Impacto inicial da pandemia pela covid-19 no perfil de atendimento aos pacientes críticos em hemodiálise / Initial impact of the covid-19 pandemic on the care profile for critically-ill patients on hemodialysis / Impacto inicial de la pandemia de covid-19 en el perfil de atención de los pacientes críticos en hemodiálisis

RESUMO Objetivo: comparar o perfil de atendimento aos pacientes críticos em hemodiálise antes e durante a pandemia pela COVID-19. Método: estudo observacional realizado em um hospital de São Paulo - Brasil. Participaram pacientes críticos em hemodiálise internados em 2019 e 2020. Os dados foram coletados de documentos das sessões de hemodiálise e prontuários. Foram utilizados os testes de Qui-quadrado, Mann-Whitney, Shapiro-Wilk e Exato de Fisher para as comparações (p<0,05). Resultados: foram realizadas 212 sessões em 50 pacientes em 2019 e 873 sessões em 171 pacientes em 2020. Em 2019 os pacientes foram encaminhados para terapia intensiva e hemodiálise após 4,62±6,38 e 17,26±24,53 dias, respectivamente, e em 2020 esses períodos foram de 2,21±3,63 e 10,24±11,99 dias. Houve mais óbitos em 2020 (p=0,01) e entre os pacientes com COVID-19 (p=0,014). Conclusão: foi observado um maior número de hemodiálises em 2020 quando comparado ao quadro pré-pandêmico, situação desconhecida nos primeiros meses da pandemia.

ABSTRACT Objective: to compare the care profile for critically-ill patients on hemodialysis before and during the COVID-19 pandemic. Method: an observational study carried out in a hospital from São Paulo, Brazil. The participants were critically-ill patients on hemodialysis hospitalized in 2019 and 2020. The data were collected from documents of hemodialysis sessions and from medical records. Chi-square, Mann-Whitney, Shapiro-Wilk and Fisher's Exact tests were used for comparisons (p<0.05). Results: a total of 212 sessions were performed with 50 patients in 2019 and 873 sessions with 171 patients in 2020. In 2019, the patients were referred to intensive care and hemodialysis after 4.62 ± 6.38 and 17.26 ± 24.53 days, respectively, and in 2020 these periods corresponded to 2.21 ± 3.63 and 10.24 ± 11.99 days. There were more deaths in 2020 (p=0.01) and among patients with COVID-19 (p=0.014). Conclusion: more hemodialysis sessions were observed in 2020 when compared to pre-pandemic times, an unknown situation in the first months of the pandemic.

RESUMEN Objetivo: comparar el perfil de atención de los pacientes críticos en hemodiálisis antes y durante la pandemia de COVID-19. Método: estudio observacional realizado en un hospital de San Pablo, Brasil. Participaron pacientes críticos en hemodiálisis hospitalizados en 2019 y 2020. Los datos se recolectaron de documentos de sesiones de hemodiálisis e historias clínicas. Para las comparaciones se utilizaron las pruebas de chi-cuadrado, Mann-Whitney, Shapiro-Wilk y exacta de Fisher (p<0,05). Resultados: se realizaron 212 sesiones en 50 pacientes en 2019 y 873 sesiones en 171 pacientes en 2020. En 2019 los pacientes fueron derivados a cuidados intensivos y hemodiálisis después de 4,62 ± 6,38 y 17,26 ± 24,53 días, respectivamente, y en 2020 los períodos fueron de 2,21 ± 3,63 y 10,24 ± 11,99 días. Hubo más muertes en 2020 (p=0,01) y de pacientes con COVID-19 (p=0,014). Conclusión: se observó un mayor número de hemodiálisis en 2020 que ante de la prepandemia, hecho que se desconocía durante los primeros meses de la pandemia.

Impact of the pandemic by COVID-19 on the profile of critical patients assisted by a hemodialysis service / Impacto da pandêmica pela covid-19 não perfil de pacientes críticos tratados pela um serviço de hemodiálise / Impacto da pandemia pela COVID-19 no perfil de pacientes críticos atendidos por um serviço de hemodiálise

Introduction and objective: Critically ill patients with COVID-19 often progress to acute kidney injury and need for hemodialysis. The aim of this study was to compare the care profile of critically ill patients undergoing renal replacement therapy before and during the COVID-19 pandemic. Methods: Observational study carried out at a university hospital in the city of São Paulo, Brazil. Critical patients undergoing hemodialysis from April to June 2019 and April to June 2020 participated in the study. Data were collected from hemodialysis care documents and electronic medical records. The Chi-square, Mann-Whitney, Shapiro-Wilk, Fisher's exact test were used (5% significance). Results: 212 patients participated, 50 in 2019 and 171 in 2020. In 2019, 30.0% of patients were hospitalized due to acute renal changes, 90.0% had increased entry creatinine, were referred to intensive care after 4.62± 6.38 days and started hemodialysis after 17.26±24.53 days. In 2020, 66.7% were hospitalized for COVID-19, 77.7% had increased entry creatinine, were referred to intensive care after 2.21±3.63 days and started hemodialysis after 10.24±11.99 days . 212 hemodialysis sessions were performed in 2019 and 873 in 2020. There were more deaths in 2020 (p=0.01) and patients with COVID-19 (p=0.014) and hemodynamic instability (p=0.016) were the most affected. Conclusion: In 2020, there was an increase of 3.42 times in the number of critical patients on hemodialysis and an increase of 4.11 times in the number of sessions compared to the year 2019.

Introducción y objetivo: Los pacientes críticamente enfermos con COVID-19 a menudo progresan a una lesión renal aguda y necesitan hemodiálisis. El objetivo de este estudio fue comparar el perfil de atención de los pacientes críticamente enfermos sometidos a terapia de reemplazo renal antes y durante la pandemia de COVID-19.Métodos: estudio observacional realizado en un hospital universitario de la ciudad de São Paulo, Brasil. En el estudio participaron pacientes críticos sometidos a hemodiálisis de abril a junio de 2019 y de abril a junio de 2020. Los datos se obtuvieron de documentos de atención de hemodiálisis y registros médicos electrónicos. Se utilizó la prueba de Chi-cuadrado, Mann-Whitney, Shapiro-Wilk, exacta de Fisher (significancia del 5%).Resultados: participaron 221 pacientes, 50 en 2019 y 171 en 2020. En 2019, el 30,0% de los pacientes fueron hospitalizados por alteraciones renales agudas, el 90,0% presentó aumento de creatinina de entrada, fueron remitidos a cuidados intensivos a los 4,62 ± 6,38 días e iniciaron hemodiálisis posteriormente. 17,26 ± 24,53 días. En 2020, el 66,7% fueron hospitalizados por COVID-19, el 77,7% presentó aumento de creatinina de entrada, fueron remitidos a cuidados intensivos a los 2,21 ± 3,63 días e iniciaron hemodiálisis a los 10,24 ± 11,99 días. Se realizaron 212 sesiones de hemodiálisis en 2019 y 873 en 2020. Hubo más muertes en 2020 (p = 0.01) y los pacientes con COVID-19 (p = 0.014) e inestabilidad hemodinámica (p = 0.016) fueron los más afectados.Conclusión: En 2020, hubo un aumento de 3,42 veces en el número de pacientes críticos en hemodiálisis y un aumento de 4,11 veces en el número de sesiones respecto al año 2019.

Introdução e objetivo: Frequentemente os pacientes críticos com COVID-19 evoluem para lesão renal aguda e necessidade de hemodiálise. O objetivo deste estudo foi comparar o perfil de atendimento aos pacientes críticos submetidos a terapia de substituição renal antes e durante a pandemia pela COVID-19. Métodos: Estudo observacional realizado em um hospital universitário da cidade de São Paulo, Brasil. Participaram do estudo pacientes críticos em hemodiálise de abril a junho de 2019 e abril a junho de 2020. Os dados foram coletados a partir de documentos de atendimento de hemodiálise e prontuário eletrônico. Foram utilizados os testes de Qui-quadrado, Mann-Whitney, Shapiro-Wilk, Teste Exato de Fisher, (significância de 5%). Resultados: Participaram 221 pacientes, sendo 50 em 2019 e 171 em 2020. Em 2019, 30,0% dos pacientes internaram por alterações renais agudas, 90,0% apresentaram creatinina de entrada aumentada, foram encaminhados para terapia intensiva após 4,62±6,38 dias e iniciaram hemodiálise após 17,26±24,53 dias. Em 2020, 66,7% internaram por COVID-19, 77,7% tiveram creatinina de entrada aumentada, foram encaminhados para terapia intensiva após 2,21±3,63 dias e iniciaram a hemodiálise após 10,24±11,99 dias. Foram realizadas 212 sessões de hemodiálise em 2019 e 873 em 2020. Houve mais óbitos em 2020 (p=0,01) e os pacientes com COVID-19 (p=0,014) e instabilidade hemodinâmica (p=0,016) foram os mais acometidos. Conclusão: Em 2020, foi observado aumento de 3,42 vezes no número de pacientes críticos em hemodiálise e aumento de 4,11 vezes no número de sessões quanto comparado ao ano de 2019.

Granulomatous intersticial nephritis secondary to sarcoidosis / Nefrite intersticial granulomatose secundária a sarcoidose

ABSTRACT Introduction: Granulomatous interstitial nephritis is a rare condition, in which renal involvement is uncommon. Its etiology is variable, and may be medicinal, infectious or inflammatory origin. Case report: This is a 65-year-old male patient with renal lesions of unknown etiology, associated with hypercalcaemia. During the investigation, cardiac insufficiency with diastolic dysfunction and interstitial lung involvement on chest tomography were evidenced. Renal function (glomerular filtration rate) has partially improved with clinical measures. Renal biopsy was performed, which showed moderate interstitial lesion with tuberculoid granulomas without caseous necrosis. Conclusion: The objective of the article was to describe a case of NIG and to alert to the importance of its clinical investigation. In this case, renal biopsy, associated with systemic clinical manifestations, contributed to the diagnosis of sarcoidosis.

RESUMO Introdução: a nefrite intersticial granulomatosa é uma condição rara, na qual o envolvimento renal é incomum. Sua etiologia é variável e pode ter origem medicinal, infecciosa ou inflamatória. Relato de caso: trata-se de um paciente do sexo masculino, com 65 anos de idade, com lesões renais de etiologia desconhecida, associadas à hipercalcemia. Durante a investigação, evidenciaram-se insuficiência cardíaca com disfunção diastólica e envolvimento pulmonar intersticial à tomografia torácica. A função renal (taxa de filtração glomerular) melhorou parcialmente com medidas clínicas. Foi realizada biópsia renal, que apresentou lesão intersticial moderada com granulomas tuberculoides sem necrose caseosa. Conclusão: o objetivo do artigo foi descrever um caso de GIN e alertar para a importância de sua investigação clínica. Neste caso, a biópsia renal, associada a manifestações clínicas sistêmicas, contribuiu para o diagnóstico de sarcoidose.

Granulomatous intersticial nephritis secondary to sarcoidosis.

INTRODUCTION: Granulomatous interstitial nephritis is a rare condition, in which renal involvement is uncommon. Its etiology is variable, and may be medicinal, infectious or inflammatory origin. CASE REPORT: This is a 65-year-old male patient with renal lesions of unknown etiology, associated with hypercalcaemia. During the investigation, cardiac insufficiency with diastolic dysfunction and interstitial lung involvement on chest tomography were evidenced. Renal function (glomerular filtration rate) has partially improved with clinical measures. Renal biopsy was performed, which showed moderate interstitial lesion with tuberculoid granulomas without caseous necrosis. CONCLUSION: The objective of the article was to describe a case of NIG and to alert to the importance of its clinical investigation. In this case, renal biopsy, associated with systemic clinical manifestations, contributed to the diagnosis of sarcoidosis.

Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report.

We report on a case of a patient with HIV infection, diagnosed 18 months prior to the development of an anti-glomerular basement membrane (anti-GBM) rapidly progressive glomerulonephritis; this is probably the first report of such an association. A 30-year-old white man presented with elevation of serum creatinine (1.3 - 13.5 mg/dL within one month). At admission, the urinalysis showed proteinuria of 7.2 g/L and 8,000,000 erythrocytes/mL. Renal biopsy corresponded to a crescentic diffuse proliferative glomerulonephritis mediated by anti-GBM, and serum testing for anti-GBM antibodies was positive; antinuclear antibodies (ANA) and anti-neutrophilic cytoplasmic antibodies (ANCA) were also positive. The patient underwent hemodyalisis and was treated with plasmapheresis, cyclophosphamide and prednisone. The association described here is not casual, as crescentic glomerulonephritis is not common in HIV-positive patients, anti-GBM glomerulonephritis is rare and anti-GBM antibodies are frequently observed in HIV-positive subjects when compared to the overall population. Based on the current case and on the elevated frequency of the positivity for such antibodies in this group of patients, it is advisable to be aware of the eventual association between these two conditions and to promote an active search for anti-GBM antibodies and early diagnosis of eventual urinary abnormalities in HIV-positive subjects, considering the severity of anti-GBM glomerulonephritis.

Anti-glomerular basement membrane glomerulonephritis in an HIV positive patient: case report

We report on a case of a patient with HIV infection, diagnosed 18 months prior to the development of an anti-glomerular basement membrane (anti-GBM) rapidly progressive glomerulonephritis; this is probably the first report of such an association. A 30-year-old white man presented with elevation of serum creatinine (1.3 - 13.5 mg/dL within one month). At admission, the urinalysis showed proteinuria of 7.2 g/L and 8,000,000 erythrocytes/mL. Renal biopsy corresponded to a crescentic diffuse proliferative glomerulonephritis mediated by anti-GBM, and serum testing for anti-GBM antibodies was positive; antinuclear antibodies (ANA) and anti-neutrophilic cytoplasmic antibodies (ANCA) were also positive. The patient underwent hemodyalisis and was treated with plasmapheresis, cyclophosphamide and prednisone. The association described here is not casual, as crescentic glomerulonephritis is not common in HIV-positive patients, anti-GBM glomerulonephritis is rare and anti-GBM antibodies are frequently observed in HIV-positive subjects when compared to the overall population. Based on the current case and on the elevated frequency of the positivity for such antibodies in this group of patients, it is advisable to be aware of the eventual association between these two conditions and to promote an active search for anti-GBM antibodies and early diagnosis of eventual urinary abnormalities in HIV-positive subjects, considering the severity of anti-GBM glomerulonephritis.

Revisão: Ácido úrico e hipertensão arterial sistêmica - evidências e controvérsias / Uric acid and systemic arterial hypertension - evidences and controversies

Diversos estudos conduzidos nas últimas seis décadas têm tentado correlacionar níveis séricos elevados de ácido úrico a uma maior incidência de eventos cardiovasculares. Estudos recentes concluíram que, em população portadora de hipertensão arterial, o nível sérico de ácido úrico correlacionou-se à maior freqüência de eventos cardiovasculares, fato validado também para a população geral. A literatura, assim, tem consistentemente demonstrado forte associação entre nível de ácido úrico, como fator independente, e mortalidade cardiovascular. Estudos utilizando drogas que podem, de forma direta ou indireta, reduzir os níveis séricos do ácido úrico devem ser realizados na tentativa de comprovar o efeito benéfico desse tratamento sobre a taxa de ocorrência de eventos cardiovasculares(au)