Performance of urinary kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, and N-acetyl-ß-D-glucosaminidase to predict chronic kidney disease progression and adverse outcomes.

Urinary biomarkers can predict the progression of chronic kidney disease (CKD). In this study, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and N-acetyl-ß-D-glucosaminidase (NAG) were correlated with the stages of CKD, and the association of these biomarkers with CKD progression and adverse outcomes was determined. A total of 250 patients, including 111 on hemodialysis, were studied. Urinary KIM-1, NGAL, and NAG were measured at baseline. Patients not on dialysis at baseline who progressed to a worse CKD stage were compared with those who did not progress. The association of each biomarker and selected covariates with progression to more advanced stages of CKD, end-stage kidney disease, or death was evaluated by Poisson regression. NGAL was moderately correlated (rs=0.467, P<0.001) with the five stages of CKD; KIM-1 and NAG were also correlated, but weakly. Sixty-four patients (46%) progressed to a more advanced stage of CKD. Compared to non-progressors, those patients exhibited a trend to higher levels of KIM-1 (P=0.064) and NGAL (P=0.065). In patients not on dialysis at baseline, NGAL was independently associated with progression of CKD, ESKD, or death (RR=1.022 for 300 ng/mL intervals; CI=1.007-1.037, P=0.004). In patients on dialysis, for each 300-ng/mL increase in urinary NGAL, there was a 1.3% increase in the risk of death (P=0.039). In conclusion, urinary NGAL was associated with adverse renal outcomes and increased risk of death in this cohort. If baseline urinary KIM-1 and NGAL predict progression to worse stages of CKD is something yet to be explored.

Etnobotânica de espécies vegetais medicinais no tratamento de transtornos do sistema gastrointestinal / Ethnobotany of medicinal species in the treatment of gastrointestinal system disorders

RESUMO O estudo objetivou selecionar na comunidade Rio Urubueua de Fátima, Abaetetuba-Pará, as espécies vegetais utilizadas no tratamento de transtornos do sistema gastrointestinal, em determinado contexto de uso, associado a um conhecimento construído localmente. A pesquisa foi realizada com 35 informantes entre 28 e 93 anos, selecionados pelo método bola de neve. Os dados foram obtidos por observação participante e entrevistas semiestruturadas. Para a importância relativa das espécies vegetais, calculou-se a porcentagem de concordância quanto aos usos principais (CUP) e concordância quanto aos usos principais corrigida (CUPc). Os interlocutores indicaram várias receitas terapêuticas, e, destas, foram escolhidas as mais empregadas no tratamento da diarreia, por ser doença recorrente na comunidade. Foi investigado o potencial químico das plantas por meio de literatura científica e bancos de dados. “Boldo” e “Anoerá” apresentaram valor máximo de CUP (100%), enquanto a “Hortelã” obteve maior CUPc (87,5%). Das 79 espécies vegetais empregadas como medicinais, nove estão na lista do SUS. Os remédios são preparados exclusivamente sob a forma de chá, sendo a folha a parte da planta mais utilizada (65%). Para o tratamento de diarreia, 12 espécies utilizadas pelos interlocutores têm compostos químicos comprovados por literatura especializada. A comunidade de Rio Urubueua de Fátima faz uso das plantas medicinais para curar doenças, apropriando-se de conhecimentos obtidos, na maioria dos relatos, de seus antepassados. Estes saberes tradicionais contribuem no conhecimento cultural da região e na pesquisa e desenvolvimento de novos fármacos.

ABSTRACT This study aimed to select the plants used to treat disorders of the gastrointestinal system, in the Rio Urubueua community of Fatima, Abaetetuba, and Pará for their particular context of use, combined with local knowledge. The survey was conducted with 35 informants between the ages of 28 and 93, selected using the snowball method.Data was obtained by participant observation, semi-structured interviews and by non-specific induction. To show the relative importance of plant species, we calculated the percentage of agreement on the main uses (CUP) and agreement with regards to the corrected main uses (cUPC).The interlocutors indicated various therapeutic recipes, and from these, those most used in the treatment of diarrhea were chosen, due to having recurrent cases of this disease in the community. The chemical potential of plants was investigated using scientific documents and databases. “Boldo” and “Anoerá” showed a maximum CUP value (100%), while the “Hortelã” obtained a higher cUPC (87.5%). Of the 79 plant species used in traditional medicine in this community, nine are used by the national healthcare service(SUS). The drugs are prepared only in the form of tea, with the leaves being the most widely used plant parts (65%).For the treatment of diarrhea, the 12 species used by the interlocutors have chemical compositions that are supported by specialized literature. The Rio Urubueua community of Fatima makes use of medicinal plants to cure diseases, from knowledge obtained, in most cases, from their ancestors. This traditional knowledge contributes to the cultural knowledge of the region and to the research and development of new drugs.