Browsing by Author "Costa, Teresa"
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- Estimating the Glomerular Filtration Rate in Pediatric Patients With Neurogenic Bladder: A Comparison Between Creatinine- and Cystatin C-EquationsPublication . Menezes, Catarina; Costa, Teresa; Brás, Catarina; Sousa, Patrícia; Mendes, Ana; Amorim, Rosa; Faria, Maria Do Sameiro; Mota, ConceiçãoBackground and objective Patients with neurogenic bladder (NB) are at a higher risk of developing chronic kidney disease (CKD). Due to their lower muscle mass, the estimated glomerular filtration rate (eGFR) based on creatinine (Cr) may be overestimated and delay the diagnosis of renal failure. This study compared eGFR calculated with different equations based on Cr and/or cystatin C (CysC) in children with NB, and the differences between patients with lower muscle mass (underdeveloped lower limbs) and those with independent gait (less muscle depletion). Methods We calculated the eGFR in pediatric patients with NB and CKD stages 1 and 2 by using the following equations: Chronic Kidney Disease in Children equation for serum creatinine (CKiD-Cr), CKiD-CysC, CKiD combined-Cr/CysC, Zappitelli-CysC, and Zappitelli combined-Cr/CysC. Results We evaluated a total of 47 patients, 74.5% with CKD stage 1, with a median age of 14.1 years. Of these participants, 59.6% had lipo/myelomeningocele. The CKiD-Cr and CysC-based equations led to significantly lower calculated eGFR (p<0.05), specifically CKiD-CysC (p<0.001), Zappitelli-CysC (p<0.001), CKiD-Cr/CysC (p<0.001), and Zappitelli combined-Cr/CysC (p<0.05). When CKiD-CysC was used, 68% of the patients moved to a more advanced CKD stage. In patients without independent gait, with lower muscle mass (55.3%), the median eGFR calculated using the CKiD-Cr and CKiD combined-Cr/CysC equations was significantly higher (p<0.05). However, there were no differences between the two groups when using the other CysC-based equations. Conclusion In patients with NB and poor muscle mass, the CKiD-Cr equation may overestimate renal function. CysC-based equations seem more reliable in these patients, especially in those with greater muscular atrophy.
- Fatores de risco para cicatriz renal após a primeira infeção febril do trato urinárioPublication . Freitas, Ana Cristina; Leite, Joana; Matos, Paula; Rocha, Liliana; Costa, Teresa; Faria, Maria Sameiro; Mota, ConceiçãoIntroduction: The urinary tract infection (UTI) is one of the most common paediatric infectious diseases and it increases the risk for hypertension and end-stage renal disease. Authors’ aim was to identify risk factors for permanent renal injury after a first febrile urinary tract infection. Methods: Retrospective analysis of clinical, laboratorial and imaging data of children aged 1 to 36 months hospitalized between January 2010 and December 2012 with the first febrile UTI, comparing with late renal scintigraphy results. Results: Seventy seven children were included - 53% female, median age of 5 months, Escherichia coli identified in 95%. Renal scintigraphy, performed after the acute episode, revealed renal scars in 19.5%. Cystourethrography was done in 21 patients and vesicoureteral reflux identified in 3. There was no statistically difference between children with and without renal scarring regarding gender, age, body temperature, C-reactive protein, plasmatic creatinine level, bacteriuria or urine nitrite test, urine bacteria identified, presence of vesicoureteral reflux or recurrence rate of UTI. Conclusions: The authors did not detect any clinical, laboratory or imaging data that may predict progression to renal scarring following a first episode of febrile UTI in children between 1 and 36 months.
- Imaging clinical casePublication . Batista, Ana Rita; Valpaços, Catarina; Sousa, Pedro; Costa, Teresa; Mota, Conceição; Reis, Armando; Faria, Maria Do SameiroHere in is reported the case of a 16-year-old female diagnosed with vitreous haemorrhage and hemangioblastoma of the retina, referred to the Emergency Department due to sudden vision loss. Brain and pelvic magnetic resonance imaging showed cerebellar hemangioblastomas and renal nodular lesions of suspicious nature. The patient was submitted to partial left nephrectomy and histological examination revealed papillary renal cell carcinoma with clear-cell predominance. Clinical diagnosis of Von Hippel-Lindau (VHL) disease was confirmed by genetic study. VHL disease is a hereditary, autosomal dominant syndrome of multiple neoplasms caused by germline mutations in VHL tumor-suppressor gene. Patients are predisposed to development of cysts and hypervascular neoplasms, the most common being hemangioblastomas of the central nervous system (CNS) and retina, cysts and renal cell carcinomas, and pheochromocytomas. VHL diagnosis should be suspected if an individual with family history of VHL presents with a characteristic disease lesion or, in absence of family history of VHL, with two CNS and/or retinal hemangioblastomas or a CNS/retinal hemangioblastoma associated with renal cell carcinoma, pheochromocytoma, pancreatic cysts or endocrine tumor, or epididymal cystadenoma. In VHL disease, imaging plays a key role in detection of abnormalities, follow-up, and screening of asymptomatic mutated gene carriers.
- Transplantação renal pediátrica: experiência de um centroPublication . Nascimento, João; Rocha, Liliana; Faria, Maria Sameiro; Matos, Paula; Costa, Teresa; Martins, La Salete; Almeida, Manuela; Dias, Leonídio; Mota, Conceição; Henriques, A. CastroIntrodução: A insuficiência renal crónica terminal está associada a numerosas comorbilidades e a um aumento do risco de mortalidade cerca de 30 vezes superior à população pediátrica geral. O primeiro transplante renal bem sucedido em crianças foi realizado em 1954. Os progressos cirúrgicos e as novas terapêuticas imunossupressoras aumentaram a sobrevida dos doentes e do enxerto renal nos últimos anos. Objetivos: Avaliação da experiência em transplantação renal em idade pediátrica do Centro Hospitalar do Porto nos últimos 30 anos. Métodos: Estudo retrospetivo dos dados epidemiológicos e clínicos dos doentes pediátricos transplantados entre Janeiro de 1984 e Agosto 2013. Foi feita a análise da evolução tempo- real da atividade de transplantação através da comparação da sobrevida do enxerto por décadas de transplantação (1984-89 / 1990-99 / 2000-09 / 2010-13). Foi também comparada a sobre- vida do enxerto em dois grupos etários (0-10 anos ; 11-17 anos) à data da transplantação. Resultados: Cento e trinta e nove doentes (58.3% - sexo masculino) foram submetidos a 147 transplantes renais (6.8% de dador vivo). As anomalias congénitas do rim e trato urinário (56.5%) e as glomerulonefrites (18.4%) foram as causas principais de insuficiência renal. A sobrevida do enxerto não censurada aos 5, 10, 15 e 20 anos foi 84.7%, 71.1%, 60.0% e 51.0% e a sobrevida do doente aos 5, 10, 15 e 20 anos foi 97.9%, 95.9%, 94.7% e 94.7%, respetivamente. A sobrevida do enxerto aumentou ao longo do tempo e a diferença entre as décadas foi estatisticamente significativa (p=0.004). Apesar da melhor sobrevida no grupo com idade superior a 11 anos, a diferença da sobrevida do enxerto entre os grupos etários não foi estatisticamente significativa (p=0.697). Conclusão: Os resultados do Centro Hospitalar do Porto são comparáveis aos dos grandes centros de transplantação renal pediátrica. Observou-se uma melhoria dos resultados ao longo dos anos na nossa Unidade. A existência de um rigoroso processo de acompanhamento poderá ter ajudado a minimizar o impacto negativo da adolescência na sobrevida do enxerto.