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1.
Arq. ciências saúde UNIPAR ; 26(3): 736-747, set-dez. 2022.
Article in Portuguese | LILACS | ID: biblio-1399333

ABSTRACT

Contexto: A doença renal crônica representa um sério problema de saúde pública, devido aos crescentes índices de morbimortalidade, e que associado à rotina de sessões de hemodiálise, promove alterações na qualidade de vida dos indivíduos com esta condição. Objetivo: Avaliar os fatores relacionados à qualidade de vida de pacientes renais crônicos em tratamento hemodialítico. Desenho e local: Estudo transversal, quantitativo, composto por 52 pacientes em hemodiálise no hospital Santa Casa de Caridade de Diamantina, Diamantina (MG), em 2017. Métodos: Foram utilizados dois questionários: socioeconômico-demográfico e o instrumento Kidney Disease and Quality of life Short Form. Os dados referentes à qualidade de vida foram analisados pelo programa elaborado e disponibilizado pelo Working Group. Resultados: Como fatores relacionados à baixa qualidade de vida foram encontrados: situação ocupacional (33,65 ± 26,71), peso da doença renal (49,28 ± 21,58), funcionamento físico (53,37 ± 22,39), saúde geral (54,71 ± 27,19) e função emocional (58,97 ± 26,23); em relação à boa qualidade de vida foram encontrados: função sexual (80,17 ± 22,46), função cognitiva (80,26 ± 35,32), satisfação do paciente (83,33 ± 20,51) e estímulo por parte da equipe de diálise (91,59 ± 29,17). Discussão: Por comparação aos trabalhos realizados em Goiânia (2006), Indaiatuba (2009), Mogi das Cruzes (2014) e ao presente estudo (2017) verificaram escores semelhantes na maioria das dimensões avaliadas, a exemplo das funções social e satisfação do paciente. Conclusão: A qualidade de vida apresentou-se como boa na maioria das dimensões avaliadas, entretanto, os fatores determinantes da baixa qualidade de vida reforçam a ideia da implementação de estratégias da equipe de saúde para melhorar a expectativa de vida desses pacientes.


Chronic kidney disease represents a serious public health problem, due to the increasing rates of morbidity and mortality, which, associated with the routine of hemodialysis sessions, promotes changes in the quality of life of individuals with this condition. Objective: To evaluate factors related to the quality of life of chronic renal patients undergoing hemodialysis. Design and location: Cross-sectional, quantitative study, composed of 52 hemodialysis patients at the Santa Casa de Caridade hospital in Diamantina, Diamantina (MG), in 2017. Methods: Two questionnaires were used: socioeconomic-demographic and the Kidney Disease and Quality of instrument life Short Form. Data on quality of life were analyzed using the program developed and made available by the Working Group. Results: As factors related to low quality of life were found: occupational situation (33.65 ± 26.71), weight of kidney disease (49.28 ± 21.58), physical functioning (53.37 ± 22.39), general health (54.71 ± 27.19) and emotional function (58.97 ± 26.23); in relation to good quality of life, sexual function (80.17 ± 22.46), cognitive function (80.26 ± 35.32), patient satisfaction (83.33 ± 20.51) and stimulation on the part were found of the dialysis team (91.59 ± 29.17). Discussion: Comparing the studies carried out in Goiânia (2006), Indaiatuba (2009), Mogi das Cruzes (2014) and the present study (2017) found similar scores in most of the dimensions evaluated, such as social functions and patient satisfaction. Conclusion: Quality of life was shown to be good in most of the dimensions evaluated, however, the determinants of low quality of life reinforce the idea of implementing health team strategies to improve the life expectancy of these patients.


Antecedentes: La enfermedad renal crónica representa un grave problema de salud pública, debido a las crecientes tasas de morbilidad y mortalidad, y la asociada a la rutina de sesiones de hemodiálisis, promueve cambios en la calidad de vida de los individuos con esta condición. Objetivo: Evaluar los factores relacionados con la calidad de vida de los pacientes renales crónicos en tratamiento hemodialítico. Diseño y entorno: Estudio transversal, cuantitativo, compuesto por 52 pacientes en hemodiálisis en el hospital Santa Casa de Caridade de Diamantina, Diamantina (MG), en 2017. Métodos: Se utilizaron dos cuestionarios: socioeconómico-demográfico y el instrumento Kidney Disease and Quality of life Short Form. Los datos relativos a la calidad de vida fueron analizados por el programa preparado y puesto a disposición por el Grupo de Trabajo. Resultados: Como factores relacionados con la baja calidad de vida se encontraron: la situación laboral (33,65 ± 26,71), la carga de la enfermedad renal (49,28 ± 21,58), el funcionamiento físico (53,37 ± 22,39), la salud general (54,71 ± 27,19) y la función emocional (58,97 ± 26,23); en relación con la buena calidad de vida se encontraron: la función sexual (80,17 ± 22,46), la función cognitiva (80,26 ± 35,32), la satisfacción del paciente (83,33 ± 20,51) y el estímulo del equipo de diálisis (91,59 ± 29,17). Discusión: En comparación con los estudios realizados en Goiânia (2006), Indaiatuba (2009), Mogi das Cruzes (2014) y el presente estudio (2017) se encontraron puntuaciones similares en la mayoría de las dimensiones evaluadas, como las funciones sociales y la satisfacción del paciente. Conclusión: La calidad de vida se presentó como buena en la mayoría de las dimensiones evaluadas, mientras que los factores determinantes de la baja calidad de vida refuerzan la idea de la implementación de estrategias del equipo de salud para mejorar las expectativas de vida de los pacientes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Renal Dialysis , Renal Insufficiency, Chronic , Physical Fitness , Public Health , Cognition , Sexuality , Nephrology
2.
Rev. enferm. neurol ; 21(1): 80-91, ene.-abr. 2022. tab
Article in Spanish | LILACS, BDENF | ID: biblio-1397931

ABSTRACT

El siguiente estudio de caso se realizó en una persona con enfermedad renal crónica secundaria a diabetes mellitus tipo 1 en tratamiento de hemodiálisis desde hace 7 años, se realizó con el fin llevar acabo las acciones e intervenciones encaminadas a contribuir en los cuidados de rehabilitación, así como aminorar las complicaciones de esta enfermedad para que la persona logre su independencia. La metodología está basada en el modelo de Virginia Henderson donde se encontraron necesidades de nutrición e hidratación, eliminación, evitar peligros y aprendizaje alterados, posteriormente se realiza los diagnósticos de enfermería y la planificación del cuidado mediante la taxonomía Nanda, Noc y Nic. Para esto se requisita la NOM-012-SSA3. 2012, mediante el cual se obtiene el consentimiento informado de la persona para ejecutar el plan de cuidados con los criterios que establece la norma para ejecutar las intervenciones con el fin de investigación para la salud, se realizó visita domiciliaria para una evaluación del plan de cuidados donde se concluye que en relación con la implicación familiar se logró cierto grado de independencia en el paciente, observando cambios positivos, conocimiento de la enfermedad y un mejor apego a su alimentación.


The following case study was carried out in a person with chronic kidney disease secondary to type 1 diabetes mellitus on hemodialysis treatment for 7 years, it was carried out in order to carry out actions and interventions aimed at contributing to rehabilitation care, as well how to reduce the complications of this disease so that the person can achieve independence. The methodology is based on the Virginia Henderson Model where needs for nutrition and hydration, elimination, danger avoidance and altered learning were found, subsequently nursing diagnoses and care planning are carried out using the Nanda, Noc and Nic taxonomy. For this, the NOM-012-SSA3 is required. 2012, through which the informed consent of the person is obtained to execute the care plan with the criteria established by the norm to execute the interventions for the purpose of health research, a home visit is made with which a evaluation of the care plan where it is concluded that in relation to family involvement, a certain degree of independence was achieved in the patient, positive changes were observed, a better knowledge of the disease, better adherence to their diet.


Subject(s)
Humans , Female , Adult , Renal Insufficiency, Chronic , Diabetes Mellitus , Hypertension
3.
Rev. Soc. Argent. Diabetes ; 56(2): 63-80, mayo - ago. 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1395868

ABSTRACT

En el paciente con diabetes mellitus (DM) y enfermedad renal crónica (ERC), las alteraciones electrolíticas y metabólicas constituyen un verdadero desafío. En noviembre de 2021, el Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó una jornada científica con el objetivo de actualizar las alteraciones hidroelectrolíticas y del metabolismo óseo mineral, y las consideraciones dietarias en ERC y DM.


In patients with diabetes mellitus (DM) and chronic kidney disease (CKD), electrolyte and metabolic alterations constitute a real challenge. In November 2021, the Nephropathy Committee of the Argentine Diabetes Society held a scientific conference with the aim of updating hydroelectrolytic and mineral bone metabolism disorders, and dietary considerations in CKD and DM.


Subject(s)
Diabetes Mellitus , Electrolytes , Renal Insufficiency, Chronic , Kidney Diseases , Minerals
4.
Medwave ; 22(5): e8697, jun.-2022.
Article in English, Spanish | LILACS-Express | LILACS | ID: biblio-1378546

ABSTRACT

INTRODUCCIÓN Se ha planteado que el uso de dieta muy baja en proteínas suplementado con keto análogos en pacientes enfermos renales crónicos pre diálisis podría enlentecer el avance hacia una enfermedad terminal e inicio de diálisis sin riesgo de desnutrición. Sin embargo, su uso habitual aún no ha sido implementado dada la incertidumbre que existe frente a su efectividad y seguridad. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 14 estudios primarios, de los cuales, 12 corresponden a ensayos aleatorizados. Concluímos que una dieta muy baja en proteínas suplementada con keto análogos disminuye la progresión a enfermedad renal crónica terminal, probablemente disminuye la caída o deterioro de la función renal, podría disminuir mortalidad por cualquier causa y resultar en poca o nula diferencia en riesgo de desnutrición, siendo la certeza de la evidencia baja en estos dos últimos puntos.


INTRODUCTION It has been proposed that a very low protein diet supplemented with keto analogues in pre-dialysis chronic kidney disease patients can slow the progression to a terminal disease and delay the start of renal replacement therapy, without a malnutrition risk. However, its common use has not yet been implemented due to the uncertainty of its efficacy and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified eight systematic reviews including 14 studies overall, of which 12 were randomized trials. We concluded that a very low protein diet supplemented with keto analogues delays the progression to end-stage kidney disease, probably reduces the fall or deterioration of renal function, could reduce mortality by any cause y result in little or no difference in malnutrition risk, but the certainty of the evidence is low for these last two results.

5.
Poblac. salud mesoam ; 19(2)jun. 2022.
Article in Spanish | LILACS-Express | LILACS, SaludCR | ID: biblio-1386955

ABSTRACT

Resumen Introducción: el objetivo del presente trabajo se centra en reconocer la importancia de las investigaciones que relacionan la biodisponibilidad de fósforo en diferentes grupos de alimentos de origen animal, vegetal e industrial y su efecto en la progresión de la enfermedad renal crónica (ERC). Metodología: la revisión se sustentó en la búsqueda literaria en páginas web como PUBMED, Redalyc, SciELO, SCIHUB y Google Academic. Se seleccionó cada estudio, descartando aquellos que no fueran cuantitativos u originales, estuvieran incompletos, sin metodología clara, realizados en mamíferos o si los resultados no se especificaban en porcentajes. La lectura puso especial énfasis en el índice de biodisponibilidad de fósforo derivado del consumo de distintos productos alimenticios. Se elaboraron tres matrices de acuerdo con el origen del comestible y la biodisponibilidad de fósforo que absorbe el organismo. Resultados: se encontró que los alimentos industrializados y los aditivos muestran una biodisponibilidad de fósforo del 90 % al 100 %, los de origen animal del 40 % al 80 % y los de origen vegetal del 30 %. Conclusiones: los aditivos de los alimentos industrializados promueven la hiperfosfatemia y, con ello, aceleran la progresión de la enfermedad renal crónica, a diferencia de los de origen animal y vegetal, menos perjudiciales para la salud. Esto da pauta a la formación del sector salud para ampliar su conocimiento sobre el tratamiento nutricional del paciente.


Abstract Introduction: to know the importance of the investigations that relate the bioavailability of phosphorus in different groups of foods of animal, vegetable and industrialized origin and its effect on the progression in patients with Chronic Kidney Disease (CKD). Methodology: the review is based on a literary search that was carried out on web pages such as: PUBMED, Redalyc, SciELO, SCIHUB and Google Academic. Each of the studies was selected discarding those that were not quantitative, original, complete, with clear methodology, carried out in mammals, and that in their results specified the bioavailability of phosphorus in percentages. All the studies were read, placing main emphasis and interest on the percentage of phosphorus bioavailability when consuming different food groups. Three matrices were made according to the origin of the food and the bioavailability of phosphorus that is absorbed in the body; grouping them into foods of animal, vegetable and industrialized origin and additives. Results: it was found that industrialized foods and additives show a phosphorus bioavailability of 90-100%, those of animal origin 40-80%, those of plant origin 30%. Conclusions: The additives used in industrialized foods promote hyperphosphatemia and thus accelerate the progression of chronic kidney disease, unlike foods of animal and vegetable origin that are less harmful to health. This guides the training of the health sector, expanding its knowledge in the nutritional treatment of the patient.


Subject(s)
Humans , Phosphorus , Biological Availability , Renal Insufficiency, Chronic , Food , Food Additives
6.
Säo Paulo med. j ; 140(3): 406-411, May-June 2022. tab
Article in English | LILACS | ID: biblio-1377398

ABSTRACT

ABSTRACT BACKGROUND: Frailty is consensually understood to be a clinical syndrome in which minimal stressors can lead to negative outcomes such as hospitalization, early institutionalization, falls, functional loss and death. Frailty is more prevalent among patients with chronic kidney disease (CKD), and those on dialysis are the frailest. Depression contributes towards putting patients with CKD into the frailty cycle. OBJECTIVE: To assess frailty and its relationship with depression among patients with CKD undergoing hemodialysis. DESIGN AND SETTING: Observational and quantitative cross-sectional study conducted in a renal therapy unit, located in the interior of the state of São Paulo, Brazil. METHODS: This investigation took place in 2019, among 80 patients. The following instruments were applied: a sociodemographic, economic and health condition characterization and the Subjective Frailty Assessment (SFA) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Among the patients, there was higher prevalence of females, individuals with a steady partner and retirees, and their mean age was 59.63 (± 15.14) years. There was high prevalence of physical frailty (73.8%) and depression (93.7%). Depression was associated with frailty, such that patients with depression were 9.8 times more likely to be frail than were patients without depression (odds ratio, OR = 9.80; 95% confidence interval, CI, 1.93-49.79). CONCLUSION: Based on the proposed objective and the results achieved, it can be concluded that depression was associated with the presence of frailty among patients with CKD on hemodialysis.


Subject(s)
Humans , Female , Aged , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Frailty/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Frail Elderly , Renal Dialysis , Depression/etiology , Depression/epidemiology , Middle Aged
7.
Säo Paulo med. j ; 140(3): 366-371, May-June 2022. tab
Article in English | LILACS | ID: biblio-1377381

ABSTRACT

ABSTRACT 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.


Subject(s)
Humans , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/epidemiology , Hypertension/epidemiology , Nephrology , Proteinuria/epidemiology , Referral and Consultation , Brazil/epidemiology , Demography , Retrospective Studies , Nephrologists , Kidney
8.
Säo Paulo med. j ; 140(3): 398-405, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377382

ABSTRACT

ABSTRACT BACKGROUND: The high number of patients with end-stage kidney disease (ESRD) on hemodialysis makes it necessary to conduct studies aimed at improving their quality of life. OBJECTIVES: To evaluate brain compliance, using the Brain4care method for intracranial pressure (ICP) monitoring, among patients with ESRD before and at the end of the hemodialysis session, and to correlate ICP with the dialysis quality index (Kt/V). DESIGN AND SETTING: Cross-sectional study conducted at a renal replacement therapy center in Brazil. METHODS: Sixty volunteers who were undergoing hemodialysis three times a week were included in this study. Brain compliance was assessed before and after hemodialysis using the noninvasive Brain4care method and intracranial pressure wave morphology was analyzed. RESULTS: Among these 60 ESRD volunteers, 17 (28%) presented altered brain compliance before hemodialysis. After hemodialysis, 12 (20%) exhibited normalization of brain compliance. Moreover, 10 (83%) of the 12 patients whose post-dialysis brain compliance became normalized were seen to present good-quality dialysis, as confirmed by Kt/V > 1.2. CONCLUSIONS: It can be suggested that changes to cerebral compliance in individuals with ESRD occur frequently and that a good-quality hemodialysis session (Kt/V > 1.2) may be effective for normalizing the patient's cerebral compliance.


Subject(s)
Renal Dialysis , Kidney Failure, Chronic/therapy , Quality of Life , Brain , Cross-Sectional Studies
9.
Arch. argent. pediatr ; 120(3): e142-e146, junio 2022. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1370735

ABSTRACT

La nefronoptisis es una enfermedad renal quística, de herencia autosómica recesiva, causada por mutaciones en genes que codifican proteínas involucradas en la función de cilios primarios, lo que resulta en enfermedad renal y manifestaciones extrarrenales como degeneración retiniana y fibrosis hepática. Según la edad de desarrollo de enfermedad renal crónica terminal, se describen tres formas clínicas de presentación: infantil, juvenil y adolescente. El diagnóstico se realiza por una prueba genética positiva o una biopsia de riñón que demuestre cambios tubulointersticiales crónicos con un engrosamiento de las membranas basales tubulares. No existe hasta la actualidad una terapia curativa, por lo que el trasplante renal oportuno es determinante en cuanto al pronóstico. Se presenta un paciente de 13 meses de edad con poliuria de 3 meses de evolución, insuficiencia renal, anemia y elevación de transaminasas. Con hallazgos histológicos compatibles en la biopsia renal, se arribó al diagnóstico de nefronoptisis infantil, con afectación hepática


Nephronophthisis is an autosomal recessive cystic kidney disease caused by mutations in genes that encode proteins involved in the primary cilia function, resulting in kidney disease and extrarenal manifestations such as retinal degeneration and liver fibrosis. According to the age of development of end-stage chronic kidney disease, three clinical forms of presentation are described: infantile, juvenile and adolescent. Diagnosis is made by a positive genetic test, or a kidney biopsy demonstrating chronic tubulointerstitial changes with thickening of the tubular basement membranes. At the moment there is no healing therapy, so early kidney transplant is a fundamental tool to improve prognosis.We present a 13-month old male patient with polyuria, kidney failure, anemia and elevated aminotransferases over three months. With compatible histological kidney biopsy, the diagnosis of infantile nephronophthisis with liver involvement was reached.


Subject(s)
Humans , Male , Infant , Kidney Diseases, Cystic/diagnosis , Kidney Diseases, Cystic/genetics , Kidney Diseases, Cystic/pathology , Kidney Diseases , Kidney Failure, Chronic/genetics , Proteins , Genetic Testing
10.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1386339

ABSTRACT

RESUMEN Los pacientes con enfermedad renal crónica pueden presentar depresión y ansiedad, lo que podría dificultar el manejo de la patología renal. El objetivo de esta investigación fue evaluar la relación entre ansiedad, depresión y los parámetros de adecuación de la diálisis. Este fue un estudio observacional, descriptivo de asociación cruzada, de corte transverso, temporalmente prospectivo, y de carácter exploratorio. Se midieron variables sociodemográficas, clínicas, psicopatológicas (ansiedad y depresión, a través de Hospital Anxiety and Depression Scale) y de adecuación a la diálisis (depuración tiempo/volumen, Kt/V; porcentaje de reducción de la urea, PRU; recirculación del acceso vascular, calcio, fósforo, producto calcio por fósforo, hemoglobina y hematocrito). Se utilizó estadística descriptiva, además de chi cuadrado, t de Student y ANOVA de un factor, según sea el caso, para buscar asociaciones. La significancia estadística quedó establecida en p<0,005. 46 pacientes fueron incluidos en el estudio, 61 % eran hombres. El 13 % calificó como un problema clínico de ansiedad y el 6,5 % como uno de depresión. La ansiedad se relacionó con los valores del hematocrito (p<0,05), mientras que la depresión se relacionó con el hematocrito y la hemoglobina (p<0,05). Se encontró relación entre el sexo femenino y la presencia de ansiedad (p<0,05). No se encontraron asociaciones entre psicopatología y otros parámetros de adecuación de la diálisis. Esta investigación, al ser la primera de su tipo en el país, permite abrir posibilidades de investigación futuras, que puedan profundizar en la salud mental de los pacientes con enfermedad renal.


ABSTRACT Patients with chronic kidney disease may present depression and anxiety, which could hinder the management of renal pathology. The objective of this study was to evaluate the relationship between anxiety, depression, and dialysis adequacy parameters. This was an observational, descriptive, cross-sectional, temporally prospective, exploratory study. Sociodemographic, clinical, psychopathological (anxiety and depression, through the Hospital Anxiety and Depression Scale) and dialysis adequacy variables were measured (clearance time/volume, Kt/V; percentage of urea reduction, PRU, vascular access recirculation, calcium, phosphorus, calcium-phosphorus product, hemoglobin, and hematocrit). Descriptive statistics were used, in addition to chi-square, Student's t-test and one-factor ANOVA, as appropriate, to search for associations. Statistical significance was established at p<0.005. Forty six patients were included in the study, 61% was male. Thirteen percent qualified as a clinical problem of anxiety and 6.5% as one of depression. Anxiety was related to hematocrit values (p<0.05), while depression was related to hematocrit and hemoglobin (p<0.05). A relationship was found between female sex and the presence of anxiety (p<0.05). No associations were found between psychopathology and other dialysis adequacy parameters. This research, being the first of its kind in the country, allows opening possibilities for future research, which may deepen in the mental health of patients with renal disease.

11.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1398234

ABSTRACT

Introducción: La mayoría de los pacientes con enfermedad renal crónica terminal en hemodiálisis desarrollan hiperparatiroidismo secundario. Algunas veces este tipo de hiperparatiroidismo secundario suele ser severo y refractario al tratamiento médico, inclusive algunos desarrollarán hiperparatiroidismo terciario, el tratamiento de ambas situaciones suele ser la paratiroidectomía subtotal o total. Reporte de Caso: Presentamos el caso de un paciente de 29 años, con enfermedad renal terminal en hemodiálisis durante 13 años, quien desarrolló hiperparatiroidismo terciario por lo que fue sometido a paratiroidectomía subtotal con autotrasplante de media glándula; el estudio patológico informó la presencia de un carcinoma de paratiroides en una de las cuatro glándulas paratiroides extirpadas. Conclusión: El carcinoma de paratiroides es una neoplasia rara que causa hiperparatiroidismo primario en menos de 1% de todos los casos, y se ha reportado en algunos pacientes operados por hiperparatiroidismo terciario.


Background: Most patients with terminal chronic kidney disease on hemodialysis develop secondary hyperparathyroidism. Sometimes this type of secondary hyperparathyroidism becomes severe and refractory to medical treatment, some will even develop tertiary hyperparathyroidism, the treatment of both situations is usually subtotal or total parathyroidectomy. Case Report: We present the case of a 29-year-old patient with end-stage kidney disease on hemodialysis for 13 years, who developed tertiary hyperparathyroidism, for which he underwent subtotal parathyroidectomy with half gland autotransplantation; the pathological study reported the presence of a parathyroid carcinoma in one of the four excised parathyroid glands. Conclusion: Parathyroid carcinoma is a rare neoplasm that causes primary hyperparathyroidism in less than 1% of all cases, and has been reported in some patients operated on for the development of tertiary hyperparathyroidism.

12.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1398241

ABSTRACT

Señor editor: Existen pocos estudios sobre la prevalencia de Enfermedad Renal Crónica (ERC) y factores asociados en el Perú, Francis publicó un estudio realizado en zonas urbanas de la costa del Perú (Lima y Tumbes), además Percy Herrera realizó un estudio con datos de pacientes de la Red Rebagliati de EsSalud en Lima. Esto preocupa, ya que no existen datos actualizados a nivel de otras regiones del Perú.


Dear Editor: There are few studies on the prevalence of Chronic Kidney Disease (CKD) and associated factors in Peru, Francis published a study conducted in urban areas of the coast of Peru (Lima and Tumbes), also Percy Herrera conducted a study with data from patients of the Red Rebagliati of EsSalud in Lima. This is of concern, since there are no updated data for other regions of Peru.

13.
Acta méd. colomb ; 47(1): 44-48, ene.-mar. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1374103

ABSTRACT

Resumen La espondiloartropatía destructiva es una patología osteoarticular presente en algunos pacientes con enfermedad crónica que puede afectar varios niveles de la columna vertebral y puede ser asintomática, generar dolor o causar complicaciones que ponen en peligro la integridad de la médula espinal y/o la vida. Presentamos el caso de un hombre de 70 años con enfermedad renal crónica terminal en hemodiálisis quien consultó por dolor dorsal y paraplejia, en quien se diagnosticó espondiloartropatía destructiva no infecciosa por imágenes y estudio histopatológico. Este caso nos muestra la importancia de pensar en esta patología y la necesidad de un enfoque multidisciplinario en el diagnóstico y manejo. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2193).


Abstract Destructive spondyloarthropathy is a bone and joint disease which presents in some patients with chronic illnesses and may affect various levels of the spinal column. It may be asymptomatic, cause pain, or produce spinal cord and/or life-endangering complications. We present the case of a 70-year-old man with end-stage renal disease on hemodialysis who consulted due to back pain and paraplegia. He was diagnosed with destructive noninfectious spondyloarthropathy through imaging and histopathological studies. This case shows us the importance of considering this disease and the need for a multidisciplinary approach in its diagnosis and management. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2193).

14.
Rev. nefrol. diál. traspl ; 42(1): 4-10, mar. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1395036

ABSTRACT

RESUMEN Introducción:La insuficiencia renal agudaes una complicación descripta en pacientes con infección por SARS-CoV-2que ronda 0,5-7% de los casos. Objetivo: evaluar el valor pronóstico del compromiso renal en los pacientes internados por enfermedad por COVID-19. Material y métodos:Se analizó una cohorte prospectiva de pacientes mayores de 18 años con diagnóstico de enfermedad por COVID-19 en el período comprendido entre los meses demayo a octubre de 2020.Todos fueron seguidos hasta el alta hospitalaria o muerte. Se evaluaron parámetros clínicos, laboratorio, score de Charlson, mortalidad y gravedad de enfermedad COVID-19. Resultados:Ingresaron 412 pacientes al estudio, 57% hombres y con promedio de edad de 51 ±16 años. El 20% tenía un score de Charlson≥3, la incidencia de insuficiencia renal aguda, definida como el aumento de la creatinina sérica 0,3 mg/dl del valor basal, fue 5,5% (n=23) yla mortalidad hospitalaria de2,2% (n=9). El análisis bi y multivariado mostró que el sexo masculino[OR= 0,32(IC0,12-0,82), p=0,017], dímero D>500ng/ml[OR= 3,68(IC 1,23-10,96), p=0,019], relación proteinuria/creatininuria >0,20[OR=2,43 (IC 1,03-5,74), p=0,043],insuficiencia renal aguda[OR=10,53 (IC 2,99-37,09), p0,0001]fueron predictores de COVID-19 grave, definido como frecuencia respiratoria 30 x min, saturación de oxígeno <93% o PO2/FIO2300.En el análisis bivariado la mortalidad se asoció con el desarrollo de COVID-19graveOR= 68.76 (IC 8,39-563,36), p0,0001 e insuficiencia renal agudaOR= 45,41 (IC 10,45-197,22), p0,0001. Conclusión:El compromiso renal está asociado a peor evolución y mayor mortalidad en COVID-19. La valoración de la función renal y la proteinuria son parámetros accesibles que deberían ser incluidos como factores de riesgo en la evaluación inicial.


ABSTRACT Introduction:Acute kidney injuryis a complication described in patients with SARS-CoV-2 infection that is around 0.5-7% of cases. Objective:evaluate the prognostic value of kidney involvement in patients hospitalized for COVID-19 disease. Methods:A prospective cohort of patients over 18 years with a diagnosis of COVID-19 disease in the period from May to October 2020 was analyzed. All were followed up until hospital discharge or death.Clinical and biochemicalparameters, Charlson score, mortality and severity of COVID-19 disease were evaluated. Results:Four hundred twelve patients entered the study, 57% men and mean age 51 ± 16 years. Twenty percent had a Charlson score ≥3, the incidence of acute kidney injury, defined as the increase in serum creatinine 0.3 mg / dl from baseline, was 5.5% (n = 23) and hospital mortality was 2.2% (n = 9). The bivariate and multivariate analysis showed that the male sex [OR= 0.32 (IC 0.12-0.82), p =0.017], D-dimer> 500 ng/ml [OR= 3.68 (IC 1.23-10.96), p = 0.019], urinary protein/creatinine> 0.20 [OR= 2.43 (CI 1.03-5.74), p = 0.043], and AKI [OR= 10.53 (CI 2.99-37.09), p <0.0001] were predictors of severe COVID-19, defined as respiratory rate>30 x min, oxygen saturation <93% or PO2/FIO2300. The univariate analysis of mortality was associated with the development of severe COVID-19 [OR= 68.76 (CI 8.39-563.36), p <0.0001 and acute kidney injury OR= 45.41 (CI 10.45-197.22), p 0.0001. Conclusion:Renal involvement is associated with worse evolution and higher mortality in COVID-19. The assessment of renal function and proteinuria are accessible parameters that should be included as risk factors in the initial evaluation of these patients.

15.
Rev. colomb. cardiol ; 29(1): 36-40, ene.-feb. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1376852

ABSTRACT

Resumen Introducción: Las alteraciones secundarias a la enfermedad renal crónica (ERC), como inflamación sistémica, anemia y sobrecarga hídrica, son un sustrato importante para el desarrollo de hipertensión arterial pulmonar. Objetivo: Valorar la relación de la presión sistólica de la arteria pulmonar (PSAP) por ecocardiograma con el tiempo y el tipo de terapia de reemplazo renal (TRR) en pacientes con ERC. Método: Estudio observacional, retrospectivo, llevado a cabo en el Hospital de Especialidades del Centro Médico Nacional La Raza, en el que se analizaron medidas de tendencia central y medidas de dispersión. Para comparar porcentajes se utilizó la prueba de χ2 con el programa estadístico SPSS 25. Resultados: Se incluyeron 141 pacientes con ERC en TRR con diálisis peritoneal o hemodiálisis. Se clasificaron de acuerdo con la PSAP en normal (30 pacientes, 21.28%), leve (43 pacientes, 30.5%), moderada (16 pacientes, 12%) y grave (52 pacientes, 36.88%). El tiempo de TRR está relacionado con una PSAP mayor, con 3.53 años en caso de PSAP normal, 5.51 años en caso de PSAP leve, 6.00 años para la PSAP moderada y 6.38 años para la PSAP grave. La PSAP grave se presentó en 13 de 56 pacientes en diálisis peritoneal y en 39 de 85 en hemodiálisis (p = 0.034). Conclusiones: Se encontró que existe relación entre la PSAP con el tiempo y el tipo de sustitución renal en pacientes con ERC.


Abstract Introduction: The disorders secondary to chronic kidney disease (CKD), such as systemic inflammation, anemia, and fluid overload are an important substrate for the development of pulmonary arterial hypertension. Objective: To assess the relationship between pulmonary artery systolic pressure (PASP) on echocardiogram and the duration and type of renal replacement therapy (RRT) in patients with CKD. Method: A retrospective observational study at Hospital de Especialidades del Centro Médico Nacional La Raza. The analysis was performed using measures of central tendency and dispersion. Chi square was used to compare percentages through the SPSS 25 statistical program. Results: A total of 141 patients with CKD on RRT with peritoneal dialysis or hemodialysis were included. They were classified according to PASP as normal (30 patients, 21.28%), mild (43 patients, 30.5%), moderate (16 patients, 12%) and severe (52 patients, 36.88%). The duration of RRT is related to a higher PASP, with 3.53 years for a normal PASP, 5.51 years for mild PASP, 6.00 years for moderate PASP, and 6.38 for those with severe PASP. Severe PASP occurred in 13 of 56 patients on peritoneal dialysis and 39 of 85 patients on hemodialysis (p = 0.034). Conclusions: This study found a relationship between PASP and the duration and type of renal replacement in patients with CKD.

16.
Arch. endocrinol. metab. (Online) ; 66(1): 12-18, Jan.-Feb. 2022. tab
Article in English | LILACS | ID: biblio-1364310

ABSTRACT

ABSTRACT Objective: The AKR1B1 gene encodes an enzyme that catalyzes the reduction of glucose into sorbitol. Chronic hyperglycemia in patients with diabetes mellitus (DM) leads to increased AKR1B1 affinity for glucose and, consequently, sorbitol accumulation. Elevated sorbitol increases oxidative stress, which is one of the main pathways related to chronic complications of diabetes, including diabetic kidney disease (DKD). Accordingly, some studies have suggested the rs759853 polymorphism in the AKR1B1 gene is associated with DKD; however, findings are still contradictory. The aim was to investigate the association of the rs759853 polymorphism in the AKR1B1 gene and DKD. Materials and methods: The sample comprised 695 patients with type 2 DM (T2DM) and DKD (cases) and 310 patients with T2DM of more than 10 years' duration, but no DKD (controls). The polymorphism was genotyped by real-time PCR. Results: Allelic and genotype frequencies of this polymorphism did not differ significantly between groups. However, the A/A genotype was associated with risk for DKD after adjustment for gender, triglycerides, BMI, presence of hypertension and diabetic retinopathy, and duration of DM, under both recessive (P = 0.048) and additive (P = 0.037) inheritance models. Conclusion: Our data suggest an association between the AKR1B1 rs759853A/A genotype and risk for DKD in Brazilians T2DM patients.


Subject(s)
Humans , Aldehyde Reductase/genetics , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/genetics , Diabetic Nephropathies/complications , Diabetic Nephropathies/genetics , Case-Control Studies , Genetic Predisposition to Disease , Polymorphism, Single Nucleotide , Alleles , Gene Frequency , Genotype
17.
Braz. j. infect. dis ; 26(1): 101701, 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364542

ABSTRACT

Abstract Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism.

18.
Article in Chinese | WPRIM | ID: wpr-928078

ABSTRACT

Based on Guidelines for the Management of Clinical Comprehensive Evaluation of Drugs(trial version 2021), this study aims to sort out the clinical evidence of Huangkui Capsules(HC) in the treatment of chronic kidney diseases in aspects of safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine( "6+1" dimensions) from real-world data, secondary literature evaluations, questionnaires, and public data, with the methods in evidence-based medicine, epidemiology, pharmacoeconomics, and health technology. Furthermore, with multi-criteria decision analysis(MCDA) model and CSC v2.0, the clinical value of the medicine is comprehensively assessed. All the above are to highlight the advantages and characteristics of HC and lay a basis for scientific decision-making by the medical management department. The dimensions are graded A, B, C, or D. According to the conclusions from phase Ⅳ clinical trial, spontaneous reporting system(SRS), systematic review and Meta-analysis, acute toxicity and long-term toxicity tests, it mainly results in the adverse reactions of nausea, abdominal distension, vomiting, pruritus, rash, and good prognosis in patients. According to the available research, the safety evidence is sufficient and the risk is controllable, so the safety of this medicine is grade B. According to Meta-analysis, HC in combination with conventional drugs in the treatment of chronic kidney disease is superior to conventional drugs alone in reducing urinary protein, serum creatinine concentration, and blood urea nitrogen. In addition, HC combined angiotensin receptor blocker(ARB) or angiotensin converting enzyme inhibitor(ACEI) is outstanding in improving total clinical effective rate, reducing 24 h urinary protein quantity, urinary albumin excretion rate, serum creatinine concentration, triglyceride, and total cholesterol in the treatment of diabetic nephropathy as compared with ARB or ACEI alone. As for chronic nephritis, the application together with ARB or ACEI can raise the total effective rate, reduce 24 h urinary protein content, serum creatinine concentration, and blood urea nitrogen, and delay the progress of the disease. HC boasts high-quality evidence in treating chronic kidney disease, diabetic nephropathy, and chronic nephritis. It has obvious clinical significance in treating chronic kidney disease and thus its efficacy in this aspect is grade B. It has outstanding clinical significance for diabetic nephropathy and chronic nephritis and corresponding and the effectiveness is grade A. As for the pharmacoeconomic value, HC combined with ARB or ACEI is more economical in the treatment of chronic kidney disease than Bailing Capsules combined with ARB or ACEI, with high-quality evidence, and thus the economy of the formula is grade B. HC is a key solution to the high urinary protein in patients with hypotension and chronic kidney disease. The innovation is evidenced by the methods to ensuring drug supply, community-level supply, drug safety, effectiveness, and reasonable price, as wells as the aspects of enterprise philosophy, equipment management, research and development in process and technology, enterprise management and marketing. Thus, the prescription is grade A in innovation. The suitability, as evidenced in drug administration, technical management, drug storage, information service, and medication, is grade B. The course of the medicine is affordable, and it is accessible in a wide range of areas and hospitals. Thus, the accessibility is grade A. HC was developed from an in-hospital preparation, with application in numerous patients and thus large-scale real-world data. As a result, HC is grade B in terms of characteristics of traditional Chinese medicine. After comprehensive evaluation, the clinical value of HC in treating chronic kidney disease is class B, and that for diabetic nephropathy and chronic nephritis is class A. The result is of great reference value for the basic clinical medication management.


Subject(s)
Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors , Capsules , Diabetic Nephropathies/drug therapy , Humans , Renal Insufficiency, Chronic/drug therapy
19.
Acta Pharmaceutica Sinica ; (12): 364-374, 2022.
Article in Chinese | WPRIM | ID: wpr-922921

ABSTRACT

The purpose of this research is to study the effect of small molecule compound piceatannol (PIC) on host inflammation in adenine induced chronic kidney disease (CKD) mice, and then to explore its mechanism based on the regulation of gut microbiota. All procedures were approved by the Institutional Animal Care and Use Committee of the Nanjing University of Chinese Medicine. The level of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) was detected by enzyme linked immunosorbent assay (ELISA); UPLC-TQ/MS technology was used to monitor the level of proinflammatory uremic toxin indoxyl sulfate (IS) and p-cresol sulfate (PCS); the expression of occludin was tested by Western blot; in vitro anaerobic culture of gut bacteria was used to produce indole; the abundance of gut microbiota was evaluated by 16S rDNA sequencing. The results showed that PIC had no effect on inflammatory infiltration in kidney tissue of CKD mice, but could decrease IL-6 level in blood and IL-6/TNF-α level in colon tissue. PIC did not improve intestinal occludin protein expression in CKD mice; while it could significantly reduce the levels of IS and PCS in blood and liver of CKD mice. Further mechanism studies showed that PIC could inhibit the synthesis of IS precursor indole in gut bacteria. Moreover, PIC could decrease the abundance of gut bacteria which producing uremic toxin, such as reducing the abundance of indole and p-cresol producing gut bacteria. In conclusion, PIC could regulate gut microbiota and inhibit the synthesis of uremic toxin precursor, thereafter reducing the accumulation of IS and PCS in vivo, ultimately relieving the inflammation of CKD mice.

20.
Gac. méd. Méx ; 158(spe): M1-M12, ene. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375541

ABSTRACT

Resumen La enfermedad renal crónica (ERC) del paciente diabético es frecuentemente una consecuencia directa de la diabetes mellitus (DM) de larga evolución y se la conoce como nefropatía diabética. En México cerca del 50% de los pacientes en terapia sustitutiva de la función renal tienen ERC por DM, y este porcentaje podría aumentar en los próximos años. Nuevas opciones terapéuticas, combinadas con cambios en el estilo de vida, han mejorado el control de la glucemia y pueden contribuir sustancialmente a retrasar la aparición o la progresión a estadios avanzados de la ERC. Las sociedades científicas internacionales han elaborado guías clínicas para el diagnóstico y manejo de la nefropatía diabética, sin embargo, en algunos puntos estas recomendaciones no se adaptan a la realidad mexicana. Se presentan las conclusiones de un consenso realizado por especialistas mexicanos sobre diabetes y ERC, con especial énfasis en el uso de los inhibidores del cotransportador de sodio-glucosa.


Abstract Chronic kidney disease (CKD) in the diabetic patient is mainly a consequence of long-term diabetes mellitus itself. In Mexico approximately 50% of patients on dialysis are diabetics and this will could increase in the coming years. New therapeutic options available, combined with lifestyle changes, have improved glycemic control and may contribute to delay the onset as well as the progression of CKD. International scientific societies have developed clinical guidelines for the diagnosis and management of CKD in diabetics, although in some points, these recommendations are not adapted to the Mexican reality. We hereby present the conclusions of the consensus reached by Mexican specialists on diabetic nephropathy.

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