Gianna Mastroianni Kirsztajn | Universidade Federal de São Paulo (UNIFESP) (original) (raw)

Papers by Gianna Mastroianni Kirsztajn

Research Square (Research Square), Aug 8, 2019

Revista Da Associacao Medica Brasileira, 2020

International Urology and Nephrology, Oct 31, 2020

The data were presented in abstract form at the 45 th meeting of the American Society of Nephrolo... more The data were presented in abstract form at the 45 th meeting of the American Society of Nephrology, October 30-November 04 2012, San Diego, CA, USA. Circulating autoantibodies against M-type phospholipase A 2 receptor (PLA 2 R) are important pathogenic antibodies of idiopathic membranous nephropathy (MN) in adults. However, previous studies on the clinical impact of anti-PLA 2 R antibodies demonstrated several limitations, including insufficient numbers of study subjects and different time points and methods for anti-PLA 2 R antibody measurement. To verify the clinical significance of anti-PLA 2 R antibodies in Korean patients with MN, we measured autoantibodies in serum samples obtained at the time of biopsy from a total of 100 patients with idiopathic MN who had not yet received immunosuppressive treatment. We detected anti-PLA 2 R antibody in 69 patients, and we observed that autoantibody reactivity reflected the severity of disease activity. Proteinuria and hypoalbuminemia were more severe in patients with anti-PLA 2 R than in those without the autoantibodies (2.95 g/g vs. 6.85 g/g, P = 0.003; 3.1 g/dL vs. 2.5 g/dL, P = 0.004, respectively). Additionally, the clinical severities worsened proportionally as the levels of anti-PLA 2 R antibodies increased (P = 0.015 and P for trend ,0.001 for proteinuria and hypoalbuminemia, respectively). However, neither the levels nor the presence or absence of anti-PLA 2 R antibody showed a significant correlation with clinical outcomes, such as remission rate and time to remission. In conclusion, we observed that anti-PLA 2 R antibodies are highly prevalent in Korean patients with idiopathic MN and that they reflect the clinical disease activity before the administration of immunosuppressive treatment. However, the levels of anti-PLA 2 R antibody at the time of kidney biopsy may not predict the clinical outcomes in current clinical practice.

Brazilian Journal of Nephrology, 2015

PLOS ONE, Apr 13, 2015

Introduction The glomerular filtration rate (GFR) is considered an especially important tool for ... more Introduction The glomerular filtration rate (GFR) is considered an especially important tool for the measurement of renal function. Inulin clearance (InCl) is the classic reference method for this purpose, although it is associated with a number of disadvantages; thus, other markers have been proposed, including iohexol. Determination of iohexol clearance (IoCl) has been established for clinical use; however, its application as a GFR marker in experimental rat models has not been reported. Objectives This study aims to standardize a methodology for the measurement of iohexol clearance and to evaluate its applicability as a marker of GFR in rats with induced toxic acute renal failure (ARF), using InCl as the gold standard. Materials and Methods Twenty-six Wistar male rats (200-300 g) were divided into the following two groups: a control group (n=7) and an ARF group (n=19). ARF was induced by the subcutaneous administration of cisplatin (5 mg/kg); IoCl and InCl were determined simultaneously, and plasma creatinine (pCreat) dosage was measured colorimetrically.

Frontiers in Immunology, Mar 11, 2020

PubMed, Jul 29, 2006

Background: Mutations in the NPHS2 gene encoding the protein podocin have recently been found in ... more Background: Mutations in the NPHS2 gene encoding the protein podocin have recently been found in a recessive form of steroid-resistant nephrotic syndrome. Focal segmental glomerulosclerosis (FSGS) was the histologic diagnosis in many of the patients harboring these mutations. FSGS is a heterogeneous glomerular lesion with diverse origins and outcomes. Although mutational analysis in children permits the identification of an unresponsive group before initiating treatment, there is not much information on adult-onset patients with FSGS. Methods: We performed NPHS2 gene mutational analysis in 39 adult Brazilian patients with primary FSGS, and evaluated the clinical course of the disease and response to treatment; in addition, we performed urinary screening in 44 relatives of these patients. Results: In this group, only 1 patient (with familial FSGS) had a mutation in the NPHS2 gene with double heterozygosity. The absence of mutations in all other patients evaluated suggests its rarity in sporadic cases of adult-onset (steroid sensitive or resistant) FSGS in our population. Conclusions: Our results suggest that the analysis of the NPHS2 gene mutation is not indicated as a routine diagnostic procedure in our population for adult-onset patients with FSGS.

Transplantation Proceedings, Dec 1, 2011

We describe a female patient with Alport disease who developed antiglomerular basement membrane n... more We describe a female patient with Alport disease who developed antiglomerular basement membrane nephritis late after kidney transplantation during the treatment of an acute bacterial pyelonephritis and discuss the potential role of the infection as a trigger for the development of this nephritis.

Brazilian Journal of Infectious Diseases, Feb 1, 2006

We report on a case of a patient with HIV infection, diagnosed 18 months prior to the development... more We report on a case of a patient with HIV infection, diagnosed 18 months prior to the development of an anti-glomerular basement membrane (anti-GBM) rapidly progressive glomerulonephritis; this is probably the first report of such an association. A 30-year-old white man presented with elevation of serum creatinine (1.3-13.5 mg/dL within one month). At admission, the urinalysis showed proteinuria of 7.2 g/L and 8,000,000 erythrocytes/mL. Renal biopsy corresponded to a crescentic diffuse proliferative glomerulonephritis mediated by anti-GBM, and serum testing for anti-GBM antibodies was positive; antinuclear antibodies (ANA) and anti-neutrophilic cytoplasmic antibodies (ANCA) were also positive. The patient underwent hemodyalisis and was treated with plasmapheresis, cyclophosphamide and prednisone. The association described here is not casual, as crescentic glomerulonephritis is not common in HIV-positive patients, anti-GBM glomerulonephritis is rare and anti-GBM antibodies are frequently observed in HIV-positive subjects when compared to the overall population. Based on the current case and on the elevated frequency of the positivity for such antibodies in this group of patients, it is advisable to be aware of the eventual association between these two conditions and to promote an active search for anti-GBM antibodies and early diagnosis of eventual urinary abnormalities in HIV-positive subjects, considering the severity of anti-GBM glomerulonephritis.

Journal of Renal Care, Mar 26, 2015

Background: IgA nephropathy (IgAN) is the third most frequent cause of renal graft loss among pat... more Background: IgA nephropathy (IgAN) is the third most frequent cause of renal graft loss among patients with primary glomerulonephritis. Objectives: To assess clinical and laboratorial profile of patients with pre and/or post transplant IgAN, in addition to patient and graft survival in both groups. Design: Data from 146 patients who had received a renal transplant were retrospectively collected and were divided in two groups: group 1-patients with biopsy-documented IgAN as the underlying native kidney disease (n ¼ 128); group 2-patients who developed post-transplant IgAN independent of the underlying disease (n ¼ 18). Participants: Patients submitted to renal transplantation (1998-2010) with pre and/or post transplant IgAN. Measurements: Clinical and laboratorial evaluation of renal function of 146 post transplant IgAN patients. Results: Recipients and deceased donors exhibited a higher degree of HLA compatibility (1.0 vs. 2.5 mismatches for groups 1 and 2, respectively). The main post-transplant IgAN presentation was haematuria associated with non-nephrotic proteinuria (44.4%). A histological pattern of focal segmental glomerulosclerosis was observed in 59.2% of biopsy samples. The 10-year patient survival was 93.5% in group 1 and 100% in group 2, and the graft survival rates were 58.5 and 87.2%, respectively. Conclusion: The rate of post-transplant IgA diagnosis in our case series was 11%, and IgAN was diagnosed late in the course of transplantation. In most cases, IgAN manifested as haematuria and non-nephrotic proteinuria, without renal graft dysfunction, and this picture might explain late indication of graft biopsies. The 10-year patient survival rates were excellent.

Brazilian Journal of Medical and Biological Research, 2023

The indirect immunofluorescence (IIF) technique for antineutrophil cytoplasmic antibodies (ANCA) ... more The indirect immunofluorescence (IIF) technique for antineutrophil cytoplasmic antibodies (ANCA) detection is subject to substantial differences across laboratories. This study aimed to assess the impact of improvements in the IIF-ANCA technique on the positivity rate of ANCA tests. A cross-sectional study was performed with serum samples from patients with ANCAassociated vasculitis (AAV), autoimmune hepatitis (AIH), and ulcerative colitis (UC). A paired analysis was performed for IIF-ANCA results using the traditional method and a modified protocol after a series of specific adjustments in the technique based on the protocol of IIF-ANCA test performed at a nationwide private laboratory in Brazil. ANCA specificity was assessed by ELISA for anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) antibodies. Sixty-one patients were evaluated. The positivity rate of IIF-ANCA tests at disease presentation performed at the University reference laboratory was 32.3% in AAV, AIH, and UC patients, whereas the positivity rates of IIF-ANCA and ELISA tests in other laboratories were 75.0 and 72.7%, respectively. After modifications in the IIF-ANCA technique, there was a significant increase in the positivity rate (14.8 vs 34.3%; P=0.0002) and in median titers [1/40 (1/30-1/160) vs 1/80 (1/40-1/80); P=0.0003] in AAV, AIH, and UC patients. UC had the highest increment in positive results from 5.3 to 36.8%. There was poor agreement between MPO-or PR3-ANCA and both IIF-ANCA techniques. In conclusion, modifications in the IIF-ANCA protocol led to a significant improvement in its positivity rate and titers.

American Journal of Nephrology, 1998

Annals of Transplantation, Mar 9, 2018

Departmental sources Background: Initially described as a relatively benign condition, recent stu... more Departmental sources Background: Initially described as a relatively benign condition, recent studies report graft loss in up to 50% of the patients with post-transplant IgA nephropathy. There is no evidence for the best therapeutic approach, and prognostic factors remain to be elucidated. Material/Methods: Single center retrospective analysis of patients >12 years old, with clinically relevant post-transplant IgA nephropathy (proteinuria ³1.0 g/g and/or graft dysfunction) and ³6 months follow-up after diagnosis (n=47). Results: Living donor transplants represented 85% of cases. Dysmorphic hematuria (100%), blood pressure elevation (95.7%), renal dysfunction (70.2%) and subnephrotic proteinuria (60.6%) predominated at presentation. Using the Oxford Classification, mesangial proliferation was the main histological lesion (91%). Treatment consisted mostly of blockade of the renin angiotensin system (89.4%) and modification of immunosuppression (85.1%), mainly by increasing oral steroids dose (83%), with venous pulse therapy in 63.8% of cases. Partial and complete remission occurred in 48.9% and 17% of cases, respectively. One patient died (sepsis) and 15 patients (31.9%) lost their grafts due to nephropathy. The percentage of decrease in glomerular filtration rate at diagnosis was independently associated with partial remission (HR 0.97, 95% CI 0.94-0.99, p=0.01) and graft loss (HR 1.13, 95% CI 1.06-1.20, p<0.001). Deceased donor (HR 28.04, 95% CI 4.41-178.39, p<0.001) and donor age (HR 1.1, 95% CI 1.04-1.16, p=0.001) were also risk factors for graft loss. Conclusions: Despite treatment, most patients with post-transplant IgA nephropathy in this cohort study presented unfavorable outcomes, and graft dysfunction at diagnosis appeared to be the main prognostic marker.

Brazilian Journal of Nephrology, Sep 1, 2024

Brazilian Journal of Nephrology, Nov 30, 2023

Research Square (Research Square), Jun 10, 2020

Background: Considering speculations on an eventual contribution of antiretroviral drugs to treat... more Background: Considering speculations on an eventual contribution of antiretroviral drugs to treat novel coronavirus, PrEP regular use may provide useful information and clarify its role in preventing u-like symptoms. Objective: To identify risk and/or protective factors against u-like symptoms during COVID-19 pandemic among PrEP regular users. Methods: Phone call interview or digital investigation (through WhatsApp® or e-mail) about PrEP regular use during the novel coronavirus pandemic, social distancing, exposure to suspected or con rmed cases of COVID-19 and recent u-like symptoms. Findings: Among 108 individuals, the majority were cisgender, white, and gay men. Although most of the individuals were in social distancing (68,52%), they did not stop taking PrEP (75,93%). Fewer people had had contact with suspected or con rmed cases of COVID-19 (12,04%), but some did have u-like symptoms the month before the interview (27,78%) including rhinorrhea (56,67%), cough (53,33%), asthenia (50,00%) and headache (43,33%). Also, PrEP regular use was a protective factor against u-like symptoms (OR = 0.26, 95% CI 0.07-0.96, p = 0.04) and was associated with social distancing adherence (OR = 7.2, 95% CI 2.74-19.02, p < 0.001). Conclusion: In our sample, regular use of PrEP was a protective factor against u-like symptoms and was related to the accomplishment of social distancing during the COVID-19 pandemic in São Paulo, Brazil.