Browsing by Author "Pimentel, Ana"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
- Altered serum levels of FGF-23 and magnesium are independent risk factors for an increased albumin-to-creatinine ratio in type 2 diabetics with chronic kidney diseasePublication . Silva, Ana Paula; Mendes, Filipa; Fragoso, André; Jerónimo, Teresa; Pimentel, Ana; Gundlach, Kristina; Büchel, Janine; Santos, Nélio; Neves, Pedro LeãoAims: To investigate the role of FGF-23 and magnesium in relation to the albumin-to-creatinine ratio in type 2 diabetics with chronic kidney disease (CKD) stages 2-4.Methods: In a cross-sectional study we included all eligible type 2 diabetic patients with CKD stages 2-4, followed in our outpatient Diabetic Kidney clinic. We used descriptive statistics, the Student's t-test, ANOVA and the chi-square tests. Our population was divided according to the UACR (G1 30-300 mg/g and G2 >= 300 mg/g), and compared these groups regarding several biological and laboratorial parameters. We employed a multiple regression model to identify risk factors of increased UACR.Results: The patients in G2 displayed a lower eGFR (p = 0.0001) and, had lower levels of magnesium (p = 0.004) as well as higher levels of FGF-23 (p = 0.043) compared to patients in Gl.FGF-23 (beta = 0.562, P = 0.0001) and the magnesium (beta = - 8.916, p = 0.0001) were associated with increased UACR.Conclusions: A dysregulation of mineral metabolism, reflected by altered levels of magnesium and FGF-23, correlates with an increased UACR in type 2 diabetic patients with CKD stages 2-4. (C) 2016 Elsevier Inc. All rights reserved.
- Calcific uraemic arteriolopathy - A mini-reviewPublication . Mendes, Filipa; Rocha, Sofia Couto; Agapii, Rodica; Silva, Ana; Fragoso, Andr?; Jerónimo, Teresa; Pimentel, Ana; Neves, Pedro LCalcific Uraemic Arteriolopathy (CUA) or calciphylaxis, is a thrombotic disorder of skin and subcutaneous tissue which typically presents with painful purpuric nodules that may progress to necrotic ulcers, and is a severe, life-threatening condition. CUA is an uncommon clinical entity that affects mostly haemodialysis (HD) patients. Although the process of vascular calcification was initially thought to be the result of a passive deposition of calcium-phosphate crystals, current knowledge suggests a distinct mechanism, including cellular activity with differentiation of vascular smooth muscle cells (VSMCs) into chondrocyte as well as osteoblast-like cellular phenotypes and deficiencies in calcification inhibitors. Although multiple studies suggest a potential relationship between warfarin and CUA, larger prospective studies are needed in order to better evaluate this association, and randomised controlled trials are needed to assess the benefit of distinct interventions in this setting. In this article the topic of CUA is reviewed based on a clinical case of a 65-year-old man undergoing haemodialysis, who underwent an aortic valve replacement one year earlier, receiving a mechanical heart valve, and who has been under warfarin therapy since then
- Fracturing issue concerning cardiovascular mortality in chronic kidney disease patientsPublication . Mendes, Filipa; Silva, Ana P.; Alonso, Isis; Fragoso, André; Pereira, Luisa Helena; Jerónimo, Teresa; Pimentel, Ana; Neves, Pedro L.With the ageing of population worldwide, the riskof both osteoporosis and chronic kidney disease increased. These two conditions multiply the riskof bone fractures. The higher riskoffractures in CKD is accompanied bya higher mortality rate in hemodialysis patients. According to the Universityof Michigan’s study,the risk mortalityafter hip fracturewas 6.5 times higher in stage 5 CKD patients compared with patient with normal kidney function. In this study we analyzed the role of bone mineral metabolism and of hip fractures on cardiovascular mortality in a population of chronic kidney disease pre-dialysis patients. Methods: In an observational study, we included 300 patients followed in a pre-dialysis clinic during a 8 years period (2005-2013). Descriptive statistics and the Cox proportional hazard regression model were used to find risk factors of cardiovascular mortality.The mean age of these patients was 69.38 years, the mean eGFR (MDRD) was 20.40 ml/min and 60% (180) were female. Results: Using the Cox proportional hazard regression model, adjusted to age, gender, Diabetes Mellitus, Charlson comorbidity index, e-GFR, calcium, phosphorus, PTH, 25 OHD, osteocalcin, albumin and hip fractures, we found that25(OH)2D3 (HR= 0.950, 95% CI, 0.697 to 0.993 p=0.035), eGFR (HR= 0.638, 95% CI, 0.586 to 0.993, p=0.028) and hip fractures (HR= 1.753, 95% CI, 1.294 to 1.893 p=0.036) were independent risk factors of cardiovascular mortality. Conclusions: In our population of chronic kidney pre-dialysis patients, the levels of 25 (OH)2D3 and renal function, as well asthe presence of hip fractures increased the risk of cardiovascular mortality.
- Gaucher disease and Lupus: a rare association?Publication . Jerónimo, Teresa; Cabrita, Ana; Pimentel, Ana; Vidinha, Joana; Fragoso, Andre; Santos, Viriato; Bernardo, Idalecio; Viana, Helena; Carvalho, Fernanda; Brito, Helena; Lazaro, Mario; Neves, Pedro LeaoGaucher disease (GD), is an autosomal recessive lysosomal storage disease that is due to mutations in the glucocerebrosidase (GC) gene, with a prevalence of 1/57,000 to 1/75,000 births worldwide and significantly more common among the Ashkenazi Jewish heritage. GD is categorized into three clinical types4 and the clinical manifestations result from the accumulation of the lipid-laden macrophages in the spleen, liver, bone, bone marrow, leading to impairment of central nervous system in the most severe cases.
- Mineral metabolism and inflammation: factors related to left ventricular hypertrophy in patients with diabetic nephropathyPublication . Jerónimo, Teresa; Fragoso, Andr?; Mendes, Filipa; Silva, Ana Paula; Pimentel, Ana; Tavares, Nelson; Camacho, Ana; Neves, Pedro LeãoLeft ventricular hypertrophy (LVH) is an important risk factor for cardiovascular disease in patients with diabetic nephropathy (DN) and is an independent predictor of mortality in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the association of LVH with mineral metabolism and inflammation in a population of patients with DN. In an observational study were included 119 type 2 diabetic patients with CKD stages 3 and 4. The population was divided into two groups, according to the presence of LVH: group 1 (G-1) with LVH (left ventricular mass index (LVMI) > 125 g/m2 in male patients and LVMI > 110 g/m2 in female patients) and group 2 (G-2) without LVH (LVMI ? 125 g/m2 in male patients and LVMI ? 110 g/m2 in female patients). The patient characteristics of each group were compared regarding several biological and laboratory parameters. Patients with LVH displayed lower values of estimated glomerular filtration rate (eGFR) (p = 0.0001) and albumin (p = 0.046), and higher levels of phosphorus (p = 0.0001), intact parathyroid hormone (iPTH) (p = 0.0001), insulin resistance (HOMA-IR) (p = 0.0001) and interleukin-6 (IL-6) (p = 0.0001), compared with patients without LVH. In a logistic regression model, phosphorus (odd ratio (OR) = 1.825 (1.075-4.414), p = 0.038), iPTH (OR = 1.991 (1.098-3.000), p = 0.004) and IL-6 (OR = 3.538 (1.863-6.719), p = 0.0001) were independently related to LVH. In a multiple linear regression model, phosphorus (r = 0.602, p = 0.038), iPTH (r = 1.009, p = 0.044) and IL-6 (r = 1.264, p = 0.0001) were positively related to LVMI. Phosphorus, PTH and IL-6 were related to LVH in our diabetic population with CKD stages 3 and 4
- Risk factors of hip fractures in chronic kidney disease patientsPublication . Mendes, Filipa; Gomes, Ana; Alonso, Isis; Fragoso, André; Pereira, Luisa Helena; Jerónimo, Teresa; Pimentel, Ana; Neves, Pedro L.In the Western World the general population is getting older. This implies a higher prevalence of osteoporosis as well as a greater incidence of patients with chronic kidney disease. These two conditions increase the riskof bone fractures. Metabolic and hormonal disarrangement in end-stage renal disease (ESRD) negativelyaffects bone remodeling as it promotes a decrease in Vitamin D availability, hyperphosphatemia, hypocalcemia, high secretion of parathormone and chronic metabolic acidosis. The NHANES III showed that even moderate-to-severe CKD patients may present with a significant increased riskoffracturewhich is justified by hyperparathyroidism at the earlystages of the disease.