Association of ethnicity and survival in peritoneal dialysis: a cohort study of incident patients in Brazil.

BACKGROUND: There are no available epidemiologic studies about the impact of ethnicity on outcomes of patients treated with peritoneal dialysis (PD) in South America. This study aims to assess the effect of ethnicity on the mortality of incident PD patients in Brazil. STUDY DESIGN: Prospective observational cohort study of incident patients treated with PD. SETTINGS & PARTICIPANTS: Patients 18 years or older who started PD therapy between December 2004 and October 2007 in 114 Brazilian dialysis centers. PREDICTORS: Self-reported ethnicity defined by the Brazilian Institute of Geography and Statistics as black and brown versus white patients and baseline demographic, socioeconomic, clinical, and laboratory data were collected at baseline. OUTCOME: Mortality, using cumulative mortality curves in which kidney transplantation and transfer to hemodialysis therapy were treated as competing end points. Multivariate Cox proportional hazards analysis was used to adjust for gradually more potential explanatory variables, censored for kidney transplantation and transfer to hemodialysis therapy. Analyses were performed for all patients, as well as stratified for elderly (aged ≥65 years) and nonelderly patients. RESULTS: 1,370 patients were white, 516 were brown, and 273 were black. The competing-risk model showed higher mortality in white patients compared with black and brown patients. With white patients as the reference, Cox proportional hazards analysis showed a crude HR for mortality of 0.77 (95% CI, 0.56-1.05) for black and 0.74 (95% CI, 0.59-0.94) for brown patients. After adjusting for potential explanatory factors, HRs were 0.67 (95% CI, 0.48-0.95) and 0.77 (95% CI, 0.43-1.01), respectively. The same results were observed in elderly and nonelderly patients. LIMITATIONS: Ethnicity was self-determined and some misclassification might have occurred. CONCLUSIONS: Black and brown Brazilian incident PD patients have a lower mortality risk compared with white patients.

Strategies of the Brazilian chronic kidney disease prevention campaign (2003-2009).

In Brazil, as in the rest of the world, the prevalence of chronic kidney disease (CKD) is increasing. In order to alert the population, health professionals and authorities to this risk, in 2003, the Brazilian Society of Nephrology launched a CKD prevention campaign called 'Previna-se'. In addition, since its onset, Brazil has participated in the World Kidney Day efforts and has developed several prevention strategies. Here, we summarize the main strategies adopted in this campaign (population screening, events and meetings, distribution of educational materials, routine report of estimated glomerular filtration rate) and our initial results, sharing practical experience that could be useful in other developing countries.

Point-of-care ultrasonography in nephrology: a cross-sectional national survey among Brazilian nephrologists.

INTRODUCTION: Point-of-care ultrasonography (US) (POCUS) has been used in several specialties, particularly in medical emergency. Despite the confirmation of its numerous benefits, the use of POCUS is still timid in nephrology. In the present study, we aim to investigate the use of POCUS by Brazilian nephrologists. METHODS: A survey carried out among the members of the Brazilian Society of Nephrology, through institutional e-mail, using the SurveyMonkey platform. We included 12 self-administered questions, which answers were given anonymously. RESULTS: It was evident that the majority (64%) of the participants did not have the opportunity to practice US during their nephrological training in their residency, specialization, or even in internships; those with experience with US use the method mainly for implanting central vascular accesses (68%), performing a renal biopsy (58%) and evaluating renal morphology (50%); and the main barriers for nephrologists who do not yet use US are the high price of US machines (26%) and the lack of time to learn about US (23%). Also, POCUS use for examinations of other organs, such as the lung (31%) and heart (18%), which are fundamental in the cardiovascular and volume assessment of patients with kidney diseases, is even more limited. However, 95% of the participants expressed an interest in learning POCUS for use in their medical practice. CONCLUSION: Most of the Brazilian nephrologists interviewed were not trained in US; however, almost all of the research participants expressed an interest in learning to use POCUS in nephrological practice.

Diastolic dysfunction for nephrologists: diagnosis at the point of care.

Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.

Chronic kidney disease increases cardiovascular unfavourable outcomes in outpatients with heart failure.

BACKGROUND: Chronic heart failure (CHF) has a high morbidity and mortality. Chronic kidney disease (CKD) has consistently been found to be an independent risk factor for unfavorable cardiovascular (CV) outcomes. Early intervention on CKD reduces the progression of CHF, hospitalizations and mortality, yet there are very few studies about CKD as a risk factor in the early stages of CHF. The aims of our study were to assess the prevalence and the prognostic importance of CKD in patients with systolic CHF stages B and C. METHODS: This is a prospective cohort study, dealing with prognostic markers for CV endpoints in patients with systolic CHF (ejection fraction

Incident elderly patients on peritoneal dialysis: Epidemiological characteristics and modality impact on survival time.

Aging of the population and the increased prevalence of diseases such as diabetes and arterial hypertension result in an increasing need of dialysis treatment. Herein we describe a cohort of elderly patients on peritoneal dialysis (PD) and assess the influence of the modality on the long-term survival. Out of a multicenter prospective cohort of 2,144 BRAZPD PD incident patients during a period from December 2004 to October 2007, 762 elderly adults, defined as patients ≥65-year-old, were eligible for the study, 413 started on automated PD (APD) and 349 on continuous ambulatory PD (CAPD). Patients were followed until death, transfer to hemodialysis, recovery of renal function, loss to follow-up, or transplantation. Demographics and clinical data were evaluated at baseline and described as mean ± standard deviation, median, or percentage. Competing risk and time-dependent Cox analysis were performed, having dialysis modality APD] vs. CAPD as a dependent variable, as hazard ratio (HR) is not proportional throughout the therapy time. Mean age was 74.5 ± 6.8 years in APD, 74.6 ± 6.7 in CAPD, 50.8% females in APD, 54.4% in CAPD. The frequently observed comorbidities were diabetes (52.3% in APD and 47% in CAPD) and left ventricular hypertrophy (36.3% in APD and 46.1% in CAPD) whereas 93.6% presented Davies score ≥2. In Cox time-dependent analysis, HR did not show difference up to 18 months HR = 1.11, confidence interval (CI) = 0.85-1.46], but thereafter, APD modality revealed lower risk of mortality (HR = 0.25, CI = 0.0073-0.86), when compared with CAPD. After adjustment for the confounding factors, CAPD presented a higher risk of mortality (HR = 4.50, CI = 1.29-15.64). No differences in survival were observed up to 18 months of therapy; however, beyond 18 months, APD modality was a protection factor.

Factors associated with tobacco use among patients with multiple chronic conditions.

BACKGROUND: Cigarette smoking is an important risk factor for disease onset and progression among the major chronic diseases accounting for most morbidity and mortality in the world. Our objective was to identify characteristics associated with tobacco use among patients with multiple chronic conditions (MCC). METHODS: This cross-sectional study was implemented at the Center HIPERDIA Minas Juiz de Fora, Brazil, which manages patients with high cardiovascular risk, hypertension, diabetes mellitus and chronic kidney disease. RESULTS: Of 1558 participants, 12% were current smokers; 41% former smokers and 47%, never smokers. In univariate analyses, current smoking was associated with gender, age, physical activity, alcohol use, depressive symptoms, overweight, and atherosclerosis. In multinomial analyses, multiple chronic conditions were associated with the current or previous use of tobacco; COPD and atherosclerotic disease were more prevalent among patients who were current smokers. CONCLUSIONS: Cigarette smoking was as prevalent in this high population as in the general population. Smokers had worse clinical profiles compared to former smokers or never smokers. Aggressive smoking cessation support should yield considerable health benefits and health care cost savings within patients with MCC, especially, those with high cardiovascular risk.

Point-of-care ultrasonography in nephrology: a cross-sectional national survey among Brazilian nephrologists / Ultrassonografia point-of-care em nefrologia: uma pesquisa nacional transversal entre nefrologistas brasileiros

Abstract Introduction: Point-of-care ultrasonography (US) (POCUS) has been used in several specialties, particularly in medical emergency. Despite the confirmation of its numerous benefits, the use of POCUS is still timid in nephrology. In the present study, we aim to investigate the use of POCUS by Brazilian nephrologists. Methods: A survey carried out among the members of the Brazilian Society of Nephrology, through institutional e-mail, using the SurveyMonkey platform. We included 12 self-administered questions, which answers were given anonymously. Results: It was evident that the majority (64%) of the participants did not have the opportunity to practice US during their nephrological training in their residency, specialization, or even in internships; those with experience with US use the method mainly for implanting central vascular accesses (68%), performing a renal biopsy (58%) and evaluating renal morphology (50%); and the main barriers for nephrologists who do not yet use US are the high price of US machines (26%) and the lack of time to learn about US (23%). Also, POCUS use for examinations of other organs, such as the lung (31%) and heart (18%), which are fundamental in the cardiovascular and volume assessment of patients with kidney diseases, is even more limited. However, 95% of the participants expressed an interest in learning POCUS for use in their medical practice. Conclusion: Most of the Brazilian nephrologists interviewed were not trained in US; however, almost all of the research participants expressed an interest in learning to use POCUS in nephrological practice.

Resumo Introdução: A ultrassonografia (US) pointof-care (POCUS) tem sido utilizada emvárias especialidades, particularmente na urgência médica. Apesar da constatação de seus numerosos benefícios, a utilização da POCUS ainda é tímida na nefrologia. No presente estudo, objetivamos fazer um levantamento sobre a utilização da POCUS pelos nefrologistas brasileiros. Métodos: Levantamento realizado entre os sócios da Sociedade Brasileira de Nefrologia, por meio do e-mail institucional, utilizando a plataforma SurveyMonkey. Foram incluídas 12 perguntas autoadministradas, cujas respostas se deram de forma anônima. Resultados: Ficou evidente que a maioria (64%) dos participantes não teve oportunidade de praticar a US durante sua formação nefrológica na residência, especialização ou mesmo em estágios; que aqueles com experiência com a US usam o método, principalmente, para implantação de acesso vascular central (68%), realização de biópsia renal (58%) e avaliação da morfologia renal (50%); e que as principais barreiras para os nefrologistas que ainda não utilizam a US são o preço elevado das máquinas de US (26%) e a falta de tempo para aprender sobre US (23%). Além disso, o uso da POCUS para exames de outros órgãos, como pulmão (31%) e coração (18%), fundamentais na avaliação cardiovascular e volêmica dos pacientes com doenças renais, ainda é mais limitado. Porém, 95% dos participantes expressaram interesse em aprender a POCUS para aplicação na sua prática médica. Conclusão: A maioria dos nefrologistas brasileiros entrevistados não foi treinada em US, contudo, a quase totalidade dos participantes da pesquisa manifestou interesse em aprender a utilizar a POCUS na prática nefrológica.

Diastolic dysfunction for nephrologists: diagnosis at the point of care

SUMMARY Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.

SUMÁRIO As doenças cardiovasculares são causa importante de morbidade e mortalidade no curso da doença renal crônica (DRC). A disfunção diastólica (DD) pode evoluir com insuficiência cardíaca manifesta clinicamente, denominada insuficiência cardíaca com fração de ejeção preservada, e precede a disfunção sistólica. A identificação precoce da DD pela ecocardiografia "point of care", antes do aparecimento dos sintomas e sinais de congestão pulmonar, e a implementação de tratamento adequado podem melhorar o prognóstico da DRC. Este artigo de revisão aborda brevemente a DD na doença renal e apresenta uma abordagem prática para o diagnóstico ecocardiográfico da DD à beira do leito

Identification of periodontal pathogens and severity of periodontitis in patients with and without chronic kidney disease.

OBJECTIVE: In this study of patients with chronic periodontitis (CP), the severity of the disease and the main periodontal pathogens identified in patients with chronic kidney disease (CKD) were compared with those detected in individuals without systemic disease. DESIGN: Nineteen patients with CP without evidence of systemic disease (control group), 25 patients with CP and CKD who were in the pre-dialysis stages (pre-dialysis group), and 22 patients with CP and CKD who were on renal replacement therapy (RRT group) were examined. The severity of CP was based on the investigation of probing depth (PD) and clinical attachment level (CAL). The definition and stage of CKD were based on the criteria proposed by the Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation. Glomerular filtration rate (GFR) was estimated using the equation of Modification of Diet in Renal Disease and the identification of microorganisms in subgingival plaque was performed using polymerase chain reaction (PCR). RESULTS: Candida albicans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were more common in patients who were on RRT and pre-dialysis than in control subjects. CP was more severe in patients with CKD. A strong association was observed between the frequency of C. albicans (P = 0.056), P.gingivalis (P = 0.008), T. denticola (P = 0.013) and CAL, when CKD patients were compared with the control group. CONCLUSION: CP is more severe and is associated with increased frequency of C. albicans, P. gingivalis, T. forsythia, and T. denticola in patients with CKD.

Assessment of matrix metalloproteinase (MMP)-2, MMP-8, MMP-9, and their inhibitors, the tissue inhibitors of metalloproteinase (TIMP)-1 and TIMP-2 in obese children and adolescents.

OBJECTIVES: To compare the circulating levels of matrix metalloproteinase (MMP)-8, pro-MMP-2, pro-MMP-9, and total MMP-9, their endogenous inhibitors, the tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2, and the MMP-8/TIMP-1, MMP-9/TIMP-1, and MMP-2/TIMP-2 ratios in normotensive obese children and adolescents with those found in non obese children and adolescents. DESIGN AND METHODS: We studied 40 obese and 40 non obese (controls) children and adolescents in this cross-sectional study. MMP and TIMP concentrations were measured in plasma samples by gelatin zymography and ELISA. RESULTS: Obese children and adolescents had higher circulating MMP-8 concentrations, lower plasma TIMP-1 concentrations, and higher MMP-8/TIMP-1 ratios than non obese controls (P<0.05). We found no differences in pro-MMP-9 or total MMP-9 levels, or in MMP-9/TIMP-1 ratios between groups (P>0.05). While we found no significant differences in pro-MMP-2 levels (P>0.05) obese subjects had higher TIMP-2 concentrations and lower pro-MMP-2/TIMP-2 ratios (P<0.05) than non obese controls. CONCLUSIONS: In conclusion, we found evidence indicating higher net MMP-8 (but not MMP-9 and MMP-2) activity in childhood obesity. The increased MMP-8 levels found in obese children suggest a possibly relevant pathophysiological mechanism that may be involved in the increase of cardiovascular risk associated with childhood obesity.

Insuficiência renal aguda nefrotóxica: prevalência, evolução clínica e desfecho / Nephrotoxic acute renal failure: prevalence, clinical course and outcome

Introdução: A insuficiência renal aguda (IRA) nefrotóxica é frequente e importante causa de morbimortalidade. objetivo: Avaliar a prevalência, o curso clínico e o desfecho da IRA nefrotóxica. pacientes e Métodos: Coorte histórica realizada em um hospital de ensino terciário, no período de fevereiro a novembro de 1997. Foram incluídos pacientes acima de 12 anos, com diagnóstico de IRA, acompanhados pela equipe de Interconsulta de Nefrologia. Foram excluídos transplantados renais, portadores de insuficiência renal crônica, dialisados por intoxicação exógena e aqueles transferidos de hospital durante o tratamento. Resultados: Dos 234 pacientes acompanhados, 12% apresentaram IRA nefrotóxica e 24%, IRA multifatorial associada ao uso de drogas nefrotóxicas. Entre as comorbidades mais prevalentes, estão hipertensão arterial, hepatopatias, neoplasias, insuficiência cardíaca congestiva e diabetes mellitus. Quinze por cento necessitaram de diálise, e o tipo mais frequentemente usado foi hemodiálise venovenosa contínua; 42% eram oligúricos, 44,7% evoluíram para óbito e 33% recuperaram a função renal. Antibióticos, AINH e contraste radiológico foram as drogas nefrotóxicas mais prevalentes. Os medicamentos nefrotóxicos implicados foram, em ordem de frequência, vancomicina, aminoglicosídeos, aciclovir, quimioterápicos e contraste radiológico. Hepatopatia foi a única variável com significância estatística (p=0,03, IC= 1,08 a 6,49) em análise multivariada. Na comparação entre IRA nefrotóxica, houve aumento da mortalidade proporcionalmente aos dias de internação. Conclusão: IRA nefrotóxica é frequente, grave e deve ser continuamente monitorada, tanto ambulatorialmente quanto no ambiente intra-hospitalar.

Background: Acute renal failure (ARF) is frequent and important cause of morbidity and mortality. Objective: To evaluate the prevalence, clinical course and outcome of nephrotoxic ARF. Patients and Methods: This historical cohort study conducted in a tertiary hospital in the period from February to November 1997. We included patients over 12 years, diagnosed with ARF, accompanied by a team of nephrologists. Were excluded from renal transplant patients, patients with chronic renal failure, dialysis with exogenous poisoning and those transferred to hospital during treatment. Results: Of 234 patients enrolled, 12% had nephrotoxic ARF, and 24% multifactorial ARF associated with the use of nephrotoxic drugs. Among the most prevalent comorbidities are arterial hypertension, liver diseases, cancer, congestive heart failure and diabetes mellitus. Fifteen percent required dialysis, and the type most often used was continuous venovenous hemodialysis, 42% were oliguric, 44.7% died and 33% recovered renal function. Antibiotics, NSAIDs and contrast radiological nephrotoxic drugs were more prevalent. The nephrotoxic drugs were, in order of frequency, vancomycin, aminoglycosides, acyclovir, chemotherapy and radiological contrast. Liver was the only variable with statistical significance (p = 0.03, CI = 1.08 to 6.49) in multivariate analysis. In comparison nephrotoxic ARF, there was increased mortality proportional to the length of hospitalization. Conclusion: Nephrotoxic ARF is common, serious and must be continuously monitored, both outpatient and in-hospital setting.

Satisfação do paciente com o atendimento interdisciplinar numambulatório de prevenção da doença renal crônica / Patient’s satisfaction with interdisciplinary care in a clinic of prevention of chronic kidney disease

Introdução: Semelhantemente ao observado em outras doenças, a satisfação do paciente com o seu tratamento pode determinar melhor evolução da doença renal crônica (DRC). Objetivo: Avaliar a satisfação dos pacientes com o atendimento interdisciplinar recebido num ambulatório de prevenção da DRC. Métodos: A pesquisa de satisfação foi aplicada a pacientes do PREVENRIM – Programa Interdisciplinar de Prevenção da DRC. O diagnóstico e o estagiamento da DRC se fundamentaram nas diretrizes do KDOQI da NKF americana. A pesquisa de satisfação baseou-se em perguntas relativas à logística do atendimento, à importância dos membros da equipe no manejo da doença, à dinâmica do atendimento e à compreensão das informações sobrea DRC. Resultados: Foram avaliados 101 pacientes, 52,6% eram do sexo masculino, com idade média de 56±13,9 anos acompanhados em média por 32,66±18,17 meses. Do total de pacientes, 43,8% possuíam ensino fundamental incompleto. A principal causa de DRC foi nefroesclerose hipertensiva. A média da FG estimada foi de 31,59±15,02mL/min/1,73m2. A maioria absoluta (95,6%) dos pacientes relatou estar satisfeita com as explicações sobre as suas doenças. O atendimento foi considerado importante ou muito importante pelos pacientes com relação à atuação do nefrologista e da nutricionista (100%), assistente social e enfermeiro (98,8%), bem como da psicóloga (97,7%). Todos recomendariam o PREVENRIM a outros pacientes com DRC. Conclusão: Nesta amostra de pacientes com DRC pré-dialítica acompanhados por uma equipe interdisciplinar, observamos um alto nível de satisfação com os cuidados de saúde ofertados. Estudos futuros avaliarão se a satisfação do paciente com o seu tratamento determinará melhores desfechos biopsicossociais na evolução da DRC.

Introduction: Similarly to the observed in other diseases, the patient’s satisfaction with his or her treatment may determine better outcomes of the chronic kidney disease (CKD). Aim: To assess the satisfaction of patients with the interdisciplinary care delivered in a Clinic of secondary prevention of CKD. Methods: The satisfaction assessment was applied to patients of the PREVENRIM – Interdisciplinary Program of Prevention of CKD. The diagnosis and staging of CKD were done as proposed by the KDOQI of the American NKF. The satisfaction assessment was made through questions covering the logistic of the Clinic, the importance of each members of the team in the management of the disease, the dynamic of the interdisciplinary care, and the understanding of the information on CKD. Results: The questionnaire were applied to 101 patients, followed for 32,66 ± 18,17 months, 52,6% were male and the mean age was 56±13,9 years. Incomplete basic education was observed in 43,8% of the patients. The main cause of CKD was hypertensive nephroesclerosis. The mean estimated GFR was 31,59±15,02mL/min/1,73m2. The great majority (95,6%) of the patients reported to be satisfied with theexplanation given about their disease. Regarding the management of their disease, the patients considered important or very important the role played by nephrologists and dietician (100%), social worker and nurse (95,6%), and psychologist (97,7%). All the patients would refer patients with CKD to the PREVENRIM. Conclusion: In this group of patients with CKD not yet on dialysis, followed by an interdisciplinary team, we observed a high satisfaction level with the health care received. Future studies should assess if the level of patients’ satisfaction with their treatment will determine better outcomes in CKD.

Avaliação comparativa da sedimentoscopia urinária realizada pelo nefrologista e pelo profissional de análises clínicas em pacientes com glomerulopatias / Comparative assessment of urinary sediment done by the nephrologist and by the clinical analyst professional in patients with glomerulonephritis

Introdução: A sedimentoscopia urinária com microscópio munido com contraste de fase (MCF) deveria ser a primeira etapa na determinação da origemdas hematúrias. Objetivo: Avaliar discrepâncias nas descrições dos parâmetros urinários relacionados à origem das hematúrias, comparando as descrições do nefrologista (Nef) e do profissional de análises clínicas (PAC). Métodos: Urinas de pacientes com glomerulopatias (GP) confirmadas por biópsia renal foram analisadas sob MCF, por um Nef e um PAC, ambos sem conhecimento prévio da origem das amostras. Cilindros hemáticos, acantocitúria ou células G1 >5% e dismorfismo eritrocitário foram utilizados na localização glomerular das hematúrias. Resultados: Dos 28 pacientes, 13 pacientes (46,4%) apresentavam glomerulonefrites não proliferativas e 15 (53,6%) glomerulonefrites proliferativas. Comparativamente ao PAC, o Nef identificou maior número de hemácias (mediana/mL de urina, 80.000 vs 4.800, p=0,001), maior número de cilindros hemáticos (39,3% vs 0%, p=0,001), maior freqüência de acantocitúria ou células G1 >5% (35,7% vs. 7,14%, p=0,021) e de dismorfismo eritrocitário (96,2% vs 7,14%, p<0,001). As discrepâncias dos resultados permaneceram após a separação das glomerulopatias em proliferativas e não proliferativas. Conclusão: Os parâmetros urinários que caracterizam a origem da hematúria foram mais freqüentemente identificados pelo nefrologista e sugerem que a urinálise, pela sua simplicidade e grande valor informativo, deveria ser incluída obrigatoriamente nos programas de treinamento em nefrologia.

Introduction: In the assessment of hematuria, the first step should be the identification of the origin of the bleeding, which can be done easily by analyzing the urine under phase-contrast microscopy. Obective: To assess the discrepancy of reports of the urinary parameters utilized in the localization of the glomerular origin of hematuria, comparing reports by the nephrologists and by the clinical laboratory technologist. Methods: Urines of patients with biopsy proven glomerulonephritis were assessed under phase-contrast microscopy by a nephrologist and a clinical laboratory technologist, both without previous knowledge of the origin of the samples. Red blood cell (RBC) casts, urinary acanthocytes or G1 cells >5%, and erithrocyte dysmorphism were used tolocalize the glomerular bleeding. Results: Among 28 patients, 13 (46.4%) had non proliferative glomerulonephritis and 15 (53.6%) had proliferative glomerulonephritis. Relatively to the clinical laboratory technologist, the nephrologist identified more RBC (median of 80.000 vs 4.800, p= 0.001), more RBC casts (39.3% vs 0%, p=0.001), more urinary acanthocytes or G1 cells >5% (35.7% vs 7.14%, p=0.021) and more dysmorphic RBC (96.2% vs 7.14%,p<0.001). The discrepancies of the reports were maintained after the separation of the glomerulonephritis in proliferative and non proliferative. Conclusion: The urinary parameters used in characterization of the origin of the hematuria were more frequently identified by the nephrologist, and suggest that the urinalysis, a simple and very informative test, should be mandatory in programs of training in nephrology.

Hiperuricemia: um marcador para doença renal crônica pré-clínica? / Hyperuricemia: a marker for chronic kidney disease pre-clinical?

Introdução: Os níveis séricos de ácido úrico aumentam na doença renal crônica (DRC), contudo o impacto desta observação clínica na história natural da doença ainda não está elucidado. Objetivo: Testar a hipóteses de que níveis elevados de ácido úrico em indivíduos com função renal preservada se associam com maior prevalência de DRC. Material e métodos: O estudo foi realizado a partir dos dados clínicos (sexo e idade) e laboratoriais (creatinina e ácido úrico) obtidos em um laboratório de análises clínicas em dois períodos distintos: basal (2000-2003) e de avaliação (2004-2005). A filtração glomerular estimada (FGe) foi calculada pela fórmula do estudo <60mL/min/1,73m², num período aproximado de 3 meses. O ácido úrico expresso em mg/dL foi analisado pela separação dos indivíduos em normouricêmicos e hiperuricêmicos e pela divisão da distribuição da amostra em quartis. Resultados: Do total de 4.991 indivíduos avaliados no período basal, 4.041 (90,0%) apresentavam FG>60mL/min/1,73m². Os indivíduos hiperuricêmicos (homens, mulheres, com menos de 60 anos e idosos) apresentaram maior risco relativo para DRC do que os normuricêmicos. Também foi observado que os grupos de indivíduos com ácido úrico mais elevado apresentaram maior prevalência de DRC no período basal (ácido úrico/FGe:<4,0/16,3%; 4,1-5,1/21,2%;5,2-6,7/28,6%;>6,7/34,0%;p<0,001). A prevalência de DRC no período de avaliação também foi maior nos grupos de indivíduos com níveis mais elevados de ácido úrico (ácido úrico/FG:<4,0/22,3%;4-5,1/26,9%; 5,2-6,7/28,5%;>6,7/22,3%;p<0,05). Conclusão: Em indivíduos não portadores de DRC níveis elevados de ácido úrico sérico se associam com maior prevalência da doença e parecem identificar um estado "pré-clínico" de disfunção renal.

Introduction: The serum uric acid increase in chronic kidney disease (CKD), however the impact of this clinical observation in the natural history of disease has not yet been elucidated. Objective: To test the hypothesis that high levels of uric acid in subjects with normal renal function are associated with higher prevalence of CKD. Methods: The study was conducted based on clinical data (age and sex) and laboratory (creatinine and uric acid) obtained in a clinical laboratory in two distinct periods: baseline (2000-2003) and evaluation (2004 - 2005). The estimated glomerular filtration (FGE) was calculated using the study <60mL/min/1, 73m ², within approximately three months. Uric acid in mg / dL was analyzed by the separation of individuals in normouricêmicos hyperuricemic and division and distribution of the sample into quartiles. Results: Of 4,991 subjects evaluated at baseline, 4,041 (90.0%) had FG> 60mL/min/1, 73m ². Hyperuricemic individuals (men, women, younger than 60 years and older) had higher relative risk for CKD than normuricêmicos. It was also observed that groups of individuals with higher uric acid had a higher prevalence of CKD at baseline (uric acid / FGE: <4.0 / 16.3%, from 4.1 to 5.1 / 21.2%; 5.2 to 6.7 / 28.6%> 6.7 / 34.0%, p <0.001). The prevalence of CKD in the evaluation period was also greater in individuals with higher levels of uric acid (uric acid / FG: <4.0 / 22.3%, from 4 to 5.1 / 26.9% 5 0.2 to 6, 7 / 28, 5%,> 6.7 / 22.3%, p <0.05). Conclusion: In non-CKD high levels of serum uric acid are associated with higher prevalence of the disease state and appear to identify a "preclinical" renal dysfunction.