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  1. Article ; Online: D313Y variant in two related end-stage renal disease patients - Pathogenic or not yet?

    Vicente, Rita / Santos, Iolanda / Coimbra, Miguel / Santos, Joana / Santos, Ricardo / Amoedo, Manuel / Pires, Carlos

    Nefrologia

    2022  Volume 43, Issue 5, Page(s) 636–639

    Abstract: Fabry disease is a multisystem lysosomal storage disorder caused by mutations in the GLA gene that result in a deficient or absent activity of alpha-galactosidase A. There is a wide spectrum of GLA gene variants, some of which are described as non- ... ...

    Abstract Fabry disease is a multisystem lysosomal storage disorder caused by mutations in the GLA gene that result in a deficient or absent activity of alpha-galactosidase A. There is a wide spectrum of GLA gene variants, some of which are described as non-pathogenic. The clinical importance of the D313Y variant is still under debate, although in recent years it has been considered as a variant of unknown significance or a benign variant. Despite this prevailing notion, there are multiple case reports of patients with D313Y variant that presented signs and symptoms consistent with FD without any other etiological explanation. In this article, we present two family members with an important renal phenotype and other typical manifestations of FD (white matter lesions and left ventricular hypertrophy) that only had the D313Y variant. These cases suggest that this variant of unknown significance may contribute to the development of common features of FD and should not be undervalued.
    MeSH term(s) Humans ; alpha-Galactosidase/genetics ; Fabry Disease/complications ; Fabry Disease/genetics ; Kidney Failure, Chronic/genetics ; Mutation ; Phenotype
    Chemical Substances alpha-Galactosidase (EC 3.2.1.22) ; GLA protein, human (EC 3.2.1.22)
    Language English
    Publishing date 2022-12-12
    Publishing country Spain
    Document type Case Reports
    ZDB-ID 2837917-2
    ISSN 2013-2514 ; 2013-2514
    ISSN (online) 2013-2514
    ISSN 2013-2514
    DOI 10.1016/j.nefroe.2022.01.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Etelcalcetide controls secondary hyperparathyroidism and raises sclerostin levels in hemodialysis patients previously uncontrolled with cinacalcet.

    Pereira, Luciano Artur Lopes / Meng, Catarina / Amoedo, Manuel Augusto Gonçalves / Mendes, Maria Teresa de Sousa Costa Pinto Ferreira / Marques, Marco Alexandre Mateus Prazeres / Frazão, João Miguel Machado Dória / Weigert, André Luiz Loureiro

    Nefrologia

    2022  Volume 43, Issue 2, Page(s) 197–203

    Abstract: Introduction: There is scarce clinical experience with etelcalcetide in patients with secondary hyperparathyroidism uncontrolled with cinacalcet. The effect of etelcalcetide on serum sclerostin levels remains to be clarified.: Materials and methods: ... ...

    Abstract Introduction: There is scarce clinical experience with etelcalcetide in patients with secondary hyperparathyroidism uncontrolled with cinacalcet. The effect of etelcalcetide on serum sclerostin levels remains to be clarified.
    Materials and methods: Prospective cohort study in prevalent hemodialysis patients with uncontrolled sHPT under cinacalcet for at least 3 months, mean parathyroid hormone (PTH)>800pg/mL and calcium (Ca)>8.3mg/dL. Etelcalcetide 5mg IV/HD was initiated after cinacalcet washout. Levels of PTH, Ca, and phosphorus (Pi) followed monthly for 6 months. Plasma sclerostin levels measured before etelcalcetide treatment and after 6 months.
    Results: Thirty-four patients were enrolled, 19 (55.9%) male gender. Mean age 60.7 (± 12.3) years; median time on HD 82.5 (7-296) months and median cinacalcet dose was 180mg/week (Interquartile Range: 180-270). Serum Ca, Pi and PTH levels showed a significant reduction after etelcalcetide treatment from 8.8mg/dL, 5.4mg/dL and 1005pg/mL to 8.1mg/dL (p=0.08), 4.9mg/dL (p=0.01) and 702pg/mL (p<0.001), respectively. Median etelcalcetide dose remained at 5mg/HD. Plasma sclerostin concentration increased from 35.66pmol/L (IQR11.94-54.58) to 71.05pmol/L (IQR54.43-84.91) (p<0.0001).
    Conclusion: Etelcalcetide improved sHPT control in this group of patients, previously under cinacalcet treatment, and significantly increased plasma sclerostin concentration. The impact of etelcalcetide treatment on sclerostin levels is a novel finding.
    Language English
    Publishing date 2022-11-25
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 2837917-2
    ISSN 2013-2514 ; 2013-2514
    ISSN (online) 2013-2514
    ISSN 2013-2514
    DOI 10.1016/j.nefroe.2022.11.014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Lupus-like nephritis with positive anti-neutrophil cytoplasmic antibodies and negative antinuclear antibodies.

    Santos, Joana Eugénio / Vicente, Rita / Malvar, Beatriz / Santos, Iolanda / Coimbra, Miguel / Amoedo, Manuel / Pires, Carlos

    Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia

    2020  Volume 44, Issue 1, Page(s) 121–125

    Abstract: Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of ... ...

    Abstract Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of controversial views. We present a case of acute kidney injury and nephrotic syndrome in a young woman with diffuse global proliferative and membranous nephritis on her kidney biopsy, showing a full-house immunofluorescence pattern, very allusive of class IV + V LN, but lacking associated clinical criteria and laboratory findings to support the diagnosis of systemic lupus erythematosus (SLE). Furthermore, the patient presented with high titers of ANCA, steadily decreasing alongside the renal function and proteinuria improvements, with mycophenolate mofetil (MMF) and steroid treatment. The authors believe this is a case of lupus-like nephritis, in which ANCAs are immunological markers, although they are not directly involved in the pathogenesis.
    MeSH term(s) Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear/therapeutic use ; Female ; Humans ; Lupus Erythematosus, Systemic/complications ; Lupus Nephritis/diagnosis ; Lupus Nephritis/drug therapy ; Mycophenolic Acid/therapeutic use
    Chemical Substances Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Mycophenolic Acid (HU9DX48N0T)
    Language Portuguese
    Publishing date 2020-10-26
    Publishing country Brazil
    Document type Case Reports ; Journal Article
    ZDB-ID 2057873-8
    ISSN 2175-8239 ; 2175-8239
    ISSN (online) 2175-8239
    ISSN 2175-8239
    DOI 10.1590/2175-8239-JBN-2020-0114
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Rituximab use in adult glomerulopathies and its rationale.

    Santos, Joana Eugénio / Fiel, David / Santos, Ricardo / Vicente, Rita / Aguiar, Rute / Santos, Iolanda / Amoedo, Manuel / Pires, Carlos

    Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia

    2019  Volume 42, Issue 1, Page(s) 77–93

    Abstract: Glomerulopathies are one of the leading causes of end-stage renal disease. In the last years, clinical research has made significant contributions to the understanding of such conditions. Recently, rituximab (RTX) has appeared as a reasonably safe ... ...

    Abstract Glomerulopathies are one of the leading causes of end-stage renal disease. In the last years, clinical research has made significant contributions to the understanding of such conditions. Recently, rituximab (RTX) has appeared as a reasonably safe treatment. The Kidney Disease: Improving Global Outcomes guidelines (KDIGO) recommended RTX only as initial treatment in antineutrophil cytoplasm antibody associated vasculitis (AAV) and in non-responders patients with lupus nephritis (LN), but these guidelines have not been updated since 2012. Nowadays, RTX seems to be at least as effective as other immunosuppressive regimens in idiopathic membranous nephropathy (IMN). In minimal-change disease, (MCD) this drug might allow a long-lasting remission period in steroid-dependent or frequently relapsing patients. Preliminary results support the use of RTX in patients with pure membranous LN and immunoglobulin-mediated membranoproliferative glomerulonephritis (MPGN), but not in patients with class III/IV LN or complement-mediated MPGN. No conclusion can be drawn in idiopathic focal segmental glomerulosclerosis (FSGS) and anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN) because studies are small, heterogeneous, and scarce. Lastly, immunosuppression including RTX is not particularly useful in IgA nephropathy. This review presents the general background, outcomes, and safety for RTX treatment in different glomerulopathies. In this regard, we describe randomized controlled trials (RCTs) performed in adults, whenever possible. A literature search was performed using clinicaltrials.gov and PubMed.
    MeSH term(s) Adult ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy ; Glomerulonephritis/drug therapy ; Humans ; Immunosuppressive Agents/adverse effects ; Nephrosis, Lipoid/drug therapy ; Randomized Controlled Trials as Topic ; Rituximab/adverse effects ; Treatment Outcome
    Chemical Substances Immunosuppressive Agents ; Rituximab (4F4X42SYQ6)
    Language English
    Publishing date 2019-12-20
    Publishing country Brazil
    Document type Journal Article ; Review
    ZDB-ID 2057873-8
    ISSN 2175-8239 ; 0101-2800
    ISSN (online) 2175-8239
    ISSN 0101-2800
    DOI 10.1590/2175-8239-jbn-2018-0254
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Peritoneal Dialysis Exit-Site Care Protocols in Portugal and Its Association with Catheter-Related Infections.

    Ferreira, Ana Carina / Fernandes, Vasco / Rodrigues, Anabela / Abreu, Cristina Pinto / Pereira, Marta / Guedes, Anabela Malho / Gomes, Ana Marta / Cabrita, António / Soares, Carlos / Pego, Cátia / Ferrer, Francisco / Bernardo, Idalécio / Fernandes, João Carlos / Assunção, José / Oliveira, Luís / Amoedo, Manuel / Carvalho, Maria João / Branco, Patrícia / Maia, Pedro /
    Chorão, Raquel / Castro, Rui / Silva, Rui / Sousa, Tânia / Mendes, Teresa

    Blood purification

    2023  Volume 52, Issue 4, Page(s) 366–372

    Abstract: Introduction: Exit-site infection (ESi) prevention is a key factor in lowering the risk of peritonitis. This study aimed to evaluate the associations between exit-site (ES) care protocols and the annual incidence rates of ESi and peritonitis in Portugal. ...

    Abstract Introduction: Exit-site infection (ESi) prevention is a key factor in lowering the risk of peritonitis. This study aimed to evaluate the associations between exit-site (ES) care protocols and the annual incidence rates of ESi and peritonitis in Portugal.
    Methods: We performed a national survey using two questionnaires: one about the incidence of catheter-related infections and the other characterizing patients' education and ES care protocols.
    Results: In 2017 and 2018, 14 Portuguese units followed 764 and 689 patients. ESi incidence rate was 0.41 episodes/year, and the peritonitis incidence rate was 0.37. All units monitor catheter-related infections on a yearly basis, use antibiotic prophylaxis at the time of catheter placement, and treat nasal carriage of S. aureus, although with different approaches. Screening for nasal carriage of S. aureus is performed by 12 units, and daily topical antibiotic cream is recommended by 6 out of 14 of the units. We did not find statistical differences in ESi/peritonitis, comparing these practices. The rate of ESis was lower with nonocclusive dressing immediately after catheter insertion, bathing without ES dressing, with the use of colostomy bags in beach baths and was higher with the use of bath sponge. The peritonitis rate was lower with bathing without ES dressing and if shaving of the external cuff was performed in the presence of chronic ESi.
    Conclusions: We found potential proceedings associated with ESi and peritonitis. A regular national audit of peritoneal dialysis units is an important tool for clarifying the best procedures for reduction of catheter-related infections.
    MeSH term(s) Humans ; Mupirocin ; Portugal ; Catheter-Related Infections/etiology ; Staphylococcus aureus ; Catheters, Indwelling/adverse effects ; Administration, Topical ; Renal Dialysis/adverse effects ; Anti-Bacterial Agents ; Peritoneal Dialysis/adverse effects ; Peritonitis/etiology
    Chemical Substances Mupirocin (D0GX863OA5) ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-01-26
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 605548-5
    ISSN 1421-9735 ; 0253-5068
    ISSN (online) 1421-9735
    ISSN 0253-5068
    DOI 10.1159/000528641
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Nefropatia de contraste.

    Santos, Ricardo Oliveira / Malvar, Beatriz / Silva, Rui / Ramalho, Vítor / Pessegueiro, Pedro / Amoedo, Manuel / Aniceto, João / Pires, Carlos

    Acta medica portuguesa

    2011  Volume 24, Issue 5, Page(s) 809–820

    Abstract: Contrast-induced nephropathy (CIN) is an iatrogenic disorder, resulting from procedures requiring the intravascular administration of iodinated contrast media. It has an association with increased morbidity and mortality, increased costs and it remains ... ...

    Title translation Contrast-induced nephropathy.
    Abstract Contrast-induced nephropathy (CIN) is an iatrogenic disorder, resulting from procedures requiring the intravascular administration of iodinated contrast media. It has an association with increased morbidity and mortality, increased costs and it remains the third most common cause of hospital-acquired kidney failure. CIN is usually defined as an increase in serum creatinine by either at least 0.5 mg/dl or by 25% from baseline within the first 48 hours after contrast administration, in the absence of other causes of renal function impairment. In its pathogenesis have been implicated 2 main mechanisms: renal vasoconstriction resulting in medullary hypoxia and direct cytotoxic effects of the contrast agents. There are several risk factors for radiocontrast nephrotoxicity but patients with underlying renal insufficiency or diabetic nephropathy with renal insufficiency have the greatest risk. Other classic risk factors include: advanced age, peri-procedural intravascular depletion, congestive heart failure. Finally, toxicity also depends on the volume, type of contrast administered and concomitant use of other nephrotoxic drugs. Since there is no specific treatment for CIN and it is limited to supportive measures, prevention is the best way to deal with this condition. In this setting it is important to use lower doses of a low or iso-osmolal agent and avoid volume depletion. Nowadays it is recommended to do volume expansion prior to and continued for several hours after the procedure. Randomized controlled trials suggest that isotonic intravenous fluids, particularly isotonic bicarbonate, confer better protection. Several pharmacologic approaches have been tested to decrease the risk of CIN in patients with preexisting renal disease, based in the mechanisms by which contrast medium is believed to cause nephrotoxicity. However, with the exception of some antioxidant agents, few of those adjunctive therapies have shown any consistent benefit. N-Acetylcysteine is the most widely studied of all prophylactic strategies and despite conflicting data it is advised to do an elevated dosage orally twice daily, the day before and the day of the procedure, based upon its potential for benefit, low toxicity and cost. This article pretends to review CIN pathogenesis, risk factors, clinical course, treatment and prevention. The authors propose themselves a prevention protocol for risk patients based on the latest clinical evidence.
    MeSH term(s) Clinical Protocols ; Contrast Media/adverse effects ; Humans ; Iodine Compounds/adverse effects ; Kidney Diseases/chemically induced ; Kidney Diseases/therapy ; Risk Factors
    Chemical Substances Contrast Media ; Iodine Compounds
    Language Portuguese
    Publishing date 2011-09
    Publishing country Portugal
    Document type English Abstract ; Journal Article ; Review
    ZDB-ID 603078-6
    ISSN 1646-0758 ; 0870-399X
    ISSN (online) 1646-0758
    ISSN 0870-399X
    Database MEDical Literature Analysis and Retrieval System OnLINE

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