No description available.

Introduction : Les modèles murins sont grandement utilisés dans l’étude des maladies rénales et des pathologies associées. La concentration de la créatinine sérique est un bon indicateur de la filtration glomérulaire et en présence d’insuffisance rénale chronique (IRC), les concentrations de créatinine sérique (et la clairance) reflètent la sévérité de l’IRC. De plus, il a été démontré que l’IRC modifie le métabolisme des médicaments en diminuant l’activité et l’expression des enzymes hépatiques du cytochrome P450 (CYP450). Afin d’étudier la modulation du P450 par l’IRC avec un modèle murin et de confirmer nos résultats chez le rat, nous devons 1) développer un modèle d’IRC chez la souris, 2) mettre au point une technique de dosage des marqueurs de l’IRC et, 3) évaluer l’expression protéique du CYP450 en présence IRC. Matériel et Méthode : Trois modèles chirurgicaux d’IRC chez la souris ont été développés. Une méthode du dosage de la créatinine par chromatographie liquide à haute performance (CLHP) a été mise au point chez la souris et l’expression protéique du P450 a été mesurée par immunobuvardage de type Western. Résultats : Plusieurs paramètres de CLHP comme le pH, la concentration et le débit de la phase mobile modifient le pic d’élution et le temps de rétention de la créatinine. Concernant le modèle expérimental, on observe une perte de poids et une augmentation de la concentration plasmatique de la créatinine chez les souris avec une IRC. De plus, l’expression protéique de plusieurs isoformes du cytochrome P450 est modulée par l’IRC. Nous observons une diminution du CYP 2D de 42% (p < 0,01), du CYP 3A11 de 60% et du CYP 1A de 37% (p <0,01) par rapport aux souris témoins. On ne dénote aucun changement significatif au niveau de l’isoforme 2E1. Conclusion : Il est possible d’induire une insuffisance rénale chronique chez la souris suite à une néphrectomie. La technique de dosage de la créatinine par CLHP est précise et exacte et permet de caractériser la sévérité de l’IRC chez la souris. L’expression protéique du CYP450 est régulée à la baisse dans le foie des souris atteintes d’IRC. / Background: Mice models are widely used in renal studies. Seric creatinine concentration is used to evaluate glomerular filtration rate and is a good marker of chronic renal failure (CRF). It has been shown that CRF diminishes drug metabolism in the rat because of a downregulation of hepatic cytochrome P450 (CYP450) isoforms. To study CYP450 regulation in the mouse model, we needed to 1) develop a model of CRF in the mouse, 2) define a method of dosage of CRF markers, and 3) evaluate CYP450 protein expression in the liver of mice with CRF. Methods: Models of CRF were tested and sub-total nephrectomy was selected because of the efficacy and reproducibility to induce CRF. A high pressure liquid chromatography (HPLC) method for the dosage of creatinine in mice sera was developed. Liver protein expression of CYP1A1, CYP3A11, CYP2D and CYP2E1 was assessed by Western Blot analysis. Results: HPLC parameters such as pH, mobile phase concentration and flow rate modified the elution profile. Weight loss and high seric creatinine concentrations are seen in mice with CRF. Furthermore, protein expression of CYP1A, CYP3A11 and CYP2D was decreased in liver microsomes of mice with CRF by 37%, 60% and 42%, respectively (p<0.01) compared to sham-operated mice. We found no significant difference in the expression of CYP2E1. Conclusions: CRF models are reproducible in the mouse. The HPLC method for creatinine determination is precise and accurate, and can assess the severity of CRF. Hepatic protein expression of CYP450 is modulated in presence of CRF as in the rat.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-07T10:55:53Z No. of bitstreams: 2 Dissertação - Mirian de Sylvio - 2009.pdf: 865608 bytes, checksum: bba24a89ef1938c31376520a3eff1e60 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-07T11:29:38Z (GMT) No. of bitstreams: 2 Dissertação - Mirian de Sylvio - 2009.pdf: 865608 bytes, checksum: bba24a89ef1938c31376520a3eff1e60 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-11-07T11:29:38Z (GMT). No. of bitstreams: 2 Dissertação - Mirian de Sylvio - 2009.pdf: 865608 bytes, checksum: bba24a89ef1938c31376520a3eff1e60 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2009-12-15 / Infection with Toxoplasma gondii occurs throughout the globe, with a prevalence of up to 90% in the population. The physiological changes caused by this parasite are well studied in immunocompromised individuals and in cases of congenital transmission. In immunocompetent individuals the infection is usually asymptomatic and little explored by researchers. Experimental studies follow the pattern of human studies, and there fow mention about the biochemical changes (liver and kidney metabolisms) in the host infected by T. gondii. This study aimed the quantification of hepatic and kidney alterations caused by acute infections by T. gondii (non cystogenic strain – RH) and by chronic infections (cystogenic strain – ME-49). The control group was formed by mice without infection, only submitted to saline stress. Several enzymes were measured in serum and peritoneal exudate of mice infected and control such as: aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamyltransferase (GGT), alkaline phosphatase (ALP), urea, creatinine and lactate dehydrogenase, using an automated methodology. AST and ALT presented a significative difference in the serum of mice infected with RH strain when compared to controls indicating a destruction of liver cells. The peritoneal exudates did not present significative changes in relation to controls nor did the urea and creatinine levels. The séric lactate dehydrogenase showed gradual changes in all days of the infection in mice peritoneal exudates as early as this change was evident only in the fifth day of infection. All samples of the group infected with ME-49 strain showed changes in serum and peritoneal exudate during all days of analysis. Only ALT peritoneal exudates showed no change during all days of analysis. An increase in urea at all doses was observed, however, creatinine showed a change only within 120 days of infection. The LDH was altered in the serum in all days of analysis. In conclusion, the T. gondii infection may cause hepatic and kidney injuries either when caused by non-cystogenic as by cystogenic strains of the parasite. / A infecção pelo Toxoplasma gondii ocorre em todo o mundo, com prevalência de até 90% na população conforme seus hábitos culturais e condições socioeconômicas. As alterações fisiopatológicas provocadas por este parasito são muito estudadas nos indivíduos imunocomprometidos, nos casos de transmissão congênita, e nos indivíduos imunocompetentes a infecção é, geralmente, assintomática e pouco explorada pelos pesquisadores. Experimentalmente, os estudos seguem o padrão dos estudos humanos, e há pouca referência sobre as alterações bioquímicas (hepáticas e renais) no hospedeiro infectado pelo T. gondii. Este trabalho objetivou avaliar as alterações hepáticas e renais causadas por esse parasito em camundongos na fase aguda, usando a cepa não cistogênica (RH), e na fase crônica, com a cepa cistogênica (ME-49), tendo como controles camundongos sem infecção, somente submetidos ao estresse de inoculação com salina. Foram dosadas no soro e no exsudato peritoneal dos camundongos infectados e controles os níveis das enzimas Aspartato aminotransferase (AST), Alanina aminotransferase (ALT), Gamaglutamiltransferase (GGT), Fosfatase alcalina (FAL), desidrogenase lática (DHL) e dos seguintes compostos: uréia e creatinina, por metodologia automatizada. As enzimas AST e ALT apresentaram diferença significativa no soro de camundongos infectados com cepa RH, demonstraram alterações em relação aos controles indicando uma destruição das células hepáticas. No exsudato peritoneal não foram demonstradas alterações em relação aos controles. A uréia e creatinina dosadas não demonstraram alteração significativa. A enzima lactato desidrogenase sérica apresentou alterações gradativas em todos os dias de infecção do camundongo no soro, já no exsudato peritoneal essa alteração foi evidenciada somente no quinto dia da infecção, mostrando que com o aumento de parasitos e a destruição celular causada por esse, essa enzima presente em várias células é responsável por demonstrar aumentos consideráveis. Todas as amostras de soro analisadas do grupo infectado com a cepa ME-49 demonstraram alterações durante todo período de acompanhamento. Enquanto que no exsudato peritoneal não mostrou nenhuma alteração durante todo período analisado. Houve aumento crescente na uréia em todos os dias de analises, porém, a creatinina não apresentou nenhuma alteração. A LDH mostrou-se alterada no soro em todos os dias de analisado. Conclui-se que a infecção pelo T. gondii pode provocar alterações hepáticas e renais ao longo do curso de infecção, tanto em infecções com cepa cistogênica quanto com cepa não cistogênica.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this work was to evaluate the effects of HgCl2 exposure in drinking water in pregnant and/or lactating rats and their offspring. Still, it evaluated if the HgCl2 intravenous exposure as well as the renal damage induced by this exposure altered the offspring mercury content. The drinking water (v.o.) HgCl2 exposure protocol was as follows: Female Wistar rats were exposed to HgCl2 (0, 0.2, 0.5, 10 and 50 μg Hg2+/mL) from gestation day 0 until 20 or until the last day of lactation. Every two days, the mercury solutions were changed, food and water intake and rats weight were analyzed. The offspring was killed on gestation day 20 and on the post-natal days 10, 20, 30 and 40. Tissues weight, essential metal homeostasis, mercury content and biochemical parameters were evaluated. Behavioral tasks were carried out on post-natal days 3, 5, 7, 9 and 11 (negative geotaxis test) and 17, 18, 19 and 20 (beaker test). The intravenous (i.v.) HgCl2 exposure protocol was as follows: Female Wistar rats were exposed to HgCl2 (0.5 and 2.5 μmol HgCl2/kg/2 mL) on gestation day 20 and killed 6 h later or on gestation day 18 and killed 48 h later. Hg maternal and fetal distribution and renal damage through histology and biochemical and molecular markers were evaluated. Dams exposed to HgCl2 v.o. presented water intake decreased. The exposure to 50 μg Hg2+/mL caused an increase in relative renal weight. Animals exposed to 10 and 50 μg Hg2+/mL presented an increase in renal and hepatic Cu and Zn levels, respectively, and mercury accumulation (pregnant rats); and, an increase in total thiol and metallothionein renal levels (lactating rats). The offspring only presented an increase in hepatic porfobilinogensynthase activity (fetuses) and in relative renal weight (post-natal day 20). The pregnant rats exposed i.v. to HgCl2 presented the greater mercury accumulation in kidney in both periods analyzed; although 48 h after the exposure the Hg levels were lower than at 6 h. The exposure to 2.5 μmol HgCl2/kg/2 mL caused an increase in serum creatinine levels and in Kim-1 renal expression as well as renal histology alterations. The placental and fetal Hg did not change in both periods analyzed; the increase in fetal organs Hg levels were dose and time dependent. In conclusion, the exposure to low doses of HgCl2 in drinking water caused mild alterations in dams; also the dam organism was able to handle the Hg avoiding offspring damages; probably, this protection is related with the increase on scavenger molecules (metallothionein, for example) during the pregnancy and lactation. Besides, we verified that when dams were exposed intravenously to HgCl2, the developing organisms (fetuses) were unable to excrete/depurate the Hg. / O objetivo deste trabalho foi avaliar os efeitos da exposição ao HgCl2 na água de beber em ratas prenhas e/ou lactantes e sua prole. Ainda, avaliar se a exposição intravenosa ao HgCl2 assim como o dano renal induzido pela mesma altera a deposição de mercúrio na prole. O protocolo de exposição ao HgCl2 na água de beber (v.o.) foi: as ratas Wistar foram expostas ao HgCl2 (0, 0,2, 0,5, 10 e 50 μg Hg2+/mL) do dia zero de gestação até o dia 20 ou até o final da lactação. A cada dois dias, as soluções de mercúrio eram trocadas, a ingestão de comida e água e o peso das ratas eram avaliados. A prole foi sacrificada no dia 20 de gestação e nos dias pós-natal 10, 20, 30 e 40. Foram analisados o peso dos órgãos, a homeostase de metais essenciais, os níveis de mercúrio e parâmetros bioquímicos. As tarefas comportamentais foram realizadas nos dias pós-natal 3, 5, 7, 9 e 11 (teste do geotactismo negativo) e 17, 18, 19 e 20 (teste do beaker). O protocolo de exposição ao HgCl2 intravenoso (i.v.) foi: as ratas Wistar foram expostas ao HgCl2 (0,5 e 2,5 μmol HgCl2/kg/2 mL) no dia 20 de gestação e sacrificadas 6 h após a exposição ou no dia 18 de gestação e sacrificadas 48 h após a exposição. Foram avaliados a distribuição do Hg nos organismos materno e fetal e o dano renal através de histologia e marcadores bioquímicos e moleculares. As mães expostas ao HgCl2 v.o. apresentaram diminuição na ingestão de água; a exposição a dose de 50 μg Hg2+/mL causou aumento no peso relativo de rim. As doses de 10 e 50 μg Hg2+/mL causaram aumento dos níveis renais de Cu e hepáticos de Zn e acúmulo de mercúrio em rins nas gestantes; e aumento nos níveis renais de tióis totais e de metalotioneínas nas lactantes. A prole exposta ao HgCl2 apresentou aumento da atividade hepática da porfobilinogênio sintase em fetos e aumento do peso relativo de rim no dia pós-natal 20. As ratas expostas ao HgCl2 i.v. apresentaram maior acúmulo de mercúrio em rins 6 e 48 h após a exposição; embora a 48 h da exposição, os níveis já haviam diminuído em relação a 6 h. A dose de 2,5 μmol HgCl2/kg/2 mL i.v. causou aumento nos níveis séricos de creatinina, aumento da expressão da proteína Kim-1 e alterações na histologia de rim. Os níveis de Hg placentário e fetal não diminuíram com o passar das horas após a exposição; nos órgãos fetais, os níveis de Hg apresentaram aumento dependente da dose e do tempo. Em conclusão, a exposição a baixas doses de HgCl2 na água de beber causou alterações brandas nas mães; e o organismo materno parece ter metabolizado o Hg, evitando danos à prole; provavelmente esta proteção está relacionada ao aumento dos níveis de moléculas detoxificantes (metalotioneínas, por exemplo) durante o período gestacional e lactacional. Ainda, verificamos a incapacidade dos organismos em desenvolvimento (fetos) em excretar/depurar os íons Hg quando as mães foram expostas intravenosamente ao metal.

Creatine is nitrogen-containing organic acid which naturally occurs in the human body. The aim of this work was to determine the optimal dose of creatine in combination with vitamin C and magnesium for male respondents aged 18-26 years. They were divided into two groups differing in the creatine dosage. Group 1 took smaller dose of creatine (3 g per day) and group 2 higher dose of creatine (10 g per day). Both groups took both magnesium and vitamin C at constant doses throughout the study. The effects of significantly different dose of creatine in the individual groups were compared with each other in terms of the performance of individuals in the powerlifting, the anthropological changes and the overal metabolism of the intakes. In all disciplines of powerlifting, group 1 recorded higher average weight gains, which were not found to be statistically significant at a significance level of alpha 0,05. Anthropological changes were measured using the InBody 160 and a diagnostic measuring tape. In both cases, group 1 recorded better results than group 2, but these results were not statistically significant at a significance level of alpha 0,05. The total metabolism of the accepted dietary supplements was investigated through analytical methods. The urine of each respondent was regularly collected and subsequently analyzed during the research. Determination of creatinine, a creatine waste product, was performed by UV-VIS spectrophotometry using the Jaffe reaction. Vitamin C was analyzed by RP-HPLC. Magnesium was determined by the ICP-OES method. After creatine suplemantion of 3 per day, group 1 showed a slight increase in creatinine in the urine, but still in the physiological range. At the significance level alpha 0,05 there was no statistically significant difference. Group 2 showed an increase above the physiological limit which was already a statistically significant difference. Overall, creatine supplementation of 3 g per day has been found as a sufficient intake of creatine needed to build up muscle mass, increase energy metabolism and overall physical performance. The metabolization itself works very well and within the physiological values.

Background: Higher protein diets, especially from animal sources, have seen a rise in popularity due to potential metabolic. This may have consequences for kidney function particularly in rising middle class populations who are allocating more income towards meat. The objective of this systematic review and meta-analysis was to evaluate the effects of higher versus lower protein intake on glomerular filtration rate (GFR) in adult populations without renal impairment. Methods: Search strategies were developed and electronic databases searched: MEDLINE and EMBASE. Data were extracted up until June 3, 2015. The main outcome measure was GFR and a random effect model (Cochrane’s Review Manager Version 5.3) was used to pool mean differences in GFR values. Results: Database searches yielded 25 trials from 1914 articles that were eligible for analysis based on inclusion/exclusion criteria. 12 studies were randomized controlled trials and 11 studies were crossover trials. As a result of data presented, 2 crossover studies were treated as 4 trials to result in 25 total trials. A total of 810 subjects from 25 trials were included in this systematic review and meta-analyses. The age of participants was 24-62 years and their BMI was 21-36 kg/m2. Higher protein compared to lower protein-containing diets were associated with increased GFR values [mean difference (MD): 8.33 ml/min (95% CI 4.87 to 11.79), P < 0.00001] but this was less pronounced when assessing change from baseline GFR values [MD: 4.71 ml/min (95% CI 0.06 to 9.36), P = 0.05]. Moreover, significant heterogeneity was present and funnel plot asymmetry indicated potential publication bias in both meta-analyses. Conclusion: Higher protein diets were associated with increased GFR, however, these results were inconclusive due to significant heterogeneity and overestimation by random effect analyses. There is still no clear evidence that high protein diets negatively impact renal function in healthy populations. / Thesis / Master of Science (MSc) / Globally, the leading causes of mortality in industrialized countries are cardiovascular disease (CVD), stroke, and type 2 diabetes (T2D). Deaths from these chronic diseases now outpace deaths due to malnutrition. Being overweight and obese increases the risk of both morbidity and mortality from CVD, stroke, and T2D. Global rates of overweight and obesity have now reached ‘epidemic’ proportions and the World Health Organization has stated that, “… [a] global epidemic of overweight and obesity – ‘globesity’ – is taking over many parts of the world. If immediate action is not taken, millions will suffer from an array of serious health disorders.” Over the past 20-30 years, the popularity of higher protein energy restricted diets have grown due to the potential benefits regarding weight loss, appetite regulation, and maintenance of lean (muscle) mass. Additionally, the expansion of the global ‘middle-class’ has resulted in families allocating more income towards meat products as a primary protein source in their diet. A health concern is that higher protein intake may have an adverse effect on kidney function. In individuals with chronic kidney disease, higher protein diets have been shown to result in further renal impairment. However, the effects of increased protein intake in healthy populations are unclear. The aim of this systematic review and meta-analysis was to compare higher versus lower protein diets on kidney function in healthy populations based on the literature to date. This was accomplished by looking at changes in glomerular filtration rate (the rate at which kidneys filter blood), which is the ‘gold standard’ marker of kidney function.

Настоящая работа состоит из 5 глав и посвящена бесферментному электрокаталитическому определению креатинина в слабокислой среде с использованием различных катализаторов, которые представляют из себя комплексы меди с новыми производными 2,2’-бипиридина. В работе приведены аналитические характеристики исследования всех пяти комплексов, трёх выбранных модификаторов и обоснования выбора наилучших веществ для модифицирования стеклоуглеродного электрода в определении концентрации креатинина. Проведено сравнение аналитических характеристик, полученных от метода циклической вольтамперометрии и метода с использованием полевого транзистора с расширенным затвором, и выбран предпочтительный метод анализа. / This work consists of 5 chapters and is devoted to the non-enzymatic electrocatalytic determination of creatinine in a weakly acidic medium using different catalysts, which are copper complexes with new 2,2'-bipyridine derivatives. Analytical characteristics of all five complexes, three selected modifiers and substantiation of the choice of the best substances for modifying the glass carbon electrode in determining creatinine concentration are given in the work. Comparison of the analytical characteristics obtained from the cyclic voltammetry method and the method using a field-effect transistor with an extended gate was carried out and the preferred method of analysis was selected.

Introduction: L’approche endovasculaire pour la réparation d’anévrysmes aortiques s’associe à une utilisation importante de produit de contraste, qui peut causer une néphropathie induite par le produit de contraste (NIC) en postopératoire. L’hydratation intraveineuse peut réduire l’incidence de NIC, mais quel produit utiliser reste incertain. Nous avons évalué le bicarbonate de sodium, comparé au NaCl 0,9%, pour réduire l’incidence de NIC. Méthode: Nous avons mené une étude prospective, randomisée et contrôlée à double insu chez 34 patients subissant une chirurgie endovasculaire pour anévrysme aortique. Les patients des deux groupes (17 patients par groupe) ont reçu du bicarbonate de sodium ou du NaCl 0,9% à raison de 3 mL/kg/h pour une heure avant l’intervention puis 1 mL/kg/h jusqu’à 6 h après la fin de la chirurgie. Tous les patients ont reçu du N-acétylcystéine. L’objectif principal était l’incidence de NIC, définie comme une élévation de plus de 25% de la créatinine sérique 48 h suivant l’exposition au produit de contraste. Des biomarqueurs précoces de lésion rénale ont été mesurés. Résultats: Une NIC s’est développée chez 1 patient (5,88%) appartenant au groupe bicarbonate, comparé à aucun patient (0%) dans le groupe NaCl 0,9% (P = 0,31). Les biomarqueurs de lésion rénale étaient significativement augmentés dans les deux groupes après l’exposition au produit de contraste. Conclusions: Nous avons démontré un faible taux d’insuffisance rénale suivant une chirurgie endovasculaire aortique, que l’hydratation soit effectuée avec du bicarbonate ou du NaCl 0,9%, malgré une élévation des biomarqueurs de lésion rénale. / Background: The endovascular approach for the repair of aortic aneurysm involves the administration of large quantities of contrast media, which can cause contrast-induced nephropathy (CIN) in the post operative period. The only proven strategy to prevent CIN is intravenous hydration, but what type of infusion to use is not clear. We evaluated the efficacy of sodium bicarbonate, compared with NaCl 0.9%, to reduce the incidence of postoperative renal failure. Methods: We conducted a prospective, controlled, double-blind, randomized study in patients presenting for endovascular aortic aneurysm surgery. Patients in group A (n = 17) received sodium bicarbonate 3 mL/kg/h for 1 h before the procedure and then 1 mL/kg/h until 6 h after surgery, whereas patients in group B (n= 17) received the same amount of NaCl 0.9%. All patients received N-acetylcysteine. The primary end point was CIN, defined by serum creatinine greater than 25 % above baseline 48 h post operatively. Biomarkers of renal injury were measured. Results: CIN developed in one patient in the bicarbonate group (5,88%), compared with no patient in the NaCl 0,9% group (0%) (difference 5.88%;95% CI -5.3% to 17.06%, P = 0.31). Interleukin-18, N-acetyl-β-D-glucosaminidase and Kidney Injury Molecule-1 increased significantly in both groups after exposure to contrast media. Conclusions: We demonstrated a low rate of renal failure following endovascular aortic surgery using contrast media, regardless of whether bicarbonate or NaCl 0.9% was used for hydration, despite significant elevation in biomarkers of renal injury.

Complicações renais e urológicas incluindo nefrolitíase, cristalúria, cólica renal e lombalgia, são eventos adversos bem conhecidos do indinavir (IDV), um inibidor de protease (IP) largamente utilizado no tratamento de pacientes infectados com o vírus da imunodeficiência humana (HIV). Prévios estudos em ratos demonstraram que o IDV, um potente IP capaz de provocar uma sustentada supressão da carga viral do HIV, induz vasoconstricção renal, diminui a filtração glomerular (RFG) e reduz a excreção urinária de nitrito (NO2-), sugerindo que a vasoconstricção causada pelo IDV deve ser mediada pelo óxido nítrico (NO). Os objetivos deste estudo foram investigar a ocorrência de insuficiência renal (clearance de creatinina < 80ml/min) em pacientes com infecção pelo HIV tratados com terapia anti-retroviral altamente potente incluindo o inibidor de protease IDV, e mensurar a excreção urinária de nitrato (NO3-) nestes pacientes, comparando-os com outro grupo de pacientes tratados com efavirenz (EFV), um inibidor de transcriptase reversa não-análogo de nucleosídeo (NNRTI). No período compreendido entre março de 2000 e outubro de 2003, estudamos 36 pacientes infectados pelo HIV que estavam em terapia com IDV na dose de 800 mg de 8/8 horas por pelo menos 12 meses. Os pacientes foram avaliados para uma variedade de parâmetros clínicos e laboratoriais: idade, peso, tempo de infecção, tempo de uso de IDV, uso de sulfametoxazol-trimetoprim (SMX-TMP) ou sulfadiazina, exames bioquímicos (colesterol total, triglicérides, magnésio, sódio, potássio e creatinina), exame do sedimento urinário, clearance de creatinina, osmolaridade urinária, volume urinário de 24 h, fração de excreção de sódio (FENa), fração de excreção de potássio (FEK) e fração de excreção de água (FEH2O). NO3 urinário foi mensurado em 18 pacientes recebendo terapia anti-retroviral com IDV e 8 pacientes recebendo terapia com EFV. Leucocitúria ocorreu em 78.8% dos pacientes tratados com IDV. Clearance de creatinina diminuído foi observado em 21 pacientes e foi associado com menor peso e uso de derivados de sulfa. Nestes pacientes com diminuição da função renal, também detectamos menor osmolaridade urinária e uma FEH2O mais alta. A excreção urinária de NO3- foi significativamente menor nos pacientes tratados com IDV (908 ± 181) quando comparados aos pacientes do grupo EFV (2247 ± 648, p<0.01). Nossos resultados mostram que insuficiência renal ocorreu em 58% dos pacientes tratados com IDV e foi associada com menor peso corpóreo e uso de derivados de sulfa. A menor excreção urinária de NO3- e as alterações na osmolaridade e FEH2O sugerem que o IDV diminui a produção de óxido nítrico e causa dano tubular, respectivamente. Sugerimos então que os pacientes em uso de IDV sejam monitorados routineiramente para função renal através do clearance de creatinina. / Renal and urological complications including nephrolithiasis, crystalluria, renal colic and flank pain are significant side effects of the HIV protease inhibitor indinavir (IDV), and IDV has been widely used in the treatment of human immunodeficiency virus (HIV) infection. Previous studies in rats demonstrated that IDV, a potent protease inhibitor that causes profound and sustained supression of HIV replication, also induces renal vasoconstriction, decreases glomerular filtration rate (GFR) and reduces urinary excretion of nitrite (NO2-), suggesting that IDV-vasoconstriction may be mediated by nitric oxide (NO). The objectives of this study were to investigate the occurrence of renal failure (creatinine clearance <80ml/min) in human HIV patients treated with highy active antiretroviral therapy (HAART), including IDV, and to measure urinary excretion of nitrate (NO3-) in those patients, comparing it with that of another group of patients treated with the non-nucleoside reverse-transcriptase inhibitor efavirenz (EFV). From March 2000 through October 2003, we evaluated 36 patients infected with HIV who was receiving IDV 800 mg q8h for at least 12 months. The patients were assessed for a variety of clinical and laboratory parameters including age, body weight, duration of infection, time of IDV treatment, trimethoprim/sulfamethoxazole (TMP/SMX) or sulfadiazine use, biochemistry (total cholesterol, triglycerides, magnesium, sodium, potassium and creatinine), urinalysis, creatinine clearance, urine osmolality, 24-hour urine volume, fractional excretion of sodium (FENa), potassium (FEK) and water (FEH2O). Urinary NO3 was measured in 18 IDV-treated patients and compared with that of 8 EFV-treated patients. Leukocyturia occurred in 78.8% of the IDV-treated patients. Reduced creatinine clearance was observed in 21 patients and was associated with lower body weight and sulfa-derivated use. In these renal failure patients, we also detected a lower osmolality and a higher FEH2O. Excretion of NO3- was significantly lower in IDV-treated patients (908 ± 181) than in EFV-treated patients (2247 ± 648, p<0.01). Our data show that renal failure occurred in 58% of IDV-treated patients and was associated with lower body weight and sulfa administration. The lower NO3- excretion suggests that this drug decreases nitric oxide production, and the alterations in osmolality and FEH2O indicate that it also causes tubular damage. Based on our findings, we suggest that the renal function of patients under IDV treatment should be closely monitored with creatinine clearance.

<p>Увод: Хронична бубрежна инсуфицијенција (ХБИ) се дефинише као структурно или функционално оштећење бубрега у трајању од најмање три месеца и/или смањење јачине гломеруларне филтрације (ЈГФ) испод 60 мл/мин/1.73м2. У доступној литератури постоје различити подаци о присуству оралних манифестација код пацијената са ХБИ у квантитативном и квалитативном погледу. Стање бубрежне дисфункције праћено је променама у протоку и саставу пљувачке што је у последњој деценији допринело испитивању клиничких и лабораторијских показатеља бубрежне болести. Циљ: Циљ студије је био да се испита објективно стање оралне слузокоже, вредности рН, сијалометрије, концентрације урее, креатинина и секреторног имуноглобулина А пљувачке као и орални микробиолошки статус код пацијената са ХБИ. Материјал и методе: Узорак је био сачињен од 50 предијализних (31 мушкарца и 19 жена просечне старости 59,06&plusmn;14,30) и 25 хемодијализних пацијената (18 мушкараца и 7 жена просечне старости 54,92&plusmn;13,60) са постављеном дијагнозом ХБИ, заједно са 25 системски здравих испитаника компарибилних по полу и старости. Поред клиничког прегледа усне дупље спроведен је тест витроадхезије, одређивање интензитета саливације, рН вредности пљувачке и индекса крварења из интерденталне папиле (PBI). На узорцима сакупљене пљувачке, уз помоћ аутоматизованог система Beckman Coulter АУ480 спроведено је лабораторијско одређивање урее и креатинина методом спектрофотометрије и секреторног имуноглобулина А методом имунотурбидиметрије. За микробилошко испитивање коришћен је брис језика и техника оралног испирка. Резултати: Нису утврђене статистички значајне разлике између група према демографско-социјалним подацима. Предијализни испитаници су имали значајно веће присуство промена оралне слузокоже и оралних симптома. Просечне вредности клиренса креатинина су биле значајно мање код оболелих испитаника са бледилом оралне слузокоже, уремичним задахом, ксеростомијом и измењеним осећајем укуса у поређењу са испитаницима без наведених промена. Код предијализних су утврђене значајно смањене вредности сијалометрије према контролним групама и повећане pH вредности према групи здравих испитаника. Просечне концентрације урее и креатинина су се статистички значајно разликовале између испитиваних група. Умерена позитивна корелација је утврђена између серумских и пљувачних концентрација урее и креатинина код предијализних и креатинина код хемодијализних. Према просечним вредностима секреторног имуноглобулина А није било разлика између група. Код пацијената са ХБИ утврђено је значајно веће присуство гљива из рода Candida са предоминацијом non-albicans Candida врста. Закључак: Резултати истраживања указују на важност утврђивања клиничких карактеристика усне дупље код предијализних пацијената. Интензитет саливације, pH вредност и пљувачне концентрације уремијских токсина могу бити поуздани маркери бубрежног оштећења. Једноставан и неинвазиван приступ приликом узорковања пљувачке и поузданост лабораторијске анализе треба да допринесу широј примени пљувачке као компетитивним дијагностичким флуидом серуму. Техника оралног испирка је прецизна квантитативна метода за одређивање степена гљивичне колонизације.</p> / <p>Uvod: Hronična bubrežna insuficijencija (HBI) se definiše kao strukturno ili funkcionalno oštećenje bubrega u trajanju od najmanje tri meseca i/ili smanjenje jačine glomerularne filtracije (JGF) ispod 60 ml/min/1.73m2. U dostupnoj literaturi postoje različiti podaci o prisustvu oralnih manifestacija kod pacijenata sa HBI u kvantitativnom i kvalitativnom pogledu. Stanje bubrežne disfunkcije praćeno je promenama u protoku i sastavu pljuvačke što je u poslednjoj deceniji doprinelo ispitivanju kliničkih i laboratorijskih pokazatelja bubrežne bolesti. Cilj: Cilj studije je bio da se ispita objektivno stanje oralne sluzokože, vrednosti rN, sijalometrije, koncentracije uree, kreatinina i sekretornog imunoglobulina A pljuvačke kao i oralni mikrobiološki status kod pacijenata sa HBI. Materijal i metode: Uzorak je bio sačinjen od 50 predijaliznih (31 muškarca i 19 žena prosečne starosti 59,06&plusmn;14,30) i 25 hemodijaliznih pacijenata (18 muškaraca i 7 žena prosečne starosti 54,92&plusmn;13,60) sa postavljenom dijagnozom HBI, zajedno sa 25 sistemski zdravih ispitanika komparibilnih po polu i starosti. Pored kliničkog pregleda usne duplje sproveden je test vitroadhezije, određivanje intenziteta salivacije, rN vrednosti pljuvačke i indeksa krvarenja iz interdentalne papile (PBI). Na uzorcima sakupljene pljuvačke, uz pomoć automatizovanog sistema Beckman Coulter AU480 sprovedeno je laboratorijsko određivanje uree i kreatinina metodom spektrofotometrije i sekretornog imunoglobulina A metodom imunoturbidimetrije. Za mikrobiloško ispitivanje korišćen je bris jezika i tehnika oralnog ispirka. Rezultati: Nisu utvrđene statistički značajne razlike između grupa prema demografsko-socijalnim podacima. Predijalizni ispitanici su imali značajno veće prisustvo promena oralne sluzokože i oralnih simptoma. Prosečne vrednosti klirensa kreatinina su bile značajno manje kod obolelih ispitanika sa bledilom oralne sluzokože, uremičnim zadahom, kserostomijom i izmenjenim osećajem ukusa u poređenju sa ispitanicima bez navedenih promena. Kod predijaliznih su utvrđene značajno smanjene vrednosti sijalometrije prema kontrolnim grupama i povećane pH vrednosti prema grupi zdravih ispitanika. Prosečne koncentracije uree i kreatinina su se statistički značajno razlikovale između ispitivanih grupa. Umerena pozitivna korelacija je utvrđena između serumskih i pljuvačnih koncentracija uree i kreatinina kod predijaliznih i kreatinina kod hemodijaliznih. Prema prosečnim vrednostima sekretornog imunoglobulina A nije bilo razlika između grupa. Kod pacijenata sa HBI utvrđeno je značajno veće prisustvo gljiva iz roda Candida sa predominacijom non-albicans Candida vrsta. Zaključak: Rezultati istraživanja ukazuju na važnost utvrđivanja kliničkih karakteristika usne duplje kod predijaliznih pacijenata. Intenzitet salivacije, pH vrednost i pljuvačne koncentracije uremijskih toksina mogu biti pouzdani markeri bubrežnog oštećenja. Jednostavan i neinvazivan pristup prilikom uzorkovanja pljuvačke i pouzdanost laboratorijske analize treba da doprinesu široj primeni pljuvačke kao kompetitivnim dijagnostičkim fluidom serumu. Tehnika oralnog ispirka je precizna kvantitativna metoda za određivanje stepena gljivične kolonizacije.</p> / <p>Introduction: Chronic kidney disease (CKD) is defined as structural and functional kidney damage for a period of at least three months and/or reduction of glomerular filtration rate (GFR) under 60 ml/min/1.73m2. There are different data in the available literature in term of quantitative and qualitative presence of the oral manifestation in patients with CKD. Kidney dysfunction is accompanied by changes in the salivary flow and composition, which is in the last decade contributed by examination of clinical and laboratory markers of renal disease. Aim: The aim of the study was to examine condition of oral mucosa, pH value, salivary flow rate, concentration of salivary urea, creatinine, secretory immunoglobulin A and oral microbiological status in patients with CKD. Materials and Methods: The sample was consisted of 50 predialysis (31 males and 19 females, mean age 59,06&plusmn;14,30) and 25 hemodialysis patients (18 males and 7 females, mean age 54,92&plusmn;13,60) with a diagnosis of CKD, along with 25 age and gender matched healthy controls. In addition of clinical examination, tongue blade adhesion test, sialometry, salivary pH test and determination of papilla bleeding index (PBI) were conducted. Saliva samples were collected for laboratory analysis performed by automated system Beckman Coulter AU480. Levels of uremic toxins (urea and creatinine) and secretory immunoglobulin A were determinated by spectrophotometric and immunoturbidimetric method, respectively. Oral swab and oral rinse method were used for microbiological examination. Results: The sociodemographic characteristics of the patients with CKD and healthy controls showed no significant differences. Predialysis subjects had significantly higher presence of oral mucosa changes and oral symptoms. Mean values of creatinine clearence were significantly lower in patients with oral mucosa pallor, uremic fetor, xerostomia and disguesia, compared to patients without listed symptoms. Predialysis patients showed significantly decreased salivary flow rate compared to both control groups and significantly increased pH values compared to healthy controls. Mean concentrations of salivary urea and creatinine were statistically different between the groups. Moderate positive correlation was determined between serum and salivary levels of urea and creatinine in predialysis patients and creatinine in hemodialysis patients. Statistical analysis showed no differences between groups in mean concentration of secretory immunoglobulin A. The rate of oral fungal colonisation was significantly higher in CKD patients with predominance of non-albicans Candida species. Conclusion: The results of the present study indicate the importance of determining the clinical characteristics of oral cavity in predialysis patients. Saliva flow rate, pH value and salivary concentration of uremic toxins could be reliable markers of kidney disease. Simple and non-invasive approach due to saliva sampling and reliability of laboratory test should contribute to a wider application of saliva as a competitive diagnostic fluid. Oral rinse technique is an accurate quantitative method for determining the rate of fungal colonization.</p>