RESUMO
La evaluación de la función renal se realiza habitualmente a través de la estimación de la tasa de filtración glomerular y el análisis de la orina. La evaluación morfológica renal a través de una imagen permite complementar esta información. Sin embargo, muchas de las aplicaciones de las técnicas actuales de imágenes son desconocidas por los médicos clínicos. Además, la comunicación entre médicos clínicos y especialistas en imágenes es menos usual de lo deseable. En esta revisión describiremos los métodos de imagen más frecuentemente utilizados para la evaluación de la función renal y otras situaciones clínicas nefrológicas, además de analizar los avances más significativos, particularmente en ultrasonografía y resonancia magnética, para la pesquisa precoz y seguimiento del daño renal.
The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.
Assuntos
Humanos , Taxa de Filtração Glomerular/fisiologia , Rim/fisiologia , Rim/diagnóstico por imagem , Nefropatias/fisiopatologia , Nefropatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Ultrassonografia , Testes de Função Renal/métodosRESUMO
The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.
Assuntos
Taxa de Filtração Glomerular , Nefropatias , Rim , Imageamento por Ressonância Magnética , Humanos , Rim/diagnóstico por imagem , Rim/fisiologia , Taxa de Filtração Glomerular/fisiologia , Nefropatias/diagnóstico por imagem , Nefropatias/fisiopatologia , Testes de Função Renal/métodos , Ultrassonografia/métodosRESUMO
SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.
Assuntos
Injúria Renal Aguda , COVID-19 , Rabdomiólise , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/virologia , Adulto , COVID-19/complicações , Feminino , Humanos , Terapia de Substituição Renal , Rabdomiólise/diagnóstico , Rabdomiólise/virologiaRESUMO
SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.
Assuntos
Humanos , Feminino , Adulto , Rabdomiólise/diagnóstico , Rabdomiólise/virologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/virologia , COVID-19/complicações , Terapia de Substituição RenalRESUMO
BACKGROUND: Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. METHODS: Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. RESULTS: nRIFLE criteria were used to divide cohorts in "NO AKI" (12 patients) and "AKI" (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. CONCLUSIONS: The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.
Assuntos
Injúria Renal Aguda , Procedimentos Cirúrgicos Cardíacos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Proteínas de Fase Aguda , Biomarcadores , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Creatinina , Humanos , Recém-Nascido , Rim/fisiologia , Lipocalina-2 , Valor Preditivo dos Testes , Proteínas Proto-OncogênicasRESUMO
Renal involvement is a frequent complication in antineutrophil cytoplasmic antibodies (ANCA)associated vasculitides, adding morbidity and mortality, such as chronic kidney disease and the need for renal replacement therapy. With the aim of reaching a consensus on relevant issues regarding the diagnosis, treatment and follow-up of patients with these diseases, the Chilean Societies of Nephrology and Rheumatology formed a working group that, based on a critical review of the available literature and their experience, raised and answered consensually a set of questions relevant to the subject. This document includes aspects related to the clinical diagnosis, the histological characteristics, the therapeutic alternatives to induce and maintain the remission of the disease, relapse surveillance strategies and complementary therapies.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Anticorpos Anticitoplasma de Neutrófilos/sangue , Nefropatias/etiologia , Nefropatias/terapia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/sangue , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Chile , Humanos , Quimioterapia de Manutenção , Indução de Remissão , Sociedades MédicasRESUMO
Renal involvement is a frequent complication in antineutrophil cytoplasmic antibodies (ANCA)associated vasculitides, adding morbidity and mortality, such as chronic kidney disease and the need for renal replacement therapy. With the aim of reaching a consensus on relevant issues regarding the diagnosis, treatment and follow-up of patients with these diseases, the Chilean Societies of Nephrology and Rheumatology formed a working group that, based on a critical review of the available literature and their experience, raised and answered consensually a set of questions relevant to the subject. This document includes aspects related to the clinical diagnosis, the histological characteristics, the therapeutic alternatives to induce and maintain the remission of the disease, relapse surveillance strategies and complementary therapies.
Assuntos
Humanos , Anticorpos Anticitoplasma de Neutrófilos/sangue , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Nefropatias/etiologia , Nefropatias/terapia , Sociedades Médicas , Indução de Remissão , Chile , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/sangue , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Quimioterapia de ManutençãoRESUMO
Renal involvement affects over one half of patients with Systemic Lupus Erythematosus increasing their mortality and morbidity, including chronic renal disease and the need of renal replacement therapies. Aiming to achieve a consensus in the most relevant topics on diagnosis, therapy and follow-up of patients with lupus renal disease, the Chilean Societies of Nephrology and Rheumatology constituted a workgroup that, based on a critical review of the available literature and their experience, raised and answered by consensus a set of relevant questions. This document includes aspects related to the clinical diagnosis, the importance of a suitable histological classification, therapeutic alternatives to induce and maintain disease remission, strategies for follow-up, additional therapies and ginecological-obstetric issues.
Assuntos
Humanos , Lúpus Eritematoso Sistêmico/complicações , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Chile , Consenso , Insuficiência Renal Crônica/diagnósticoRESUMO
Renal involvement affects over one half of patients with Systemic Lupus Erythematosus increasing their mortality and morbidity, including chronic renal disease and the need of renal replacement therapies. Aiming to achieve a consensus in the most relevant topics on diagnosis, therapy and follow-up of patients with lupus renal disease, the Chilean Societies of Nephrology and Rheumatology constituted a workgroup that, based on a critical review of the available literature and their experience, raised and answered by consensus a set of relevant questions. This document includes aspects related to the clinical diagnosis, the importance of a suitable histological classification, therapeutic alternatives to induce and maintain disease remission, strategies for follow-up, additional therapies and gynecological-obstetric issues.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Chile , Consenso , Humanos , Insuficiência Renal Crônica/diagnósticoAssuntos
Cardiomegalia/tratamento farmacológico , Fármacos Cardiovasculares/farmacologia , Nefropatias/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Quinases Associadas a rho/antagonistas & inibidores , Animais , Coração/efeitos dos fármacos , Humanos , Rim/efeitos dos fármacos , Rim/enzimologia , Camundongos , Miocárdio/enzimologia , RatosRESUMO
OBJECTIVE: Renal vasoconstriction has been blamed as a cause of perioperative renal dysfunction after cardiac surgery. Endothelial function is a critical determinant of vascular tonus, including vasoconstriction. The objective of this study was to establish whether the release of the endothelial vasodilator nitric oxide (NO) or NO products is altered in patients undergoing surgery with cardiopulmonary bypass in 3 different clinical conditions. DESIGN: Observational and randomized prospective study. SETTING: University hospital. PARTICIPANTS: Adults and pediatric patients undergoing elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Three groups of patients were studied: group 1, 10 patients undergoing elective coronary artery surgery; group 2, 20 patients undergoing elective coronary artery surgery randomized to 2 hematocrit values during cardiopulmonary bypass, high (27%) and low (23%); and group 3, 10 pediatric patients undergoing surgical repair of noncyanotic cardiac defects. MEASUREMENTS AND MAIN RESULTS: NO products (NO2 + NO3) and cyclic guanosine monophosphate (cGMP) in urine were measured before, during hypo- and normothermic cardiopulmonary bypass, and 1 hour postoperatively. Filtration fraction was calculated. The glomerular filtration rate and effective renal plasma flow were measured with inulin and (131)I-hippuran clearances, respectively. Urinary alpha glutathione s-transferase was measured pre- and postoperatively in groups 1 and 3. NO products, as well as cGMP, decreased significantly during hypo- and normothermic cardiopulmonary bypass in all groups. This was not because of urine dilution or the degree of hemodilution. Age did not appear to alter this response. Filtration fraction decreased during cardiopulmonary bypass. Alpha glutathione s-transferase was normal pre-and postoperatively. CONCLUSIONS: Cardiac surgery with cardiopulmonary bypass is associated with a significant decrease of NO products. In the absence of kidney damage, decreased NO products could represent a physiologic response to cardiopulmonary bypass; however, endothelial dysfunction cannot be excluded.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Óxido Nítrico/urina , Adulto , Idoso , Anestesia Geral , Biomarcadores , Ponte de Artéria Coronária , Creatinina/sangue , GMP Cíclico/sangue , Feminino , Cardiopatias Congênitas/cirurgia , Hematócrito , Humanos , Lactente , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Tono Muscular/fisiologia , Músculo Liso Vascular/fisiologia , Circulação Renal/fisiologiaRESUMO
BACKGROUND: Patients with valvular heart disease are at high risk of acute renal failure after surgery with extracorporeal circulation. AIM: To describe changes in renal function parameters during surgery with extracorporeal circulation in patients with valvular heart disease and compare them with those found in patients undergoing elective coronary surgery. MATERIAL AND METHODS: Two groups of patients were studied. Group 1 was composed by twelve patients undergoing elective coronary surgery and group 2 was composed by eleven patients undergoing surgery for heart valve replacement. Glomerular filtration rate and effective renal plasma now were estimated from inulin and the 131 I-hippuran clearance respectively, at five different times, during surgery and the postoperative period. Sodium filtration fraction and fractional excretion were calculated. Alpha and pi-glutathione s-transferase in urine were measured as markers of tubular damage in the pre and postoperative periods. RESULTS: Effective renal plasma flow was reduced in both groups before induction of anesthesia, did not change during surgery and decreased significantly in patients with valvular disease in the postoperative period. Glomerular filtration rates were normal during all the study period. There was a non significant reduction of filtration fraction during extracorporeal circulation. Alpha and pi glutathione s-transferases were normal and did not change. Fractional excretion of sodium increased significantly postoperatively. CONCLUSIONS: In patients with valvular disease undergoing surgery with extracorporeal circulation, renal function does not deteriorate. No significant difference was found when compared with patients undergoing coronary surgery. No evidence of functional and cellular renal disfunction or damage was found in both study groups.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Circulação Extracorpórea , Doenças das Valvas Cardíacas/cirurgia , Testes de Função Renal , Rim/fisiologia , Adulto , Idoso , Análise de Variância , Nitrogênio da Ureia Sanguínea , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Período Intraoperatório , Túbulos Renais/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Circulação Renal/fisiologia , Estatísticas não ParamétricasRESUMO
Background: Patients with valvular heart disease are at high risk of acute renal failure after surgery with extracorporeal circulation. Aim: To describe changes in renal function parameters during surgery with extracorporeal circulation in patients with valvular heart disease and compare them with those found in patients undergoing elective coronary surgery Material and Methods: Two groups of patients were studied. Group 1 was composed by twelve patients undergoing elective coronary surgery and group 2 was composed by eleven patients undergoing surgery for heart valve replacement. Glomerular filtration rate and effective renal plasma now were estimated from inulin and the 131 I-hippuran clearance respectively, at five different times, during surgery and the postoperative period. Sodium filtration fraction and fractional excretion were calculated. Alpha and pi-glutathione s-transferase in urine were measured as markers of tubular damage in the pre and postoperative periods. Results: Effective renal plasma flow was reduced in both groups before induction of anesthesia, did not change during surgery and decreased significantly in patients with valvular disease in the postoperative period. Glomerular filtration rates were normal during all the study period. There was a non significant reduction of filtration fraction during extracorporeal circulation. Alpha and pi glutathione s-transferases were normal and did not change. Fractional excretion of sodium increased significantly postoperatively Conclusions: In patients with valvular disease undergoing surgery with extracorporeal circulation, renal function does not deteriorate. No significant difference was found when compared with patients undergoing coronary surgery. No evidence of functional and cellular renal disfunction or damage was found in both study groups.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos , Circulação Extracorpórea , Doenças das Valvas Cardíacas/cirurgia , Testes de Função Renal , Rim/fisiologia , Análise de Variância , Nitrogênio da Ureia Sanguínea , Taxa de Filtração Glomerular/fisiologia , Período Intraoperatório , Túbulos Renais/fisiologia , Estudos Prospectivos , Circulação Renal/fisiologia , Estatísticas não ParamétricasRESUMO
UNLABELLED: A strong interrelationship exists between the regulation of bile acid (BA) metabolism and hepatic very low density lipoprotein (VLDL) production. We have recently shown that BA synthesis is increased in gallstone disease. We investigated the activity of hepatic microsomal triglyceride transfer protein (MTTP) as a surrogate of VLDL production, BA synthesis, and mRNA expression levels of proteins that regulate fatty acid (FA) metabolism in the liver of gallstone (GS) patients compared with GS-free patients. Twenty-seven volunteers subjected to elective surgery; 9 were GS-free and 18 with GS agreed to have a liver biopsy. We quantified by a fluorescence assay the activity of MTTP and by quantitative reverse-transcription PCR (RT-PCR) the mRNA content of hepatic MTTP and genes that regulate hepatic sterol and FA metabolism. Plasma was assayed for lathosterol and 7alpha-hydroxy-4-cholesten-3-one. Liver histology was normal in GS and GS-free patients. Serum VLDL triglycerides and apoB were significantly increased in GS. Hepatic triglycerides tripled in GS (P<0.001) compared with GS-free. MTTP activity increased 70% (P<0.001). Serum lathosterol and hepatic cholesterol concentrations, and mRNA expressions of MTTP, CD36, and FABP1 were similar in GS-free and GS patients. Hepatic mRNA expression of hydroxy-3-methylglutaryl-coenzyme A reductase (HMGR) and 3-hydroxyl-3-methyl-glutaryl-CoA synthase (HMGS) were significantly decreased--40% and 27%, respectively--in GS. Serum 7alpha-hydroxy-4-cholesten-3-one was 75% higher, and mRNA expression of CYP7A1 was increased sevenfold (P<0.001) in GS. CONCLUSION: Hepatic MTTP activity and BA synthesis are increased in GS. Results suggest that hepatic VLDL production and trafficking of BA are increased in gallstone patients.
Assuntos
Ácidos e Sais Biliares/biossíntese , Proteínas de Transporte/metabolismo , Cálculos Biliares/metabolismo , Adulto , Apolipoproteínas B/metabolismo , Glicemia/metabolismo , Colestenonas/sangue , Colesterol/sangue , Ácidos Graxos/metabolismo , Humanos , Hidroximetilglutaril-CoA Redutases/metabolismo , Hidroximetilglutaril-CoA Sintase/metabolismo , Lipoproteínas VLDL/biossíntese , Fígado/metabolismo , Pessoa de Meia-Idade , Triglicerídeos/metabolismoRESUMO
We studied prospectively the perioperative changes of renal function in nine children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured with inulin and (131)I-hippuran clearances before CPB, during hypo and normothermic CPB, following sternal closure and 1 h postoperatively. Urinary alpha glutathione S-transferase (alpha GS-T) was measured pre- and postoperatively as a marker for tubular cellular damage. Plasma and urine creatinine and electrolytes were measured. Free water, osmolal and creatinine clearances, as well as fractional excretion of sodium (FeNa) and potassium transtubular gradient (TTKG) were calculated. GFR was normal before and after surgery. ERPF was low before and after surgery; it increased significantly immediately after CPB. Filtration fraction (FF) was abnormally elevated before and after surgery; however, a significant decrease during normothermic CPB and sternal closure was found. Alpha GS-T presented a moderate, but nonsignificant increase postoperatively. FeNa also increased in this period, but not significantly. Creatinine, osmolal, free water clearances, as well as TTKG, were normal in all patients pre- and postoperatively. We conclude that there is no evidence of clinically significant deterioration of renal function in children undergoing repair of cardiac lesions under CPB. Minor increases of alpha GS-T in urine postoperatively did not confirm cellular tubular damage. There was no tubular dysfunction at that time.
Assuntos
Ponte Cardiopulmonar , Túbulos Renais/patologia , Túbulos Renais/fisiologia , Creatinina/urina , Feminino , Taxa de Filtração Glomerular/fisiologia , Glutationa Transferase/urina , Humanos , Lactente , Inulina/urina , Ácido Iodoipúrico/metabolismo , Isoenzimas/urina , Testes de Função Renal , Masculino , Estudos Prospectivos , Fluxo Plasmático Renal/fisiologiaRESUMO
A 33 years old woman was admitted to the hospital after four days with cough, dyspnea, orthopnea and hemoptysis. Blood pressure was 170/90 mmHg, pulse was 112 and temperature was normal. She had cyanosis and a left ventricular gallop, without heart murmurs. A chest radiograph revealed pulmonary edema and echocardiogram showed a global left ventricular systolic disfunction. Oxygen and furosemide were started, but cardiopulmonary collapse ensued. The patient was supported with mechanical ventilation and treated with inotropic drugs. A right sided cardiac catheterization showed pulmonary wedge pressure of 18 mmHg and a cardiac index of 3 l/min/m2. The levels of creatinine and urea nitrogen were elevated and a urine protein was 97 mg/dl. Coagulation tests were normal except by a positive lupic anticoagulant. Markers of connective tissue diseases or vasculitis were negatives. The clinical evolution suggested that a catastrophic antiphospholipid syndrome was ongoing. Intravenous corticoids, gammaglobulin and cyclophosphamide were administered with transient improvement. On her fourth day of treatment, the patient presented sudden pulmonary bleeding and embolism. A plasmapheresis was performed with improvement of renal, cardiac and pulmonary function. After this episode, the patient has been treated with prednisone and oral anticoagulants treatment for the last two years, without further clinical events.
Assuntos
Síndrome Antifosfolipídica/complicações , Débito Cardíaco Elevado/etiologia , Doença Aguda , Adulto , Síndrome Antifosfolipídica/tratamento farmacológico , Débito Cardíaco Elevado/tratamento farmacológico , Doença Catastrófica , Feminino , Humanos , Inibidor de Coagulação do Lúpus/sangueAssuntos
Hemofiltração , Potássio/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Transporte Biológico/fisiologia , Biomarcadores/sangue , Chile , Feminino , Humanos , Hiperpotassemia/metabolismo , Hiperpotassemia/terapia , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Estatística como Assunto , Resultado do TratamentoRESUMO
Se analiza el embarazo en la adolescencia, un problema de relevancia en Salud Pública en Chile, en la comuna de Curacaví, localidad agrícola cercana a Santiago. Se enfoca el estudio en base a las siguientes variables: características de las madres, algunas características del embarazo y del parto y características del hijo. Se constata un 19.6% de hijos de madres adolescentes en el total de inscritos en 1983 en el Hospital de Curacaví. Se comprueba un alto porcentaje de madres solteras. Destaca el alto porcentaje de recién nacidos con peso de nacimiento inferior a 3.000 grs. y una prevalencia de desnutrición de 29.3% que triplica la cifra nacional para el año en cuestión. Se determina un promedio de 5 consultas por niño y por año por morbilidad especialmente respiratoria y digestiva. Se observa correspondencia de estos resultados con los de estudios nacionales