Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin.

BACKGROUND: After kidney transplantation neurologic manifestations may develop, including Parkinson's disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD. METHODS: In renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed. RESULTS: RTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations. CONCLUSION: RTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.

The spleen size in patients undergoing hemodialysis / O tamanho do baço em pacientes em hemodiálise

Abstract Introduction: Inflammation promotes the progression of chronic renal failure, and the start of dialysis worsens inflammation. The enlargement of the spleen is associated with inflammation, and patients on hemodialysis may show a large spleen. The aim of the present study was to compare the spleen size of patients undergoing hemodialysis versus controls to update this thread. Methods: Controls and patients were eligible to participate in the study provided they were negative for serological markers of hepatitis B and C viruses and HIV, if they had no lymphoproliferative disorder, and if they were at least 18 years of age. Age, sex, and the duration of dialysis were recorded. Laboratory variables (hemoglobin, hematological cell count, serum creatinine) and the underlying cause of end-stage renal disease were analyzed. The spleen sizes of the patients were divided into tertiles. Results: The 75 controls and 168 patients selected were sex-matched. The patients were older, had larger spleens and lower platelet counts than controls. The relationship between spleen size and age in the controls and patients was quite similar. The patients in the first tertile of spleen size compared with those in the third were older and had a higher platelet counts. The underlying disease and dialysis vintage had no effect on spleen size. Discussion: The patients had larger spleens and a greater range of spleen sizes than the controls. In patients, the association between larger and smaller spleen with lower and higher platelet counts, respectively, sparked the speculation of occurrence of hypersplenism and hyposplenism.

Resumo Introdução: A inflamação promove a progressão da insuficiência renal crônica, e o início da diálise agrava a inflamação. O aumento do baço está associado à inflamação e os pacientes em hemodiálise podem apresentar um baço grande. O objetivo do presente estudo foi comparar o tamanho do baço de pacientes em hemodiálise versus aquele de controles, para atualizar este tópico. Métodos: Controles e pacientes foram elegíveis para participar do estudo desde que fossem negativos para marcadores sorológicos dos vírus da hepatite B, C e HIV, se não apresentassem distúrbio linfoproliferativo e tivessem pelo menos 18 anos de idade. Registramos idade, sexo e duração da diálise. Avaliamos as variáveis laboratoriais (hemoglobina, contagem de células hematológicas, creatinina sérica) e a causa básica da doença renal terminal. O tamanho dos baços dos pacientes foram divididos em tercis. Resultados: Os 75 controles e 168 pacientes selecionados foram pareados por sexo. Os pacientes eram mais velhos, tinham baços maiores e menor contagem de plaquetas do que os controles. A relação entre o tamanho do baço e a idade dos controles e pacientes foi bastante semelhante. Os pacientes do primeiro tercil de tamanho do baço, em comparação com os do terceiro, eram mais velhos e apresentavam contagens de plaquetas mais altas. A doença subjacente e o período de diálise não tiveram efeito no tamanho do baço. Discussão: Os pacientes tinham baços maiores e uma maior variedade de tamanhos de baço do que os controles. Entre os pacientes, a associação entre baço maior e menor com contagens de plaquetas mais baixas e mais altas, respectivamente, gerou a especulação da ocorrência de hiperesplenismo e hiposplenismo.

The spleen size in patients undergoing hemodialysis.

INTRODUCTION: Inflammation promotes the progression of chronic renal failure, and the start of dialysis worsens inflammation. The enlargement of the spleen is associated with inflammation, and patients on hemodialysis may show a large spleen. The aim of the present study was to compare the spleen size of patients undergoing hemodialysis versus controls to update this thread. METHODS: Controls and patients were eligible to participate in the study provided they were negative for serological markers of hepatitis B and C viruses and HIV, if they had no lymphoproliferative disorder, and if they were at least 18 years of age. Age, sex, and the duration of dialysis were recorded. Laboratory variables (hemoglobin, hematological cell count, serum creatinine) and the underlying cause of end-stage renal disease were analyzed. The spleen sizes of the patients were divided into tertiles. RESULTS: The 75 controls and 168 patients selected were sex-matched. The patients were older, had larger spleens and lower platelet counts than controls. The relationship between spleen size and age in the controls and patients was quite similar. The patients in the first tertile of spleen size compared with those in the third were older and had a higher platelet counts. The underlying disease and dialysis vintage had no effect on spleen size. DISCUSSION: The patients had larger spleens and a greater range of spleen sizes than the controls. In patients, the association between larger and smaller spleen with lower and higher platelet counts, respectively, sparked the speculation of occurrence of hypersplenism and hyposplenism.

Determinants of the serial changes in measurements of renal allograft Doppler resistive index in the first postoperative month / Determinantes de alterações seriadas nas medidas do índice de resistividade de Doppler do aloenxerto renal no primeiro mês pós-operatório

Abstract Introduction: The role of single Doppler-derived renal resistive index (RI) in renal allograft management is still a controversial issue, however detection of changes in serial duplex scanning has been reported as more valuable. This study aimed to test the hypothesis that early change in RI following transplantation may be related to factors associated with delayed graft function (DGF). Material and methods: 113 patients were included, in whom two RI measurements were performed within 30 days post-transplant. According to an RI change (equal to or more than 10%) in the second measurement, patients were assigned to decrease (Group I), no change (Group II), or increase (Group III) group. Results: 30 subjects had a decrease, 55 had no change, and 28 had an increase in the second RI measurement. The donors were younger in Group III in comparison to Group II. In comparison to Group I, Group III had a higher frequency of deceased donor, DGF, and presence of tubular necrosis and tubular vacuolization in peri-implantation biopsies. Conclusion: the increase of RI during the first weeks of the postoperative period seems to be associated with DGF and with tubular necrosis / tubular vacuolization in peri-implantation biopsies, likely related to ischemia reperfusion injury.

Resumo Introdução: O papel do índice de resistividade renal (IR) derivado de varredura por Doppler no manejo de aloenxertos renais, em exame isolado, ainda é uma questão controversa; no entanto, em exames seriados, a detecção de alterações nas imagens duplex tem sido relatada como mais relevante. Material e métodos: 113 pacientes foram incluídos, nos quais duas medidas de IR foram realizadas dentro de 30 dias após o transplante. De acordo com uma alteração do IR (igual ou superior a 10%) na segunda medida, os pacientes foram classificados em redução (Grupo I), nenhuma alteração (Grupo II) ou aumento (Grupo III). Resultados: 30 indivíduos tiveram redução, 55 não tiveram alterações e 28 tiveram aumento na segunda medição do IR. Os doadores eram mais jovens no Grupo III em comparação ao Grupo II. Em comparação ao Grupo I, o Grupo III apresentou maior frequência de doador falecido, FTE, presença de necrose tubular e vacuolização tubular nas biópsias peri-implantares. Conclusão: o aumento do IR durante as primeiras semanas no período pós-operatório parece estar associado à FTE e à necrose tubular/vacuolização tubular nas biópsias peri-implantares, provavelmente relacionadas à lesão por isquemia-reperfusão.

Determinants of the serial changes in measurements of renal allograft Doppler resistive index in the first postoperative month.

INTRODUCTION: The role of single Doppler-derived renal resistive index (RI) in renal allograft management is still a controversial issue, however detection of changes in serial duplex scanning has been reported as more valuable. This study aimed to test the hypothesis that early change in RI following transplantation may be related to factors associated with delayed graft function (DGF). MATERIAL AND METHODS: 113 patients were included, in whom two RI measurements were performed within 30 days post-transplant. According to an RI change (equal to or more than 10%) in the second measurement, patients were assigned to decrease (Group I), no change (Group II), or increase (Group III) group. RESULTS: 30 subjects had a decrease, 55 had no change, and 28 had an increase in the second RI measurement. The donors were younger in Group III in comparison to Group II. In comparison to Group I, Group III had a higher frequency of deceased donor, DGF, and presence of tubular necrosis and tubular vacuolization in peri-implantation biopsies. CONCLUSION: the increase of RI during the first weeks of the postoperative period seems to be associated with DGF and with tubular necrosis / tubular vacuolization in peri-implantation biopsies, likely related to ischemia reperfusion injury.

Sonographically determined kidney measurements are better able to predict histological changes and a low CKD-EPI eGFR when weighted towards cortical echogenicity.

BACKGROUND: The renal length and cortical echogenicity have shown correlation to the renal function and histological changes in CKD patients. The aim of this study was to assess the accuracy of crude and composite ultrasound parameters based on kidney measurements and cortical echogenicity to detect renal dysfunction and histological changes. METHODS: Kidney sonography and biopsy were performed in 112 patients. Histological changes were graded in 0, < 25%, ≥25%, ≤50 and > 50% of the sample. Cortical echogenicity was graded relative to liver or spleen parenchyma: less than, equal to and higher than the liver/spleen. Kidney length, the kidney length/body height ratio (KL/H) and cortical thickness were obtained. Each parameter was multiplied by a cortical echogenicity-weighting arbitrary factor: 1.17, 1 or 0.69 for cortex less than, equal to or higher than the liver, respectively. The GFR was estimated using the CKD-EPI formula. The accuracy of crude and composite parameters to identify patients with a high creatinine, a low GFR and histological changes were evaluated. RESULTS: The discriminative power of kidney length and cortical thickness for renal dysfunction and histological changes was improved after weighting for cortical echogenicity. However, the best discriminative was the kidney length to height ratio weighted towards renal echogenicity (w-KL/H). CONCLUSION: w-KL/H exceeded the other parameters as a marker of renal impairment and histological changes in CKD. Calculation of the w-KL/H index may be of help as a non-invasive tool to identify patients with significant renal disease and might be useful to guide therapeutic decisions.

Time-intensity curve analysis of contrast-enhanced ultrasound is unable to differentiate renal dysfunction in the early post-transplant period - a prospective study.

BACKGROUND: Contrast enhanced ultrasonography (CEUS) assessment of kidney allografts mainly focuses on graft rejection. However, studies on delayed graft function (DGF) without acute rejection are still lacking. The aim of this study was to build a time-intensity curve (TIC) using CEUS in non-immunological DGF to understand the utility of CEUS in early transplantation. METHODS: Twenty-eight patients in the short-term postoperative period (<14 days) were divided according to the need for dialysis (early graft function [EGF] and [DGF]) and 37 subjects with longer than 90 days follow-up were divided into creatinine tertiles. Time to peak [TTP] and rising time [RT were compared between groups. RESULTS: EGF and DGF were similar, except for creatinine. In comparison to the late group, medullary TTP and RT were shorter in the early group as well as the delay regarding contrast arrival in the medulla (in relation to cortex) and reaching the medullary peak (in relation to artery and cortex). In the late group, patients with renal dysfunction showed shorter temporal difference to reach medullary peak in relation to artery and cortex. CONCLUSIONS: Although it was not possible to differentiate EGF and DGF using TIC, differences between early and late groups point to blood shunting in renal dysfunction.

Howell-Jolly bodies and liver-spleen scanning for assessment of splenic filtrative function yields discordant results in renal transplant recipients.

Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears.

Achados de ultrassonografia transcraniana na doença de Parkinson e no tremor essencial: relato de casos / Transcranial sonography findings in Parkinson's disease and essential tremor: cases report

A ultrassonografia transcraniana tem sido objeto de investigação como ferramenta diagnóstica em neurologia nos últimos anos. Ela permite boa visualização de estruturas cerebrais situadas na linha média, sítio frequente de anormalidades nas doenças do movimento. Relatamos os casos de pacientes com a doença de Parkinson e o tremor essencial em que a ultrassonografia transcraniana foi capaz de sugerir o diagnóstico.

Over the last years, transcranial sonography has been investigated as a diagnostic tool in neurology. It allows a good visualization of midline brain structures, a frequent site of involvement in movement disorders. The authors discuss cases of Parkinson's disease and essential tremor where transcranial sonography could suggest the diagnosis of the condition.

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil / A Ultrassonografia transcraniana como método diagnóstico para a doença de Parkinson: um estudo piloto na cidade do Rio de Janeiro, Brasil

In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. OBJECTIVE: To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. METHOD: We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinson's disease (PD) and 14 healthy controls. RESULTS: 10.8 percent of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean±SD, 0.31±0.08cm²) compared to controls (mean±SD, 0.17±0.02cm²). TCS accurately identified 88.2 percent of PD patients. CONCLUSION: A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies.

No Brasil não há estudos sistemáticos sobre a Ultrassonografia Transcraniana (USTC), modalidade de neuroimagem que visualiza estruturas ecogênicas profundas do parênquima cerebral utilizando ultrassom. OBJETIVO: Determinar a porcentagem de indivíduos com janelas ósseas adequadas e a capacidade da USTC da substância negra (SN) de discernir pacientes parkinsonianos em amostra brasileira. MÉTODO: USTC realizada com equipamento AcusonX300 (Siemens, Germany) em 37 indivíduos: 23 com doença de Parkinson (DP) e 14 controles saudáveis. RESULTADOS: 10,8 por cento dos participantes apresentaram janelas acústicas temporais inadequadas. As áreas de ecogenicidade da SN foram maiores nos pacientes (média±desvio padrão, 0,31±0,08 cm²) do que nos controles (média±desvio padrão, 0,17±0,02 cm²). A USTC identificou 88,2 por cento dos pacientes com DP. CONCLUSÃO: Grande proporção de brasileiros parece ser elegível para a realização de USTC. Um número expressivo dos pacientes com DP poderia ser diagnosticado com base no aumento da área ecogênica da SN. Contudo, esses dados preliminares devem ser corroborados com amostra mais numerosa.

A ultrassonografia transcraniana como método diagnóstico em neurologia. Parte II: revisão da literatura / Transcranial Ultrasonography as diagnostic method in neurology. Part II: Literature review

A ultrassonografia transcraniana (USTC) é um método de neuroimagem baseado na física acústica. Nos indivíduos com janela acústica temporal adequada, o exame permite a visualização de estruturas encefálicas, principalmente o mesencéfalo, núcleos da base, tálamos e segmentos do sistema ventricular. A técnica já foi utilizada em pesquisas de diversas doenças neuropsiquiátricas. Em cerca de 90% dos portadores da doença de Parkinson, observa-se um aumento da área ecogênica da substância negra visualizada à USTC. O presente artigo é a segunda parte de uma revisão bibliográfica sobre o tema.

Transcranial sonography (TCS) is a neuroimaging technique that uses physical acoustic principles. A good acoustic temporal bone window allows sonographic depiction of encephalic structures as the mesencephalon, basal ganglia, thalami and fragments of the ventricular system. The technique has been used in researches of different neuropsychiatric diseases. In 90% of Parkinsonïs disease patients an enlargement of the substantia nigra echogenic area is found by TCS. This paper is a review on the subject.

A ultrassonografia transcraniana como método diagnóstico em neurologia. Parte I: Princípios e metodologia / Transcranial ultrasonography as a diagnostic method in neurology. Part I: Principles and methodology

A ultrassonografia transcraniana (USTC) é uma promissora técnica de neuroimagem para a investigação de distúrbios do movimento. O exame tem baixo custo, é inócuo, não é invasivo e pode ser realizado nos pacientes com movimentos involuntários sem sedação. As suas limitações incluem dependência de janela óssea adequada e de experiência e qualificação do examinador. Os valores de referência, no momento, só existem para pacientes da Europa, Estados Unidos da América e Ásia. A primeira parte do artigo apresenta alguns aspectos da técnica do exame; a segunda parte faz uma revisão da bibliografia disponível sobre a utilização da USTC em doenças neurológicas, particularmente na doença de Parkinson.

Transcranial sonography (TCS) is a promising neuroimaging technique for investigating movement disorders. The exam is inexpensive, harmless, non-invasive, and quick to perform in moving patients. Its limitations include its dependency on an adequate bone window and on qualified personnel. Reference values only exist for patients from Europe, North America and Asia. In the first part of this paper we present some technical aspects of the exam; the second part reviews the bibliography about TCS in neurological diseases, Parkinson's disease above all.

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil.

UNLABELLED: In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. OBJECTIVE: To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. METHOD: We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinson's disease (PD) and 14 healthy controls. RESULTS: 10.8% of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean ± SD, 0.31 ± 0.08 cm(2)) compared to controls (mean ± SD, 0.17 ± 0.02 cm(2)). TCS accurately identified 88.2% of PD patients. CONCLUSION: A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies.

Um índice clínico preditor de sobrevida renal / A clinical predictor index for renal survival

Introdução: Um índice capaz de antecipar a progressão da doença renal independente dos achados histológicos seria de inestimável valor para a indicação da biópsia renal. Objetivo: Avaliar se um índice clínico baseado na ecogenicidade cortical renal, na relação diâmetro longitudinal do rim/altura do indivíduo (KL/H) e na creatinina sérica pode predizer a sobrevida renal. Métodos: As lesões crônicas (obsolesc~encia glomerular, esclerose segmentar e focal, atrofia tubular e fibrose intersticial) e agudas (proliferação mesaginal, permeação leucocitária, necrose fibrinoide e crescentes e infiltrado intersticial) das biópsias de 154 pacientes foram graduadas e somadas para geração de índices. Um índice clínico de cronicidade foi criado pela soma da gradação da ecogenicidade cortical relativa a do fígado ou baço, dos níveis de creatinina sérica e da relação KL/H. O desfecho do estudo foi a necessidade de iniciar a diálise. Resultados: Os maiores graus do índice clínico de cronicidade e do índice crônico de biópsia foram associados com sobrevida renal mais curta. Dos seis pacientes com creatinina sérica >2,5 mg/dL, maior ecogenicidade cortical e KL/H<0,60 antes da biópsia, cinco iniciaram diálise e um elevou a creatinina para 4,5 mg/dL. O índice clínico apresentou boa correlação com o índice crônico de biópsia. Conclusões: O índice clínico pode ser útil para predizer uma situação na qual a biópsia mostrará lesões crônicas avançadas e irreversíveis. Nos pacientescom os graus mais altos dos parãmetros clínicos, a biópsia pode ser descartada. Para grupos de pacientes, o índice pode ser utilizado na comparação de desfechos e eficácia terapêutica.

Introduction: An index able to anticipate the progression of renal disease independent of histological findings would be invaluable for the indication of renal biopsy. Objective: To evaluate whether a clinical index based on renal cortical echogenicity in longitudinal diameter ratio of kidney / height of the individual (KL / H) and serum creatinine to predict renal survival. Methods: The chronic lesions (obsoletes ~ ence glomerular focal segmental sclerosis, tubular atrophy and interstitial fibrosis) and acute (mesaginal proliferation, leukocyte permeation, fibrinoid necrosis and crescents and interstitial infiltration) of biopsies from 154 patients were graded and summed to generate indices. A clinical index of chronicity was created by the sum of gradation on the echogenicity of the liver or spleen, the levels of serum creatinine and the ratio KL / H. The study endpoint was the need to start dialysis. Results: The highest degree of clinical index and chronicity index of chronic biopsy were associated with shorter renal survival. Of the six patients with serum creatinine> 2.5 mg / dL, increased cortical echogenicity and KL / H <0.60 before biopsy, five started dialysis and a raised creatinine to 4.5 mg / dL. The clinical index had good correlation with chronic biopsy. Conclusions: The clinical index may be useful to predict a situation in which the biopsy shows chronic lesions advanced and irreversible. In pacientescom the highest levels of clinical parameters, the biopsy may be discarded. For groups of patients, the index can be used to compare outcomes and therapeutic efficacy.

[A clinical predictor index for renal survival].

INTRODUCTION: A clinical index that discriminates disease progression independent of histopathologic features may be valuable in the best timing of biopsy. OBJECTIVE: This study addresses the question if a clinical index based on cortical echogenicity, renal length to body height ratio (KL/H), and serum creatinine levels predicts renal survival. METHODS: The study enrolled 154 patients. Biopsy specimens were graded for chronic (glomerular obsolescence, segmental glomerular sclerosis, tubular atrophy and interstitial fibrosis) and acute (mesangial proliferation, leucocyte permeation, crescent and fibrinoid necrosis and interstital infiltrate) index by the sum of scored lesions. A chronic clinical index was created by the sum of scored cortical echogenicity relative to liver or spleen, creatinine serum levels and KL/H. The study end point was start on dialisis. RESULTS: Higher grade of chronic clinical and biopsy indices were associated with poorer long-term renal survival. Five out of six patients with serum creatinine levels > 2.5mg/dL, highest cortical echogenicity and KL/H < 0.60, before biopsy, started on dialysis and one increased creatinine levels up to 4.5 mg/dL. The chronic clinical index correlates well with chronic biopsy index. CONCLUSIONS: The chronic clinical index could be useful to predict a clinical setting in which a renal biopsy will show advanced chronic and irreversible lesion. In patients with highest grade of clinical parameters renal biopsy can be obviate. As a chronicity of illness index for groups of patients with renal medical diseases, the system could be useful in outcome comparisons and evaluation of therapeutic efficacy.

[Renal parenchymal disease: histopathologic-sonographic correlation]. / Doença parenquimatosa renal: correlação histológico-sonográfica.

PURPOSE: This study was designed to address the correlation between sonography of a kidney with histological lesions and clinical findings in patients with renal parenchymal disease based on a multivariate logistic regression analysis. METHODS: Clinical and laboratory data, sonograms and renal biopsies were evaluated in 154 patients. Cortical echogenicity was graded as less than (0), equal to (1) or greater than (2) liver/spleen parenchyma. Histological lesions - mesangial proliferation (MP), leukocyte permeation (LP), fibrinoid necrosis and crescents (FNC), interstitial infiltrate (II), segmental glomerular sclerosis (SGS), glomerular obsolescence (GO), tubular atrophy (TA) interstitial fibrosis (IF) and interstitial edema (IE) - were graded according to extension and severity as normal (0%), mild (<25%), moderate (>25% <50%), and severe (>50%). RESULTS: a) II, IF, SGS, IE and increased creatinine occurred less in cortical echogenicity grade 0; b) MP, arterial hypertension and normal parenchymal thickness predict cortical echogenicity grade 1; c) IF, IE, increased creatinine and thin parenchyma predict occurrence of echogenicity grade 2; d) Excluding obese patients, both youth and hematocrit accounted for pyramid prominence; e) increased creatinine and GO was probable in patients with small kidneys. CONCLUSIONS: Increased cortical echogenicity was a very sensitive marker of renal parenchymal disease. Different lesions rather than degree of lesion severity accounted for progressive increase of cortical echogenicity. IE exponentially increased the effect of IF on cortical echogenicity.

Doença parenquimatosa renal: correlação histológico-sonográfica / Renal parenchymal disease: histopathologic-sonographic correlation

OBJETIVO: Este estudo foi planejado para avaliar a correlação da ecografia do rim com as lesões histológicas e com os achados clínico-laboratoriais na doença parenquimatosa renal, por análise de regressão logística multivariada. MÉTODOS: Os dados clínicos, laboratoriais, ecográficos e as biópsias foram avaliados em 154 pacientes. A ecogenicidade cortical foi graduada como menor que grau zero, igual a grau um ou maior que grau dois a do parênquima hepático ou esplênico. As lesões histológicas - proliferação mesangial (PM), permeação leucocitária (PL), crescente e necrose fibrinóide (CNF), infiltrado inflamatório intersticial (II), esclerose glomerular segmentar (ES), obsolescência glomerular (OG), atrofia tubular (AT), fibrose intersticial (FI) e edema intersticial (EI) - foram graduadas de acordo com a extensão, em normal (0 por cento), leve (<25 por cento), moderada (>25 por cento <50 por cento), e grave (>50 por cento). RESULTADOS: a) II, FI, ES, EI e creatinina elevada ocorreram menos no grau 0 de ecogenicidade cortical; b) PM, hipertensão arterial e espessura normal do parênquima foram preditores do grau 1 de ecogenicidade cortical; c) FI, EI, creatinina elevada e parênquima fino foram preditores do grau 2 de ecogenicidade cortical; d) Excluindos os obesos, em jovens com hematócrito baixo, a pirâmide proeminente foi mais comum; e) Creatinina elevada e OG foram preditores de rins pequenos. CONCLUSÃO: A ecogenicidade cortical foi um sensível marcador de doença parenquimatosa renal. Lesões distintas mais do que o grau de severidade da lesão contribuiram para o aumento da ecogenicidade cortical. O EI aumenta exponencialmente o efeito da FI na ecogenicidade cortical.

PURPOSE: This study was designed to address the correlation between sonography of a kidney with histological lesions and clinical findings in patients with renal parenchymal disease based on a multivariate logistic regression analysis. METHODS: Clinical and laboratory data, sonograms and renal biopsies were evaluated in 154 patients. Cortical echogenicity was graded as less than (0), equal to (1) or greater than (2) liver/spleen parenchyma. Histological lesions - mesangial proliferation (MP), leukocyte permeation (LP), fibrinoid necrosis and crescents (FNC), interstitial infiltrate (II), segmental glomerular sclerosis (SGS), glomerular obsolescence (GO), tubular atrophy (TA) interstitial fibrosis (IF) and interstitial edema (IE) - were graded according to extension and severity as normal (0 percent), mild (<25 percent), moderate (>25 percent <50 percent), and severe (>50 percent). RESULTS: a) II, IF, SGS, IE and increased creatinine occurred less in cortical echogenicity grade 0; b) MP, arterial hypertension and normal parenchymal thickness predict cortical echogenicity grade 1; c) IF, IE, increased creatinine and thin parenchyma predict occurrence of echogenicity grade 2; d) Excluding obese patients, both youth and hematocrit accounted for pyramid prominence; e) increased creatinine and GO was probable in patients with small kidneys. CONCLUSIONS: Increased cortical echogenicity was a very sensitive marker of renal parenchymal disease. Different lesions rather than degree of lesion severity accounted for progressive increase of cortical echogenicity. IE exponentially increased the effect of IF on cortical echogenicity.

Efeitos do fenobarbital em pacientes com nefrolitíase de cálcio / Phenobarbital effects in patients with calcium nephrolithiasis

Os autores apresentam os resultados de um estudo realizado em 20 pacientes com nefrolitíase cálcica tratados com fenobarbital, 100mg/dia, durante 32 dias. O tratamento com o fenobarbital reduziu a calcemia (9,21 ñ 0,57mg/dl vs. 8,30 ñ 1,07mg/dl; p < 0,05), a calciúria (185,4 ñ 74,91mg/24h vs. 132,8 ñ 50,12mg/24h; p < 0,001), a uricosúria (785,27mg/24h vs. 551,8 ñ 215,02mg/24h; p < 0,05) e a FEAU (12,07 ñ 5,95// vs. 8,33 ñ 3,00//; p < 0,05) e elevou a RTP (82,45 ñ 6,20// vs. 89,11 ñ 4,11//; p < 0,01). O TSCa näo sofreu alteraçöes. Visto que o fenobarbital é uma droga segura, cujos efeitos nos parâmetros hematológicos, hepáticos e renais säo despreziveis, e a ocorrência de doença óssea desmineralizante é rara, os autores consideram que o medicamento deva ser objeto de investigaçäo no tratamento da litíase cálcica, principalmente quando a hipercalciúria e/ou a hiperuricosúria estiverem associadas