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3. Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Author

Elbert, Alicia, Vallejos, Augusto, Alvarisqueta, Andres, Maffei, Laura, Juncos, Luis, de Arteaga, Javier, Greloni, Gustavo, Farias, Eduardo, Zucchini, Alfredo, Vogel, Daniel, Cusumano, Ana, Santos, Juan, Fraenkel, Margaret, Gallagher, Martin, Davis, Tim, Acharya, Shamasunder, Cooke, Duncan, Suranyi, Michael, Roger, Simon, Toussaint, Nigel, Pollock, Carol, Chan, Doris, Stranks, Stephen, MacIsaac, Richard, Endre, Zoltan, Schmidt, Alice, Prager, Rudolf, Mayer, Gert, Warling, Xavier, Jadoul, Michel, Hougardy, Jean, Vercammen, Chris, Van Vlem, Bruno, Gillard, Pieter, Costa e Forti, Adriana, Borges, Joao Lindolfo, Santos Canani, Luis, Eliaschewitz, Freddy, Leite, Silmara, Fraige Filho, Fadlo, Paschoalin, Raphael, Moura Neto, Jose Andrade, Deboni, Luciane, de Lourdes Noronha, Irene, Cercato, Cintia, Prompt, Carlos Alberto, Zanella, Maria, Rassi, Nelson, D'Avila, Domingos, Milagres, Rosangela, Felicio, Joao, Pecoits Filho, Roberto, Riella, Miguel Carlos, Salles, Joao, Keitel, Elizete, Draibe, Sergio, Amodeo, Celso, Youmbissi, Joseph, Roy, Louise, Cournoyer, Serge, Jolly, Shivinder, Pichette, Vincent, Nesrallah, Gihad, Bajaj, Harpreet Singh, Khandwala, Hasnain, Aronson, Ronnie, Goluch, Richard, Tam, Paul, Rabbat, Christian, Tobe, Sheldon, Bailey, Gordon, Chow, Stephen, Castillo, Alvaro, Danin Vargas, Alfredo, Gonzalez, Fernando, Munoz, Rodrigo, Gutierrez, Vicente, Godoy, Gonzalo, Zhao, Hongwen, Liu, Zhangsuo, Zhao, Minghui, Guo, Xiaohui, Su, Benli, Fu, Shuxia, Xu, Yan, Yang, Jinkui, Shi, Bingyin, Xiao, Guanqing, Shi, Wei, Hao, Chuanming, Xing, Changying, Hou, Fanfan, Luo, Qun, Li, Yuxiu, Ji, Linong, Zuo, Li, Wang, Song, Ni, Zhaohui, Ding, Guohua, Chen, Nan, Zhao, Jiajun, Jia, Weiping, Yu, Shengqiang, Weng, Jian, Xu, Gang, Fu, Ping, Sun, Shiren, Liu, Bicheng, Ding, Xiaoqiang, Rychlik, Ivan, Oplustilova, Alexandra, Bartaskova, Dagmar, Honova, Vaclava, Chmelickova, Hana, Petr, Martin, Bucek, Petr, Tesar, Vladimir, Zahumensky, Emil, Povlsen, Johan, Egstrup, Kenneth, Oczachowska-Kulik, Anna, Rossing, Peter, Lahtela, Jorma, Strand, Jorma, Kantola, Ilkka, Petit, Catherine, Combe, Christian, Zaoui, Philippe, Esnault, Vincent, Urena Torres, Pablo, Halimi, Jean-Michel, Dussol, Bertrand, Bieler, Tasso, Budde, Klemens, Dellanna, Frank, Segiet, Thomas, Kosch, Christine, Schmidt-Guertler, Hans, Schenkenberger, Isabelle, Vielhauer, Volker, Pistrosch, Frank, Alscher, Mark, Hasslacher, Christoph, Hugo, Christian, Muehlfeld, Anja, Wanner, Christoph, Passadakis, Ploumis, Apostolou, Theofanis, Tentolouris, Nikolaos, Stefanidis, Ioannis, Mavromatidis, Konstantinos, Liakopoulos, Vasilios, Goumenos, Dimitrios, Siamopoulos, Konstantinos, Yeung, Vincent, Ozaki, Risa, Fung, Samuel, Tan, Kathryn, Tang, Sydney, Lui, Sing Leung, Cheung, Siu Fai, Sreenan, Seamus, Eustace, Joseph, O'Shea, Donal, Lavin, Peter, Stack, Austin, Yagil, Yoram, Wainstein, Julio, Knobler, Hilla, Cohen, Josef, Kenis, Irina, Daoud, Deeb, Bar-Dayan, Yosefa, Frajewicki, Victor, Adawi, Faiad, Gesualdo, Loreto, Santoro, Domenico, Marino, Francesco, Galfre, Andrea, Brunati, Chiara, Ruggenenti, Piero, Rombola, Giuseppe, Pugliese, Giuseppe, Ravera, Maura, Malberti, Fabio, Pontoriero, Giuseppe, Rampino, Teresa, De Cosmo, Salvatore, Esposito, Ciro, Nappi, Felice, Abaterusso, Cataldo, Conte, Giuseppe, Panichi, Vincenzo, Lauro, Davide, Capasso, Giovambattista, Russo, Domenico, Anzai, Jiichi, Naka, Motoji, Ato, Keita, Tsujimoto, Tetsuro, Nimura, Toshinori, Nakashima, Eitaro, Takeda, Tetsuro, Fujii, Shinya, Kobayashi, Kunihisa, Iwaoka, Hideaki, Nagayama, Koji, Harada, Hiroyuki, Maeda, Hajime, Kishimoto, Rui, Iitsuka, Tadashi, Itabashi, Naoki, Furuya, Ryuichi, Maeda, Yoshitaka, Yamada, Daishiro, Sasaki, Nobuhiro, Sasaki, Hiromitsu, Ueda, Shinichiro, Kashihara, Naoki, Watanabe, Shuichi, Nakamura, Takehiro, Kanai, Hidetoshi, Makita, Yuichiro, Ono, Keiko, Iehara, Noriyuki, Goto, Daisuke, Kosuge, Keiichiro, Tsuchida, Kenichi, Sato, Toshiaki, Sekikawa, Takashi, Okamoto, Hideki, Tanaka, Tsuyoshi, Ikeda, Naoko, Tadika, Takenobu, Mukasa, Koji, Osonoi, Takeshi, Hirano, Fuminori, Nishimura, Motonobu, Yambe, Yuko, Tanaka, Yukio, Ujihara, Makoto, Sakai, Takashi, Imura, Mitsuo, Umayahara, Yutaka, Makino, Shinya, Nakazawa, Jun, Yamaguchi, Yukinari, Kashine, Susumu, Miyaoka, Hiroaki, Suzuki, Katsunori, Inoue, Toshihiko, Nagai, Sou, Sato, Nobuyuki, Yamamoto, Masahiro, Taya, Noriyasu, Fujita, Akira, Matsutani, Akira, Shibagaki, Yugo, Sato, Yuichi, Yamauchi, Akira, Tsutsui, Masahiro, Ishiko, Tamayo, Kaneko, Shizuka, Azuma, Nobuyuki, Matsuda, Hirofumi, Hashiguchi, Yasuhiro, Onishi, Yukiko, Tokui, Mikiya, Matsuhisa, Munehide, Kiyosue, Arihiro, Shinoda, Junji, Ishikawa, Kazuo, Ahmad, Ghazali, Vijayasingham, Shalini, Aziz, Nor Azizah, Hussein, Zanariah, Fung, Yin Khet, Hassan, Wan Hasnul Halimi Wan, Wong, Hin Seng, Goh, Bak Leong, Ali, Norhaliza Mohd, Merican, Nor Shaffinaz Yusuf Azmi, Vaithilingam, Indralingam, Nik Ahmad, Nik Nur Fatnoon, Adam, Noor, Sukor, Norlela, Vengadasalam, V Paranthaman P, Abdul Kadir, Khalid, Mohamed, Mafauzy, Renoirte Lopez, Karina, Leguizamo-Dimas, Aniceto, Chew Wong, Alfredo, Chevaile-Ramos, Jose, Gonzalez Gonzalez, Jose, Rico Hernandez, Raul, Nino-Cruz, Jose, Sauque Reyna, Leobardo, Gonzalez-Galvez, Guillermo, Madero Rovalo, Magdalena, Bochicchio-Ricardelli, Tomasso, Aldrete, Jorge, Carranza-Madrigal, Jaime, Vogt, Liffert, Smak Gregoor, Peter, Barendregt, JNM, Luik, Peter, Gansevoort, Ronald, Laverman, Gozewijn, Pilmore, Helen, Lunt, Helen, Baker, John, Miller, Steven, Rabindranath, Kannaiyan, Zapata-Rincon, Luis, Vargas-Gonzales, Rolando, Calderon Ticona, Jorge, Dextre Espinoza, Augusto, Burga Nunez, Jose, Zea-Nunez, Carlos Antonio, Herrada Orue, Benjamin, Medina-Santander, Boris, Delgado-Butron, Cesar, Farfan-Aspilcueta, Julio, Mazur, Stanislaw, Necki, Miroslaw, Wruk, Michal, Klodawska, Katarzyna, Popenda, Grazyna, Skokowska, Ewa, Arciszewska, Malgorzata, Wiecek, Andrzej, Ciechanowski, Kazimierz, Nowicki, Michal, Birne, Rita, Cabrita, Antonio, Ramos, Aura, Antunes Ferreira, Manuel Anibal, Matta Fontanet, Evelyn, Alcantara-Gonzalez, Altagracia Aurora, Comulada-Rivera, Angel, Galindo Ramos, Eugenia, Cangiano, Jose, Quesada-Suarez, Luis, Calderon Ortiz, Ricardo, Vazquez-Tanus, Jose, Burgos-Calderon, Rafael, Rosado, Carlos, Hancu, Nicolae, Pintilei, Ella, Mistodie, Cristina, Bako, Gabriel, Ionutiu, Lavinia, Petrica, Ligia, Timar, Romulus, Tuta, Liliana, Duma, Livia, Tutescu, Adriana, Ivanova, Svetlana, Essaian, Ashot, Zrazhevskiy, Konstantin, Tomilina, Natalia, Smolyarchuk, Elena, Kuzin, Anatoly, Lantseva, Olga, Karpova, Irina, Shamkhalova, Minara, Liberanskaya, Natalia, Yavdosyuk, Andrey, Shvarts, Yuri, Bardymova, Tatiana, Blagoveshchenskaya, Olga, Solovev, Oleg, Rechkova, Elena, Pikalova, Natalia, Pavlova, Maria, Kolmakova, Elena, Sayfutdinov, Rustam, Villevalde, Svetlana, Koziolova, Natalya, Martynenko, Vladimir, Marasaev, Vyacheslav, Maksudova, Adelya, Sigitova, Olga, Mordovin, Viktor, Klimontov, Vadim, Samoylova, Yulia, Karonova, Tatiana, Yeoh, Lee Ying, Teo, Boon Wee, Foo, Marjorie Wai Yin, Liew, Adrian, Tkac, Ivan, Oroszova, Aniko, Fekete, Jozef, Rosenberger, Jaroslav, Obetkova, Ida, Fulopova, Alla, Kolesarova, Eva, Raslova, Katarina, Smolko, Peter, Oksa, Adrian, Distiller, Larry, Trokis, Julien, Adams, Luthando, Makan, Hemant, Ramlachan, Padaruth, Mitha, Essack, Coetzee, Kathleen, Punt, Zelda, Bhorat, Qasim, Naiker, Puvenesvari, Ellis, Graham, Van Zyl, Louis, Lee, Kwan Woo, Kim, Min Seon, Yoo, Soon-Jib, Yoon, Kun Ho, Cho, Yong-Wook, Park, Tae-Sun, Kim, Sang Yong, Choi, Moon-Gi, Oh, Tae Keun, Lee, Kang-Wook, Shon, Ho Sang, Suh, Sung Hwan, Kim, Byung-Joon, Doo-Man, Kim, Yi, Joo Hark, Lee, Sang Ah, Cho, Ho Chan, Kim, Sin-Gon, Cha, Dae-Ryong, Seo, Ji A, Choi, Kyung Mook, Woo, Jeong-Taek, Ahn, Kyu Jeung, Lee, Jae Hyuk, Kim, In-Joo, Lee, Moon-Kyu, Jang, Hak Chul, Park, Kyong-Soo, Kim, Beom Seok, Mok, Ji Oh, Shin, Mijung, Yoon, Sun Ae, Nam-Goong, Il-Seong, Chung, Choon Hee, Yu, Tae Yang, Lee, Hyoung Woo, Soto Gonzalez, Alfonso, Almirall, Jaume, Egido, Jesus, Calero Gonzalez, Francesca, Fernandez Fresnedo, Gema, Valera Cortes, Ildefonso, Praga Terente, Manuel, Garcia Mendez, Isabel, Navarro Gonzalez, Juan, Herrero Calvo, Jose, Cigarran Guldris, Secundino, Prieto Velasco, Mario, Minguela Pesquera, Jose Ignacio, Galan, Antonio, Pascual, Julio, Marques Vidas, Maria, Martins Munoz, Judith, Rodriguez-Perez, Jose, Castro-Alonso, Cristina, Bonet Sol, Josep, Seron, Daniel, Fernandez Giraldez, Elvira, Arrieta Lezama, Javier, Montero, Nuria, Hernandez-Jaras, Julio, Santamaria Olmo, Rafael, Molas Coten, Jose Ramon, Hellberg, Olof, Fellstrom, Bengt, Bock, Andreas, Pei, Dee, Lin, Ching-Ling, Tien, Kai-Jen, Chen, Ching-Chu, Huang, Chien-Ning, Jiang, Ju-Ying, Wu, Du-An, Chu, Chih-Hsun, Tseng, Shih-Ting, Chen, Jung-Fu, Bau, Cho-Tsan, Sheu, Wayne, Wu, Mai-Szu, Sari, Ramazan, Sezer, Siren, Yildiz, Alaattin, Satman, Ilhan, Kalender, Betul, Mankovskyy, Borys, Fushtey, Ivan, Stanislavchuk, Mykola, Kolenyk, Mykola, Dudar, Iryna, Zolotaikina, Viktoriia, Abrahamovych, Orest, Kostynenko, Tetyana, Petrosyan, Olena, Kuskalo, Petro, Galushchak, Olga, Legun, Oleg, Topchii, Ivan, Martynyuk, Liliya, Stryzhak, Vasyl, Panina, Svitlana, Tkach, Sergii, Korpachev, Vadym, Maxwell, Peter, Gnudi, Luigi, Kon, Sui Phin, Tindall, Hilary, Kalra, Phillip, Mark, Patrick, Patel, Dipesh, El-Shahawy, Mohamed, Bai, Liqun, Nica, Romanita, Lien, Yeong-Hau, Menefee, Judson, Busch, Robert, Miller, Alan, Ahmed, Azazuddin, Arif, Ahmed, Lee, Joseph, Desai, Sachin, Bansal, Shweta, Bentsianov, Marie, Belledonne, Mario, Jere, Charles, Gaona, Raul, Greenwood, Gregory, Brusco, Osvaldo, Boiskin, Mark, Belo, Diogo, Minasian, Raffi, Atray, Naveen, Lawrence, Mary, Taliercio, John, Pergola, Pablo, Scott, David, Alvarez, German, Marder, Bradley, Powell, Thomas, Bakdash, Wa'el, Stoica, George, McFadden, Christopher, Rendell, Marc, Wise, Jonathan, Jones, Audrey, Jardula, Michael, Madu, Ivy-Joan, Varghese, Freemu, Tulloch, Brian, Ahmed, Ziauddin, Hames, Melanie, Nazeer, Imran, Shahid, Newman, John, Rekha, Montero, Manuel, Fitz-Patrick, David, Phillips, Lawrence, Guasch, Antonio, Christofides, Elena, Gundroo, Aijaz, Amin, Mohammad, Bowman-Stroud, Cynthia, Link, Michael, Mulloy, Laura, Nammour, Michael, Lalwani, Tarik, Hanson, Lenita, Whaley-Connell, Adam, Herman, Lee, Chatha, Rupi, Osama, Sayed, Liss, Kenneth, Kayali, Zeid, Bhargava, Anuj, Israel, Ezra, Peguero-Rivera, Alfredo, Fang, Michael, Slover, Judith, Barengolts, Elena, Flores, Jose, Muoneke, Rosemary, Savin, Virginia, Awua-Larbi, Stella, Levine, Andrew, Newman, George, Golestaneh, Laden, Bohm, Guillermo, Reisin, Efrain, Cruz, Lucita, Weiss, Robert, Zieve, Franklin, Horwitz, Edward, Chuang, Peale, Mersey, James, Manley, John, Graf, Ronald, Bedros, Fadi, Joshi, Sudhir, Frias, Juan, Assefi, Ali, O'Shaughnessy, Andrew, Brantley, Roman, Minga, Todd, Tietjen, David, Kantor, Samuel, Jamal, Aamir, Guadiz, Ramon, Hershon, Kenneth, Bressler, Peter, Kopyt, Nelson, Cathcart, Harold, Bloom, Scott, Reichel, Ronald, Nakhle, Samer, Dulude, Emily, Tarkan, Joshua, Baker, Penelope, Zeig, Steven, Moya Hechevarria, Jaynier, Ropero-Cartier, Armando, De la Calle, Gilda, Doshi, Ankur, Saba, Fadi, Sligh, Teresa, Shaw, Sylvia, Kumar, Jayant, Szerlip, Harold, Bayliss, George, Perlman, Alan, Sakhrani, Lakhi, Gouge, Steven, Argoud, Georges, Acosta, Idalia, Elder, John, Joshi, Sucharit, Sensenbrenner, John, Vicks, Steven, Mangoo-Karim, Roberto, Galphin, Claude, Leon-Forero, Carlos, Gilbert, John, Brown, Eric, Ijaz, Adeel, Butt, Salman, Markell, Mariana, Arauz-Pacheco, Carlos, Sloan, Lance, Alvarado, Odilon, Jabbour, Serge, Simon, Eric, Rastogi, Anjay, James, Sam, Bakris, George, Hall, Karen, Melish, John, Dixon, Brad, Adolphe, Allen, Kovesdy, Csaba, Beddhu, Srinivasan, Solomon, Richard, Fernando, Ronald, Levin, Ellis, Thakar, Charuhas, Robey, Brooks, Goldfarb, David, Fried, Linda, Maddukuri, Geetha, Thomson, Stephen, Annand, Andrew, Kronfli, Saeed, Kalirao, Paramjit, Schmidt, Rebecca, Dahl, Neera, Blumenthal, Samuel, Weinstein, Debra, Ostergaard, Ove, Weinstein, Talia, Ono, Yasuhiro, Yalcin, Murat, Karim, Shahana, Heerspink, Hiddo J L, Parving, Hans-Henrik, Andress, Dennis L, Correa-Rotter, Ricardo, Hou, Fan-Fan, Kitzman, Dalane W, Kohan, Donald, Makino, Hirofumi, McMurray, John J V, Melnick, Joel Z, Miller, Michael G, Pergola, Pablo E, Perkovic, Vlado, Yi, Tingting, Wigderson, Melissa, and de Zeeuw, Dick

Published
2019
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36. Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Author

Heerspink, Hiddo J L, primary, Parving, Hans-Henrik, additional, Andress, Dennis L, additional, Bakris, George, additional, Correa-Rotter, Ricardo, additional, Hou, Fan-Fan, additional, Kitzman, Dalane W, additional, Kohan, Donald, additional, Makino, Hirofumi, additional, McMurray, John J V, additional, Melnick, Joel Z, additional, Miller, Michael G, additional, Pergola, Pablo E, additional, Perkovic, Vlado, additional, Tobe, Sheldon, additional, Yi, Tingting, additional, Wigderson, Melissa, additional, de Zeeuw, Dick, additional, Elbert, Alicia, additional, Vallejos, Augusto, additional, Alvarisqueta, Andres, additional, Maffei, Laura, additional, Juncos, Luis, additional, de Arteaga, Javier, additional, Greloni, Gustavo, additional, Farias, Eduardo, additional, Zucchini, Alfredo, additional, Vogel, Daniel, additional, Cusumano, Ana, additional, Santos, Juan, additional, Fraenkel, Margaret, additional, Gallagher, Martin, additional, Davis, Tim, additional, Acharya, Shamasunder, additional, Cooke, Duncan, additional, Suranyi, Michael, additional, Roger, Simon, additional, Toussaint, Nigel, additional, Pollock, Carol, additional, Chan, Doris, additional, Stranks, Stephen, additional, MacIsaac, Richard, additional, Endre, Zoltan, additional, Schmidt, Alice, additional, Prager, Rudolf, additional, Mayer, Gert, additional, Warling, Xavier, additional, Jadoul, Michel, additional, Hougardy, Jean, additional, Vercammen, Chris, additional, Van Vlem, Bruno, additional, Gillard, Pieter, additional, Costa e Forti, Adriana, additional, Borges, Joao Lindolfo, additional, Santos Canani, Luis, additional, Eliaschewitz, Freddy, additional, Leite, Silmara, additional, Fraige Filho, Fadlo, additional, Paschoalin, Raphael, additional, Moura Neto, Jose Andrade, additional, Deboni, Luciane, additional, de Lourdes Noronha, Irene, additional, Cercato, Cintia, additional, Prompt, Carlos Alberto, additional, Zanella, Maria, additional, Rassi, Nelson, additional, D'Avila, Domingos, additional, Milagres, Rosangela, additional, Felicio, Joao, additional, Pecoits Filho, Roberto, additional, Riella, Miguel Carlos, additional, Salles, Joao, additional, Keitel, Elizete, additional, Draibe, Sergio, additional, Amodeo, Celso, additional, Youmbissi, Joseph, additional, Roy, Louise, additional, Cournoyer, Serge, additional, Jolly, Shivinder, additional, Pichette, Vincent, additional, Nesrallah, Gihad, additional, Bajaj, Harpreet Singh, additional, Khandwala, Hasnain, additional, Aronson, Ronnie, additional, Goluch, Richard, additional, Tam, Paul, additional, Rabbat, Christian, additional, Bailey, Gordon, additional, Chow, Stephen, additional, Castillo, Alvaro, additional, Danin Vargas, Alfredo, additional, Gonzalez, Fernando, additional, Munoz, Rodrigo, additional, Gutierrez, Vicente, additional, Godoy, Gonzalo, additional, Zhao, Hongwen, additional, Liu, Zhangsuo, additional, Zhao, Minghui, additional, Guo, Xiaohui, additional, Su, Benli, additional, Fu, Shuxia, additional, Xu, Yan, additional, Yang, Jinkui, additional, Shi, Bingyin, additional, Xiao, Guanqing, additional, Shi, Wei, additional, Hao, Chuanming, additional, Xing, Changying, additional, Hou, Fanfan, additional, Luo, Qun, additional, Li, Yuxiu, additional, Ji, Linong, additional, Zuo, Li, additional, Wang, Song, additional, Ni, Zhaohui, additional, Ding, Guohua, additional, Chen, Nan, additional, Zhao, Jiajun, additional, Jia, Weiping, additional, Yu, Shengqiang, additional, Weng, Jian, additional, Xu, Gang, additional, Fu, Ping, additional, Sun, Shiren, additional, Liu, Bicheng, additional, Ding, Xiaoqiang, additional, Rychlik, Ivan, additional, Oplustilova, Alexandra, additional, Bartaskova, Dagmar, additional, Honova, Vaclava, additional, Chmelickova, Hana, additional, Petr, Martin, additional, Bucek, Petr, additional, Tesar, Vladimir, additional, Zahumensky, Emil, additional, Povlsen, Johan, additional, Egstrup, Kenneth, additional, Oczachowska-Kulik, Anna, additional, Rossing, Peter, additional, Lahtela, Jorma, additional, Strand, Jorma, additional, Kantola, Ilkka, additional, Petit, Catherine, additional, Combe, Christian, additional, Zaoui, Philippe, additional, Esnault, Vincent, additional, Urena Torres, Pablo, additional, Halimi, Jean-Michel, additional, Dussol, Bertrand, additional, Bieler, Tasso, additional, Budde, Klemens, additional, Dellanna, Frank, additional, Segiet, Thomas, additional, Kosch, Christine, additional, Schmidt-Guertler, Hans, additional, Schenkenberger, Isabelle, additional, Vielhauer, Volker, additional, Pistrosch, Frank, additional, Alscher, Mark, additional, Hasslacher, Christoph, additional, Hugo, Christian, additional, Muehlfeld, Anja, additional, Wanner, Christoph, additional, Passadakis, Ploumis, additional, Apostolou, Theofanis, additional, Tentolouris, Nikolaos, additional, Stefanidis, Ioannis, additional, Mavromatidis, Konstantinos, additional, Liakopoulos, Vasilios, additional, Goumenos, Dimitrios, additional, Siamopoulos, Konstantinos, additional, Yeung, Vincent, additional, Ozaki, Risa, additional, Fung, Samuel, additional, Tan, Kathryn, additional, Tang, Sydney, additional, Lui, Sing Leung, additional, Cheung, Siu Fai, additional, Sreenan, Seamus, additional, Eustace, Joseph, additional, O'Shea, Donal, additional, Lavin, Peter, additional, Stack, Austin, additional, Yagil, Yoram, additional, Wainstein, Julio, additional, Knobler, Hilla, additional, Cohen, Josef, additional, Kenis, Irina, additional, Daoud, Deeb, additional, Bar-Dayan, Yosefa, additional, Frajewicki, Victor, additional, Adawi, Faiad, additional, Gesualdo, Loreto, additional, Santoro, Domenico, additional, Marino, Francesco, additional, Galfre, Andrea, additional, Brunati, Chiara, additional, Ruggenenti, Piero, additional, Rombola, Giuseppe, additional, Pugliese, Giuseppe, additional, Ravera, Maura, additional, Malberti, Fabio, additional, Pontoriero, Giuseppe, additional, Rampino, Teresa, additional, De Cosmo, Salvatore, additional, Esposito, Ciro, additional, Nappi, Felice, additional, Abaterusso, Cataldo, additional, Conte, Giuseppe, additional, Panichi, Vincenzo, additional, Lauro, Davide, additional, Capasso, Giovambattista, additional, Russo, Domenico, additional, Anzai, Jiichi, additional, Naka, Motoji, additional, Ato, Keita, additional, Tsujimoto, Tetsuro, additional, Nimura, Toshinori, additional, Nakashima, Eitaro, additional, Takeda, Tetsuro, additional, Fujii, Shinya, additional, Kobayashi, Kunihisa, additional, Iwaoka, Hideaki, additional, Nagayama, Koji, additional, Harada, Hiroyuki, additional, Maeda, Hajime, additional, Kishimoto, Rui, additional, Iitsuka, Tadashi, additional, Itabashi, Naoki, additional, Furuya, Ryuichi, additional, Maeda, Yoshitaka, additional, Yamada, Daishiro, additional, Sasaki, Nobuhiro, additional, Sasaki, Hiromitsu, additional, Ueda, Shinichiro, additional, Kashihara, Naoki, additional, Watanabe, Shuichi, additional, Nakamura, Takehiro, additional, Kanai, Hidetoshi, additional, Makita, Yuichiro, additional, Ono, Keiko, additional, Iehara, Noriyuki, additional, Goto, Daisuke, additional, Kosuge, Keiichiro, additional, Tsuchida, Kenichi, additional, Sato, Toshiaki, additional, Sekikawa, Takashi, additional, Okamoto, Hideki, additional, Tanaka, Tsuyoshi, additional, Ikeda, Naoko, additional, Tadika, Takenobu, additional, Mukasa, Koji, additional, Osonoi, Takeshi, additional, Hirano, Fuminori, additional, Nishimura, Motonobu, additional, Yambe, Yuko, additional, Tanaka, Yukio, additional, Ujihara, Makoto, additional, Sakai, Takashi, additional, Imura, Mitsuo, additional, Umayahara, Yutaka, additional, Makino, Shinya, additional, Nakazawa, Jun, additional, Yamaguchi, Yukinari, additional, Kashine, Susumu, additional, Miyaoka, Hiroaki, additional, Suzuki, Katsunori, additional, Inoue, Toshihiko, additional, Nagai, Sou, additional, Sato, Nobuyuki, additional, Yamamoto, Masahiro, additional, Taya, Noriyasu, additional, Fujita, Akira, additional, Matsutani, Akira, additional, Shibagaki, Yugo, additional, Sato, Yuichi, additional, Yamauchi, Akira, additional, Tsutsui, Masahiro, additional, Ishiko, Tamayo, additional, Kaneko, Shizuka, additional, Azuma, Nobuyuki, additional, Matsuda, Hirofumi, additional, Hashiguchi, Yasuhiro, additional, Onishi, Yukiko, additional, Tokui, Mikiya, additional, Matsuhisa, Munehide, additional, Kiyosue, Arihiro, additional, Shinoda, Junji, additional, Ishikawa, Kazuo, additional, Ahmad, Ghazali, additional, Vijayasingham, Shalini, additional, Aziz, Nor Azizah, additional, Hussein, Zanariah, additional, Fung, Yin Khet, additional, Hassan, Wan Hasnul Halimi Wan, additional, Wong, Hin Seng, additional, Goh, Bak Leong, additional, Ali, Norhaliza Mohd, additional, Merican, Nor Shaffinaz Yusuf Azmi, additional, Vaithilingam, Indralingam, additional, Nik Ahmad, Nik Nur Fatnoon, additional, Adam, Noor, additional, Sukor, Norlela, additional, Vengadasalam, V Paranthaman P, additional, Abdul Kadir, Khalid, additional, Mohamed, Mafauzy, additional, Renoirte Lopez, Karina, additional, Leguizamo-Dimas, Aniceto, additional, Chew Wong, Alfredo, additional, Chevaile-Ramos, Jose, additional, Gonzalez Gonzalez, Jose, additional, Rico Hernandez, Raul, additional, Nino-Cruz, Jose, additional, Sauque Reyna, Leobardo, additional, Gonzalez-Galvez, Guillermo, additional, Madero Rovalo, Magdalena, additional, Bochicchio-Ricardelli, Tomasso, additional, Aldrete, Jorge, additional, Carranza-Madrigal, Jaime, additional, Vogt, Liffert, additional, Smak Gregoor, Peter, additional, Barendregt, JNM, additional, Luik, Peter, additional, Gansevoort, Ronald, additional, Laverman, Gozewijn, additional, Pilmore, Helen, additional, Lunt, Helen, additional, Baker, John, additional, Miller, Steven, additional, Rabindranath, Kannaiyan, additional, Zapata-Rincon, Luis, additional, Vargas-Gonzales, Rolando, additional, Calderon Ticona, Jorge, additional, Dextre Espinoza, Augusto, additional, Burga Nunez, Jose, additional, Zea-Nunez, Carlos Antonio, additional, Herrada Orue, Benjamin, additional, Medina-Santander, Boris, additional, Delgado-Butron, Cesar, additional, Farfan-Aspilcueta, Julio, additional, Mazur, Stanislaw, additional, Necki, Miroslaw, additional, Wruk, Michal, additional, Klodawska, Katarzyna, additional, Popenda, Grazyna, additional, Skokowska, Ewa, additional, Arciszewska, Malgorzata, additional, Wiecek, Andrzej, additional, Ciechanowski, Kazimierz, additional, Nowicki, Michal, additional, Birne, Rita, additional, Cabrita, Antonio, additional, Ramos, Aura, additional, Antunes Ferreira, Manuel Anibal, additional, Matta Fontanet, Evelyn, additional, Alcantara-Gonzalez, Altagracia Aurora, additional, Comulada-Rivera, Angel, additional, Galindo Ramos, Eugenia, additional, Cangiano, Jose, additional, Quesada-Suarez, Luis, additional, Calderon Ortiz, Ricardo, additional, Vazquez-Tanus, Jose, additional, Burgos-Calderon, Rafael, additional, Rosado, Carlos, additional, Hancu, Nicolae, additional, Pintilei, Ella, additional, Mistodie, Cristina, additional, Bako, Gabriel, additional, Ionutiu, Lavinia, additional, Petrica, Ligia, additional, Timar, Romulus, additional, Tuta, Liliana, additional, Duma, Livia, additional, Tutescu, Adriana, additional, Ivanova, Svetlana, additional, Essaian, Ashot, additional, Zrazhevskiy, Konstantin, additional, Tomilina, Natalia, additional, Smolyarchuk, Elena, additional, Kuzin, Anatoly, additional, Lantseva, Olga, additional, Karpova, Irina, additional, Shamkhalova, Minara, additional, Liberanskaya, Natalia, additional, Yavdosyuk, Andrey, additional, Shvarts, Yuri, additional, Bardymova, Tatiana, additional, Blagoveshchenskaya, Olga, additional, Solovev, Oleg, additional, Rechkova, Elena, additional, Pikalova, Natalia, additional, Pavlova, Maria, additional, Kolmakova, Elena, additional, Sayfutdinov, Rustam, additional, Villevalde, Svetlana, additional, Koziolova, Natalya, additional, Martynenko, Vladimir, additional, Marasaev, Vyacheslav, additional, Maksudova, Adelya, additional, Sigitova, Olga, additional, Mordovin, Viktor, additional, Klimontov, Vadim, additional, Samoylova, Yulia, additional, Karonova, Tatiana, additional, Yeoh, Lee Ying, additional, Teo, Boon Wee, additional, Foo, Marjorie Wai Yin, additional, Liew, Adrian, additional, Tkac, Ivan, additional, Oroszova, Aniko, additional, Fekete, Jozef, additional, Rosenberger, Jaroslav, additional, Obetkova, Ida, additional, Fulopova, Alla, additional, Kolesarova, Eva, additional, Raslova, Katarina, additional, Smolko, Peter, additional, Oksa, Adrian, additional, Distiller, Larry, additional, Trokis, Julien, additional, Adams, Luthando, additional, Makan, Hemant, additional, Ramlachan, Padaruth, additional, Mitha, Essack, additional, Coetzee, Kathleen, additional, Punt, Zelda, additional, Bhorat, Qasim, additional, Naiker, Puvenesvari, additional, Ellis, Graham, additional, Van Zyl, Louis, additional, Lee, Kwan Woo, additional, Kim, Min Seon, additional, Yoo, Soon-Jib, additional, Yoon, Kun Ho, additional, Cho, Yong-Wook, additional, Park, Tae-Sun, additional, Kim, Sang Yong, additional, Choi, Moon-Gi, additional, Oh, Tae Keun, additional, Lee, Kang-Wook, additional, Shon, Ho Sang, additional, Suh, Sung Hwan, additional, Kim, Byung-Joon, additional, Doo-Man, Kim, additional, Yi, Joo Hark, additional, Lee, Sang Ah, additional, Cho, Ho Chan, additional, Kim, Sin-Gon, additional, Cha, Dae-Ryong, additional, Seo, Ji A, additional, Choi, Kyung Mook, additional, Woo, Jeong-Taek, additional, Ahn, Kyu Jeung, additional, Lee, Jae Hyuk, additional, Kim, In-Joo, additional, Lee, Moon-Kyu, additional, Jang, Hak Chul, additional, Park, Kyong-Soo, additional, Kim, Beom Seok, additional, Mok, Ji Oh, additional, Shin, Mijung, additional, Yoon, Sun Ae, additional, Nam-Goong, Il-Seong, additional, Chung, Choon Hee, additional, Yu, Tae Yang, additional, Lee, Hyoung Woo, additional, Soto Gonzalez, Alfonso, additional, Almirall, Jaume, additional, Egido, Jesus, additional, Calero Gonzalez, Francesca, additional, Fernandez Fresnedo, Gema, additional, Valera Cortes, Ildefonso, additional, Praga Terente, Manuel, additional, Garcia Mendez, Isabel, additional, Navarro Gonzalez, Juan, additional, Herrero Calvo, Jose, additional, Cigarran Guldris, Secundino, additional, Prieto Velasco, Mario, additional, Minguela Pesquera, Jose Ignacio, additional, Galan, Antonio, additional, Pascual, Julio, additional, Marques Vidas, Maria, additional, Martins Munoz, Judith, additional, Rodriguez-Perez, Jose, additional, Castro-Alonso, Cristina, additional, Bonet Sol, Josep, additional, Seron, Daniel, additional, Fernandez Giraldez, Elvira, additional, Arrieta Lezama, Javier, additional, Montero, Nuria, additional, Hernandez-Jaras, Julio, additional, Santamaria Olmo, Rafael, additional, Molas Coten, Jose Ramon, additional, Hellberg, Olof, additional, Fellstrom, Bengt, additional, Bock, Andreas, additional, Pei, Dee, additional, Lin, Ching-Ling, additional, Tien, Kai-Jen, additional, Chen, Ching-Chu, additional, Huang, Chien-Ning, additional, Jiang, Ju-Ying, additional, Wu, Du-An, additional, Chu, Chih-Hsun, additional, Tseng, Shih-Ting, additional, Chen, Jung-Fu, additional, Bau, Cho-Tsan, additional, Sheu, Wayne, additional, Wu, Mai-Szu, additional, Sari, Ramazan, additional, Sezer, Siren, additional, Yildiz, Alaattin, additional, Satman, Ilhan, additional, Kalender, Betul, additional, Mankovskyy, Borys, additional, Fushtey, Ivan, additional, Stanislavchuk, Mykola, additional, Kolenyk, Mykola, additional, Dudar, Iryna, additional, Zolotaikina, Viktoriia, additional, Abrahamovych, Orest, additional, Kostynenko, Tetyana, additional, Petrosyan, Olena, additional, Kuskalo, Petro, additional, Galushchak, Olga, additional, Legun, Oleg, additional, Topchii, Ivan, additional, Martynyuk, Liliya, additional, Stryzhak, Vasyl, additional, Panina, Svitlana, additional, Tkach, Sergii, additional, Korpachev, Vadym, additional, Maxwell, Peter, additional, Gnudi, Luigi, additional, Kon, Sui Phin, additional, Tindall, Hilary, additional, Kalra, Phillip, additional, Mark, Patrick, additional, Patel, Dipesh, additional, El-Shahawy, Mohamed, additional, Bai, Liqun, additional, Nica, Romanita, additional, Lien, Yeong-Hau, additional, Menefee, Judson, additional, Busch, Robert, additional, Miller, Alan, additional, Ahmed, Azazuddin, additional, Arif, Ahmed, additional, Lee, Joseph, additional, Desai, Sachin, additional, Bansal, Shweta, additional, Bentsianov, Marie, additional, Belledonne, Mario, additional, Jere, Charles, additional, Gaona, Raul, additional, Greenwood, Gregory, additional, Brusco, Osvaldo, additional, Boiskin, Mark, additional, Belo, Diogo, additional, Minasian, Raffi, additional, Atray, Naveen, additional, Lawrence, Mary, additional, Taliercio, John, additional, Pergola, Pablo, additional, Scott, David, additional, Alvarez, German, additional, Marder, Bradley, additional, Powell, Thomas, additional, Bakdash, Wa'el, additional, Stoica, George, additional, McFadden, Christopher, additional, Rendell, Marc, additional, Wise, Jonathan, additional, Jones, Audrey, additional, Jardula, Michael, additional, Madu, Ivy-Joan, additional, Varghese, Freemu, additional, Tulloch, Brian, additional, Ahmed, Ziauddin, additional, Hames, Melanie, additional, Nazeer, Imran, additional, Shahid, Newman, additional, John, Rekha, additional, Montero, Manuel, additional, Fitz-Patrick, David, additional, Phillips, Lawrence, additional, Guasch, Antonio, additional, Christofides, Elena, additional, Gundroo, Aijaz, additional, Amin, Mohammad, additional, Bowman-Stroud, Cynthia, additional, Link, Michael, additional, Mulloy, Laura, additional, Nammour, Michael, additional, Lalwani, Tarik, additional, Hanson, Lenita, additional, Whaley-Connell, Adam, additional, Herman, Lee, additional, Chatha, Rupi, additional, Osama, Sayed, additional, Liss, Kenneth, additional, Kayali, Zeid, additional, Bhargava, Anuj, additional, Israel, Ezra, additional, Peguero-Rivera, Alfredo, additional, Fang, Michael, additional, Slover, Judith, additional, Barengolts, Elena, additional, Flores, Jose, additional, Muoneke, Rosemary, additional, Savin, Virginia, additional, Awua-Larbi, Stella, additional, Levine, Andrew, additional, Newman, George, additional, Golestaneh, Laden, additional, Bohm, Guillermo, additional, Reisin, Efrain, additional, Cruz, Lucita, additional, Weiss, Robert, additional, Zieve, Franklin, additional, Horwitz, Edward, additional, Chuang, Peale, additional, Mersey, James, additional, Manley, John, additional, Graf, Ronald, additional, Bedros, Fadi, additional, Joshi, Sudhir, additional, Frias, Juan, additional, Assefi, Ali, additional, O'Shaughnessy, Andrew, additional, Brantley, Roman, additional, Minga, Todd, additional, Tietjen, David, additional, Kantor, Samuel, additional, Jamal, Aamir, additional, Guadiz, Ramon, additional, Hershon, Kenneth, additional, Bressler, Peter, additional, Kopyt, Nelson, additional, Cathcart, Harold, additional, Bloom, Scott, additional, Reichel, Ronald, additional, Nakhle, Samer, additional, Dulude, Emily, additional, Tarkan, Joshua, additional, Baker, Penelope, additional, Zeig, Steven, additional, Moya Hechevarria, Jaynier, additional, Ropero-Cartier, Armando, additional, De la Calle, Gilda, additional, Doshi, Ankur, additional, Saba, Fadi, additional, Sligh, Teresa, additional, Shaw, Sylvia, additional, Kumar, Jayant, additional, Szerlip, Harold, additional, Bayliss, George, additional, Perlman, Alan, additional, Sakhrani, Lakhi, additional, Gouge, Steven, additional, Argoud, Georges, additional, Acosta, Idalia, additional, Elder, John, additional, Joshi, Sucharit, additional, Sensenbrenner, John, additional, Vicks, Steven, additional, Mangoo-Karim, Roberto, additional, Galphin, Claude, additional, Leon-Forero, Carlos, additional, Gilbert, John, additional, Brown, Eric, additional, Ijaz, Adeel, additional, Butt, Salman, additional, Markell, Mariana, additional, Arauz-Pacheco, Carlos, additional, Sloan, Lance, additional, Alvarado, Odilon, additional, Jabbour, Serge, additional, Simon, Eric, additional, Rastogi, Anjay, additional, James, Sam, additional, Hall, Karen, additional, Melish, John, additional, Dixon, Brad, additional, Adolphe, Allen, additional, Kovesdy, Csaba, additional, Beddhu, Srinivasan, additional, Solomon, Richard, additional, Fernando, Ronald, additional, Levin, Ellis, additional, Thakar, Charuhas, additional, Robey, Brooks, additional, Goldfarb, David, additional, Fried, Linda, additional, Maddukuri, Geetha, additional, Thomson, Stephen, additional, Annand, Andrew, additional, Kronfli, Saeed, additional, Kalirao, Paramjit, additional, Schmidt, Rebecca, additional, Dahl, Neera, additional, Blumenthal, Samuel, additional, Weinstein, Debra, additional, Ostergaard, Ove, additional, Weinstein, Talia, additional, Ono, Yasuhiro, additional, Yalcin, Murat, additional, and Karim, Shahana, additional

Published
2019
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42. Um diagnóstico a não esquecer em doentes transplantados renais de longa data: Pneumonia por pneumocystis

Author

Bento,Claudia, Martins,La Salete, Almeida,Manuela, Pedroso,Sofia, Dias,Leonideo, Henriques,Antonio Castro, and Cabrita,Antonio

Subjects
kidney transplant, Fever, Pneumocystis jiroveci pneumonia, high immunosuppression, Elevada imunossupressão, respiratory failure, febre, transplante renal, insuficiência respiratória, pneumonia por pneumocystis jiroveci
Abstract

Potential aetiologies of infection in kidney transplant patients are diverse, ranging from common community-acquired infectious diseases to uncommon opportunistic infections. Pneumocystis is a wellknown opportunistic fungus that can cause life-threatening pneumonia in kidney transplant patients mostly within the first 6 months post-transplantation. This en tity may occur after one year post-transplant, but the rate is very low. High immunosuppression, cytomegalovirus infection, previous history of acute rejection and poor GFR are risk factors for the occurrence of pneumocystis pneumonia (PCP) in kidney transplant patients. The treatment of choice is high-dose trimethoprim-sulfamethoxazol (TMP-SMX), reduction of immunosuppressive therapy and, in severe cases (defined by PaO2 < 70 mmHg or an arterial-alveolar gradient > 35 mmHg), association with steroids. We report a case of PCP 12.5 years after renal transplant. A 51-yearold male presented to the hospital with a 3-day history of asthenia, fever and genitourinary complains. Despite the initial treatment for cystitis he kept fever (> 38.5°C) and developed dry cough, hypoxaemia and rapidly progressive dyspnea. Physical examination revealed increased respiratory rate, tachycardia, cyanosis, wheezing and crackles on pulmonary auscultation. Radiographic alterations showed a bilateral interstitial infiltrates (not present on admission). On the 3th day, he was transferred to the intensive care unit and started non-invasive ventilation. The diagnosis was established by the identification of Pneumocystis in bronchoalveolar lavage. Treatment was made with high-dose intravenous TMP-SMX plus steroids and resulted in clinical improvement of the symptoms and complaints. Early diagnosis and prompt administration of empiric antimicrobial therapy are the cornerstones of successful treatment since the disease is associated with high mortality rate. This diagnosis should never be forgotten. Complicações infeciosas nos doentes transplantados renais são diversas e ocorrem quer por microrganismos habituais, quer por microrganismos oportunistas. Pneumocystis jiroveci, fungo oportunista, pode provocar pneumonia ameaçadora à vida nos doentes transplantados renais principalmente nos primeiros 6 meses após o transplante renal. Esta infeção pode ocorrer 1 ano após o transplante renal, mas a sua frequência é muito baixa. Elevada dose de imunossupressão, infeção por citomegalovirus, rejeição aguda e baixa taxa de filtração glomerular são fatores de risco para o desenvolvimento de pneumonia por pneumocystis nos doentes transplantados renais. O tratamento de escolha é realizado com doses elevadas de trimetoprim-sulfametoxazol, redução da dose de imunossupressão e em casos de severidade (definido: PaO2 < 70 mmHg ou gradiente arterio-alveolar > 35 mmHg), associação com esteroides é recomendada. Apresentamos o caso de pneumonia por pneumocystis jiroveci, 12,5 anos após o transplante renal. Doente do sexo masculino de 51 anos que recorreu ao hospital por astenia, febre e queixas geniturinárias com 3 dias de evolução. Apesar do tratamento inicial para a cistite ele manteve febre (> 38,5°C) e desenvolveu de novo tosse seca, hipoxemia e dispneia súbita. Ao exame físico a realçar taquicardia, cianose, sibilos e crepitações na auscultação pulmonar. Alterações radiográficas a demonstrar infiltrado intersticial bilateral (não presente aquando da admissão). Transferido ao 3º dia para a unidade de cuidados intensivos para início de ventilação não invasiva. O diagnóstico foi realizado pelo isolamento de pneumocystis no lavado broncoalveolar. O tratamento foi realizado com doses elevadas de trimetoprim-sulfametoxazol endovenoso em associação com corticoide com melhoria clínica. O diagnóstico adequado e a administração precoce de antibiótico foram os pontos-chave para o sucesso terapêutico, uma vez que esta patologia se associa a elevada taxa de mortalidade. Este diagnóstico não deverá ser esquecido

Published
2014

43. Predictive factors of dialysisdependent chronic kidney disease associated with ANCA vasculites

Author

Antunes, Ana L, Campos, Andreia, Santos, Sofia, Malheiro, Jorge, Aguiar, Pedro, Vizcaino, Ramon, Santos, Josefina, Lobato, Luisa, and Cabrita, Antonio

Subjects
prognostico, predictors, Chronic kidney disease, vasculite ANCA, prognosis, ANCA vasculitis, preditivos, urologic and male genital diseases, Doenca renal cronica
Abstract

Renal involvement in antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis is frequent and, if there is no response to treatment, progression to end-stage renal disease is fast, leading to increased mortality. We evaluated several factors (clinical, analytical and histological) as predictors of progression to dialysis-dependent stage 5 chronic kidney disease within 2 years after diagnosis of kidney biopsy-proven ANCA-associated vasculitis (outcome), between 1997 and 2010. Twenty-seven patients (16 men, mean age 58 years) met the inclusion criteria. The most common extra-renal manifestations were haematological (93%) and systemic symptoms (70%). At the time of biopsy, mean creatinine and proteinuria were 5.11 �± 2.5mg/dL and 2.36 �± 2.1g/day, respectively. The majority of patients (81%) had ANCA against myeloperoxidase. The induction therapy was with corticosteroids and cyclophosphamide in 71%; 40% received maintenance treatment with azathioprine. At 2 years, 12 patients (27.44%) began renal replacement therapy (RRT). Only a higher serum creatinine at diagnosis, within the clinical and analytical variables analysed, was a significant predictor of renal outcome (odds ratio (OR) = 1.73, p = 0.046) in a logistic regression model adjusted for age and sex. We developed a histological index (0 to 1 point considering the absence or presence of: < 30% of normal glomeruli, > 50% cellular crescents, > 30% glomerulosclerosis, moderate-severe tubular atrophy and interstitial infiltrate), which was associated with renal prognosis at 2 years (OR = 2.07, p = 0.043). This means that for each 1-point increase in the created index the likelihood of needing to RRT to 2 years rises 2.1 times. We then stratified the histological variables into glomerular and tubulointerstitial findings. We found that only the glomerular findings (OR = 4.99, p = 0.049) were independent predictors of the outcome, with glomerulosclerosis (OR = 16.7, p = 0.04) being the most significant. We concluded that baseline serum creatinine and glomerular histological findings were independent predictors of the renal prognosis and may prove helpful in the management of these patients. O envolvimento renal nas vasculites associadas aos anticorpos anticitoplasma de neutrofilos (ANCA) e frequente e, na ausencia de resposta ao tratamento, evoluem rapidamente para doenca renal terminal, com aumento da mortalidade. Avaliamos varios fatores (clinicos, analiticos e histologicos) como preditores da evolucao para Doenca Renal Cronica Estadio 5 com necessidade de dialise aos 2 anos em doentes com envolvimento renal por vasculite ANCA confirmado por biopsia (“outcome”) entre 1997 e 2010. Vinte e sete doentes (16 do sexo masculino, idade media de 58 anos) obedeceram aos criterios de inclusao. As manifestações extra-renais mais frequentes foram hematologicas (93%) e sintomas sistemicos (70%). A data da biopsia a creatinina e a proteinuria media eram 5,11 �± 2,5mg/dL e 2,36 ± 2,1g/dia, respectivamente. A maioria dos doentes (81%) tinha ANCA contra mieloperoxidase. A terapeutica de inducao foi em 71% com corticoides e ciclofosfamida; 40% receberam tratamento de manutencao com azatioprina. Aos 2 anos, 12 (27,44%) iniciaram tecnicas de substituicao renal (TSR). Apenas a creatinina mais elevada a apresentacao, dentro das variaveis clinicas e analiticas, foi preditor significativo de “outcome” (odds ratio (OR) = 1,73; p = 0,046), num modelo de regressao logistica ajustado para a idade e sexo. Desenvolvemos um indice histológico (0 ou 1 ponto considerando a presenca de: < 30% de glomerulos normais, > 50% crescentes celulares, > 30% glomerulosclerose, infiltrado intersticial e atrofia tubular moderados-graves), que se associava com o prognostico renal aos 2 anos (OR = 2,07, p = 0,043). Isto significa que, por cada aumento de 1 ponto no indice criado, a probabilidade de necessidade de TSR aos 2 anos torna-se 2,1 vezes maior. Depois estratificamos as variaveis histologicas em achados glomerulares e tubulointersticiais: verificamos que apenas os primeiros eram preditivos do prognostico (OR = 4,99, p =0,049), sendo a glomerulosclerose a mais significativa (OR = 16,07, p = 0,04). Concluiu-se que a creatinina e os achados histologicos glomerulares sao preditores independentes do prognostico renal, podendo mostrar-se uteis no acompanhamento destes doentes.

Published
2014

44. Glomerulonefrite membranoproliferativa em associação com crioglobulinemia tipo II em doente transplantado renal portador do vírus da hepatite C

Author

Bento,Claudia, Malheiro,Jorge, Almeida,Manuela, Martins,La Salete, Dias,Leonideo, Vizcaino,Ramon, Henriques,Antonio Castro, and Cabrita,Antonio

Subjects
kidney transplant, hepatite C, rituximab, membranoproliferative glomerulonephritis, Crioglobulinemia, Cryoglobulinaemia, transplante renal, hepatitis C, glomerulonefrite membranoproliferativa
Abstract

The most common HCV-related nephropathy is glomerulonephritis (MPGN), usually in the context of cryoglobulinaemia. The treatment of this entity is not consensual and represents a challenge to clinicians. We report a case of membranoproliferative glomerulonephritis associated with type II in a 46-year-old Caucasian male recipient of a deceased kidney transplant in 2010. His baseline serum creatinine (SCr) was 1.1 mg/dl. After three years post-transplantation, he presented with nephritic syndrome in association with renal function impairment (SCr - 2.1 mg/dl). The laboratory tests revealed positive rheumatoid factor, hypocomplementaemia and a positive cryocrit with type II cryoglobulinaemia. Antinuclear autoantibodies and anti-double stranded DNA antibodies were negative. Despite the presence of anti-HCV antibodies, the viral load remained undetectable. The allograft biopsy showed lesions compatible with membranoproliferative , with staining in the immunofluorescence for granular IgM and C3 and no C4d. He was treated with methylprednisolone pulses followed by oral prednisolone in association with rituximab. Two months after the last dose of rituximab, the SCr improved to 1.27 mg/dl, the proteinuria decreased and serum C3 levels normalized. Cryogloglobulins and rheumatoid factor became negative and HCV RNA remained undetectable. The patient was lost for follow-up. In our case, the treatment with rituximab resulted in a favourable outcome, although a longer follow-up period may be needed to evaluate the clinical response, since other studies reported high relapse rates. A glomerulonefrite membranoproliferativa com crioglobulinemia associa-se frequentemente à infeção pelo vírus da hepatite C. O tratamento desta entidade não é consensual e representa um desafio para os clínicos. Apresentamos um caso de glomerulonefrite membranoproliferativa associada a crioglobulinemia tipo II num doente do sexo masculino de 46 anos portador de enxerto renal de dador cadavérico desde 2010. O seu valor de creatinina sérico (SCr) era 1,1 mg/dl. Após 3 anos do transplante o paciente apresentou-se com síndrome nefrítico em associação com agravamento da função renal (SCr - 2,1 mg/dl). Os exames laboratoriais demonstraram: fator reumatoide positivo, crioglobulinemia tipo II, hipocomplementemia. Os anticorpos antinuclear e anti-double stranded DNA foram negativos. Apesar da presença de anticorpos anti-HCV a carga vírica era indetectável. A biópsia do enxerto renal demonstrou lesões compatíveis com glomerulonefrite membranoproliferativa com depósitos granulares para IgM e C3 e marcação com C4d negativa na imunofluorescência. Iniciou terapêutica com pulsos de metilprednisolona seguido posteriormente por prednisolona oral em associação com rituximab. Dois meses após a última dose de Rituximab o valor de creatinina melhorou para 1,27 mg/dl, a proteinúria diminuiu e os níveis de C3 normalizaram. O doseamento de crioglobulinas e de fator reumatoide foi negativo e a carga vírica do VHC permaneceu indetectável. Foi perdido o follow-up do doente. No nosso caso o tratamento com Rituximab associou-se a uma melhoria clínica. Um período de follow-up maior é necessário para a monitorização clínica uma vez que as taxas de recidiva são elevadas de acordo com estudos publicados na literatura.

Published
2014

45. Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival

Author

Costa, Rui, Malheiro, Jorge, Santos, Clara, Fonseca, Isabel, Martins, La Salete, Pedroso, Sofia, Almeida, Manuela, Dias, Leonidio, Castro-Henriques, Antonio, Morgado, Teresa, and Cabrita, Antonio

Subjects
kidney transplant, predictors, sobrevida, preditores, transplante renal, rejeição aguda, acute rejection, survival
Abstract

Objective: To determine risk factors for acute rejection in the first 6 months post- transplant and their effect on death-censored graft and patient survival in the 990-1999 and 2000-2009 periods. Patients and Methods: Retrospective analysis of acute rejection episodes was performed separately in two periods: 1990-1999 and 2000-2009. Multivariate logistic regression analysis was performed in order to identify risk factors for acute rejection. Death-censored graft and patient survival comparison between patients with or without acute rejection occurrence was performed by Kaplan-Meier analysis. Multivariate Cox regression analysis identified independent predictors for death-censored graft and patient survival, assuming the following model: acute rejection, patient’s age (< 40 vs. ≥ 40 years) and gender, time on haemodialysis / peritoneal dialysis (< 36 vs. ≥ 36 months), live vs. deceased donor (only after the year 2000), HLA mismatches (0-3 vs. 4-6), PRA (≤ 15 vs. > 15%), number of previous kidney transplants (< 2 vs. ≥ 2), status of hepatitis B/C, donor´s age (< 38 vs. ≥ 38 years) and gender, delayed graft function (DGF), ATG use in induction immunosuppression (IS), MMF or Tacrolimus use in induction / maintenance IS (after 2000). Results: A total of 1299 kidney transplants were analyzed. Acute rejection was more frequently diagnosed in the 1990s (26.2% vs. 11.1%, p < 0.001). Over this period, ATG non-use (OR 1.88, p = 0.025) and patients’ age < 40 years (OR 2.39, p = 0.001) were risk factors for AR while, after 2000, DGF (OR 1.895, p = 0.046) and PRA > 15% (OR 3.519, p = 0.001) were identified. Five years death-censored graft survival was lower in AR cases in the 1990s (81% vs. 94%, p < 0.001) and after 2000 (81% vs. 91%, log rank p = 0.004). Independent predictors for worse death-censored graft survival in 1990-1999 patients were AR (HR 2,436, p < 0.001), patient´s age < 40 years (HR 1.984, p = 0.002) and donor´s age ≥ 38 years (HR 1.961, p = 0.002), while after 2000, DGF (HR 3.247, p < 0.001) and donor´s age ≥ 38 years (HR 2.32, p = 0.017) were identified. No difference was found at five-year patient survival in both groups. Only hepatitis B/C (HR 1.714, p = 0.023) was identified as an independent predictor for patient death in the 1990-1999 period, while after 2000, retransplantation (HR 2,718, p = 0.049) and AR (HR 2,619, p = 0.023) were determinant. Conclusion: After the year 2000, AR was no longer an independent predictor for poor graft survival. Inversely, AR began to play a deleterious effect on patient survival. Advances on immunosuppressive drugs allowed the increase of kidney transplant on hypersensitized patients, with improvement of graft survival in those patients but also with a possible deleterious effect on patient survival. Objetivo: Avaliar na década de 90 e 2000 os fatores preditores de rejeição aguda (RA) aos 6 meses pós transplante renal (TR) e o seu efeito na sobrevida censurada do enxerto e do doente. Material e Métodos: Análise retrospetiva dos casos de RA efetuada separadamente em dois períodos: 1990-1999 e 2000-2009. Na avaliação dos fatores de risco para RA foi utilizado um modelo de regressão logística multivariada. Procedemos à construção de curvas comparativas de sobrevivência do enxerto entre paciente com e sem RA pelo método de Kaplan-Meier em cada período. A regressão de Cox multivariada permitiu identificar os preditores de sobrevivência censurada do enxerto e doente, usando como modelo: rejeição aguda, idade (< 40 vs ≥ 40 anos) e sexo do recetor, tempo em HD/DP (< 36 vs. ≥ 36meses), dador vivo vs. cadavérico (apenas na década de 2000), incompatibilidades HLA (0-3 vs. 4-6), PRA (≤ 15 vs. > 15%), número de TR prévios (< 2 vs. ≥ 2), status de hepatite B/C, idade (< 38 vs. ≥ 38 anos) e sexo do dador, episódio de necrose tubular aguda (NTA), uso de ATG na imunossupressão (IS) de indução, uso de MMF ou Tacrolimus (apenas na década de 2000) na IS de indução/manutenção. Resultados: Num total de 1299 transplantes renais, 644 (49.5%) foram realizados na década de 90 e 655 (50.5%) na década de 2000. A RA foi mais frequente na década de 90 (26.2% vs. 11.1%, p < 0.001). Nesta década, os fatores de risco para RA foram o não-uso de ATG (OR 1.88, p = 0.025) e a idade do recetor < 40 anos (OR 2.39, p = 0.001). Na década de 2000, NTA (OR 1.895, p = 0.046) e PRA > 15% (OR 3.519, p = 0.001) foram os fatores de risco identificados. A sobrevivência censurada do enxerto aos 5 anos foi inferior nos casos de RA na década de 90 (81% vs. 94%, p < 0.001) e 2000 (81% vs. 91%, log rank p = 0.004). Na análise de regressão Cox, os preditores de menor sobrevivência do enxerto na década de 90 foram a RA (HR 2,436, p < 0.001), idade do recetor < 40 anos (HR 1.984, p = 0.002) e idade do dador ≥ 38 anos (HR 1.961, p = 0.002). Na década de 2000 foram identificadas a NTA (HR 3.247, p < 0.001) e idade de dador ≥ 38 anos (HR 2.32, p = 0.017). Não encontramos diferenças na sobrevida do doente aos 5 anos em ambos períodos. Apenas o status de Hepatite B/C (HR 1.714, p = 0.023) foi preditor independente de morte do doente na década de 90, enquanto que na década de 2000, os preditores significativos foram TR prévio (HR 2,718, p = 0.049) e RA (HR 2,619, p = 0.023). Conclusão: A partir de 2000, a RA aos 6 meses deixou de ser um preditor independente de sobrevivência do enxerto. Inversamente, passou a ter um efeito negativo independente na sobrevivência do doente. Os avanços na IS permitiu o TR em recetores cada vez mais sensibilizados, com melhoria na sobrevida do enxerto nestes casos mas com possível efeito desfavorável na sobrevida do doente.

Published
2014

48. Transplantação Reno-Pancreática: Análise de 150 doentes de um Centro em Portugal

Author

Martins, La Salete, Fonseca, Isabel, Aguiar, Pedro, Rocha, Ana, Costa, Rui, Santos, Clara, Malheiro, Jorge, Pedroso, Sofia, Almeida, Manuela, Dias, Leonidio, Henriques, Antonio C, Cabrita, Antonio, and Davide, Jose

Subjects
patient death, resultados a longo-prazo, perda de enxerto, transplantação reno-pancreática, long-term results, morte do doente, graft loss, pancreas-kidney transplantation
Abstract

Introduction: Simultaneous pancreas-kidney transplantation (SPKT) outcomes are conditioned in the short-term mostly by post-operative complications. In the long-term, cardiovascular (CV) disease and immunological loss are the main limitations to transplant survival. Aims: To analyse retrospectively the results from 150 SPKT performed at our centre. Patients and Methods: The 81 females and 69 males had a mean age of 35 ±6 years; they were diabetic for 24 ±6 years and had been on dialysis for 30±21months (except 5 preemptive). Anti-lymphocyte globulin, tacrolimus, mycophenolate and steroids were used as immunosuppressive therapy. Deceased-donor mean age was 28 ±11 years. In 28.7% the transplant was performed with 6 HLA-mismatches. Results: Acute rejection’s incidence was 16%. Ten SPKT patients died; infection was the leading cause of death (five cases), followed by Cardiovascular/cerebrovascular disease (three cases). In 21 patients the pancreas failed, mainly due to thrombosis or bleeding (11 cases), and infection (five cases); in two it was due to late acute rejection. In four patients only the kidney failed, due to chronic rejection. Five patients lost both grafts, from late acute rejection in four and thrombosis in one. We analyzed the 110 SPKT patients (73.3%) with both grafts functioning. Their mean serum creatinine was 1.2 ±0.4mg/dl; creatinineclearance was 76±24 ml/min; fasting glycaemia was 81 ±10mg/dl; and HbA1c was 5.3±0.4%. Hypertension has been treated in 47.2% of patients, in the majority (28.2%) with only one drug. Hyperlipidaemia was observed in 19.1% and excessive weight (>25kg/m2) in 17.3%. Conclusions: From our cohort of SPKT, 93.3% of patients are alive, 73.3% have both grafts functioning. Rejection was the main cause of late pancreas loss. Early mortality was due to infection (3.3%). CV/cerebrovascular disease was the main cause of late mortality (2%). The prevalence of hyperlipidaemia and overweight was inferior to 20%. Hypertension was the most frequently found CV risk factor Introdução: A sobrevivência do transplante de rim-pâncreas (TRP) e condicionada na fase precoce pelas complicações inerentes ao próprio acto cirúrgico. A sua perda tardia deve-se essencialmente a morte por doença cardiovascular (CV), ou imunológica. Objectivos: Analisamos retrospectivamente os resultados dos 150 TRP realizados no nosso centro. Doentes e métodos: Os 81 doentes do sexo F e 69 do sexo M, tinham uma idade media de 35 ±6 anos; eram diabéticos ha 24±6 anos; e estavam em dialise ha 30 ±21meses (excepto 5 preemptive). A terapêutica imunossupressora consistiu em globulina antilinfocitica, tacrolimus, micofenolato e corticoides. A media de idades do dador (cadáver) foi 28 ±11 anos. Em 28.7% o transplante foi realizado com 6 incompatibilidades HLA. Resultados: A incidência de rejeição aguda foi de 16%. Faleceram 10 doentes: a causa mais frequente foi a infecciosa (5 casos), seguida da CV/cerebrovascular (3 casos). Em 21 casos houve falência isolada do pâncreas maioritariamente por trombose ou hemorragia (11 casos) e por infecção (5 casos), em 2 casos por rejeição aguda tardia. Em 4 TRP ocorreu falência isolada do rim, por rejeição cronica. Em 5 casos ambos os enxertos faliram: por rejeição aguda tardia 4 doentes; trombose 1 doente. Os 110 TRP (73.3%) que mantem ambos os enxertos funcionantes, tem creatinina de 1.2±0.4mg/dl; clearance da creatinina de 76±24 ml/min; glicemia em jejum de 81±10mg/dl; e HbA1c de 5.3 ±0.4%. Apresentam hipertensão 47,2%, a maioria (28,2%) requerendo apenas 1 fármaco. Hiperlipidemia verificou-se em 19,1% e excesso de peso (>25kg/m2) em 17,3% dos doentes. Conclusões: Deste grupo de TRP estudado, estão vivos 93.3% e 73.3% tem ambos os enxertos funcionantes. Rejeição foi a principal causa de perda tardia do pâncreas. A mortalidade precoce deveu-se a infeção (3.3%). Doença CV/cerebrovascular foi a causa mais frequente de mortalidade tardia (2%). A prevalência de hiperlipidemia e excesso de peso foi inferior a 20%. Hipertensão foi o factor de risco CV mais frequentemente encontrado

Published
2013

50. Colaboradores

Author

Alonso Melgar, Ángel, Álvarez Quiroga, Mabel, Amair Miani, Pablo, Ariceta Iraola, Gema, Arocha Rodulfo, J. Ildefonzo, Arrieta Lezama, Javier, Arteaga Díaz, Javier de, Ayala Palma, Harold Ismael, Bajo Rubio, María Auxiliadora, Bento, Cláudia, Bilbao Ortega, Saioa, Blasco Cabañas, Concepción, Borràs Sans, Mercè, Brandão, Fausto, Caravaca Magariños, Francisco, Caro Martínez, Araceli, Carrero, Juan Jesús, Casas García, Diego, Cobo, Gabriela, Cornago Delgado, José Ignacio, Coronel Díaz, Francisco, Correa-Rotter, Ricardo, Cortés Sanabria, Laura, Craver Hospital, Lourdes, Cueto Manzano, Alfonso M., Cusumano, Ana María, Daza González, M.ª Ángeles, Dehesa López, Edgar, Espinosa-Cuevas, María de los Ángeles, Fernández Giráldez, Elvira, Fernández Prado, Encarni, Fragío Arnold, Cristina, Gainza de los Ríos, Francisco Javier, García Erauzkin, Gorka, García García, Manuel, García Ledesma, Paula, García-Llana, Helena, Gianotti Franco, Marcia Regina, Gil Cunquero, José Manuel, González Peña, Olga, González Rico, Miguel, Hendel, Irene, Hernando Rubio, Ainhoa, Irízar Santana, Sergio Raúl, Jiménez Heffernan, José A., Lanuza Luengo, Manuel, Leiva Santos, Juan Pablo, Locatelli, Alberto, López Cabrera, Manuel, López Gómez, Juan M., Maduell Canals, Francisco, Martínez-Castelao, Alberto, Martínez Fernández, Isabel, Menoyo Calonge, Victorio, de Miguel Carrasco, Alfonso, Minguela Pesquera, José Ignacio, Montenegro Martínez, Isabel, Montenegro Martínez, Jesús, Muñoz, Jesús Eduardo, Neyra Bohórquez, Pierre P., Nunes Cabrita, Antonio, Octavio Seijas, José Andrés, Ortiz Arduan, Alberto, Padierna Acero, Jesús Ángel, Paniagua Sierra, José Ramón, Pecoits Filho, Roberto, Pérez-Bañasco, Vicente, Pérez Fontán, Miguel, Pérez García, Rafael, del Peso Gilsanz, Gloria, Ponz Clemente, Esther, Portolés Pérez, José M., Prieto Velasco, Mario Alfredo, Proença de Moraes, Thyago, Puchades Montesa, María Jesús, Quirós Ganga, Pedro Luis, Remón Rodríguez, César, Riella, Miguel Carlos, Rivera Gorrín, Maite, Rodríguez Benítez, María Patrocinio, Rodríguez Suárez, Carmen, Rodríguez-Carmona de la Torre, Ana, Rojas Campos, Enrique, Ruiz de Gauna López de Heredia, Ramón, Sánchez Álvarez, Emilio, Sánchez González, Carmen, Sánchez Hernández, Rosa, Sánchez Moreno, Ana, Saracho Rotaeche, Ramón, Selgas Gutiérrez, Rafael, da Silva Fernandes, Natália M., Soares Rodrigues, Anabela, Tejuca Marenco, Mercedes, Tobalina Aguirrezabala, Ernesto, Ureña Torres, Pablo, Vázquez Hernández, Rosario, Ventura García, María de Jesús, and Vera Rivera, Manel

Published
2016
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