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OBJECTIVE -To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] Ͻ20 g/min), and 35 were microalbuminuric (UAER 20 -200 g/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymaticcolorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl 2 , and dextran sulfate; and apolipoprotein B by immunoturbidimetry.RESULTS -Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 Ϯ 11.0%), especially of the n-6 family (21.7 Ϯ 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 Ϯ 11.3%, P ϭ 0.001 and 31.4 Ϯ 11.5%, P Ͻ 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 Ϯ 18.0% vs. 34.7 Ϯ 13.1%, P ϭ 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85-0.98, P ϭ 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo-and microalbuminuric patients.CONCLUSION -Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease. Diabetes Care 26:613-618, 2003M icroalbuminuria is known to be an independent risk factor for cardiovascular death in type 2 diabetic patients (1,2), but the mechanisms underlying this association have not been clarified. It could be that other cardiovascular risk factors that are frequently associated with microalbuminuria, such as hyperglycemia, hypertension (3), and endothelial dysfunction (4), might also contribute to the increased cardiovascular mortality observed in these patients. In addition, dyslipidemia has also been described in type 2 diabetic patients with microalbuminuria (2,5,6). Although those studies did not specifically assess the effect of nutrient intake, the effect of dietary habits on the development of dyslipidemia in these microalbuminuric patients cannot be ruled out.Dietary habits influence serum lipid levels and renal function in patients with diabetes. For example, higher intake of fish protein has been shown to be related to a lower risk for microalbuminuria in type 1 diabetic patients (7), and replacement of red meat with chicken reduces albumin excretion rate and serum cholesterol levels in microalbuminuric type 2 diabetic patients (8). These effects may result from the hig...

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Efeitos da conversão de inibidores da calcineurina para everolimo na viremia por hepatite C em receptores adultos de transplantes renais Introdução: Atualmente não há um protocolo imunossupressor específico para os receptores de transplantes renais portadores de hepatite C (HCV). Assim, o objetivo deste estudo foi avaliar o efeito da conversão a Everolimo (EVR) na HCV em receptores adultos de transplantes renais. Método: Trata-se de um estudo unicêntrico, prospectivo, randomizado, exploratório, controlado, aberto em receptores de aloenxertos renais com sorologia positiva para HCV. Os participantes foram randomizados para conversão a EVR ou manutenção dos inibidores da calcineurina. Resultados: Trinta pacientes foram randomizados e 28 foram acompanhados por um período de 12 meses (grupo de conversão, Grupo 1 = 15 e grupo controle, Grupo 2 = 13). Níveis de RT-PCR HCV descritos em valores logarítmicos foram compará-veis entre os grupos e entre pacientes em um mesmo grupo. A análise estatística não mostrou efeitos de interação entre tempo e grupo (valor p G*M = 0,852), ao longo do tempo em cada grupo (valor p M = 0,889) e entre grupos (valor p G = 0,286). O Grupo 1 apresentou uma maior incidência de eventos de dislipidemia (p = 0,03) e proteinúria (p = 0,01); não houve diferença na incidência de anemia (p = 0,17), diabetes mellitus de início pós-transplante (p = 1,00) ou infecção do trato urinário (p = 0,60). A TFGe média foi semelhante nos dois grupos. Conclusão: Nosso estudo não mostrou redução da carga viral após conversão a EVR com manutenção do tratamento antiproliferativo. ResumoPalavras-chave: Imunossupressão; Hepatite C; Transplante Renal; Carga Viral. Introduction:Currently, there is no specific immunosuppressive protocol for hepatitis C (HCV)-positive renal transplants recipients. Thus, the aim of this study was to evaluate the conversion effect to everolimus (EVR) on HCV in adult kidney recipients. Method: This is an exploratory single-center, prospective, randomized, open label controlled trial with renal allograft recipients with HCV-positive serology. Participants were randomized for conversion to EVR or maintenance of calcineurin inhibitors. Results: Thirty patients were randomized and 28 were followed-up for 12 months (conversion group, Group 1 = 15 and control group, Group 2 = 13). RT-PCR HCV levels reported in log values were comparable in both groups and among patients in the same group. The statistical analysis showed no interaction effect between time and group (p value G*M = 0.852), overtime intra-groups (p-value M =0.889) and between group (p-value G = 0.286). Group 1 showed a higher incidence of dyslipidemia (p = 0.03) and proteinuria events (p = 0.01), while no difference was observed in the incidence of anemia (p = 0.17), new onset of post-transplant diabetes mellitus (p = 1.00) or urinary tract infection (p = 0.60). The mean eGFR was similar in both groups. Conclusion: Our study did not show viral load decrease after conversion to EVR with maintenance of antiproliferative therapy. AbstRAct