ABSTRACT
We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.
Subject(s)
Acute Kidney Injury/therapy , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Renal Replacement Therapy/standards , Vascular Access Devices/standards , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Brazil/epidemiology , COVID-19 , Clinical Decision-Making , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Critical Care , Humans , Kidney/drug effects , Nephrology/standards , Occupational Diseases/prevention & control , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Recovery of Function , Renal Replacement Therapy/methods , Respiration, Artificial/adverse effects , SARS-CoV-2 , Societies, MedicalSubject(s)
Coronavirus Infections/therapy , Critical Care , Hospital Bed Capacity , Intensive Care Units , Pneumonia, Viral/therapy , Betacoronavirus , Brazil , COVID-19 , Extracorporeal Membrane Oxygenation/methods , Health Care Rationing , Health Workforce , Humans , Mobile Health Units , Pandemics , Patient Isolation , Personal Protective Equipment/supply & distribution , Quality of Health Care , Respiration, Artificial/methods , SARS-CoV-2Subject(s)
Acute Kidney Injury/physiopathology , Ambulatory Care Facilities/organization & administration , Coronavirus Infections/physiopathology , Kidney Failure, Chronic/therapy , Pneumonia, Viral/physiopathology , Renal Dialysis/methods , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Betacoronavirus , Brazil , COVID-19 , Continuous Renal Replacement Therapy/methods , Coronavirus Infections/complications , Humans , Kidney Failure, Chronic/complications , Nephrology , Pandemics , Peritoneal Dialysis , Personal Protective Equipment , Pneumonia, Viral/complications , SARS-CoV-2 , Time FactorsABSTRACT
The new coronavirus disease, named by World Health Organization (WHO) as COVID-19 brought great challenges to patients with end-stage renal disease (ESRD). In general, ESRD patients have higher number of comorbidities and are at age-risk for severe pulmonary presentation of this disease. Another important issue is that hemodialysis (HD) clinics are usually not located in small towns, and these frail patients often travel to their dialysis center in groups and also cannot keep the 6-feet safe distance during their HD session.1.
ABSTRACT
ABSTRACT We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.
RESUMO Este documento foi desenvolvido para trazer informações pertinentes à prática nefrológica em relação ao conhecimento sobre o acometimento renal da COVID-19, conduta frente aos casos de injúria renal aguda e orientações práticas sobre a provisão do suporte dialítico.Como as informações sobre a COVID-19 evoluem a uma velocidade jamais vista na ciência médica, as orientações apresentadas, embora baseadas em evidências científicas recentes, referem-se ao momento presente. Essas orientaços poderão ser atualizadas à medida que dados publicados e outras informações relevantes venham a ser disponibilizadas.
Subject(s)
Humans , Pneumonia, Viral/epidemiology , Renal Replacement Therapy/standards , Coronavirus Infections/epidemiology , Acute Kidney Injury/therapy , Vascular Access Devices/standards , Betacoronavirus , Respiration, Artificial/adverse effects , Societies, Medical , Brazil/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/drug therapy , Recovery of Function , Critical Care , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Clinical Decision-Making , SARS-CoV-2 , COVID-19 , Occupational Diseases/prevention & controlABSTRACT
A doença renal crônica acarreta alterações em todos os sistemas corporais. Os pacientes cursam com marcada redução do condicionamento cardiorrespiratório, alterações musculares, reduzida performance física e pior qualidade de vida. A atividade física tem sido cada vez mais utilizada como forma de tratamento para essa população. Programas de treinamento físico aeróbio e/ou resistidos de moderada ou baixa intensidade no período interdialítico e durante a hemodiálise têm sido utilizados. Entretanto, os benefícios dessas intervenções no doente renal crônico, a escolha mais apropriada do tipo de treinamento e a segurança da aplicabilidade de atividades específicas não estão bem esclarecidos. Esta revisão tem como objetivo abordar os aspectos relacionados com o tipo de treinamento, período em que este é realizado, assim como os possíveis benefícios que o treinamento físico pode induzir nessa população.
Chronic renal disease has consequences on several physiological systems. Patients present decrease on cardiorespiratory capability, muscular changes, reduced physical performance and worse quality of life. Physical activity has been increasingly used as therapy for these patients, including training programs with aerobic and resistance exercises of low to moderate intensity in the interdialytic period and during hemodialysis. However, the benefits of physical exercise therapy to chronic renal patients, the choice of better training programs and the applicability safety of specific exercises are not clear yet. Thus, this review has the objective to discuss the aspects concerned with the type of training, better period to perform it and the relevance of their benefits to patients.
Subject(s)
Exercise , Exercise Therapy , Quality of Life , Renal Dialysis , Renal Insufficiency , Resistance TrainingABSTRACT
Porfiria aguda intermitente é patologia incomum, com conseqüências potencialmente graves se não reconhecida precocemente. Dentre as possíveis causas de indução de crises de porfiria, a redução da ingestão calórica é descrita na literatura. Relatamos um caso de porfiria aguda intermitente no pós-operatório tardio de gastroplastia indicada para tratamento da obesidade, revisando aspectos do diagnóstico e tratamento da patologia na unidade de terapia intensiva. Paciente feminina, 31 anos, com história de gastroplastia há 3 semanas admitida na unidade de terapia intensiva com rebaixamento do nível de consciência e desconforto respiratório. Evoluiu com agitação psicomotora, confusão mental, dor abdominal e tetraparesia proximal. Na investigação diagnóstica foi encontrado hiponatremia grave (92 mEq/L), hipomagnesemia, hipofosfatemia e hipocalcemia, urina turva, sem hematúria. Aventou-se hipótese de porfiria aguda, realizado dosagem do ácido delta-aminolevulínico e porfobilinogênio na urina de 24h, com elevação de ambos. Iniciado tratamento com dieta rica em carboidratos, sem utilizar hematina ou arginato de heme, devido à dificuldades no fornecimento destas medicações. Evoluiu com melhora clínica gradativa e recuperação completa da força muscular após 8 meses. A porfiria aguda intermitente possui sinais e sintomas comuns a muitas patologias clínicas e neuropsiquiátricas dificultando o diagnóstico, em especial quando estes se manifestam isoladamente. Assim, deve-se incluir a porfiria aguda intermitente no diagnóstico diferencial de distúrbios neurológicos, psiquiátricos e gastroenterológicos em crises, no qual todos os demais exames estejam normais. Atenção deve ser dada a pacientes submetidos à cirurgias, em especial cirurgia bariátrica que, além do estresse cirúrgico, limita substancialmente a ingesta calórica podendo desencadear crises. Não há descrito na literatura, até o momento, nenhum caso de porfiria aguda intermitente no pós-operatório...
Acute intermittent porphyria is an unusual pathology with potentially severe consequences when not early detected. Among the possible causes of porphyric crises decrease of caloric intake has been described. A case of acute intermittent porphyria in the late postoperative period of a bariatric surgery performed for treatment of obesity is reported. A review of the diagnostic aspects and management of this pathology in the intensive care unit follows. A 31 year old woman was admitted in the intensive care unit three weeks after a bariatric surgery, with decreased level of consciousness and respiratory distress. The patient evolved with psychomotor agitation, mental confusion, abdominal pain and proximal tetraparesis. Diagnosis investigation disclosed severe hyponatremia (92mEq/L), hypomagnesemia, hypophosfatemia and hypocalcemia and cloudy urine without hematuria. Acute porphyria was suspected and the urine test detected high delta amino-levulinic acid and porphobilinogen. Treatment consisted of a correction of electrolyte disturbances and high carbohydrate intake. Hematin and heme arginate were not used, due to the difficulty to acquire the medication. After 8 months the patient progressed with full recovery of muscle strength and a clinical improvement. Acute intermittent porphyria has signs and symptoms common to several clinical, neurological, psychiatric and gastroenterological pathologies, which complicate diagnosis. Therefore, acute intermittent porphyria should be included in the differential diagnosis of neurological, psychiatric and gastroenterological alterations when results of all other exams are normal. Attention must be given to patients undergoing surgery mainly bariatric that, in addition to procedure stress, substantially limit the total caloric intake, potentially triggering crises. Review of literature did not disclose any report of acute intermittent porphyria crisis induced by bariatric surgery.
Subject(s)
Humans , Female , Adult , Bariatric Surgery , Hyponatremia , Porphyria, Acute Intermittent/diagnosisABSTRACT
Acute intermittent porphyria is an unusual pathology with potentially severe consequences when not early detected. Among the possible causes of porphyric crises decrease of caloric intake has been described. A case of acute intermittent porphyria in the late postoperative period of a bariatric surgery performed for treatment of obesity is reported. A review of the diagnostic aspects and management of this pathology in the intensive care unit follows. A 31 year old woman was admitted in the intensive care unit three weeks after a bariatric surgery, with decreased level of consciousness and respiratory distress. The patient evolved with psychomotor agitation, mental confusion, abdominal pain and proximal tetraparesis. Diagnosis investigation disclosed severe hyponatremia (92mEq/L), hypomagnesemia, hypophosfatemia and hypocalcemia and cloudy urine without hematuria. Acute porphyria was suspected and the urine test detected high delta amino-levulinic acid and porphobilinogen. Treatment consisted of a correction of electrolyte disturbances and high carbohydrate intake. Hematin and heme arginate were not used, due to the difficulty to acquire the medication. After 8 months the patient progressed with full recovery of muscle strength and a clinical improvement. Acute intermittent porphyria has signs and symptoms common to several clinical, neurological, psychiatric and gastroenterological pathologies, which complicate diagnosis. Therefore, acute intermittent porphyria should be included in the differential diagnosis of neurological, psychiatric and gastroenterological alterations when results of all other exams are normal. Attention must be given to patients undergoing surgery mainly bariatric that, in addition to procedure stress, substantially limit the total caloric intake, potentially triggering crises. Review of literature did not disclose any report of acute intermittent porphyria crisis induced by bariatric surgery.