Browsing by Author "Fernandes, V"
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- Assessment of Fluid Status in Dialysis: Clinical Importance and Diagnostic ToolsPublication . Damas, J; Fernandes, VFluid status is crucial for dialysis patients. Volume overload is a major cardiovascular risk factor. Nevertheless, volume depletion is associated with myocardial stunning and cerebral ischaemia. For decades, many diagnostic tools have been proposed for increased accuracy in evaluation of volemia, considering that clinical assessment is unreliable. Lung ultrasound and bioimpedance analysis emerged as the most useful tools, although randomized clinical studies are lacking to implement their universal use. Early management of hydration may improve clinical outcomes, as it allows personalized dialysis prescriptions and nutritional support
- Epilepsia por Agua Caliente. Una Forma Rara de Epilepsia ReflejaPublication . Marta, R; Garcia, P; Fernandes, V; Rocha, S; Rodrigues, E
- Henoch-Schönlein Purpura Associated with Pulmonary AdenocarcinomaPublication . Azevedo, A; Fernandes, V; Navarro, D; Ferreira, AC; Sousa, J; Viana, H; Carvalho, F; Nolasco, FIntroduction: The Henoch-Schönlein purpura (HSP) is an immunoglobulin A (IgA)-mediated smallvessel systemic vasculitis, rare in adults. The association with solid tumours has been described, especially with lung cancer. Case Report: We present the case of a 60-year-old Caucasian male, diagnosed with lung adenocarcinoma that underwent surgical resection without (neo)adjuvant theraphy. Two months latter he was admitted for abdominal pain, purpuric rash on his lower extremities and acute kidney injury, with serum creatinine (Scr) of 2 mg/dl. Urinalysis revealed haematuria and 24h proteinuria (P24h) of 1.5 g. The serum protein electrophoresis, complement components C3 and C4, circulating immune complexes, cryoglobulins, ANCA, ANA, anti-dsDNA and the remaining immunologic study as screening for viral infections (HCV, HBV and HIV) were negative. Renal ultrasound was normal and kidney biopsy revealed mild mesangial proliferation; 2 cellular glomerular crescents and 1 fibrinoid necrosis lesion; large amounts of red blood cell casts; lymphocytic infiltration in the intertubular interstitial capillaries; moderate arteriolar hyalinosis. Immunofluorescence demonstrated mesangial and parietal deposits of IgA. The diagnosis of HSP was assumed, and the patient started prednisolone 1 mg/kg/day. Ten months after diagnosis the patient’s baseline Scr is 1.4 mg/dl with P24h of 0.18g, without haematuria. Conclusion: Although this is a rare association and the exact mechanism behind the disease is yet unknown, physicians should be aware of it. The early recognition and treatment may prevent renal disease progression.
- Idiopathic Hypocomplementaemic Tubulointerstitial NephritisPublication . Azevedo, A; Mesquita, I; Viana, H; Rocha, G; Ferreira, C; Fernandes, V; Murinello, A; Carvalho, F; Nolasco, FBackground: Tubulointerstitial nephritis (TIN) is a common cause of kidney injury typically seen in association with drug exposure, infection or autoimmune diseases. However, TIN with interstitial immune complex deposition, without glomerular injury, is rarely observed. Case: We report a case of a 64-yearold Indian woman admitted for dialysis-requiring renal failure, without involvement of other organs. Urinalysis showed blood 3+ and 24h proteinuria of 1.5 g. Renal ultrasound revealed normal sized kidneys with loss of parenchymal-sinus differentiation. Laboratory tests disclosed low C3, positive ANA but negative anti-dsDNA, SSA and SSB. Serum protein electrophoresis was normal. The renal biopsy showed tubulointerstitial nephritis with positive immunoglobulin staining involving the interstitium and tubular basement membrane with glomerular sparing. The patient started prednisolone (1mg/kg/day) without recovery of the renal function. Conclusion: Idiopathic hypocomplementaemic tubulointerstitial nephritis is a rare disease with few cases described in the literature. To our knowledge this is the first case reported in Portugal.
- Peritoneal Dialysis in HIV Infected Patients. A Good Option?Publication . Ferreira, AC; Fernandes, V; Sousa, J; Vila Lobos, A; Nolasco, F
- Peritoneal Dialysis in Patients Transferred from HemodialysisPublication . Ferreira, AC; Fernandes, V; Vila Lobos, A; Nolasco, F
- Symmetrical Peripheral GangrenePublication . Ferreira, AC; Fernandes, V
- The 2009 Pandemic Influenza A (H1N1) Infection: Renal Histopathology Findings in Two Infected PatientsPublication . Fernandes, V; Ferreira, AC; Viana, H; Carvalho, F; Vila Lobos, A; Nolasco, FBackground: Acute kidney injury in the pandemic swine origin influenza A virus (H1N1) infection has been reported as coursing with severe illness, although renal pathogenic mechanisms and histologic features are still being characterised. Case Report: We present two patients admitted with H1N1 pneumonia, sepsis, acute respiratory distress syndrome and need for invasive mechanical ventilation who developed acute kidney injury and became dialysis-dependent. In both cases a kidney biopsy was performed to establish a definitive diagnosis. Severe acute tubular necrosis was identified, with no further abnormalities. Conclusion: This report seems to confirm that the acute kidney injury in H1N1 infection is focused on the tubular cells. Our cases corroborate the renal histopathologic findings of other studies, highlighting the central role of the tubular cell. We bring new evidence of the histopathology of AKI in H1N1 infection since our data were collected in living patients and not via post-mortem studies.
- Transplantation in Highly Sensitised Patients Treated with Intravenous Immunoglobulin and RituximabPublication . Ferreira, AC; Brum, S; Fernandes, V; Buinho, F; Viana, H; Alcântara, P; Ferreira, A; Candeias, N; Sousa, J; Lima, A; Carvalho, F; Trindade, H; Nolasco, FRenal transplant in highly sensitised patients is associated with increased morbidity. The aim of this retrospective study was to evaluate the clinical evolution of 30 highly sensitised deceased donor kidney transplants and the influence of different timing of B cell directed treatment and its importance in the outcome of these patients. All recipients had negative complement dependent lymphocytotoxicity cytotoxic T cell crossmatch and no identified anti human leucocyte antigen class I donor specific antibodies. T cell flow crossmatch was performed within 24h of transplantation with serum obtained pretransplant (historic, recent or baseline). Posttransplant flow crossmatch were performed prospectively starting on the 3rd posttransplantation day. The immunosuppressive regime included thymoglobulin, tacrolimus, mycofenolate mofetil and steroids. Positive flow crossmatch occurred in 20/29 patients by the 3rd posttransplantation day, and in 17/27 patients after the 3rd posttransplantation day. All patients were started on intravenous immunoglobulin before transplantation: in nine patients (group A) at 400mg/kg/day for five days; in the remaining 21 patients (group B), as a continued infusion of 2g/kg during 48h. In group A, Rituximab was added only in the presence of antibody mediated rejection; in group B, introduced on the 3rd posttransplantation day whenever a positive flow crossmatch (with serum obtained pre or posttransplant) was reported. Antibody mediated rejection was observed in 44.4% of patients in group A, and 19% of those in group B. Mean follow-up was 12.2±5.5 months. Overall allograft survival was 76.6%, 81% in group B, and 66.6% in group A. At last follow up, mean serum creatinine was 1.3±0.6 mg/dl. Renal transplantation with pretransplant positive flow crossmatch is highly associated with antibody mediated rejection, despite introduction of intravenous immunoglobulin pretransplantation. However high dose intravenous immunoglobulin for 48h plus Rituximab by the 3rd posttransplantation day reduce the incidence of antibody mediated rejection by more than 50% and allowed for allograft survival of 81% at one year, with an excellent renal function.