ABSTRACT
A common criticism of the classification of lupus nephritis is the relative scarcity of information regarding tubular, interstitial, and vascular changes compared to the available information regarding glomerular changes, even though their potential for independent progression is known. This study reviewed the importance of less explored lesions by the current and widely used 2003 classification of lupus nephritis of the International Society of Nephrology/Renal Pathology Society (ISN/RPS), with emphasis on the tubulointerstitial, podocyte, and vascular lesions, increasingly recognised as being important in the pathogenesis and prognosis of the disease. Recognition of these lesions can help with therapeutic decision-making, thereby allowing better results for patients with systemic lupus erythematosus.
ABSTRACT
Introduction: high sodium intake is a risk factor for diseases such as systemic arterial hypertension, stroke, left ventricular hypertrophy, and chronic kidney disease (CKD). Objective: to evaluate the correlation between estimated sodium intake by dietary intake and 24-hour urinary excretion in patients with non-dialysis CKD. Material and Methods: a cross-sectional study with 151 individuals. Demographic, socioeconomic, clinical and lifestyle data were evaluated. Sodium was dosed in 24-hour urine and estimated by 24-hour Food Recall (R24h). To evaluate the association between demographic, anthropometric, nutritional and laboratory variables with sodium excretion in 24-hour urine, variance analysis (ANOVA) or Kruskal-Wallis test were used. The correlation between 24-hour urinary sodium excretion and dietary sodium intake was performed by Spearman's correlation coefficient. Results: mean age was 60.8 ± 11.8 years, 51.7 % were women. Hypertensive patients, 88.9 %; diabetics, 45.0 %; and 39.1 % were in stage 3B of CKD. Median sodium excretion in 24-hour urine was 112.2 mmol/L and R24h intake was 833.8 mg/day. Individuals belonging to the highest tertile of sodium excretion (T3) presented lower PTH values, and those with lower tertile (T1), higher serum HDL-c levels (p < 0.05). There was no statistical correlation between dietary sodium intake and 24-hour urine excretion (p-value = 0.241). Conclusion: the non-correlation between sodium obtained by 24-hour urinary excretion and dietary intake demonstrates the fragility of the estimation of sodium excretion through the dietary survey. (AU)
Introducción: la ingesta elevada de sodio es un factor de riesgo para enfermedades como la hipertensión arterial sistémica, el accidente cerebrovascular, la hipertrofia ventricular izquierda y la enfermedad renal crónica (ERC). Objetivo: evaluar la correlación entre la ingesta estimada de sodio y la excreción urinaria de 24 horas en pacientes con ERC sin diálisis.Métodos: estudio transversal con 151 individuos. Se evaluaron datos demográficos, socioeconómicos, clínicos y de estilo de vida. El sodio se cuantificó en orina de 24 horas y se estimó en Food Recall (R24h) de 24 horas. Para evaluar la asociación entre variables demográficas, antropométricas, nutricionales y de laboratorio con la excreción de sodio en orina de 24 horas, se utilizó el análisis de varianza (ANOVA) o la prueba de Kruskal-Wallis. La correlación entre la excreción urinaria de sodio de 24 horas y la ingesta de sodio en la dieta se realizó mediante el coeficiente de correlación de Spearman. Resultados: la edad media fue de 60,8 ± 11,8 años, el 51,7 % eran mujeres. Los pacientes hipertensos eran el 88,9 %; los diabéticos, el 45,0 %, y el 39,1 % se encontraban en estadio 3B de ERC. La mediana de excreción de sodio en orina de 24 horas fue de 112,2 mmol/L y la ingesta de R24h fue de 833,8 mg/día. Los individuos pertenecientes al tercil más alto de excreción de sodio (T3) presentaron valores de PTH más bajos y aquellos con niveles más bajos de tercil (T1), mayores niveles séricos de HDL-c (p < 0,05). No hubo correlación estadística entre la ingesta de sodio en la dieta y la excreción de orina durante 24 horas (valor p = 0,241). Conclusión: la ausencia de correlación entre el sodio obtenido por excreción urinaria de 24 horas y la ingesta dietética demuestra la fragilidad de la estimación de la excreción de sodio a través de la encuesta dietética. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Renal Insufficiency, Chronic , Sodium, Dietary , Nutrition Surveys , Cross-Sectional StudiesABSTRACT
BACKGROUND: Ingestion of vitamin C is generally regarded as harmless. Oxalate nephropathy is an infrequent condition and is characterized by oxalate deposition in the renal tubules, in some cases resulting in acute kidney injury. It can be caused by overproduction of oxalate in genetic disorders and, more frequently, as a secondary phenomenon provoked by ingestion of oxalate or substances that can be transformed into oxalate in the patient. CASE PRESENTATION: We present a case of acute oxalate nephropathy in a 59-year-old black male with type 2 diabetes mellitus, who received a kidney transplant 11 years prior. He ingested a large amount of cashew pseudofruit ("cashew apple") during 1 month and developed acute kidney injury. His previous blood creatinine was 2.0 mg/dL, which increased to 7.2 mg/d; he required hemodialysis. He was subsequently discharged without need for dialysis; 3 months later his blood creatinine stabilized at 3.6 mg/dL. CONCLUSIONS: This pseudofruit is rich in ascorbic acid (vitamin C) and poor in oxalate. Urinary oxalate excretion begins to increase when amounts of ascorbic acid above bodily requirements are ingested, and may provoke acute oxalate nephropathy. The patient's oxalate acute nephropathy, in this case, was attributed to excessive vitamin C ingestion from the cashew pseudofruit associated with decreased renal function.
