O papel da biópsia renal percutânea no transplante renal / The value of percutaneous renal biopsy in kidney transplantation

A biópsia renal percutânea (BRP) vem sendo utilizada como padräo-ouro para o diagnóstico das disfunçöes renais pós-transplante renal. OBJETIVO. Avaliar o papel atual da BRP como modificadora do diagnóstico e conduta nas disfunçöes renais agudas (DRA) pós-transplante renal. MÉTODOS. Foram estudados 67 pacientes tranplantados renais como disfunçöes renais agudas submetidos a 95 biópsias válidas feitas à beira do leito, sem complicaçöes maiores. RESULTADOS. Foi observado discordância entre o diagnóstico clínico e o patológico em 28 ocasiöes (29,5 por cento). Em 36 situaçöes (37,9 por cento) os resultados dos exames histopatológicos levaram a mudanças no manejo dos pacientes. Entre essas modificaçöes destacam-se: suspensäo do pulso de esteróides (oito casos); nefrectomia do enxerto renal (oito casos); suspensäo ou diminuiçäo da dosagem de ciclosporina (seis casos); início de pulso de esteróides (cinco casos) e início de antibioticoterapia por pielonefrite aguda em quatro casos. O uso de rins de doadores cadavéricos esteve significativamente associado a uma freqüência aumentada de biópsia renais (p < 0,05). CONCLUSAO. Esses resultados demonstram que, apesar da existência de métodos menos invasivos, a BRP permanece sendo um método indispensável no manejo do paciente transplantado renal com DRA

[The role of percutaneous renal biopsy in kidney transplant]. / O papel da biópsia renal percutânea no transplante renal.

Percutaneous renal biopsy (PRB) is an useful tool for diagnostic and therapeutic orientation in renal transplantation. PURPOSE--To evaluate the current role of PRB in post-transplant acute renal dysfunction (ARD) of renal allografts. METHODS--Sixty-five renal transplant patients were submitted to 95 valid renal biopsies with no major complications. RESULTS--There was disagreement between the clinical and the pathological diagnosis in 28 occasions (29.5%). In 36 cases (37.9%) the results of the pathological examination led to a modification in patient's management. These modifications were most commonly the avoidance or witholding of a steroid pulse (8 cases); nephrectomy of the renal allograft (8 cases); witholding or decrease of cyclosporine dosage (6 cases); giving a steroid pulse (5 cases) and giving antibiotics to treat acute pyelonephritis in 4 cases. The use of kidneys from cadaveric donors was significantly associated with an increased number of biopsies (p < 0.05). CONCLUSION--These results demonstrate that even though several less invasive procedures are currently employed, renal biopsy is still an indispensable method to the management of ARD in renal transplant patients.

Fine needle aspirative biopsy of the liver in HBsAG-positive patients with end-stage renal failure.

HBsAg-positive patients with end-stage renal failure have a high prevalence of asymptomatic chronic hepatitis. In order to determine the usefulness of hepatic cytology in the diagnosis of liver disease, the findings of hepatic needle core biopsy (NCB) and fine needle aspirative biopsy (FNAB) were compared in 15 HBsAg-positive uremic patients. The patients, aged 42 +/- 12 years, 14 males, were on hemodialysis for periods ranging from 13 to 105 months. The NCB was processed by standard histologic and immunohistochemical techniques and FNAB by the conventional technique, using the total corrected increment score (TCI). Plasma samples were collected for evaluation of hepatic function and for viral serologic tests. In 15 patients a diagnosis was made by NCB: normal, 7 cases; chronic persistent hepatitis, 4 cases; and chronic active hepatitis, 4 cases. When the patients were allocated into two groups according to the severity of the liver histologic findings [group I--minor changes (normal+chronic persistent hepatitis), 11 patients; group II--major changes (chronic active hepatitis), 4 patients], statistically higher values were found in the major changes group for alanine aminotransferase (49 +/- 33 vs. 24 +/- 11, p = 0.04), gamma-glutamyl transpeptidase [148 +/- 53 vs. 38 +/- 28, p < (minor) 0.02] and TCI (3.7 +/- 1.2 vs. 2.5 +/- 0.8, p = 0.04). In conclusion, liver FNAB can be useful as a screening procedure for the identification of liver histologic changes (minor or major) in uremic HBsAG-positive patients.

Alteraçöes hidroeletrolíticas, ácido-básicas e da funçäo renal em pacientes portadores da síndrome da imunodeficência adquirida / Hydroelectrolyte changes, acid-base and renal function in patients carrier acquired immunodeficiency syndrome

OBJETIVO. Avaliar a influência no curso clínico e a prevalência de distúrbios hidroeletrolíticos, ácido-básicos e da funçäo renal em pacientes portadores da síndrome da imunodeficiência adquirida (SIDA). Casuística e Métodos. A partir de um protocolo preestabelecido, revisaram-se os prontuários da primeira internaçäo de todos os pacientes admitidos durante o primeiro semestre de 1989. RESULTADOS. Noventa e nove pacientes foram estudados. A prevalência de hiponatremia, no momento da baixa, foi de 45% e durante a internaçäo, de 80,7% dos pacientes avaliados. Hipopotassemia esteve presente em 23,1% dos pacientes e acidose metabólica e insuficiência renal em 20,1 e 28,4%, respectivamente. O risco relativo para mortalidade em pacientes com hipopotassemia foi 4,4. Acidose metabólica e insuficiência renal aguda apresentaram riscos relativos de 12,9 e 21,4. Estes fatores, hipopotassemia (p < 0,01), acidose metabólica (p < 0,001) e insuficiência renal aguda (p < 0,001), estiveram significativamente associados à mortalidade. DISCUSSÄO E CONCLUSOES. Conclui-se que existe uma elevada prevalência das alteraçöes avaliadas nos pacientes com SIDA e que o desenvolvimento de hipopotassemia, acidose metabólica e insuficiência renal aguda está significativamente associado à mortalidade nestes pacientes

[Hydroelectrolyte, acid-base, and renal function changes in patients with acquired immunodeficiency syndrome]. / Alterações hidroelectrolíticas, ácido-básicas e da função renal em pacientes portadores da síndrome da imunodeficiência adquirida.

BACKGROUND: A variety of metabolic and renal disturbances have been described in patients with Acquired Immunodeficiency Syndrome (AIDS) but their influence on the clinical outcome has not been reported. The present study was undertaken in order to evaluate the prevalence of fluid and electrolyte, acid-base, and renal function disturbances in AIDS patients. The influence of these abnormalities on the clinical outcome was studied as well. MATERIAL AND METHODS: Following to a previously established protocol, the charts of all patients hospitalized during the first semester of 1989 were reviewed. RESULTS: The prevalence of hyponatremia was 45% and 80.7% at admission and during hospitalization respectively of 99 patients. Hypokalemia was present in 23.1% of the patients. Metabolic acidosis and renal failure were 20.1% and 28.4% prevalent. The relative risk for mortality in patients with hypokalemia was 4.4. Metabolic acidosis and acute renal failure had relative risks of 12.9 and 21.4. CONCLUSIONS: There is an elevated prevalence of fluid and electrolyte, acid-base and renal function disturbances in these patients. The presence of hypokalemia, metabolic acidosis, and renal failure are significantly associated with mortality in AIDS.

Caliceal-cutaneous fistula in renal transplantation: successful conservative management.

Caliceal-cutaneous fistula is an uncommon complication of renal transplantation that frequently leads to graft resection. We report our experience with the successful conservative management of a case of caliceal-cutaneous fistula secondary to acute allograft rejection in a renal transplant recipient.

[Acquired renal cystic disease in uremia: a prevalence survey]. / Doença renal cística adquirida da uremia: estudo de prevalência.

The acquired cystic disease of the kidney (ACDK) occurs in uremic patients before and during dialysis treatment. It has been defined as a disease with multiple acquired cystic lesions in patients with advanced renal failure. We evaluated its prevalence in a group of 94 uremic patients employing ultrasonographic examinations. Eighteen patients were not on dialysis treatment (group I) and 76 patients were undergoing hemodialytic treatment (group II). The prevalence of ACDK in groups I and II was 16.7% and 39.5% respectively. There is a noteworthy progression in the prevalence of the disease as the patients are kept alive by dialysis treatment. Primary renal disease, age and sex were not important factors in the disease's prevalence.

Hemodialise e hepatite a virus B. / Hemodialysis and virus B hepatitis

Realizou-se um levantamento do grau de exposicao ao virus da hepatite B, observada entre pacientes e funcionarios de algumas unidades de hemodialise e fez-se um estudo comparativo com o que ocorre na populacao geral e em alguns grupos de pessoal tecnico hospitalar. A pesquisa, que empregou marcadores da hepatite B (HBsAg e anti-HBs), indicou maior exposicao ao virus entre os pacientes em hemodialise cronica (61%) e, em menor proporcao, entre os funcionarios hospitalares, com maior contato com sangue humano