Browsing by Author "Verdelho, M"
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- Acute-on-Chronic Liver Failure: A Portuguese Single-Center Reference ReviewPublication . Verdelho, M; Perdigoto, R; Machado, J; Mateus, É; Marcelino, P; Pereira, R; Fortuna, P; Bagulho, L; Bento, L; Ribeiro, F; Nolasco, F; Martins, A; Barroso, EAcute-on-chronic liver failure (ACLF) is a syndrome characterized by an acute deterioration of a patient with cirrhosis, frequently associated with multi-organ failure and a high short-term mortality rate. We present a retrospective study that aims to characterize the presentation, evolution, and outcome of patients diagnosed with ACLF at our center over the last 3 years, with a comparative analysis between the group of patients that had ACLF precipitated by infectious insults of bacterial origin and the group of those with ACLF triggered by a nonbacterial infectious insult; the incidence of acute kidney injury and its impact on the prognosis of ACLF was also analyzed. Twenty-nine patients were enrolled, the majority of them being male (89.6%), and the mean age was 53 years. Fourteen patients (48.3%) developed ACLF due to a bacterial infectious event, and 9 of them died (64.2%, overall mortality rate 31%); however, no statistical significance was found (p < 0.7). Of the remaining 15 patients (51.7%) with noninfectious triggers, 11 died (73.3%, overall mortality rate 37.9%); again there was no statistical significance (p < 0.7). Twenty-four patients (83%) developed acute kidney injury (overall mortality rate 65.5%; p < 0.022) at the 28-day and 90-day follow-up. Twelve patients had acute kidney injury requiring renal replacement therapy (41.37%; overall mortality rate 37.9%; p < 0.043). Hepatic transplant was performed in 3 patients, with a 100% survival at the 28-day and 90-day follow-up (p < 0.023). Higher grades of ACLF were associated with increased mortality (p < 0.02; overall mortality 69%). CONCLUSIONS: ACLF is a heterogeneous syndrome with a variety of precipitant factors and different grades of extrahepatic involvement. Most cases will have some degree of renal dysfunction, with an increased risk of mortality. Hepatic transplant is an efficient form of therapy for this syndrome.
- New-Onset Seizures 15 Years After Renal TransplantPublication . Costa, BM; Verdelho, M; Cotovio, P; Nolasco, F
- Oxalate Nephropathy Following Roux‑en‑Y Gastric Bypass Surgery – Mini‑ReviewPublication . Verdelho, M; Mendes, M; Ribeiro, F; Sousa Viana, H; Carvalho, F; Nolasco, FOxalate Nephropathy is characterised by the presence of tubular crystalline deposits of calcium oxalate, which can lead to both acute and chronic tubular injury and progressive renal failure. Enteric hyperoxaluria is the most common cause of moderate hyperoxaluria; it occurs in conditions associated with fat or bile acid malabsorption, which include jejunoileal bypass and other bariatric procedures such as Roux‑en‑Y gastric bypass surgery. We present the clinical case of a 69‑year‑old man who was hospitalised for non‑oliguric renal dysfunction, with a serum creatinine of 10 mg/dl and normocytic normochromic anaemia. There was no prior history of renal disease. Twenty months before admission the patient was diagnosed with a gastro‑oesophageal junction adenocarcinoma and was treated with pre‑operative chemotherapy, followed by total gastrectomy, with a Roux‑en‑Y gastric bypass reconstruction. On discharge from gastric surgery, renal function was normal. On the first day of hospital stay haemodialysis was initiated. Over the following days, the rapid unexplained renal impairment was investigated, and this workup [2] included a kidney biopsy. Histological examination of the biopsy specimen revealed a predominantly interstitial nephropathy with tubular atrophy and interstitial fibrosis, with bright intra‑tubular calcium oxalate crystals in over 50% of the tubules and so the histological diagnosis was of oxalate nephropathy. Subsequently, no recovery of renal function was observed, so the patient is currently undergoing regular haemodialysis. Oxalate nephropathy is a rare but severe complication of Roux‑en‑Y gastric bypass surgery that can lead to a rapid progression to kidney failure. Although the treatment of obesity is the main indication for this surgery, this is also the preferred approach for gastrointestinal reconstruction after total gastrectomy for treatment of gastric carcinoma. Considering the rapid progression of oxalate nephropathy to kidney failure, patients who undergo Roux‑en‑Y gastric bypass surgery should have regular follow‑up of renal function.
- Renal Dysfunction in a Patient with a Roux-en-Y Gastric Bypass SurgeryPublication . Viana, H; Verdelho, M; Mendes, M; Carvalho, F; Nolasco, F