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Biomedical subjects

R Sesso

Publications and source records attributed to R Sesso.

At least 19 recordsLinked to original sources
PubMed1997

Renal abnormalities in ankylosing spondylitis.

Renal abnormalities have been reported in Ankylosing Spondylitis (AS) patients. Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis, particularly the ones associated with deposition of IgA-containing immune complexes and the renal deposition of amyloid. These observations prompted us to evaluate in detail the frequency and severity of renal dysfunction in 40 AS patients, consecutively selected attending the rheumatology disease unit outpatient clinic at Escola Paulista de Medicina, using sensitive tests of glomerular and tubular function. Fourteen of the 40 patients presented one or more signs of renal involvement: microscopic hematuria (9 patients), microalbuminuria (4 patients), decreased renal function assessed by serum creatinine (2 patients), and creatinine clearance (4 patients). None of the patients presented increased urinary excretion of retinol binding protein (RBP). The finding of renal abnormalities in 35% of our patients suggests that in this illness evidence of renal involvement should be actively investigated.

Adolescent↗
PubMed1996

Late diagnosis of chronic renal failure and mortality on maintenance dialysis.

BACKGROUND: Recent observations in our country have shown that late diagnosis of chronic renal failure (CRF) is an important cause of late referral and late commencement of maintenance dialysis. We prospectively investigated the influence of late diagnosis of CRF on patient mortality during dialysis therapy. METHODS: Among 184 consecutive patients with nondiabetic end-stage renal disease starting chronic dialysis at the Federal University Hospital in the city of São Paulo, 106 had a late diagnosis of CRF (less than 1 month before starting dialysis) and 78 had an early diagnosis. During the first 6 months of dialysis treatment, patient survival was compared in the two groups, using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: Six-month patient survival rate was lower in the late than in the early diagnosis group (69% versus 87%, P < 0.01). In the late diagnosis group, the hazard ratio of mortality was 2.77 (95% CI, 1.36-5.66) times that of the early diagnosis group. In a multivariate analysis, after adjusting for age, comorbid illness, and serum biochemical measurements, time of diagnosis did not remain significantly associated with mortality risk. In this analysis, age, pulmonary infection, and low serum albumin were significant predictors of mortality. CONCLUSIONS: Patients with a late diagnosis have a higher mortality risk during the first 6 months of maintenance dialysis. This increased risk is related to comorbid conditions, some of which could be prevented by predialysis care. Interventions to promote early diagnosis of CRF and adequate predialysis follow-up need to be evaluated if the survival of patients with chronic renal failure is to improve.

Adolescent↗
PubMed1996

Acceptance for chronic dialysis treatment: insufficient and unequal.

BACKGROUND: Evidence suggests that a number of end-stage renal disease (ESRD) patients die without receiving dialysis. We investigated and compared ESRD patients who died without receiving treatment and those who were accepted for dialysis. METHODS: All patients starting chronic dialysis in 1991 in the city of Sao Paulo and prospectively registered in the Health Secretariat files were studied. From death certificates we obtained data from all patients dying with an underlying cause associated with chronic renal failure. Medical records from a sample of patients who died without receiving dialysis were reviewed. RESULTS: Of 2127 patients, 1582 (74.7%) received dialysis and 545 (25.6%) did not. The best chance of being dialysed occurred in the 20-29 age group. The age groups with the least chance of receiving dialysis were 0-9 years and over 79 years old. The odds ratio (95% Cl) of not receiving dialysis was 12.42 (6.63-23.82) times greater for patients over 60 years old compared to those aged 10-19 years. Patients with renal failure due to congenital diseases, chronic pyelonephritis, unknown cause, and hypertension were less likely to receive dialysis than those with glomerulonephritis or diabetes. CONCLUSIONS: Our results suggest that many ESRD patients die without receiving dialysis. Age and cause of renal disease influence the chance of being accepted for treatment. Restrictions of treatment need to be corrected to guarantee that maintenance dialysis will be accessible to ESRD patients.

Adolescent↗
PubMed1995

Predictors of mortality in long-term haemodialysis patients with a low prevalence of comorbid conditions.

BACKGROUND: Total and cardiovascular mortality rates for haemodialysis patients are still high despite the continuous improvement of dialysis technology. This trend may be a consequence of the increased number of elderly patients and patients with concurrent systemic diseases admitted to dialysis programmes. The objective of the present investigation was to determine the predictors of mortality more closely related to uraemic status and to dialysis treatment by studying relatively young haemodialysis patients with a low prevalence of comorbid conditions using the Cox proportional hazards model. METHODS: Seventy-four haemodialysis patients with a low prevalence of extrarenal diseases (mean age 44.5 +/- 12.1 years, mean dialysis duration 51.3 +/- 36.1 months) were submitted to extensive cardiological and clinical evaluation and followed prospectively for a median period of 60.8 months (range: 5.1-79.8). There were only three diabetics and all patients denied previous myocardial infarction. RESULTS: At follow-up 23 patients had died, 10 of cardiac causes. Five-year survival rates were 70% for overall mortality and 83% for cardiac mortality. Age over 44 years (relative risk 3.73; 95% confidence interval 1.35-10.26) and serum creatinine (inverse correlation) (relative risk 0.73; 95% confidence interval 0.57-0.94) were shown to be independently associated with global mortality by the Cox proportional hazards analysis. Gender, race, dialysis duration, interdialytic weight gain, angina, NYHA classification, hypertension, LV hypertrophy, LV systolic and diastolic dysfunction, complex ventricular arrhythmias and altered myocardial perfusion tests were not significant predictors of overall mortality. There were crude associations between cardiac mortality and cardiothoracic and Sokolow indices (P < 0.01) and age, NYHA classification, systolic hypertension, LV wall and septum hypertrophy, LV dilatation and complex ventricular arrhythmias (P < 0.05). CONCLUSION: In the absence of serious comorbid conditions, the survival of patients on long-term haemodialysis is influenced by nutritional status (as indicated by lower serum creatinine) and age.

Adult↗
PubMed1994

A controlled trial of pulse cyclophosphamide versus pulse methylprednisolone in severe lupus nephritis.

We carried out a prospective randomized trial comparing pulse cyclophosphamide and pulse methylprednisolone in 29 patients with severe lupus nephritis in activity. Patients were assigned to one of two regimens: monthly pulse cyclophosphamide (0.5-1.0 g/m2 body surface area) for 4 months, followed by bimonthly doses for 4 months and quarterly doses for 6 months (14 patients) or pulse methylprednisolone (10-20 mg/kg weight) initially for 3 consecutive days and thereafter in the same intervals as the alternative regimen (15 patients). The mean follow-up was 15 months. Two patients in the cyclophosphamide group and three in the methylprednisolone group died. Renal failure (doubling of serum creatinine) developed in four patients in the cyclophosphamide group compared with five patients in the methylprednisolone group. Cumulative probability of not doubling serum creatinine was similar for cyclophosphamide and methylprednisolone groups (0.66 vs 0.69, respectively, P > 0.20, after 18 months). Cumulative probability of survival without renal failure was also not significantly different (0.61 and 0.63, respectively, P > 0.20, after 18 months). These results suggest that pulse cyclophosphamide is as effective as pulse methylprednisolone in preserving renal function in patients with severe lupus nephritis.

Adult↗
PubMed1994

Effect of sodium fusidate and ofloxacin on Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis.

The effectiveness of sodium fusidate and ofloxacin to eliminate nasal and catheter exit-site Staphylococcus aureus colonization and to prevent infections was compared in 31 patients on continuous ambulatory peritoneal dialysis (CAPD). In a prospective randomized study, 9 patients were treated with topical 2% sodium fusidate ointment applied in the anterior nares and in the pericatheter skin twice daily for 5 days; 9 subjects received oral ofloxacin 200 mg taken every 48 hours for 5 days and 13 subjects were in the control group. Treatment courses were repeated at one-month intervals. Mean duration of follow-up was 7.8 months (242 patients-month). Follow-up samples from the nares and the catheter exit-site were obtained every month from all participants to determine the presence of S. aureus. Development of S. aureus exit-site infection and peritonitis were assessed. During the study, S. aureus was recovered from 45%, 59% and 52% of the samples from the nares and/or exit-site in the sodium fusidate, ofloxacin and control groups, respectively (p = 0.13). S. aureus grew less frequently (p < 0.01) in samples from the exit-site in the sodium fusidate than in the other two groups. Eradication of nasal colonization (two negative cultures within one month) was observed in 43%, 40% and 33% of the cases in the sodium fusidate, ofloxacin and control groups, respectively (p > 0.50). The corresponding figures for exit-site eradication were 43%, 33% and 11%, respectively (p = 0.34). Twenty-four S. aureus-associated infection episodes (12 of exit-site and 12 of peritonitis) were diagnosed in 16 of the 31 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1994

Assessment of lupus nephritis activity using urinary retinol-binding protein.

We evaluated the presence of proximal renal tubular dysfunction as measured by urinary retinol-binding protein (RBP) in 70 patients with systemic lupus erythematosus. Renal disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index. This is a clinical-laboratory score based on the principle of the physician's intention to treat. Increased urinary RBP (> 400 micrograms/l) was detected in 17 of 22 (77%) patients with active nephritis, six of 18 (33%) patients with probably active nephritis, one of nine (12%) cases with stable renal disease, and one of 21 (5%) cases without apparent renal disease (P < 0.01). Compared to initial values, mean urinary RBP decreased significantly in six patients evaluated after improvement of the exacerbation of renal disease. There was a positive correlation between urinary RBP and 24-h proteinuria (r = 0.40, P < 0.01), and an inverse correlation between urinary RBP and creatinine clearance (r = -0.60, P < 0.01). In a multivariate analysis adjusting for duration of disease, blood pressure, 24-h proteinuria, and creatinine clearance, mean urinary RBP continued to be significantly and progressively greater for patients with no renal disease, stable renal disease, probably active and active nephritis. Proximal tubular dysfunction is frequent in patients with active lupus nephritis. This association cannot be completely explained by the effects of increased total proteinuria, reduced glomerular filtration rate, and systemic hypertension. Urinary RBP seems to be a marker of renal disease activity. This test may be clinically useful to differentiate patients with active lupus nephritis from those with stable or absent renal disease.

Adolescent↗
PubMed1993

Effect of age and gender on kidney function in renal transplant donors: a prospective study.

We evaluated the long-term residual renal function in 64 living related kidney donors. Our main objective was to identify baseline factors, including gender and age, that could predict renal impairment after nephrectomy. Forty-four (69%) of the 64 donors were women. The mean +/- SEM age of those studied was 36 +/- 1.3 years and their mean +/- SEM duration of follow-up was 62 +/- 4.9 months (range, 6 to 174). Overall mean serum creatinine concentration after kidney donation was increased compared to baseline values (1.13 mg/dl vs 0.92 mg/dl, respectively, p < 0.001). At the last follow-up visit, post-nephrectomy mean glomerular filtration rate (GFR) values, adjusted for body surface area, age at donation, baseline serum creatinine and duration of follow-up, measured by 99mTc-DTPA were significantly lower in women than in men (72.11 ml/min vs 87.17 ml/min, respectively, p = 0.02). At follow-up, mean effective renal plasma flow, adjusted for the same variables, measured by 131I-hippuran was also significantly lower in women compared to men (318.07 ml/min vs 400.82 ml/min, respectively, p < 0.01). Eleven of twelve patients with post-nephrectomy GFR values less than 60 ml/min were women. Following nephrectomy, serum creatinine concentration increased significantly as a function of greater age at donation in women but not in men. Similarly, in women but not in men, follow-up GFR measurements decreased significantly as a function of age after adjusting for baseline serum creatinine and duration of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Kidney transplantation from living unrelated donors.

OBJECTIVE: To compare patient and graft survival of recipients of kidneys from living, unrelated donors (LUDs); cadaveric donors; and living, related donors (LRDs) matched for zero (mismatched), one, or two (identical) haplotypes. DESIGN: Cohort study. SETTING: Sixty-three renal transplantation centers affiliated with the Brazilian Transplantation Registry (accounting for more than 95% of the transplantation activity in Brazil). PATIENTS: Patients having renal transplantation between January 1987 and March 1991. Of 2892 patients, 165 (6%) received transplants from LUDs; 964 (33%), from cadaveric donors; 183 (6%), from zero haplotype, HLA-matched LRDs; 1259 (44%), from one haplotype-matched LRDs; and 321 (11%), from two haplotype-matched LRDs. MEASUREMENTS: Patient and graft survival. Patients were followed for an average of 15.8 months. RESULTS: After adjustment for age, race, diagnosis of primary disease, history of previous transplantation, cyclosporine use, and number of transplants from LUDs per center, patient survival did not differ statistically for recipients of kidneys from LUDs and recipients of cadaveric kidneys (risk ratio [RR], 1.16; 95% Cl, 0.68 to 1.98). Little difference was seen between the adjusted death rate for recipients of zero haplotype-matched LRDs and recipients of cadaveric kidneys (RR, 1.13; Cl, 0.69 to 1.87). Similarly, in a multivariate analysis, recipients of kidneys taken from LUDs and zero haplotype-matched LRDs had a risk for graft failure that did not differ statistically from that of cadaveric kidney recipients (RR, 0.74; Cl, 0.45 to 1.22 and RR, 0.82; Cl, 0.53 to 1.25, respectively). CONCLUSIONS: Graft survival for recipients of kidneys from LUDs is similar to that from zero haplotype-matched LRDs and is at least as good as that achieved with cadaveric transplants.

Adolescent↗
PubMed1992

Prediction of steroid responsiveness in the idiopathic nephrotic syndrome using urinary retinol-binding protein and beta-2-microglobulin.

OBJECTIVES: To determine the prevalence of early proximal tubular dysfunction, measured by urinary excretion of retinol-binding protein (RBP) and beta-2-microglobulin (B2M), in patients with the idiopathic nephrotic syndrome and to investigate the value of these tests in predicting steroid responsiveness. DESIGN: Before-after trial with 8-week treatment period. SETTING: Tertiary referral center. PATIENTS: Sequential sample of 37 patients with the idiopathic nephrotic syndrome caused by minimal change disease, focal segmental glomerulosclerosis, or mesangial proliferative glomerulonephritis. INTERVENTION: All patients were treated with prednisone as one dose of 1 to 1.5 mg/kg body weight per day for 8 weeks. MEASUREMENTS: Urinary RBP was measured by an immunoenzymometric assay and B2M, by an enzyme-linked immunosorbent assay. Remission of the nephrotic syndrome after steroid treatment was the main outcome variable. RESULTS: Elevated levels of urinary RBP and B2M before treatment were detected in 65% and 75% of the patients, respectively. Median urinary RBP and B2M, before treatment, were significantly higher in the steroid-unresponsive group than in the responsive group (P less than 0.01). In the steroid-responsive group, urinary RBP and B2M levels decreased significantly after remission (P less than 0.01). In the steroid-unresponsive group, the likelihood ratios for urinary RBP greater than 4000 micrograms/g creatinine and for B2M greater than 3000 micrograms/g creatinine were 3.8 and 3.0, respectively. The probability was 100% that values of RBP of less than 1300 micrograms/g creatinine and B2M of less than 130 micrograms/g creatinine were from steroid-responsive patients. Multivariate analysis confirmed that higher urinary levels of RBP and B2M were associated with a lower likelihood of steroid responsiveness, independent of age and histologic diagnosis. CONCLUSIONS: Proximal tubular dysfunction is frequent in patients with the idiopathic nephrotic syndrome. Pretreatment urinary RBP and B2M levels may be helpful in identifying nephrotic patients who are more likely to be responsive to steroids.

Adolescent↗
PubMed1991

Use of antimicrobial susceptibility testing for epidemiology and the selection of oral, parenteral and topical regimens for control of CAPD-associated Staphylococcus aureus infection.

Staphylococcus aureus is an important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Using standard broth microdilution and disk diffusion methodology, we evaluated the in vitro activity of selected antimicrobial agents against S. aureus strains isolated from CAPD patients to assess candidate regimens for 1) topical agent control of colonization, 2) oral chemotherapy of CAPD infectious complications, and 3) parenteral treatment of serious CAPD-associated staphylococcal infections. A total of 34 isolates (31 patients) of S. aureus were available for testing, including 29 isolates (29 patients) from pericatheter skin, four isolates (four patients) from the nares, and one isolate from an episode of peritonitis. Six of the isolates were oxacillin-resistant (ORSA). The antimicrobial agents tested by broth microdilution included 17 different quinolones, 10 cephalosporins, six glycopeptides, two aminoglycosides, and imipenem. A total of eight potential topical agents, including the antistaphylococcal agent mupirocin, were tested by disk diffusion. All of the quinolones, with the exception of nalidixic acid (MIC90 greater than 16 micrograms/ml), had excellent activity against both ORSA and oxacillin-susceptible S. aureus (OSSA) with the most active agent being WIN57273 (MIC90 less than or equal to 0.015 microgram/ml). Imipenem and the cephalosporins, with the exception of cefixime, ceftazidime, and E-1040, possessed good activity against OSSA. None of the beta-lactam agents tested were active against ORSA. Likewise, the aminoglycosides, amikacin and gentamicin, exhibited good activity against OSSA strains but no activity against ORSA strains. All glycopeptides tested demonstrated excellent activity against ORSA strains. Of the topical antimicrobial agents tested only bacitracin, mupirocin, and nitrofurantoin were active against all OSSA and ORSA strains tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1990

Cost-effectiveness analysis of the treatment of end-stage renal disease in Brazil.

Cost-effectiveness analysis compared four treatments of end-stage renal disease in Brazil: continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (HD), cadaver donor transplantation (CD-Tx), and living related donor transplantation (LR-Tx). After 2 years, the costs per year of survival were CAPD, $12,134; HD, $10,065; CD-Tx, $6,978; and LR-Tx, $3,022. The HD cost was lower than CAPD partially because of the reuse of hemodialyzers in Brazil. Although less cost-effective, both dialysis treatments yielded more years of survival after 2 years. This analysis reveals a trade-off between cost per year of survival and years of survival.

Adolescent↗
PubMed1990

Survival analysis of 1563 renal transplants in Brazil: report of the Brazilian Registry of Renal Transplantation.

Little is known about renal transplantation activity in developing countries. The objective of this study was to evaluate patient and graft survival among the different types of renal transplant recipients in Brazil. The study population consisted of 1563 patients receiving renal grafts for the first time between 1 October 1987 and 31 December 1989 in 49 transplant centres in Brazil. Data were prospectively collected through individual patient questionnaires. Of the 1563 transplantations performed, 1051 (67%) were from living donors, 467 (30%) from cadaver donors, and 45 (3%) unspecified. A total of 963 (62%) transplants came from living related donors (10% HLA-identical, 45% HLA-haploidentical and 6% HLA-distinct). Among the transplant recipients, only 7% were more than 55 years old, 5% were younger than 15 and 4% had diabetes mellitus. Blacks accounted for 24% of patients receiving transplants. An immunosuppressive regimen, including cyclosporin was used in 75% of cadaver kidney recipients, in 42% of living donor kidney recipients; and in 43% and 75% of HLA-haploidentical and HLA-distinct living related donor recipients, respectively. At 2 years, patient survival for living donor and cadaver donor transplant recipients was 89% and 80% respectively, and graft survival was 76% and 61% respectively. Patient survival for recipients of HLA-identical, haploidentical, and distinct living related donor kidneys was respectively 94%, 90%, and 81% at 2 years, and graft survival was 90%, 75%, and 65% respectively. Graft survival for recipients of HLA-distinct living related donor and non-related donor kidneys compared to cadaver donor kidneys was not significantly different at 2 years (63% vs 61%, P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis.

Staphylococcus aureus is the most common cause of peritonitis in patients undergoing peritoneal dialysis in Brazil. Using restriction endonuclease analysis of plasmid DNA, we investigated the importance of chronic carriage of S. aureus in the development of peritonitis in patients on continuous ambulatory peritoneal dialysis at the Division of Nephrology, Escola Paulista de Medicina, Sao Paulo, Brazil. A total of 117 isolates (30 patients) of S. aureus were available for typing, including 51 isolates (22 patients) from the nares, 58 isolates (27 patients) from pericatheter skin, and 8 isolates (6 patients) from peritoneal fluid, from patients with peritonitis. Restriction endonuclease subtyping showed that although most patients harbored more than one subtype of S. aureus, in the majority of patients nasal and/or pericatheter skin isolates with identical restriction endonuclease digest patterns were recovered on more than one occasion. Furthermore, 95% of patients with both nasal and pericatheter colonization were colonized with the same subtypes at both sites. All of the patients with peritonitis were infected with a subtype which colonized the nares, pericatheter skin, or both. These results demonstrate the importance of an endogenous source of S. aureus in the development of continuous ambulatory peritoneal dialysis-associated peritonitis.

Carrier State↗
PubMed1990

Exposure to hydrocarbons and rapidly progressive glomerulonephritis.

1. A case-control study of the relationship between the regular exposure to hydrocarbons and rapidly progressive glomerulonephritis (GN) was carried out in São Paulo, Brazil. Regular exposure was defined as 1 h or more weekly for 3 consecutive months or longer. We studied 17 patients with rapidly progressive renal failure and biopsy-proven crescentic GN and 34 matched hospital controls. 2. We found an increased risk of rapidly progressive GN associated with exposure to organic solvents (relative risk = 5.00; 95% confidence interval = 1.14 to 22.00). The frequency of exposure to solvents was 52.9% among the patients and 17.7% among the control subjects (P less than 0.05). However, no statistically significant increased risk was detected in those patients who had been exposed to fuels (relative risk = 3.25; 95% confidence interval = 0.76 to 13.89); the proportion of exposure to fuels was 47.1% among the patients and 20.6% among the control subjects. 3. Renal histologic findings suggest that immune complex mediated injury as well as a direct glomerular toxic effect may participate in the pathogenesis of rapidly progressive GN associated with hydrocarbon exposure.

Adolescent↗