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BACKGROUND: Although approximately 25% of Brazilians have private health coverage (PHC), studies on the surveillance of chronic kidney disease (CKD) in this population are scarce. The objective of this study was to estimate the prevalence of CKD in individuals under two PHC regimes in Brazil, who total 8,335,724 beneficiaries. METHODS: Outpatient serum creatinine and proteinuria results of individuals from all five regions of Brazil, ≥ 18 years of age, and performed between 10/01/2021 and 10/31/2022, were analyzed through the own laboratory network database. People with serum creatinine measurements were evaluated for the prevalence and staging of CKD, and those with simultaneous measurements of serum creatinine and proteinuria were evaluated for the risk category of the disease. CKD was classified according to current guidelines and was defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73 m² estimated by the 2021 CKD-EPI equation. RESULTS: The number of adults with serum creatinine results was 1,508,766 (age 44.0 [IQR, 33.9-56.8] years, 62.3% female). The estimated prevalence of CKD was 3.8% (2.6%, 0.8%, 0.2% and 0.2% in CKD stages 3a, 3b, 4 and 5, respectively), and it was higher in males than females (4.0% vs. 3.7%, p < 0.001, respectively) and in older age groups (0.2% among 18-29-year-olds, 0.5% among 30-44-year-olds, 2.0% among 45-59-year-olds, 9.4% among 60-74-year-olds, and 32.4% among ≥ 75-year-olds, p < 0.001) Adults with simultaneous results of creatinine and proteinuria were 64,178 (age 57.0 [IQR, 44.8-67.3] years, 58.1% female). After adjusting for age and gender, 70.1% were in the low-risk category of CKD, 20.0% were in the moderate-risk category, 5.8% were in the high-risk category, and 4.1% were in the very high-risk category. CONCLUSION: The estimated prevalence of CKD was 3.8%, and approximately 10% of the participants were in the categories of high or very high-risk of the disease. While almost 20% of beneficiaries with PHC had serum creatinine data, fewer than 1% underwent tests for proteinuria. This study was one of the largest ever conducted in Brazil and the first one to use the 2021 CKD-EPI equation to estimate the prevalence of CKD.
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Creatinina , Insuficiencia Renal Crónica , Humanos , Masculino , Femenino , Brasil/epidemiología , Persona de Mediana Edad , Adulto , Insuficiencia Renal Crónica/epidemiología , Creatinina/sangre , Prevalencia , Anciano , Vigilancia de la Población/métodos , Adulto Joven , Adolescente , Seguro de Salud/estadística & datos numéricos , Proteinuria/epidemiología , Tasa de Filtración GlomerularRESUMEN
OBJECTIVE AND DESIGN: Circulating enzymatic activity and RAAS regulation in severe cases of COVID-19 remains unclear, therefore we measured the serum activity of several proteases as potential targets to control the SARS-CoV-2 infection. MATERIAL OR SUBJECTS: 152 patients with COVID-19-like symptoms were grouped according to the severity of symptoms (COVID-19 negative, mild, moderate and severe). METHODS: Serum samples of COVID-19 patients and controls were subjected to biochemical analysis and enzymatic assays of ACE2, ACE, DPPIV, PREP and CAT L. One-way ANOVA and multivariate logistic regression analysis were used. Statistical significance was accepted at p < 0.05. RESULTS: We detected a positive correlation among comorbidities, higher C-reactive protein (CRP) and D-dimer levels with disease severity. Enzymatic assays revealed an increase in serum ACE2 and CAT L activities in severe COVID-19 patients, while ACE, DPPIV and PREP activities were significantly reduced. Notably, analysis of ACE2/ACE activity ratio suggests a possible imbalance of ANG II/ANG(1-7) ratio, in a positive association with the disease severity. CONCLUSION: Our findings reveal a correlation between proteases activity and the severity of COVID-19. These enzymes together contribute to the activation of pro-inflammatory pathways, trigger a systemic activation of inflammatory mediators, leading to a RAAS dysregulation and generating a significant damage in several organs, contributing to poor outcomes of severe cases.
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COVID-19 , Humanos , Enzima Convertidora de Angiotensina 2/metabolismo , COVID-19/enzimología , Peptidil-Dipeptidasa A/metabolismo , Sistema Renina-Angiotensina/fisiologíaRESUMEN
Onychomycosis is common among immunosuppressed individuals. Renal transplant recipients (RTR) and lupus nephritis (LN) patients are submitted to corticosteroid and other immunosuppressive therapy; and diabetes mellitus (DM) patients are intrinsically immunocompromised. OBJECTIVES: The aim of this study was to characterise and identify fungal infections on the nails (feet and hands) in immunocompromised patients. METHODS: The clinical material, nail scales (foot and/or hand), was collected from 47 RTR, 66 LN, 67 DM, and 78 immunocompetent individuals (control group). Phenotypic and molecular analyses were performed. RESULTS: A total of 258 patients were examined. There was a female predominance, except in the RTR. The average age was 52 years old. Lateral distal subungual onychomycosis (OSDL) (75.2%), mainly affecting the hallux nail, was frequent. The predominance of dermatophyte on toenails and Candida species on fingernails was statistically significant. A higher frequency of fingernail involvement in LN and DM, and for LN, the difference was significant (p = .0456). Infections by Candida spp. were more frequent in DM. Using molecular methods, 87.2% of diagnoses were confirmed, identifying fungal agents at the species level. Dermatophytes, Trichophyton rubrum and Trichophyton interdigitale and the species of Candida, C. parapsilosis and C. albicans, were the most frequent fungal agents. CONCLUSIONS: Molecular techniques (sequencing of ITS regions of rDNA) offer greater accuracy, although there is no difference, regarding the detection. Clinical presentation and fungal species may differ somewhat from the general population. Immunosuppression did not increase fungal detection positivity.
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Onicomicosis , Humanos , Femenino , Persona de Mediana Edad , Masculino , Onicomicosis/diagnóstico , Onicomicosis/epidemiología , Onicomicosis/microbiología , Uñas/microbiología , Candida albicans , Candida/genética , Huésped Inmunocomprometido , Candida parapsilosisRESUMEN
BACKGROUND: Performing a kidney biopsy is necessary to accurately diagnose diseases such as glomerulonephritis and tubulointerstitial nephritis, among other such conditions. These conditions predispose patients to chronic kidney disease, as well as acute kidney injury (AKI). Notably, most epidemiological studies describing AKI have not investigated this patient population. METHODS: Included patients admitted to the nephrology ward of a tertiary hospital who underwent percutaneous kidney biopsy. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes criteria. RESULTS: Of the 223 patients investigated, 140 (62.8%) showed AKI. Of these, 91 (65%), 19 (13.6%), and 30 (21.4%) presented with AKI classified as stages 1, 2, and 3, respectively. The primary indication for performing biopsy was nephrotic syndrome or nephrotic proteinuria (73 [52.1%] in the AKI vs. 51 [61.4%] in the non-AKI group, p = 0.048). Focal segmental glomerulosclerosis was the most prevalent primary disease (24 [17.1%] in the AKI vs. 15 [18.0%] in the non-AKI group, p = 0.150). Multivariate analysis of risk factors associated with AKI showed hemoglobin levels (odds ratio [OR] 0.805, 95% confidence interval [CI] 0.681-0.951, p = 0.011), serum high-density lipoprotein cholesterol levels (HDL-c, OR 0.970, 95% CI 0.949-0.992, p = 0.008), and baseline serum creatinine levels (OR 2.703, 95% CI 1.471-4.968, p = 0.001) were significantly associated with AKI. CONCLUSIONS: We observed a high prevalence of AKI in hospitalized patients who underwent kidney biopsy to investigate their renal disease, particularly glomerulonephritis. Higher levels of hemoglobin and serum HDL-c were associated with a lower risk of AKI.
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Lesión Renal Aguda/patología , Pacientes Internos , Riñón/patología , Lesión Renal Aguda/sangre , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Adulto , Biopsia/efectos adversos , HDL-Colesterol/sangre , Creatinina/sangre , Femenino , Glomerulonefritis/patología , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Hemoglobina A/análisis , Humanos , Pacientes Internos/estadística & datos numéricos , Enfermedades Renales/patología , Masculino , Multimorbilidad , Síndrome Nefrótico/complicaciones , Prevalencia , Proteinuria/complicaciones , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To establish the occurrence and intensity of podocyturia and its relation to grade of disease activity, as defined by clinical and laboratory criteria. METHODS: Prospective, cross-sectional study involving 50 patients with lupus nephritis and 29 controls, which had podocyturia levels determined from random urine samples using an immunofluorescence technique. Disease activity was graded by BILAG (renal criteria) and an additional system used in the service (S2). RESULTS: Fifty patients with lupus nephritis (WHO classes III, IV and V), with a median age of 37 years, were evaluated. Of these, 86.5% were female, and 52% were BILAG A. Podocyturia quantification in the lupus nephritis and control groups differed significantly (p = 0.009). This score was higher in relation to classes III, IV and V. The correlation with C3 consumption was stronger (p = 0.011) than with C4. The highest levels were found in the most active groups (A and B of BILAG and S2). Lower podocyturia correlated with a lower dose of prednisone. There was no association with the intensity of proteinuria, hematuria or pyuria, serum creatinine levels, among others. CONCLUSIONS: Podocyturia assessment, which was performed by immunofluorescence in this study, can be used as an indicator of disease activity with the advantage of being a urinary biomarker. The levels proved to be higher in patients with lupus nephritis than in the controls and were particularly higher in class IV.
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Nefritis Lúpica/orina , Podocitos , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Orina/citología , Adulto JovenAsunto(s)
Glomerulonefritis Membranosa , Glomerulonefritis , Hepatitis B , Poliarteritis Nudosa , Glomerulonefritis/diagnóstico , Glomerulonefritis/etiología , Glomerulonefritis Membranosa/diagnóstico , Glomerulonefritis Membranosa/etiología , Hepatitis B/complicaciones , Hepatitis B/diagnóstico , Humanos , Poliarteritis Nudosa/complicaciones , Poliarteritis Nudosa/diagnóstico , Poliarteritis Nudosa/tratamiento farmacológicoRESUMEN
Renal involvement is one of the most severe morbidities of Fabry disease (FD), a multisystemic lysosomal storage disease with an X-linked inheritance pattern. It results from pathogenic variants in the GLA gene (Xq22.2), which encodes the production of alpha-galactosidase A (α-Gal), responsible for glycosphingolipid metabolism. Insufficient activity of this lysosomal enzyme generates deposits of unprocessed intermediate substrates, especially globotriaosylceramide (Gb3) and derivatives, triggering cellular injury and subsequently, multiple organ dysfunction, including chronic nephropathy. Kidney injury in FD is classically attributed to Gb3 deposits in renal cells, with podocytes being the main target of the pathological process, in which structural and functional alterations are established early and severely. This configures a typical hereditary metabolic podocytopathy, whose clinical manifestations are proteinuria and progressive renal failure. Although late clinical outcomes and morphological changes are well established in this nephropathy, the molecular mechanisms that trigger and accelerate podocyte injury have not yet been fully elucidated. Podocytes are highly specialized and differentiated cells that cover the outer surface of glomerular capillaries, playing a crucial role in preserving the structure and function of the glomerular filtration barrier. They are frequent targets of injury in many nephropathies. Furthermore, dysfunction and depletion of glomerular podocytes are essential events implicated in the pathogenesis of chronic kidney disease progression. We will review the biology of podocytes and their crucial role in regulating the glomerular filtration barrier, analyzing the main pathogenic pathways involved in podocyte injury, especially related to FD nephropathy.
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Enfermedad de Fabry , Enfermedades Renales , Podocitos , Enfermedad de Fabry/complicaciones , Enfermedad de Fabry/patología , Podocitos/patología , Humanos , Enfermedades Renales/etiología , Enfermedades Renales/patologíaRESUMEN
INTRODUCTION: Patients with end-stage renal disease often face a challenging routine of hemodialysis, dietary restrictions, and multiple medications, which can affect their hemodynamic function. Home-based, safe, and nonpharmacological approaches such as transcranial direct current stimulation (tDCS) should be combined with conventional treatment. OBJECTIVE: To assess the safety and feasibility of tDCS on blood pressure and heart rate in patients with end-stage renal disease undergoing hemodialysis. METHOD: This is a parallel, randomized, sham-controlled trial. Patients undergoing hemodialysis for more than three months were included. The patients received ten non-consecutive 2mA tDCS sessions on the primary motor cortex . Each session lasted 20 minutes. At baseline and after each of the ten sessions, blood pressure and heart rate of the patients were measured hourly for four hours. RESULTS: Thirty patients were randomized to the active or sham group. The mean difference between the groups was calculated as the mean value of the sham group minus the mean value of the active group. Despite there were no statistical changes for all outcomes considering all 10 sessions, we found differences between groups for systolic -10.93 (-29.1;7.2), diastolic -3.63 (-12.4; 5.1), and mean blood pressure -6.0 (-16.3; 4.2) and hear rate 2.26 (-2.5; 7.1). No serious adverse events were found. The active group showed higher blood pressure values at all points, while heart rate was lower in the active group. CONCLUSION: tDCS is safe and feasible for patients with end-stage renal disease undergoing hemodialysis. Future studies should investigate whether tDCS could potentially induce a hypotensive protective effect during hemodialysis.
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Estudios de Factibilidad , Fallo Renal Crónico , Diálisis Renal , Estimulación Transcraneal de Corriente Directa , Humanos , Diálisis Renal/métodos , Diálisis Renal/efectos adversos , Fallo Renal Crónico/terapia , Masculino , Femenino , Persona de Mediana Edad , Estimulación Transcraneal de Corriente Directa/métodos , Presión Sanguínea , Frecuencia Cardíaca , AncianoRESUMEN
Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.
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Nefrología , Patología Clínica , Insuficiencia Renal Crónica , Humanos , Tasa de Filtración Glomerular , Creatinina , Brasil , Consenso , Diálisis Renal , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapiaRESUMEN
INTRODUCTION: Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria. OBJECTIVE: To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population. METHOD: Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed. RESULTS: A total of 1138 subjects were interviewed, with a median age of 36 years old (27-52); 55.1% were female. Regarding the "creatinine" biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were "I don't know" (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into "knows" and "does not know" the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16-8.43, p < 0.001). CONCLUSION: There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.
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Insuficiencia Renal Crónica , Adulto , Femenino , Humanos , Masculino , Biomarcadores , Brasil , Creatinina , Estudios Transversales , Insuficiencia Renal Crónica/diagnóstico , Persona de Mediana EdadRESUMEN
Chronic kidney disease (CKD) provides a worse prognosis for patients with heart disease. In Latin America, studies that analyzed the prevalence and risk stratification of CKD in this population are scarce. We aimed to evaluate CKD prevalence and risk categories in patients of a public referral cardiology hospital in São Paulo, Brazil. This was a cross-sectional study based on a laboratory database. Outpatient serum creatinine and proteinuria results performed between 1 January 2021 and 31 December 2021 were analyzed. CKD was defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and proteinuria, by the albumin/creatinine ratio in a spot urine sample (UACR) >30 mg/g. A total of 36,651 adults were identified with serum creatinine levels (median age 72.4 [IQR, 51.0-73.6] years, 51% male). Among them, 51.9% had UACR dosage (71.5% with UACR < 30 mg/g, 22.6%, between 30-300 mg/g, and 5.9% with UACR > 300 mg/g). The prevalence of CKD was 30.9% (15.3% stage 3a, 10.2% stage 3b, 3.6% stage 4, and 1.7% stage 5), and the distribution of patients in the risk categories of the disease was: 52.0% with low-risk, 23.5%, moderate risk, 13.0%, high risk, and 11.2%, very high. In an outpatient setting, the prevalence of CKD in cardiological patients was almost three times (31%) that of the general population; about half of the individuals evaluated (48%) were not screened for an important risk marker (proteinuria), and approximately a quarter of these patients (24%) were in the high or very high CKD risk categories.
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OBJECTIVE: To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. METHODS: This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. RESULTS: Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). CONCLUSION: In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.
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Pruebas Diagnósticas de Rutina , Insuficiencia Renal Crónica , Brasil , Humanos , Riñón , Derivación y Consulta , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiologíaRESUMEN
CONTEXT: Chronic pain in end-stage renal disease (ESRD) is an increasingly neglected clinical problem affecting more than 60% of patients. Long-term chronic pain could be associated with brain imbalance in circuits of pain matrix and is associated with poor quality of life (QoL) and mood disturbance. OBJECTIVES: The aim of this study was evaluating the effects of transcranial direct current stimulation (tDCS) on pain, QoL, depression, anxiety and affectivity in ESRD patients undergoing hemodialysis (HD). METHODS: This double-blind, randomized, sham-controlled trial included 30 patients with chronic pain undergoing HD. Participants were allocated to Active tDCS and Sham tDCS and received ten non-consecutive sessions of anodal motor cortex stimulation (M1/Sp2 montage) at 2 mA intensity for 20 min. The primary outcome was pain assessed using numeric rating scale (NRS) and collected at baseline, immediately after the 10th day of intervention, one week, two weeks, and four weeks after the last stimulation. Secondary outcomes included QoL, depression, anxiety and affectivity collected before and after intervention. RESULTS: A mixed ANOVA model showed significant interaction between group and time on pain F(4.112) = 3.106, P = 0.01 with main effects of group (P = 0.03). Before and after intervention, a significant improvement was observed in QoL (P = 0.009), general health (P = 0.03), fatigue (P = 0.05), symptoms (P = 0.05) depression (P = 0.01) and anxiety (P = 0.01). No difference was found for affectivity. CONCLUSION: Anodal tDCS over the motor cortex emerges as a potential therapeutic approach for improving pain, QoL, and mood in patients with ESRD.
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Dolor Crónico , Fallo Renal Crónico , Estimulación Transcraneal de Corriente Directa , Dolor Crónico/terapia , Método Doble Ciego , Humanos , Fallo Renal Crónico/terapia , Manejo del Dolor , Calidad de Vida , Resultado del TratamientoRESUMEN
BACKGROUND: The number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce. OBJECTIVE: To determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist. DESIGN AND SETTING: Retrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil. METHODS: From December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment. RESULTS: The main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009). CONCLUSION: Referrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.
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Hipertensión , Nefrología , Insuficiencia Renal Crónica , Brasil/epidemiología , Demografía , Humanos , Hipertensión/epidemiología , Riñón , Nefrólogos , Proteinuria/epidemiología , Derivación y Consulta , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Estudios RetrospectivosRESUMEN
Complications of chronic kidney disease (CKD) can be avoided when promptly diagnosed and treated. The objective was to describe quality indicators of CKD detection and health care in the primary care public service of a city in the State of São Paulo, Brazil. This retrospective study analyzed charts of patients who attended primary care in the public service between November 2019 and February 2020. We selected 10 health quality indicators based on their scientific relevance and availability from the medical records that could express how CKD was identified and managed in primary health care. We estimated the adequate percentage of health indicators with data from 1,066 individuals who had ≥ one risk factor for CKD: hypertension, diabetes, or > 60 years old. Among patients, 79.4% had information on serum creatinine, whereas 58.8% were investigated for proteinuria. Blood pressure data were found in 98.9% of the records. The percentage of patients with blood pressure < 140x90mmHg, glycosylated hemoglobin < 6.5% and LDL-cholesterol < 100mg/dL was 79.2%, 49.2%, and 33.3%, respectively. Renin-angiotensin system blockers were prescribed to 82.8% of the patients with hypertension and CKD. Serum potassium was measured in 35.7% for those who were using renin-angiotensin system blockers. Among those people with CKD, 16.7% had CKD assigned in the medical records as a diagnose. Among those participants at higher risk for CKD, the referral rate to a nephrologist was 31.6%. This study confirmed some missed quality indicators of CKD in primary healthcare. Our results may help administrators develop public policies that improve health care for individuals at high risk for CKD. Long-term follow-up of the health indicators we proposed here will be useful to assess the impact of policy intervention.
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Indicadores de Calidad de la Atención de Salud , Insuficiencia Renal Crónica , Brasil/epidemiología , Humanos , Persona de Mediana Edad , Atención Primaria de Salud , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Estudios RetrospectivosRESUMEN
PURPOSE: To describe Brazilians' behavior regarding face mask use and health literacy during the COVID-19 pandemic before and after the Ministry of Health of Brazil formal recommendation. DESIGN: Cross-sectional surveys using a web-based questionnaire. Participants were recruited via snowball techniques. SETTING: São Paulo state, the urban epicenter of the COVID-19 pandemic in Brazil at the time of the study. PARTICIPANTS: 2.203 clicks to the survey link and 1.223 surveys completed (55.5% response rate). However, only 1118 surveys were considered after the exclusion criteria (>18 years-old and consent). MEASURES: Demographics, educational status, COVID-19-related symptoms (headache, cough, sore throat, rhinorrhea, fever, asthenia, diarrhea, dyspnea, nausea, vomiting, vertigo, anosmia, and ageusia), and face mask use. ANALYSIS: Self-reports of COVID-19 symptoms were categorized as dichotomous variables (Cohen's h = 0.94). Pearson Chi-square test evaluated differences between T1 and T2 and logistic multiple regression analyzed odds-ratio for the presence of symptoms and independent variables. RESULTS: Face mask use increased from 43.60% in T1 to 90.52% in T2 (P < .0001) as the pandemic went on. Health literacy also changed within 2 weeks and people started to assume everybody should use face masks (62.93% in T1 vs 94.12% in T2; P < .0001; ES = 0.29) during outside activities (43.60% in T1 vs 90.52% in T2; P < .0001; ES = 0.39). Self-reports of face mask use were associated with fewer self-reports of COVID-19 symptoms (OR = 0.65, P = .01, 95% CI 0.48; 0.88). CONCLUSION: Face mask use was already high among educated Brazilians before the formal recommendation by the authorities. This may have contributed to fewer self-reports of COVID-19-related symptoms.
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COVID-19 , Máscaras , Adolescente , Brasil/epidemiología , Estudios Transversales , Humanos , Pandemias , SARS-CoV-2RESUMEN
Inflammation is closely related to renal diseases. This is particularly true for renal diseases caused by infections as in viral diseases. In this review, we highlight the inflammatory mechanisms that underlie kidney dysfunction in SARS-CoV-2, human immunodeficiency (HIV), hepatitis C (HCV), and hepatitis B (HBV) infections. The pathophysiology of renal involvement in COVID-19 is complex, but kidney damage is frequent, and the prognosis is worse when it happens. Virus-like particles were demonstrated mostly in renal tubular epithelial cells and podocytes, which suggest that SARS-CoV-2 directly affects the kidneys. SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptor, which is found in endothelial cells, to infect the human host cells. Critical patients with SARS-CoV-2-associated acute kidney injury (AKI) show an increase in inflammatory cytokines (IL-1ß, IL-8, IFN-γ, TNF-α), known as cytokine storm that favors renal dysfunction by causing intrarenal inflammation, increased vascular permeability, volume depletion, thromboembolic events in microvasculature and persistent local inflammation. Besides AKI, SARS-CoV-2 can also cause glomerular disease, as other viral infections such as in HIV, HBV and HCV. HIV-infected patients present chronic inflammation that can lead to a number of renal diseases. Proinflammatory cytokines and TNF-induced apoptosis are some of the underlying mechanisms that may explain the virus-induced renal diseases that are here reviewed.
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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.
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Nefrología , Sistemas de Atención de Punto , Estudios Transversales , Humanos , Nefrólogos , UltrasonografíaRESUMEN
BACKGROUND: The risk of eculizumab therapy discontinuation in patients with atypical hemolytic uremic syndrome (aHUS) is unclear. The main objective of this study was to analyze the risk of aHUS relapse after eculizumab interruption due to drug shortage in Brazil. METHODS: We screened all the registered dialysis centers in Brazil (n = 800), willing to participate in the aHUS Brazilian shortage cohort, through electronic mail and formal invitation by the Brazilian Society of Nephrology. We included patients with aHUS whose eculizumab therapy underwent unplanned discontinuation for at least 30 days between January 1st, 2016 and December 31st, 2019 during the maintenance phase of treatment. Relapse was defined by the development of thrombocytopenia, hemolytic anemia, acute kidney injury or thrombotic microangiopathy (TMA) in a kidney biopsy. RESULTS: We analyzed 25 episodes of exposure to risk of relapse, from 24 patients. Median age was 33 (6-53) years, 18 (72%) were female, 9 (36%) had a functioning renal graft, 5 (20%) were undergoing dialysis. CFH variant was found in 8 (32%) episodes. There were 11 relapses. The risk of relapse was 34%, 44.5% and 58% at 114, 150 and 397 days, respectively. No baseline variable was related to relapse in Cox multivariate analysis, including CFH variant. CONCLUSIONS: In this study, the cumulative incidence of aHUS relapse at 397 days was 58% after eculizumab interruption. The presence of complement variant does not seem to be associated with a higher relapse rate. The eculizumab interruption was deemed not safe, considering that the rate of relapse was high.