Agenor Spallini Ferraz

Facial leontiasis ossea : a rare presentation of hyperparathyroidism secondary to chronic renal insufficiency

The term renal osteodystrophy is often used in a generic sense to include skeletal disorders of patients with chronic renal failure due to secondary hyperparathyroidism. The prevalence of this condition among patients on hemodialysis is considerably high. However, extreme forms such as facial leontiasis ossea are very rare, only 2 well-characterized cases having been reported thus far in the literature. In the present article we report the case of a female patient who developed hyperparathyroidism secondary to end-stage renal disease which was manifested as facial leontiasis ossea and culminated in dysphagia and respiratory difficulties caused by excess bone tissue growth.

Acute tubular necrosis in kidney transplant patients treated with enalapril.

We report two cases of acute renal failure in renal transplant patients using cyclosporine-A (CsA) after the introduction of angiotensin-converting enzyme inhibitor (ACEI) to control arterial hypertension. They had no renal artery stenosis or acute rejection. Both patients presented severe acute tubular necrosis (ATN), which subsided after discontinuation of the ACEI. Synergistic toxic effect of ACEI and CsA on the renal tubules might explain ATN in these two cases.

Pregnancy and kidney transplantation : experience in a developing country

Between January 1968 and December 1992, 136 kidney transplants were performed in the University Hospital of Ribeirão Preto, with women of childbearing age (14 to 40 years) as receptors. From this population, 19 patients became pregnant at least once after transplantation, and 2 were transplanted inadvertently during the first trimester of their pregnancies. There was a total of 25 pregnancies and 27 offspring. The mean age at the time of conception was 28.6 years (23 to 41 years), with a mean interval of 3.5 years from transplant to conception (< 1 to 16 years). All patients continued their immunosuppressive regimens during the entire pregnancy, but only 5 of 25 were taking cyclosporine. There were two miscarriages (8%) and two therapeutic abortions (8%); of those that passed the 20th week of pregnancy, the mean gestation time at delivery was 35 weeks (range, 28 to 38 weeks) with an incidence of prematurity (gestation < 37 weeks) of 67%, and their offspring weighed from 670 to 3,100 g (mean, 2,236 g), presenting a very high incidence of low birthweight (64%). There was one stillborn and one neonatal death. The most common complications that occurred during pregnancy were infections (especially urinary tract and vaginal mycotic infections) followed by hypertension. The obstetric complications were distributed as follows: premature rupture of membranes in 27%, fetal distress in 24%, preterm labor in 24%, and oligohydramnios in 10%. Lower segment cesarean section was necessary in 16 of 21 cases (76%), and all were for obstetric reasons. One patient died during the puerperium because of sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Nocardia infection in renal transplant recipient: diagnostic and therapeutic considerations

In the present report the authors discuss the diagnostic difficulties, therapeutic measures and the clinical course of Nocardia infection which occurred among renal transplant recipients at the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (UH-FRP), from 1968 to 1991. Among 500 individuals submitted to renal transplant, 9 patients developed Nocardiosis at varying times after transplant (two months to over two years). All the patients had pulmonary involvement and their most common symptoms were fever, cough and pleural pain. Dissemination of the process is common and three patients presented cutaneous abscesses, four CNS involvement and one had pericarditis due to Nocardia. The diagnostic is quite difficult since there is no specific clinical picture, concomitant infections are frequent and the microorganism presents slow growth in culture (ranging from four to forty days, in our experience). In this report, three cases were only diagnosed by necropsy. The treatment of choice is a combination of Sulfamethoxazole and Trimethoprim (SMX-TMP). In the present series, overall mortality was 77% (7 cases) and in five of the patients who died the diagnosis was late. All the patients who had CNS involvement died.

Candidíase em pacientes transplantados renais

The medical records of 620 patients submitted to renal transplant from February 1968 to February 1995 were surveyed for Candida infection. Of these, 87 presented 107 episodes of candidiasis. In 42.9% the infection appeared up to 6 months after the transplant. The most frequent involved sites were: urinary tract, respiratory tract, and gastrointestinal tract. The most frequent etiological agents were: C. albicans, C. tropicalis and C. glabrata. Most urinary tract infections occurred in the first 6 months (61.7%) and manifested clinically as a bacterial infection. In the respiratory tract infections were characterized by isolation of the agent in sputum. In the gastrointestinal infections, 9/16 episodes were esophageal. There were 3 deaths directly related to Candidiasis (one pulmonary and 2 disseminated cases). In the urinary tract, and respiratory tract infections there was association of candidiasis with previous antibiotic treatment (76% and 67%, respectively), and with concomitant bacterial infections (34% and 64%, respectively). The overall prevalence of Candida infections was 14.5%. The predominant location was in the urinary tract (51.0%), followed by the respiratory (26.0%) and gastrointestinal tract (15.0%), with a high rate of association with previous antibiotic treatment and bacterial infections.

Revisão integrativa: indicadores de resultado processo de doação de órgãos e transplantes

OBJECTIVE Identify by integrated review the main result indicators in the process of organ donation and transplants used in Brazil and worldwide. The integrated review of this literature was performed on bibliographic database MedLine/PubMed and LILACS and governmental and nongovernmental sites between 1995 and 2011. The describers/keywords used were organ donations, organ transplant and results in health, being selected 26 articles and nine sites. The evidence level classification in the articles changed from one to six. RESULTS The evidence level in the articles in its totality was 66.6% was four (12:18 PubMed) all the articles of LILACS database (8). The indicators showed in the articles intends to evaluate, assess, measure and control data related to the profile of the donor, clinical and hospital conditions, ischemia timing, organ size, surgical procedure and the complications that came from transplants.

Comparative study of HLA-DR typing by serology and sequence-specific primer analysis in a genetically highly diverse population of kidney transplant recipients

IN 1987, 24 BRAZILIAN dialysis and kidney transplant centers in the state of Sao Paulo, located in 17 cities, joined efforts to participate in a single society named Sao Paulo Interior Transplant (SPIT). The main objective of SPIT is the allocation of cadaver kidneys according to HLA matching. Accordingly, all recipient candidates and cadaver donors were typed for HLA antigens in the city of Ribeirao Preto, and the allocation, scheme used the criteria proposed by The United Network for Organ Sharing (UNOS). Since its foundation, SPIT has performed over 1000 kidney transplants. The Brazilian population was formed by the contribution of genes of individuals from several ethnic backgrounds, including Caucasian immigrants from many regions of Europe, African American individuals predominantly from the Niger-Congo area of Equatorial Africa, and native Amerindian populations. DNA typing of HLA alleles for kidney transplantation has been considered to be much more accurate than serologic identification, leading to an increased allograft survival, according to the data published by several large multicenter studies. Since the Brazilian population is genetically highly diverse and since HLA molecular typing has been correlated with better allograft survival, all kidney recipients on the waiting list of SPIT were retyped for HLA-DRB1 alleles by DNA technology using sequence-specific primers (PCR-SSP) in polymerase chain reactions. In this study, we compared the results of previous HLA-DR typing using conventional serology with HLA-DRB1 typing using the PCR-SSP technique.

Association of Alport's syndrome with HLA-DR2 antigen in a group of unrelated patients

A few family studies have evaluated HLA antigens in Alports syndrome; however, there are no large population studies. In the present report, we studied 40 unrelated white patients with Alports syndrome seen at the Unit of Renal Transplantation, Faculty of Medicine of Ribeirão Preto, São Paulo, Brazil. HLA-A, -B, -DR and -DQ antigens were typed using a complement-dependent microlymphocytotoxicity assay. A control white population (N = 403) from the same geographical area was also typed for HLA antigens. Although the frequencies of HLA-A and -B antigens of patients were not statistically different from controls, the frequency of HLA-DR2 antigen observed in patients (65%) was significantly increased in relation to controls (26%; P < 0.001). The relative risk and etiologic fraction for HLA-DR2 antigen were 5.2 and 0.525, respectively. Although few immunological abnormalities have been shown in Alports syndrome, in this report we emphasize the association of HLA molecules and Alports syndrome. Besides the well-known inherited molecular defects encoded by type IV collagen genes in Alports syndrome, the major histocompatibility alleles may be in linkage disequilibrium with these defective collagen genes.

Perfil epidemiológico dos pacientes em lista de espera para o transplante renal

Resumo Objetivo Identificar e descrever o perfil dos pacientes inscritos em lista unica de espera para a realizacao do transplante renal no estado de Sao Paulo. Metodos Estudo epidemiologico transversal com abordagem quantitativa para identificar e descrever o perfil dos pacientes inscritos em fila unica de espera para o transplante renal. Realizou-se levantamento nas bases de dados da Central de Notificacao, Captacao e Distribuicao de Orgaos do Cadastro Tecnico Unico, estabelecendo-se como variaveis as caracteristicas clinicas, demograficas e relativas ao [...]