Peritoneal dialysis in an adult patient with myelomenigocele and ventriculoperitoneal shunt

Novaes, Glivia Renata Silva; Gutiérrez-Peredo, Gabriel Brayan; Montaño-Castellón, Iris; Gutiérrez-Peredo, Andrea Jimena; Júnior, Miguel Nino Labanca; Brandão, Oriana Mattos; Ataide, Stenio Cerqueira de

doi:10.1016/j.nefroe.2022.01.004

Cited by 2 publications

(2 citation statements)

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“…Clinical identification of LN can be challenging, being commonly discovered after careful examination of urine and renal function tests [1,3]. Monitoring the activity and/or control of LN is essential to prevent the progression of chronic kidney disease, which can have a negative impact on quality of life, functional dependence, comorbidities, and mortality risk [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Urinary Protein/Creatinine Ratio as an Alternative to 24-h Proteinuria in Lupus Nephritis: TUNARI Study

Gutiérrez-Peredo,

Montaño-Castellón,

Gutiérrez-Peredo

et al. 2023

Nephron

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Background: Lupus nephritis (LN) occurs in approximately 50% of people with Systemic Lupus Erythematosus (SLE). The 24-hour proteinuria (gold standard) is measured among other tests for the control and monitoring of LN activity. This study investigates the use of the protein/creatinine ratio (PCR) as an alternative for the detection of proteinuria and its accuracy compared to the gold standard in a predominantly non-white population. Methods: This was a prospective study conducted in Salvador, Brazil, between December 2021 and May 2022. We invited adult patients diagnosed with SLE and LN, regardless of their disease activity. The estimation of the PCR and 24-hour proteinuria was performed using conventional methods. The analysis used was the correlation test (rs), coefficient of determination (r2) and concordance by the Bland-Altman method. A specific sensitivity was measured by the ROC curve with its respective cut-off by the Youden Index. Results: We compared 112 samples of 75 patients with LN, with a mean age of 34.5 ± 11.8 years. Of these patients, 85% were women, 87.9% were non-white. A high degree of correlation was observed between PCR with 24-hour proteinuria (rs = 0.77 and r² = 0.59). The ROC analysis shows an area under the curve (AUC) of 0.92 and the cut-off point calculated by the Youden Index was 0.78 with a sensitivity of 90.0% and specificity of 82%. However, the Bland-Altman graph indicated decreasing concordance as the degree of proteinuria increased, despite showing concordance at high levels of proteinuria. Conclusion: The PCR shows high sensitivity to follow-up patients with LN when compared with 24-hour proteinuria. Our findings suggest that PCR is a useful parameter for the evaluating and monitoring patients in complete remission. However, in cases of partial remission, the utility of PCR is limited.

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Section: Introductionmentioning

confidence: 99%

Comparison of Urinary Protein/Creatinine Ratio as an Alternative to 24-h Proteinuria in Lupus Nephritis: TUNARI Study

Gutiérrez-Peredo,

Montaño-Castellón,

Gutiérrez-Peredo

et al. 2023

Nephron

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“…The current therapeutic consensus suggests a clone-directed approach in case of MGRS-associated renal disease, i.e., antimyeloma agents in patients with plasma cell clones, rituximab-containing regimens in patients with lymphocytes or lymphoplasmacytic clone [ 5 ]. Treatment should also primarily aim to protect against the risk of progression to end-stage chronic kidney disease (ESRD), which brings high functional dependence, low quality of life and high risk of mortality [ 5 , 14 – 16 ]. The prevention of thrombotic and infectious risk should be performed in cases of nephrotic syndrome, proteinuria and hypertension should be controlled, preferably with blockers of the renin-angiotensin system, and bicarbonate, phosphate and vitamin D supplements should be administered in patients with FS to prevent osteomalacia [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Lambda light chain-induced monoclonal gammopathy of renal significance, manifesting with Fanconi Syndrome and osteomalacia

et al. 2022

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Background Monoclonal gammopathy of renal significance (MGRS) encompasses a heterogeneous group of kidney diseases in which a monoclonal immunoglobulin secreted by a clone of B cells or plasma cells causes kidney damage without meeting the hematological criteria for malignancy. Among the various forms of involvement, MGRS can manifest as a proximal tubule disorder, such as Fanconi syndrome (FS), characterized by urinary loss of phosphate, glucose, amino acids, uric acid and bicarbonate. Few cases of MGRS have been described in the literature, manifesting as FS and monoclonal production of lambda light chains, almost all of which are secondary to the production of kappa light chains. Case presentation Here we report a clinical case of a 45-year-old Brazilian male, African descent, with proximal weakness of the lower limbs, whose initial assessment showed a urine summary with the presence of proteinuria and glycosuria without hyperglycemia, associated with mild worsening of renal function, hypouricemia, hypocalcemia and phosphaturia. Evolution was characterized by a MGRS manifesting as FS and osteomalacia. Conclusion The diagnosis of MGRS is not always easy, it requires knowledge of the clinical characteristics, diagnostic criteria and prognosis of each case. Therefore, all possible efforts should be made for multidisciplinary diagnosis.

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Peritoneal dialysis in an adult patient with myelomenigocele and ventriculoperitoneal shunt

Cited by 2 publications

References 9 publications

Comparison of Urinary Protein/Creatinine Ratio as an Alternative to 24-h Proteinuria in Lupus Nephritis: TUNARI Study

Comparison of Urinary Protein/Creatinine Ratio as an Alternative to 24-h Proteinuria in Lupus Nephritis: TUNARI Study

Lambda light chain-induced monoclonal gammopathy of renal significance, manifesting with Fanconi Syndrome and osteomalacia

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