nÃo hà / INTRODUÃÃO: as glomerulopatias ainda sÃo uma das principais causas de insuficiÃncia renal crÃnica no mundo. à crescente o surgimento de registros de glomerulopatias em diversos paÃses, inclusive no Brasil. Os dados sobre incidÃncia e prevalÃncia das glomerulopatias no Brasil sÃo escassos. As conseqÃÃncias da lesÃo glomerular sÃo basicamente: proteinÃria, hematÃria, queda de filtraÃÃo glomerular, podendo evoluir para oligo-anÃria e hipertensÃo arterial decorrente da retenÃÃo de sÃdio. OBJETIVOS: determinar o perfil clÃnico, patolÃgico e epidemiolÃgico dos pacientes em acompanhamento no ambulatÃrio de glomerulopatias do ServiÃo de Nefrologia do Hospital Geral de Fortaleza. MÃTODOS: a populaÃÃo do estudo consistiu de pacientes portadores de doenÃa glomerular, submetidos à biÃpsia renal que foram atendidos no ambulatÃrio do serviÃo de Nefrologia do Hospital Geral de Fortaleza, CearÃ, durante o perÃodo de fevereiro de 2010 e setembro de 2011. RESULTADOS: foram incluÃdos no estudo um total de 168 pacientes. A idade mÃdia foi de 37  14 anos, variando de 14-77 anos. Desse total 84 pacientes (50%) eram do sexo feminino. Na avaliaÃÃo dos resultados das amostras biopsiadas obteve-se uma mÃdia de 20  12 glomÃrulos por amostra. Um total de 154 biÃpsias (92,2%) apresentaram um nÃmero maior ou igual a 8 glomÃrulos por amostra. SÃndrome nefrÃtica, foi a principal apresentaÃÃo clÃnica, correspondendo a um total de 113 pacientes (67,3%). As glomerulopatias mais prevalentes foram a GESF (19,6%), a LesÃo MÃnima (17,9%), a Glomerulopatia Membranosa (16,7%) e a Glomerulonefrite LÃpica (11,9%). As glomerulopatias primÃrias foram mais prevalentes, total de 124 casos (74,7%). Em relaÃÃo a resposta ao tratamento medicamentoso instituÃdo, 81 pacientes (68,6%) responderam ao tratamento.CONCLUSÃO: a GESF foi a glomerulopatia primÃria mais freqÃente e sÃndrome nefrÃtica a forma clÃnica de apresentaÃÃo mais comum na admissÃo. As amostras das biÃpsias renais colhidas foram satisfatÃrias em 92,2% dos casos. / INTRODUCTION: glomerulonephritis still are one of the main causes of Chronic Renal Failure (CRF). The number of cases is increasing, especially in Brazil. There are few data regarding the incidence and prevalence of glomerulonephritis in our country. Glomerular damage results in proteinuria, hematuria, decrease in glomerular filtration rate (GFR), oliguria, anuria and hypertension due to sodium overload. OBJECTIVES: the aim of this study is to determine the clinical, pathological and epidemiological features of the patients with glomerular diseases followed at the General Hospital of Fortaleza. METHODS: the study population consisted of patients with biopsy proven glomerular disease followed at the Nephrology Department of the General Hospital of Fortaleza, CearÃ, in the period between February 2010 and July 2011. RESULTS: a total of 168 patients were included. The mean age was 37  14 years. The mean number of glomeruli in each renal biopsy was 20  12. A total of 154 biopsies (92,2%) had at least 8 glomeruli per sample. Half of them were women, 84 patients (50%). The most common clinical presentation at admission was nephrotic syndrome, observed in 113 patients (67,3%). The most prevalent glomerulonephritis were Focal Segmental Glomerulosclerosis (FSGS) (19,6%), Minimal Change Disease (17,9%), Membranous Nephropathy (16,7%), and Lupus Nephritis (11,9%). Primary glomerulopathies were more common, 124 cases (74,7%). A total of 81 patients (68.6%) presented a good response to therapy, and 37 patients (31,4%) did not respond well to treatment. CONCLUSION: FSGS was the most frequent glomerulonephritis in the present study, and nephrotic syndrome was the most common clinical presentation at admission. Renal biopsies had an adequate sample size in 92,2%.

Orientador: Flávio Quaresma Moutinho / Resumo: Objetivando avaliar a viabilidade da técnica de biopsia renal "de janela" modificada com exteriorização do rim em gatos, foram estudadas as complicações decorrentes do procedimento e a qualidade das amostras obtidas. Para tanto, foram utilizados 25 gatos, sem raça definida, adultos, machos e com peso corporal entre 2,5 e 5 kg, pertencendo a um único grupo. A biopsia renal, pela técnica "de janela" modificada foi realizada nos rins esquerdo e direito utilizando-se agulhas do tipo "Spring-Cut", semi-automatizadas de 18 gauge. Os animais foram avaliados antes e após a biopsia, em intervalos de 2, 24 e 168 horas. Os animais foram acompanhados por meio de exame clínico e testes laboratoriais durante este período. A qualidade das amostras de biopsia foi avaliada pela microscopia de luz, de acordo com o número de glomérulos existentes, sendo considerado como padrão para a classificação da amostra, a presença de no mínimo cinco glomérulos por biopsia. As principais alterações clínicas observadas após a biopsia renal foram presença de hematúria transitória e formação de hematomas perirrenais. Nenhum animal do experimento veio a óbito ou apresentou complicações maiores. Das amostras de biopsia avaliadas, 84% apresentaram cinco ou mais glomérulos. Desta forma, conclui-se que a técnica estudada associada ao tipo de agulha utilizada ("Spring-Cut" semi-automatizada) pode ser considerada segura e de grande valor diagnóstico. / Abstract: Aiming to evaluate the technical viability of modified "keyhole" renal biopsy with open up of the Kidney in cats, it was studied the involvement originated from the procedures and the quality of the acquired samples. For that, it was used 25 cats with no defined breed, adults, male and weighing between 2 and a half and 5 kilos, belonging in just on group. The renal biopsy, by modified "keyhole" technique was performed in the right and left kidney using "Spring Cut" needles, semiautomatic of 18 gauge. The animals were evaluated before and after the biopsy, in a period of 2, 24 and 168 hours.The animals wore to be present at by clinic examination and laboratory tests during this period. It was done the observation by light microscopy, according to existent glomeruli, it was considered as pattern for the sample classification, the presence of at least 5 glomeruli for the biopsy. The main observed clinical alterations after the renal biopsy was the presence of transitory haematuria and formation of subcapsular haematomas. No animal from the experience has died or shoed serious complications. From the evaluated biopsy samples, 84% showed five or more glomeruli. Then, it is inferred that the studied technique associated with the used needle ("Spring-Cut" semiautomatic) can be considered safe and great diagnostic value. / Mestre

Background: Repeat renal biopsies in patients with lupus nephritis (LN) are usually done to guide treatment or to establish disease chronicity. Their value is not clear from available literature. There is also no available data in Africa to guide clinicians. Methods: This was a retrospective study of patients undergoing a repeat renal biopsy between January 2003 and December 2014 from a single centre in Cape Town, South Africa. Relevant demographic, clinical and histological records of patients with repeat renal biopsies were documented. Comparison of data from 1st and 2nd renal biopsy was performed. Results: 44 patients had at least 2 biopsies done during the study period. Most patients were females (81.8%). The mean biopsy interval was 2.8± 1.8 (range 0.38 – 9.4) years. Proteinuria was the main indication for the repeat biopsy (36.1%). The glomerular filtration rate and proteinuria worsened between the two biopsies (p=0.001 and 0.019) respectively suggesting disease progression. Most patients (65.4%) with a non-proliferative class of LN at first biopsy progressed into a proliferative class whereas patients with initial proliferative LN at first biopsy (77.8%) remained as proliferative at repeat biopsy. Treatment was changed in 85% of patients at second biopsy. Conclusion: Repeat renal biopsies in patients with LN presents a useful means of assessing disease progression and provides guidance regarding modification of treatment. More studies are however required to evaluate the value of repeat biopsies and perhaps the need for protocol renal biopsies in patients with LN.

Made available in DSpace on 2014-06-11T19:24:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2005Bitstream added on 2014-06-13T18:51:24Z : No. of bitstreams: 1 bissoli_edg_me_botfmvz.pdf: 641017 bytes, checksum: 0b08b2ad7a2c38242d17418128347169 (MD5) / Universidade Estadual Paulista (UNESP) / Objetivando avaliar a viabilidade da técnica de biopsia renal de janela modificada com exteriorização do rim em gatos, foram estudadas as complicações decorrentes do procedimento e a qualidade das amostras obtidas. Para tanto, foram utilizados 25 gatos, sem raça definida, adultos, machos e com peso corporal entre 2,5 e 5 kg, pertencendo a um único grupo. A biopsia renal, pela técnica de janela modificada foi realizada nos rins esquerdo e direito utilizando-se agulhas do tipo Spring-Cut, semi-automatizadas de 18 gauge. Os animais foram avaliados antes e após a biopsia, em intervalos de 2, 24 e 168 horas. Os animais foram acompanhados por meio de exame clínico e testes laboratoriais durante este período. A qualidade das amostras de biopsia foi avaliada pela microscopia de luz, de acordo com o número de glomérulos existentes, sendo considerado como padrão para a classificação da amostra, a presença de no mínimo cinco glomérulos por biopsia. As principais alterações clínicas observadas após a biopsia renal foram presença de hematúria transitória e formação de hematomas perirrenais. Nenhum animal do experimento veio a óbito ou apresentou complicações maiores. Das amostras de biopsia avaliadas, 84% apresentaram cinco ou mais glomérulos. Desta forma, conclui-se que a técnica estudada associada ao tipo de agulha utilizada (Spring-Cut semi-automatizada) pode ser considerada segura e de grande valor diagnóstico. / Aiming to evaluate the technical viability of modified keyhole renal biopsy with open up of the Kidney in cats, it was studied the involvement originated from the procedures and the quality of the acquired samples. For that, it was used 25 cats with no defined breed, adults, male and weighing between 2 and a half and 5 kilos, belonging in just on group. The renal biopsy, by modified keyhole technique was performed in the right and left kidney using Spring Cut needles, semiautomatic of 18 gauge. The animals were evaluated before and after the biopsy, in a period of 2, 24 and 168 hours.The animals wore to be present at by clinic examination and laboratory tests during this period. It was done the observation by light microscopy, according to existent glomeruli, it was considered as pattern for the sample classification, the presence of at least 5 glomeruli for the biopsy. The main observed clinical alterations after the renal biopsy was the presence of transitory haematuria and formation of subcapsular haematomas. No animal from the experience has died or shoed serious complications. From the evaluated biopsy samples, 84% showed five or more glomeruli. Then, it is inferred that the studied technique associated with the used needle (Spring-Cut semiautomatic) can be considered safe and great diagnostic value.

Made available in DSpace on 2016-08-19T18:16:07Z (GMT). No. of bitstreams: 1 Dissertacao Janeide.pdf: 1805392 bytes, checksum: 2720a3f24598c01180f7c7259186c12d (MD5) Previous issue date: 2012-07-31 / Introduction: Prevalence of glomerulopathies in a Teaching Hospital. Epidemiologic data on renal diseases based on populations are limited. A better view around the clinically significant glomerulonephritis can be acquired from diagnosis by renal biopsy. Objectives: To determine the prevalence of glomerulopathies, classify them according to the classification of the World Health Organization. Methods: Transversal descriptive study, based on medical records of biopsied patients as well as on their histopathological technical opinions of 409 renal biopsies, executed between january of 1999 and december of 2010 in Presidente Dutra School Medicine Hospital s Nephrology Service of the Universidade Federal do Maranhão (UFMA) Results: The most common glomerulopathy, both in adults and in patients under 20 years old, was segmental glomerulosclerosis and focal glomerulosclerosis (22%) and nephrotic syndrome was found as the most common glomerular syndrome at the moment of diagnosis, in patients of all ages. Most of the diagnoses occurred in patients between ages of 20 to 39 years old, corresponding to 42,05% of all biopsies, a number that decreases as patients are nearer to the extremities of life. There was a balance between sex distributions, but with a remarkable predominance of the female sex in lupus nephritis (88,60 %). Conclusion: The epidemiologic profile of glomerulopathies in a School Hospital in Maranhão resembled the ones found in national level. These data supply important bases to future studies on glomerulopathies in Maranhão. / Introdução: Prevalência das glomerulopatias em um Hospital Universitário. Dados epidemiológicos sobre as doenças renais com bases populacionais são limitados. Uma melhor percepção acerca do espectro das glomerulonefrites clinicamente significantes pode ser obtido através do diagnóstico por biópsia renal. Objetivos: Determinar a prevalência das glomerulopatias e classificá-las de acordo com Organização Mundial de saúde. Métodos: Estudo descritivo e transversal, com base nas informações dos prontuários dos pacientes biopsiados e dos respectivos laudos histopatológicos de 409 biópsias renais, realizadas entre janeiro de 1999 e dezembro de 2010 no Serviço de Nefrologia do Hospital Universitário da Universidade Federal do Maranhão (UFMA). Resultados: A glomerulopatia mais comum tanto em adultos quanto em menores de 20 anos foi a glomeruloesclerose segmentar e focal (22%) e a síndrome nefrótica apresentou-se como a síndrome glomerular mais comum no momento do diagnóstico, em todas as faixas etárias. A maior prevalência de diagnósticos ocorreu na faixa etária de 20 a 39 anos, correspondendo a 42,05% da biópsias, valor que decresce à medida que se aproxima dos extremos de vida. Houve um equilíbrio entre a distribuição por sexo, com predomínio do sexo feminino na nefrite lúpica (88,60%). Conclusão: O perfil epidemiológico das glomerulopatias em um Hospital Universitário no estado do Maranhão assemelhou-se aos demais achados nacionais. Esses dados fornecem bases importantes para futuros estudos sobre glomerulopatias no Maranhão.

Njurbiopsi tas för att ställa diagnos och för behandlingskontroll av flera njursjukdomar. En del av sjuksköterskans arbete att förbereda och övervaka patienter. Njurbiopsi är förenat med risken att drabbas av en blödning vilken kan vara livshotande. I Sverige tycks vården vid njurbiopsi skilja sig åt mellan olika sjukhus. Det saknas en systematisk sammanställning av praxis. Syfte: Att beskriva och jämföra aktuellt forskningsläge med svensk praxis samt beskriva sjuksköterskans roll och kompetensbehov vid njurbiopsi. Design och metod: Mixed method approach. Dels en litteraturgenomgång vilken syftade till att identifiera viktiga faktorer vid njurbiopsi dels en inventeringsdel där rutindokument samlades in från svenska njurmedicinska avdelningar. Resultat: Vården kring njurbiopsi har visat sig vara komplex. En mängd värden samlas in före och efter njurbiopsi genom blodprovtagning och andra mätvärden. Det åligger sjuksköterskan att bedöma dessa värden och vid behov konsultera läkare. Det tycks dock råda oklarheter kring vilka åtgärder som har betydelse för komplikationsfrekvensen. Slutsats: Av de insamlade rutindokumenten är det endast ett fåtal som tillhandahåller beskrivningar av hur insamlad information ska tolkas och de utgör således ett svagt handlingsstöd i arbetet för sjuksköterskan som vårdar patienter som genomgår njurbiopsi. / Renal biopsy is performed to diagnose and evaluate treatment in many renal diseases. To prepare and monitor patients is a part of a nurse’s assignments. Renal biopsy is associated with the risk of internal bleeding which may be life-threatening. In Sweden treatment seams to differ between hospitals. There is no systematic compilation of established practice. Aim: To describe and compare current state of the art with swedish practice and also describe the role of the nurse and his or her need of competence in relation to renal biopsy. Design and method: Mixed method approach. Partly a literature review which aimed to identify important factors in relation to renal biopsy. Partly an inventory where directions of the procedure was collected from swedish nephrology wards. Result: Treatment and care in relation to renal biopsy has shown to be complex. A quantity of values were collected prior to and after renal biopsy by blood testing and and other measurements. It is the nurse’s assignment to assess these values and when necessary consult medical personnel. Yet there seems to be some uncertainty as regarding which measurements and actions that influence the outcome. Conclusion: Out of the collected directions of procedure there is only a few that offer descriptions of how observed data should be assessed and accordingly they constitute a weak support for nurses in their line of work when caring for patients that undergo renal biopsy.

Hintergrund und Zielsetzung: Jährlich erkranken in Westeuropa 4% der Gesamtbevölkerung an Akutem Nierenversagen (ANV). Zudem leiden 8,5% der Bevölkerung an einer Chronischen Niereninsuffizienz (CNI). Valide epidemiologische Daten über Erkrankungen der Niere existierten für Deutschland jedoch nicht, da zu diesem Zeitpunkt Erkrankungsfälle noch nicht flächendeckend systematisch erfasst wurden und das Deutsche Nierenregister noch im Aufbau war. Die vorliegende retrospektive Analyse untersucht und dokumentiert räumliche und zeitliche Veränderungen des histomorphologischen Befundspektrums aus Eigennierenbiopsien im Großraum Leipzig über den Zeitraum 1993-2012. Methoden: Als Grundlage der Arbeit dient ein zeitlich und geographisch strukturiertes Nierenbiopsieregister, welches für die vorliegende Arbeit aus den gesammelten histologischen Eigennierenbiopsiebefunden erstellt wurde. Zu jedem Fall wurde zur räumlichen Zuordnung, wenn ermittelbar, die Postleitzahl (PLZ) des Wohnortes des jeweiligen Patienten eingetragen. Bei einer annähernd vollständigen Erfassung der PLZ wurde für den jeweiligen Zeitraum für das Stadtgebiet Leipzig eine Inzidenzberechnung durchgeführt. Für das Leipziger Umland war dies nicht vorgesehen, da von einer unvollständigen Erfassung auszugehen war. Die statistische Auswertung erfolgte über Kontingenztafeln per Chi-Quadrat-Test oder per Varianzanalyse. Ergebnisse: In die Analyse des erstellten Biopsieregisters wurden n=943 Erstbiopsien eingeschlossen, unter vorherigem Ausschluss pädiatrischer Fälle und Folgebiopsien. Die IgA-Nephropathie (IgANP) war mit 19,5% die häufigste gestellte Diagnose, gefolgt von der Hypertensiven Nephropathie (HZNP) bzw. der Fokal-Segmentalen Glomerulosklerose (FSGS) und der Granulomatose mit Polyangiitis (GPA). Die räumliche Verteilung innerhalb der Untersuchungsregion unterlag teilweise großen Schwankungen. Die IgANP wurde im Leipziger Umland 36% häufiger beobachtet als im Leipziger Stadtgebiet. Auch im Zeitverlauf waren Schwankungen zu beobachten. Im Zeitraum 2009-2012 war die HTNP/FSGS mit 18.9% die häufigste Diagnose, gefolgt von der GPA mit 17,8% und der IgANP mit 15,6%. Zudem nahm die Häufigkeit der Glomerulopathie der dünnen Basalmembran (TBMD) bzw. des Alport-Syndroms stark ab. Auch die regionale Verteilung schwankte im Zeitverlauf stark. Auf Basis der ermittelten Postleitzahlen wurden für den Leipziger Stadtraum für den Zeitraum 2001-2009 jährliche Inzidenzen berechnet. Am Häufigsten trat dabei die GPA mit 0,9 (0,0-2,2) Fällen pro 100.000 Einwohner auf, gefolgt von der HTNP/FSGS mit 0,8 (0,2-2,2) und der IgANP mit 0,8 (0,2-1,4). Schlussfolgerung: Das Nephropathiespektrum im Großraum Leipzigs deckt sich, soweit konsolidierte Vergleichszahlen existieren, mit der bestehenden Literatur. In den Vergleichsstudien zeigte sich eine große Heterogenität. Einige Schwankungen, wie bei der HTNP/Alport-Syndrom oder bei der diabetischen Nephropathie (DNP) beobachtet, sind klar auf Variabilitäten in der Indikationsstellung zurückzuführen. Andere mögliche Einflussfaktoren wurden diskutiert. / Background and Objectives: Annually, 4% of Western Europe\'s population fall ill with acute kidney injury (AKI). Furthermore, 8.5% of the same population are affected by chronic kidney disease (CKD). In Germany, valid nationwide epidemiological data on renal pathology didn\'t exist at the time of this study, although progress has been made with creating the German kidney biopsy register. This study analyzes temporal and spatial variances in the histomorphological spectrum of renal diseases of native kidney biopsies in the metropolitan area of Leipzig, Germany, from 1993 through 2012. Methods: For this study, a temporally and spatially structured kidney biopsy register was created from nephro-pathologic biopsy results. Spatial analysis was implemented by giving every entry its corresponding postal code. Unidentifiable entries were omitted. If the postal code was determined for every case within a timeframe, incidences for the city of Leipzig were calculated for the timeframe. Incidence for the surrounding areas were not calculated, because coverage was expected to be incomplete. Statistical analysis was done via Chi-Squared-Test or analysis of variances. Results: For this study n=943 cases were analyzed, omitting pediatric and follow-up biopsies. The leading diagnosis was IgA nephropathy (IgANP) with 19.5% (male: 22.1%, female: 15.4%), followed by hypertensive nephropathy (HTNP) resp. focal-segmental glomerulosclerosis (FSGS) and granulomatosis with polyangiitis (GPA). Spatial variance between the analyzed regions was high. Compared to the city of Leipzig, IgANP was observed one third more frequently in the surrounding regions. High temporal variance was also observed. From 2009 through 2012, HTNP/FSGS became leading diagnosis with 18.9%, followed by GPA with 17.8% and IgANP with 15.6%. Furthermore, frequency of thin base membrane disease (TBMD) resp. Alport\'s syndrome decreased sharply. Variance in spatial distribution was also observed over time. On the basis of determined postal codes, incidences for the city of Leipzig were calculated for the years 2001 through 2009. Highest annual incidence was observed in GPA with 0.9 (0.0-2.2) cases per 100 000 people, followed by HTNP/FSGS with 0.8 (0.2-2.2), IgANP with 0.8 (0.2-1.4). Conclusions: The spectrum of kidney pathology for the metropolitan area of Leipzig is in accordance with the data in literature, as far as consolidated figures were available. Results in compared studies were highly heterogenous. Some differences, e.g. decrease in TBMD resp. Alport\'s Syndrome or fluctuation of DNP, can be attributed to variance in indication for biopsy. External factors were discussed.

Introdução: O transplante renal é amplamente reconhecido como a melhor forma de tratamento para os pacientes que necessitam de terapia de substituição renal. Frequentemente a equipe transplantadora se depara com a difícil questão de determinar se órgãos, provenientes de doadores falecidos e limítrofes ou em parada cardíaca, estão aptos para serem transplantados. É difícil quantificar a intensidade do dano provocado pela isquemia no enxerto a ser utilizado, especialmente se o doador apresentou quadro de instabilidade hemodinâmica com queda significativa da perfusão tecidual e aumento do risco de diminuir a função do enxerto e afetar adversamente sua sobrevida. Desta forma torna-se justificável a utilização da técnica de espectroscopia de fluorescência induzida pelo laser, na tentativa de se avaliar a correlação entre os seus achados e o grau de lesão histológica renal experimental, uma vez que se trata de um método objetivo, não invasivo, rápido e em tempo real que, futuramente, pode ser aplicada nos transplantes renais em humanos. Objetivos: Avaliar a correlação entre os dados da espectroscopia de fluorescência induzida pelo laser e alterações histológicas na isquemia e reperfusão renal em ratos, e se existe diferença significativa na leitura da espectroscopia entre os polos superior, inferior e o terço médio. Materiais e Métodos: Foram utilizados 33 ratos (Rattus norvegicus) machos adultos da linhagem Wistar que, depois de anestesiados, tiveram seus rins esquerdos abordados. Inicialmente os rins foram submetidos à detecção da espectroscopia de fluorescência dos pólos superiores, inferiores e terços médios. As excitações foram geradas por lasers com comprimentos de onda de 408, 442 e 532 nm. Em seguida os pedículos renais esquerdos foram dissecados, isolados e clampeados com auxílio de mini-pinça vascular. Então, os animais foram divididos aleatoriamente em três grupos isquêmicos de 30, 60 e 120 minutos de isquemia quente. Em cada um dos grupos, os rins foram novamente analisados pela espectroscopia de fluorescência, bem como após 5 minutos de reperfusão, utilizando novamente feixes excitatórios com os mesmos comprimentos de onda, nas mesmas regiões renais. Posteriormente os rins esquerdos foram coletados e enviados para estudo histológico. Resultados: O tempo de isquemia mostrou forte influência com a graduação histológica. Com 30 minutos de isquemia, nenhum comprimento de onda (408, 442 e 532 nm) apresentou correlação com a graduação histológica (p = 0,81; p = 0,11; p = 0,21, respectivamente). Com 60 minutos de isquemia, o laser de excitação de 532 nm (na fase de reperfusão) apresentou coeficiente de correlação negativa significativa (r = - 0,61) com a graduação histológica. Na isquemia de 120 minutos, o laser com 442 nm de comprimento de onda (na fase de reperfusão) mostrou o coeficiente de correlação negativa significativa (r = - 0,73) com a graduação histológica. O terço médio renal apresentou média estatística superior à dos polos (p < 0,001) na leitura da espectroscopia de fluorescência. Conclusões: Há correlação entre os dados da espectroscopia de fluorescência induzida pelo laser e as alterações histológicas na isquemia renal em ratos, sendo necessário, durante a investigação, analisar apenas o terço médio renal. / Introduction: Renal transplantation is widely recognized as the best form of treatment for patients who require renal replacement therapy. Often, the transplant team is faced with a difficult question, if organs from deceased marginal donors or non-heart beating donors are able to be transplanted. It is difficult to quantify the intensity of damage caused by ischemia in the graft to be used, especially if the donor had hemodynamic instability with a significant decrease of the tissue perfusion and an increased of the risk of diminishing the graft function which could affect adversely its survival. Thus it is justified to use the technique of laser-induced fluorescence spectroscopy, to assess the correlations between its results and the histological grade in experimental renal injury, since it is an objective, non-invasive, fast and in real-time analysis, which can be applied, in the future, in human kidney transplants. Objectives: To evaluate the correlation between the data of laser-induced fluorescence spectroscopy and histological changes in kidney ischemia and reperfusion in rats, and if there are significant differences of reading between the upper and lower poles and the middle area of such kidneys. Materials and Methods: We used 33 adults male rats (Rattus norvegicus) of Wistar strain, which after anesthetized, had their left kidney addressed. Initially such kidneys were submitted to detection of the fluorescence spectroscopy of the upper pole, lower pole and the middle area. Excitations were generated by lasers having wavelengths of 408, 442 and 532 nm. Then the left renal pedicles were dissected, isolated and clamped. Then the animals were randomized into three ischemic groups of 30, 60 and 120 minutes. In each group, the kidneys were analyzed by fluorescence spectroscopy for the second time, and again after 5 minutes of reperfusion, using excitatory beam with same wavelength, at the poles (upper and lower) and the middle area of the kidneys. Later, the left kidney were collected and sent for histological examination. Results: The ischemia time showed a strong influence on the histological grade. With 30 minutes of ischemia, no wavelength (408, 442 and 532 nm) was correlated with the histological lesions (p = 0.81, p = 0.11, p = 0.21, respectively). With 60 minutes of ischemia, the laser excitation of 532 nm (in the reperfusion phase) showed a significant negative correlation coefficient (r = - 0.61) with the histological grading. In 120 minutes of ischemia, laser with 442 nm wavelength (in the reperfusion phase) showed a significant negative correlation coefficient (r = - 0.73) with the histological grade. The middle area of the kidneys showed a higher average statistically (p< 0,001) than the poles in the reading of fluorescence spectroscopy. Conclusions: There is a strong correlation between the data of laser-induced fluorescence spectroscopy and the histological changes in rats renal ischemia, being necessary, during the investigation, to analyze only the middle area of the kidneys.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-08-11T13:56:44Z No. of bitstreams: 1 Glória Maria Maranhão Sweet. Glomerulopatias...2011.pdf: 578339 bytes, checksum: 050d39acf575d9cf6dcb179b62ab3ec3 (MD5) / Made available in DSpace on 2014-08-11T13:56:44Z (GMT). No. of bitstreams: 1 Glória Maria Maranhão Sweet. Glomerulopatias...2011.pdf: 578339 bytes, checksum: 050d39acf575d9cf6dcb179b62ab3ec3 (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / A prevalência de doenças renais em pacientes encaminhados aos Serviços de Nefrologia em hospitais terciários em Salvador, Brasil, foi avaliada através de exames histopatológicos. Analisamos, retrospectivamente, 228 biópsias renais realizadas entre janeiro de 2003 a junho de 2006. Destes, 159 preencheram os critérios para inclusão no estudo. Foram examinados por microscopia óptica, imunofluorescência (arquivos de imagens digitais) e, quando necessário, por microscopia eletrônica. Compilamos informações sobre gênero, idade, etnicidade, a síndrome clínica e a duração da doença renal. A revisão histológica das biópsias foi realizada em três etapas. Inicialmente, por dois patologistas, simultaneamente, usando um microscópio multiobservador. Em seguida, os diagnósticos foram revistos por um observador independente. Ao final, os casos sem unanimidade no diagnóstico foram revistos pelos três patologistas em conjunto, para se chegar a um diagnóstico consensual. A nefropatia primária mais freqüente foi a esclerose glomerular focal e segmentar, somando 27% dos casos. Outros 15% foram identificados como parte do espectro alteração mínima-esclerose segmentar focal desta doença. Encontramos glomerulopatia membranosa em 9%, glomerulonefrite membranoproliferativa em 7%, e nefropatia por imunoglobulina A em 5%. A nefropatia secundaria mais freqüente foi a nefrite lúpica, constituindo 14% do total. Concordância entre observadores no diagnóstico das nefropatias foi de 93%, com kapa 0,919, DP 0,03 e p<0,01. Este é o primeiro estudo descritivo da prevalência das glomerulopatias em Salvador, Brasil, com utilização de imunofluorescência e microscopia eletrônica. As glomerulopatias primárias e secundárias mais freqüentes foram glomeruloesclerose focal e segmentar e nefrite lúpica. Estes achados representam uma alteração da prevalência das glomerulopatias na Bahia, antes mais influenciada pela infestação por Schistosoma. mansoni. / The prevalence of renal diseases in patients referred to tertiary hospitals in Salvador, Brazil was evaluated by histopathological examination. 228 biopsies of native kidneys, performed from January, 2003 through June, 2006, were retrospectively analyzed; 159 of these fulfilled the criteria for inclusion in this study. They were reviewed by light microscopy, immunofluorescence (digital image archives) and, whenever necessary, by electron microscopy. Gender, age ethnicity, duration of the renal disease and clinical syndrome were studied. Histological revision of the biopsies was performed in three rounds: 1st, by two pathologists using a multiobserver microscopy; 2nd, an independent revision by an external examiner and 3rd, the cases given discrepant diagnosis were revised by all the observers working together. Focal and segmental glomerular sclerosis was the most frequent primary nephropathy, encountered in 27% of the cases. Another 15% were identified as part of the minimal change - focal segmental sclerosis spectrum of disease. Membranous glomerulopathy comprised 9%, membranoproliferative glomerulonephritis 7%, and immunoglobulin A nephropathy, 5% of the total. Lupus nephritis was the most common secondary nephropathy, corresponding to 14% of the cases. Interobserver concordance in the diagnosis of nephropathies was 93%, with Kappa 0.919, standard error 0.03 and P < 0.01. This is the first descriptive study of the prevalence of glomerulopathies in renal biopsies in Salvador, Brazil, using all the recourses of immunofluorescence and electron microscopy. Focal and segmental glomerulosclerosis and systemic lupus nephritis were identified as the most frequent primary and secondary glomerulopathies, respectively. This data may represent a shift in the patter of distribution of glomerulopaties in Bahia, formerly influenced by S. mansoni infection.

Introdução: O transplante renal é amplamente reconhecido como a melhor forma de tratamento para os pacientes que necessitam de terapia de substituição renal. Frequentemente a equipe transplantadora se depara com a difícil questão de determinar se órgãos, provenientes de doadores falecidos e limítrofes ou em parada cardíaca, estão aptos para serem transplantados. É difícil quantificar a intensidade do dano provocado pela isquemia no enxerto a ser utilizado, especialmente se o doador apresentou quadro de instabilidade hemodinâmica com queda significativa da perfusão tecidual e aumento do risco de diminuir a função do enxerto e afetar adversamente sua sobrevida. Desta forma torna-se justificável a utilização da técnica de espectroscopia de fluorescência induzida pelo laser, na tentativa de se avaliar a correlação entre os seus achados e o grau de lesão histológica renal experimental, uma vez que se trata de um método objetivo, não invasivo, rápido e em tempo real que, futuramente, pode ser aplicada nos transplantes renais em humanos. Objetivos: Avaliar a correlação entre os dados da espectroscopia de fluorescência induzida pelo laser e alterações histológicas na isquemia e reperfusão renal em ratos, e se existe diferença significativa na leitura da espectroscopia entre os polos superior, inferior e o terço médio. Materiais e Métodos: Foram utilizados 33 ratos (Rattus norvegicus) machos adultos da linhagem Wistar que, depois de anestesiados, tiveram seus rins esquerdos abordados. Inicialmente os rins foram submetidos à detecção da espectroscopia de fluorescência dos pólos superiores, inferiores e terços médios. As excitações foram geradas por lasers com comprimentos de onda de 408, 442 e 532 nm. Em seguida os pedículos renais esquerdos foram dissecados, isolados e clampeados com auxílio de mini-pinça vascular. Então, os animais foram divididos aleatoriamente em três grupos isquêmicos de 30, 60 e 120 minutos de isquemia quente. Em cada um dos grupos, os rins foram novamente analisados pela espectroscopia de fluorescência, bem como após 5 minutos de reperfusão, utilizando novamente feixes excitatórios com os mesmos comprimentos de onda, nas mesmas regiões renais. Posteriormente os rins esquerdos foram coletados e enviados para estudo histológico. Resultados: O tempo de isquemia mostrou forte influência com a graduação histológica. Com 30 minutos de isquemia, nenhum comprimento de onda (408, 442 e 532 nm) apresentou correlação com a graduação histológica (p = 0,81; p = 0,11; p = 0,21, respectivamente). Com 60 minutos de isquemia, o laser de excitação de 532 nm (na fase de reperfusão) apresentou coeficiente de correlação negativa significativa (r = - 0,61) com a graduação histológica. Na isquemia de 120 minutos, o laser com 442 nm de comprimento de onda (na fase de reperfusão) mostrou o coeficiente de correlação negativa significativa (r = - 0,73) com a graduação histológica. O terço médio renal apresentou média estatística superior à dos polos (p < 0,001) na leitura da espectroscopia de fluorescência. Conclusões: Há correlação entre os dados da espectroscopia de fluorescência induzida pelo laser e as alterações histológicas na isquemia renal em ratos, sendo necessário, durante a investigação, analisar apenas o terço médio renal. / Introduction: Renal transplantation is widely recognized as the best form of treatment for patients who require renal replacement therapy. Often, the transplant team is faced with a difficult question, if organs from deceased marginal donors or non-heart beating donors are able to be transplanted. It is difficult to quantify the intensity of damage caused by ischemia in the graft to be used, especially if the donor had hemodynamic instability with a significant decrease of the tissue perfusion and an increased of the risk of diminishing the graft function which could affect adversely its survival. Thus it is justified to use the technique of laser-induced fluorescence spectroscopy, to assess the correlations between its results and the histological grade in experimental renal injury, since it is an objective, non-invasive, fast and in real-time analysis, which can be applied, in the future, in human kidney transplants. Objectives: To evaluate the correlation between the data of laser-induced fluorescence spectroscopy and histological changes in kidney ischemia and reperfusion in rats, and if there are significant differences of reading between the upper and lower poles and the middle area of such kidneys. Materials and Methods: We used 33 adults male rats (Rattus norvegicus) of Wistar strain, which after anesthetized, had their left kidney addressed. Initially such kidneys were submitted to detection of the fluorescence spectroscopy of the upper pole, lower pole and the middle area. Excitations were generated by lasers having wavelengths of 408, 442 and 532 nm. Then the left renal pedicles were dissected, isolated and clamped. Then the animals were randomized into three ischemic groups of 30, 60 and 120 minutes. In each group, the kidneys were analyzed by fluorescence spectroscopy for the second time, and again after 5 minutes of reperfusion, using excitatory beam with same wavelength, at the poles (upper and lower) and the middle area of the kidneys. Later, the left kidney were collected and sent for histological examination. Results: The ischemia time showed a strong influence on the histological grade. With 30 minutes of ischemia, no wavelength (408, 442 and 532 nm) was correlated with the histological lesions (p = 0.81, p = 0.11, p = 0.21, respectively). With 60 minutes of ischemia, the laser excitation of 532 nm (in the reperfusion phase) showed a significant negative correlation coefficient (r = - 0.61) with the histological grading. In 120 minutes of ischemia, laser with 442 nm wavelength (in the reperfusion phase) showed a significant negative correlation coefficient (r = - 0.73) with the histological grade. The middle area of the kidneys showed a higher average statistically (p< 0,001) than the poles in the reading of fluorescence spectroscopy. Conclusions: There is a strong correlation between the data of laser-induced fluorescence spectroscopy and the histological changes in rats renal ischemia, being necessary, during the investigation, to analyze only the middle area of the kidneys.