Browsing by Author "Domingos, Ana Teresa"
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- Multidisciplinary cardiorenal program for heart failure patients: Improving outcomes through comprehensive carePublication . Calça, Rita; Malho, Anabela; Domingos, Ana Teresa; Fernandes, Raquel Menezes; Silva, Francisca Gomes da; Aguiar, Carlos; Tralhão, António; Ferreira, Jorge; Rodrigues, Anabela; Fonseca, Cândida; Branco, PatríciaThe cardiorenal program (CRP), implemented within a specialized heart failure and kidney disease clinic, encompasses a multidisciplinary approach to the management of patients with heart failure and kidney disease. It focuses on optimizing therapy and improving patient outcomes. The CRP includes a range of services, including clinical evaluation, diagnostic testing, medical treatment, and patient education. The program provides comprehensive care for patients with cardiorenal syndrome, and includes a variety of healthcare professionals, such as cardiologists, nephrologists, pharmacists, and nurses, working together to provide the best possible care. The program also incorporates specific performance indicators to continuously evaluate and improve patient outcomes. The CRP's integrated multidisciplinary care and patient-centered approach is promising for the management of patients with cardiorenal syndrome. (c) 2025 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
- Peritoneal protein loss with time in peritoneal dialysisPublication . Guedes, Anabela Malho; Marques, Roberto Calças; Domingos, Ana Teresa; Laranjo, Céu; Silva, Ana Paula; Rodrigues, Anabela; Krediet, Raymond T.Longitudinal evolution of peritoneal protein loss (PPL), a reflection of hydrostatic pressure-driven leak of plasma proteins through the large-pore pathway, is not clear. Time on PD causes loss of mesothelial cells, vasculopathy, and increased thickness of the submesothelial fibrous layer. Are these structural changes associated with progressive increase of PPL, in a parallel with the rise in the D/P creatinine? The aim of the present study was to identify longitudinal changes of PPL over time. This single-center, longitudinal study included 52 peritoneal dialysis (PD) patients with a median follow-up of 26.5 months, evaluated at two different time points with a minimum interval of 6 months. Repeated measures analysis was performed using paired sample t-test or the nonparametric Wilcoxon signed-rank test, depending on the distribution. After a median interval of 15.5 months, lower levels of residual renal function and urine volume, lower Kt/V, and creatinine clearance were found. D/P creatinine and PPL were stable, but a decrease in ultrafiltration was present. Systemic inflammation, nutrition, and volume overload showed no significant change with time on PD. Analysis of a subpopulation with over 48 months between initial and subsequential assessment (n = 11) showed again no difference in inflammation, nutritional and hydration parameters from baseline, but importantly PPL decreased after more than 4 years on PD (mean difference 1.2 g/24, p = 0.033). D/P creatinine and dip of sodium remained unchanged. The absence of deleterious effects of time on PD is reassuring, pointing to the benefit of updated PD prescription, including the standard use of more biocompatible solutions towards membrane preservation and adjusted prescription avoiding overhydration and inflammation while maintaining nutritional status. After controlling for confounders, PPL may act as a biomarker of acquired venous vasculopathy, even if small pore fluid transport rates and free water transport are preserved.
- Tip lesion variant of focal and segmental glomerulosclerosis in a COVID-19 patientPublication . Afonso, Rita Serra; Calças Marques, Roberto; Borges, Henrique; Carias, Eduarda; Domingos, Ana Teresa; Cabrita, Ana; Sampaio, Sandra; Silva, Ana PaulaAcute kidney injury is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Several pathologic findings are continually being reported, showing a probably multifactorial etiology. The authors present a case of a patient diagnosed with a tip lesion variant of focal segmental glomerulosclerosis (FSGS) in the setting of COVID-19. A 43-year-old African American female with no known renal disease presented to the emergency department with a 6-day history of fatigue, headache, hypoageusia, myalgia, cough, nausea, and vomiting. Laboratory tests confirmed SARS-CoV-2 infection. During hospitalization, there was a progressive decline in kidney function and evidence of nephrotic-range proteinuria without nephrotic syndrome. Biopsy specimen showed a tip lesion variant of FSGS. Genetic test revealed a homozygous variant of uncertain clinical significance (c.397G>A [p.V133M]) in the epithelial membrane protein 2 (EMP2) gene. To our knowledge, this is the first case report of a tip lesion in a COVID-19 patient with no renal history. More studies are warranted to define susceptible groups and identify the detailed mechanisms of COVID-19-related kidney disease that would allow for specific management of this complication.