Crioglobulinemia: relação entre hepatite C e glomerulonefrite / Cryoglobulinemia: link between hepatitis C and glomerulonephritis

A Hepatite C é um problema de saúde mundial. Uma associação entre infecção pelo vírus da hepatite C (HCV) e crioglobulinemia mista com doença renal tem sido descrita, sendo a glomerulonefrite membranopoliferativa (GNMP) tipo I o acometimento renal mais comum. A GNMP é frequentemente associada com a crioglobulinemia mista tipo II. Esse relato de caso objetiva descrever fatores clínicos dos pacientes com crioglobulinemia mista, a qual é uma manifestação extra-hepática da infecção por HCV, assim como discutir a sua fisiopatologia e tratamento, baseado no relato de caso. (AU)

Hepatitis C is a public health concern worldwide. An association of hepatitis C virus (HCV) infection with mixed cryoglobulinemia and renal disease has been described, and type I membranoproliferative glomerulonephritis (MPGN) is the most common. MPGN is often associated with type II mixed cryoglobulinemia. This case report aimed to describe the clinical features of patients with mixed cryoglobulinemia, a major extrahepatic manifestation of HCV infection, and to discuss its pathophysiology and treatment of HCV infection based on the case report. (AU)

Renal artery pseudoaneurysm / Pseudoaneurisma de artéria rena

Abstract The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

Resumo O pseudoaneurisma de artéria renal constitui-se de uma rara complicação vascular advinda de procedimentos percutâneos, biópsias renais, nefrectomia, traumas penetrantes e mais raramente traumas contusos. A clínica pode variar de acordo com cada paciente, sendo a hematúria o sintoma mais comum. Visto isso, é necessário um alto nível de suspeição clínica para seu diagnóstico, que pode ser elucidado através de exames complementares, como o Ecodoppler colorido e tomografia computadorizada. Neste relato, apresentamos o caso de um paciente submetido à biópsia renal direita percutânea e que, após o procedimento, iniciou com hematúria macroscópica, tenesmo urinário e dor em hipogástrico. O diagnóstico de pseudoaneurisma foi dado após uma semana de evolução, quando o paciente foi internado por hematúria franca, taquicardia, hipotensão e dor em hipocôndrio. Em angiotomografia, foi revelada uma dilatação focal da artéria renal polar acessória inferior à direita, dilatação da pelve renal e de todo trajeto ureteral, com presença de material hiperdenso (coágulos) no interior do terço médio do ureter. O tratamento de escolha para a maioria dos casos é conservador, através da embolização arterial, indicada para aqueles de menores dimensões em pacientes estáveis hemodinamicamente. Entretanto, optou-se inicialmente pelo tratamento clínico com ácido aminocapróico 1 g, com base nos estudos prévios para tratamento da hematúria. O paciente recebeu alta sem evidências de hematúria macroscópica e com ecografia renal normal, seguindo em acompanhamento ambulatorial.

Renal artery pseudoaneurysm.

The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

Pseudocisto esplênico não parasítico: um relato de caso / Non-parasitic splenic cyst: a case report

Os cistos esplênicos são raros, podem ser congênitos ou adquiridos e são encontrados, muitas vezes, em exames incidentais. Aparecem como tumorações na topografia do hipocôndrio esquerdo, associados a sintomas obstrutivos e dor abdominal. Os pseudocistos são formados por uma camada de tecido fibroso, sem revestimento epitelial, e têm como fator etiológico mais provável o trauma esplênico prévio. Atualmente, o ultrassom abdominal é o método mais importante para o diagnóstico de cisto esplênico, pois evita a realização de exames mais agressivos. Para o tratamento de cisto esplênico sintomático de grande tamanho, não parasítico, com risco aumentado de ruptura e etiologia desconhecida, a indicação de escolha é a esplenectomia. Este relato objetiva apresentar essa doença incomum, ressaltando seu quadro clínico, métodos diagnósticos e tratamento (AU)

Splenic cysts are rare, can be congenital or acquired, and are most often found in incidental exams. They appear as tumors in the left hypochondrium, in association with obstructive symptoms and abdominal pain. Pseudocysts are formed by fibrous tissue layer, without epithelial coating, and their most probable cause is previous splenic trauma. Nowadays, abdominal ultrasound is the most important method for the diagnosis of splenic cyst, avoiding more aggressive exams. For symptomatic, large, non-parasitic splenic cysts with high risk of rupture and unknown etiology, splenectomy is indicated. This report intends to present this uncommon disease, emphasizing its clinical condition, diagnostic methods, and treatment (AU)

Stressors in the relatives of patients admitted to an intensive care unit. / Estressores em familiares de pacientes internados na unidade de terapia intensiva.

OBJECTIVE: To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. METHODS: Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. RESULTS: The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). CONCLUSION: Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.

Estressores em familiares de pacientes internados na unidade de terapia intensiva / Stressors in the relatives of patients admitted to an intensive care unit

RESUMO Objetivo: Identificar e estratificar os principais fatores estressores para os familiares de pacientes internados na unidade de terapia intensiva adulto de um hospital escola. Métodos: Estudo transversal descritivo com familiares de pacientes internados na unidade de terapia intensiva no período de abril a outubro de 2014. Foi utilizado questionário contendo identificação e dados demográficos dos familiares, dados clínicos dos pacientes, bem como 25 fatores estressores adaptados da Escala de Estressores em Unidade de Terapia Intensiva. O grau de estresse de cada fator foi determinado por uma escala de valores pontuando de 1 a 4. Os fatores estressores foram ranqueados conforme média dos pontos obtida. Resultados: A principal causa de admissão na unidade de terapia intensiva foi clínica em 36 (52,2%) casos. Os principais fatores estressores foram a presença do estado de coma (3,15 ± 1,23), o paciente não conseguir falar (3,15 ± 1,20) e o motivo da internação (3,00 ± 1,27). Quando retirados da análise os 27 (39,1%) pacientes em coma, os fatores de maior estresse para os familiares foram o motivo da internação (2,75 ± 1,354), ver o paciente na unidade de terapia intensiva (2,51 ± 1,227) e o paciente não conseguir falar (2,50 ± 1,269). Conclusão: A dificuldade na comunicação e na relação com o paciente internado na unidade de terapia intensiva foi apontada como os maiores estressores por seus familiares, com destaque para o estado de coma. Por outro lado, o ambiente, as rotinas de trabalho e a relação entre familiar e equipe da unidade de terapia intensiva tiveram menor impacto como fatores estressores.

ABSTRACT Objective: To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods: Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results: The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion: Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.

Distanciamento dos familiares como principal fator estressor em uma unidade de terapia intensiva / Distancing from family as main stressor in an intensive care unit

A internação em Unidade de Terapia Intensiva (UTI) gera estresse ao paciente por diversos fatores, que, se identificados, são passíveis de modificação.Assim, buscamos identificar os principais fatores estressores dos pacientes internados na UTI de um hospital-escola. Métodos: Estudo transversal descritivo com pacientes que estiveram internados na UTI adulto de um hospital-escola entre agosto e outubro de 2014. Os pacientes responderam questionário adaptado da Escala de Estressores em Unidade de Terapia Intensiva ICUESS), com 40 itens. Coletaram-se dados clínicos (tempo e tipo de internação) e demográficos (sexo, idade, escolaridade, religião). O grau de estresse de cada item foi determinado por meio de escala de valores pontuados de 1 a 4, considerando um ponto não estressante, dois pontos pouco estressante, três pontos estressante e quatro pontos muito estressante. Os escores obtidos foram ranqueados através da média de cada item, de maior para menor. Resultados: Foram analisados 49 questionários. A idade média foi 56±15,04 anos, com maioria feminina, correspondendo a 34 (69,4%) pacientes. A internação foi cirúrgica em 26 (53,1%) pacientes e a média de dias de internação foi 5,08±5,20. A maioria era aposentada 23 (46,9%) e católica 30 (61,2%). Quanto à escolaridade, 34 (69,4%) completaram o primeiro grau. Os principais fatores estressores foram sentir falta do marido/esposa (2,72±1,26), ver família/ amigos por apenas alguns minutos (2,65±1,3), estar amarrado por tubos (2,59±1,35), ter tubos no nariz e/ou boca (2,44±1,39) e não conseguir dormir (2,42±1,39). Conclusão: Os fatores que geraram maior estresse nos pacientes durante a internação na UTI relacionam-se ao distanciamento dos familiares e ao uso de materiais invasivos.

Introduction: Hospitalization in Intensive Care Unit (ICU) creates stress to the patient by several factors, which, if identified, are modifiable. Here we sought to identify the main stressors to patients admitted to the ICU of a school hospital. Methods: A descriptive cross-sectional study with patients who were admitted to the adult ICU of a school hospital between August and October 2014. Patients answered a questionnaire adapted from the Intensive Care Unit Environmental Stressor Scale (ICUESS), with 40 items. We collected clinical (time and type of admission) and demographic (gender, age, education, religion) data. Each item’s degree of stress was determined by means of a scoring system from 1 to 4, where 1 meant non-stressing, 2 as a little stressing, 3 as stressing, and 4 very stressing. The scores obtained were ranked from each item’s average, from highest to lowest. Results: 49 questionnaires were analyzed. The mean age was 56 ± 15.04 years, with a majority of women, accounting for 34 (69.4%) patients. Hospitalization was surgical in 26 (53.1%) patients and the mean length of ICU stay was 5.08 ± 5.20. Most patients were retired (23; 46.9%) and Catholic (30; 61.2%). As for level of education, 34 (69.4%) completed elementary school. The main stressors were missing husband/wife (2.72 ± 1.26), seeing family/friends for just a few minutes (2.65 ± 1.3), being tied by tubes (2.59 ± 1, 35), having tubes in the nose and/or mouth (2.44 ± 1.39) and not being able to sleep (2.42 ± 1.39). Conclusion: The factors that led to increased stress in patients during hospitalization in ICU are related to distancing from family and the use of invasive materials.

Prevalência de doença periodontal em pacientes com insuficiência renal crônica em hemodiálise / Prevalence of periodontal disease in patients with chronic renal failure on hemodialysis

A insuficiência renal crônica origina-se do declínio da função renal por ao menos três meses. Especialmente em pacientes dialíticos, percebe-se maior incidência e cronicidade de doença periodontal, que, por sua vez, também pode afetar adversamente a saúde sistêmica, podendo caracterizar um fator de risco para a doença renal crônica. O presente trabalho propôs avaliar a prevalência de doença periodontal e seus diferentes níveis em pacientes com insuficiência renal crônica em hemodiálise na Clínica de Doenças Renais Unirim, em Santa Cruz do Sul – RS, bem como a inter-relação entre as doenças. Foram avaliados 43 pacientes adultos, dentados que assinaram o Termo de Consentimento Livre e Esclarecido. Foram excluídos 74 pacientes (edêntulos, muito debilitados, tabagistas, diabéticos e/ou que se negaram a assinar o Termo de Consentimento). No aspecto periodontal, avaliou-se índice de sangramento gengival, profundidade de sondagem, presença de sangramento/supuração à sondagem, perda de inserção clínica e envolvimento de furca. Como resultados, da amostra avaliada (43), 34 pacientes (79,07%) apresentaram doença periodontal. A forma prevalente foi a periodontite localizada, encontrada em 27 pacientes (79,41%). Quanto à gravidade, a periodontite grave foi a prevalente, em 26 pacientes (76,47%). O ISG apresentou-se significativamente elevado em pacientes com periodontite generalizada grave. Assim, conclui-se que os índices apresentados confirmam a grande relação da doença periodontal com os pacientes dialíticos, corroborando com a bibliografia existente.

The chronic renal failure is originated from the decline of the renal function for at least three months. Mainly in dialysis patients, we can see a higher incidence and chronicity of periodontal disease, which, in turn, can also adversely affect the systemic health, and may characterize a risk factor for chronic kidney disease.This study proposed to evaluate the prevalence of periodontal disease and its levels in patients with chronic renal failure on hemodialysis at Clínica de Doenças Renais Unirim in Santa Cruz do Sul – RS, as well as the interrelationship between the diseases. 43 adults and dentate patients, who agreed to sign the Instrument of Consent, were evaluated. 74 patients were excluded (edentulous, debilitated, smokers, diabetics and / or those who refused to sign the Consent Form). In the periodontal aspect, were evaluated the gingival bleeding index, the probing pocket depth, the presence of bleeding and/or suppuration on probing, the clinical attachment level and the furcation involvement. As results, of the sample evaluated (43), 34 patients (79.07%) had periodontal disease. The prevalent form was the localized periodontitis, found in 27 patients (79.41%). Regarding severity, the severe periodontitis was prevalent, in 26 patients (76.47%). The gingival bleeding index was significantly high in patients diagnosed with severe generalized periodontitis. So, it is concluded that the results presented confirm the strong relationship between periodontal disease and dialysis patients, corroborating the existing literature.

Síndrome 47, XYY / 47, XYY Syndrome

A síndrome XYY é definida como uma aneuploidia de cromossomos sexuais, a qual o indivíduo recebe um cromossomo Y extra, apresentando cariótipo 47,XYY. A síndrome apresenta como características principais alta estatura na primeira infância, atraso na fala, dificuldade de leitura e concentração. A maioria dos homens XYY é fértil e não apresenta manifestações clínicas significativas e permanece sem diagnóstico O objetivo do presente trabalho é relatar o caso de um paciente de 12 anos afetado pela Síndrome 47,XYY.

XYY syndrome is defined as a sex chromosome aneuploidy, in which the individual receives an extra Y chromosome, presenting karyotype 47,XXY. The main features of the syndrome are tall stature in early childhood, delayed speech, and difficulty reading and concentrating. Most XYY males are fertile, show no significant clinical symptoms and remain undiagnosed. The aim of this study is to report the case of a 12-year-old patient affected by 47, XYY syndrome.

Analysis of FOXP3 gene and protein expressions in renal allograft biopsies and their association with graft outcomes.

BACKGROUND: The transcription factor FOXP3 is increased in acute renal rejection, but its influence on graft outcomes is unclear. This study correlated FOXP3 with dendritic cells and graft outcomes. METHODS: We assessed 96 kidney transplants undergoing allograft biopsy for cause. FOXP3 mRNA was analyzed by real-time polymerase chain reaction (PCR) and FOXP3 protein and DCsCD83(+) by immunohistochemistry. Graft function and survival were assessed at 5 years post-transplantation, as well as by independent predictors of graft loss. RESULTS: Intragraft FOXP3 gene and protein expression were significantly correlated (r = 0.541, p < 0.001). Both FOXP3 mRNA and protein were increased in patients with acute rejection (AR). High expression of FOXP3 mRNA or protein in biopsies did not correlate with clinical variables, but there was a trend to higher positive variation in the glomerular filtration rate (GFR) from biopsy to last follow-up. Patients with FOXP3-mRNA(high) had more DCsCD83(+) in biopsy, but these cells did not associate with AR. Five-year graft survival was not influenced by either FOXP3 mRNA or protein expressions. CONCLUSIONS: FOXP3 mRNA and protein had a good correlation in archival renal graft tissue. Increased FOXP3 expression was found in AR and FOXP3 associated with high numbers of DCs. However, both FOXP3 mRNA and protein was not associated with better allograft outcomes.

FOXP3+ regulatory T cells: from suppression of rejection to induction of renal allograft tolerance.

Naturally occurring and induced regulatory T cells (Tregs) can become hyporesponsive and anergic to antigen stimulation in autoimmune diseases and allograft rejection. The mechanisms of suppression of effector T cells by Tregs remain unclear, but there are in vitro and in vivo evidences showing that these cells are able to suppress antigen-specific responses via direct cell-to-cell contact, secrete anti-inflammatory cytokines such as TGF-ß and IL-10, and inhibit the generation of memory T cells, among others. The transcription factor FOXP3 is a specific marker of Tregs and its deficiency is associated with autoimmune diseases and inflammation. During acute rejection of kidney allografts, an augmented FOXP3 gene expression as well as increased CD4(+)CD25(+)FOXP3(+) and other cell populations are observed in graft biopsies. However, it is not clear whether Tregs migrate into the graft and are retained there to suppress the inflammatory process, or whether they are directly associated with more complex mechanisms to induce immune tolerance. FOXP3(+) Tregs may direct the immune response toward a graft acceptance program, potentially affecting the long-term survival of transplanted organs and tissues. Immunosuppressive drugs modulate the number and function of circulating Tregs and FOXP3 expression. Experimental and clinical studies have shown that mTOR inhibitors have positive and calcineurin inhibitors negative effects on Tregs, but it is difficult to set apart the effect of multiple other factors known to be associated with short- and long-term renal graft outcomes. This review aimed to describe the functions of Tregs and its transcription factor FOXP3 in suppression of immune response during rejection and in induction of kidney graft tolerance, as well as to review the individual effects of immunosuppressive drugs on Tregs.

[Atheroembolic renal disease: a cause of acute renal failure not much explored]. / Doença renal ateroembólica: uma causa de insuficiência renal aguda pouco explorada.

Atheroembolism is a multisytemic disease which affects many organs, including the kidneys, by the release of cholesterol emboli to tissues from an erosed atherosclerotic plaque, causing vascular obstruction in many tissues. The atheroembolic renal disease (AERD) is histologically represented by cholesterol crystals in renal arterioles with an inflammatory infiltrate around the vessels, and causes acute renal failure that may be severe and prolonged, weeks or even months after the embolic episode. The AERD carries a bad prognosis, with a high mortality. We herein report a case of a patient presenting AERD which was manifested two months after he was submitted to a cardiac catheterism and coronary angioplasty. The prevalence, clinical findings, renal histology, treatment and prognosis of AERD are discussed.

[Chronic renal disease, inflammation and atherosclerosis: new concepts about an old problem]. / Doença renal crônica, inflamação e aterosclerose: novos conceitos de um velho problema.

Chronic kidney disease (CKD) has reached epidemic proportions in the last few years, generating an emergent public health problem. Common risk factors for CKD and cardiovascular disease (CVD) are now well known resulting in a high prevalence rate of cardiovascular events which are the main cause of death in CKD patients. Development of accelerated atherosclerosis is related to traditional risk factors such as diabetes mellitus, arterial hypertension, dislipidemia and smoking, but recently other non traditional factors were found to be significantly associated with cardiovascular mortality, including inflammation, oxidative stress, endothelial dysfunction and uremia, even at early stages of CKD. Inflammatory markers such as C-reactive protein, interleukin 6 and fibrinogen are all correlated with cardiovascular death. The MIA syndrome is characterized by the association between inflammation, malnutrition and accelerated atherosclerosis, a condition commonly found in uremic patients, which is related to the genesis of CVD. Other important factors are the high level of oxidative stress, expressed by oxidized lipids, proteins and carbohydrates (AGES) (Advanced Glycation End Products), which cause tissue damage and endothelial dysfunction, that is aggravated by the uremic environment and other factors. These alterations are the basis for the pathogenic process of atherosclerosis and CVD in CKD patients, contributing to their high morbidity/mortality. This article is an updated review of the mechanisms of inflammation and oxidative stress and their relation to atherosclerosis in CKD.

Doença renal crônica, inflamação e aterosclerose: novos conceitos de um velho problema / Chronic renal disease, inflammation and atherosclerosis: new concepts about an old problem

A doença renal crônica (DRC) atinge hoje proporções epidêmicas e constitui um problema emergente de saúde pública. Fatores de risco comuns entre a uremia e a doença cardiovascular (DCV) são reconhecidos e resultam na elevada prevalência de eventos cardiovasculares que são a principal causa de morte em pacientes com DRC. O desenvolvimento de aterosclerose acelerada está relacionado a fatores de risco tradicionais, como diabetes mellitus, hipertensão arterial, dislipidemia e tabagismo, mas recentemente tem sido verificado que outros fatores não tradicionais também estão fortemente associados, entre os quais inflamação, estresse oxidativo, disfunção endotelial e a uremia per se, mesmo em estágios mais precoces da DRC. Marcadores do estado inflamatório, como proteína C-reativa, interleucina 6 e fibrinogênio, correlacionam-se com mortalidade cardiovascular. A associação entre inflamação, desnutrição e aterosclerose acelerada compõe a síndrome MIA (malnutrition, inflammation and atherosclerosis), comumente detectada em urêmicos, e que está diretamente relacionada com a gênese da DCV. Outros fatores importantes são o estresse oxidativo exacerbado, medido pela oxidação lipídica, protéica e de carboidratos (AGES) e que ocasiona dano tecidual, e a disfunção endotelial, agravada pelo ambiente urêmico e por outros fatores. Estas alterações, em conjunto, constituem a base do processo patogênico de aterosclerose e da DCV em pacientes com DRC, contribuindo para a sua elevada morbi-mortalidade. Este artigo é uma revisão atualizada dos mecanismos de inflamação e estresse oxidativo e sua relação com aterosclerose na doença renal crônica.

Chronic kidney disease (CKD) has reached epidemic proportions in the last few years, generating an emergent public health problem. Common risk factors for CKD and cardiovascular disease (CVD) are now well known resulting in a high prevalence rate of cardiovascular events which are the main cause of death in CKD patients. Development of accelerated atherosclerosis is related to traditional risk factors such as diabetes mellitus, arterial hypertension, dislipidemia and smoking, but recently other non traditional factors were found to be significantly associated with cardiovascular mortality, including inflammation, oxidative stress, endothelial dysfunction and uremia, even at early stages of CKD. Inflammatory markers such as C-reactive protein, interleukin 6 and fibrinogen are all correlated with cardiovascular death. The MIA syndrome is characterized by the association between inflammation, malnutrition and accelerated atherosclerosis, a condition commonly found in uremic patients, which is related to the genesis of CVD. Other important factors are the high level of oxidative stress, expressed by oxidized lipids, proteins and carbohydrates (AGES) (Advanced Glycation End Products), which cause tissue damage and endothelial dysfunction, that is aggraveted by the uremic environment and other factors. These alterations are the basis for the pathogenic process of atherosclerosis and CVD in CKD patients, contributing to their high morbidity/ mortality. This article is an updated review of the mechanisms of inflammation and oxidative stress and their relation to atherosclerosis in CKD.

Systemic conditions, oral findings and dental management of chronic renal failure patients: general considerations and case report.

Chronic renal failure is a relatively common systemic disease. Systemic abnormalities such as anemia, platelet disorders and hypertension as well as oral manifestations including xerostomia, uremic stomatitis, periodontal disease and maxillary and mandibular radiographic alterations can be observed in individuals with chronic renal disease. In view of its frequent occurrence and the need of knowledge by dentists dealing with this condition, this paper discusses the most important issues regarding chronic renal failure, addressing its systemic and oral manifestations and the dental management of chronic renal patients. A case report is presented.

Systemic conditions, oral findings and dental management of chronic renal failure patients: general considerations and case report

A insuficiência renal crônica é uma doença sistêmica relativamente comum. Manifestações sistêmicas tais como anemia, hipertensão, distúrbios plaquetários e manifestações bucais como xerostomia, estomatite urêmica, doença periodontal, alterações radiográficas na maxila e mandíbula podem ser observadas em pacientes com insuficiência renal crônica. Frente à freqüência desta condição e à necessidade de informações para o cirurgião-dentista lidar com essa condição, este artigo discute os aspectos mais importantes da insuficiência renal crônica, abordando suas manifestações sistêmicas e orais e o tratamento odontológico de pacientes renais crônicos. A descrição de um caso clínico é apresentada.

Insuficiência renal aguda: revisão / Acute renal failure: review

A insuficiência renal aguda é um problema clínico freqüente em pacientes hospitalizados(5%), principalmente em unidades de terapia intensiva. Apesar dos avanços na medicina, ainsuficiência renal aguda ainda está associada a uma mortalidade que pode variar de 50 a 80%.Esta revisão aborda os aspectos relevantes quanto ao diagnóstico, patogênese, prevenção etratamento da insuficiência renal aguda.

Acute renal failure is a common clinical problem in hospitalized patients (5%), particularlyin intensive care units. Despite the advances in medical care, acute renal failure is still associatedwith a mortality rate ranging from 50 to 80%. This review discusses diagnosis, pathogenesis,prevention and treatment of acute renal failure.