Papers by Patrícia Branco
Nephrology Dialysis Transplantation, Jun 1, 2023
Background and Aims: Some biomarkers in drained dialysate or peritoneal membrane have been found ... more Background and Aims: Some biomarkers in drained dialysate or peritoneal membrane have been found related to the dialysate/plasma ratio of creatinine at 4 h (D/P Cr) in patients undergoing peritoneal dialysis (PD). But so far, there is no report on serum markers. Some biomarkers are associated with cardiovascular diseases (CVDs). Chemerin is a multifunctional chemoattractant adipokine which plays roles in inflammation, adipogenesis and metabolism. In this study, we intended to investigate the role of chemerin in the peritoneal membrane transport function and CVDs in incident PD patients. Method: This prospective cohort study was conducted in our PD center. The patients underwent initial standardized peritoneal equilibration test (PET) after PD for 4-6 weeks. Level of serum chemerin was determined via enzymelinked immunosorbent assay (ELISA). The patients' CVDs were recorded during the follow-up period. Results: 151 eligible patients with a mean age of 46.59±13.52 years were enrolled. And the median duration of PD was 25.0 months. The median concentration of serum chemerin was 29.09 ng/mL. Baseline D/P Cr was found to be positively correlated with serum chemerin (r = 0.244, p = 0.003). The multivariate analyses revealed that serum chemerin (p = 0.002), age (p = 0.041), albumin (p = 0.000), and high-density lipoprotein (HDL) (p = 0.022) were independent factors of D/P Cr. The serum chemerin level was significantly higher in diabetes mellitus (DM) patients than that of patients without DM (36.45 vs 27.37 ng/mL, p = 0.000). And there was a significant statistical difference in CVDs between the high chemerin group (≥29.09 ng/mL) and low chemerin group (<29.09 ng/mL) (42% vs 21%, p = 0.009). Serum chemerin has a positive correlation with baseline D/P Cr in incident PD patients. It may be a biomarker that can predict the baseline transport function of peritoneal membrane. And serum chemerin may be a risk factor of CVDs for incident PD patients. Multicenter studies with a larger sample size are warranted in the future.
Nephrology Dialysis Transplantation, Jun 1, 2023
Background and Aims: Peritoneal dialysis (PD) is the incident kidney replacement therapy (KRT) fo... more Background and Aims: Peritoneal dialysis (PD) is the incident kidney replacement therapy (KRT) for 16% of patients in Scotland. Conveying the healthcare-related burden associated with KRT is essential for informed patient choice but has not been characterised as comprehensively in PD as in haemodialysis (HD) or kidney transplantation. Knowledge of the patient journey and the cumulative impact of renal service interactions is key to practising patient-centred realistic medicine, and considering service configuration, resource deployment, and the targeting of carbon emission reductions necessary for addressing the climate emergency. This study therefore aimed to capture the nature and extent of kidney-related healthcare activity in the first year of PD therapy. Method: This retrospective observational study included all incident adult patients on PD between 1 st January 2015-31 st December 2019 from two Scottish health boards servicing a population of 1.6 million people. Analysis was undertaken of prospectively recorded healthcare-related activity from the electronic patient record. Data pertaining to hospital admissions, scheduled and unscheduled outpatient clinic, and home visit activity was captured up to the first 365 days post commencement of PD, and censored by death or switch in KRT modality. Data concerning dialysis access activity, radiological activity and relevant infection episodes was also analysed. Carbon mapping of healthcare activity was estimated using patient postcode data and previously published carbon footprint estimations. Results: PD was initiated in 122 patients over the study period. Four patients died and 63 patients (52%) transitioned to another KRT within 365 days of commencing PD (10 live donor kidney transplantation, 19 cadaveric kidney transplantation, 34 HD) and one patient recovered native function. The median duration from insertion of PD catheter to utilisation was 26 days (IQR 34). Mean distance travelled to renal unit was 23.7 miles. Over the first year, patients had a mean 36.4 days (SD 22.7) of face-to-face contact days with renal services. This included a mean of 1.5 (SD 1.6) hospital admissions, with a median 5 (IQR 10.8) in-patient days. Additionally, a mean of 2.5 (SD 2.5) unscheduled ambulatory assessments per patient; 4.7 (SD 6.2) telephone consultations; 14.9 (SD 8.96) face-to-face clinics with a PD nurse and 7 (SD 3.9) with a nephrologist, and 2.5 (SD 3.4) home visits occurred. Within these contact episodes there were on average 4.4 (SD 4.1) radiological investigations per patient (3.1 x-rays, 0.4 CTs, 0.4 ultrasounds, 0.1 MRIs); and 1.4 (SD 0.3) infection events (0.02 bloodstream infections, 0.2 urinary tract infections, 0.7 PD catheter site infections, and 0.5 PD peritonitis episodes). The estimated carbon footprint from patient contact with renal services was 803.6kg CO 2e /patient; this included 402.6kg CO 2e /patient for inpatient days, 54.6kg CO 2e /patient for unscheduled ambulatory assessment, 0.24kg CO 2e /patient for telephone consultations, 293.8kg CO 2e /patient for outpatient clinic activity and 17.6kg CO 2e /patient for home visits, and 34.8kg CO 2e /patient for radiological investigation and treatment of infection episodes. Although PD is a home-based therapy patients should be aware of the frequency of attendance and admission days in the first year.
Nephrology Dialysis Transplantation, Jun 1, 2023
Nephrology Dialysis Transplantation, May 1, 2015
Mycoses, 2007
The aim of this study was to analyse the clinical and microbiological features of fungal peritoni... more The aim of this study was to analyse the clinical and microbiological features of fungal peritonitis, in chronic peritoneal dialysis patients, focusing on non-traditional risk factors for this feared complication. From 2001 to 2004, five episodes of fungal peritonitis were diagnosed in five different patients, accounting for 4.5% of all peritonitis cases seen during this period. Candida spp. were the most frequent isolates. In all cases, peritoneal dialysis catheter removal and switching to haemodialysis were necessary. In these five cases of fungal peritonitis only one was preceded by antibiotic use, within the previous 3 months, the classical risk factor for fungal peritonitis. Identifying predisposing factors usually not taken into account, may lead to an early diagnosis and to a better understanding of fungal peritonitis pathogenesis.
Acta Médica Portuguesa, Feb 10, 2023
A R e v i s t a C i e n t í f i c a d a O r d e m d o s M é d i c o s ARTIGO ACEITE PARA PUBLICAÇ... more A R e v i s t a C i e n t í f i c a d a O r d e m d o s M é d i c o s ARTIGO ACEITE PARA PUBLICAÇÃO DISPONÍVEL EM WWW.ACTAMEDICAPORTUGUESA.COM A insuficiência cardíaca aguda é uma causa frequente de internamento hospitalar em Portugal, com tendência a aumentar devido ao envelhecimento da população. Apesar de a maioria dos internamentos por insuficiência cardíaca aguda ser motivada por quadros congestivos, nem todos os doentes apresentam um fenótipo congestivo, o que reflecte a complexidade de um processo com múltiplas vias fisiopatológicas. A utilização de diuréticos, habitualmente diuréticos de ansa, constitui a base do tratamento da congestão. No entanto, muitos doentes desenvolvem resistência, constituindo assim um desafio sem solução consensual até à data, apesar do extenso debate ao longo dos anos. Apesar da sua utilização frequente na prática clínica, a coadministração de albumina e furosemida permanece controversa na gestão de doentes com insuficiência cardíaca aguda, hipoalbuminémia e resistência aos diuréticos. Esta revisão aborda os mecanismos fisiopatológicos da congestão nesses doentes e explora a base teórica que suporta a coadministração de albumina e furosemida no respectivo contexto clínico. Pretende-se clarificar o potencial benefício da estratégia combinada nesta população específica e identificar possíveis lacunas na literatura que possam ser alvo de estudos futuros.
Nephrology Dialysis Transplantation, Jun 1, 2023
Background and Aims: Patients with chronic kidney disease (CKD) have an increased risk of mortali... more Background and Aims: Patients with chronic kidney disease (CKD) have an increased risk of mortality due to many causes. One of them is sarcopenia, a progressive skeletal muscle disorder that increases adverse outcomes such as fractures, falls, and physical disability, and has been considered an independent risk factor for mortality. Sarcopenia could be defined as a muscle failure in which muscle strength is the most solid measure of muscle function and a better predictor of adverse events rather than muscle mass. Grip strength is considered a reliable surrogate for measures of arm and leg strength. The aim of this study was to evaluate the prevalence of probable sarcopenia in peritoneal dialysis (PD) patients and its association with body composition and several clinical variables.
Nephrology Dialysis Transplantation, Jun 1, 2023
The "Surprise Question" (SQ) ("would you be surprised if this patient died in 6 months/one year?"... more The "Surprise Question" (SQ) ("would you be surprised if this patient died in 6 months/one year?") has proven to be an interesting prognostication tool in a range of settings. However, its reliability in non-dialysis-dependent CKD is still unclear. Our aim was to study the applicability of the SQ to an outpatient CKD-EPI stages 4 to 5 and correlate it with mortality. Method: Observational, prospective and single center study. Baseline comorbid conditions, cause of CKD, degree of autonomy, literacy, social support and baseline laboratory values (i.e., serum creatinine/ estimated glomerular filtration rate, serum albumin and hemoglobin) were collected. Results: A total of 269 patients completed the study, mean age 65 years old; 256 patients (85.3%) had hypertension and 124 (41.3%) had diabetes. The main causes of renal disease were diabetic kidney disease (n = 53; 17.7%), hypertension (n = 15; 5%) and IgA nephropathy (n = 11; 3.7%). The etiology of kidney disease was undetermined for 24 patients (8.0%). Average CKD-EPI was15.5±7.4 mL/min/1.73 m 2 . A total of 188 patients (63%) were independent for daily living activities and 68 (23%) were professionally active and 45 (48%) were accompanied by family members or caregivers in outpatient consultation to discuss and define the care of plan regarding end stage renal disease. Mean follow up time of the study was 365±254 days, and 27 (9%) patients died during this time period. Using the SQ, providers responded Yes and No for 162 (54%) and 92 (31%) patients, respectively. There were no differences in CKD-EPI stage, arterial hypertension, cerebrovascular disease and dyslipidemia. The No group was older (73±16 vs. 63±16, p<0.001) and had more diabetes (n = 46, 55%, p = 0.015). About 8 (30%) and 18 (67%) of Yes and No patients died, respectively (P<0.001). In the Cox-proportional hazard model adjusted to diabetes, the risk of all-cause mortality was significantly increased by around 5.700 times in patients with a No answer by the providers to the SQ (95%CI, 2.340-13.900; p<0.001) and around 1.045 times with increasing age (95%IC, 1.012-1.080; p = 0.007). The model of the SQ to have predictive capacity for occurrence of death had an area under the ROC curve of 0.684 (95%CI, 0.580-0.790; p = 0.002). Conclusion: SQ proved to be a support tool in order to identify patients at high risk of death, who might not have a full benefit of starting dialysis. The choice around kidney replacement therapy is a shared decision-making process, in which competing risks and benefits must be considered. It is essential and urgent to identify means of support for patients, caregivers and health providers to provide and discuss personalized prognostic information.
portuguese journal of nephrology and hypertension, Feb 19, 2023
Nephrology Dialysis Transplantation
Background and Aims Acute kidney injury (AKI) is a frequent complication in neonates and infants ... more Background and Aims Acute kidney injury (AKI) is a frequent complication in neonates and infants after congenital heart disease surgery, with great impact on morbidity and mortality. Peritoneal dialysis (PD) is the renal replacement therapy of choice, as it allows continuous gentle ultrafiltration with minimal impact on hemodynamic status. However, there is no standardized prescription. The present study aimed to describe our experience of using PD in the management of AKI after cardiac surgery in pediatric patients and the postoperative outcomes. Method Single-center cross-sectional study including 21 children undergoing cardiac surgery between 2017 and 2022, in a congenital heart disease reference center. Demographic and clinical data were collected from the electronic records. Results Of the 21 patients treated with PD, 11 were female. Mean age was 32 ± 45 days and median weight was 3.4 kg (IQR 0.5). All pregnancies had been full-term with a mean birth weight of 3.2 ± 0.3 kg. No ...
Nephrology Dialysis Transplantation, May 1, 2022
BACKGROUND AND AIMS: Peritoneal protein loss has been for many years seen as a detrimental conseq... more BACKGROUND AND AIMS: Peritoneal protein loss has been for many years seen as a detrimental consequence of peritoneal dialysis (PD). Many studies correlated this leakage with mortality, malnutrition and inflammation. More recent knowledge has brought overhydration to this equation. This study aims to review classic and recent factors associated with peritoneal protein clearance and its consequences on overall mortality. METHOD: Prevalent and incident PD patients were included. Interleukin 6 (IL-6; dialysate and serum) was obtained during a 3.86% glucose peritoneal equilibration test. Hydration and nutritional status was assessed by bioimpedance. Linear and Cox regression were performed. RESULTS: A total of 78 patients were included (54 incident, 24 prevalent), the mean age was 54.6 ± 18.1 years, 65% were males, and the mean follow-up was 33.9 ± 29.3 months. The mean Charlson comorbidity index (CCI) was 4.4 ± 2.4. The residual GFR was 6.7 ± 3.6 mL/min/1.73 m 2 and the D/P creatinine 0.65 ± 0.12. The IL-6 concentration in the dialysate was 24.9 ± 30.8 pg/mL and in serum was 37.3 ± 5.1 pg/mL. The phase angle was 5.4 ± 1.1°, overhydration 0.88 ± 0.94 L and peritoneal protein clearance 85.6 ± 54.7 mL/24 h. Overall, eight patients died. Linear univariable analysis showed positive associations between peritoneal protein clearance and (i) small solute transport, as measured by D/P creatinine, (ii) body composition, as measured by phase angle and overhydration and (iii) CCI. The peritoneal protein clearance also correlated positively with dialysate IL-6, but not with serum IL-6. By linear multivariable analysis, using the backward method, a significant positive association between peritoneal protein and overhydration (P < 0.001; IC:26.665-71.694) and also phase angle (P = 0.032; IC: 1.845-39.330) were validated. In the exploratory survival analysis, no relationship was found between mortality and peritoneal protein clearance. A univariable positive association was shown with serum IL-6 concentration, overhydration and CCI. A higher phase angle was associated with lower mortality. No relationship with dialysate IL-6 or D/P creatinine was found. In this early-stage PD population, with globally preserved residual kidney function, an effect of this variable on mortality was not evident. Cox regression, conditional backward method, showed CCI (OR: 1.896, IC: 1.235-2.913, P = 0.003), overhydration (OR: 10.034, IC: 1.426-70.587, P = 0.021) and peritoneal protein clearance (OR: 0.576, IC: 0.339-0.978, P = 0.041) were predictors for mortality. CONCLUSION: A better nutrition status and overhydration are the major determinants of peritoneal protein clearance. The survival analysis showed that mortality is higher in overhydrated patients, with higher CCI, but not with higher peritoneal protein clearance. Inflammation, local or systemic, as assessed by IL-6 concentration, did not reveal to be such a strong prognosis predictor as overhydration in these PD patients.
Background: Patients under dialysis have a high cardiovascular risk and they are at increased ris... more Background: Patients under dialysis have a high cardiovascular risk and they are at increased risk when submitted to cardiac surgery. Aim of the study: to evaluate morbidity, early and late mortality, and predictive factors of mortality in patients under dialysis who underwent cardiac surgery. Methods: A retrospective observational study was performed including all dialysis dependent patients who underwent cardiac surgery (coronary, valvular or combined procedures) in our institution between 2007 and 2014. A population of 95 consecutive patients was obtained (no exclusions). Perioperative variables and predictors of mortality were analysed and the endpoints were early and late mortality. Propensity score matching, with a control group of patients with creatinine clearance >90mL/min, was performed by logistic regression, with a 1:1 matching. Kaplan Meier curves were performed for late mortality. Results: Early mortality was 9.4% (EuroSCORE II 4.1%). In univariate analysis, mean ti...
Chronic kidney disease is a global public health problem and is associated with an increased risk... more Chronic kidney disease is a global public health problem and is associated with an increased risk of serious cardiovascular events and mortality. Since Portugal is one of the European countries with the highest incidence of this pathology, we emphasize the importance of promoting the increase of notoriety of this problem with the health authorities, the health professionals and the scientific community. We present a few recommendations that we consider relevant for the better management of this problematic in our country, namely the promotion of communication between different medical specialties, healthcare organization, and we mention others that may play an important role in the future pharmacotherapy approach, such as sodium–glucose cotransporter 2 inhibitors to reduce morbidity and mortality of this population.
Portuguese Journal of Nephrology & Hypertension, 2020
Background: Anemia is a common complication of Chronic Kidney Disease (CKD), in which iron defici... more Background: Anemia is a common complication of Chronic Kidney Disease (CKD), in which iron deficiency's (ID) role is frequently underrated. In CKD, anemia has been associated with higher morbidity and lower quality of life. Nonetheless, reported treatment rates of anemia in CKD are low and guidelines' variability and/or absence for its management and treatment may be preventing patients from receiving optimal treatment. Within this context, we aimed to assess the agreement level on anemia and iron deficiency diagnosis, management, and treatment in CKD patients, by Portuguese physicians in Nephrology, through a Delphi Panel. Methods: A group of seven medical experts in Nephrology and Transfusion Medicine was assembled, and a focus group was conducted, in which 28 statements were agreed upon. Then, a two-round Delphi Panel using a Likert scale was conducted online, inviting Portuguese Society of Nephrology associates to participate. Results: Answers were collected from 76 participants in Round 1 and consensus level was obtained for 1 statement, 57 (75%) respondents fully disagreeing on transfusing all patients with hemoglobin below 9 g/dl, regardless of the clinical situation. The remaining 27 statements were used in Round 2, none obtaining consensus level and 14 statements being categorized as qualified majority: 4 on diagnosis, 3 on disease management, and 7 on treatment. Discussion: Our study showed a lack of consensus on diagnosis, management, and treatment of anemia in CKD patients among the nephrology community in Portugal. Overall, our results illustrated the heterogeneity of national clinical practices in: laboratory parameters' choice; cutoff values defining anemia and/or ID; parameter-based therapeutic decisions. Nonetheless, it was shown clear that patient's individual characteristics, clinical settings, and the physician's "clinical sense" seem to be considered to a further extent than the available guidelines. Future studies should be considered to develop recommendations that can be widely accepted.
Frontiers in Cell and Developmental Biology, 2020
Kidney function in metabolism is often underestimated. Although the word "clearance" is associate... more Kidney function in metabolism is often underestimated. Although the word "clearance" is associated to "degradation", at nephron level, proper balance between what is truly degraded and what is redirected to de novo utilization is crucial for the maintenance of electrolytic and acid-basic balance and energy conservation. Insulin is probably one of the best examples of how diverse and heterogeneous kidney response can be. Kidney has a primary role in the degradation of insulin released in the bloodstream, but it is also incredibly susceptible to insulin action throughout the nephron. Fluctuations in insulin levels during fast and fed state add another layer of complexity in the understanding of kidney fine-tuning. This review aims at revisiting renal insulin actions and clearance and to address the association of kidney dysmetabolism with hyperinsulinemia and insulin resistance, both highly prevalent phenomena in modern society.
International Journal of Integrated Care, 2019
European Heart Journal – Cardiovascular Imaging, 2015
Background: Handheld ultrasound devices allow for a bedside screening although quantitative param... more Background: Handheld ultrasound devices allow for a bedside screening although quantitative parameters are not easily obtained. We aim to assess the reliability of visual qualitative evaluation of left ventricle (LV) compared with standard quantitative evaluation with 2D transthoracic echocardiography (TTE). Methods: Two cardiologists have reviewed 135 consecutive standard TTE examinations. Both observers visually assessed LV size, hypertrophy (LVH) and ejection fraction (EF). LV diameter, volume, wall thickness and EF (Teichholz and Simpson) were also measured by both observers. Visual and quantitative agreement and inter and intraobserver variability were calculated. Results: Image quality allowed for evaluation of 130 examinations. Visually assessed EF compared with Simpson had better consistency (Intraclass correlation coefficient [ICC] 0,91 IC95% 0,88-0,94) than with Teichholz (ICC 0,75 IC95% 0,66-0,82). We have also observed good interobserver agreement regarding visually assessed EF (ICC 0,81 IC95% 0,71-0,87) and Simpson EF (ICC 0,80 IC95% 0,70-0,89) as well as good intraobserver agreement (visual EF: ICC 0,81 IC95% 0,74-0,86; Simpson: ICC 0,89 IC95% 0,84-0,93). Regarding LVH we found moderate agreement between visual and quantitative assessment (weighted Kappa [wK] 0,44 (IC95% 0,32-0,56)), moderate interobserver agreement for quantitative assessment (ICC 0,59 IC95% 0,44-0,71) and poor interobserver agreement for visual assessment (wK 0,19 IC95% 0,08-0,30). Intraobserver variability regarding LVH visual estimation was moderate (wK 0,40 IC95% 0,29-0,52) and regarding LVH quantification was good (ICC 0,78 IC95% 0,70-0,84). LVH was visually overestimated in 25% of examinations. Regarding LV size, we found poor agreement between visual assessment and its quantification with end-diastolic diameter (wK 0,22 IC95% 0,06-0,39) and moderate agreement between visual assessment and end-systolic LV volume (wK 0,62 IC95% 0,47-0,77). Interobserver agreement regarding quantitative volume assessment was good (ICC 0,90 IC95% 0,85-0,94) and regarding visual assessment was moderate (wK 0,43 IC95% 0,26-0,70). We found good intraobserver variability of volume measurement (wK 0,64 IC95% 0,50-0,78) and of visual size assessment (ICC 0,96 IC95% 0,94-0,97). Conclusions: Visual LVEF assessment is consistent with quantitative assessment and should be regarded as a reliable parameter that can be obtained from bedside examination with a handheld device. Visual assessment of LV size and wall thickness is less reliable than its quantification and should be confirmed with standard measurements.
International Journal of Nephrology, 2015
Background/Aims. Peritoneal dialysis is a successful renal replacement therapy (RRT) for old and ... more Background/Aims. Peritoneal dialysis is a successful renal replacement therapy (RRT) for old and dependent patients. We evaluated the clinical outcomes of an assisted peritoneal dialysis (aPD) program developed in a Portuguese center.Methods. Retrospective study based on 200 adult incident patients admitted during ten years to a PD program. We included all 17 patients who were under aPD and analysed various parameters, including complications with the technique, hospitalizations, and patient and technique survival.Results. The global peritonitis rate was lower in helped than in nonhelped patients: 0.4 versus 0.59 episodes/patient/year. The global hospitalization rate was higher in helped than in nonhelped patients: 0.67 versus 0.45 episodes/patient/year (p=NS). Technique survival in helped patients versus nonhelped patients was 92.3%, 92.3%, 83.1%, and 72.7% versus 91.9%, 81.7%, and 72.1%, and 68.3%, at 1, 2, 3, and 4 years, respectively (p=NS), and patient survival in helped patien...
Transplantation Proceedings, 2000
A 66-year-old white woman received a cadaveric kidney allograft on 4 April 1999. Her past clinica... more A 66-year-old white woman received a cadaveric kidney allograft on 4 April 1999. Her past clinical history included lung tuberculosis in infancy, one episode of acute glomerulonephritis when she was 17, hypertension since she was 23, and preeclampsia on both her two term pregnancies. She began a regular hemodialysis program 7 years ago, when she was 59, due to end-stage renal disease, probably related to an ongoing chronic glomerulonephritis. No biopsy was performed. While on dialysis, she had chronic anaemia compensated with recombinant human erythropoetin (rHuEPO) and occasionally intravenous iron. In addition, there was a fluctuating rise of hepatic transaminases, although the AgHBs and both anti-HCV antibody and HCV-PCR were all negative, and there was no history of ethanol abuse. Serum transferrin saturation and ferritin were also elevated in the last 2 years before transplantation, but she had no symptoms associated with parenchymal iron overload (see Table 1). In April 1998 she was diagnosed with a reactivation of lung tuberculosis, with Koch bacilli being isolated in her sputum, and she was medicated with antituberculous agents until December 1998. On 4 April 1999, she was transplanted with a cadaveric kidney with two HLA matches on DR and a cold ischemia time of 12 hours. A triple immunosuppressive therapy was begun with cyclosporine, prednisone, and azathioprine. There was an immediate diuresis with a rapid decline of serum creatinine (Scr). She was medicated with isoniazid for tuberculosis prophylaxis. There was a slight rise of hepatic transaminases (two to three times the reference value) while she was in the hospital, which persisted in spite of the reduction on isoniazid dosage (300 to 150 mg/day). She was discharged on the ninth day with an Scr of 1.5 mg/dL. On her first outpatient visit, she complained of tiredness, and we noticed a hyperpigmented skin. In addition, the evolution of several hematological and biochemical parameters was surprising: there was not just a rise of hemoglobin, but also of serum fast glycemia and of serum transaminases, as well as of both serum fast transferrin saturation and ferritin (Table 1). In the face of this clinical and laboratorial data, we considered hemochromatosis as the most likely diagnosis and ordered several exams to confirm it. The abdominal CT scan showed evidence of a slightly enlarged but hyperdense liver. Its biopsy showed abundant iron deposits within the hepatocytes, compatible with the diagnosis of hemochromatosis. The hepatic iron concentration was found to be 384 mmol/g of dry weight (normally less than 36 mmol/g). The calculated hepatic iron index (hepatic iron concentration/patient’s age) was 5.8, the norm being 1 or less and values equal to or greater than 1.9 were found in hereditary hemochromatosis. The echocardiogram showed moderate concentric ventricular hypertrophy, good systolic function, and fibrosed nodule on the aortic valve. We were not able to investigate her past family history, and her only living daughter has no signs of the disease. Her genetic study showed the presence of HLA A3, but was negative for the mutations in the HFE gene, namely C282Y and H63D. On 1 June 1999, she was started on a weekly phlebotomy program, removing 350 mL of blood at each session, and she was started on subcutaneous rHuEPO (2000 U/week, about 30 U/kg/ week), aiming to mobilize and remove parenchymal iron stores. To control diabetes, she began oral gliclazide. Since then, transferrin saturation and ferritin have been decreasing. Also, diabetes has been easier to control and transaminases have reached normal values. This evolution is shown in Table 2. Fatigue complaints have disappeared, and her skin hyperpigmentation is less marked.
Port J Nephrol …, 2007
We report a case of a non-infected right external iliac artery false aneurysm. The patient was a ... more We report a case of a non-infected right external iliac artery false aneurysm. The patient was a 44 year-old woman on chronic peritoneal dialysis who had had an allograft nephrectomy 12 years before and who presented with acute abdominal pain. Ultrasound and CT-scan showed a saccular aneurysm arising from the right external iliac artery. A large false aneurysm was identified during surgery, arising from donor arterial vessel remaining in situ after graft nephrectomy. Resection of the false aneurysm, with ligation of the right external iliac artery and interposition of a femorofemoral graft was successfully performed, with an uneventful post-operative recovery. False aneurysms after renal allograft nephrectomy are very rare. To our knowledge, this is the longest reported period of time between an allograft nephrectomy and clinical evidence of a false aneurysm.
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Papers by Patrícia Branco