Browsing by Author "Serra, A"
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- Atypical renal presentation of antiphospholipid syndromePublication . Gaspar, A; Manso, RT; Pereira, F; Cunha, L; Inchaustegui, L; Serra, A; Rodrigues, B; Correia, PAntiphospholipid syndrome (APS) is a systemic autoimmune disease which can occur as a primary disease or in association with other autoimmune diseases, the most frequent being Systemic Lupus Erythematosus (SLE). Although renal manifestations of SLE are well known, antiphospholipid syndrome renal manifestations such as antiphospholipid syndrome nephropathy and glomerulopathies have yet to be better characterized. The authors present the case of a 39 -year -old Caucasian woman with antiphospholipid syndrome diagnosis and a previous history of deep venous thrombosis and intermittent polyarthralgia, who was referred to a nephrology consultation for proteinuria and microscopic haematuria with preserved renal function. The renal biopsy showed a pattern of membranous glomerulopathy and thrombotic microangiopathy in association with antiphospholipid syndrome nephropathy. This case report illustrates a complex clinical and anatomopathological case of a 39 - year -old woman with a previous antiphospholipid syndrome diagnosis who presented with unspecific manifestations such as proteinuria and microscopic haematuria and preserved renal function. The histological findings alert us to the range of possible renal manifestations of APS and the need to better characterize these patients by preforming renal biopsy.
- Consentimento informado livre e esclarecido para procedimentos cirúrgicos e procedimentos invasivosPublication . Serra, A; Fernandes, F
- Metabolic syndrome: a multifaceted risk factor for kidney stonesPublication . Domingos, F; Serra, AKidney stones and metabolic syndrome (MetS) are common conditions in industrialized countries. There is growing evidence of associations between kidney stone disease and MetS or some of its components. The link between uric acid stones and MetS is well understood, but the link with calcium oxalate (CaOx) stones, the most common kidney stone composition, is more complex, and MetS is frequently overlooked as a risk factor for calcium nephrolithiasis. The physiopathological mechanisms of kidney stone disease in MetS are reviewed in this article. Uric acid stones are a consequence of the excessively acidic urine that results from insulin resistance. The pathophysiology of CaOx stones may include: increased excretion of lithogenesis promoters and decreased excretion of inhibitors; increased risk of Randall's plaque development; and inflammatory damage to renal epithelia by oxidative stress, as a consequence of the insulin-resistant milieu that characterizes MetS. The last mechanism contributes to the adhesion of CaOx crystals to subepithelial calcium deposits working as anchor sites where stones can grow. The predominant MetS features could determine the chemical composition of the stones in each patient. Kidney stones may be a renal manifestation of MetS and features of this syndrome should be looked for in patients with idiopathic nephrolithiasis.
- Renal lithiasis from a nephrologist’s perspectivePublication . Serra, AMan has known urinary lithiasis since antiquity. In Portuguese medicine, this is a pathology seen predominantly from the urology perspective, but renal lithiasis is evaluated and treated preventively by nephrologists worldwide, and its study has contributed significantly to knowledge of how the renal tubule works. Nephrolithiasis is a relatively common disease in the adult population and, in Portugal, is observed in about 7.3% of the population. The main pathophysiological mechanisms of the most frequent types of kidney stones and who and how to conduct the metabolic research are briefly described. Medical treatment is also addressed, keeping in mind that nephrolithiasis is often accompanied by extra-renal manifestations that should be investigated and treated, namely arterial hypertension, obesity, diabetes mellitus and osteo-metabolic disease.