Browsing by Author "Silva, Filipa"
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- Association of the Calcification Score of the Abdominal Aorta, Common Iliac, and Renal Arteries with Outcomes in Living Kidney DonorsPublication . Ribeiro, Luís Costa; Almeida, Manuela; J, Malheiro; Silva, Filipa; Nunes-Carneiro, Diogo; Martins, La Salete; Pedroso, Sofia; Silva-Ramos, MiguelBackground: Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. Methods: This is a retrospective analysis of 156 living kidney donors who underwent living donor nephrectomy between January 2010 and December 2016. We quantified the total calcification score (TCaScore) by calculating the Agatston score for each vessel, abdominal aorta, common iliac, and renal arteries. Donors were placed into two different groups based on their TCaScore: <100 TCaScore group and ≥100 TCaScore group. The relationship between TCaScore, 1-year eGFR, proteinuria, and risk of 1 measurement of decreased renal function (eGFR < 60 mL/min/1.73 m2) over 5 years of follow-up was investigated. Results: The ≥100 TCaScore group consisted of 29 (19%) donors, with a median (interquartile range) calcification score of 164 (117-358). This group was significantly older, 56.7 ± 6.9 vs. 45.5 ± 10.6 (p < 0.001), had a higher average BMI (p < 0.019), and had a lower preoperative eGFR (p < 0.014). The 1-year eGFR was similarly diminished, 69.9 ± 15.7 vs. 76.3 ± 15.5 (p < 0.048), while also having an increased risk of decreased renal function during the follow-up, 22% vs. 48% (p < 0.007). Conclusions: Our study, through univariate analyses, found a relationship between a TCaScore > 100, lower 1-year eGFR, and decreased renal function in 5 years. However, a higher-than-expected vascular calcification should not be an excluding factor in donors, although they may require closer monitoring during follow-up.
- CT volumetry performs better than nuclear renography in predicting estimated renal function one year after living donationPublication . Almeida, Manuela; Pereira, Pedro R.; Ramos, Miguel; Nunes-Carneiro, Diogo; Mandaleno, Mariana; Silva, Filipa; Pedroso, Sofia; França, Manuela; Martins, La Salete; J, MalheiroThe evaluation of split renal function (SRF) is a critical issue in living kidney donations and can be evaluated using nuclear renography (NR) or computerized tomography (CT), with unclear comparative advantages. We conducted this retrospective study in 193 donors to examine the correlation of SRF assessed by NR and CT volumetry and compared their ability to predict remaining donor renal function at 1 year, through multiple approaches. A weak correlation between imaging techniques for evaluating the percentage of the remaining kidney volume was found in the global cohort, with an R2 = 0.15. However, the Bland-Altman plot showed an acceptable agreement (95% of the difference between techniques falling within - 8.51 to 6.11%). The predicted and observed eGFR one year after donation were calculated using the CKD-EPI, and CG/BSA equations. CT volume showed a better correlation than NR for both formulas (adjusted R2 of 0.42. and 0.61 vs 0.37 and 0.61 for CKD-EPI and CG/ BSA equations, respectively). In non-nested modeling tests, CT volumetry was significantly superior to NR for both equations. CT volumetry performed better than NR in predicting the estimated renal function of living donors at 1-year, independently from the eGFR equation.
- Does Cystatin C have a role as metabolic surrogate in peritoneal dialysis beyond its association with residual renal function?Publication . Leal Moreira, Carla; Cunha, Liliana; Correia, Sofia; Silva, Filipa; Castro, Ana; Tavares, Joana Manuel; Carvalho, Maria João; Oliveira, José Carlos; Santos, Maria Olivia; Cabrita, Antonio; Rodrigues, AnabelaIntroduction: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. Aim: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. Methods: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. Results: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. Conclusions: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.
- A Rare Cause of Abdominal Pain: Intestinal AngioedemaPublication . Ferreira, Tania Araujo; Alves, Marta Rebocho; Oliveira, Ana Maria Pinheiro; Silva, Filipa; Pereira, ClaudiaAngioedema with evidence of mucosal swelling is a rare condition that can be caused by angiotensin-converting enzyme inhibitors. The authors describe a case of a 28-year-old woman medicated with lisinopril 2 months before, with abdominal pain associated with nausea, vomiting and a onetime watery stool. A small volume of ascites was found in the abdominal ultrasound and the parietal thickening of the middle ileum in the abdominal computed tomography (CT). The complementary study was negative. The symptoms stopped after drug withdrawal. The authors intend to warn to this diagnosis, which has non-specific symptoms and if not suspected, can lead to a great morbidity for patients. The authors also intend to identify various signs that can be clues for its correct diagnosis.
- Remaining kidney volume indexed to weight as a strong predictor of estimated glomerular filtration rate at 1 year and mid‐term renal function after living‐donor nephrectomy ‐ a retrospective observational studyPublication . Nunes-Carneiro, Diogo; Madanelo, Mariana; Silva, Filipa; Pestana, Nicole; Ribeiro, Catarina; Gil‐Sousa, Diogo; Martins, La Salete; Almeida, Manuela; Dias, Leonidio; J, Malheiro; Cavadas, Vítor; Castro‐Henriques, Antonio; Fraga, Avelino; Silva-Ramos, MiguelThe donors' estimated glomerular filtration rate (eGFR) after living nephrectomy has been a concern, particularly in donors with smaller kindeys. Therefore, we developed this retrospective observational study in 195 donors to determine the ability remaining kidney volume indexed to weight (RKV/W) to predict eGFR at 1 year through multivariate linear regression and to explore this relationship between annual eGFR change from 1 to 4 years postdonation evaluated by a linear mixed model. Comparing RKV/W tertiles (T1, T2, T3), RKV/W was a good predictor of 1-year eGFR which was significantly better in T3 donors. Gender, predonation eGFR, and RKV/W were independent predictors of eGFR at 1-year. In a subgroup with predonation eGFR < 90mL/min/1.73 m2 , a significant prediction of eGFR < 60mL/min/1.73 m2 was detected in males with RKV/W ≤ 2.51cm3 /kg. Annual eGFR (ml/min/year) change from 1 to 4 years was + 0.77. RKV/W divided by tertiles (T1-T3) was the only significant predictor: T2 and T3 donors had an annual eGFR improvement opposing to T1. RKV/W was a good predictor of eGFR at 1 year, independently from predonation eGFR. A higher RKV/W was associated with improved eGFR at 1 year. A decline in eGFR on the four years after surgery was only noticeable in donors with RKV/W ≤ 2.13cm3 /kg.