Risk factors for acute kidney injury after liver transplantation in intensive care unit: a retrospective cohort study

ABSTRACT BACKGROUND: Acute kidney injury (AKI) is a frequent complication during the postoperative period following liver transplantation. Occurrence of AKI in intensive care unit (ICU) patients is associated with increased mortality and higher costs. OBJECTIVE: To evaluate occurrences of moderate or severe AKI among patients admitted to the ICU after liver transplantation and investigate characteristics associated with this complication. DESIGN AND SETTING: Single-center retrospective cohort study in a public hospital, Belo Horizonte, Brazil. METHODS: Forty-nine patients admitted to the ICU between January 2015 and April 2017 were included. AKI was defined from a modified Kidney Disease Improving Global Outcomes (KDIGO) score (i.e. based exclusively on serum creatinine levels). RESULTS: Eighteen patients (36.7%) developed AKI KDIGO 2 or 3; mostly KDIGO 3 (16 out of the 18 patients). Lactate level within the first six hours after ICU admission (odds ratio, OR: 1.3; 95% confidence interval, CI: 1.021-1.717; P = 0.034) and blood transfusion requirement within the first week following transplantation (OR: 8.4; 95% CI: 1.687-41.824; P = 0.009) were independently associated with development of AKI. Patients with AKI KDIGO 2 or 3 underwent more renal replacement therapy (72.2% versus 3.2%; P < 0.01), had longer hospital stay (20 days versus 15 days; P = 0.001), higher in-hospital mortality (44.4% versus 6.5%; P < 0.01) and higher mortality rate after one year (44.4% versus 9.7%; P = 0.01). CONCLUSION: Need for blood transfusion during ICU stay and hyperlactatemia within the first six postoperative hours after liver transplantation are independently associated with moderate or severe AKI. Developing AKI is apparently associated with poor outcomes.

Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

ABSTRACT This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

Dificuldades para aplicação do protocolo pós-exposição a material biológico em estudantes de medicina / Dificulties in fulfilling the protocol for medical students exposed to biological material

São analisadas as dificuldades que alunos da Faculdade de Medicina, expostos ao material biológico durante atividades rotineiras de ensino e assistência, encontraram para seguir o Protocolo Pós-Exposição, proposto pelo Serviço de Atenção à Saúde do Trabalhador (SAST) da UFMG, a partir dos relatos de três casos. Entre os problemas identificados estão: falhas na organização das atividades, despreparo dos profissionais e desinformação dos alunos. São sugeridas medidas para o aperfeiçoamento dessa atividade e enfatizada a importância da prevenção.

The study of three cases of exposition to biologic material that took place in UFMG involving medical students shows that although the post-expositional protocol adopted by the institution may be flawless the adherence to its precepts is not. The flaws inherent to the process seem to be all related to the way in which it has been organized and to the spatial disposition of the material resources necessary, as well as the unfitness of health personnel involved. All the problems detected might be solved by the diligent application of adequate human and financial resources.

Nefrolitíase associada ao uso de indinavir: relato de caso / Nephrolithiasis triggered by indinavir use: case report

O sulfato de indinavir, em associação com inibidofores d transcripfase reversa, promove, de forma efetiva, aumento da contagem de células CD4+ e redução da carga viral (ARN-VIH) em pacientes com sindrome de imunodeficiência adquirida. Esse inibidor da protease provoca nefrolitiase em até 34,4% dos pacientes. Em decorrência do uso ainda freqüente deste antiretroviral, seus efeitos adversos devem ser prontamente reconhecidos e prevenidos, quando possível. Este trabalho descreve a associação de litíase urinária com manifestações clínicas exuberantes com o uso de indinavir.

A case of nephrolithiasis related to the use of indinavir sulfate is described. This drug, in association with reverse transcriptase inhibitors, effectively promotes a rise in the CD4+ T cell count and a decrease in the levels of HIV RNA in AIDS patients. This protease inhibitor elicits the development of nephrolithiasis in up to 34.4% of patients. Since indinavir sulfate is a frequently prescribed drug, its side effects should be well known and avoided whencver possibie.

Fisiopatologia da nefropatia diabética / Physiopathology of diabetic nephropathy

A nefropatia diabética é uma complicação comum em pacientes com diabetes mellitus tipo 1. O diabetes mellitus do tipo 1, normalmente, inicia-se na infância e, após cinco a quinze anos de doença, podem ocorrer as complicações, sobretudo a nefropatia diabética. Muitos fatores relacionam-se ao desenvolvimento do dano renal, tais como controle glicêmico, mediadores humorais, perfil genético e fatores de crescimento. Sua evolução para insuficiência renal crônica implica aumento na mortalidade, aumento dos gastos com o tratamento e queda na qualidade de vida dos pacientes. Esses aspectos justificam a busca de um melhor entendimento dos fatores associados ao aparecimento e à evolução dessa complicação. Este artigo consiste de uma revisão sobre a fisiopatologia da nefropatia diabética.

Diabetic nephropathy is a common complication found in type 1 diabetes patients. This normally starts in childhood and, after five to fifteen years of the disease, the complications, mainly nephropathy, may be present. Several factors may explain the development of renal involvement such as: glycemia control, humoral mediators, genetic profile, and growth factors. The progression of diabetic nephropathy to chronic renal failure results in an increased mortality and a worse quality of life, demanding more expensive and sophisticated approaches to treatment. These features indicate that a better understanding of the causative factors and a thorough elucidation of the evolutionary mechanisms of this disease are needed. A revision of the physiopathology of diabetic nephropathy is made.