Use of probiotics in patients with chronic kidney disease on hemodialysis: a randomized clinical trial / Uso de probióticos em pacientes com doença renal crônica em hemodiálise: um ensaio clínico randomizado

ABSTRACT Introduction: Supplementation with probiotics for patients with chronic kidney disease (CKD) may be associated with decreased systemic inflammation. Objective: To assess the impact of oral supplementation with probiotics for patients with CKD on hemodialysis. Method: This double-blind randomized clinical trial included 70 patients on hemodialysis; 32 were given oral supplementation with probiotics and 38 were in the placebo group. Blood samples were collected at the start of the study and patients were given oral supplementation with probiotics or placebo for three months. The probiotic supplement comprised four strains of encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium longum A101. Patients were given one capsule per day for 3 months. Blood samples were taken throughout the study to check for inflammatory biomarkers. Non-traditional biomarkers Syndecan-1, IFN-y, NGAL, and cystatin C were measured using an ELISA kit, along with biochemical parameters CRP, calcium, phosphorus, potassium, PTH, GPT, hematocrit, hemoglobin, glucose, and urea. Results: Patients given supplementation with probiotics had significant decreases in serum levels of syndecan-1 (239 ± 113 to 184 ± 106 ng/mL, p = 0.005); blood glucose levels also decreased significantly (162 ± 112 to 146 ± 74 mg/dL, p = 0.02). Conclusion: Administration of probiotics to patients with advanced CKD was associated with decreases in syndecan-1 and blood glucose levels, indicating potential improvements in metabolism and decreased systemic inflammation.

Resumo Introdução: A suplementação com probióticos na doença renal crônica (DRC) pode estar associada à redução do processo inflamatório sistêmico. Objetivo: Avaliar a suplementação oral com probióticos em pacientes com DRC em hemodiálise. Método: Ensaio clínico, duplo cego, randomizado com 70 pacientes em hemodiálise, sendo 32 do grupo que recebeu o suplemento de probióticos e 38 do grupo placebo. Inicialmente ocorreu a coleta de sangue e suplementação oral com probióticos ou placebo durante três meses. O suplemento probiótico foi composto pela combinação de 4 cepas de bactérias Gram-positivas encapsuladas: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 e Bifidobacterium longum A101, sendo 1 cápsula do suplemento ao dia, durante 3 meses. Após esse período foram feitas novas coletas de sangue para dosagem dos biomarcadores inflamatórios. Foram analisados os biomarcadores não tradicionais: Syndecan-1, IFN-y, NGAL e cistatina C pelo método ELISA, e os seguintes parâmetros bioquímicos: PCR, cálcio, fósforo, potássio, PTH, TGP, hematócrito, hemoglobina, glicose e ureia. Resultados: Os pacientes que receberam suplemento tiveram diminuição significativa dos níveis séricos de syndecan-1 (de 239 ± 113 para 184 ± 106 ng/mL, p = 0,005). Outro parâmetro que diminuiu significativamente nos pacientes que receberam suplemento foi a glicemia (de 162 ± 112 para 146 ± 74 mg/dL, p = 0,02). Conclusão: O uso de probióticos na DRC avançada esteve associado à redução dos níveis de syndecan-1 e glicemia, sinalizando possível melhora no metabolismo e redução do processo inflamatório sistêmico.

Association of serum lipoproteins and inflammatory parameters derived from the blood test with renal function in COVID-19 outpatients

Abstract Changes in lipoprotein metabolism are among the main causes of hemodynamic impairment in renal function. COVID-19 is an multisystemic inflammatory disease, aggravating this situation. This cross-sectional study investigated the relationship of serum lipoprotein profile with inflammatory parameters and renal function in 95 COVID-19 outpatients in comparison with 173 with flu-like symptoms. Serum samples were collected for the determination of total cholesterol and fractions, apolipoproteins (Apo A-I and Apo B), urea (sUr) and creatinine (sCr). The glomerular filtration rate (eGFR) was calculated. Neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) ratios were calculated as inflammatory parameters derived from the blood tests. COVID-19 patients presented lower high-density lipoprotein cholesterol (HDL-c) (47.90 ± 1.543 vs. 51.40 ± 0.992) and higher PLR (190.9 ± 9.410 vs. 137.6 ± 5.534) and NLR (3.40 ± 0.22 vs. 2.80 ± 0.15). Both NLR and PLR correlated with each other (r = 0.639). Furthermore, the Apo B/Apo A-I ratio was correlated with PLR (r = 0.5818) and eGFR (r = -0.2630). COVID-19 patients classified as at high risk of developing acute myocardial infarction based on the Apo B/ Apo A-I ratio had higher values for sUr/sCr. Thus, serum apolipoproteins, PLR, and NLR could be related to renal dysfunction in COVID-19.

Subclinical signs of podocyte injury associated with Circulating Anodic Antigen (CAA) in Schistosoma mansoni-infected patients in Brazil

ABSTRACT Background: The long-term effects of schistosomiasis on the glomerulus may contribute to the development of chronic kidney disease. This study aimed to investigate baseline Schistosoma mansoni-Circulating Anodic Antigen (CAA) levels and their association with kidney biomarkers related to podocyte injury and inflammation in long-term follow-up after praziquantel (PZQ) treatment. Methods: Schistosoma infection was diagnosed by detecting CAA in urine using a quantitative assay based on lateral flow using luminescent up-converting phosphor reporter particles. A cutoff threshold of 0.1 pg/mL CAA was used to diagnose Schistosoma infection (baseline) in a low-prevalence area in Ceará, Northeast, Brazil. Two groups were included: CAA-positive and CAA-negative individuals, both of which received a single dose of PZQ at baseline. Urinary samples from 55 individuals were evaluated before (baseline) and at 1, 2, and 3 years after PZQ treatment. At all time points, kidney biomarkers were quantified in urine and adjusted for urinary creatinine levels. Results: CAA-positive patients had increased baseline albuminuria and proteinuria and showed greater associations between kidney biomarkers. CAA levels correlated only with Vascular Endothelial Growth Factor (VEGF) (podocyte injury) levels. Increasing trends were observed for malondialdehyde (oxidative stress), monocyte chemoattractant protein-1 (inflammation marker), and VEGF. In the follow-up analysis, no relevant differences were observed in kidney biomarkers between the groups and different periods. Conclusions: S. mansoni-infected individuals presented subclinical signs of glomerular damage that may reflect podocyte injury. However, no causal effect on long-term renal function was observed after PZQ treatment.

Nephroprotective effects of Lippia sidoides ethanolic extract against ischemia/reperfusion-induced acute kidney injury

Abstract Ischemia/reperfusion injury (I/R) is commonly related to acute kidney injury (AKI) and oxidative stress. Antioxidant agents are used to treat this condition. Lippia sidoides is a brazillian shrub with anti-inflammatory and anti-oxidative properties. Thus, the aim of this study is to evaluate the effect of Lippia sidoides ethanolic extract (LSEE) on in vivo and in vitro models of AKI induced by I/R. Male Wistar rats were submitted to unilateral nephrectomy and ischemia on contralateral kidney for 60 min via clamping followed by reperfusion for 48 h. They were divided into four groups: Sham, LSEE (sham-operated rats pre-treated with LSEE), I/R (rats submitted to ischemia) and I/R-LSEE (rats treated with LSEE before ischemia). Kidney tissues homogenates were used to determine stress parameters and nephrin expression. Plasma and urine samples were collected for biochemical analysis. I/R in vitro assays were evaluated by 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) and flow cytometry assays in Rhesus Monkey Kidney Epithelial Cells (LLC-MK2). The LSEE treatment prevented biochemical and nephrin expression alterations, as well as oxidative stress parameters. In the in vitro assay, LSEE protected against cell death, reduced the reactive oxygen species and increased mitochondrial transmembrane potential. LSEE showed biotechnological potential for a new phytomedicine as a nephroprotective agent.

Use of non-conventional biomarkers in the early diagnosis of acute kidney injury in preterm newborns with sepsis / Biomarcadores não tradicionais de lesão renal aguda em recém-nascidos prematuros com sepse: diagnóstico precoce

Abstract Acute kidney injury (AKI) is a common finding in Neotatal Intensive Care Units (NICU). Sepsis is one the main causes of AKI in preterm newborns. AKI has been associated with significant death rates. Early detection of the condition is the first step to improving prevention, treatment, and outcomes, while decreasing length of hospitalization, care costs, and morbimortality. AKI may progress to chronic kidney disease (CKD), a condition linked with dialysis and greater risk of cardiovascular disease. This review article aims to discuss cases of AKI in preterm newborns with sepsis, the use of biomarkers in lab workup, and the use of non-conventional biomarkers for the early identification of AKI.

Resumo A lesão renal aguda (LRA) é comum na Unidade de Terapia Intensiva Neonatal (nUTI) e a sepse é uma de suas principais causas, especialmente em prematuros. Apresenta altas taxas de mortalidade e sua detecção precoce é o primeiro passo para a prevenção dessa condição, pois permite o tratamento adequado e melhora o desfecho, diminui o tempo de internação, os custos não médicos e a morbimortalidade. Destaca-se ainda que a LRA pode evoluir para doença renal crônica (DRC), havendo a necessidade de diálise, com maior risco de desenvolver doenças cardiovasculares. Este artigo de revisão tem como objetivo discutir a LRA em recém-nascidos (RNs) prematuros com sepse, abordando biomarcadores utilizados na rotina laboratorial e principalmente a utilização de biomarcadores não tradicionais para identificação precoce de LRA.

Seroprevalence and risk factors of Chagas disease in a rural population of the Quixeré municipality, Ceará, Brazil

Abstract INTRODUCTION: This study estimated the seroprevalence and risk factors of Chagas disease (CD) in a population of the Quixeré municipality, Ceará. METHODS: We conducted serological methods to detect the Trypanosoma cruzi infection. The other variables were evaluated by a standardized questionnaire. RESULTS: The estimated prevalence of CD was 3.7%. Male sex, age >40 years, being farmers, low education level, origin from rural areas, and being born in Quixeré were significantly associated with infection. CONCLUSION: CD persists in this rural population of Northeast Brazil. Poverty, low education, and limited information regarding CD are critical issues that need to be addressed.

COVID-19 and Kidney: a narrative review / COVID-19 e os rins: uma revisão narrativa

Abstract COVID-19 is a pandemic associated with systemic clinical manifestations. In this study, we aimed to present a narrative review on kidney involvement in COVID-19. Kidney involvement could be derived from direct cytopathic effects, immunological mechanisms, indirect effects on renal tissue through other mediators, and dysfunction or injury of other organs. The evolution of COVID-19 may be complicated with acute kidney injury (AKI) in a significant percentage of patients, and renal dysfunction seems to be associated with worse prognosis. Patients with chronic kidney disease (CKD) seem to be more susceptible to the severe forms of COVID-19. Patients with renal replacement therapy (RRT) are also a vulnerable population as consequence of their advanced age, underlying comorbidities, impaired immune response, and clustering in hemodialysis centers, with requirements for frequent contact with healthcare services. Kidney transplant patients may be at high-risk due to long-term immunosuppression and comorbidities, hence, managing immunosuppression is imperative. Lastly, renal replacement therapy may be required during COVID-19, and different modalities are discussed based on clinical findings and laboratorial aspects. Therefore, COVID-19 seems to affect kidney by different mechanisms, which contributes for AKI development and increases the severity of the disease. Also, patients with CKD and kidney transplant recipients are at higher risk for COVID-19 and mortality.

Resumo COVID-19 é uma pandemia associada a manifestações clínicas sistêmicas. Neste estudo, apresenta-se revisão narrativa acerca do envolvimento renal na COVID-19. Envolvimento renal parece ser relacionado a efeitos citopáticos diretos, mecanismos imunológicos, efeitos indiretos de outros mediadores no tecido renal, além de disfunção e lesão de outros órgãos. A evolução da COVID-19 pode ser complicada por lesão renal aguda (LRA) em percentual significativo dos pacientes, e a disfunção renal parece ser associada a pior prognóstico. Pacientes com doença renal crônica (DRC) parecem ser mais suscetíveis a formas severas da COVID-19. Pacientes em terapia de substituição renal (TSR) contínua também constituem população vulnerável em razão de idade avançada, comorbidades subjacentes, resposta imune disfuncional e aglomeração em unidades de diálise, com necessidade de visitas frequentes aos serviços de saúde. Pacientes transplantados renais podem estar em alto risco dadas imunossupressão a longo prazo e comorbidades; assim, o manejo da imunossupressão é mandatório. Finalmente, TSR pode ser necessária durante a COVID-19, e diferentes modalidades são discutidas conforme manifestações clínicas e aspectos laboratoriais. Assim, COVID-19 parece acometer os rins por diferentes mecanismos, os quais contribuem para o desenvolvimento de LRA e aumento da severidade da doença. Ainda, pacientes com DRC e transplantados renais apresentam elevado risco para desenvolvimento de COVID-19 e de mortalidade.

Protective Effect of Quercetin on Renal Tubular Cells and the Involvement with the Renin-Angiotensin-Aldosterone Axis

Abstract Ischemia-reperfusion (I/R) plays an important role in the process of acute kidney injury (AKI) due to the generation of reactive oxygen species (ROS). Substances of natural origin have been studied in the prevention of oxidative damage related to I/R. Quercetin is a flavonoid with antioxidant potential and modulate enzymes, such the inhibition of the Rennin-Angiotensin System (RAS). The aim of this study is to evaluate the nephroprotective effect of quercetin against the I/R and analyze the inhibition of RAS. Rhesus monkey Kidney Epithelial Cells (LLC-MK2 line) were submitted to an in vitro ischemia/reperfusion model. After the reperfusion cells were treated with quercetin, the cell viability was accessed by the MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide) assay. Tubular cell damage was assessed by the Kidney Injury Molecule-1 (KIM-1) measurement. Oxidative stress was evaluated through Thiobarbituric Acid Reactive Substances (TBARS) and reduced glutathione (GSH). The evaluation of cell death and the mitochondrial depolarization were analyzed by flow cytometry. Quercetin prevents cell death reducing oxidative stress and preventing mitochondrial membrane depolarization. Molecular docking showed that quercetin prevents cell damage better than losartan and lisinopril, inhibitors of RAS. Quercetin has a potential to interact with type 1 angiotensin II receptor (AT1) with greater affinity through the formation of five hydrogen bonds of strong intensity.

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.(AU)

Acute kidney injury due to systemic Loxoscelism: a cross-sectional study in Northeast Brazil

Abstract INTRODUCTION: Loxoscelism is a clinical condition involving spiders of the genus Loxosceles. One of the most severe complications is acute kidney injury (AKI). This study aimed to investigate AKI and other complications associated with loxoscelism. METHODS: We analyzed cases diagnosed with loxoscelism in an area where most accidents were caused by Loxosceles amazonica from January 2010 to December 2015. AKI was defined according to the KDIGO criteria. RESULTS: Forty-five patients were recorded: 95.6% presented characteristic necrotic skin lesions and 13.3% AKI. CONCLUSIONS: Loxoscelism could cause kidney involvement which is uncommon and could lead to the death of these patients.

Pattern of hemolysis parameters and association with fetal hemoglobin in sickle cell anemia patients in steady state

This study aimed to evaluate the influence of fetal hemoglobin (Hb F) on hemolysis biomarkers in sickle cell anemia patients. Methods: Fifty adult sickle cell anemia patients were included in the study. All patients were taking hydroxyurea for at least six months and were followed at the outpatient clinic of a hospital in Fortaleza, Ceará, Brazil. The control group consisted of 20 hemoglobin AA individuals. The reticulocyte count was performed by an automated methodology, lactate dehydrogenase and uric acid were measured by spectrophotometry and arginase I by enzyme-linked immunosorbent assay (ELISA). The presence of Hb S was detected by high-performance liquid chromatography. The level of significance was set for a p-value <0.05. Results: A significant increase was observed in the reticulocyte count and lactate dehydrogenase, uric acid and arginase I levels in sickle cell anemia patients compared to the control group (p-value <0.05). Patients having Hb F levels greater than 10% showed a significant decrease in the reticulocyte count, arginase I and lactate dehydrogenase. A significant decrease was observed in arginase I levels in patients taking hydroxyurea at a dose greater than 20 mg/kg/day. Conclusion: The results of this study show that sickle cell anemia patients have increases in the hemolysis biomarkers, lactate dehydrogenase, reticulocyte count, arginase I, uric acid and increases in Hb F can reduce the reticulocyte count and arginase I and lactate dehydrogenase levels.

The effect of Cratylia floribunda lectin on renal hemodynamics and ion transport

Lectins have been described as glycoproteins that reversibly and specifically bind to carbohydrates. Legume lectins isolated from the subtribe Diocleinae (Canavalia, Dioclea andCratylia) are structurally homologous with respect to their primary structures. The Diocleinae lectins of Canavalia brasiliensis, Dioclea guianensis andCanavalia ensiformis have been shown to distinctly alter physiological parameters in isolated rat kidneys. Thus, the aim of this study was to investigate the effect of Cratylia floribunda lectin (CFL) on renal hemodynamics and ion transport in rats. In isolated perfused kidneys, CFL (10 mg/mL, n=5) increased RPP, RVR and decreased %TK+, but did not change urinary flow, glomerular filtration rate, sodium or chloride tubular transport. In isolated perfused mesenteric bed, CFL (3 and 10 mg/mL/min; n=4) did not alter tissue basal tonus or tissue contraction by phenylephrine (1 mM/mL/min). In conclusion, the seed lectin of Cratylia floribunda increased renal hemodynamic parameters showing a kaliuretic effect. This effect could be of tubular origin, rather than a result from haemodynamic alterations.

As lectinas são descritas como (glico)proteínas que se ligam, especificamente e reversivelmente, a carboidratos. Lectinas de leguminosas isoladas da subtribo Diocleinae (Canavalia, Dioclea eCratylia) são estruturalmente homólogas em relação às suas estruturas primárias. Demonstrou-se que as lectinas de DiocleinaeCanavalia brasiliensis, Dioclea guianensis eCanavalia ensiformis alteram diferentemente parâmetros fisiológicos em rins isolados de ratos. Dessa maneira, o objetivo deste estudo foi investigar o papel da lectina de Cratylia floribunda (CFL) na hemodinâmica renal e no transporte de íons em ratos. Em rins isolados perfundidos, CFL (10 mg/mL, n=5) aumentou a pressão de perfusão renal, a resistência vascular renal e reduziu o percentual do transporte tubular de K+, mas não alterou o fluxo urinário, a taxa de filtração glomerular e o percentual de transporte tubular dos íons sódio e cloreto. No leito mesentérico isolado perfundido, CFL (3 e 10 mg/mL/min, n=4) não alterou o tônus basal ou a contração do tecido induzida por fenilefrina (1 mM/mL/min). Em conclusão, a lectina de sementes de Cratylia floribunda altera parâmetros hemodinâmicos renais, provavelmente de origem tubular, e não por alterações hemodinâmicas.

Adesão ao tratamento farmacológico em pacientes com doença renal crônica / Medication compliance in patients with chronic kidney disease

Introdução: A não-adesão ao tratamento farmacológico prejudica o alcance dos resultados terapêuticos no retardo da progressão da doença renal crônica(DRC). O objetivo do presente estudo foi mensurar a prevalência da não-adesão ao tratamento farmacológico e avaliar os motivos apontados pelos pacientes para o comportamento não aderente. Método: Estudo transversal envolvendo 130 pacientes com DRC do ambulatório de nefrologia de um hospitaluniversitário, com idade média de 48,8 + 15,8 anos, em uso contínuo de algum medicamento anti-hipertensivo ou imunossupressor e que não estivessemsendo submetidos a qualquer terapia de substituição renal. A adesão foi mensurada através do método do auto-relato em uma entrevista com questionário. Foram considerados não aderentes pacientes que relataram ter ingerido menos de 80% dos comprimidos prescritos de pelo menos um medicamento. Foram coletados dados sociodemográficos, clínico-laboratoriais e os motivos alegados pelos pacientes para não aderir ao tratamento. Resultados: A prevalênciada não-adesão ao tratamento farmacológico foi de 18,5%. A falta de acesso aos medicamentos foi o motivo mais relatado pelos pacientes (54,5%) para a não-adesão. Não houve diferença estatisticamente significante entre a não-adesão ao tratamento com anti-hipertensivos e com imunossupressores.Discussão: Empregando o mesmo método, outros estudos encontraram prevalências de não-adesão ao tratamento da hipertensão e do diabetes variando entre 4% e 37,8%. Conclusões: Uma parcela significativa de pacientes estudados foi considerada não aderente ao tratamento farmacológico. A falta de acesso aos medicamentos permanece como uma causa de não-adesão, sugerindo a necessidade de melhorias na assistência farmacêutica.

Background: Medication noncompliance hinders the accomplishment of the therapeutic goals of delaying the progression of chronic kidney disease (CKD).The aim of the present study was to calculate the prevalence of medication noncompliance and to assess the reasons mentioned by the patients for theirnoncompliant behavior. Methods: A cross-sectional study was performed with 130 CKD patients from a nephrology outpatient university clinic, average age of 48.8 + 15.8 years old, continuously taking some self-administered antihypertensive or immunosuppressive drug and who were not on renal replacementtherapy. Noncompliance was measured through the self-reporting method (during an interview). Patients were considered noncompliant if they had taken less than 80% of the prescribed medication of any antihypertensive or immunosuppressive drug. Survey data showed sociodemographic, clinical, andlaboratorial characteristics and the reasons mentioned by the patients for their non-compliance. Results: Prevalence of medication noncompliance was 18.5%. Lack of access to medicine was the most commonly reported problem with medication use (54.5%). There was no statistically significant difference between the antihypertensive drug noncompliance and the immunosuppressive drug noncompliance. Discussion: Using the same method other studieshave reported prevalence of antihypertensive and hypoglycemic drug noncompliance ranging from 4 to 37.8%. Conclusions: A significant share of the studied patients was considered noncompliant to the pharmacotherapy. Lack of access to medicine remains as an important cause of medicationnoncompliance, suggesting the need for improvement in pharmaceutical assistance.

Conhecimento sobre o tratamento farmacológico em pacientes com doença renal crônica / Medication knowledge in patients with chronic kidney disease

O adequado conhecimento dos pacientes sobre os medicamentos que utilizam é considerado um fator fundamental para a adesão ao tratamento. O nível de conhecimento sobre a terapia farmacológica de pacientes com doença renal crônica (DRC) e os fatores associados a este conhecimento foram avaliados em um estudo transversal envolvendo 130 indivíduos em uso contínuo de algum medicamento pertencente aos grupos C, H02 ou L04 da classificação Anatomical Therapeutic Chemical e que não estivessem sendo submetidos a qualquer terapia de substituição renal. O nível de conhecimento foi mensurado através de um questionário e um escore de zero a dez pontos. Foram estabelecidos três níveis de conhecimento: baixo (menos de seis pontos), médio (seis a oito pontos) e bom (mais de oito pontos). O escore médio foi de 7,8 ± 1,7 pontos e 51,5 por cento dos pacientes apresentaram nível de conhecimento baixo ou médio. Os fatores associados ao alto nível de conhecimento foram: declínio rápido do ritmo de filtração glomerular, controle da pressão arterial e crença do paciente em já ter sofrido reação adversa a algum medicamento prescrito. A maioria dos entrevistados possuía conhecimentos insuficientes para o uso seguro e eficaz dos medicamentos, o que sugere a necessidade de melhor orientação aos pacientes.

The suitable patients' medication knowledge is a essential factor for the medication compliance. The level of medication knowledge in patients with chronic kidney disease (CKD) and the medication knowledge associated factors were assessed in a cross-sectional study performed with 130 subjects from a nephrology outpatient university clinic, continuously taking some self-administered drug from the C, H02 or L04 groups of the Anatomical Therapeutic Chemical classification system and who were not on a kidney replacement therapy. The level of medication knowledge was measured through a researcher-administered questionnaire and a score ranking from zero to ten points. Three levels of knowledge were defined: low (less than six points), moderate (six to eight points) and high (more than 8 points). The patients' medication knowledge average score was 7.8 ± 1.7 points and 51.5 percent of the patients showed low or moderate level of knowledge. The factors associated to the high level of medication knowledge were: fast decline of the glomerular filtration rate, control of the blood pressure and the patients' belief that they suffered adverse drug reaction to any of the prescribed medicines. Most patients had insufficient knowledge for a safe and effective use of prescribed medicines, so a better patient counseling is necessary.

Epidemiologia dos acidentes por Thalassophryne nattereri (niquim) no Estado do Ceará (1992-2002) / Epidemiology of the injuries caused by Thalassophryne nattereri (niquim) in Ceara State (1992-2002)

No Estado do Ceará (1992 a 2002), 16 casos de envenenamento com o Thalassophyne nattereri ocorreram no litoral, a maioria (87,5 por cento) em praias de Fortaleza e 12,5 por cento do interior. Noventa e quatro por cento eram do sexo masculino e 6 por cento feminino. Com relacão à idade, 75 por cento estavam na faixa etária de 21 a 40 anos, 19 por cento entre 41 e 60 anos e 6 por cento entre 1 a 10 anos. O tempo de exposicão foi de 1 a 5 horas (4), 6 a 12 (3), mais de 12 horas (4), 5 pacientes não informaram o tempo decorrido entre o acidente e o atendimento. Manifestacões clínicas observadas foram dor, edema local, isquemia transitória, parestesia, equimose e sensacão de queimacão local. O tratamento consistiu de antiinflamatórios e analgésicos. Em alguns casos, foram usados anestésicos, água morna, debridamento cirúrgico e anti-histamínicos. Em 75 por cento dos casos, observou-se cura confirmada e em 12 por cento a cura não foi confirmada, em dois a evolucão foi ignorada. Provavelmente, o número de acidentes ocorridos é maior do que o encontrado devido a subnotificacão.

Acute renal failure after massive honeybee stings

Two clinical cases of patients who survived after numerous attacks of Africanized bees (600 and 1500 bee stings, respectively) are reported. Clinical manifestation was characterized by diffuse and widespread edema, a burning sensation in the skin, headache, weakness, dizziness, generalized paresthesia, somnolence and hypotension. Acute renal failure developed and was attributed to hypotension, intravascular hemolysis, myoglobinuria due to rhabdomyolysis and probably to direct toxic effect of the massive quantity of injected venom. They were treated with antihistaminic, corticosteroids and fluid infusion. One of them had severe acute renal failure and dialysis was required. No clinical complication was observed during hospital stay and complete renal function recovery was observed in both patients. In conclusion, acute renal failure after bee stings is probably due to pigment nephropathy associated with hypovolemia. Early recognition of this syndrome is crucial to the successful management of these patients

Análise laboratorial do líquido céfalo-raquidiano (líquor/LCR) / Clinical laboratory analysis cerebrospinal fluid (CSF)

Diversos trabalhos científicos publicados descrevem que, a exemplo do exame sumário de urina, os testes e os resultados do líquor, particularmente a citobioquímica, são realizados e descritos de diferentes formas nos laboratórios clínicos. Certamente, essa situação introduz a possibilidade de erros sistemáticos, provocados ou não pelo analista, além de dificultar a compreensão e a correta interpretação, do resultado por parte dos médicos assistente e/ou solicitante. A padronização de procedimentos é o único meio e, de fundamental importância, para se obter a precisão e a exatidão dos resultados, levando o laboratório a aumentar e melhorar o desempenho, no sentido de executar cada vez melhor sua função social a serviço do usuário. O presente artigo é uma revisão de vários trabalhos, publicados na literatura sobre o assunto, com a intenção de descrever o exame do líquido céfalo-raquidiano quanto às técnicas de coleta da amostra, características físicas, contagens celulares e análises bioquímicas, imunológicas e microbiológicas, bem como, apontar os problemas mais freqüentes nas etapas pré-analítica, analítica e pós-analítica e descrever o quadro característico das meningites, diante do resultado de alguns parâmetros laboratoriais.

Efeitos renais induzidos pelo sobrenadante de macrofagos estimulados pelo veneno da Crotalus durissus cascavella e determinação de suas frações que induzem toxicidade renal / Renal effects induced by macrophages supernatant stimulated by the venom of Crotalus durissus cascavella and determining their fractions that induce renal toxicity

O gênero Crotalus é responsável por 1500 casos de acidentes ofídicos no Brasil anualmente. Em casos letais, a insuficiência renal aguda constitui a manifestação clínica mais comum cujos efeitos ainda não são completamente compreendidos. Neste trabalho, examinamos os efeitos renais causados pelo sobrenadante de macrófagos estimulados pelo veneno da Crotalus durissus cascavella bem como o papel de mediadores inflamatórios. Utilizamos o Sephadex G75 e a cromatografia RP-HPLC para isolar e purificar as frações crotoxina (fosfolipase A2 e crotapotina), convulxina, giroxina e crotamina do veneno da Crotalus durissus cascavella a fim de investigar seus efeitos sobre a fisiologia renal em método de perfusão de rim isolado de rato. Macrófagos peritoniais de rato foram coletados e colocados em um meio RPMI e estimulados pelo veneno da Crotalus durissus cascavella (1,3 ou 10 μg/mL) por 1 hora. Em seguida, foram lavados e mantidos nesta cultura por 2 horas. O sobrenadante (1 mL) foi testado no método de perfusão de rim isolado de rato. Os primeiros 30 minutos de cada experimento foram usados como controle interno, e o sobrenadante foi adicionado ao sistema depois deste veneno (1 μg/mL) não foi estatisticamente diferente dos valores do controle. Os efeitos mais intensos foram observados com 10 μg/mL do veneno em todos os parâmetros renais...