INTRODUÇÃO: A bexiga neurogênica é considerada um fator de risco importante para insuficiência renal crônica. A preservação da função renal é um dos principais objetivos do tratamento nefrourológico dos portadores desta doença. OBJETIVOS: Descrever as características demográficas de 58 pacientes com bexiga neurogênica congênita, as características anatômicas e funcionais do trato urinário superior e inferior desta população ao início do seguimento e ao final da coleta dos dados e identificar fatores de risco associados à piora de função glomerular e tubular nesta população, utilizando como marcadores a quantificação do ritmo de filtração glomerular e o desenvolvimento de microalbuminúria e acidose metabólica. MÉTODOS: Estudo retrospectivo de uma coorte de 58 pacientes portadores de bexiga neurogênica congênita com seguimento mínimo de seis meses, matriculados no ambulatório de Disfunções Miccionais da Infância da Unidade de Nefrologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O período de coleta de dados foi encerrado em janeiro de 2006. Os resultados obtidos no estudo foram descritos por médias e desvios padrões, medianas, valores mínimos e máximos, ou por frequências e percentuais. A comparação entre a avaliação inicial e a final para variáveis quantitativas contínuas foi feita usando-se o teste t de Student para amostras pareadas. A associação entre variáveis dicotômicas foi feita considerando-se o teste exato de Fisher. Para avaliação da evolução dos pacientes e comparação de subgrupos definidos por variáveis dicotômicas, foram construídas curvas de Kaplan-Meier e aplicado o teste de Long-rank. Valores de p<0,05 indicaram significância estatística. RESULTADOS: Das 58 crianças avaliadas, 33 eram do sexo feminino (56,9%). A idade média com que as crianças chegaram ao serviço foi de 4,2±3,5 anos, a média de tempo de seguimento foi de 3,8±3,1 anos. A etiologia predominante de bexiga neurogênica foi mielomeningocele, em 42 dos 58 pacientes (72,4%). O encaminhamento à Unidade ocorreu por infecção urinária em 48 (82,8%) casos, por enurese em 5 (8,6%) e por retenção urinária em 5 (8,6%). Dentre os 49/58 (84,5%) pacientes com ITU de repetição ao início do seguimento, 41/49 (83,7%) pacientes apresentaram melhora no período de seguimento. A hipertensão arterial foi diagnosticada em 11 (19,3%) das crianças na avaliação inicial e em 18 (31%) na avaliação final. A média do RFG inicial foi de 146,7±70,1 mL/1,73m2/min e a média final de 193,6±93,6 mL/1,73m2/min, com p=0,0004. A microalbuminúria estava presente em 20 (54,1%) dos exames na avaliação inicial e em 26 (61,9%) na avaliação final. A acidose metabólica estava presente em 11 (19%) dos exames na avaliação inicial e em 19 (32,8%) na avaliação final. As crianças que chegaram à Unidade de Nefrologia mais precocemente (< 3 anos) foram aquelas que mais apresentaram acidose metabólica no decorrer do acompanhamento (p=0,01). Os pacientes que não tinham acidose metabólica ao final do estudo apresentaram valores menores de Z-escore peso final (p= 0,048), Zescore altura/estatura inicial (p= 0,047) e Z-escore altura/estatura final (p=0,022) com relação aos pacientes do grupo que evoluiu com acidose. CONCLUSÃO: Pacientes com bexiga neurogênica congênita evoluem com acometimento renal glomerular e tubular precoce, cujo manejo demanda acompanhamento por profissional especializado. / INTRODUCTION: Neurogenic bladder is considered an important risk factor for chronic renal failure. In these patients, preservation of renal function is one of the most important goals of nephro-urological treatment. PURPOSE: To describe demographic data of 58 children with congenital neurogenic bladder, the anatomic and functional characteristics of their upper and lower urinary tracts at the beginning of the follow-up and at the end of the data collection period and to identify risk factors associated with worsening of the glomerular and tubular functions using as markers the quantitation of glomerular filtration rate and the development of microalbuminuria and metabolic acidosis. METHODS: Retrospective study of a cohort of 58 children with congenital neurogenic bladder treated at the Voiding Dysfunction Clinic, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with a minimum follow-up period of 6 months. The period of data collection ended in January 2006. The obtained results were described as means, standard deviations, medians, minimum and maximum values, or as frequencies and percentages. The comparison between the initial and final evaluations for continuous quantitative variables was done using the Student´s t test for paired samples. The association between dichotomous variables was performed considering the Fisher´s exact test. For evaluation of patients` outcomes and comparison of subgroups defined by dichotomous variables, Kaplan-Meier curves were performed and Long-rank test was applied. P values < 0.05 indicated statistical significance. RESULTS: 58 children were evaluated with 33 females (56,9%). The mean age at presentation to the service was 4.2 ± 3.5 years, the mean follow-up period was 3.8 ± 3.1 years. Myelomeningocele was the leading aetiology, corresponding to 42/58 patients (72.4%). Referral to the service occurred in 48 (82.8%) patients due to urinary tract infection, in 5 (8.6%) due to enuresis and in 5 (8.6%) due to urinary retention. Recurrent urinary tract infections were found in 49/58 patients (84.5%) at the beginning and 41/49 (83.7%) had improvement during the follow-up period. Systemic Hypertension was diagnosed in 11 (19.3%) children at the first visit and in 18 (31%) in the final evaluation. The initial mean glomerular filtration rate was 146.7 ±70.1 mL/1.73m²/min and the final mean was 193.6±mL/1.73m²/min, p = 0.0004. Microalbuminuria was found in 20 (54.1%) samples in the initial evaluation and in 26 (61.9%) in the final evaluation. Metabolic acidosis was present in 11 (19%) samples in the initial evaluation and in 19 (32.8%) in the final assessment. The children who most developed metabolic acidosis during the follow-up period were those who presented earlier to the service (< 3 years of age), p= 0.01. The group of patients that did not present metabolic acidosis at the end of the study had lower values of final weight z-score (p=0.048), initial height/stature z-score (p=0.047) and final height/stature z-score (p=0.022) than the patients of the group that developed acidosis. CONCLUSIONS: Children with congenital neurogenic bladder develop early compromise of renal glomerular and tubular functions and require adequate management by specialized professionals.

<p>Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. </p><p>Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients.</p><p>Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. </p><p>Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. </p><p>Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed.</p><p>Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.</p>

<p>In patients with unstable coronary artery disease (CAD) biochemical markers are emerging as useful tools in clinical management. In this thesis we studied the use of markers of low-density lipoprotein (LDL) oxidation and renal function.</p><p>Our study populations consisted of unstable CAD patients included in the Fast Revascularisation during Instability in Coronary artery disease (FRISC)-II trial and healthy controls. Patients were followed for 2 years regarding death and myocardial infarction (MI).</p><p>Using receiver operating characteristic curve analysis, we found that oxidized low-density lipoprotein (OxLDL), especially when combined with high-density lipoprotein, compared to traditionally measured lipids/lipoproteins, and a new lipoprotein marker, lipoprotein associated-phospholipase A2, was better at discriminating between healthy controls and CAD patients. In patients, OxLDL was found to be an independent prognostic marker associated with an increased risk of MI, of particular use in patients with no evidence of myocardial necrosis. </p><p>In our study on the effects of an early invasive treatment strategy in unstable CAD patients with mild to moderate renal dysfunction (i.e. creatinine clearance <90mL/min) we found that in patients randomized to invasive treatment, the rates of death/MI and MI alone were significantly lower than in patients randomized to non-invasive treatment. In patients treated invasively, no detrimental effects were seen on renal function at follow-up at 6 months. </p><p>In healthy controls, we investigated new markers of renal (cystatin C) and cardio-renal function (N-terminal probrain natriuretic peptide, [NT-proBNP]) regarding reference levels and physiological determinants. We found that cystatin C is influenced by age whereas NT-proBNP is influenced by age and gender.</p><p>Our studies suggest that OxLDL and renal dysfunction are associated with a poor prognosis in unstable CAD patients and that these markers demonstrate potential for clinical use. In the search for new markers related to renal function we have contributed with reference levels of cystatin C and NT-proBNP. </p>

Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients. Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed. Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.

In patients with unstable coronary artery disease (CAD) biochemical markers are emerging as useful tools in clinical management. In this thesis we studied the use of markers of low-density lipoprotein (LDL) oxidation and renal function. Our study populations consisted of unstable CAD patients included in the Fast Revascularisation during Instability in Coronary artery disease (FRISC)-II trial and healthy controls. Patients were followed for 2 years regarding death and myocardial infarction (MI). Using receiver operating characteristic curve analysis, we found that oxidized low-density lipoprotein (OxLDL), especially when combined with high-density lipoprotein, compared to traditionally measured lipids/lipoproteins, and a new lipoprotein marker, lipoprotein associated-phospholipase A2, was better at discriminating between healthy controls and CAD patients. In patients, OxLDL was found to be an independent prognostic marker associated with an increased risk of MI, of particular use in patients with no evidence of myocardial necrosis. In our study on the effects of an early invasive treatment strategy in unstable CAD patients with mild to moderate renal dysfunction (i.e. creatinine clearance &lt;90mL/min) we found that in patients randomized to invasive treatment, the rates of death/MI and MI alone were significantly lower than in patients randomized to non-invasive treatment. In patients treated invasively, no detrimental effects were seen on renal function at follow-up at 6 months. In healthy controls, we investigated new markers of renal (cystatin C) and cardio-renal function (N-terminal probrain natriuretic peptide, [NT-proBNP]) regarding reference levels and physiological determinants. We found that cystatin C is influenced by age whereas NT-proBNP is influenced by age and gender. Our studies suggest that OxLDL and renal dysfunction are associated with a poor prognosis in unstable CAD patients and that these markers demonstrate potential for clinical use. In the search for new markers related to renal function we have contributed with reference levels of cystatin C and NT-proBNP.

Hydronephrosis, due to ureteropelvic junction obstruction, is a common condition in infants with an incidence of approximately 0.5-1%. During the last decade, the surgical management of non-symptomatic hydronephrosis has become more conservative, and the long-term physiological consequences of this new policy are unclear. The overall aim of this thesis was to determine whether there is a link between hydronephrosis and the development of hypertension. Hydronephrosis was induced by partial ureteral obstruction in 3-week old rats or mice. In the adult animals, blood pressure was measured telemetrically during different sodium conditions and the renal function was evaluated. Both species developed salt-sensitive hypertension and histopathological changes (i.e. fibrosis, inflammation, glomerular and tubular changes) that correlated with the degree of hydronephrosis. An abnormal renal excretion pattern with increased diuresis and impaired urine concentrating ability was observed in hydronephrosis. The mechanisms were primarily located to the diseased kidney, as relief of the obstruction attenuated blood pressure and salt-sensitivity. Increased renin angiotensin system activity, due to ureteral obstruction, might be involved in the development but not necessary the maintenance of hypertension. Hydronephrotic animals displayed reduced nitric oxide availability, which might be due to increased oxidative stress in the diseased kidney. Renal nitric oxide deficiency and subsequent resetting of the tubuloglomerular feedback mechanism, appeared to have an important role in the development of hypertension. In conclusion, experimental hydronephrosis, induced by partial ureteral obstruction, provides a new model for studies of salt-sensitive hypertension. Furthermore, the new findings imply that the current conservative treatment strategy in hydronephrosis should be reconsidered in favour of treatment that is more active, in order to prevent the development of renal injury and hypertension in later life.

Submitted by ANA CAROLINA DOS SANTOS DEMARCHI null (carol_demarchi@hotmail.com) on 2016-04-02T14:54:57Z No. of bitstreams: 1 Tese_Repositório_Unesp_AnaCarolinaDemarchipdf.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-05T14:52:16Z (GMT) No. of bitstreams: 1 demarchi_acs_dr_bot.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) / Made available in DSpace on 2016-04-05T14:52:16Z (GMT). No. of bitstreams: 1 demarchi_acs_dr_bot.pdf: 1702968 bytes, checksum: eb996abea5f69285187e67149717aac1 (MD5) Previous issue date: 2016-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundamentação. A presença de Hipertensão Abdominal é condição frequente em pacientes de UTI com importante impacto sobre a mortalidade. Tais pacientes contam com diversos fatores de risco para aumento da pressão abdominal, entre eles ventilação mecânica e balanço hídrico positivo. Um discreto aumento da pressão abdominal pode levar a disfunções orgânicas, entre elas a Lesão Renal Aguda, complicação bastante prevalente, que acomete pacientes internados em terapia intensiva, com importante impacto sobre a mortalidade. Pacientes de terapia intensiva e em ventilação mecânica são diariamente submetidos a técnicas de fisioterapia respiratória, entretanto não foram localizados estudos que demonstrassem os efeitos das técnicas mais utilizadas em terapia intensiva sobre a pressão intra-abdominal e função renal destes pacientes. Objetivos. Avaliar a influência de diferentes técnicas de fisioterapia respiratória sobre a pressão intra-abdominal de pacientes de terapia intensiva, bem como o comportamento da função renal e hemodinâmica abdominal com a aplicação destas técnicas. Casuística e Método. Foi realizado ensaio clínico, randomizado, controlado, cruzado, no período de março de 2013 a dezembro de 2014, no Serviço de Terapia Intensiva da Faculdade de Medicina de Botucatu-SP. Os pacientes foram randomizados para receberem três possíveis sequências de técnicas que incluíam: Compressão Torácica Expiratória, Hiperinsuflação Manual e Bag-Squeezing. Todos os pacientes foram submetidos às três técnicas, em dias diferentes e consecutivos. Para análise das técnicas os dados foram reagrupados de acordo com as intervenções realizadas e comparados entre si. Foram avaliados parâmetros hemodinâmicos e pressão intra-abdominal antes, após e nas duas horas seguintes às intervenções. A função renal foi avaliada por meio do clearance de creatinina, clearance de uréia e fração de excreção de sódio e a pressão intra-abdominal avaliada pelo método original de Kron nos mesmos momentos. Resultados. Foram avaliados 31 pacientes, 17 do gênero masculino com idade média de 58,1 ±17,6 anos. A Pressão intra-abdominal diminuiu de forma estatisticamente significante com a utilização das três técnicas e nos dois momentos em que foram avaliadas. Imediatamente após a técnica Hiperinsuflação Manual, houve aumento estatisticamente significante do gradiente de filtração glomerular e com a técnica Bag-Squeezing, observou-se aumento do gradiente de filtração glomerular imediatamente após e nas duas horas seguintes à intervenção. Foi observado aumento da pressão de perfusão abdominal imediatamente após e nas duas horas seguintes à aplicação da referida técnica. O clearance de uréia apresentou aumento após a aplicação da técnica Bag-Squeezing e também foi observado aumento da fração de excreção de sódio com as técnicas Hiperinsuflação Manual e Bag-Squeezing. Conclusões. Técnicas de fisioterapia respiratória reduziram a pressão e melhoraram a hemodinâmica intra-abdominais de pacientes de terapia intensiva. As técnicas Hiperinsuflação Manual e Bag-Squeezing aumentaram a fração de excreção de sódio e apenas a última o clearance de uréia. De maneira geral, as técnicas empregadas se associaram a melhora dos parâmetros de avaliados. / Rationale: The presence of Abdominal Hypertension is a frequent condition in ICU patients with a significant impact on mortality. Critical patients have several risk factors for increased abdominal pressure, including mechanical ventilation and positive water balance. A slight increase in abdominal pressure can lead to organ dysfunction, including the Acute Renal Injury, which is a prevalent complication affecting patient in intensive care with a significant impact on mortality. Patients submitted mechanical ventilation are daily undergoing respiratory therapy techniques, however there aren’t studies demonstrating the effects of the techniques used in intensive care on intra-abdominal pressure and renal function in these patients. Objective: To evaluate the influence of different techniques of respiratory physiotherapy on intra-abdominal pressure on critical patients as well as the behavior of renal function and abdominal hemodynamic by implementing these techniques. Patients and Methods: Clinical trial conducted randomized, controlled, crossover, from March 2013 to December 2014 in the Intensive Care Unit at Hospital of São Paulo State University (UNESP-HC) (Botucatu, Brazil). Patients were randomized to receive three sequences of techniques that included: Chest Compression Expiratory, Hyperinflation and Manual Bag-Squeezing. All patients were submitted to three techniques in different consecutive days. Analysis of the technical data were grouped according to the measures carried out and compared among each other. Hemodynamic parameters were evaluated and intra-abdominal pressure before, after and within two hours after the intervention. Renal function was assessed by creatinine clearance, urea clearance and sodium excretion fraction and the intra-abdominal pressure assessed by the original method of Kron at the same moments. Results: We evaluated 31 patients, 17 males with a mean age of 58.1 ± 17.6 years. Intra-abdominal pressure decreased in a statistically significant way with the use of three techniques and two different times that were evaluated. Immediately after the Manual Hyperinflation technique there was a statistically significant increase in glomerular filtration gradient and the Bag-Squeezing technique, there was also an increase in glomerular filtration gradient immediately after and in two hours of intervention. There was an increase of abdominal perfusion pressure immediately at the end and two hours after application of this technique. The urea clearance showed an increase after the implementation of the Bag-Squeezing technique and increased sodium excretion fraction to the technical Manual Hyperinflation and Bag-Squeezing also were observed. Conclusions: Respiratory therapy techniques reduced pressure and improved intra-abdominal hemodynamic in critical care patients. Technical Manual Hyperinflation and Bag-Squeezing increased sodium excretion fraction, and only the last technique increase the clearance of urea. In general, the techniques employed were associated with improvement of the evaluated parameters.

Made available in DSpace on 2014-06-11T19:31:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-01-19Bitstream added on 2014-06-13T19:20:15Z : No. of bitstreams: 1 covizzi_gj_dr_jabo.pdf: 864511 bytes, checksum: 486b6b2592415ef19352604b7366b859 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / A ingestão de proteína promove modificações na função renal. O mecanismo que governa este evento ainda não é conhecido. O estudo foi composto por seis experimentos realizados com os mesmos animais. Inicialmente (capítulo 2) foi conduzida a avaliação basal e investigação das modificações da fisiologia renal determinadas pela carga de proteína (CP). No capítulo 3, foi estudada a participação das prostaglandinas na regulação das funções glomerular e tubular por meio do uso de antiinflamatório não-esteroidal, em condição basal e com CP. Do mesmo modo, o capítulo 4 destinou-se a estudar a relação do Sistema Renina Angiotensina Aldosterona (SRAA) sobre a função renal e sua possível interação com a resposta dos rins à CP. Assim foram utilizados o inibidor da ECA (i-ECA), e a combinação de CP+i-ECA. Os experimentos permitiram concluir que cães sadios alimentados com uma carga de proteína equivalente à necessidade diária, respondem com aumento importante da taxa de filtração glomerular (TFG). As prostaglandinas participam do mecanismo de manutenção renal da homeostase de água, sódio e potássio continuamente e, atuam no mecanismo que aumenta a filtração glomerular após CP. Por outro lado, a angiotensina II (AII) pode ser responsável pela manutenção da TFG em situação basal, ou seja, quando o aumento da filtração não é requerido. Se fisiologicamente o cão apresenta aumento da TFG após ingestão de proteína, e este evento fica parcialmente restringido com a inibição da formação de AII, o aumento de liberação de renina pode desencadear diminuição não fisiológica da TFG. Assim, há indicativos de que o SRAA e as postaglandinas trabalham de maneira contrabalanceada para manutenção da TFG, e a conservação destes mecanismos é essencial para a homeostase renal. / The ingestion of protein promotes modifications in renal function but its mechanism is still unknown. The present study was based on six experimental essays using the same animals. Initially, there was a basal evaluation and also an investigation of modifications in renal physiology due to load protein (chapter 2). In chapter 3, it was studied the action of prostaglandin upon regulation of glomerular and tubular function through the use of nonsteroidal anti-inflamatory drugs (basal and load protein). The relation of the renin angiotensin aldosterone system on renal function and its possible interaction with kidneys response to load protein was studied in chapter 4. For that purpose it was used ECA inhibitor (i-ECA), and the combination of load protein + i-ECA. The experiments allow us to conclude that healthy dogs fed with load protein equivalent to diary ingestion, presented a remarkable increase in GFR. Prostaglandins participate continuously of renal mechanism of water, sodium and potassium homeostasis and act in the mechanism that increases glomerular filtration after load protein. On the other hand, angiotensin II (AII) may be responsible for the maintenance of GFR when the increase of filtration is not required (basal). If the dog presents increase in GFR after protein ingestion and this event remains partially restricted with the inhibition of AII formation, the increase in renin release may promote a non-physiological diminution of GFR. Thus, there are indicatives that the renin angiotensin aldosterone system and the prostaglandins act in a counterbalanced way to maintain the GFR and the preservation of these mechanisms are essential for renal homeostasis.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-15T15:03:15Z No. of bitstreams: 1 DISS_2014_Larissa Finger.pdf: 952368 bytes, checksum: ce15137e3eda929260a105c871adbf0a (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-19T13:39:00Z (GMT) No. of bitstreams: 1 DISS_2014_Larissa Finger.pdf: 952368 bytes, checksum: ce15137e3eda929260a105c871adbf0a (MD5) / Made available in DSpace on 2017-09-19T13:39:00Z (GMT). No. of bitstreams: 1 DISS_2014_Larissa Finger.pdf: 952368 bytes, checksum: ce15137e3eda929260a105c871adbf0a (MD5) Previous issue date: 2014-08-29 / CAPES / A redução na ingestão de proteínas e aumento na ingestão de carboidratos perfaz um padrão alimentar muito presente no estilo de vida atual da população mundial e está associado à incidência de patologias tais como diabetes mellitus, obesidade, hipertensão, entre outras. A ingestão de quantidades insuficientes de proteínas também está associada ao desenvolvimento de estresse oxidativo, o que contribui para o estabelecimento de lesões teciduais que podem culminar em prejuízo funcional de diversos órgãos. Diante destes fatos, o nosso objetivo foi investigar os possíveis danos renais decorrentes da administração da dieta hipoproteica-hiperglicídica a ratos no início da fase de crescimento. Ratos Wistar machos (~30 dias e 100g) foram divididos nos grupos: 1) Controle, alimentado com uma dieta com 17% de proteína e 63% de carboidrato por 15 (C15) ou 45 dias (C45); 2) LPHC, ratos alimentados com uma dieta contendo 6% de proteína e 74% de carboidrato por 15 (LPHC15) ou 45 dias (LPHC45) e 3) reversão, alimentados por 15 dias com a dieta LPHC e por mais 30 dias com a dieta controle (R45). A tolerância à glicose (GTT) foi avaliada pelas áreas sob as curvas (AUC) glicêmicas obtidas pelo método trapezoidal e a tolerância à insulina (ITT) pela constante de decaimento da glicose sérica (Kitt). O estresse oxidativo foi avaliado pela da quantificação do nível de lipoperoxidação através da dosagem do MDA (malondialdeído) nos rins, níveis de GSH (glutationa reduzida) e determinação da atividade das enzimas GPx (glutationa peroxidase), GR (glutationa redutase), catalase e SOD (superóxido dismutase) nos rins, além da quantificação da capacidade antioxidante total (CAT) no plasma. Analisou-se também. A função renal foi avaliada pela da quantificação da creatinina plasmática e análise histológica. Os resultados foram expressos como a média ± E.P.M. e as comparações estatísticas realizadas através do Teste t de Student ou ANOVA uma via, seguida de pós-teste de Tukey (p < 0,05). Os animais LPHC15, apresentaram valores similares ao grupo C15 para GSH, GPx, GR, SOD e catalase. No entanto, o peso dos rins (C15: 5,59 ± 0,21; LPHC15: 4,60 ± 0,08 mg / g de peso corporal) e a CAT (C15: 0,486 ± 0,059; LPHC5: 0,252 ± 0,059 mmol/L) foram menores e a creatinina plasmática (C45: 0,672 ± 0,028; LPHC45: 1,003 ± 0,039 mg/dL) e o nível de MDA (C15: 0,0195 ± 0,001; LPHC15: 0,033 ± 0,001 mmol/g de tecido) foram maiores no grupo LPHC15 em relação ao C15. Após a administração da dieta LPHC por 45 dias, os valores da glicemia de jejum dos animais C45 e LPHC45 foram similares. No entanto, a glicemia dos animais do grupo R45 foi 11% (p0,05) maior que nos demais grupos. No GTT não houve diferença na AUC entre os grupos analisados. O mesmo ocorreu na análise do decaimento da glicose plasmática após administração de insulina entre os diferentes grupos. A atividade das enzimas SOD e catalase também foi similar nos três grupos avaliados, já a atividade das enzimas GPx (C45: 2,730 ± 0,732; LPHC45: 0,928 ± 0,176; R45: 3,290 ± 0,304 U/mg de proteína) e GR (C45: 4,701 ± 0,320; LPHC45: 2,840 ± 0,151; R45: 6,308 ± 1,087 U/mg de proteína) foram menores no grupo LPHC45. A concentração de GSH foi menor no grupo R45 (C45: 0,785 ± 0,034; LPHC45: 0,760 ± 0,047; R45: 0,510 ± 0,024 mmol/g de tecido). O nível de MDA foi maior nos grupos LPHC45 e R45 (C45: 11,170 ± 2,020; LPHC45: 31,030 ± 3,060; R45: 31,540 ± 4,460 mmol/g de tecido). O peso dos rins (C45: 3,72 ± 0,03; LPHC45: 3,17 ± 0,05; R45: 3,66 ± 0,09) e a CAT (C45: 0,583 ± 0,059; LPHC45: 0,135 ± 0,050; R45= 0,407 ± 0,108 mmol/L) foram menores no grupo LPHC45. O nível plasmático de creatinina foi maior nos grupos LPHC45 e R45 (C45: 0,556 ± 0,020; LPHC45: 0,640 ± 0,021; R45: 0,678 ± 0,023 mg/dL). Análise histológica mostrou deposição de lipídeos no interstício dos rins nos grupos LPHC45 e R45, classificada como leve a acentuada. Estes dados permitem concluir que a dieta LPHC introduzida logo após o desmame e administrada por 45 dias não altera a tolerância à glicose nem a sensibilidade à insulina, diferente do que já foi demonstrado em estudo prévio, quando a mesma é administrada por 15 dias, resultando em maior sensibilidade à insulina. No entanto, restrição protéica introduzida logo após o desmame levou a um prejuízo no desenvolvimento dos rins, com possível prejuízo na função renal, associada a acúmulo de lipídeos e ao stresse oxidativo. Embora a reversão da dieta recupere o peso dos rins, os níveis elevados de creatinina sérica e o maior conteúdo de MDA no órgão sugerem que os danos funcionais decorrentes do stress oxidativo são irreversíveis. / The reduction in protein intake and the increase in carbohydrate intake feature a dietary pattern present in the current lifestyle of the population worldwide, and it is associated with the incidence of pathologies such as diabetes mellitus, obesity and high blood pressure among others. Low protein intake is also associated with the development of oxidative stress, which contributes to the establishment of tissue lesions that may result in functional impairment of various organs. In view of these facts, this study aimed to investigate the possible renal damages caused by the administration of a hypoproteic-hyperglycemic diet to rats in the early growth stages. Male Wistar rats (~30 days and 100g) were divided into the following groups: 1) Control, fed on a diet containing 17% protein and 63% carbohydrates for 15 (C15) or 45 (C45) days; 2) LPHC, fed on a diet containing 6% protein and 74% carbohydrates for 15 (LPHC15) or 45 (LPHC45) days, and 3) reversal group, fed on a LPHC diet during 15 days and then fed on a control diet for the following 30 days (R45). Glucose tolerance (GTT) was assessed by the areas under glycemic curves (AUC) obtained by the Trapezoidal Rule and insulin tolerance (ITT) was calculated according to the serum glucose decline rate constant (Kitt). Oxidative stress was evaluated by quantifying the lipid peroxidation level through the dosage of MDA (malondialdehyde) in kidneys, levels of GSH (reduced glutathione) and by determining the activity of the enzymes GPx (glutathione peroxidase), GR (glutathione reductase), catalase and SOD (superoxide dismutase) in the kidneys as well as quantifying the total antioxidant capacity (TAC) in plasma. The renal function was evaluated by the quantification of plasma creatinine and histological analysis. Results were expressed as the mean ± SEM, and statistical comparisons were carried out by means of the Student t Test or one-way ANOVA, followed by Tukey’s post-test (p < 0,05). LPHC15 animals presented similar values to those of the C15 group in reference to GSH, GPx, GR, SOD and catalase. However, the weight of kidneys (C15: 5,59 ± 0,21; LPHC15: 4,60 ± 0,08 mg / g body weight) and TAC values (C15: 0,486 ± 0,059; LPHC5: 0,252 ± 0,059 mmol/L) were lower, while plasma creatinine (C45: 0,672 ± 0,028; LPHC45: 1,003 ± 0,039 mg/dL) and MDA level (C15: 0,0195 ± 0,001; LPHC15: 0,033 ± 0,001 mmol/g tissue) were higher for the LPHC15 group compared with C15. After administering the LPHC diet for 45 days, the values for fasting glycemia in C45 and LPHC45 animals were similar. However, the glycemia level of R45 animals was 11% (p < 0,05) higher than in the other groups. There were no differences in the AUC between groups analyzed for GTT. The same happened when plasma glucose decline was analyzed following insulin administration. The activity of SOD and catalase enzymes was similar in the three groups under evaluation, whereas the activity of GPx (C45: 2,730 ± 0,732; LPHC45: 0,928 ± 0,176; R45: 3,290 ± 0,304 U/mg protein) and GR (C45: 2,730 ± 0,732; LPHC45: 0,928 ± 0,176; R45: 3,290 ± 0,304 U/mg protein) was lower in the LPHC45 group. GSH concentration was lower in the R45 group (C45: 0,785 ± 0,034; LPHC45: 0,760 ± 0,047; R45: 0,510 ± 0,024 mmol/g of tissue). The level of MDA was higher in the LPHC45 and R45 groups (C45: 11,170 ± 2,020; LPHC45: 31,030 ± 3,060; R45: 31,540 ± 4,460 mmol/g of tissue). The weight of kidneys (C45: 3,72 ± 0,03; LPHC45: 3,17 ± 0,05; R45: 3,66 ± 0,09) and TAC (C45: 0,583 ± 0,059; LPHC45: 0,135 ± 0,050; R45= 0,407 ± 0,108 mmol/L) showed lower values in the LPHC45 group. LPHC45 and R45 groups presented higher levels of plasma creatinine (C45: 0,556 ± 0,020; LPHC45: 0,640 ± 0,021; R45: 0,678 ± 0,023 mg/dL). Histological analysis showed interstitial lipid deposition in kidneys for LPHC45 and R45 groups, graded from mild to marked. These data lead to the conclusion that the LPHC diet, when introduced immediately after weaning and administered along 45 days, does not alter either glucose tolerance or insulin sensitivity. This conclusion is different from what was concluded in a previous study where LPHC diet administered during 15 days resulted in greater insulin sensitivity. Yet protein restriction, introduced soon after weaning, has led to damage in kidney development, which may result in impaired renal function associated to increased fat deposition and oxidative stress. Even though the diet reversal may recover kidney weight, the increased levels of serum creatinine and higher content of MDA in the organ suggest that functional damages resulting from oxidative stress are irreversible.

Orientador: Luís Cuadrado Martín / Resumo: Fundamentação. A presença de Hipertensão Abdominal é condição frequente em pacientes de UTI com importante impacto sobre a mortalidade. Tais pacientes contam com diversos fatores de risco para aumento da pressão abdominal, entre eles ventilação mecânica e balanço hídrico positivo. Um discreto aumento da pressão abdominal pode levar a disfunções orgânicas, entre elas a Lesão Renal Aguda, complicação bastante prevalente, que acomete pacientes internados em terapia intensiva, com importante impacto sobre a mortalidade. Pacientes de terapia intensiva e em ventilação mecânica são diariamente submetidos a técnicas de fisioterapia respiratória, entretanto não foram localizados estudos que demonstrassem os efeitos das técnicas mais utilizadas em terapia intensiva sobre a pressão intra-abdominal e função renal destes pacientes.Objetivos. Avaliar a influência de diferentes técnicas de fisioterapia respiratória sobre a pressão intra-abdominal de pacientes de terapia intensiva, bem como o comportamento da função renal e hemodinâmica abdominal com a aplicação destas técnicas.Casuística e Método. Foi realizado ensaio clínico, randomizado, controlado, cruzado, no período de março de 2013 a dezembro de 2014, no Serviço de Terapia Intensiva da Faculdade de Medicina de Botucatu-SP. Os pacientes foram randomizados para receberem três possíveis sequências de técnicas que incluíam: Compressão Torácica Expiratória, Hiperinsuflação Manual e Bag-Squeezing. Todos os pacientes foram submetidos às ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Rationale: The presence of Abdominal Hypertension is a frequent condition in ICU patients with a significant impact on mortality. Critical patients have several risk factors for increased abdominal pressure, including mechanical ventilation and positive water balance. A slight increase in abdominal pressure can lead to organ dysfunction, including the Acute Renal Injury, which is a prevalent complication affecting patient in intensive care with a significant impact on mortality. Patients submitted mechanical ventilation are daily undergoing respiratory therapy techniques, however there aren’t studies demonstrating the effects of the techniques used in intensive care on intra-abdominal pressure and renal function in these patients.Objective: To evaluate the influence of different techniques of respiratory physiotherapy on intra-abdominal pressure on critical patients as well as the behavior of renal function and abdominal hemodynamic by implementing these techniques.Patients and Methods: Clinical trial conducted randomized, controlled, crossover, from March 2013 to December 2014 in the Intensive Care Unit at Hospital of São Paulo State University (UNESP-HC) (Botucatu, Brazil). Patients were randomized to receive three sequences of techniques that included: Chest Compression Expiratory, Hyperinflation and Manual Bag-Squeezing. All patients were submitted to three techniques in different consecutive days. Analysis of the technical data were grouped according to the measures ... (Complete abstract click electronic access below) / Doutor