Browsing by Author "Barreto, P."
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- BK virus nephropathy in kidney transplantation - A literature review following a clinical casePublication . Barreto, P.; Almeida, M.; Dias, L.; Vieira, P.; Pedroso, S.; Martins, L.; Castro-Henriques, A.; Cabrita, A.Over the last 15 years, better immunosuppressive drugs have decreased acute rejection rates in kidney transplantation but have also led to an increase in the incidence and impact of BK virus nephropathy. The authors report the case of a 62 -year -old man submitted to a renal transplant of a deceased donor with an immunosuppression regimen free of rabbit anti -thymocyte globulin and tacrolimus, in whom BK nephropathy was diagnosed at seven weeks post -transplant. Intravenous human immunoglobulin (IVIG) was administered after immunosuppression reduction. Instituted treatment was successful. This clinical case highlights the importance of a high index of suspicion for an atypical presentation of BK nephropathy in renal transplant recipients and strengthens the need for other therapeutic interventions beyond the reduction of immunosuppression. It was the starting point for a review of BK virus nephropathy in kidney transplantation with a focus on risk factors, diagnosis and treatment.
- Infectious risk of elderly patients on peritoneal dialysis: Experience of a portuguese centerPublication . Belino, C.; Barreto, P.; Santos, M.; Gomes, A.; Fonseca, Isabel; Fernandes, J.Background: The goal of this study was to compare the risk of peritoneal dialysis‑related infections in younger and older patients and to identify risk factors for infection in elderly patients. Methods: We performed a longitudinal retrospective study on a population of Portuguese peritoneal dialysis patients treated at the same center between January 2005 and December 2015. Clinical and laboratory data were collected from medical reports. Two groups of patients were compared: non elderly (< 65 years) and elderly (≥ 65 years). Results: Among 100 patients, there were 73 non elderly (median age 52 years) and 27 elderly (median age 74 years). Elderly patients were not associated with higher PD‑infection rates or with less time to PD‑related infections. Cerebrovascular disease was the only significant adverse predictor of peritonitis in elderly (crude HR 3.8; 95% CI 1.10 to 13.34; P = 0.035) and those with higher levels of serum albumin were less likely to develop peritonitis (crude HR 0.47 per each g/dl of increase; 95% CI 0.24 to 0.89; P = 0.023). Conclusions: In our study, elderly patients did not present a greater risk for peritonitis or catheter‑related infections.
- The first ABO-incompatible kidney transplantation performed in PortugalPublication . Barreto, P.; Vieira, P.; Dias, L.; Almeida, M.; Pedroso, S.; Martins, L.; Castro-Henriques, A.; Bini, M.; Cabrita, A.Kidney transplantation is the optimal treatment of end-stage renal disease (ESRD) improving survival and quality of life for most recipients. In our country, potential living donors have been refused due to the ABO incompatibility barrier. However, ABO -incompatible living donor kidney transplant is presently common practice in several countries with good outcomes. The authors describe a case of a 49-year-old female patient, with chronic kidney disease due to autosomal dominant polycystic kidney disease, who had started haemodialysis 10 months before and with blood group O. The living donor was a 53-year-old sister with blood group B. The desensitization protocol was based on rituximab and plasmapheresis. The induction protocol used was basiliximab, tacrolimus, mofetil mycophenolate and metilprednisolone. Five days post -transplant she presented a normal graft function that remained during the eight months follow -up. This case reveals the first ABO incompatible living donor kidney transplant performed in Portugal with excellent outcome