This cross-sectional study aims to evaluate the association of caffeine intake with renal function among adults between ages 18-55. Participants of the National Health and Nutritional Examination Survey (NHANES) survey for the three consecutive years (2013-2014, 2015-2016, and 2017-2018) were used. A weighted multivariable linear regression analysis of the caffeine concentration was conducted. Greater intake was associated with lowered renal function. This association persisted when limiting the daily caffeine intake to 2000 mg/day or less. Among younger adults, ages 18 to 39 the beta coefficient was about 50 percent larger than the beta coefficient for individuals ages 40 to 55. This suggests that caffeine intake may have a greater impact on renal function among younger adults. While greater caffeine intake was associated with reduced renal function in this cross-sectional study, further investigation such as an experimental study should be performed to confirm the findings of this thesis. / Epidemiology

Yes / The purpose of this paper is to identify current UK screening practices prior to contrast-enhanced CT. To determine the patient management strategies to minimize the risk of contrast-induced acute kidney injury (CI-AKI) risk in outpatients. An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult National Health Service hospital trusts. The survey included questions related to local protocols and national guidance on which these are based. Details of the assessment of renal function prior to imaging and thresholds for contrast contraindication and patient management were also sought. A response rate of 47.1% was received. Almost all sites had a policy in place for contrast administration (n = 80/82; 97.6%). The majority of sites require a blood test on outpatients undergoing a contrast-enhanced CT scan (n = 75/82; 91.5%); however, some (15/75; 20.0%) sites only check the result in patients at high risk and a small number (7/82; 8.5%) of sites indicated that it was a referrer responsibility. The estimated glomerular filtration rate (eGFR) or serum creatinine (SCr) result threshold at which i.v. contrast was contraindicated varied and 19 different threshold levels of eGFR or SCr were identified, each leading to different prophylactic strategies. Inconsistency was noted in the provision of follow-up blood tests after contrast administration. The wide variation in practice reflects inconsistencies in published guidance. Evidence-based consensuses of which patients to test and subsequent risk thresholds will aid clinicians identify those patients in which the risk of CI-AKI is clinically significant but manageable. There is also a need to determine the value of the various prophylactic strategies, follow-up regimen and efficient service delivery pathways. This survey has identified that further work is required to define which patients are high risk, confirm those which require renal function testing prior to contrast administration and how best to manage patients at risk of CI-AKI. The role of new technologies within this service delivery pathway requires further investigation.

Objective: To evaluate the effect of fenoldopam on renal function in normal dogs subjected to bisection nephrotomy. In addition, effects of bisection nephrotomy on renal function in normal dogs were evaluated. Study Design: Controlled, randomized, blinded experiment Sample Population: Sixteen mixed breed adult dogs Methods: Dogs were paired for sex, body weight, and approximate age and were assigned to one of two groups: fenoldopam (F) or placebo (P). Baseline glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (SCr), urinalysis (UA), and urine culture were performed prior to surgery. A left bisection nephrotomy was performed via a standard midline celiotomy. Dogs in Group F received perioperative intravenous infusion of fenoldopam (0.1 ìg/kg/min) for 90 minutes; dogs in Group P received 0.9 % saline (equivalent volume/kg) for 90 minutes. Body temperature, heart rate, respiration, direct arterial blood pressure, and urine volume were recorded during anesthesia. Renal function was assessed by measuring SCr, BUN, and GFR based on quantitative renal scintigraphy using 99mTc-DTPA at 1, 21, and 42 days after surgery. Results: There was no significant difference between groups in physiologic parameters assessed. There was no significant difference in GFR, BUN, or SCr between groups or between operated or control kidneys. Conclusions: Bisection nephrotomy in normal dogs with renal arterial occlusion of 15 minutes and a simple continuous capsular closure does not adversely affect renal function. Clinical Relevance: Further study investigating perioperative effects of fenoldopam in dogs with existing renal dysfunction is indicated. Bisection nephrotomy, as described in this study, does not decrease renal function as measured by BUN, SCr, or GFR. / Master of Science

O aumento da atividade do Sistema Nervoso Simpático e a estimulação crônica dos receptores β-adrenérgicos (β-AR) estão associados a diversas patologias que acometem o sistema cardiovascular. Entretanto, ainda não estão evidenciados os efeitos da hiperatividade β-AR no tecido renal. Assim, o objetivo deste estudo foi investigar os efeitos da ativação crônica β-AR na função e morfologia renal, bem como na expressão do SRA intrarrenal. Os experimentos revelaram que o tratamento com ISO não alterou a pressão arterial, mas induziu hipertrofia cardíaca. ISO reduziu a perfusão glomerular e aumentou a FF, mas não alterou a morfologia renal. Nos estudos de qPCR, ISO aumentou a expressão de RNAm para renina, angiotensinogênio, ECA1, AT1, Nox 4, p22phox, NFB, IL-1β, TGF-β e Bax no córtex. Em conclusão, a ativação crônica β-AR alterou a hemodinâmica renal, sugeriu ativação do SRA intrarrenal e aumento na geração de espécies reativas de oxigênio, o que justifica o aumento da expressão de RNAm para moléculas pró- inflamatórias, pró-fibróticas e pró-apoptóticas. / The increased activity of the Sympathetic Nervous System and the chronic stimulation of β-adrenergic receptors (β-AR) are associated to several pathologies that affect the cardiovascular system. However, the effects of β-AR hyperactivity on renal tissue have not been evidenced yet. Thus, the aim of this study was to investigate the effects of chronic β-AR activation on renal function and morphology, as well as on intrarenal RAS expression. The experiments revealed that ISO treatment did not alter blood pressure, but induced cardiac hypertrophy. ISO reduced glomerular perfusion and increased FF, but did not alter renal morphology. In the qPCR studies, ISO increased the mRNA expression for renin, angiotensinogen, ECA1, AT1, Nox4, p22phox, NFB, IL-1β, TGF-β and Bax in the cortex. In conclusion, chronic β-AR activation altered renal hemodynamics, suggested activation of intrarenal RAS and increased generation of reactive oxygen species, which justifies the increase of mRNA expression for pro-inflammatory, pro-fibrotic and pro- apoptotic molecules.

O objetivo deste estudo foi avaliar os efeitos morfofuncionais da leptina por 7 e 28 dias sobre os rins e a participação do Sistema Renina-Angiotensina (SRA) neste processo. Os animais tratados por 7 dias apresentaram redução no ganho de peso (p<0.05), aumento da pressão arterial (PA, p<0.05), sem alterar o fluxo plasmático renal (FPR) e o ritmo de filtração glomerular (RFG). Também apresentaram aumento na fração de filtração (FF) (p<0.05), diurese e natriurese. No tratamento por 28 dias houve aumento da PA (p<0.05), queda no FPR (p<0.05), nenhuma alteração no RFG e aumento na FF (p<0.05). Ambos os grupos apresentaram hipertrofia glomerular, aumento da expressão de desmina e proteinúria. Os estudos in vitro demonstraram que a leptina (100 e 250 ng/ml, por 72 horas) induziu apoptose de células mesangiais. Em conclusão, o tratamento com leptina por 7 e 28 dias levou a alterações morfofuncionais renais e estas são, em grande parte, normalizadas com o Losartan, evidenciando uma interação entre a leptina e o SRA sistêmico, neste modelo experimental. / The aim of this study was to evaluate the morphofunctional effects of leptin treatment for 7 and 28 days on kidneys and the participation of the Renin-Angiotensin System (RAS) in this process. The animals treated for 7 days showed a reduction in weight gain (p<0.05), enhancement of blood pressure (BP; p<0.05), without changes in renal plasmatic flow (RPF) and glomerular filtrtaion rate (GFR). They also showed an increase in filtration fraction (FF) (p<0.05), diuresis and natriuresis. In the treatment for 28 days, there was an increase in BP (p<0.05), decrease in RPF (p<0.05), no changes in GFR and enhacement in FF (p<0.05). Both groups showed glomerular hypertrophy, increased desmin staining and proteinuria. The in vitro studies showed that leptin (100 and 250 ng/ml for 72 hours) induced mesangial cells apoptosis. In conclusion, the treatment with leptin for 7 and 28 days induced renal morphofunctional changes and they are mostly normalized by Losartan, demonstrating an interaction between leptin and systemic RAS, in this experimental model.

Para avaliar a influência da intoxicação cúprica cumulativa e do seu tratamento com tetratiomolibdato de amônia (TTM) sobre a função renal e sobre o metabolismo oxidativo, foram empregados 10 cordeiros da raça Santa Inês os quais receberam doses crescentes de sulfato de cobre, até o surgimento de hemoglobinúria macroscópica. Neste momento foram distribuídos ao acaso cinco ovinos para cada um dos dois grupos, onde foi o primeiro foi mantido como controle (C) e o grupo subseqüente foram tratados diariamente, no decorrer de quatro dias, com 3,4 mg TTM por kg de peso vivo. Todos os ovinos do grupo C sucumbiram no decorrer de quatro dias, enquanto que tal fato só ocorreu em um animal tratado com TTM. A intoxicação provocou um quadro clínico típico, gerando grandes alterações na função renal como diminuição da taxa de filtração glomerular, a qual provocou oligúria ou anúria, proteinúria e uremia. O quadro tóxico ainda determinou drásticas diminuições na capacidade de reabsorção tubular manifestada por: glicosúria, menor densidade urinária, maiores excreções urinárias de fósforo, sódio, cloro, potássio, cobre e ferro, maior atividade da enzima NAG na urina. Uma acidúria também foi constatada. O tratamento com TTM promoveu melhora na maioria destas variáveis dentro do 2º ou 5º dias após o início do tratamento. No tocante ao metabolismo oxidativo o quadro tóxico provocou uma intensa formação de radicais livres, com concomitante redução no teor de glutationa reduzida eritrocitária, embora tenha aumentado a capacidade anti-oxidante no plasma, em parte por formação de ácido úrico. Quanto maior foi a formação de radicais livres menor foi a taxa de filtração glomerular. O tratamento com TTM reduziu de maneira significativa a formação de radicais livres,aumentando a concentração de glutationa reduzida eritrocitária. / Twelve Santa Inês lambs were used to study the effects of cumulative copper poisoning and the treatment with ammonium tetrathiomolybdate (TTM) on renal function and oxidative metabolism. The lambs were drenched with increasing doses of copper sulfate until the onset of macroscopic hemoglobinuria. So the lambs were randomly distributed in two groups of five sheep each and treated (TTM) or not (C) with tetrathiomolybdate (3.4 mg/kg BW/ per day, for four days). All sheep C succumbed in four days of hemoglobinuria, while only one lamb died in the other group. A typical clinical picture was observed in both groups causing a marked renal insufficiency with decreased glomerular filtration rate, which caused anuria or oliguria, proteinuria and uremia. The poisoning also generated an intense decreased in the tubular reabsorption capacity with higher urinary excretion of glucose, phosphorus, sodium, chloride, potassium, iron and copper, higher urinary NAG activity and lower urinary density. An aciduria was also detected. The treatment with TTM caused a marked improvement in the renal function within 2 to 5 days. As far as the oxidative is concerned, the poisoning caused a higher formation of free radicals and decreased the erythrocyte levels of reduced glutathione, although the plasma anti-oxidant capacity was increased, partially by production of uric acid. The higher the free radical formation, the lower the glomerular filtration rate. The treatment with TTM decreased significantly the amount of free radical formation and increased the levels of erythrocyte reduced glutathione.

A introdução da terapia antirretroviral altamente potente (HAART) diminuiu dramaticamente a mortalidade dos indivíduos infectados pelo HIV. No entanto, a variabilidade nas concentrações e o uso prolongado desses fármacos podem ter conseqüências relevantes na área da terapia antirretroviral (TARV). Dentre essas, têm-se observado alterações metabólicas e fatores de riscos cardiovasculares, como também, alterações na função renal. O rim tem um papel importante no metabolismo e excreção dos medicamentos antirretrovirais e isso torna-o vulnerável a vários tipos de lesões. Muitos estudos têm sido realizados para avaliar os fatores de risco que podem contribuir para a insuficiência renal em pacientes infectados pelo HIV.9 Esses fatores são numerosos e dependem de características subjacentes do paciente, bem como do regime de drogas. Alguns estudos têm ligado certos medicamentos antirretrovirais, especialmente o tenofovir (TDF) e os inibidores de protease (IPs) lopinavir / ritonavir (LPV / RTV), atazanavir / ritonavir (ATV / RTV) e indinavir (IDV), com redução na taxa de filtração glomerular estimada (eTFG) e anormalidades nos túbulos renais. As alterações nas concentrações plasmáticas dos antirretrovirais (ARV) podem ser suficientes para não ocorrer a manutenção da supressão viral e promover falência no tratamento, ou, por outro lado, gerar efeitos adversos. Portanto, torna-se necessário o desenvolvimento de estratégias específicas para minimizar as ocorrências dessas anormalidades e preservar a eficácia da TARV. Objetivo O objetivo deste trabalho foi avaliar a associação entre os níveis plasmáticos de ATV e a função renal em uma coorte de indivíduos infectados pelo HIV com doença controlada (carga viral indetectável e CD4 > 200/mm3). Métodos Cento e quatro pacientes foram consecutivamente selecionados no período de Abril a Novembro de 2011. Para inclusão no estudo, os pacientes deveriam estar em uso de ATV por no mínimo 6 meses, com carga viral indetectável ( < 50 cópias/ mL) por um período igual ou superior a 12 meses, com contagens de linfócitos T CD4+ superiores a 200 células/mm3 e com idade maior que 18 anos. Os indivíduos foram divididos em quatro grupos de tratamento de acordo com o esquema do ATV. As concentrações plasmáticas do ATV foram comparados com função renal utilizando o Modelo de Regressão Linear Simples. Resultados No grupo de tratamento com ATV não potenciado, as concentrações plasmáticas foram estatisticamente menores (p = 0,001) do que as concentrações encontradas em outros grupos. Nenhuma diferença estatística foi encontrada na função renal entre os grupos. Finalmente, não foi encontrada associação entre os níveis plasmáticos de ATV e função renal (CKD-EPI, p = 0,079; MDRD, p = 0,059). Conclusão De acordo com os achados deste estudo, os níveis plasmáticos do ATV não estão associados com alteração na função renal. Estudos prospectivos são necessários para que se observe com maior exatidão se a função renal alterada atribuída ao uso de ATV realmente existe ou se está relacionada com o uso de RTV, TDF, ou a outros fatores ainda não identificados. / Background The introduction of highly potent antiretroviral therapy (HAART) has dramatically decreased mortality rates of the subjects infected with HIV. However, the variability in concentrations and prolonged use of these drugs may have important consequences in the area of antiretroviral therapy (ART). Among these have been observed metabolic changes and cardiovascular risk factors, but also changes in renal function. The kidney plays an important role in the metabolism and excretion of antiretroviral drugs and that makes it vulnerable to various injuries. Many studies have been conducted to evaluate the risk factors that may contribute to renal failure in HIV-infected patients. Some studies have linked certain antiretroviral drugs, especially tenofovir (TDF) and protease inhibitors (PIs) lopinavir / ritonavir (LPV / RTV), atazanavir / ritonavir (ATV / RTV) and indinavir (IDV), reducing the estimated glomerular filtration rate (eGFR) and abnormalities in the renal tubules. Changes in plasma concentrations of antiretrovirals (ARVs) may not be sufficient to place the maintenance of viral suppression and failure to promote the treatment, or, on the other hand, have adverse effects. Therefore, it becomes necessary to develop specific strategies to minimize the occurrence of these abnormalities and to preserve the effectiveness of ART. Objective The purpose of this study is to assess the association between ATV plasma levels and renal function in a cohort of subjects infected with HIV whose disease is under control (undetectable viral load and CD4 > 200/mm3). Methods One hundred and four subjects were consecutively enrolled between April and November 2011. In order to be included in the study, patients had to be on ATV for at least six months, with undetectable viral load for a period equal to or longer than 12 months, with T CD4+ lymphocyte counts higher than 200 cells/mm3 and older than 18 years. Subjects were divided into four treatment groups according to ATV regimen. ATV plasma concentrations were compared with renal function using the Simple Linear Regression Model. Results In treatment group with ATV unboosted, the plasma concentrations were statistically smaller (p=0.001) than the concentrations found in the other groups. No statistical difference was found in renal function among the groups. Finally, no association was found between ATV plasma levels and renal function (CKD-EPI, p=0.079; MDRD, p=0.059). Conclusion According to the findings of this study, plasma levels of ATV are not associated with impaired renal function. Prospective studies with larger samples are required in order to more accurately observe if changes in renal function attributed to the use of ATV actually exist or if they are related to the use of RTV, TDF or other factors yet to be identified.

No description available.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is the standard stone treatment. Increased excretion of tubular enzymes and hypercalciuria has been reported after ESWL. We investigated the importance of renally induced hypercalciuria after ESWL. Material and Methods: 30 calcium oxalate stoneformers (23 men, 7 women), mean age 53.3 (range 30–71) years, were evaluated prospectively. Plasma calcium and creatinine concentrations and 8-hour overnight urine were measured before ESWL and on the 1st and 2nd days after ESWL. To estimate the changes of tubular reabsorption, the calcium/creatinine clearance ratios were calculated. Results: Hypercalciuria (>5 mmol/24 h) was seen in 5/30 (16.7%) before, in 12/30 (40.0%) on day 1 and in 13/30 (43.3%) on day 2 after ESWL. The mean plasma levels of calcium were significantly decreased from 2.36 mmol/l before to 2.28 mmol/l on day 2 after ESWL (p< 0.01). The mean calcium/creatinine clearance ratio was significantly increased from 0.012 before to 0.019 after ESWL (p< 0.01). Before and on day 2 after ESWL, the calcium/creatinine clearance ratio was significantly correlated with the age of the patients (r = 0.33, p< 0.04). Conclusion: Our data show an age-related significantly increased urine calcium excretion after ESWL possibly due to decreased tubular calcium reabsorption. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

A introdução da terapia antirretroviral altamente potente (HAART) diminuiu dramaticamente a mortalidade dos indivíduos infectados pelo HIV. No entanto, a variabilidade nas concentrações e o uso prolongado desses fármacos podem ter conseqüências relevantes na área da terapia antirretroviral (TARV). Dentre essas, têm-se observado alterações metabólicas e fatores de riscos cardiovasculares, como também, alterações na função renal. O rim tem um papel importante no metabolismo e excreção dos medicamentos antirretrovirais e isso torna-o vulnerável a vários tipos de lesões. Muitos estudos têm sido realizados para avaliar os fatores de risco que podem contribuir para a insuficiência renal em pacientes infectados pelo HIV.9 Esses fatores são numerosos e dependem de características subjacentes do paciente, bem como do regime de drogas. Alguns estudos têm ligado certos medicamentos antirretrovirais, especialmente o tenofovir (TDF) e os inibidores de protease (IPs) lopinavir / ritonavir (LPV / RTV), atazanavir / ritonavir (ATV / RTV) e indinavir (IDV), com redução na taxa de filtração glomerular estimada (eTFG) e anormalidades nos túbulos renais. As alterações nas concentrações plasmáticas dos antirretrovirais (ARV) podem ser suficientes para não ocorrer a manutenção da supressão viral e promover falência no tratamento, ou, por outro lado, gerar efeitos adversos. Portanto, torna-se necessário o desenvolvimento de estratégias específicas para minimizar as ocorrências dessas anormalidades e preservar a eficácia da TARV. Objetivo O objetivo deste trabalho foi avaliar a associação entre os níveis plasmáticos de ATV e a função renal em uma coorte de indivíduos infectados pelo HIV com doença controlada (carga viral indetectável e CD4 > 200/mm3). Métodos Cento e quatro pacientes foram consecutivamente selecionados no período de Abril a Novembro de 2011. Para inclusão no estudo, os pacientes deveriam estar em uso de ATV por no mínimo 6 meses, com carga viral indetectável ( < 50 cópias/ mL) por um período igual ou superior a 12 meses, com contagens de linfócitos T CD4+ superiores a 200 células/mm3 e com idade maior que 18 anos. Os indivíduos foram divididos em quatro grupos de tratamento de acordo com o esquema do ATV. As concentrações plasmáticas do ATV foram comparados com função renal utilizando o Modelo de Regressão Linear Simples. Resultados No grupo de tratamento com ATV não potenciado, as concentrações plasmáticas foram estatisticamente menores (p = 0,001) do que as concentrações encontradas em outros grupos. Nenhuma diferença estatística foi encontrada na função renal entre os grupos. Finalmente, não foi encontrada associação entre os níveis plasmáticos de ATV e função renal (CKD-EPI, p = 0,079; MDRD, p = 0,059). Conclusão De acordo com os achados deste estudo, os níveis plasmáticos do ATV não estão associados com alteração na função renal. Estudos prospectivos são necessários para que se observe com maior exatidão se a função renal alterada atribuída ao uso de ATV realmente existe ou se está relacionada com o uso de RTV, TDF, ou a outros fatores ainda não identificados. / Background The introduction of highly potent antiretroviral therapy (HAART) has dramatically decreased mortality rates of the subjects infected with HIV. However, the variability in concentrations and prolonged use of these drugs may have important consequences in the area of antiretroviral therapy (ART). Among these have been observed metabolic changes and cardiovascular risk factors, but also changes in renal function. The kidney plays an important role in the metabolism and excretion of antiretroviral drugs and that makes it vulnerable to various injuries. Many studies have been conducted to evaluate the risk factors that may contribute to renal failure in HIV-infected patients. Some studies have linked certain antiretroviral drugs, especially tenofovir (TDF) and protease inhibitors (PIs) lopinavir / ritonavir (LPV / RTV), atazanavir / ritonavir (ATV / RTV) and indinavir (IDV), reducing the estimated glomerular filtration rate (eGFR) and abnormalities in the renal tubules. Changes in plasma concentrations of antiretrovirals (ARVs) may not be sufficient to place the maintenance of viral suppression and failure to promote the treatment, or, on the other hand, have adverse effects. Therefore, it becomes necessary to develop specific strategies to minimize the occurrence of these abnormalities and to preserve the effectiveness of ART. Objective The purpose of this study is to assess the association between ATV plasma levels and renal function in a cohort of subjects infected with HIV whose disease is under control (undetectable viral load and CD4 > 200/mm3). Methods One hundred and four subjects were consecutively enrolled between April and November 2011. In order to be included in the study, patients had to be on ATV for at least six months, with undetectable viral load for a period equal to or longer than 12 months, with T CD4+ lymphocyte counts higher than 200 cells/mm3 and older than 18 years. Subjects were divided into four treatment groups according to ATV regimen. ATV plasma concentrations were compared with renal function using the Simple Linear Regression Model. Results In treatment group with ATV unboosted, the plasma concentrations were statistically smaller (p=0.001) than the concentrations found in the other groups. No statistical difference was found in renal function among the groups. Finally, no association was found between ATV plasma levels and renal function (CKD-EPI, p=0.079; MDRD, p=0.059). Conclusion According to the findings of this study, plasma levels of ATV are not associated with impaired renal function. Prospective studies with larger samples are required in order to more accurately observe if changes in renal function attributed to the use of ATV actually exist or if they are related to the use of RTV, TDF or other factors yet to be identified.