Quality of information provided by Brazilian Fertility Clinic websites: Compliance with Brazilian Medical Council (CFM) and American Society for Reproductive Medicine (ASRM) Guidelines.

OBJECTIVE: To evaluate the websites of Brazilian fertility clinics included in the 11th Report of the National Embryo Production System (SisEmbrio, 2017) for compliance with the 2004 American Society for Reproductive Medicine (ASRM) and the Brazilian Medical Council (Conselho Federal de Medicina, CFM) guidelines for advertising. METHODS: We performed an online evaluation of the websites of clinics listed in the 11th SisEmbrio report based on criteria from the 2004 ASRM guidelines (publication of success rates, live birth rates (LBR), method of LBR calculation, success rates by age range and diagnosis, experimental/investigational nature of procedures and the practice of comparison marketing) and CFM guidelines (clinic director name and register visible on the website; no prices displayed, no photos of patients nor success stories with patient identification). RESULTS: A total of 161 SiSEmbrio-registered clinics were evaluated: 153 (95.0%) had functional websites, and only seven were public clinics. Social media presence was as follows: 87 (54.03%) were on WhatsApp; 128 (79.5%) were on Facebook; and 122 (75.8%) were on Instagram. Seventy-five (46.6%) were on other social media platforms (YouTube, LinkedIn, and Twitter). Regarding CFM recommendations, 49 (30.4%) showed information of a registered director, 85 (52.8%) showed patient photos on their websites and/or social media accounts. Fifty-four clinics published success rates (33.5%) and 19 (11.8%) used their own data, whereas seven (4.3%) showed pregnancy rates by age. None reported LBR or advertised prices. CONCLUSIONS: The information published online by Brazilian fertility clinics is heterogeneous in nature. A significant portion of the websites does not follow some of the ASRM and CFM guidelines for advertising.

Hepatorenal syndrome in children: a review.

Hepatorenal syndrome (HRS) occurs in patients with cirrhosis or fulminant hepatic failure and is a kind of pre-renal failure due to intense reduction of kidney perfusion induced by severe hepatic injury. While other causes of pre-renal acute kidney injury (AKI) respond to fluid infusion, HRS does not. HRS incidence is 5% in children with chronic liver conditions before liver transplantation. Type 1 HRS is an acute and rapidly progressive form that often develops after a precipitating factor, including gastrointestinal bleeding or spontaneous bacterial peritonitis, while type 2 is considered a slowly progressive form of kidney failure that often occurs spontaneously in chronic ascites settings. HRS pathogenesis is multifactorial. Cirrhosis causes portal hypertension; therefore, stasis and release of vasodilator substances occur in the hepatic vascular bed, leading to vasodilatation of splanchnic arteries and systemic hypotension. Many mechanisms seem to work together to cause this imbalance: splanchnic vasodilatation; vasoactive mediators; hyperdynamic circulation states and subsequent cardiac dysfunction; neuro-hormonal mechanisms; changes in sympathetic nervous system, renin-angiotensin system, and vasopressin. In patients with AKI and cirrhosis, fluid expansion therapy needs to be initiated as soon as possible and nephrotoxic drugs discontinued. Once HRS is diagnosed, pharmacological treatment with vasoconstrictors, mainly terlipressin plus albumin, should be initiated. If there is no response, other options can include surgical venous shunts and kidney replacement therapy. In this regard, extracorporeal liver support can be a bridge for liver transplantation, which remains as the ideal treatment. Further studies are necessary to investigate early biomarkers and alternative treatments for HRS.

COVID-19 and Renal Diseases: An Update.

BACKGROUND: It becomes increasingly evident that the SARS-CoV-2 infection is not limited to the respiratory system. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease. METHODS: Data was obtained by a comprehensive and non-systematic search in the PubMed, Cochrane, Scopus and SciELO databases, using mainly the terms "SARS-CoV-2", "COVID-19", "chronic kidney disease", "renal transplantation", acute kidney injury" and "renal dysfunction" Discussion: The membrane-bound angiotensin-converting enzyme 2 is the receptor for SARS-CoV- -2, and this interaction may lead to an imbalance of the Renin-Angiotensin System (RAS), associated with worse clinical presentations of COVID-19, including acute pulmonary injury, hyperinflammatory state and hematological alterations. In the framework of renal diseases, the development of acute kidney injury is associated mostly with immune alterations and direct cytopathic lesions by the virus, leading to higher mortality. As for chronic kidney disease, the patients at a non-terminal stage have a worse prognosis, while the hemodialysis patients appear to have mild courses of COVID-19, probably due to lower chances of being affected by the cytokine storm. Furthermore, the current scenario is unfavorable to kidney donation and transplantation. The relationship between COVID-19 and immunosuppression in kidney transplantation recipients has been greatly discussed to determine whether it increases mortality and how it interacts with immunosuppressive medications. CONCLUSION: The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection, and more research is required to have a complete understanding of the repercussions caused by COVID-19 in renal diseases.