Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV
Autor(a) principal: | |
---|---|
Data de Publicação: | 2018 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da FAMERP |
Texto Completo: | http://bdtd.famerp.br/handle/tede/470 |
Resumo: | Although the antirretroviral therapy, in spite of having reduced the mortality for AIDS and increased the lifespan of the HIV bearers, it can contribute to the arrise of adverse long time effects, besides renal ones. The tenofovir (TDF), a first line antirretroviral (ARV) for treatment, has low general toxicity. TDF can take to moderate reduction in glomerular filtration rate (GFR) and a larger prevalence of renal tubular dysfunction (RTD) when compared to those patients who are not on therapy of this medication. The decline of the renal function found in the patients can vary from mild to chronic injuries or a simple reduction in GFR. The mechanism of RTD is not completely understood, and it has been attributed to the mitocondrial lesion in the proximal tubule cells caused by the increasing of the intracelular TDF concentration. Aditionaly, host´s genetic polymorphisms have been considered one of the TDF concentration increasing causes. RTD can be characterized concisely by the deficiency in the solutes reabsorption as bicarbonate, uric acid, phosphate, glucose and low weight molecular proteins. Objectives: verify the prevalence of RTD in the HIV bearers on TDF treatment, identify the risk factors associated and compare the 24-hours urine methods with the serum creatinine and its clearance for the RTD identification. Methods: longitudinal prospective study, performed in the Complexo de Doenças Transmissíveis em São José do Rio Preto/SP, between january 2011 to december 2015. Results: 163 patients were included in the study, in which 106 (68,4%) didn't use TDF and 57 (31,6%) used TDF. RTD occured in 8 patients that used TDF, a prevalence of 14%. The patients age was identified as significant risk factor for the development of RTD. The proteinuria (average 109,2mg/24h) and the phosphaturia (average 791,9mg/24h) were significant for the diagnosis of RTD. Conclusions: the prevalence of RTD was 14%. The age was determined as risk factor for RTD, mainly in patients over 60 years-old. Phosphaturia and the proteinuria showed the greatest diagnosis sensibility for RTD, respectively. The serum creatinine and phosphorus concentration, the creatinine clearance and the stand alone hyperproteinuria should not be used as diagnosis predictors for RTD. |
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Rubio, Fernando Gongorahttp://lattes.cnpq.br/1888582463299650Rosa, Ricardo Santaella5624896828608448Ramalho, Ana Luiza de Araújo Souzahttp://lattes.cnpq.br/528425317114326630114631824http://lattes.cnpq.br/7729462962457471Souza, Renato Ferneda de2018-11-09T18:53:26Z2018-04-27Souza, Renato Ferneda de. Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV. 2018. 52 f. Dissertação (Programa de Pós-Graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto.1347http://bdtd.famerp.br/handle/tede/470Although the antirretroviral therapy, in spite of having reduced the mortality for AIDS and increased the lifespan of the HIV bearers, it can contribute to the arrise of adverse long time effects, besides renal ones. The tenofovir (TDF), a first line antirretroviral (ARV) for treatment, has low general toxicity. TDF can take to moderate reduction in glomerular filtration rate (GFR) and a larger prevalence of renal tubular dysfunction (RTD) when compared to those patients who are not on therapy of this medication. The decline of the renal function found in the patients can vary from mild to chronic injuries or a simple reduction in GFR. The mechanism of RTD is not completely understood, and it has been attributed to the mitocondrial lesion in the proximal tubule cells caused by the increasing of the intracelular TDF concentration. Aditionaly, host´s genetic polymorphisms have been considered one of the TDF concentration increasing causes. RTD can be characterized concisely by the deficiency in the solutes reabsorption as bicarbonate, uric acid, phosphate, glucose and low weight molecular proteins. Objectives: verify the prevalence of RTD in the HIV bearers on TDF treatment, identify the risk factors associated and compare the 24-hours urine methods with the serum creatinine and its clearance for the RTD identification. Methods: longitudinal prospective study, performed in the Complexo de Doenças Transmissíveis em São José do Rio Preto/SP, between january 2011 to december 2015. Results: 163 patients were included in the study, in which 106 (68,4%) didn't use TDF and 57 (31,6%) used TDF. RTD occured in 8 patients that used TDF, a prevalence of 14%. The patients age was identified as significant risk factor for the development of RTD. The proteinuria (average 109,2mg/24h) and the phosphaturia (average 791,9mg/24h) were significant for the diagnosis of RTD. Conclusions: the prevalence of RTD was 14%. The age was determined as risk factor for RTD, mainly in patients over 60 years-old. Phosphaturia and the proteinuria showed the greatest diagnosis sensibility for RTD, respectively. The serum creatinine and phosphorus concentration, the creatinine clearance and the stand alone hyperproteinuria should not be used as diagnosis predictors for RTD.A TARV, apesar de ter reduzido a mortalidade por AIDS e aumentado a expectativa de vida dos portadores de HIV, pode contribuir para o aparecimento de efeitos adversos de longo prazo, inclusive renal. O tenofovir (TDF), antirretroviral (ARV) de primeira linha para o tratamento, tem baixo perfil geral de toxicidade. No entanto, pode levar a uma moderada redução na taxa de filtração glomerular (TFG) e uma maior prevalência de disfunção tubular renal (DTR) quando comparado àqueles pacientes que não o utilizam. O declínio da função renal encontrado nos pacientes podem ser injúrias agudas, crônicas ou uma simples redução na TFG. O mecanismo da DTR não é totalmente conhecido; atribui-se à lesão mitocondrial nas células dos túbulos proximais pelo aumento da concentração do TDF intracelular, além da suspeita da influência de polimorfismos genéticos dos hospedeiros. Pode ser resumidamente caracterizada pela deficiência na reabsorção de solutos como bicarbonato, ácido úrico, fosfato, glicose e proteínas de baixo peso molecular. Objetivos: Verificar a prevalência da DTR nos portadores de HIV em uso de TDF; identificar os fatores de risco associados e comparar os métodos de Urina de 24 horas com a creatinina sérica e o clearance para a sua identificação. Casuística e método: estudo longitudinal prospectivo, com 163 pacientes, realizado no Complexo de Doenças Transmissíveis em São José do Rio Preto/SP, no período de janeiro de 2011 a dezembro de 2015. Resultados: Foram incluídos 163 pacientes no estudo, dos quais 106 (68,4%) não utilizaram TDF e 57 (31,6%) utilizaram TDF. A DTR ocorreu em 8 pacientes que utilizaram TDF; uma prevalência de 14%. A idade dos pacientes (média de 43,9 anos) foi identificada como fator de risco significante para o desenvolvimento da DTR. A proteinúria (média 109,2mg/24h) e a fosfatúria (média 791,9mg/24h) foram significantes para o diagnóstico da DTR. Conclusões: A prevalência da DTR foi de 14%. A idade foi determinada como fator de risco para a DTR, principalmente, na faixa acima dos 60 anos. Os exames laboratoriais que mostraram a maior sensibilidade diagnóstica para a DTR foram a fosfatúria e a proteinúria, respectivamente. A creatinina sérica, o fósforo sérico, o clearance de creatinina e a hiperproteinúria isolada não mostraram sensibilidade como preditores diagnósticos para a DTR.Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-09T18:53:26Z No. of bitstreams: 1 RenatoFerneda_dissert.pdf: 585980 bytes, checksum: 7c6b97dc0f3805fe789d0fdbee741928 (MD5)Made available in DSpace on 2018-11-09T18:53:26Z (GMT). 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dc.title.por.fl_str_mv |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
title |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
spellingShingle |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV Souza, Renato Ferneda de Antiretroviral Therapy, Highly Active HIV Kidney Tubules Terapia Antirretroviral de Alta Atividade HIV Túbulos Renais CIENCIAS DA SAUDE::8765449414823306929::600 |
title_short |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
title_full |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
title_fullStr |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
title_full_unstemmed |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
title_sort |
Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV |
author |
Souza, Renato Ferneda de |
author_facet |
Souza, Renato Ferneda de |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Rubio, Fernando Gongora |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/1888582463299650 |
dc.contributor.referee1.fl_str_mv |
Rosa, Ricardo Santaella |
dc.contributor.referee1Lattes.fl_str_mv |
5624896828608448 |
dc.contributor.referee2.fl_str_mv |
Ramalho, Ana Luiza de Araújo Souza |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/5284253171143266 |
dc.contributor.authorID.fl_str_mv |
30114631824 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7729462962457471 |
dc.contributor.author.fl_str_mv |
Souza, Renato Ferneda de |
contributor_str_mv |
Rubio, Fernando Gongora Rosa, Ricardo Santaella Ramalho, Ana Luiza de Araújo Souza |
dc.subject.eng.fl_str_mv |
Antiretroviral Therapy, Highly Active HIV Kidney Tubules |
topic |
Antiretroviral Therapy, Highly Active HIV Kidney Tubules Terapia Antirretroviral de Alta Atividade HIV Túbulos Renais CIENCIAS DA SAUDE::8765449414823306929::600 |
dc.subject.por.fl_str_mv |
Terapia Antirretroviral de Alta Atividade HIV Túbulos Renais |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::8765449414823306929::600 |
description |
Although the antirretroviral therapy, in spite of having reduced the mortality for AIDS and increased the lifespan of the HIV bearers, it can contribute to the arrise of adverse long time effects, besides renal ones. The tenofovir (TDF), a first line antirretroviral (ARV) for treatment, has low general toxicity. TDF can take to moderate reduction in glomerular filtration rate (GFR) and a larger prevalence of renal tubular dysfunction (RTD) when compared to those patients who are not on therapy of this medication. The decline of the renal function found in the patients can vary from mild to chronic injuries or a simple reduction in GFR. The mechanism of RTD is not completely understood, and it has been attributed to the mitocondrial lesion in the proximal tubule cells caused by the increasing of the intracelular TDF concentration. Aditionaly, host´s genetic polymorphisms have been considered one of the TDF concentration increasing causes. RTD can be characterized concisely by the deficiency in the solutes reabsorption as bicarbonate, uric acid, phosphate, glucose and low weight molecular proteins. Objectives: verify the prevalence of RTD in the HIV bearers on TDF treatment, identify the risk factors associated and compare the 24-hours urine methods with the serum creatinine and its clearance for the RTD identification. Methods: longitudinal prospective study, performed in the Complexo de Doenças Transmissíveis em São José do Rio Preto/SP, between january 2011 to december 2015. Results: 163 patients were included in the study, in which 106 (68,4%) didn't use TDF and 57 (31,6%) used TDF. RTD occured in 8 patients that used TDF, a prevalence of 14%. The patients age was identified as significant risk factor for the development of RTD. The proteinuria (average 109,2mg/24h) and the phosphaturia (average 791,9mg/24h) were significant for the diagnosis of RTD. Conclusions: the prevalence of RTD was 14%. The age was determined as risk factor for RTD, mainly in patients over 60 years-old. Phosphaturia and the proteinuria showed the greatest diagnosis sensibility for RTD, respectively. The serum creatinine and phosphorus concentration, the creatinine clearance and the stand alone hyperproteinuria should not be used as diagnosis predictors for RTD. |
publishDate |
2018 |
dc.date.accessioned.fl_str_mv |
2018-11-09T18:53:26Z |
dc.date.issued.fl_str_mv |
2018-04-27 |
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Souza, Renato Ferneda de. Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV. 2018. 52 f. Dissertação (Programa de Pós-Graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto. |
dc.identifier.uri.fl_str_mv |
http://bdtd.famerp.br/handle/tede/470 |
dc.identifier.doi.por.fl_str_mv |
1347 |
identifier_str_mv |
Souza, Renato Ferneda de. Disfunção tubular renal associada ao tenofovir na terapia antirretroviral em portadores de HIV. 2018. 52 f. Dissertação (Programa de Pós-Graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto. 1347 |
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