Proteinuria predicts relapse in adolescent and adult minimal change disease

OBJECTIVE: This study sought to outline the clinical and laboratory characteristics of minimal change disease in adolescents and adults and establish the clinical and laboratory characteristics of relapsing and non-relapsing patients.METHODS: We retrospectively evaluated patients with confirmed diagnoses of minimal change disease by renal biopsy from 1979 to 2009; the patients were aged >13 years and had minimum 1-year follow-ups.RESULTS: Sixty-three patients with a median age (at diagnosis) of 34 (23-49) years were studied, including 23 males and 40 females. At diagnosis, eight (12.7%) patients presented with microscopic hematuria, 17 (27%) with hypertension and 17 (27%) with acute kidney injury. After the initial treatment, 55 (87.3%) patients showed complete remission, six (9.5%) showed partial remission and two (3.1%) were nonresponders. Disease relapse was observed in 34 (54%) patients who were initial responders (n = 61). In a comparison between the relapsing patients (n = 34) and the non-relapsing patients (n = 27), only proteinuria at diagnosis showed any significant difference (8.8 (7.1-12.0) vs. 6.0 (3.6-7.3) g/day, respectively, p = 0.001). Proteinuria greater than 7 g/day at the initial screening was associated with relapsing disease.CONCLUSIONS: In conclusion, minimal change disease in adults may sometimes present concurrently with hematuria, hypertension, and acute kidney injury. The relapsing pattern in our patients was associated with basal proteinuria over 7 g/day.

Padrões morfológicos de lesão glomerular e correlação com achados clinicolaboratoriais de 43 crianças com síndrome nefrótica

OBJETIVOS: Avaliar a associação entre os parâmetros clinicolaboratoriais e alteração morfológica de biópsias renais em crianças com síndrome nefrótica. MÉTODOS: Os dados foram obtidos dos prontuários médicos de 43 crianças com síndrome nefrótica submetidas a biópsia renal. RESULTADOS: Vinte e oito pacientes eram do sexo masculino (65,1%), idades entre 1,4 a 12 anos (média de 4,7±3,2). Quarenta e dois pacientes (97,7%) apresentaram edema; 83,7%, oligúria e 32,5%, hipertensão arterial. A média de proteinúria foi 15,3g/1,73m²SC/dia e 55,8% apresentaram hematúria microscópica. As biópsias renais mostraram: glomerulonefrite proliferativa mesangial (GNPM) em 37,2%, glomeruloesclerose segmentar e focal (GESF) em 27,9%, alterações glomerulares mínimas (LM) em 25,6%, glomerulonefrite membranoproliferativa (GNMP) em 7% e glomerulonefrite membranosa (GNM) em 2,3%. Vinte e seis pacientes (60,5%) apresentaram resistência ao corticosteróide. Idade, sexo, hipertensão arterial, oligúria, uréia e creatinina séricas não mostraram diferenças estatísticas significativas entre os pacientes com GNPM, GESF e LM. Os pacientes com GNPM e GESF apresentaram maior freqüência de hematúria microscópica (p < 0,003 e p < 0,03; respectivamente). Os pacientes com GESF apresentaram maiores níveis de proteinúria (p < 0,01 versus LM e p < 0,05 versus GNPM). Os pacientes com LM apresentaram sensibilidade ao corticosteróide (p < 0,001 versus GESF e p = 0,047 versus GNPM). CONCLUSÕES: Sexo, idade, presença de hipertensão arterial ou oligúria e níveis séricos de uréia e creatinina não auxiliaram na diferenciação entre pacientes com GNPM, GESF e LM. Os pacientes com LM apresentaram sensibilidade a corticosteróides e menos probabilidade de apresentar hematúria microscópica. Pacientes com GESF apresentaram maiores níveis de proteinúria.

Paulista registry of glomerulonephritis: 5-year data report

Background. The Paulista Registry of Glomerulopathies was created in May 1999 and comprises several centres of São Paulo, the most populous Brazilian State, that concentrates people from all regions of the country who look for health care.Methods. This report includes data from 2086 patients from Brazil submitted to renal biopsy due to the presumed diagnosis of glomerular diseases, registered prospectively since May 1999 until January 2005. Data were collected by the integrants of the 11 centres involved, utilizing a standardized questionnaire.Results. The mean age of the patients was 34.5 +/- 14.6 years. Primary glomerular diseases were more frequent in males (55.1%) than in females; on the other hand, secondary glomerular diseases were more frequent in females (71.8%). The most common clinical presentation was nephrotic syndrome and the frequency of hypertension, at this time, was 55.5%. There was a predominance of indication of biopsies in the third, fourth and fifth decades of life. The most common primary glomerular diseases were focal and segmental glomerulosclerosis (29.7%), followed by membranous nephropathy (20.7%), IgA nephropathy (17.8%), minimal change disease (9.1%), membranoproliferative glomerulonephritis (7%), crescentic glomerulonephritis (4.1%), advanced chronic glomerulopathy (4%), non-IgA mesangial glomerulonephritis (3.8%), diffuse proliferative glomerulonephritis (2.5%), focal segmental proliferative glomerulonephritis (1%) and others (0.3%). The most frequent secondary glomerular disease was lupus nephritis, corresponding to 66.2% of the cases, followed by post-infectious glomerulonephritis (12.5%), diabetic nephropathy (6.2%), diseases associated to paraproteinaemia (4.9%), hereditary diseases (4.6%), vasculitis (3.2%), malignancies (0.9.%), secondary focal segmental glomerulosclerosis (0.6%) and others (0.9%).Conclusion. Focal segmental glomerulosclerosis was the most frequent primary glomerular disease, followed by membranous nephropathy and IgA nephropathy. Lupus nephritis predominated over all the other secondary glomerular diseases.

Estudo da interação genótipo ambiente em búfalos leiteiros do Brasil e da Colômbia

Pós-graduação em Zootecnia - FCAV

Static potential in scalar QED(3) with non-minimal coupling

Here we compute the static potential in scalar QED(3) at leading order in 1/Nf. We show that the addition of a non-minimal coupling of Pauli-type (is an element of(mu nu alpha)j(mu)partial derivative(nu)A(alpha)), although it breaks parity, it does not change the analytic structure of the photon propagator and consequently the static potential remains logarithmic ( confining) at large distances. The non-minimal coupling modifies the potential, however, at small charge separations giving rise to a repulsive force of short range between opposite sign charges, which is relevant for the existence of bound states. This effect is in agreement with a previous calculation based on Moller scattering, but differently from such calculation we show here that the repulsion appears independently of the presence of a tree level Chern-Simons term which rather affects the large distance behaviour of the potential turning it into a constant.