Background. The aim of this study is to investigate abnormalities in glomerular and tubular function in VL patients. Methods. This is a prospective study with 16 VL patients before treatment with pentavalent antimonium, in hospital monitoring, in Fortaleza, CearÃ, Brazil. Urinary concentration and acidification tests were performed after a 12h period of water and food deprivation using desmopressin and calcium chloride (CaCl2). Glomerular filtration rate (GFR) Fractional excretion of sodium (FENa), transtubular potassium gradient (TTKG) and solute free water reabsorption (TcH2O) were calculated. MicroalbuminÃria and proteinÃria were measured. The VL group pre-treatment was compared to a group of 13 healthy volunteers (control group) and 5 VL patients were revalued after treatment. Aquaporin 2 (AQP2), renal outer medullary K+ channels (ROMK) and pendrin were quantified trough exosomes search in urine. Monocyte chemotactic protein-1 (MCP-1) and malondialdehyde (MDA) were quantified in urine. Results. Urinary concentration deficit was found in all VL patients before (100%) and 4 in 5 cases (80%) after treatment. Urinary osmolality was significantly lower in VL patients pre-treatment compared to control group (516Â113 vs. 743Â189 mOsm/L, p<0,001, after 12h period water deprivation and desmopressin). There was no difference after treatment revaluation. Urinary acidification deficit was found in 9 cases before (56,22%) and 2 (40%) after treatment, considering urinary pH > 5.5 after CaCl2 test. GRF was similar between the groups. Proteinuria was significantly higher in VL patients prÃ-treatment (250,6Â375,5 vs. 83,7Â49,2 mg/24h, p=0,022) and presented important regression after revaluation (268,1Â259,4 vs. 113,3Â50,1, p=0,043). FENa was higher in VL group when compared to control group. The search for AQP2 (128Â88 vs.100Â40%, p=0,41), ROMK (122Â42 vs. 100Â27%, p=0,34) and pendrin (105Â7,5 vs. 100Â13% p=0,48) were not significant. Urinary MCP-1 showed significant difference between VL patients before treatment and control group (374Â359 vs. 42Â29 pg/mg-Cr, p=0.002) well as urinary MDA (5.4Â2.6 vs. 2.0Â0.8 μmol/mL). Conclusion. VL patients present persistent urinary concentration and acidification deficit in 90 days period after treatment and present inflammation and incipient renal damage although other classical markers such as creatinine are not cha / IntroduÃÃo. O objetivo desse estudo à investigar as alteraÃÃes tÃbulo-glomerulares e avaliar marcadores urinÃrios nos pacientes com LV. MÃtodos. Foi realizado estudo prospectivo com 16 pacientes com LV antes do tratamento com antimonial pentavalente, em acompanhamento na cidade de Fortaleza, CearÃ, Brasil. Testes de concentraÃÃo e acidificaÃÃo urinÃrias foram realizados. Foram calculadas taxa de filtraÃÃo glomerular (TFG), fraÃÃo de excreÃÃo de sÃdio (FENa), transporte transtubular de potÃssio (TTKG) e transporte de Ãgua livre de solutos (TCH2O). Avaliou-se a proteinÃria. O grupo LV prÃ-tratamento foi comparado com 13 voluntÃrios sadios (grupo controle) e cinco pacientes foram reavaliados no pÃs-tratamento. Os transportadores aquaporina 2 (AQP2), canal de K+ apical (ROMK) e pendrina foram quantificados pela pesquisa de exossomas na urina. A proteÃna quimiotÃtica de monÃcitos (MCP-1) e o malondialdeÃdo (MDA) foram quantificados na urina. Resultados. DÃficit de concentraÃÃo urinÃria foi encontrado em todos os pacientes antes (100%) e em cinco dos quatro casos reavaliados (80%) depois do tratamento. A osmolaridade urinÃria mÃdia foi significativamente menor nos pacientes LV prÃ-tratamento quando comparado ao controle (516Â113 vs. 743Â189 mOsm/L, p<0,001) e nÃo houve diferenÃa entre os pacientes reavaliados no pÃs-tratamento. DÃficit de acidificaÃÃo foi detectado em nove casos (56,2%) antes e 2 (40%) apÃs o tratamento, considerando o pH urinÃrio > 5,5 apÃs sobrecarga de CaCl2. A proteinÃria mostrou-se significantemente maior no grupo LV prÃ-tratamento (250,6Â375,5 vs. 83,7Â49,2 mg/24h, p=0,022) regredindo apÃs o tratamento (268,1Â259,4 vs. 113,3Â50,1mg/24h, p=0,043). FENa foi mais elevada no grupo LV prÃ-tratamento. A pesquisa dos exossomas urinÃrios AQP2 nÃo mostrou diferenÃa significativa em relaÃÃo ao grupo controle (128Â88 vs.100Â40, p=0,41), assim como a do canal ROMK (122Â42 vs. 100Â27, p=0,34) e da pendrina (105Â7,5 vs. 100Â13% p=0,48). A dosagem de MCP-1 e MDA urinÃrios foram mais elevadas nos pacientes prÃ-tratamento quando comparado aos controles (374Â359 vs. 42Â29 pg/mg-Cr, p=0.002 e 5.4Â2.6 vs. 2.0Â0.8 μmol/mL, respectivamente). ConclusÃo. Pacientes com LV apresentam dÃficit de concentraÃÃo e acidificaÃÃo urinÃrias antes e 90 dias apÃs o tratamento e evidÃncias de inflamaÃÃo renal incipiente.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:8254 |
| Date | 28 April 2014 |
| Creators | Michelle Jacintha Cavalcante Oliveira |
| Contributors | Elizabeth de Francesco Daher, Alexandre Braga LibÃrio, SÃnia Leite da Silva |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em CiÃncias MÃdicas, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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