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Ricardo de Amorim Corrêahttp://lattes.cnpq.br/2931887430324877Vandack Alencar Nobre Júniorhttp://lattes.cnpq.br/3345116100947099Katia de Paula FarahGláucia Fernandes Cotahttp://lattes.cnpq.br/6228682464449562Leonardo Meira de Faria2023-04-06T14:12:37Z2023-04-06T14:12:37Z2020-12-07http://hdl.handle.net/1843/51684https://orcid.org/0000-0001-7505-487XO transplante renal é uma modalidade eficiente de tratamento da doença renal terminal. Devido ao estado de imunossupressão prolongada e exposições ambientais, complicações infecciosas são relativamente comuns notadamente as infecções em trato respiratório inferior. Os dados na literatura nacional são escassos a respeito de fatores de risco associados a infecções pulmonares nestes pacientes. O presente estudo caso-controle, na proporção 1:1,8, pareados por sexo, faixa etária, e tipo de doador (doadores vivos ou falecidos) unicêntrico realizado em hospital de referência de transplante renal no Estado de Minas Gerais - Hospital Felício Rocho no período de dezembro de 2017 a março de 2020. Os objetivos principais foram o estudo da etiologia e fatores associados a infecções pulmonares em pacientes transplantados renais, além de identificar na amostra de pacientes transplantados renais, subgrupos específicos com risco aumentado de infecções pulmonares e proposta final de abordagem sistematizada ao transplantado renal com opacidade pulmonar aguda. Incluídos 197 pacientes, sendo 70 do grupo caso e 127 do grupo controle. A média de idade foi de 55 e 53 anos no grupo caso e controle, respectivamente, com predomínio do sexo masculino em ambos os grupos. A maioria das etiologias da doença renal prévia foi indeterminada em ambos grupos. Entre as etiologias identificadas, houve maior proporção de diabetes mellitus para os casos (17,1%) e para os controles de glomerulopatia (23%) seguido de diabetes mellitus (22,2%).Pacientes do grupo caso apresentaram índice de massa corporal (IMC) significativamente mais baixo quando comparados aos controles (p=0,013).Na amostra estudada, dentre as classes de imunossupressores utilizadas, o uso de corticosteróide em 67 casos e 106 controles associou-se a risco aumentado de infecção (OR: 4,4 – IC 95%:1,3 - 15,4 ), assim como à presença de bronquiectasias (9 casos e 3 controles; OR:6,1 – IC 95%: 1,6 a 23,2) . Na análise dos pacientes casos isoladamente, foi observado no parâmetro radiológico o predomínio da manifestação em vidro fosco em cerca de 50% dos pacientes. Em relação à etiologia infecciosa, destaca-se a alta prevalência de agentes fúngicos (21,4%), sendo mais prevalentes Histoplasma capsulatum (5 casos), Cryptococcus neoformans e Paracoccidioides brasiliensis, ambos com 3 casos. Citomegalovírus foi diagnosticado em 14,3% dos pacientes caso. No presente estudo envolvendo pacientes adultos transplantados renais, uso de corticosteróide e presença de bronquiectasias foram associados à ocorrência de infecções pulmonares nesses pacientes. Diferentemente de estudos prévios em população geral, baixo nível nutricional não foi relacionado a risco aumentado de infecções pulmonares nesta população. Destaca-se a necessidade de seguimento cuidadoso dos pacientes transplantados renais, com ações no pré e no pós-transplante visando a adequada identificação daqueles sob maior risco para complicações infecciosas pulmonares.Kidney transplantation is an efficient treatment for end-stage renal disease. Due to the state of prolonged immunosuppression and environmental exposures, infectious complications are relatively common, notably lower respiratory tract infections. Data in the national literature are scarce regarding risk factors associated with pulmonary infections in these patients. The present case-control study, in the proportion 1: 1.8, matched by sex, age group, and type of donor (living or deceased donors), carried out in a reference kidney transplant hospital in the State of Minas Gerais - Hospital Felício Rocho from December 2017 to March 2020. The main objectives were to study the etiology and factors associated with lung infections in kidney transplant patients, in addition to identifying in the sample of kidney transplant patients, specific subgroups with increased risk of lung infections and proposal end of systematic approach to renal transplant recipients with acute pulmonary opacity.197 patients were included, 70 from the case group and 127 from the control group. The mean age was 55 and 53 years in the case and control group, respectively, with a male predominance in both groups. Most of the etiologies of previous kidney disease were undetermined in both groups. Among the etiologies identified, there was a higher proportion of diabetes mellitus for the cases (17.1%) and for the glomerulopathy controls (23%) followed by diabetes mellitus (22.2%). Patients in the case group had a significantly lower body mass index (BMI) when compared to controls (p = 0.013).In the sample studied, among the classes of immunosuppressants used, the use of corticosteroids in 67 cases and 106 controls was associated with an increased risk of infection (OR: 4.4 - 95% CI: 1.3 - 15.4), as well as the presence of bronchiectasis (9 cases and 3 controls; OR: 6.1 - 95% CI: 1.6 to 23.2). In the analysis of the isolated case patients, the predominance of ground-glass manifestation was observed in approximately 50% of the patients in the radiological parameter. Regarding the infectious etiology, the high prevalence of fungal agents (21.4%) stands out, the most prevalent being Histoplasma capsulatum (5 cases), Cryptococcus neoformans and Paracoccidioides brasiliensis, both with 3 cases. Cytomegalovirus was diagnosed in 14.3% of the case patients. In the present study involving adult renal transplant patients, the use of corticosteroids and the presence of bronchiectasis were associated with the occurrence of pulmonary infections in these patients. Unlike previous studies in the general population, low nutritional level was not related to an increased risk of pulmonary infections in this population. The need for careful follow-up of renal transplant patients is highlighted, with actions in the pre- and post-transplantation aiming at the adequate identification of those most at risk for pulmonary infectious complications. Patients in the case group had a significantly lower body mass index (BMI) when compared to controls (p = 0.013).In the sample studied, among the classes of immunosuppressants used, the use of corticosteroids in 67 cases and 106 controls was associated with an increased risk of infection (OR: 4.4 - 95% CI: 1.3 - 15.4), as well as well as the presence of bronchiectasis (9 cases and 3 controls; OR: 6.1 - 95% CI: 1.6 to 23.2). In the analysis of the isolated case patients, the predominance of ground-glass manifestation was observed in approximately 50% of the patients in the radiological parameter.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências Aplicadas à Saúde do AdultoUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICATransplante de RimTerapia de ImunossupressãoPneumoniaDiabetes MellitusFatores de RiscoTransplante de rimImunossupressãoPneumoniaFatores associados a infecções pulmonares em transplantados Renais e rim-pâncreas: um estudo caso-controleFactors associated with lung infections in kidney and kidney-pancreas transplants: a case-control studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALdissertação mestrado versão repositório .pdfdissertação mestrado versão repositório .pdfapplication/pdf2387742https://repositorio.ufmg.br/bitstream/1843/51684/1/disserta%c3%a7%c3%a3o%20mestrado%20vers%c3%a3o%20reposit%c3%b3rio%20.pdf1466039fc39dda9dcabb0411cf6365a8MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/51684/2/license.txtcda590c95a0b51b4d15f60c9642ca272MD521843/516842023-05-22 15:55:18.786oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-05-22T18:55:18Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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