highest rejection rates (53.3%). In all distinct group the rejection rates were similar with basiliximab or Thymoglobulin, p = NS. The use of induction therapy was associated independently with a lower risk of rejection (OR = 0.32 CI: 0.11 to 0.93, p = 0.036). There were no differences in renal function at 6 months and patient survival and graft in the three groups. Discussion: The haploidentical patients without induction were those with higher rates of acute rejection. The group of patients induced with Thymoglobulin had a higher immunological risk, however showed low rates of rejection. Conclusion: The use of induction therapy resulted in lower rates of rejection in transplantation with living donor.

Hemoglobin I-Philadelphia [alpha 16 (A14) LYS→GLU] heterozygote among blood donors from Brazil

We describe a heterozygous case of Hb I-Philadelphia [alpha 16 (A14) LYS-->GLU] in a blood donor from the Acre State Blood Bank, in the Brazilian Amazon region. We confirmed the mutation by electrophoretic and chromatographic methods and by DNA sequencing. A literature search showed that this is the first description of this alpha globin mutant in a Brazilian Caucasian group. We also emphasize the importance of the hemoglobin study in blood donors for the purpose of the genetic counseling and quality assurance of the blood to be transfused. Screening tests for hemoglobin mutants are also important for gathering anthropological information about the Brazilian population.

Peritoneal dialysis in acute kidney injury: trends in the outcome across time periods

Peritoneal dialysis (PD) should be considered a suitable method of renal replacement therapy in acute kidney injury (AKI) patients. This study is the largest cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in a developing country. Its objective was to describe the main determinants of patient and technique survival, including trends over time of PD treatment in AKI patients. This was a Brazilian prospective cohort study in which all adult AKI patients on PD were studied from January/2004 to January/2014. For comparison purposes, patients were divided into 2 groups according to the year of treatment: 2004-2008 and 2009-2014. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. A total of 301 patients were included, 51 were transferred to hemodialysis (16.9%) during the study period. The main cause of TF was mechanical complication (47%) followed by peritonitis (41.2%). There was change in TF during the study period: compared to 2004-2008, patients treated at 2009-2014 had relative risk (RR) reduction of 0.86 (95% CI 0.77-0.96) and three independent risk factors were identified: period of treatment at 2009 and 2014, sepsis and age>65 years. There were 180 deaths (59.8%) during the study. Death was the leading cause of dropout (77.9% of all cases) mainly by sepsis (58.3%), followed cardiovascular disease (36.1%). The overall patient survival was 41% at 30 days. Patient survival improved along study periods: compared to 2004-2008, patients treated at 2009-2014 had a RR reduction of 0.87 (95% CI 0.79-0.98). The independent risk factors for mortality were sepsis, age>70 years, ATN-ISS > 0.65 and positive fluid balance. As conclusion, we observed an improvement in patient survival and TF along the years even after correction for several confounders and using a competing risk approach.

Dialysis complications in acute kidney injury patients treated with prolonged intermittent renal replacement therapy sessions lasting 10 versus 6 hours: results of a randomized clinical trial

Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 mu g/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed. Seventy-five patients were treated with 195 PIRRT sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalemia, and hypophosphatemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 was composed of 38 patients treated with 100 sessions, whereas G2 consisted of 37 patients treated with 95 sessions. G1 and G2 were similar in male predominance (65.7 vs. 75.6%, P=0.34), age (63.6 +/- 14 vs. 59.9 +/- 15.5 years, P=0.28) and Sequential Organ Failure Assessment score (SOFA; 13.1 +/- 2.4 vs. 14.2 +/- 3.0, P=0.2). There was no significant difference between the two groups in hypotension (81.5 vs. 83.7%, P=0.8), filter clotting (23.6 vs. 27%, P=0.73), hypokalemia (13.1 vs. 8.1%, P=0.71), and hypophosphatemia (18.4 vs. 21.6%, P=0.72). However, the group treated with sessions of 10h were refractory to clinical measures for hypotension, and dialysis sessions were interrupted more often (9.5 vs. 30.1%, P=0.03). Metabolic control and fluid balance were similar between G1 and G2 (blood urea nitrogen [BUN]: 81 +/- 30 vs. 73 +/- 33mg/dL, P=1.0; delivered Kt/V: 1.09 +/- 0.24 vs. 1.26 +/- 0.26, P=0.09; actual ultrafiltration: 1731 +/- 818 vs. 2332 +/- 947mL, P=0.13) and fluid balance (-731 +/- 125 vs. -652 +/- 141mL, respectively) . In conclusion, intradialysis hypotension was common in AKI patients treated with PIRRT. There was no difference in the prevalence of dialysis complications in patients undergoing different durations of PIRRT.

Fetal kidney programming by severe food restriction: effects on structure, hormonal receptor expression and urinary sodium excretion in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Paradoxical effects of bovine somatotropin treatment on the ovarian follicular population and in vitro embryo production of lactating buffalo donors submitted to ovum pick-up

The aim of the present study was to evaluate the effect of bovine somatotropin (bST; 500 mg) administration on lactating buffalo donors submitted to two different ovum pick-up (OPU) and in vitro embryo production schemes with a 7 or 14 d intersession OPU interval. A total of 16 lactating buffalo cows were randomly assigned into one of four experimental groups according to the bST treatment (bST or No-bST) and the OPU intersession interval (7 or 14 d) in a 2 x 2 factorial design (16 weeks of OPU sessions). The females submitted to OPU every 14d had a larger (P < 0.001) number of ovarian follicles suitable for puncture (15.6 +/- 0.7 vs. 12.8 +/- 0.4) and an increased (P = 0.004) number of cumulus-oocyte complexes (COCs) recovered (10.0 +/- 0.5 vs. 8.5 +/- 0.3) compared to the 7 d interval group. However, a 7 or 14 d interval between OPU sessions had no effect (P = 0.34) on the number of blastocysts produced per OPU (1.0 +/- 0.1 vs. 13 +/- 0.2, respectively). In addition, bST treatment increased (P < 0.001) the number of ovarian follicles suitable for puncture (15.3 +/- 0.5 vs. 12.1 +/- 0.4) but reduced the percentage (18.9% vs. 10.9%; P = 0.009) and the number (1.4 +/- 0.2 vs. 0.8 +/- 0.1; P = 0.003) of blastocysts produced per OPU session compared with the non-bST-treated buffaloes. In conclusion, the 14d interval between OPU sessions and bST treatment efficiently increased the number of ovarian follicles suitable for puncture. However, the OPU session interval had no effect on embryo production, and bST treatment reduced the in vitro blastocyst outcomes in lactating buffalo donors.

Electropolymerization using binuclear nickel(II) Schiff base complexes bearing N4O4 donors as supramolecular building blocks

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Lycopene supplementation reduces TNF-alpha via RAGE in the kidney of obese rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of chronic fluoride intake on the antioxidant systems of the liver and kidney in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Topography of the blood vessels in the hilum of the kidney of Myrmecophaga tridactyla

The study was undertaken in 10 formol-imbibed kidneys of great anteater (Myrmecophaga tridactyla). After the dissection the following characteristics were showed: kidney blood vessels are distributed in 2 different sites, namely hilar and extrahilar, amounting 3 to 6 in the right side 3 to 7 in the left side. Arterial branches in extrahilar region range from 1 to 2 in both sides and in hilar region they present from 1 to 4 in the right and 1 to 2 in the left. Venous roots occur in 1 to 2 vessels in the right and 1 to 3 vessels in the left, occupying only the hilar region, except one case where it was present in the right side.

Acute kidney injury after massive attack of Africanised bees

Acute kidney injury (AKI) is a well-documented complication of massive attack by Africanised bees and can be observed 48-72 h after the accident. We report a case of Africanised bees attack followed by severe and lethal AKI. A 56-year-old man was admitted to emergency department after a massive attack of Africanised bees (>1000 bee stings). He was unconscious, presenting with hypotension and tachycardia. Mechanical ventilation, volume expansion and care for anaphylaxis were instituted. The patient was transferred to the intensive care unit (ICU) and after 48 h he developed rhabdomyolysis, oliguria, increased creatinine levels, hyperkalaemia and refractory acidosis. A diagnosis of AKI secondary to rhabdomyolysis and shock was made. The patient was treated with a prolonged course of haemodialysis. However, he progressed to refractory shock and died 5 days after admission.

Acute kidney injury in septic patients admitted to emergency clinical room: risk factors and outcome

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)