Resultados maternos y fetales en mujeres embarazadas con enfermedad renal crónica basada en la tasa de filtración glomerular / Maternal And Fetal Outcomes In Pregnant Women With Chronic Kidney Disease Based On Glomerular Filtration Rate

Introducción: el embarazo causa adaptaciones en el riñón, tanto en anatomía como en función, para mantener el entorno extracelular, hemodinámico y hormonal. Sin embargo, estos pueden no llevarse a cabo de manera completamente óptima en presencia de enfermedad renal. El objetivo era estudiar la relación entre la enfermedad renal y los resultados maternos de fetal durante el embarazo, asociado con un rechazo por paciente y/o en relación con el tratamiento especializado. Material y métodos: estudio observacional y retrospectivo en una serie de casos, revisando 134 archivos de pacientes embarazadas con cierto grado de enfermedad renal antes del embarazo. Los resultados maternos registrados fueron: enfermedad hipertensiva durante el embarazo, deterioro renal agudo, necesidad de terapia de sustitución renal y en productos: prematuridad, restricción del crecimiento intrauterino, muerte fetal y aborto espontáneo. Resultados: Resultados maternos: tasa media de filtración glomerular (GFR) de 58.23 ml/min, aumento de peso de 7 kg; La preeclampsia fue diagnosticada en 92 mujeres (55 severas). 46 pacientes mostraron lesión renal aguda, 40 se resolvieron conservativamente; 1 requirió diálisis peritoneal y 15 hemodiálisis (con una decisión retrasada un promedio de un mes por rechazo por paciente y/o pariente). La resolución del embarazo fue por cesárea en 111 pacientes; Nacieron 116 productos antes de las 37 semanas de gestación, con un peso promedio de 1910 g, 94 mostraron restricción del crecimiento intrauterino. Conclusión: la enfermedad renal influyó directamente en el mayor número de resultados adversos maternos y fetales cuando se rechazó la atención médica especializada. Existe una correlación entre el ligero estado de Davison con los estados I, II y IIIA de Kdigo en el análisis de correspondencia

Introduction: Pregnancy causes adaptations in the kidney, both in anatomy and function, to maintain the extracellular, hemodynamic and hormonal environment. However, these may not be carried out completely optimally in the presence of kidney disease. The objective was to study the relation between kidney disease and maternal-fetal outcomes during pregnancy, associated with a rejection by patient and/or relative to specialized treatment. Material and Methods: Observational, retrospective study in a series of cases, reviewing 134 files of pregnant patients with some degree of kidney disease prior to pregnancy. Maternal outcomes recorded were: hypertensive disease during pregnancy, acute renal deterioration, need for renal substitution therapy, and in products: prematurity, restriction of intrauterine growth, fetal death and miscarriage. Results: Maternal outcomes: mean glomerular filtration rate (GFR) of 58.23ml/min, weight gain of 7 kg; preeclampsia was diagnosed in 92 women (55 severe). 46 patients showed acute renal lesion, 40 were conservatively resolved; 1 required peritoneal dialysis and 15 hemodialysis (with decision delayed an average of one month by rejection by patient and/or relative). Resolution of pregnancy was by cesarean in 111 patients; 116 products were born before 37 weeks of gestation, with average weight of 1910 g, 94 showed restriction of intrauterine growth. Conclusion: Kidney disease directly influenced the greater number of adverse maternal and fetal outcomes when specialized medical care was rejected. There is a correlation between slight Davison state with states I, II and IIIa of KDIGO in correspondence analysis.

Clinicopathological features and prognosis of kidney injury in patients after hematopoietic stem cell transplantation / 中华预防医学杂志

To summarize the clinicopathological features and prognosis of kidney injury after hematopoietic stem cell transplantation (HSCT), to provide basis for preventing its occurrence and development. By using a retrospective cohort study method, we collected the clinical and renal biopsy pathological data of all the patients who hospitalized in the Department of Nephrology of Peking University First Hospital from June 2011 to June 2021 with renal injury after HSCT and underwent renal biopsy, and prognosis was followed up by telephone. The clinical laboratory characteristics, renal pathology and prognosis, and their association were analyzed. The results showed that the most common clinical phenotype was chronic kidney disease (CKD,69.2%, 18/26), in this term 13/18 patients received stem cells from haploidentical donors, and 11/18 patients experienced with extrarenal graft-versus-host disease (GVHD). The most common pathologic phenotype was thrombotic microangiopathy (TMA, 61.5%, 16/26). Renal function returned to baseline level in 6 patients, and the kidney survival at 2 years and 5 years were 95.7% (22/23) and 87.5% (14/16), respectively. In conclusion, the clinical phenotype of renal injury after HSCT were mainly CKD, and the most common pathologic phenotype was TMA, the long-term prognosis was favourable.

Reflection about the hemodialysis water microbiological quality in Brazil

Abstract Dialysis has been widely used in the treatment of patients with chronic kidney diseases and is considered a global public health issue. This treatment, which has changed the prognosis and quality of life in patients with chronic renal failure, can lead to complications that are often fatal. For this reason, there is a need for validation of alternative tests that favor the monitoring of treated water for dialysis in real-time to promote and prevent injuries to patients submitted to this procedure.

Hallazgos ultraestructurales renales de pacientes con nefritis intersticial crónica de las comunidades agrícolas en El Salvador / Renal ultrastructural findings of patients with chronic interstitial nephritis from farming communities in El Salvador

Introducción: Desde hace 20 años se presenta en Centroamérica una enfermedad renal crónica que fundamentalmente afecta a hombres agricultores y no asociada a las causas tradicionales. Se caracteriza por presentar una nefritis intersticial crónica, en tanto las características ultraestructurales no se conocen con exactitud. En su origen se invoca el uso de agroquímicos y otros agentes nefrotóxicos, la deshidratación crónica, el consumo de medicamentos, entre otros factores. Objetivo: Describir las características ultraestructurales de la nefritis intersticial crónica en comunidades agrícolas. Método: Se realizó un estudio descriptivo de corte transversal. Se estudiaron muestras de biopsias renales de ocho pacientes con diagnóstico de nefritis intersticial crónica de las comunidades agrícolas. Resultados: De los ocho pacientes estudiados, dos (25 por ciento) trabajaban en labores agrícolas y cinco eran del sexo femenino (62,5 por ciento). Dos de los pacientes (25 por ciento) presentaban una enfermedad renal crónica estadio 2, y seis (75 por ciento) estadio 3. En cinco pacientes se hallaron fagolisosomas con presencia de componente lipídico entremezclado con material electrodenso en células del túbulo distal. En igual cantidad de pacientes se observaron cuerpos mieloides con zonas laminadas y núcleo central en células de túbulo proximal y de los vasos sanguíneos. Conclusiones: En pacientes de comunidades agrícolas que padecen nefritis intersticial crónica se evidencian fagolisosomas y estructuras mieloides en túbulos y vasos renales, cuyo contenido y origen se desconocen(AU)

Introduction: Chronic kidney disease mainly affecting male farmers and not associated to traditional causes has been present in Central America for twenty years. The condition is characterized by the presence of chronic interstitial nephritis, but its ultrastructural features are not fully known. Factors suggested as responsible for its occurrence include the use of agrochemicals and other nephrotoxic agents, chronic dehydration and medicine consumption. Objective: Describe the ultrastructural characteristics of chronic interstitial nephritis in farming communities. Method: A cross-sectional descriptive study was conducted of renal biopsy samples from eight patients diagnosed with chronic interstitial nephritis in farming communities. Results: Of the eight patients studied, two (25 percent) were farm workers and five (62.5percent) were female. Two of the patients (25 percent) had stage 2 and six (75 percent) stage 3 chronic kidney disease. In five patients evidence was found of phagolysosomes with lipid component mixed with electrodense material in distal tubule cells. An equal number of patients had myeloid bodies with laminated areas and central nucleus in proximal tubule and blood vessel cells. Conclusions: Evidence of phagolysosomes and myeloid structures of unknown content and origin was found in renal tubules and vessels of patients from farming communities diagnosed with chronic interstitial nephritis(AU)

Salivary and Serum Biochemical Analysis from Patients with Chronic Renal Failure in Hemodialysis: A Cross-Sectional Study

ABSTRACT Objective: To compare salivary and serum biochemical levels in patients with chronic renal failure undergoing hemodialysis. Material and Methods: The sample was composed of 57 patients treated in Hemodialysis Reference Centers, from a state of Northeastern Brazilian, with age ≥21 years old with at least 3 months of hemodialysis treatment time. Serum data were obtained from records. Unstimulated and stimulated saliva were collected. Flow rate (mL/min) was measured. Spectrophotometry was performed for the measurement of salivary levels of calcium (570 nm), urea (340 nm), and creatinine (510 nm). Statistical analysis used Mann Whitney and Kruskal-Wallis tests (p<0.05). Results: Unstimulated and stimulated salivary flow rates were 0.43 mL/min and 1.69 mL/min, respectively. There was significant difference (p<0.001) of levels of calcium (5.41 mg/dL and 9.70 mg/dL), urea (118.03 mg/dL and 183.22 mg/dL) and creatinine (0.59 mg/dL and 9.20 mg/dL) between saliva and serum, respectively. Concerning the time of hemodialysis, salivary and serum calcium not exhibited significant association; however, serum urea (p=0.012) and serum creatinine (p=0.025) showed significant association to the time of hemodialysis. Conclusion: Salivary biochemical levels of urea, creatinine and calcium can indicate the presence of a possible chronic renal failure and the saliva demonstrated to be a potential auxiliary biofluid for clinical monitoring renal alterations.

Relación entre Nivel de 25 (OH) D Vitaminas y Deterioro Cognitivo en Enfermedad renal Crónica (ERC) en pacientes en diálisis y sin diálisis mediante el uso de la prueba B / Relationship between Level of 25 (OH) D Vitamins and Cognitive Impairment in Chronic Kidney Disease (CKD) in Dialysis and NonDialysis Patients Using Trial Making Test B

Deficiency in vitamin D and cognitive dysfunction commonly are associated together in patients suffering from chronic kidney disease (CKD) in both dialysis and non-dialysis patients, vitamin D develop new protective regulatory roles in the functions of CNS. Combination of low levels of vitamin D and CKD can be enrolled for devastating and lead to sever cognitive dysfunction. Patients with CKD mostly associated with Hypovitaminosisand moreover common in elderly patients and related with cognitive decline, one of the hypotheses that CKD patients commonly have a low level of vitamin D and have potential experience in accelerated cognitive decline which rarely link on this topic. Most of CKD patients particularly sensitive for developing in the deficiency of vitamin D. Reduce vitamin D intake, male absorption in compromised GIT patients, loosing of vitamin D binding protein with urine, and α-hydroxylase enzyme reduction in the kidney all are the risk factors included in the causes of 25(OH) D vitamin decrease production. Aim of study: assess cognitive function by using one validated score: trial making test B in patients with CKD in both dialysis and non-dialysis. Patients and methods: a total of 54 patients with CKD and 57 patients with ESRD on hemodialysis enrolled in this study, where CKD defined as GFR < 60 ml/min by MDRD study. Exclusion criteria include CVA, deaf and blind, and low education patients. Cognitive functions assessment done for patients who are on hemodialysis and non- dialysis by using trial B testing, this second assess spatial scanning concentration and executive function by time measuring that needed to connect the series of numbered that are sequentially and littered circles. Catastrophic shorter time completion with a maximum of 300 second indicates better performance. 25 (OH) D vitamins has assessed from each patients using direct immunoassay method, with assay at 4-110 ng/ml. Results: for patients on hemodialysis 27 (39.7%) has deficient 25(OH) D vitamin status 25 (36.7%) insufficient,20 (29.4%) had sufficient vitamin D levels, significant low level in patients on hemodialysis in comparison to those with non-hemodialysis. Trial making test B score was significantly lower in dialysis patients, significant correlation between cognitive function assessment (trial making test B) and low vitamin D level. Conclusions: the prevalence of deficiency in vitamin D in CKD especially hemodialysis patients associated with cognitive decline.

Fabry disease: genetics, pathology, and treatment

SUMMARY Fabry disease (FD) is a recessive monogenic inheritance disease linked to chromosome X, secondary to mutations in the GLA gene. Its prevalence is estimated between 1:8,454 and 1:117,000 among males and is probably underdiagnosed. Mutations in the GLA gene lead to the progressive accumulation of globotriaosylceramide (Gb3). Gb3 accumulates in lysosomes of different types of cells of the heart, kidneys, skin, eyes, central nervous system, and gastrointestinal system, and may lead to different clinical scenarios. The onset of symptoms occurs during childhood, with acroparesthesia, heat intolerance, and gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, and neuropathic pain. Subsequently, symptoms related to progressive impairment appear, such as angiokeratomas, cornea verticillata, left ventricular hypertrophy, myocardial fibrosis, proteinuria, and renal insufficiency. The latter being the main cause of death in FD. The gold standard for diagnosis is the genetic analysis in search of mutation, in addition to family history. In homozygous patients, the enzyme activity can also be used. Once the diagnosis is confirmed, the patient and their family should receive genetic counseling. The treatment, in turn, currently focuses mainly on replacing the enzyme that is absent or deficient by means of enzyme replacement therapy, with the purpose of avoiding or removing deposits of Gb3. Chaperones can also be used for the treatment of some cases. It is considered that the specific treatment should be initiated as soon as a diagnosis is obtained, which can change the prognosis of the disease.

Educação nutricional como estratégia no controle de hiperfosfatemia e hipercalemia em pacientes em hemodiálise / Nutritional education as a strategy for control of hyperkalemia and hyperphosphatemia in hemodialysis patients

Introdução: A manutenção de concentrações sanguíneas adequadas de fósforo (P) e potássio (K) é um dos principais desafios no tratamento dos pacientes com doença renal crônica (DRC). Para evitar inadequações dos valores séricos, a orientação nutricional sobre o consumo destes minerais para pacientes com DRC em hemodiálise (HD) se torna imprescindível. Objetivo: Avaliar o efeito de um programa de educação nutricional no conhecimento e nas concentrações séricas de P e K em pacientes em HD. Método: Trata-se de um estudo longitudinal, realizado de setembro a dezembro de 2014, no qual foram incluídos 37 pacientes em HD que faziam diálise há pelo menos 5 meses. Foram aplicados questionários para avaliar o conhecimento sobre P e K antes e após a intervenção educativa. Utilizaram-se três materiais educativos durante as sessões de HD. Foram avaliadas as concentrações mensais de P, K, paratormônio (PTH) e albumina durante o estudo. Resultados: Após a aplicação do programa educacional, houve aumento de 36% na pontuação do questionário de conhecimento. Os valores séricos de P e K não se modificaram e houve aumento das concentrações de PTH e albumina. Conclusão: A intervenção educativa colaborou para que os pacientes em HD adquirissem maior conhecimento sobre o controle da fosfatemia e calemia, porém não foi suficiente para repercutir nos valores séricos destes minerais. Desta forma, há necessidade de realizar estudos com educação nutricional por um período de tempo maior para que os resultados sejam capazes de melhorar os indicadores do tratamento e a qualidade de vida destes indivíduos.

Introduction: Maintaining adequate blood concentration of phosphorus (P) and potassium (K) is one of the major challenges in the treatment of patients with chronical kidney diseases. To avoid high serum values, the nutrition guidance on the consumption of these minerals to CKD patients in hemodialysis (HD) becomes essential. Objective: To evaluate the effect of an educational nutrition program in the knowledge and serum concentration of P and K in HD patients. Methods: It is a longitudinal study, conducted from September to December 2014 in which 37 HD patients who have dialyzed for at least five months were included. Questionnaires were used to access the knowledge about P and K before and after the educational intervention. Three educational materials were used during the HD sessions. During the study the monthly concentrations of P, K, parathyroid hormone (PTH) and albumin were evaluated. Results: After applying the educational program, there was an increase of 36% in the scores of the knowledge questionnaire. The serum values of P and K did not change and there was an increase of the PTH and albumin. Conclusion: The educational intervention contributed to increased knowledge of HD patients about the control of phosphatemia and kalemia, however it was not enough to modify the serum values of these minerals. Thus, there is the need of having studies with nutrition education for a longer period of time so that the results can be able to improve the indicators of the treatment and the life quality of these people.(AU)

Avaliação da ingestão nutricional de pacientes com doença renal crônica em tratamento hemodialítico / Nutritional intake assessment in patients with chronic kidney disease in hemodialitic treatment

Introdução: A hemodiálise é um tratamento comumente realizado em pacientes que apresentam perda da função renal, com o intuito de liberar resíduos prejudiciais à saúde do corpo. Esta terapêutica ocasiona perdas de nutrientes do sangue, sendo, dessa forma, contribuinte para a desnutrição, o que reforça o papel da nutrição como tratamento coadjuvante.A análise da ingestão alimentar é capaz de fornecer informações para nortear as condutas dietéticas,portanto, este estudo objetivou verificar a adequabilidade da ingestão nutricional com as recomendações nutricionais específicas e sua relação com o estado nutricional de pacientes submetidos a tratamento hemodialítico em uma clínica do município de Vitória da Conquista, BA. Método: A avaliação da ingestão nutricional foi procedida determinando a ingestão proteica por quilo de peso, de quilocalorias por quilo de peso, cálcio, ferro, potássio e fósforo,comparando-as com as recomendações específicas. O estado nutricional foi determinado por meio da Avaliação Subjetiva Global modificada. Resultados: Um total de 122 pacientes foram incluídos no estudo, estando a maioria em risco nutricional e nenhum com desnutrição gravíssima. A maioria também apresentou inadequação quanto à ingestão de calorias e dos nutrientes avaliados. Não foram encontradas correlações entre a ingestão calórica vs. estado nutricional e ingestão proteica vs. estado nutricional, mas analisando a ingestão calórica e proteica foi observada forte correlação (r=0,799). Conclusão: As ingestões de proteínas, quilocalorias, cálcio, ferro, potássio e fósforo apresentaram-se inadequadas na população estudada, o que pode influenciar o estado clínico e nutricional destes pacientes.(AU)

Introduction: Hemodialysis is a treatment commonly performed in patients who had loss of kidney function, in order to release harmful waste to body's health. This therapy causes loss of nutrients from the blood, and thus contributes to malnutrition, which reinforces the role of nutrition as adjuvant treatment. Analysis of food intake is able to provide information to guide dietetic conducts, so this study aimed to verify the nutritional intake adequacy with specific nutritional recommendations and their relation with the nutritional status of patients undergoing hemodialysis treatment at a clinic in the city of Vitória da Conquista, BA. Method: The assessment of nutritional intake was done determining the protein intake per kilogram of weight, kilocalories per kilogram of weight, calcium, iron, potassium and phosphorus comparing it to the specific recommendations. Nutritional status was determined using the Subjective Global Assessment modified. Results: A total of 122 patients were included in the study, with the majority in nutritional risk and none had very serious malnutrition. Similarly, most also had impairments as to intake of calories and nutrients evaluated. No correlations were found between calorie intake vs. nutritional status and protein intake vs. nutritional status, but in the analyse caloric and protein intake was found strong correlation (r=0.799). Conclusion: The intake of protein, kilocalories, calcium, iron, potassium and phosphorus showed to be inadequate in the study population, which may influence the clinical and nutritional status of these patients.(AU)

The Oxford Classification predictors of chronic kidney disease in pediatric patients with IgA nephropathy / Preditores da doença renal crônica segundo a Classificação de Oxford em pacientes pediátricos com nefropatia por IgA

Abstract Objective: The Oxford Classification for Immunoglobulin A nephropathy (IgAN) identifies pathological variables that may predict the decline of renal function. This study aimed to evaluate the Oxford Classification variables as predictors of renal dysfunction in a cohort of Brazilian children and adolescents with IgAN. Methods: A total of 54 patients with IgAN biopsied from 1982 to 2010 were assessed. Biopsies were re-evaluated and classified according to the Oxford Classification. Multivariate analysis of laboratory and pathological data was performed. The primary outcomes were decline of baseline estimated glomerular filtration rate (eGFR) greater than or equal to 50%. Results: Mean follow-up was 7.6 ± 5.0 years. Mean renal survival was 13.5 ± 0.8 years and probability of decline ≥50% in baseline eGFR was 8% at five years of follow-up and 15% at ten years. Ten children (18.5%) had a decline of baseline eGFR ≥ 50% and five (9.3%) evolved to end-stage renal disease. Kaplan-Meier analysis showed that baseline proteinuria, proteinuria during follow-up, endocapillary proliferation, and tubular atrophy/interstitial fibrosis were associated with the primary outcome. Multivariate Cox analysis showed that only baseline proteinuria (HR, 1.73; 95% CI, 1.20-2.50, p = 0.003) and endocapillary hypercellularity (HR, 37.18; 95% CI, 3.85-358.94, p = 0.002) were independent predictors of renal dysfunction. No other pathological variable was associated with eGFR decline in the multivariate analysis. Conclusion: This is the first cohort study that evaluated the predictive role of the Oxford Classification in pediatric patients with IgAN from South America. Endocapillary proliferation was the unique pathological feature that independently predicted renal outcome.

Resumo Objetivo: A Classificação Oxford para a Nefropatia por Imunoglobulina A (IgAN) identificou variáveis patológicas de risco para disfunção renal. O presente estudo teve como objetivo avaliar as variáveis da Classificação de Oxford como preditores de disfunção renal em crianças brasileiras com IgAN. Métodos: Foram analisados 54 pacientes com diagnóstico de IgAN entre 1982-2010. As biópsias renais foram reavaliadas pela Classificação de Oxford. Foram feitas análises uni e multivariada das variáveis clínicas e patológicas. O desfecho primário foi queda da taxa de filtração glomerular (TFG) ≥ 50% da filtração basal. Resultados: O acompanhamento médio foi de 7,6 ± 5,0 anos. A sobrevida renal média foi de 13,5 ± 0,8 anos e a probabilidade de atingir o desfecho primário foi de 8% em cinco anos e 15% em 10 anos de seguimento. Dez crianças (18,5%) apresentaram queda na TFG basal ≥ 50% e cinco (9,3%) evoluíram para doença renal crônica terminal. A análise de Kaplan-Meier mostrou que a proteinúria basal e de seguimento, a proliferação endocapilar e a atrofia tubular/fibrose intersticial foram associadas com o desfecho primário. A análise multivariada de Cox mostrou que a proteinúria basal (HR = 1,73; IC95% 1,20-2,50, p = 0,003) e a proliferação endocapilar (HR = 37,18; IC95% 3,85-358,94, p = 0,002) foram preditores independentes de disfunção renal. Nenhuma outra variável patológica foi associada com declínio da TFG na análise multivariada. Conclusão: Este é o primeiro estudo brasileiro que avaliou a Classificação Oxford em crianças com IgAN. A proliferação endocapilar foi a única característica patológica capaz de predizer independentemente o declínio da função renal.

Obesity and kidney disease: hidden consequences of the epidemic / Obesidad y enfermedad renal: las consecuencias ocultas de una epidemia

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset Chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

La obesidad se ha convertido en una epidemia mundial, y se ha proyectado que su prevalencia se incrementrá en 40% en la próxima década. Esta creciente prevalencia supone implicaciones tanto para el riesgo de desarrollo de diabetes mellitus y enfermedades cardiovasculares como para el desarrollo de Enfermedad renal crónica. Un elevado índice de masa corporal es uno de los factores de riesgo más importantes para el desarrollo de enfermedad renal crónica. En individuos afectados por la obesidad, tiene lugar una hiperfiltración compensatoria necesaria para alcanzar la alta demanda metabólica secundaria al aumento del peso corporal. El incremento de la presión intraglomerular puede generar daño renal y elevar el riesgo de desarrollar enfermedad renal crónica a largo plazo. La incidencia de glomerulopatía asociada a obesidad se ha incrementado 10 veces en los últimos años. Asimismo se ha demostrado que la obesidad es un factor de riesgo para el desarrollo de nefrolitiasis y un número de neoplasias, incluyendo cáncer renal. Este año, el Día Mundial del Riñón promueve la educación acerca de las consecuencias nocivas de la obesidad y su asociación con la enfermedad renal, abogando por un estilo de vida saludable y la implementación de políticas públicas de salud que promuevan medidas preventivas alcanzables.

Tempo de hemodiálise e o estado nutricional em pacientes com doença renal crônica / Hemodialysis time and nutritional status in patients with chronic kidney disease

Introdução: A desnutrição nos pacientes em hemodiálise é desencadeada por causas multifatoriais, sendo condição relacionada ao aumento da morbimortalidade. O tempo, em anos, que o paciente é submetido à diálise parece ser um dos grandes fatores implicados na fisiopatologia da desnutrição em portador de doença renal crônica (DRC). O objetivo deste estudo foi avaliar o estado nutricional dos pacientes com DRC e sua relação com o tempo de hemodiálise. Método: Foi realizado um estudo quantitativo com uma amostra de 80 pacientes de um centro de doenças renais. Para avaliação nutricional, foram utilizados a Avaliação Subjetiva Global e um questionário semiestruturado para a coleta dos dados dietéticos e clínicos. Os dados foram tabulados e analisados pelo programa SPSS versão 18. Para análise estatística foi aplicado o teste do Qui-Quadrado utilizando p<0.05. Resultados: Em relação aos pacientes da amostra, 21,2% se encontravam com suspeita de desnutrição ou com desnutrição moderada e 78,8% nutridos. Do total de pacientes, 62,5% se encontravam há menos de 5 anos realizando HD e 37,5% há mais de 5 anos. Dos 17 indivíduos classificados com desnutrição moderada, 15 realizavam HD há menos de 5 anos e dois há mais de 5 anos. O teste do Qui-Quadrado obteve valor significativo (p<0,05) em relação a essas duas variáveis. Conclusão: Os pacientes em HD tendem a apresentar desnutrição logo nos primeiros 5 anos de terapia, a albumina não se correlacionou com o estado nutricional dos pacientes desnutridos e a dieta deste grupo de pacientes tem baixa frequência generalizada de consumo de alimentos.

Introduction: Malnutrition in hemodialysis patients is triggered by multifactorial causes, being a condition related to increased morbidity and mortality in this group of patients. The time in years that the patient remains in hemodialysis appears to be one of the major factors involved in the pathophysiology of malnutrition in patients with chronic kidney disease. The purpose of this study was to assessment the nutritional state of patients with chronic kidney disease on hemodialysis. Methods: The sample was composed of 80 patients from a kidney disease center of Bahia, to assessment the nutritional status was applied the Subjective Global Assessment (SGA), beyond another semi-structured questionnaire to data collection about clinic and dietetics aspects. Data were tabulated and analyzed using Statistical Package for the Social Sciences, version 18.0 to Windows (SPSS, Inc. Chicago) and for static analysis of data was performed the qui-square test considering a p<0.05. Results: Twenty-one dot two percent of total sample was classified with moderately or suspected of being malnourished and 78.8% classified as well-nourished. Sixty-two dot five percent performed HD less than 5 years and 37.5% performed HD more than 5 years. The 17 patients classified as moderately malnourished, 15 performed HD less than 5 years and 2 more than 5 years and Chi-Square test showed a significant difference (p<0.05) between these variables. Conclusion: We concluded that the patients on HD tend to develop malnourished during first years of this therapy. The malnourished isn't associated with albumin levels and the diet of these patients have a generalized low rate of food consumption.

Performance of urinary kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, and N-acetyl-beta-D-glucosaminidase to predict chronic kidney disease progression and adverse outcomes

Urinary biomarkers can predict the progression of chronic kidney disease (CKD). In this study, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and N-acetyl-β-D-glucosaminidase (NAG) were correlated with the stages of CKD, and the association of these biomarkers with CKD progression and adverse outcomes was determined. A total of 250 patients, including 111 on hemodialysis, were studied. Urinary KIM-1, NGAL, and NAG were measured at baseline. Patients not on dialysis at baseline who progressed to a worse CKD stage were compared with those who did not progress. The association of each biomarker and selected covariates with progression to more advanced stages of CKD, end-stage kidney disease, or death was evaluated by Poisson regression. NGAL was moderately correlated (rs=0.467, P<0.001) with the five stages of CKD; KIM-1 and NAG were also correlated, but weakly. Sixty-four patients (46%) progressed to a more advanced stage of CKD. Compared to non-progressors, those patients exhibited a trend to higher levels of KIM-1 (P=0.064) and NGAL (P=0.065). In patients not on dialysis at baseline, NGAL was independently associated with progression of CKD, ESKD, or death (RR=1.022 for 300 ng/mL intervals; CI=1.007-1.037, P=0.004). In patients on dialysis, for each 300-ng/mL increase in urinary NGAL, there was a 1.3% increase in the risk of death (P=0.039). In conclusion, urinary NGAL was associated with adverse renal outcomes and increased risk of death in this cohort. If baseline urinary KIM-1 and NGAL predict progression to worse stages of CKD is something yet to be explored.

Preclinical evaluation of nephroprotective potential of a probiotic formulation LOBUN on Cyclosporine-A induced renal dysfunction in Wistar rats

ABSTRACT The aim of present study was to evaluate the nephroprotective effect of probiotic formulation LOBUN on Cyclosporine A (CsA) induced renal dysfunction in Wistar rats. CsA (20 mg/kg body weight s.c) was administered for 15 days to cause renal dysfunction in Wistar rats. The probiotic formulation LOBUN was administered with the dose of 500 mg/kg body weight (p.o) for twice (TGI) and thrice a day (TGII). The samples were analyzed for the parameters like blood urine nitrogen (BUN), serum creatinine, serum uric acid, total serum protein and urine proteins, urine potassium, urine sodium. The renal functional and histopathological studies revealed that the oral administration of probiotic formulation LOBUN has provided appreciable renoprotection and possibly alleviated the symptoms of Chronic Kidney Disease (CKD) at the dose of 500 mg/kg body weight administered thrice a day and also the results were supported by histopathological findings.

Educação nutricional como estratégia no controle de hiperfosfatemia e hipercalemia em pacientes em hemodiálise / Nutritional education as a strategy for control of hyperkalemia and hyperphosphatemia in hemodialysis patients

Introdução: A manutenção de concentrações sanguíneas adequadas de fósforo (P) e potássio (K) é um dos principais desafios no tratamento dos pacientes com doença renal crônica (DRC). Para evitar inadequações dos valores séricos, a orientação nutricional sobre o consumo destes minerais para pacientes com DRC em hemodiálise (HD) se torna imprescindível. Objetivo: Avaliar o efeito de um programa de educação nutricional no conhecimento e nas concentrações séricas de P e K de pacientes em HD. Método: Estudo longitudinal, realizado de setembro a dezembro de 2014, no qual foram incluídos 37 pacientes em HD que faziam diálise há pelo menos 5 meses. Foram aplicados questionários para avaliar o conhecimento sobre P e K, antes e após a intervenção educativa. Utilizaram-se três materiais educativos durante as sessões de HD. Foram avaliadas as concentrações mensais de P, K, paratormônio (PTH) e albumina durante o estudo. Resultados: Após a aplicação do programa educacional, houve aumento de 36% na pontuação do questionário de conhecimento. Os valores séricos de P e K não se modificaram e houve elevação das concentrações de PTH e albumina. Conclusão: A intervenção educativa colaborou para que os pacientes em HD adquirissem maior conhecimento sobre o controle da fosfatemia e calemia, porém não foram suficientes para repercutir nos valores séricos destes minerais. Desta forma, há necessidade de realizar estudos com educação nutricional por um período de tempo maior, para que os resultados sejam capazes de melhorar os indicadores do tratamento e a qualidade de vida destes indivíduos.(AU)

Introduction: Maintaining adequate blood concentration of phosphorus (P) and potassium (K) is one of the major challenges in the treatment of patients with chronical kidney diseases. To avoid high serum values, the nutrition guidance on the consumption of these minerals to CKD patients in hemodialysis (HD) becomes essential. Objective: To evaluate the effect of an educational nutrition program in the knowledge and serum concentration of P and K in HD patients. Methods: This is a longitudinal study, conducted from September to December 2014 in which 37 HD patients who have dialyzed for at least five months were included. Questionnaires were used to access the knowledge about P and K before and after the educational intervention. Three educational materials were used during the HD sessions. During the study the monthly concentrations of P, K, parathyroid hormone (PTH) and albumin were evaluated. Results: After applying the educational program, there was an increase of 36% in the scores of the knowledge questionnaire. The serum values of P and K did not change and there was an increase of the PTH and albumin. Conclusion: The educational intervention contributed to increased knowledge of HD patients about the control of phosphatemia and kalemia, however it was not enough to modify the serum values of these minerals. Thus, there is the need of having studies with nutrition education for a longer period of time so that the results can be able to improve the indicators of the treatment and the life quality of these people.(AU)

Signs and symptoms of developmental abnormalities of the genitourinary tract / Sinais e sintomas das anormalidades do desenvolvimento do trato geniturinário

Abstract Objective: The abnormalities of the genitourinary tract development are the leading cause of chronic kidney disease (CKD) in children. The diagnosis of this disease in Brazil is late and incomplete, which results in increased morbidity and mortality in this age group. Early diagnosis of this condition is the prerogative of generalist pediatricians, and the aim of this study was to review the clinical signs and symptoms associated with developmental abnormalities of the genitourinary tract. Data sources: Based on the description of a symbolic clinical case, the authors conducted a non-systematic review of medical literature. Data synthesis: The results suggest that the following data should be used as a warning for early diagnosis of affected children: (a) combined urinary tract abnormalities (chromosomal abnormalities; sequence of malformations [VACTERLand Prune-Belly]; and musculoskeletal, digestive tract, heart, and nervous system malformations); (b) previous history (congenital anomalies of the kidney and urinary tract [CAKUT] in the family, low birth weight, and oligoamnios); (c) clinical signs (polyuria/nocturia, urinary tract infection, systemic arterial hypertension, failure to thrive, weak urinary stream, difficulty to start urination, distended bladder, non-monosymptomatic enuresis, urinary/urge incontinence, and bowel and bladder dysfunction); and (d) pre- and postnatal ultrasonographic alterations (increased anteroposterior diameter of the renal pelvis, mainly in the third trimester of pregnancy; single kidney; hydronephrosis associated with other abnormalities; and hydronephrosis with parenchymal involvement in the post-neonatal assessment). Conclusion: The suggestions shown here can help the pediatrician to establish clinical hypotheses for the early diagnosis of developmental abnormalities of the genitourinary tract without resorting to expensive and invasive procedures.

Resumo Objetivo: As anormalidades do desenvolvimento do trato geniturinário são a principal causa de doença renal crônica (DRC) em crianças. O diagnóstico dessa doença no Brasil é formulado de maneira incompleta e tardia, o que resulta em aumento na morbimortalidade nessa faixa etária. O diagnóstico precoce dessa condição é prerrogativa dos pediatras generalistas e o objetivo deste trabalho foi revisar os sinais e sintomas clínicos associados às anormalidades do desenvolvimento do trato geniturinário. Fontes dos dados: A partir da descrição de um caso clínico simbólico, fizemos uma revisão não sistemática da literatura médica. Síntese dos dados: Os resultados sugerem que os seguintes dados devem ser usados como alerta para o diagnóstico precoce das crianças acometidas: a) anomalias do trato urinário compostas (anomalias cromossômicas, sequências de malformações – Vacterl e Prune-Belly, malformações musculoesqueléticas, do trato digestivo, cardíacas e do sistema nervoso); b) antecedentes (anomalias congênitas do rim e trato urinário (CAKUT) na família, baixo peso ao nascer e oligoâmnio); c) sinais clínicos (polaciúria/noctúria, infecção urinária, hipertensão arterial sistêmica, baixo ganho de peso, jato urinário fraco, dificuldade para iniciar a micção, bexigoma, enurese não monossintomática, urge/incontinência urinária, disfunção do intestino e da bexiga) e d) alterações ultrassonográficas ante e pós-natais (diâmetro anteroposterior da pélvis renal aumentado principalmente no terceiro trimestre da gestação, rim único, hidronefrose associada a outras anomalias e hidronefrose com comprometimento de parênquima na avaliação pós-neonatal). Conclusão: As sugestões apresentadas podem ajudar o pediatra a estabelecer hipóteses clínicas para o diagnóstico precoce das anormalidades do desenvolvimento do trato geniturinário sem metodologias caras e invasivas.

Qualidade da dieta e consumo de sódio por pacientes em hemodiálise de uma clínica renal da fronteira oeste do Rio Grande do Sul / Quality of diet and sodium consumption by hemodialysis patients in a renal clinic of the border west of Rio Grande do Sul

Objetivo: Avaliar a qualidade da dieta e estado nutricional de pacientes submetidos à hemo- diálise em Clínica Renal de um município do sul do Brasil. Método: Neste estudo descritivo, observacional foram incluídos 15 pacientes. Dados sociodemográficos, clínicos e laboratoriais foram coletados dos prontuários de cada paciente. Para avaliação dos dados antropométricos, foram aferidas medidas de peso seco, peso pré e pós-diálise, altura e circunferência da cintura. Dados dietéticos foram coletados por meio de um recordatório de 24h e avaliados pelo Índice de Qualidade da Dieta Revisado. O consumo de alimentos ricos em sódio foi avaliado por meio de questionário de frequência específico. Resultados: Na população estudada, a média de idade foi de 57,3 anos, sendo a maioria dos pacientes do sexo masculino (60%). A classificação do índice de massa corporal foi de eutrofia para metade dos pacientes (53,3%). A média da circunferência da cintura foi de 89,67 cm, sendo que 73,3% dos pacientes apresentaram valores adequados. Conforme avaliação dos dados dietéticos, o consumo de sódio diário foi de 3,98 g e a pontuação média do Índice de Qualidade da Dieta foi de 63,33 pontos; 66,7% da população apresentaram necessidade de modificação da dieta. Conclusões: Os pacientes apresentaram hábitos alimentares que necessitam de modificações, principalmente no que diz respeito ao consumo de frutas, verduras e cereais integrais. Também se destaca o elevado consumo de sódio, sendo o sódio adicional o mais prevalente entre o consumo total diário. Desta maneira, tornam-se necessárias estratégias de educação nutricional para uma mudança efetiva dos hábitos alimentares destes pacientes.(AU)

Objective: To evaluate dietary quality and nutritional status of hemodialysis patients in a Renal Clinic of southern Brazil. Methods: Fifteen patients were included in the study. Sociodemo- graphic, clinical and laboratory data were collected from medical records. To evaluate the anthropometric measurements were measured dry weight, weight pre and post-dialysis, height, and waist circumference. Dietary data were collected using 24-hour recalls and evaluated by the Diet Quality Index - Revised. The consumption of foods high in sodium was assessed by a food frequency questionnaire. Results: In this study the mean age was 57.3 years and most patients were male (60%). Body mass index classification was eutrophic to half of patients (53.3%). The average waist circumference was 89.67 cm, and 73.3% of patients had appro- priate values. According to the assessment of dietary data, daily sodium intake was 3.98 g and the mean score of the Diet Quality Index was 63.33 points; 66.7% of the population was classified as "need a diet modification". Conclusions: Patients of the renal clinic need dietary changes, especially regarding to the consumption of fruits, vegetables and whole grains. Also highlights the high sodium intake, being the added sodium the most prevalent among total daily consumption. Therefore, become necessary nutritional education strategies for effective change in eating habits of these patients.(AU)

Compromiso renal en síndrome de Poems: caso clínico / Chronic kidney disease associated with Poems syndrome: report of one case

POEMS syndrome is characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes. We report a woman with the syndrome, who had peripheral polyneuropathy, osteosclerotic myeloma, monoclonal IgA elevation, hypothyroidism, hypogonadotrophic hypogonadism, hyperprolactinemia, adrenal insufficiency, hepatosplenomegaly, lymphadenopathy, thyroid and parotid enlargement, Castleman’s disease, papilledema, stiff and hyperpigmented skin, white nails, clubbing, ascites and chronic diarrhea. She had also a nephropathy characterized by microscopic hematuria, proteinuria, renal insufficiency and a unilateral kidney retraction. She was treated with melphalan and prednisone, achieving remission of the disease and nephropathy. She survived twelve years and died due to a myocardial infarction 20 years after POEMS diagnosis.

Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.