Navegando por Palavras-chave "AKI"

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    Effect of polymyxin B-containing regimens on renal function for the treatment of carbapenem-resistant Enterobacteriacea mediastinitis
    (Elsevier Brazil, 2018) Abboud, Cely Saad; Rao, Gauri G.; Souza, Ercilia E.; Zavascki, Alexandre P.; Kiffer, Carlos [UNIFESP]
    A retrospective cohort study, were evaluated: polymyxin B plus aminoglycosides or polymyxin B plus other antibiotics. Any degree of acute kidney injury occurred in 26 (86.6%) patients. The median time to acute kidney injury was 6.0 (95% CI 3-14) days in the polymyxin-aminoglycoside containing regimen group, against 27.0 (95% CI 6-42) days in the polymyxin with other antimicrobial combinations group (p = 0.03). Polymyxin B with aminoglycosides group progressed faster to any degree of renal dysfunction. (C) 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license.
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    Effects of simvastatin on cytokines secretion from mononuclear cells from critically ill patients with acute kidney injury
    (Elsevier B.V., 2011-05-01) Ferrari, Gabriela Laender [UNIFESP]; Quinto, Beata Marie [UNIFESP]; Queiroz, Kelly Cristina Batista de Souto [UNIFESP]; Iizuka, Ilson Jorge; Monte, Julio Cesar Martins [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Durão, Marcelino de Souza [UNIFESP]; Cendoroglo Neto, Miguel [UNIFESP]; Santos, Oscar Fernando Pavão dos [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); IAEH IEP Hosp Israelita Albert Einstein Inst Ensi
    Purpose: To assess the in vitro effects of simvastatin on IL-10 and TNF-alpha secretion from peripheral blood mononuclear cells (PBMC) of critically ill patients with and without acute kidney injury (AKI).Methods: PBMC were collected from 63 patients admitted to the intensive care unit (ICU) and from 20 healthy controls. Patients were divided in 3 subgroups: with AKI, with sepsis and without AKI and with AKI and sepsis. After isolation by ficoll-gradient centrifugation cells were incubated in vitro with LPS 1 ng/mL, simvastatin (10(-8)M) and with LPS plus simvastatin for 24 h. TNF-alpha and IL-10 concentrations on cells surnatant were determined by ELISA.Results: Cells isolated from critically ill patients showed a decreased spontaneous production of TNF-alpha and IL-10 compared to healthy controls (6.7(0.2-12) vs 103(64-257) pg/mL and (20 (13-58) vs 315(105-510) pg/mL, respectively, p < 0.05). Under LPS-stimulus, IL-10 production remains lower in patients compared to healthy control (451 (176-850) vs 1150(874-1521) pg/mL,p < 0.05) but TNF-alpha production was higher (641 (609-841) vs 406 (201-841) pg/mL, p < 0.05). the simultaneous incubation with LPS and simvastatin caused decreased IL-10 production in cells from patients compared to control (337 (135-626) vs 540 (345-871) pg/mL, p < 0.05) and increased TNF-alpha release (711 (619-832) vs 324 (155-355) pg/mL, p < 0.05). Comparison between subgroups showed that the results observed in TNF-alpha and IL-10 production by PBMC from critically ill patients was independent of AKI occurrence.Conclusions: the PBMC treatment with simvastatin resulted in attenuation on pro-inflammatory cytokine spontaneous production that was no longer observed when these cells were submitted to a second inflammatory stimulus. Our study shows an imbalance between pro and anti-inflammatory cytokine production in PBMC from critically ill patients regardless the presence of AKI. (C) 2011 Elsevier B.V. All rights reserved.
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    TNF-alpha depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatment
    (Elsevier B.V., 2015-02-01) Quinto, Beata Marie R. [UNIFESP]; Iizuka, Ilson J.; Monte, Julio C. M. [UNIFESP]; Santos, Bento F.; Pereira, Virgilio; Durao, Marcelino S. [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Cendoroglo, Miguel [UNIFESP]; Santos, Oscar F. P. [UNIFESP]; Batista, Marcelo C. [UNIFESP]; Hosp Israelita Albert Einstein; Universidade Federal de São Paulo (UNIFESP); Tufts Univ; Univ Uninove
    Introduction: Critically ill patients with acute kidney injury (AKI) present high mortality rates. the magnitude of inflammatory response could determine the prognosis of such patients. Continuous renal replacement therapy (CRRT) may play an important role in removing inflammatory mediators in patients with AKI.Aim: To investigate whether the magnitude of inflammatory mediator's removal is associated with mortality among critically ill patients on CVVHDF, a CRRT modality.Methods: This study consisted of 64 critically ill patients requiring CVVHDF. Plasma levels of C3a, TNF-alpha, IL-10, IL-6, IL-1 beta, sTNFRI and sTNFRII were determined by enzyme-linked immunosorbent assay (ELISA) at the beginning of CVVHDF and after 24 h (outlet). Clearance of cytokines during the first 24 h of CVVHDF was calculated. Clinical and laboratory data were acquired from patient's records data.Results: Mean age of patients requiring CVVHDF was 63 years, 67.2% were men and 87.3% were Caucasian. Thirty-five (35) patients (54.7%) died. Comparing non-survivors with the group of survivors we observed higher incidence of sepsis (68.6 versus 37.9%, p < 0.05), higher APACHE II score (34.8 +/- 7.6 versus 29.2 +/- 7.1, p < 0.05) and higher lactate levels (23.2 +/- 17.6 versus 16.4 +/- 6.6, p < 0.05). According to the inter-tertile range of TNF-alpha clearance (ITR1 (<0.54); ITR2 (0.54-2.93); ITR3 (>2.93)) we found that those patients with higher TNF-alpha removal by RRT (ITR3) had a better survival. Multivariable analysis showed that lower clearance of TNF-alpha remained independently associated with high mortality after adjustment for sex, age, use of vasoactive drugs, APACHE II score sepsis, creatinine and lactate before CVVHDF (HR: 0.179, 95% IC: 0.049-0.661, p < 0.01).Conclusion: the attenuation of inflammatory response may be related to the lower mortality observed on those patients with higher TNF-alpha removal by CVVHDF. (C) 2014 Elsevier B.V. All rights reserved.