Renal Outcomes in Brazilian Patients with Immunoglobulin A Nephropathy and Cellular Crescentic Lesions

Background and Aim: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy. The Oxford classification was recently updated to include crescents as markers of poor prognosis. The aim of this study was to evaluate the impact of cellular crescents on the prognosis of patients with IgAN in Brazil. Methods: This was a single-centre retrospective analysis of medical records and renal biopsies in patients with IgAN. The renal biopsy findings were classified according to the revised Oxford classification: mesangial hypercellularity, endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy or interstitial fibrosis (T), and crescent formation (C). We evaluated a composite outcome (progression to end-stage renal disease or creatinine doubling). We performed analyses between the patients with crescents in the renal biopsy specimen (C1/C2 group) and those without such crescents (C0 group). Results: We evaluated 111 patients, of whom 72 (65.0%) were women, 80 (72.0%) self-identified as White, 73 (65.6%) were hypertensive, and 95 (85.6%) had haematuria. The distribution of patients according to cellular crescentic lesions was: C0, 80 (72%); C1, 27 (24.4%); C2, 4 (3.6%). The composite outcome was observed in 33 (29.72%) of the 111 patients. In comparison with the C0 group, the C1/C2 group had higher proportions of patients with hypertension (p = 0.04), haematuria (p = 0.03), worse serum creatinine (p = 0.0007), and worse estimated glomerular filtration rate (p = 0.0007). The C1/C2 group also had higher proportions of patients in whom the biopsy specimen was classified as E1 (p = 0.009), S1 (p = 0.001), or T1/T2 (p = 0.03), In addition, the mean follow-up period was shorter in the C1/C2 group (p < 0.0001). Furthermore, the composite outcome was observed in a greater proportion of patients and in a shorter length of time in the C1/C2 group than in the C0 group (p = 0.002 and p = 0.0014, respectively). In a Cox regression analysis, the independent risk factors for the composite outcome had Oxford classifications of S1, T1/T2, and C1/C2. Conclusion: Oxford classification findings of S1, T1/T2, or C1/C2 were independent risk factors for the composite outcome, corroborating previous studies.

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The Impact of Non-Dialysis-Dependent Renal Dysfunction on Outcome Following Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20101161 ◽

2011 ◽

Vol 14 (4) ◽

pp. 214 ◽

Cited By ~ 1

Author(s):

Barış Çaynak ◽

Zehra Bayramoğlu ◽

Burak Onan ◽

Ismihan Selen Onan ◽

Ertan Sağbaş ◽

...

Keyword(s):

Risk Factors ◽

Cerebrovascular Accident ◽

Blood Products ◽

Platelet Suspension ◽

Cox Regression Analysis ◽

Late Mortality ◽

Valvular Surgery ◽

Independent Risk Factors ◽

Group 2 ◽

The Impact

Background: We evaluated the results of different types of cardiovascular surgery in patients with chronic renal failure (CRF) (serum creatinine ?2 mg/dL) who were not dialysis-dependent.Methods: Eighty-two patients who presented with non-dialysis-dependent CRF were retrospectively evaluated. Patients in Group 1 (n = 12) underwent valvular surgery, those in Group 2 (n = 58) underwent coronary artery bypass grafting (CABG), and those in Group 3 (n = 12) underwent combined CABG and valvular surgery.Results: The demographics were similar among the groups. Cardiopulmonary bypass and aortic cross-clamping times were shorter (P < .01), the use of blood and blood products was less, and the mechanical ventilation time and hospital stay were shorter in Group 2 in comparison to the other groups (P < .01). There were 4 (6.9%) early mortalities in Group 2. Late mortalities occurred in 4 (33.3%), 16 (27.6%), and 6 (50%) patients from Groups 1, 2, and 3, respectively. Cox regression analysis revealed that age, the presence of a preoperative cerebrovascular accident, the presence of a left main coronary lesion, preoperative blood urea nitrogen level, and the use of blood and blood products were independent risk factors for early mortality. High Euroscore, cerebrovascular accident, the use of platelet suspension, longer ventilation support times, and combined CABG and valvular surgery were independent risk factors for late mortality.Conclusions: Morbidity and survival seemed to be more dependent on preoperative patient characteristics than the type of surgery in this group of patients. Combined CABG and valvular surgery was a risk factor for late mortality.

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Reproducibility of the Oxford classification of immunoglobulin A nephropathy, impact of biopsy scoring on treatment allocation and clinical relevance of disagreements: evidence from the VALidation of IGA study cohort

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy337 ◽

2018 ◽

Vol 34 (10) ◽

pp. 1681-1690 ◽

Cited By ~ 8

Author(s):

Shubha S Bellur ◽

Ian S D Roberts ◽

Stéphan Troyanov ◽

Virginie Royal ◽

Rosanna Coppo ◽

...

Keyword(s):

Interstitial Fibrosis ◽

Immunoglobulin A ◽

Study Cohort ◽

Immunoglobulin A Nephropathy ◽

Oxford Classification ◽

Tubular Atrophy ◽

Tubulointerstitial Lesions ◽

The Oxford Classification ◽

The Impact

Abstract Background The VALidation of IGA (VALIGA) study investigated the utility of the Oxford Classification of immunoglobulin A nephropathy (IgAN) in 1147 patients from 13 European countries. Methods. Biopsies were scored by local pathologists followed by central review in Oxford. We had two distinct objectives: to assess how closely pathology findings were associated with the decision to give corticosteroid/immunosuppressive (CS/IS) treatments, and to determine the impact of differences in MEST-C scoring between central and local pathologists on the clinical value of the Oxford Classification. We tested for each lesion the associations between the type of agreement (local and central pathologists scoring absent, local present and central absent, local absent and central present, both scoring present) with the initial clinical assessment, as well as long-term outcomes in those patients who did not receive CS/IS. Results All glomerular lesions (M, E, C and S) assessed by local pathologists were independently associated with the decision to administer CS/IS therapy, while the severity of tubulointerstitial lesions was not. Reproducibility between local and central pathologists was moderate for S (segmental sclerosis) and T (tubular atrophy/interstitial fibrosis), and poor for M (mesangial hypercellularity), E (endocapillary hypercellularity) and C (crescents). Local pathologists found statistically more of each lesion, except for the S lesion, which was more frequent with central review. Disagreements were more likely to occur when the proportion of glomeruli affected was low. The M lesion, assessed by central pathologists, correlated better with the severity of the disease at presentation and discriminated better with outcomes. In contrast, the E lesion, evaluated by local pathologists, correlated better with the clinical presentation and outcomes when compared with central review. Both C and S lesions, when discordant between local and central pathologists, had a clinical phenotype intermediate to double absent lesions (milder disease) and double present (more severe). Conclusion We conclude that differences in the scoring of MEST-C criteria between local pathologists and a central reviewer have a significant impact on the prognostic value of the Oxford Classification. Since the decision to offer immunosuppressive therapy in this cohort was intimately associated with the MEST-C score, this study indicates a need for a more detailed guidance for pathologists in the scoring of IgAN biopsies.

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A Prognostic Model for Patients With Gastric Signet Ring Cell Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/15330338211027912 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110279

Author(s):

Qinping Guo ◽

Yinquan Wang ◽

Jie An ◽

Siben Wang ◽

Xiushan Dong ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Cox Regression ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Training Set ◽

Cox Regression Analysis ◽

Signet Ring ◽

Ring Cell ◽

Independent Risk Factors

Background: The aim of our study was to develop a nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with gastric signet ring cell carcinoma (GSRC). Methods: GSRC patients from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to the training and validation sets. Multivariate Cox regression analyses screened for OS and CSS independent risk factors and nomograms were constructed. Results: A total of 7,149 eligible GSRC patients were identified, including 4,766 in the training set and 2,383 in the validation set. Multivariate Cox regression analysis showed that gender, marital status, race, AJCC stage, TNM stage, surgery and chemotherapy were independent risk factors for both OS and CSS. Based on the results of the multivariate Cox regression analysis, prognostic nomograms were constructed for OS and CSS. In the training set, the C-index was 0.754 (95% CI = 0.746-0.762) for the OS nomogram and 0.762 (95% CI: 0.753-0.771) for the CSS nomogram. In the internal validation, the C-index for the OS nomogram was 0.758 (95% CI: 0.746-0.770), while the C-index for the CSS nomogram was 0.762 (95% CI: 0.749-0.775). Compared with TNM stage and SEER stage, the nomogram had better predictive ability. In addition, the calibration curves also showed good consistency between the predicted and actual 3-year and 5-year OS and CSS. Conclusion: The nomogram can effectively predict OS and CSS in patients with GSRC, which may help clinicians to personalize prognostic assessments and clinical decisions.

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Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01744-21 ◽

2021 ◽

Author(s):

Mariana Chumbita ◽

Pedro Puerta-Alcalde ◽

Carlota Gudiol ◽

Nicole Garcia-Pouton ◽

Júlia Laporte-Amargós ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Kidney Injury ◽

Bloodstream Infections ◽

Gram Positive ◽

Gram Negative ◽

Neutropenic Patients ◽

Prospective Cohorts ◽

Independent Risk Factors ◽

The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

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Oxidative Stress Inside the Pathogenesis of Ascending Aorta Aneurysms: A Clearer Vision for Identifying Promising Biomarkers and Therapeutic Targets

10.20944/preprints202111.0346.v1 ◽

2021 ◽

Author(s):

Carmela Balistreri ◽

Calogera Pisano ◽

Giovanni Ruvolo

Keyword(s):

Oxidative Stress ◽

Risk Factors ◽

Genetic Variants ◽

Complex Disease ◽

Ascending Aorta ◽

Oxygen Species ◽

Aorta Aneurysm ◽

Independent Risk Factors ◽

The Impact ◽

And Oxidative Stress

Ascending aorta aneurysm (AsAA) is a complex disease, currently defined an inflammatory disease. In the sporadic form, AsAA has, indeed, a complex physiopathology with a strong inflammatory basis, significantly modulated by genetic variants in innate/inflammatory genes, acting as independent risk factors and as largely evidenced in our recent studies performed during the last 10 years. Based on these premises, here, we want to revise the impact of reactive oxygen species (ROS) and oxidative stress on AsAA pathophysiology and consequently on the onset and progression of sporadic AsAA. This might consent to add other important pieces in the intricate puzzle of the pathophysiology of this disease with the translational aim to identify biomarkers and targets to apply in the complex management of AsAA, by facilitating the AsAA diagnosis currently based only on imaging evaluations, and the treatment exclusively founded on surgery approaches.

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The impact of the recurrent laryngeal nerve injury on prognosis after McKeown esophagectomy for ESCC

10.21203/rs.3.rs-88872/v1 ◽

2020 ◽

Author(s):

Rirong Qu ◽

Dehao Tu ◽

Wei Ping ◽

Qi Wang ◽

Ni Zhang ◽

...

Keyword(s):

Risk Factors ◽

Recurrent Laryngeal Nerve ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Term Survival ◽

Laryngeal Nerve Injury ◽

Independent Risk Factors ◽

Mckeown Esophagectomy ◽

The Impact

Abstract Background: The objective of this study was to assess the impact of the recurrent laryngeal nerve injury (RLNI) after esophagectomy on prognosis.Methods: Retrospectively collected data from 297 patients with esophageal squamous cell carcinoma who underwent McKeown esophagectomy at our department from April 2014 to May 2018, were analyzed.Results: RLNI occurred in 31.9% of the patients. Left-side RLNI occurred 2.8 times more often than right-side RLNI. Among the cases in which assessment of the vocal cords was continued, 8.4% involved permanent injury. There were no significant differences among clinicopathological data between patients with RLNI and without. Compared with patients without RLNI,patients with RNLI have longer operation time,more number of bronchoscopy suctions, longer postoperation hospital stay, and higher incidence of postoperative complications. T stage, N stage, RLN LN metastasis were independent risk factors for the prognosis, but RLNI is not independent risk factors for long-term survival. Conclusion: RLNI is a serious complication that will affect the short-term prognosis of patients and reduce the quality of life of patients. It should be avoided as much as possible during surgery, but it may not have negative impact on the long-term survival.

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Exclusive Characteristics of Graft Survival and Risk Factors in Recipients with Immunoglobulin A Nephropathy: A Retrospective Analysis of Registry Data

Transplantation Journal ◽

10.1097/01.tp.0000179150.84803.56 ◽

2005 ◽

Vol 80 (8) ◽

pp. 1012-1018 ◽

Cited By ~ 29

Author(s):

Margret B. Andresdottir ◽

Geert W. Haasnoot ◽

Ilias I. N. Doxiadis ◽

Guido G. Persijn ◽

Frans H. J. Claas

Keyword(s):

Risk Factors ◽

Retrospective Analysis ◽

Graft Survival ◽

Immunoglobulin A ◽

Registry Data ◽

Immunoglobulin A Nephropathy

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Urinary Incontinence and Quality of Life in Female Patients with Obesity

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1670626 ◽

2018 ◽

Vol 40 (09) ◽

pp. 534-539 ◽

Cited By ~ 2

Author(s):

Christiana Nygaard ◽

Lucas Schreiner ◽

Thiago Morsch ◽

Rodrigo Saadi ◽

Marina Figueiredo ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Urinary Incontinence ◽

Vaginal Delivery ◽

Short Form ◽

Female Patients ◽

International Consultation ◽

Independent Risk Factors ◽

The Impact

Objective To analyze the prevalence of urinary incontinence (UI) in female patients with an indication for bariatric surgery, to investigate the potential risk factors and the impact on quality of life. Methods A cross-sectional study with female patients with obesity. The evaluation consisted of a structured interview, a specific study form and quality of life questionnaires. The Poisson regression was performed to identify independent risk factors related to UI. Results A total of 221 patients were enrolled; 118 of the study participants (53.4%) reported UI episodes. Mixed UI (MUI), stress UI (SUI) only, and urgency UI (UUI) only were reported by 52.5% (62), 33.9% (40) , and 13.5% (16) of these patients respectively. The prevalence of UI was increased by 47% among the women who had given birth vaginally and by 34% of the women who had entered menopause. Vaginal delivery and menopause were identified as independent risk factors related to UI. The mean International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) score was 9.36 ± 4.9. The severity of symptoms was considered moderate in 53.3% (63) of the patients with UI. Conclusion Urinary incontinence impacts quality of life negatively, and the prevalence of UI is high among obese patients. In the present study, vaginal delivery and menopause were independently associated with UI.

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Secular trends in the incidence of end-stage renal disease and its risk factors in Japanese patients with immunoglobulin A nephropathy

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx223 ◽

2017 ◽

Vol 33 (6) ◽

pp. 963-971 ◽

Cited By ~ 3

Author(s):

Shigeru Tanaka ◽

Toshiharu Ninomiya ◽

Ritsuko Katafuchi ◽

Kosuke Masutani ◽

Akihiro Tsuchimoto ◽

...

Keyword(s):

Risk Factors ◽

Renal Disease ◽

End Stage Renal Disease ◽

Immunoglobulin A ◽

Japanese Patients ◽

Secular Trends ◽

Immunoglobulin A Nephropathy ◽

Stage Renal Disease ◽

End Stage

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Impact of postoperative complications on pancreatic cancer survival and recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.446 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 446-446

Author(s):

Masahiro Asari ◽

Toru Aoyama ◽

Yusuke Katayama ◽

Masaaki Murakawa ◽

Koichiro Yamaoku ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Cancer ◽

Overall Survival ◽

Postoperative Complications ◽

Cancer Survival ◽

Disease Recurrence ◽

Lymphatic Invasion ◽

Curative Surgery ◽

Independent Risk Factors ◽

The Impact

446 Background: We investigated the impact of postoperative complications on pancreatic cancer survival and recurrence after curative surgery. Methods: This study included 164 patients who underwent curative surgery for pancreatic cancer between 2005 and 2014. The patients were classified into those with postoperative complications (C group) and those without postoperative complications (NC group). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. Results: Postoperative complications were found in 61 of the 164 patients (37.2%). The RFS rate at five years after surgery was 10.6% in the C group patients and was 21.0% in the NC group patients. The RFS tended to be worse in the C group than in the NC group (p=0.1756). The OS rate at five years after surgery was 7.4% in the C group and 22.8% in the NC group, which was significantly different (p=0.0189). The multivariate analysis demonstrated that postoperative complications and lymphatic invasion were significant independent risk factors for the RFS and OS. Conclusions: The development of postoperative complications was a risk factor for a decreased overall survival and for disease recurrence in patients who underwent curative surgery for pancreatic cancer. The surgical procedure, perioperative care and the surgical strategy should be carefully planned to avoid complications.

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