Lúcio R. Cardoso

Effects of Mycophenolate Mofetil and Lisinopril on Collagen Deposition in Unilateral Ureteral Obstruction in Rats

Background/Aims: Unilateral ureteral obstruction (UUO) in rats has been used as a model of renal interstitial fibrosis, in which therapeutic trials can be of important clinical relevance. In this study, we investigated the effects of mycophenolate mofetil (MMF), the angiotensin-converting enzyme (ACE) inhibitor lisinopril (L), and the combination of both drugs, given daily for 14 days to UUO rats, on the renal fibrogenic process triggered by UUO. Methods: Rats underwent surgical UUO, followed by treatment with daily doses of either MMF, lisinopril, or both, and were then sacrificed after 14 days. Kidney fragments were fixed for histopathological examination (hematoxylin-eosin and periodic acid-Schiff reactive) and immunohistochemistry for myofibroblasts (α-smooth muscle actin; α-SMA) and macrophages (ED-1). Histomorphometrical analysis of collagen was performed with Sirius red staining, and collagen content was assessed by the amount of hydroxyproline. Cortex and medulla were analyzed separately. Results: MMF, lisinopril and MMF+L reduced the density of α-SMA- and ED-1-positive cells (p < 0.05), interstitial volume (p < 0.05) and decreased Sirius-red-stained areas by 54.6, 35.6 and 58.0%, and hydroxyproline content by 60.1, 49.7 and 62.7%, respectively. No differences were observed among treated groups. Conclusion: MMF and the ACE inhibitor lisinopril attenuated the progression of the fibrogenic process of UUO in an equivalent manner. The combination of both drugs did not add any further improvement in the collagen content.

Violence against women: Profile of the aggressors and victims and characterization of the injuries. A forensic study

OBJECTIVE This study, carried out based on examinations of battered women by the Clinical Forensic Service of the Afrânio Peixoto Medical-Legal Institute in the city of Rio de Janeiro, aims to characterize the nature of the injuries suffered by victims of domestic violence and to investigate the motivation of such events, the family situations in which they occur, the habits of victims and aggressors and the social milieu involved. METHOD A questionnaire was given to 1000 battered women attended by that service between October 2009 and March 2012, along with simultaneous quantification/classification of the injuries suffered. RESULTS We found a prevalence of working women (63.3%), with at least some high school (46.6%), who were the main household breadwinners (50.9%). In contrast, the largest percentages of male aggressors only had primary school educations at most (45.9%), were illegal drug users (60.4%) and were self-employed/freelance workers (72.4%). Regarding classification of the injuries (according to the Brazilian Penal Code), there were 971 cases of injuries considered slight, 23 of severe injuries and 6 of very severe injuries. CONCLUSION The majority of the women studied continue suffering aggressions even though they have their own means of support without depending on a male companion or husband. The reasons given for accepting the aggressive acts were mainly associated with the psychological sphere, in a relation of dependence and subordination.

Early withdrawal of calcineurin inhibitor from a sirolimus‐based immunosuppression stabilizes fibrosis and the transforming growth factor‐β signalling pathway in kidney transplant

The focus in renal transplantation is to increase long‐term allograft survival. One of the limiting factors is calcineurin inhibitor (CNI)‐induced fibrosis. This study attempted to examine the histological aspect of interstitial fibrosis and the modulation of the transforming growth factor‐β (TGF‐β) canonical signalling pathway following early withdrawal of CNI from sirolimus‐based immunosuppressive therapy.

Estudo da morfologia renal após a oclusão da aorta abdominal infra-renal em ratos

OBJETIVO: Relacionar as alteracoes morfologicas renais sob microscopia de luz, de ratos submetidos a oclusao de aorta, em modelo que simule a condicao clinica de reparacao cirurgica de um aneurisma de aorta abdominal. METODO: Ratos Wistar (N = 60), machos pesando entre 200 e 250g, foram distribuidos em tres grupos: I (simulado); II (isquemia); III (isquemia + reperfusao); e cada grupo redistribuido em dois subgrupos: A (30 min); B (60 min). Foi realizada isquemia utilizando clamp vascular (8mm) na aorta abdominal infra-renal de acordo com o grupo estudado. Ao final de cada experimento os animais foram mortos e realizada analise histologica renal cortical e medular (descritiva e morfometrica) atraves de metodologia convencional (parafina-hematoxilinaeosina). A analise semiquantitativa de lesao tubular e intersticial foi realizada de acordo com o indice de lesao tubular e indice de lesao intersticial. Para a analise estatistica foram aplicados os seguintes testes: Mann-Whitney, Kruskal-Wallis, Comparacoes multiplas (p < 0,001). RESULTADOS: Observou-se no grupo III alteracoes histologicas tubulares e intersticiais significantes com relacao aos outros grupos (p < 0,001). CONCLUSOES: A oclusao da aorta abdominal infra-renal em ratos esta associada a lesoes estruturais renais tanto tubulares quanto intersticiais principalmente na fase de reperfusao.

The evaluation of sequential platelet counts has prognostic value for acute kidney injury patients requiring dialysis in the intensive care setting

OBJECTIVE: To evaluate the prognostic value of platelet counts in acute kidney injury patients requiring renal replacement therapy. METHODS: This prospective cohort study was performed in three tertiary-care hospitals. Platelet counts were obtained upon admission to the intensive care unit and during the first week of renal replacement therapy on days 1, 3, 5 and 7. The outcome of interest was the hospital mortality rate. With the aim of minimizing individual variation, we analyzed the relative platelet counts on days 3, 5, 7 and at the point of the largest variation during the first week of renal replacement therapy. Logistic regression analysis was used to test the prognostic value of the platelet counts. RESULTS: The study included 274 patients. The hospital mortality rate was 62%. The survivors had significantly higher platelet counts upon admission to the intensive care unit compared to the non-survivors [175.5×103/mm3 (108.5–259×103/mm3) vs. 148×103/mm3 (80−141×103/mm3)] and during the first week of renal replacement therapy. The relative platelet count reductions were significantly associated with a higher hospital mortality rate compared with the platelet count increases (70% vs. 44% at the nadir, respectively). A relative platelet count reduction >60% was significantly associated with a worse outcome (mortality rate = 82.6%). Relative platelet count variations and the percentage of reduction were independent risk factors of hospital mortality during the first week of renal replacement therapy. CONCLUSION: Platelet counts upon admission to the intensive care unit and at the beginning of renal replacement therapy as well as sequential platelet count evaluation have prognostic value in acute kidney injury patients requiring renal replacement therapy.

Alterações decorrentes do envelhecimento podem impedir a indetificação de indivíduos submetidos a radiografias da coluna lombar? Potencial contribuição da avaliação radiológica para a atividade forense

OBJECTIVE: The present study was aimed at evaluating the possibility of a radiological study of the lumbar spine determining the correct identification of an individual despite the changes associated with aging. MATERIALS AND METHODS: The study sample included 60 pairs of lumbar spine radiographic images of both male and female, adult patients of different ages, acquired at different times, at three-year minimum intervals. The pairs of images were mixed up so two experienced radiologists could put them back together. The vertebrae of each pair were compared for similarities and differences in anatomical details. Pairing criteria adopted were finding a specific anatomical variation or detail, or finding two or more similarities among anatomical details, with no point of divergence. RESULTS: Correct pairing of radiographs of the whole sample was achieved by both observers, who presented countless coincidence points in their analyses. The statistical analysis demonstrated a good-to-perfect interobserver agreement. CONCLUSION: Comparison between radiographic images of lumbar spine can determine a correct identification of individuals, despite changes associated with aging. Therefore, radiography represents a potential tool to be utilized in forensic identification studies.

Correction of Acidosis by Hemodialysis: Proposal of a Correlation with Urea Kinetics

Background/Aims: We examined the effect of hemodialysis (HD) on acid-base status and its relation to urea kinetics in clinically stable renal HD patients. The purpose of this study was to design a practical approach to monitoring the correction of acidosis, as it can be assisted by routine parameters of adequacy. Methods: Blood samples were drawn immediately before and after HD from 46 chronic renal patients to determine electrolytes, blood gases, serum albumin and blood urea nitrogen (BUN). Additional measurements of pH and serum bicarbonate were done in 35 patients in the periods before, immediately after and 4 h after HD. The normalized protein catabolic rate (nPCR) was calculated and correlated with the serum albumin and bicarbonate values before HD. Equilibrated KT/V (eKT/V) and urea reduction ratio (URR) were calculated and correlated with the degree of bicarbonate correction, defined as ΔHCO3–. Results: There was no correlation between nPCR and pre-HD HCO3–, while there was a significant correlation between URR and eKT/V and ΔHCO3– (p < 0.003). Conclusions: The Δbicarbonate was well correlated with URR and eKT/V, and the study suggests that in standard HD the correction of acidosis may be related to target URR and eKT/V levels.