Browsing by Author "Silva, F."
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- Acute tubulointersticial nephritis with uveitis: A report of two casesPublication . Silva, F.; Correia, S.; Castro, A.; Moreira, C.; Santos, S.; Malheiro, J.; Santos, J.; Martins, L.; Cabrita, A.Tubulointersticial nephritis and uveitis syndrome is an idiopathic and rare cause of acute kidney injury that should not overlooked, because it usually requires specific therapeutic interventions. We report two distinct cases: a young and an elder female. Both cases presented with unspecific constitutional symptoms but had different onset of renal and ocular involvement. Both were treated with topical and systemic corticoids and although there was a good initial response in both cases, an early relapse after steroids taper was observed in the younger patient and a persistent renal dysfunction in the older one. A high clinical suspicion and understanding of this disease is necessary for an adequate management and treatment of these patients. Recent data associates a worse renal prognosis when the disease appears in advanced age. In both of our cases the outcome was good but we had a short follow-up. The histological presentation of this disease in our older patient was similar to that reported in the literature, with a high percentage of fibrosis and chronicity of renal tissue that can contribute to the higher grade of renal dysfunction in this type of patients.
- Are we building too many arteriovenous fistulas? A single-center experiencePublication . Leal-Moreira, C.; Teixeira, V.; Bessa, L.; Queirós, J.; Silva, F.; Cabrita, A.Introduction: Arteriovenous fistula has been associated with improved morbimortality in hemodialysis patients. This has resulted in the “fistula First, catheter last” initiative. Nonetheless, the survival benefit of arteriovenous fistula has been questioned. Methods: We conducted a retrospective observational study of all patients with non-end stage renal disease referred for first vascular access building between January 2014 and December 2015 in our hospital center. Our main goal was to evaluate the clinical impact and burden of building fistula in predialysis patients. Results: During this period, of 178 first arteriovenous accesses placed, 87 patients remained in predialysis and 91 patients started a chronic hemodialysis program. Median follow-up time by a nephrologist was 3.9 (2.5, 9.7) years. The mean age was 65.8±14.7 years, with 50.6% (n=90) of male patients. A higher rate of thrombosis in the predialysis group (26% vs 13%, p=0.037) was observed, but vascular access survival did not differ significantly (55% vs 67%, p=0.12). Mean vascular access placing was higher in the predialysis group (1.4±0.7 vs 1.2±0.4, p=0.006) and less interventions were requested (0.2±0.5 vs 0.3±0.6, p=0.10). Median time from vascular access placement to hemodialysis start was 22 (13, 41) months. At hemodialysis initiation, 10 (10.9%) patients used a central venous catheter; 80 (87.9%) patients an arteriovenous fistula, and one patient a graft. A total of 227 vascular accesses were built; 121 (53.3%) in predialysis vs 106 (46.7%) in incident hemodialysis patients. In a multivariate model, the presence of a functional arteriovenous fistula at hemodialysis start was only associated with a trend to survival benefit (HR 0.38, 95% CI 0.14-1.00, p=0.05). Conclusions: Our results stress the need for an individual approach and for future tools to assess the risk of death and progression to end-stage renal disease, therefore helping reduce the number of unutilized vascular accesses and rising cost of interventions.
- Arterio-arterial graft – an option for hemodialysis patients with exhaustion of venous patrimonyPublication . Castro, A.; Almeida, P.; Silva, F.; Rego, D.; Tavares, J.; Santos, J.; Silva, F.; Queirós, J.; Cabrita, A.; Almeida, R.Introduction: Vascular access (VA) for hemodialysis (HD) is the lifeline for End Stage Renal Disease (ESRD) patients. Long-term HD patients often have exhaustion of their venous patrimony for an autologous VA construction and, sometimes, even for a central venous catheter (CVC) placement. Case report: We describe the case of a 43-year-old woman with ESRD due to lupus nephritis, on maintenance HD since 2009. She also had secondary antiphospholipid syndrome and was chronically anticoagulated. Nevertheless, the patient had multiorgan thrombotic events (without sequelae) and several episodes of irreversible thrombosis of arteriovenous fistulas. Her HD course was also marked by multiple severe CVC infections, at diferente locations; a hemoperitoneum during cholecystectomy, and an immediate thrombosis of the renal artery of a kidney transplant. She was admitted to our hospital after an irreversible dysfunction of a right jugular CVC, with documentation of thrombosis of the superior and inferior vena cava. Exhaustion of the venous patrimony for HD was assumed and it was decided to make an arterio-arterial graft (AAG) of early cannulation. The first cannulation of the AAG was performed two days after surgical intervention, with no complications. The patient performed a twelve hour per week HD treatment with good efficiency. Conclusion: AAG is an alternative for HD patients who have exhausted all their venous patrimony and it can be considered prior to the placement of a CVC as their sole remaining vascular access.
- Biomarkers and Imaging Findings of Anderson-Fabry Disease-What We Know NowPublication . Beirão, I.; Cabrita, A.; Torres, M.; Silva, F.; Aguiar, P.; Laranjeira, F.; Gomes, A.Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder, caused by deficiency or absence of the alpha-galactosidase A activity, with a consequent glycosphingolipid accumulation. Biomarkers and imaging findings may be useful for diagnosis, identification of an organ involvement, therapy monitoring and prognosis. The aim of this article is to review the current available literature on biomarkers and imaging findings of AFD patients. An extensive bibliographic review from PubMed, Medline and Clinical Key databases was performed by a group of experts from nephrology, neurology, genetics, cardiology and internal medicine, aiming for consensus. Lyso-GB3 is a valuable biomarker to establish the diagnosis. Proteinuria and creatinine are the most valuable to detect renal damage. Troponin I and high-sensitivity assays for cardiac troponin T can identify patients with cardiac lesions, but new techniques of cardiac imaging are essential to detect incipient damage. Specific cerebrovascular imaging findings are present in AFD patients. Techniques as metabolomics and proteomics have been developed in order to find an AFD fingerprint. Lyso-GB3 is important for evaluating the pathogenic mutations and monitoring the response to treatment. Many biomarkers can detect renal, cardiac and cerebrovascular involvement, but none of these have proved to be important to monitoring the response to treatment. Imaging features are preferred in order to find cardiac and cerebrovascular compromise in AFD patients.
- [Is it Fabry Disease? Diagnostic and Follow-Up Approach]Publication . Beirao, I.; Cabrita, A.; Torres, M.; Silva, F.; Aguiar, P.; Gomes, A.
- Overhydration prevalence in peritoneal dialysis - A 2 year longitudinal analysisPublication . Aguiar, P.; Santos, O.; Teixeira, L.; Silva, F.; Azevedo, P.; Vidinha, J.; Ferrer, F.; Carvalho, M.; Cabrita, A.; Rodrigues, A.Hypervolemia is a major concern in dialysis patients, and is associated with increased cardiovascular risk and death. Cross sectional analysis have previously demonstrated that peritoneal dialysis (PD) patients are not more overhydrated when compared to haemodialysiś ones. This study was designed to evaluate longitudinal trends in hydration status and corporal composition in a PD population.
- [Physical exercise in the treatment of Ankylosing Spondylitis: a systematic Review]Publication . Ribeiro, F.; Leite, M.; Silva, F.; Sousa, O.O exercício físico é um componente regular no tratamento de várias patologias, entre as quais a espondilite anquilosante (EA). A EA é uma patologia reumática, crónica e sistémica, sem cura conhecida e na qual o exercício físico se tem revelado como terapia essencial no controlo e prevenção de deformidades associadas. No sentido de promover uma prática de acordo com a evidência e de ajudar na tomada de decisões acerca dos cuidados de saúde em pacientes com EA, foi efectuada uma revisão de estudos randomizados controlados tendo por objectivo examinar o papel do exercício físico no tratamento de pacientes com EA. Uma pesquisa computorizada nas bases de dados Cochrane Central,Pubmed/ Medline e PEDro permitiu identificar 13 estudos envolvendo 1.056 pacientes, com classificação metodológica de 5,62 na escala de PEDro. Dos estudos incluídos, 3 avaliaram o efeito aditivo do exercício físico à medicação, 3 compararam os benefícios da prática regular de exercício supervisionado em grupo com os benefícios do exercício físico não supervisionado no domicílio, 5 avaliaram programas de exercício alternativo (hidroterapia e reeducação postural global) ao programa tradicionalmente usado em pacientes do EA e 2 centraram-se sobre o rácio custo/efectividade da terapia. Os estudos incluídos nesta revisão sugerem que o exercício físico é uma terapia benéfica no tratamento de pacientes com EA; este exercício deve ser efectuado em grupo com supervisão de fisioterapeuta. Novas modalidades de exercício, hidroterapia ou exercício baseado na reeducação postural global, parecem oferecer igualmente uma terapia alternativa válida e promissora para pacientes com EA.
- Transposição da Veia Basílica: um contributo para a melhoria da técnica cirúrgicaPublication . Norton-Matos, A.; Nogueira, C.; Queiros, J.; Silva, F.; Rocha, S.; Azevedo, P.; Machado, R.; Mergulão-Mendonça, J.Introdução: O aumento crescente da população em hemodiálise tem implicado o recurso a acessos vasculares de maior complexidade técnica. A introdução de modificações na técnica cirúrgica da transposição da veia basílica (TVB) pretende agilizar o procedimento e diminuir a sua morbilidade. Métodos: Análise prospectiva das TVB efectuadas no CHP-HSA entre Setembro de 2005 e Setembro de 2009. Resultados: Efectuaram-se 74 TVB em 74 doentes, os quais tinham,em média, 2 acessos autólogos prévios. A TVB foi o primeiro acesso em 20,3% dos doentes. O intervalo médio de seguimento foi de 14,5 meses. Ocorreram 2 falências nos primeiros 30 dias. A taxa de patência secundária aos 3, 12 e 24 meses foi de 95,7%, 85,1% e 62,2%, respectivamente. A Diabetes associou-se a pior taxa de patência(p=0,018). A taxa de complicações perioperatórias foi de 28,4%, sendo a infecção a mais frequente (n=6, 8,1% do total de TVB). A trombose foi a principal causa de falência, tendo ocorrido em 24,3% de todas as TVB. Conclusões: Reconhece-se a superioridade do acesso autólogo, como a melhor opção de acesso vascular para hemodiálise. A TVB é subutilizada, devido às exigências técnicas e necessidades logísticas. Melhoramos a técnica cirúrgica e de tunelização, ao reduzir o tamanho das incisões e o tempo cirúrgico. Os nossos resultados revelaram uma boa patência a longo prazo, pelo que consideramos que deve ser mais utilizada.