Hugo Abensur - Academia.edu (original) (raw)
Papers by Hugo Abensur
Brazilian Journal of Nephrology, 2014
Romão Jr e cols Insuficiência renal aguda e cirurgia cardíaca em lactentes
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2007
Latin America is a heterogeneous region comprised of 20 countries, former colonies of European co... more Latin America is a heterogeneous region comprised of 20 countries, former colonies of European countries, in which Latin-derived languages are spoken. According to the Latin American Society of Nephrology and Hypertension/ Sociedad Latino Americana de Nefrologia e Hipertensión (SLANH), the acceptance rate for renal replacement therapy is 103 new patients per million population. In Latin America, hemodialysis is the predominant form of replacement therapy for end-stage renal disease; however, some countries employ peritoneal dialysis (PD) in 30% or more patients. In particular, Mexico is the country with the largest PD utilization in the world, and furthermore, it is estimated that approximately 25% of the world's PD population may be found Latin America. Data concerning clinical practice and long-term outcome of PD in Latin America are scarce, although regional registries are increasing in number and quality. In this review article, we present an overview of the situation of PD ...
J Bras Nefrol, Dec 1, 2007
Profile of Patients with End-Stage Renal Disease before Starting Renal Replacement Therapy, deriv... more Profile of Patients with End-Stage Renal Disease before Starting Renal Replacement Therapy, derived from a Tertiary Nephrology Center RESUMO Objetivos: Analisar as caracteristicas dos portadores de doenca renal cronica (DRC) quando encaminhados a terapia renal substitutiva (TRS) do ambulatorio de nefrologia de um hospital terciario. Materiais e metodos: Foram analisados retrospectivamente dados epidemiologicos, clinicos e laboratoriais de 246 pacientes com DRC encaminhados para TRS entre janeiro de 2004 e janeiro de 2006. Resultados: 50,6% eram homens, com 54,5±15,5 anos [...]
Revista do Instituto de Medicina Tropical de São Paulo, 1992
Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In t... more Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (p<0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membra-noproliferative glomerulonephri...
Transplantation Proceedings, 2007
Sirolimus (SRL) is a potent immunosuppressive drug used in organ transplantation for prophylaxis ... more Sirolimus (SRL) is a potent immunosuppressive drug used in organ transplantation for prophylaxis of acute allograft rejection. Conversion from calcineurin inhibitors to SRL has become an important alternative in patients with chronic allograft nephropathy. Recently, some reports have described the appearance of proteinuria after the use of SRL. The aim of the present study was to describe the incidence of proteinuria in transplant recipients receiving SRL in our transplant center. We studied 78 patients receiving SRL either de novo or after conversion. Eighteen transplant recipients (23.1%) developed proteinuria after SRL treatment. Proteinuria was diagnosed at 11.2 Ϯ 2.1 months after the initiation of SRL; in eight patients (44.4%) it occurred in the first 6 months. The mean value of proteinuria was 2.6 Ϯ 0.6 g/24 hours. In 5 patients (27.8%), proteinuria reached nephrotic levels, and in 13 patients (72.2%) was associated with edema. Renal allograft biopsies were performed before conversion to SRL, and a new biopsy, after the appearance of proteinuria. The light microscopy of biopsies performed after the onset of proteinuria showed no specific glomerular changes, except in 2 cases wherein the diagnosis was focal segmental glomerulosclerosis. Immunofluorescence was negative in all cases. In conclusion, in this study proteinuria was observed in 21.3% of patients receiving SRL therapy either as de novo protocol or after conversion to SRL. Proteinuria occurred early after the initiation of SRL therapy and in these cases, withdrawal of SRL was associated with reversion of proteinuria.
Transplantation Proceedings, 2006
Pancreas transplantation alone (PTA) has become an accepted treatment of nonuremic diabetic patie... more Pancreas transplantation alone (PTA) has become an accepted treatment of nonuremic diabetic patients, when the risks of secondary complications of diabetes mellitus are greater than those of the surgical procedure and the posttransplant immunosuppression. As a decrease in native renal function is expected, we followed this parameter among patients who underwent PTA. From January 1997 through January 2005, we performed 69 PTA in 66 patients. All patients showed glucose hyperlability with hypoglycemic unawareness, or two or more diabetic complications as well as creatinine clearance (CrCl) Ն 45 mL/min. Immunosuppression was based on tacrolimus, mycophenolate mofetil and prednisone. Twenty-four hour CrCl were performed after all successful PTA. We divided patients in two groups according to the pretransplant CrCl: group 1, CrCl Յ 70 mL/min (n ϭ 20) and group 2, CrCl Ͼ 70 mL/min (n ϭ 25). The data were analyzed using Student's t-test (P Յ .05 was considered significant). Twenty-one patients were excluded from the analysis because of death (n ϭ 5) or graft loss (n ϭ 8) during the first year or follow-up shorter than 1 year (n ϭ 8). The mean value of CrCl decreased 28.8% (85.0 Ϯ 31 versus 60.5 Ϯ 36 mL/min; P Ͻ .001). There was also a 39.3% reduction among group 1 subjects (P ϭ .003), including 10 who displayed CrCl Յ 30 mL/min. There was also a 24.4% reduction among group 2 (P ϭ .008), but no patient developed end-stage renal disease. In conclusion, native renal function decreased significantly after PTA, but was well tolerated among patients with CrCl Ͼ 70 mL/min. Patients with CrCl Ͻ 70 mL/min show a significant risk of worsened renal function.
Transplantation Proceedings, 2006
The optimal immunosuppressive regimen for simultaneous kidney pancreas transplantation (SKPT) is ... more The optimal immunosuppressive regimen for simultaneous kidney pancreas transplantation (SKPT) is still not established. We conducted a study to compare the safety and efficacy of no induction versus anti-IL-2 receptor induction protocols in SKPT recipients receiving the same maintenance regimen. Methods. Sixty-three SKPT recipients were divided into two groups: no induction group (n ϭ 42) and anti-IL-2 receptor induction group (n ϭ 21). All patients were maintained on tacrolimus, mycophenolate mofetil, and prednisone. Primary endpoints were 1-year acute rejection incidence and patient and graft survivals. Results. Demographic characteristics were similar between the groups. Acute rejection incidence at 1 year was equal in both groups (28.6%). Kidney and pancreas allograft survival in the no induction group were 78.6% and 76.2%, and in the anti-IL-2R induction group, 81% and 71.4%, respectively (P ϭ NS). Patient survival was also similar: 83.3% in the no induction versus 85.7% in the anti-IL-2R induction group. Deaths due to sepsis were higher in the anti-IL-2R induction group, albeit not significantly. Conclusion. The use of a no-induction protocol in SKPT is safe and effective immunosuppression that also reduces transplantation costs.
Transplantation Proceedings, 2002
Transplantation, 2004
In this retrospective analysis, demographic features of a transplantation outpatient clinic that ... more In this retrospective analysis, demographic features of a transplantation outpatient clinic that follows kidney recipients transplanted in both Turkey and different regions of the world, was analyzed. Methods: The patients were divided into 4 main groups: 1. Those being followed up with functioning grafts (n:432), 2. Those who lost their grafts (n:218), 3. Those who died (n: 135) and those who lost to follow up (n:70). Every group was subgrouped as either having cadaver (CT) or live donor transplantation (LT) performed in: A. In our institute (ICT:147, ILT:304) B. Other institutions in Turkey (TCT: 16, TLT:86), C. Foreign countries (FCT:66, FLT:154). Results: The patients with functioning grafts, FLT transplantations (which vast majority was paid transplantations) constituted the second largest group (n:105), following ILT (214.). In the ILT group, five and 10 year graft survival rates were 77% and 45%, respectively and patient survival rates were 87% and 77%, respectively. Considering FLT group, five and 10 year graft survival figures were 65% and 34%, while patient survival rates in these periods were 79% and 65. Patients with paid transplantations were characterized by high risk of unconventional infectious complications in the early period, while mid-term patient and graft survival was somewhat better, than that expected considering the high rate of complications in the early period. Conclusions: Paid organ transplantation should be discouraged and organ donation should be stimulated by every means to avoid potentially fatal unconventional infections of paid transplantation. If patients receive a paid transplant, however, they should be closely followed-up for these complications, since if they can survive the early period, quite reasonable mid-term outcomes can be expected in the long term.
Transplantation, 2006
Reports on the use of sirolimus (SRL) in pancreas transplantation are still limited. The aim of t... more Reports on the use of sirolimus (SRL) in pancreas transplantation are still limited. The aim of this study was to evaluate the outcome of SRL conversion in pancreas transplant patients. Among 247 patients undergoing simultaneous kidney-pancreas or solitary pancreas transplantation, 33 (13%) were converted to SRL. The reasons for conversion were calcineurin inhibitors (CNI) nephrotoxicity (n ϭ 24; 73%), severe neurotoxicity owing to CNI (n ϭ 1; 3%), severe and/or recurrent acute rejection episodes (n ϭ 7; 21%), gastrointestinal (GI) side effects of mycophenolate mofetil (MMF; n ϭ 5; 15%), and hyperglycemia (n ϭ 4; 12%).
Nephron, 1998
Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialytic treatm... more Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialytic treatment, and the most adequate dialysis therapy in the management of these pregnant patients has not been established. During the period 1988–1995, we estudied the outcome of 17 pregnancies in dialyzed females, with an average age of 28.2±5.9 years (range: 18–38 years). Seven women had adequate urine volume (>800 ml/24 h). Five patients started dialysis after conception and the remaining 12 pregnancies were diagnosed after 6–72 months on dialysis. Fourteen women were maintained on hemodialysis (HD) and 3 on continuous ambulatory peritoneal dialysis (CAPD). The HD schedule was increased to 3 h 5–6 times weekly, and CAPD was increased to six 2-liter exchanges/day. Mean serum urea was 78.6 ± 27.4 mg/dl (range 45–110); serum creatinine was 6.5 ± 3.7 mg/dl (3.3–9.8 mg/dl); and hematocrit was 28.9 ± 3.3 vol% (22–35 vol%). Anemia was partially controlled with rHuEpo in 8 patients. Significant pr...
Nephrology Dialysis Transplantation, 2010
During haemodialysis, calcium balance can affect, or be affected by, mineral metabolism. However,... more During haemodialysis, calcium balance can affect, or be affected by, mineral metabolism. However, when dialysate calcium concentration (d[Ca]) is chosen or kinetic models are employed to calculate calcium balance, bone remodelling is rarely considered. In this study, we examined whether bone remodelling affects calcium mass transfer during haemodialysis. We dialysed 23 patients using a d[Ca] of 1.0, 1.25, 1.5 or 1.75 mmol/L. Calcium mass transfer was measured and associated with remodelling bone factors. Calcium balance varied widely depending on the d[Ca]. Calcium removal was -578 +/- 389, -468 +/- 563, +46 +/- 400 and +405 +/- 413 mg when a d[Ca] of 1.0, 1.25, 1.5 or 1.75 mmol/L was used, respectively (1.0 and 1.25 vs 1.5 and 1.75 mmol/L, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; 1.5 vs 1.75 mmol/L, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Univariate analysis showed that calcium balance correlated with calcium gradient, parathyroid hormone (PTH), osteocalcin and dialysis vintage. Multivariate analysis revealed that calcium balance was dependent on calcium gradient, PTH and osteocalcin. These results suggest that bone remodelling could affect calcium mass transfer during haemodialysis.
Clinical Infectious Diseases, 2009
Background. Solid-organ transplant (SOT) recipients are classically considered to be at increased... more Background. Solid-organ transplant (SOT) recipients are classically considered to be at increased risk for listeriosis. However, risk factors for this infection have not been assessed. Methods. We carried out a multicenter, matched case-control study (1:2 ratio) from January 1995 through December 2007. Control subjects were matched for center, transplant type, and timing. Conditional logistic regression was performed to identify independent risk factors. Clinical features and outcomes for all case patients were reviewed. Results. Thirty patients (0.12%) with cases of listeriosis were identified among 25,997 SOT recipients at 15 Spanish transplant centers. In a comparison of case patients with 60 matched control subjects, the following independent risk factors for listeriosis were identified: diabetes mellitus (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6-19.6;), history of cytomegalovirus infection or disease within the preceding 6 months P p .007 (OR, 35.9; 95% CI, 2.1-620;), receipt of high-dose prednisone within the preceding 6 months (OR, 6.2; P p .014 95% CI, 1.8-21.1;), and trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis (OR, 0.07; 95% CI, P p .003 0.006-0.76;). Twenty-six patients (86.7%) had bacteremia, and 7 had shock at presentation. Other P p .029 manifestations included meningoencephalitis (10 cases), spontaneous peritonitis (2), pleural empyema (1), brain abscesses (1), and liver abscesses (1). The 30-day mortality rate was 26.7% (8 of 30 patients died). Conclusions. Listeriosis in SOT recipients is uncommon but causes high mortality. Diabetes mellitus, cytomegalovirus infection or disease, and receipt of high-dose steroids are independent risk factors for this infection, whereas TMP-SMZ prophylaxis is a protective factor. Listeria monocytogenes is an environmental gram-positive, motile bacillus which has the ability to survive and multiply in phagocytic host cells. The main route of infection acquisition is through the intestinal tract after ingestion of contaminated food products, as well
British Journal of Dermatology, 2012
164:553–9. 7 Binymin K, Cooper RG. Late reactivation of spinal tuberculosis by low-dose methotrex... more 164:553–9. 7 Binymin K, Cooper RG. Late reactivation of spinal tuberculosis by low-dose methotrexate therapy in a patient with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40:341–2. 8 Benson J, Peritt D, Scallon BJ et al. Discovery and mechanism of ustekinumab: a human monoclonal antibody targeting interleukin-12 and interleukin-23 for treatment of immune-mediated disorders. MAbs 2011; 3:535–45.
J. bras. …, 1991
Base de dados : LILACS. Pesquisa : 115252 [Identificador único]. Referências encontradas : 1 [ref... more Base de dados : LILACS. Pesquisa : 115252 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. Abensur, Hugo. experimental, Documentos relacionados. Id: 115252 ...
J. Bras. …, 1999
Page 1. 112 J. Bras. Nefrol. 1999; 21(3): 112-123 Peritonite esclerosante e encapsulante secundár... more Page 1. 112 J. Bras. Nefrol. 1999; 21(3): 112-123 Peritonite esclerosante e encapsulante secundária à diálise peritoneal ambulatorial contínua David José de Barros Machado, João Egidio Romão Jr., Emil Sabbaga, Marcello Marcondes Machado, Hugo Abensur ...
Einstein
Expression of cytotoxic mediators (perforin, granzyme B, FAS, and FAS-l) in renal allograft biops... more Expression of cytotoxic mediators (perforin, granzyme B, FAS, and FAS-l) in renal allograft biopsies ... Expression of cytotoxic mediators (perforin, granzyme B, FAS, ... Expressão de mediadores citotóxicos (perforina, granzima B, FAS e FAS-l) em biópsias de
American Journal of Nephrology, 2008
Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the ... more Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the factors associated with the origin of OSA as well as the cardiovascular consequences in this population are not completely understood. We evaluated, by standard overnight polysomnography, 24-hour ambulatory blood pressure (BP) monitoring and echocardiography in 30 patients (14 males, age 34 ± 11 years, BMI 23.2 ± 5.2) – 15 on short daily hemodialysis (SDH) and 15 matched patients on conventional hemodialysis (CHD). The hemodialysis dose (standard Kt/V) was higher in patients on SDH than on CHD (p = 0.001). OSA (apnea-hypopnea index >5 events/h) was present in 13 patients (43%). Patients with OSA were predominantly males (77 vs. 44%), presented a higher BMI (25.5 ± 6.2 vs. 21.5 ± 3.6), a larger neck circumference (38 ± 1 vs. 34 ± 1 cm) and a lower Kt/V (2.6 ± 0.3 vs. 2.2 ± 0.1) than patients with no OSA (p < 0.05). Neck circumference and lower Kt/V were independently associated with...
Brazilian Journal of Nephrology, 2014
Romão Jr e cols Insuficiência renal aguda e cirurgia cardíaca em lactentes
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2007
Latin America is a heterogeneous region comprised of 20 countries, former colonies of European co... more Latin America is a heterogeneous region comprised of 20 countries, former colonies of European countries, in which Latin-derived languages are spoken. According to the Latin American Society of Nephrology and Hypertension/ Sociedad Latino Americana de Nefrologia e Hipertensión (SLANH), the acceptance rate for renal replacement therapy is 103 new patients per million population. In Latin America, hemodialysis is the predominant form of replacement therapy for end-stage renal disease; however, some countries employ peritoneal dialysis (PD) in 30% or more patients. In particular, Mexico is the country with the largest PD utilization in the world, and furthermore, it is estimated that approximately 25% of the world's PD population may be found Latin America. Data concerning clinical practice and long-term outcome of PD in Latin America are scarce, although regional registries are increasing in number and quality. In this review article, we present an overview of the situation of PD ...
J Bras Nefrol, Dec 1, 2007
Profile of Patients with End-Stage Renal Disease before Starting Renal Replacement Therapy, deriv... more Profile of Patients with End-Stage Renal Disease before Starting Renal Replacement Therapy, derived from a Tertiary Nephrology Center RESUMO Objetivos: Analisar as caracteristicas dos portadores de doenca renal cronica (DRC) quando encaminhados a terapia renal substitutiva (TRS) do ambulatorio de nefrologia de um hospital terciario. Materiais e metodos: Foram analisados retrospectivamente dados epidemiologicos, clinicos e laboratoriais de 246 pacientes com DRC encaminhados para TRS entre janeiro de 2004 e janeiro de 2006. Resultados: 50,6% eram homens, com 54,5±15,5 anos [...]
Revista do Instituto de Medicina Tropical de São Paulo, 1992
Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In t... more Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (p<0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membra-noproliferative glomerulonephri...
Transplantation Proceedings, 2007
Sirolimus (SRL) is a potent immunosuppressive drug used in organ transplantation for prophylaxis ... more Sirolimus (SRL) is a potent immunosuppressive drug used in organ transplantation for prophylaxis of acute allograft rejection. Conversion from calcineurin inhibitors to SRL has become an important alternative in patients with chronic allograft nephropathy. Recently, some reports have described the appearance of proteinuria after the use of SRL. The aim of the present study was to describe the incidence of proteinuria in transplant recipients receiving SRL in our transplant center. We studied 78 patients receiving SRL either de novo or after conversion. Eighteen transplant recipients (23.1%) developed proteinuria after SRL treatment. Proteinuria was diagnosed at 11.2 Ϯ 2.1 months after the initiation of SRL; in eight patients (44.4%) it occurred in the first 6 months. The mean value of proteinuria was 2.6 Ϯ 0.6 g/24 hours. In 5 patients (27.8%), proteinuria reached nephrotic levels, and in 13 patients (72.2%) was associated with edema. Renal allograft biopsies were performed before conversion to SRL, and a new biopsy, after the appearance of proteinuria. The light microscopy of biopsies performed after the onset of proteinuria showed no specific glomerular changes, except in 2 cases wherein the diagnosis was focal segmental glomerulosclerosis. Immunofluorescence was negative in all cases. In conclusion, in this study proteinuria was observed in 21.3% of patients receiving SRL therapy either as de novo protocol or after conversion to SRL. Proteinuria occurred early after the initiation of SRL therapy and in these cases, withdrawal of SRL was associated with reversion of proteinuria.
Transplantation Proceedings, 2006
Pancreas transplantation alone (PTA) has become an accepted treatment of nonuremic diabetic patie... more Pancreas transplantation alone (PTA) has become an accepted treatment of nonuremic diabetic patients, when the risks of secondary complications of diabetes mellitus are greater than those of the surgical procedure and the posttransplant immunosuppression. As a decrease in native renal function is expected, we followed this parameter among patients who underwent PTA. From January 1997 through January 2005, we performed 69 PTA in 66 patients. All patients showed glucose hyperlability with hypoglycemic unawareness, or two or more diabetic complications as well as creatinine clearance (CrCl) Ն 45 mL/min. Immunosuppression was based on tacrolimus, mycophenolate mofetil and prednisone. Twenty-four hour CrCl were performed after all successful PTA. We divided patients in two groups according to the pretransplant CrCl: group 1, CrCl Յ 70 mL/min (n ϭ 20) and group 2, CrCl Ͼ 70 mL/min (n ϭ 25). The data were analyzed using Student's t-test (P Յ .05 was considered significant). Twenty-one patients were excluded from the analysis because of death (n ϭ 5) or graft loss (n ϭ 8) during the first year or follow-up shorter than 1 year (n ϭ 8). The mean value of CrCl decreased 28.8% (85.0 Ϯ 31 versus 60.5 Ϯ 36 mL/min; P Ͻ .001). There was also a 39.3% reduction among group 1 subjects (P ϭ .003), including 10 who displayed CrCl Յ 30 mL/min. There was also a 24.4% reduction among group 2 (P ϭ .008), but no patient developed end-stage renal disease. In conclusion, native renal function decreased significantly after PTA, but was well tolerated among patients with CrCl Ͼ 70 mL/min. Patients with CrCl Ͻ 70 mL/min show a significant risk of worsened renal function.
Transplantation Proceedings, 2006
The optimal immunosuppressive regimen for simultaneous kidney pancreas transplantation (SKPT) is ... more The optimal immunosuppressive regimen for simultaneous kidney pancreas transplantation (SKPT) is still not established. We conducted a study to compare the safety and efficacy of no induction versus anti-IL-2 receptor induction protocols in SKPT recipients receiving the same maintenance regimen. Methods. Sixty-three SKPT recipients were divided into two groups: no induction group (n ϭ 42) and anti-IL-2 receptor induction group (n ϭ 21). All patients were maintained on tacrolimus, mycophenolate mofetil, and prednisone. Primary endpoints were 1-year acute rejection incidence and patient and graft survivals. Results. Demographic characteristics were similar between the groups. Acute rejection incidence at 1 year was equal in both groups (28.6%). Kidney and pancreas allograft survival in the no induction group were 78.6% and 76.2%, and in the anti-IL-2R induction group, 81% and 71.4%, respectively (P ϭ NS). Patient survival was also similar: 83.3% in the no induction versus 85.7% in the anti-IL-2R induction group. Deaths due to sepsis were higher in the anti-IL-2R induction group, albeit not significantly. Conclusion. The use of a no-induction protocol in SKPT is safe and effective immunosuppression that also reduces transplantation costs.
Transplantation Proceedings, 2002
Transplantation, 2004
In this retrospective analysis, demographic features of a transplantation outpatient clinic that ... more In this retrospective analysis, demographic features of a transplantation outpatient clinic that follows kidney recipients transplanted in both Turkey and different regions of the world, was analyzed. Methods: The patients were divided into 4 main groups: 1. Those being followed up with functioning grafts (n:432), 2. Those who lost their grafts (n:218), 3. Those who died (n: 135) and those who lost to follow up (n:70). Every group was subgrouped as either having cadaver (CT) or live donor transplantation (LT) performed in: A. In our institute (ICT:147, ILT:304) B. Other institutions in Turkey (TCT: 16, TLT:86), C. Foreign countries (FCT:66, FLT:154). Results: The patients with functioning grafts, FLT transplantations (which vast majority was paid transplantations) constituted the second largest group (n:105), following ILT (214.). In the ILT group, five and 10 year graft survival rates were 77% and 45%, respectively and patient survival rates were 87% and 77%, respectively. Considering FLT group, five and 10 year graft survival figures were 65% and 34%, while patient survival rates in these periods were 79% and 65. Patients with paid transplantations were characterized by high risk of unconventional infectious complications in the early period, while mid-term patient and graft survival was somewhat better, than that expected considering the high rate of complications in the early period. Conclusions: Paid organ transplantation should be discouraged and organ donation should be stimulated by every means to avoid potentially fatal unconventional infections of paid transplantation. If patients receive a paid transplant, however, they should be closely followed-up for these complications, since if they can survive the early period, quite reasonable mid-term outcomes can be expected in the long term.
Transplantation, 2006
Reports on the use of sirolimus (SRL) in pancreas transplantation are still limited. The aim of t... more Reports on the use of sirolimus (SRL) in pancreas transplantation are still limited. The aim of this study was to evaluate the outcome of SRL conversion in pancreas transplant patients. Among 247 patients undergoing simultaneous kidney-pancreas or solitary pancreas transplantation, 33 (13%) were converted to SRL. The reasons for conversion were calcineurin inhibitors (CNI) nephrotoxicity (n ϭ 24; 73%), severe neurotoxicity owing to CNI (n ϭ 1; 3%), severe and/or recurrent acute rejection episodes (n ϭ 7; 21%), gastrointestinal (GI) side effects of mycophenolate mofetil (MMF; n ϭ 5; 15%), and hyperglycemia (n ϭ 4; 12%).
Nephron, 1998
Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialytic treatm... more Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialytic treatment, and the most adequate dialysis therapy in the management of these pregnant patients has not been established. During the period 1988–1995, we estudied the outcome of 17 pregnancies in dialyzed females, with an average age of 28.2±5.9 years (range: 18–38 years). Seven women had adequate urine volume (>800 ml/24 h). Five patients started dialysis after conception and the remaining 12 pregnancies were diagnosed after 6–72 months on dialysis. Fourteen women were maintained on hemodialysis (HD) and 3 on continuous ambulatory peritoneal dialysis (CAPD). The HD schedule was increased to 3 h 5–6 times weekly, and CAPD was increased to six 2-liter exchanges/day. Mean serum urea was 78.6 ± 27.4 mg/dl (range 45–110); serum creatinine was 6.5 ± 3.7 mg/dl (3.3–9.8 mg/dl); and hematocrit was 28.9 ± 3.3 vol% (22–35 vol%). Anemia was partially controlled with rHuEpo in 8 patients. Significant pr...
Nephrology Dialysis Transplantation, 2010
During haemodialysis, calcium balance can affect, or be affected by, mineral metabolism. However,... more During haemodialysis, calcium balance can affect, or be affected by, mineral metabolism. However, when dialysate calcium concentration (d[Ca]) is chosen or kinetic models are employed to calculate calcium balance, bone remodelling is rarely considered. In this study, we examined whether bone remodelling affects calcium mass transfer during haemodialysis. We dialysed 23 patients using a d[Ca] of 1.0, 1.25, 1.5 or 1.75 mmol/L. Calcium mass transfer was measured and associated with remodelling bone factors. Calcium balance varied widely depending on the d[Ca]. Calcium removal was -578 +/- 389, -468 +/- 563, +46 +/- 400 and +405 +/- 413 mg when a d[Ca] of 1.0, 1.25, 1.5 or 1.75 mmol/L was used, respectively (1.0 and 1.25 vs 1.5 and 1.75 mmol/L, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; 1.5 vs 1.75 mmol/L, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Univariate analysis showed that calcium balance correlated with calcium gradient, parathyroid hormone (PTH), osteocalcin and dialysis vintage. Multivariate analysis revealed that calcium balance was dependent on calcium gradient, PTH and osteocalcin. These results suggest that bone remodelling could affect calcium mass transfer during haemodialysis.
Clinical Infectious Diseases, 2009
Background. Solid-organ transplant (SOT) recipients are classically considered to be at increased... more Background. Solid-organ transplant (SOT) recipients are classically considered to be at increased risk for listeriosis. However, risk factors for this infection have not been assessed. Methods. We carried out a multicenter, matched case-control study (1:2 ratio) from January 1995 through December 2007. Control subjects were matched for center, transplant type, and timing. Conditional logistic regression was performed to identify independent risk factors. Clinical features and outcomes for all case patients were reviewed. Results. Thirty patients (0.12%) with cases of listeriosis were identified among 25,997 SOT recipients at 15 Spanish transplant centers. In a comparison of case patients with 60 matched control subjects, the following independent risk factors for listeriosis were identified: diabetes mellitus (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6-19.6;), history of cytomegalovirus infection or disease within the preceding 6 months P p .007 (OR, 35.9; 95% CI, 2.1-620;), receipt of high-dose prednisone within the preceding 6 months (OR, 6.2; P p .014 95% CI, 1.8-21.1;), and trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis (OR, 0.07; 95% CI, P p .003 0.006-0.76;). Twenty-six patients (86.7%) had bacteremia, and 7 had shock at presentation. Other P p .029 manifestations included meningoencephalitis (10 cases), spontaneous peritonitis (2), pleural empyema (1), brain abscesses (1), and liver abscesses (1). The 30-day mortality rate was 26.7% (8 of 30 patients died). Conclusions. Listeriosis in SOT recipients is uncommon but causes high mortality. Diabetes mellitus, cytomegalovirus infection or disease, and receipt of high-dose steroids are independent risk factors for this infection, whereas TMP-SMZ prophylaxis is a protective factor. Listeria monocytogenes is an environmental gram-positive, motile bacillus which has the ability to survive and multiply in phagocytic host cells. The main route of infection acquisition is through the intestinal tract after ingestion of contaminated food products, as well
British Journal of Dermatology, 2012
164:553–9. 7 Binymin K, Cooper RG. Late reactivation of spinal tuberculosis by low-dose methotrex... more 164:553–9. 7 Binymin K, Cooper RG. Late reactivation of spinal tuberculosis by low-dose methotrexate therapy in a patient with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40:341–2. 8 Benson J, Peritt D, Scallon BJ et al. Discovery and mechanism of ustekinumab: a human monoclonal antibody targeting interleukin-12 and interleukin-23 for treatment of immune-mediated disorders. MAbs 2011; 3:535–45.
J. bras. …, 1991
Base de dados : LILACS. Pesquisa : 115252 [Identificador único]. Referências encontradas : 1 [ref... more Base de dados : LILACS. Pesquisa : 115252 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. Abensur, Hugo. experimental, Documentos relacionados. Id: 115252 ...
J. Bras. …, 1999
Page 1. 112 J. Bras. Nefrol. 1999; 21(3): 112-123 Peritonite esclerosante e encapsulante secundár... more Page 1. 112 J. Bras. Nefrol. 1999; 21(3): 112-123 Peritonite esclerosante e encapsulante secundária à diálise peritoneal ambulatorial contínua David José de Barros Machado, João Egidio Romão Jr., Emil Sabbaga, Marcello Marcondes Machado, Hugo Abensur ...
Einstein
Expression of cytotoxic mediators (perforin, granzyme B, FAS, and FAS-l) in renal allograft biops... more Expression of cytotoxic mediators (perforin, granzyme B, FAS, and FAS-l) in renal allograft biopsies ... Expression of cytotoxic mediators (perforin, granzyme B, FAS, ... Expressão de mediadores citotóxicos (perforina, granzima B, FAS e FAS-l) em biópsias de
American Journal of Nephrology, 2008
Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the ... more Obstructive sleep apnea (OSA) is common among patients on maintenance hemodialysis. However, the factors associated with the origin of OSA as well as the cardiovascular consequences in this population are not completely understood. We evaluated, by standard overnight polysomnography, 24-hour ambulatory blood pressure (BP) monitoring and echocardiography in 30 patients (14 males, age 34 ± 11 years, BMI 23.2 ± 5.2) – 15 on short daily hemodialysis (SDH) and 15 matched patients on conventional hemodialysis (CHD). The hemodialysis dose (standard Kt/V) was higher in patients on SDH than on CHD (p = 0.001). OSA (apnea-hypopnea index >5 events/h) was present in 13 patients (43%). Patients with OSA were predominantly males (77 vs. 44%), presented a higher BMI (25.5 ± 6.2 vs. 21.5 ± 3.6), a larger neck circumference (38 ± 1 vs. 34 ± 1 cm) and a lower Kt/V (2.6 ± 0.3 vs. 2.2 ± 0.1) than patients with no OSA (p < 0.05). Neck circumference and lower Kt/V were independently associated with...