Albumin-to-protein ratio in spot urine samples for analysis of proteinuria selectivity in chronic kidney disease / Razão albumina/proteína em amostras isoladas de urina para análise da seletividade de proteinúria na doença renal crônica

ABSTRACT Introduction: The albumin-to-creatinine ratio and total protein-to-creatinine ratio in spot urine samples have already been validated as surrogates for 24-hour albuminuria and proteinuria measurements. Thus, we hypothesized that the type of proteinuria, detected by the electrophoretic pattern of 24-hour urine, could be predicted by the simple proportion of albumin in the total urine protein content, using the albumin-to-protein ratio (APR). Our study sought to validate the use of APR as a cheaper substitute for urinary protein electrophoresis (UPE). Methods: Using different mathematical models, we compared, the albumin fraction in 24-hour urine samples by electrophoresis and the APR ratio in spot samples from 42 outpatients with chronic kidney disease (CKD). Results: A strong log-order correlation r = 0.84 (0.75-0.92; 95% CI, p = 0.001) was observed between APR and the albumin fraction in the UPE. Conclusion: The APR can substitute electrophoresis in CKD outpatients.

Resumo Introdução: A utilização da razão albumina/creatinina e da razão proteína total/creatinina em amostras isoladas de urina já foram validadas como substitutos para a albuminúria e proteinúria em 24 horas. Assim, nossa hipótese é que o tipo de proteinúria, dado pelo padrão eletroforético da urina de 24 horas, poderia ser previsto pela simples proporção de albumina no conteúdo total de proteínas na urina, utilizando a razão albumina/proteína (RAP). O presente estudo procurou validar o uso da RAP como um substituto mais prático e de menor custo da eletroforese de proteínas urinárias (EPU). Métodos: Foram utilizados diferentes modelos matemáticos a fim de comparar a fração de albumina pela eletroforese em amostras de urina de 24 horas e a RAP em amostras isoladas em 42 pacientes ambulatoriais com doença renal crônica. Resultados: Foi observada uma forte correlação logarítmica r = 0,84 (0,75-0,92; 95% CI, p = 0,001) entre a RAP e a fração de albumina pela EPU. Conclusão: A RAP pode substituir a eletroforese urinária em pacientes renais crônicos ambulatoriais.

Albumin-to-protein ratio in spot urine samples for analysis of proteinuria selectivity in chronic kidney disease.

INTRODUCTION: The albumin-to-creatinine ratio and total protein-to-creatinine ratio in spot urine samples have already been validated as surrogates for 24-hour albuminuria and proteinuria measurements. Thus, we hypothesized that the type of proteinuria, detected by the electrophoretic pattern of 24-hour urine, could be predicted by the simple proportion of albumin in the total urine protein content, using the albumin-to-protein ratio (APR). Our study sought to validate the use of APR as a cheaper substitute for urinary protein electrophoresis (UPE). METHODS: Using different mathematical models, we compared, the albumin fraction in 24-hour urine samples by electrophoresis and the APR ratio in spot samples from 42 outpatients with chronic kidney disease (CKD). RESULTS: A strong log-order correlation r = 0.84 (0.75-0.92; 95% CI, p = 0.001) was observed between APR and the albumin fraction in the UPE. CONCLUSION: The APR can substitute electrophoresis in CKD outpatients.

Effect of cranberry supplementation on toxins produced by the gut microbiota in chronic kidney disease patients: A pilot randomized placebo-controlled trial.

BACKGROUND & AIMS: Patients with Chronic Kidney Disease (CKD) have an imbalance in the gut microbiota that can lead to increase levels of lipopolysaccharides (LPS) and uremic toxins such as indoxyl sulfate (IS), p-cresyl sulfate (p-CS), and indole-3 acetic acid (IAA). Among the therapeutic options for modulating gut microbiota are the bioactive compounds such as polyphenols present in cranberry, fruit with potential antioxidant and anti-inflammatory effects. This clinical trial focuses on evaluating the effects of supplementation with a dry extract of cranberry on plasma levels of LPS and uremic toxins in non-dialysis CKD patients. METHODS: It was a randomized, double-blind, placebo-controlled study. Patients were randomized into two groups: the cranberry group received 500 mg of dry cranberry extract (2 times daily), and the placebo group received 500 mg of corn starch (2 times daily) for two months. LPS plasma levels were evaluated by enzyme-linked immunosorbent assay (ELISA) and uremic toxins (IS, p-CS, and IAA) by high-performance liquid chromatography-fluorescence detection. Anthropometric measurements and food intake using the 24-h food recall technique were also evaluated before and after the intervention. RESULTS: Twenty-five participants completed two months of supplementation: 12 patients in the cranberry group (8 women, 56.7 ± 7.5 years, estimated glomerular filtration rate (eGFR) of 39.2 ± 21.9 mL/min); 13 patients in the placebo group (9 women, 58.8 ± 5.1 years, eGFR of 39.7 ± 12.9 mL/min). As expected, there was a negative association between glomerular filtration rate and p-CS and IS plasma levels at the baseline. No change was observed in the uremic toxins and LPS levels. CONCLUSION: Cranberry dry extract supplementation for two months did not reduce the LPS and uremic toxins plasma levels produced by the gut microbiota in non-dialysis CKD patients.

Em tempos de COVID: A Ciência, a Ética e a Medicina são indissolúveis! E nunca é demais repetir / In times of COVID: Science, Ethics and Medicine are indissoluble! And it never hurts to repeat

A pandemia provocada pelo vírus Sars-CoV-2 não só aproximou o público leigo do meio acadêmico-médico, mas também pressionou médicos, pesquisadores e estadistas por resultados rápidos a fim de contê-la. É nesse ambiente de incerteza e necessidade de produção cientifica rápida, que devemos lembrar que o progresso não é a qualquer custo, deve-se agir com cautela, afinal a Ciência, a Ética e a Medicina são indissolúveis!

The pandemic caused by the Sars-CoV-2 virus not only brought the lay public closer to the academic-medical environment, but also put pressure on doctors, researchers and statesmen for quick results in order to contain it. It is in this environment of uncertainty and the need for rapid scientific production, that we must remember that progress is not at any cost, one must act with caution, after all Science, Ethics and Medicine are indissoluble!

Effects of Low Protein Diet on Nuclear Factor Erythroid 2-Related Factor 2 Gene Expression in Nondialysis Chronic Kidney Disease Patients.

OBJECTIVE(S): Low protein diets (LPD; 0.6 g/kg/day), prescribed for nondialysis chronic kidney disease (CKD) patients, have demonstrated numerous benefits. LPDs may modulate inflammation and oxidative stress through the nuclear factor erythroid 2-related factor 2 (Nrf2), which encodes antioxidant and phase II detoxifying enzymes. LPDs also inhibit or antagonize nuclear factor kB (NF-kB) activity, which orchestrates inflammatory and oxidative stress responses. The objective of this study was to evaluate the effects of LPD on Nfr2 and NF-κB messenger RNA (mRNA) expression in nondialysis CKD patients. METHODS: In this longitudinal study, a LPD was prescribed for 30 nondialysis CKD patients for 6 months. Peripheral blood mononuclear cells were isolated, and quantitative real-time polymerase chain reaction analysis was performed to evaluate Nrf2, NF-κB, and NADPH quinine oxidoreductase-1 mRNA expression. Thiobarbituric acid-reactive substance (TBARS) levels, a marker of lipid peroxidation, were also evaluated. RESULTS: (Age 55.5 ± 14.0 years; body mass index 29.1 ± 5.9 kg/m2; glomerular filtration rate 35.6 ± 12.2 mL/minute). After 6 months of nutritional intervention, Nrf2 mRNA expression increased from 0.85 (0.47-1.56) to 1.28 (0.63-2.63) nmol/mL (P = .03), and TBARS levels were significantly decreased from 1.78 (1.31-2.38) to 1.30 (1.07-2.22) nmol/mL (P = .04). NF-κB mRNA expression showed no significant difference after 6 months, but the Nrf2/NF-κB ratio was increased. CONCLUSION(S): In this study, a LPD appeared to modulate Nrf2 expression and decrease the levels of TBARS in nondialysis CKD patients. However, more studies are needed to confirm the effectiveness of LPD on the modulation of transcription factors involved with oxidative stress and inflammation in nondialysis CKD patients.

Cranberries - potential benefits in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) present many complications that potentially could be linked to increased cardiovascular mortality such as inflammation, oxidative stress, cellular senescence and gut dysbiosis. There is growing evidence suggesting that nutritional strategies may reduce some of these complications. Clinical studies suggest that supplementation of cranberries may have beneficial effects on human health such as prevention of urinary tract infections. More recently, the anti-inflammatory and anti-oxidant effects as well as modulation of gut microbiota provided by cranberry phytochemicals have drawn more attention. A better understanding of possible effects and mechanisms of action of cranberry supplementation in humans could inform researchers about warranted future directions for clinical studies targeting these complications in CKD patients by applying nutritional strategies involving cranberry supplementation.

Does Low-Protein Diet Influence the Uremic Toxin Serum Levels From the Gut Microbiota in Nondialysis Chronic Kidney Disease Patients?

OBJECTIVES: To evaluate the effects of low-protein diet (LPD) on uremic toxins and the gut microbiota profile in nondialysis chronic kidney disease (CKD) patients. DESIGN AND METHODS: Longitudinal study with 30 nondialysis CKD patients (stage 3-4) undergoing LPD for 6 months. Adherence to the diet was evaluated based on the calculation of protein equivalent of nitrogen appearance from the 24-hour urine analysis. Good adherence to LPD was considered when protein intake was from 90% to 110% of the prescribed amount (0.6 g/kg/day). Food intake was analyzed by the 24-hour recall method. The anthropometric, biochemical and lipid profile parameters were measured according to standard methods. Uremic toxin serum levels (indoxyl sulfate, p-cresyl sulfate, indole-3-acetic acid) were obtained by reversed-phase high-performance liquid chromatography (RP-HPLC). Fecal samples were collected to evaluate the gut microbiota profile through polymerase chain reaction and denaturing gradient gel electrophoresis. Statistical analysis was performed by the SPSS 23.0 program software. RESULTS: Patients who adhered to the diet (n = 14) (0.7 ± 0.2 g/kg/day) presented an improvement in renal function (nonsignificant) and reduction in total and low-density lipoprotein cholesterol (183.9 ± 48.5-155.7 ± 37.2 mg/dL, P = .01; 99.4 ± 41.3-76.4 ± 33.2 mg/dL, P = .01, respectively). After 6 months of nutricional intervention, p-cresyl sulfate serum levels were reduced significantly in patients who adhered to the LPD (19.3 [9.6-24.7] to 15.5 [9.8-24.1] mg/L, P = .03), and in contrast, the levels were increased in patients who did not adhere (13.9 [8.0-24.8] to 24.3 [8.1-39.2] mg/L, P = .004). In addition, using the denaturing gradient gel electrophoresis technique, it was observed change in the intestinal microbiota profile after LPD intervention in both groups, and the number of bands was positively associated with protein intake (r = 0.44, P = .04). CONCLUSION: LPD seems be a good strategy to reduce the uremic toxins production by the gut microbiota in nondialysis CKD patients.

Ensino da Bioética Convergente de ricardo maliandi nos Cursos de medicina / Maliandi's Bioethics in undergraduate medicine Courses

RESUMO Este artigo sublinha a patente deficiência dos currículos de Medicina em relação às Ciências Humanas e defende que o estudo da Bioética — disciplina que procura integrar as Ciências Humanas às Ciências Biológicas — poderá ajudar a preencher essa nociva lacuna. Apresentamos a Bioética Convergente de Ricardo Maliandi e Oscar Thüer como um valioso arcabouço teórico capaz de auxiliar o médico a protagonizar a resolução dos conflitos éticos inerentes à sua prática profissional, sem incorrer em unilateralidade. Comparamos sua fundamentação teórica com a conhecida proposta, também principialista, de Beauchamp e Childress, apontando as vantagens daquela em relação a esta. Exemplificamos sua aplicabilidade com a análise de potenciais conflitos éticos inferidos de informações obtidas em prontuário de uma paciente internada no Centro de Terapia Intensiva do Hospital Universitário Antônio Pedro. Para a realização dessa análise, buscamos, na literatura médica, dados probabilísticos em relação ã doença em questão (neoplasia de esôfago com fístula traqueoesofageana complicada por choque séptico pulmonar), ressaltando que esses dados podem ajudar na melhor compreensão do prognóstico, sem que por isso possam ser utilizados como respaldo da equipe médica para decisões unilaterais de limitação terapêutica. A literatura médica também nos brindou com propostas de condução de casos difíceis do ponto de vista ético, como o da paciente em tela. Escolhemos uma delas (Azoulayet al.12), reconhecendo e demonstrando sua compatibilidade com a Bioética Convergente de Maliandi e Thüer. Trata-se de um ensaio teórico sobre limitação terapêutica, no qual procuramos unir a fundamentação da literatura à aplicabilidade em um caso real de paciente crítica. Acreditamos que este artigo poderá ser um ponto de partida para a difusão da Ética Convergente — trabalho de toda a vida do filósofo Ricardo Maliandi, explicitada, no que tange à Bioética, com auxílio do médico Oscar Thüer — nos cursos de Medicina, trazendo mais segurança e menos solidão ao difícil processo de tomada de decisão inerente à relação médico-paciente ou médico-família, em especial no que se refere à atenção médica no fim da vida.

ABSTRACT This article points out the deficiency of medical courses in relation to Humanities and argues that the study of Bioethics — a discipline that seeks to integrate the Human and Biological Sciences — can help fill this harmful gap. We present the Convergent Bioethics of Ricardo Maliandi and Oscar Thüer as a valuable theoretical framework able to help physicians to solve or minimize ethical conflicts inherent to their professional practice, without undue unilateralism. Comparing its theoretical foundation with the well-known proposal of Beauchamp and Childress we point out the advantages of the former. We showcase its applicability with the analysis of potential ethical conflicts inferred from information obtained from medical records of a patient admitted tothe Intensive Care Unit of the Hospital Universitário Antônio Pedro. To that end, medical literature was studied in search of probabilistic data about the disease in question (esophageal cancer with fistula, complicated by pulmonary septic shock), noting that these data can help toward gaining a better understanding of the prognosis, but cannot be used by the medical team as support for unilateral decisions about therapeutic limitations. Reading Azoulay's work regarding patients with diseases with poor prognosis who eventually find themselves in intensive care, we highlight his proposal for difficult cases from an ethical point of view, recognizing and demonstrating its compatibility with the Convergent Bioethics of Maliandi and Thüer. This is a theoretical essay on therapeutic limitation, in which we seek to link the literature's foundation to real-case applicability of a critical patient. We believe that this article could be a starting point for the dissemination of Convergent Ethics - developed by the philosopher Ricardo Maliandi and explained with the aid of the physician Oscar Thüer as refers to bioethics — in medical courses, bringing more security and less loneliness in the difficult decision-making process inherent to the relationship between physicians and patient/family, particularly with regard to end of life medical care.

Impact of gender in early structural changes of contrast induced nephropathy in rats.

INTRODUCTION: Contrast-induced nephropathy (CIN) is a major iatrogenic cause of acute kidney injury. Experimental studies have shown that intravascular injection causes intense vacuolization of the contrast agent in the proximal renal tubules cells, preceding the increase in serum creatinine, and that the female may be at a higher risk for CIN. OBJECTIVE: To study the early kidney histomorphometric changes in contrast-induced nephropathy according to the gender. METHODS: Twenty previously uninephrectomized Wistar rats were divided into 4 groups (n = 5): control males; control females; contrast exposed males; and contrast exposed females. The animals were sacrificed immediately after contrast administration and kidney tissue samples were collected for histomorphometric analysis. The research project was approved by the Research Ethics Committee of the School of Medicine of Universidade Federal Fluminense. RESULTS: There was a more intense presence of microvacuoles in proximal tubules in the rats exposed to contrast than in the control groups. Such proximal tubular vacuolation was more intensive in the female rats (p = 0.001). CONCLUSION: Proximal tubular vacuolation is a very early change in CIN and is more intensive in female than in male rats.

Is there a relationship between tryptophan dietary intake and plasma levels of indoxyl sulfate in chronic kidney disease patients on hemodialysis?

INTRODUCTION: Gut microbiota is involved in generation of uremic toxins in chronic kidney disease (CKD) patients on hemodialysis (HD), like indoxyl sulfate (IS) that is originated from tryptophan amino acid fermentation. OBJECTIVE: To evaluate the tryptophan intake by chronic renal failure patients on HD and its possible relationship with IS plasma levels. METHODS: Participated of the study 46 patients with CKD on HD regular program (56.5% men; 52.7 ± 10.3 years; 63 (32.2-118.2) months on HD; BMI 25.6 ± 4.9 kg/m2). The tryptophan intake was evaluated by a 24-hours dietary recall (R-24h) performed on 3 different days. Routine biochemical tests and anthropometric measurements were evaluated. IS plasma levels were determined by High Performance Liquid Chromatography (HPLC) with fluorescent detection and the interleukin-6 (IL-6) plasma levels by immunoenzymatic method (ELISA, Enzyme Linked Immunosorbent Assay). RESULTS: The average of tryptophan intake was according to recommendation, but IS plasma levels (35.0 ± 11.9 mg/L) were elevated, however according to the EUTox values for uremic individuals. There was no correlation between the tryptophan intake and IS plasma levels. However, there was positive correlation between protein intake and tryptophan and variables used to evaluate lean body mass, and moreover, IS levels were positively associated with IL-6 (r = 0.6: p = 0.01). CONCLUSION: The present study suggests that tryptophan dietary intake may not be a determinant factor to IS levels. However, it suggests that gut microbiota may play an important role in systemic inflammation in patients with CKD.

Impact of gender in early structural changes of contrast induced nephropathy in rats / Impacto do gênero em alterações estruturais precoces da nefropatia induzida por contraste em ratos

Abstract Introduction: Contrast-induced nephropathy (CIN) is a major iatrogenic cause of acute kidney injury. Experimental studies have shown that intravascular injection causes intense vacuolization of the contrast agent in the proximal renal tubules cells, preceding the increase in serum creatinine, and that the female may be at a higher risk for CIN. Objective: To study the early kidney histomorphometric changes in contrast-induced nephropathy according to the gender. Methods: Twenty previously uninephrectomized Wistar rats were divided into 4 groups (n = 5): control males; control females; contrast exposed males; and contrast exposed females. The animals were sacrificed immediately after contrast administration and kidney tissue samples were collected for histomorphometric analysis. The research project was approved by the Research Ethics Committee of the School of Medicine of Universidade Federal Fluminense. Results: There was a more intense presence of microvacuoles in proximal tubules in the rats exposed to contrast than in the control groups. Such proximal tubular vacuolation was more intensive in the female rats (p = 0.001). Conclusion: Proximal tubular vacuolation is a very early change in CIN and is more intensive in female than in male rats.

Resumo Introdução: A nefropatia induzida por contraste (NIC) é uma das principais causas iatrogênicas de lesão renal aguda. Estudos experimentais têm demonstrado que a injeção intravascular do agente de contraste provoca vacuolização intensa nas células dos túbulos renais proximais, que precede o aumento da creatinina sérica, e que a fêmea podem estar em maior risco de CIN. Objetivo: Estudar as primeiras mudanças histomorfométricas renais na nefropatia induzida por contraste de acordo com o gênero. Métodos: Vinte ratos Wistar anteriormente uninefrectomizados foram divididos em 4 grupos (n = 5): machos de controle; fêmeas de controle; machos expostos ao contraste e fêmeas expostas ao contraste. Os animais foram sacrificados imediatamente após a administração de contraste e amostras de tecido de rim foram coletadas para análise histomorfométrica. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense. Resultados: Houve presença mais intensa de microvacuolização em túbulos proximais nos ratos expostos ao contraste do que nos grupos de controle. Tal vacuolização tubular proximal foi mais intensa nos ratos do sexo feminino p = 0,001). Conclusão: Vacuolização do tpubulo proximal é uma mudança precoce na CIN e é mais intensa em ratos fêmeas do que em ratos machos.

Is there a relationship between tryptophan dietary intake and plasma levels of indoxyl sulfate in chronic kidney disease patients on hemodialysis? / Há relação entre ingestão alimentar de triptofano e níveis plasmáticos de indoxil sulfato em pacientes renais crônicos em hemodiálise?

Abstract Introduction: Gut microbiota is involved in generation of uremic toxins in chronic kidney disease (CKD) patients on hemodialysis (HD), like indoxyl sulfate (IS) that is originated from tryptophan amino acid fermentation. Objective: To evaluate the tryptophan intake by chronic renal failure patients on HD and its possible relationship with IS plasma levels. Methods: Participated of the study 46 patients with CKD on HD regular program (56.5% men; 52.7 ± 10.3 years; 63 (32.2-118.2) months on HD; BMI 25.6 ± 4.9 kg/m2). The tryptophan intake was evaluated by a 24-hours dietary recall (R-24h) performed on 3 different days. Routine biochemical tests and anthropometric measurements were evaluated. IS plasma levels were determined by High Performance Liquid Chromatography (HPLC) with fluorescent detection and the interleukin-6 (IL-6) plasma levels by immunoenzymatic method (ELISA, Enzyme Linked Immunosorbent Assay). Results: The average of tryptophan intake was according to recommendation, but IS plasma levels (35.0 ± 11.9 mg/L) were elevated, however according to the EUTox values for uremic individuals. There was no correlation between the tryptophan intake and IS plasma levels. However, there was positive correlation between protein intake and tryptophan and variables used to evaluate lean body mass, and moreover, IS levels were positively associated with IL-6 (r = 0.6: p = 0.01). Conclusion: The present study suggests that tryptophan dietary intake may not be a determinant factor to IS levels. However, it suggests that gut microbiota may play an important role in systemic inflammation in patients with CKD.

Resumo Introdução: A microbiota intestinal está envolvida na geração de toxinas urêmicas presentes nos pacientes com doença renal crônica (DRC) em hemodiálise (HD) como indoxil sulfato (IS), formado a partir da fermentação do aminoácido triptofano. Objetivo: Avaliar a ingestão de triptofano alimentar pelos pacientes renais crônicos em HD e sua possível relação com os níveis plasmáticos de IS. Métodos: Participaram do estudo 46 pacientes com DRC em programa regular de HD (56,5% homens; 52,7 ± 10,3 anos; 63 (32,2-118,2) meses em HD; IMC 25,6 ± 4,9kg/m2. A ingestão de triptofano foi avaliada por meio do recordatório alimentar de 24 (R-24h) realizado em três diferentes dias. Exames bioquímicos de rotina, bem como a avaliação antropométrica foram avaliados. Os níveis plasmáticos de IS foram determinados por cromatografia líquida de alto desempenho (HPLC) com detecção fluorescente e as concentrações plasmáticas de interleucina-6 (IL-6) pelo método imunoenzimático (ELISA, Enzyme Linked Immunosorbent Assay). Resultados: A ingestão média de triptofano estava dentro do recomendado, já os níveis plasmáticos de IS (35,0 ± 11,9mg/L) estavam elevados, porém de acordo com os valores da EUTox para indivíduos urêmicos. Não houve correlação entre a ingestão de triptofano e os níveis plasmáticos de IS. Contudo, houve correlação positiva entre ingestão de proteína e triptofano e variáveis que avaliam massa magra e, além disso, os níveis IS foram positivamente associados com os de IL-6 (r = 0,6: p = 0,01). Conclusão: O presente estudo sugere que a ingestão alimentar de triptofano pode não ser um fator determinante dos níveis de IS. No entanto, sugere que o intestino pode ter importante papel na inflamação sistêmica presente nos pacientes com DRC.

NF-κB expression and its association with nutritional status in hemodialysis patients.

PURPOSE: This study aimed to evaluate the association among the expressions of pro- and anti-inflammatory nuclear factors (nuclear factor-kappaB, NF-κB and nuclear erythroid 2-related factor 2, Nrf2) and nutritional status in HD patients. METHODS: This cross-sectional study included eighty-three HD patients. The peripheral blood mononuclear cells were isolated and processed for the evaluation of NF-κB and Nrf2 RNAm expression by quantitative real-time polymerase chain reaction. Muscle mass was estimated by creatinine index (CI) and percentage of body fat (%BF) by anthropometry. Seven-point subjective global assessment was also used to evaluate the nutritional status. RESULTS: The NF-κB expression was negatively correlated with CI (r = -0.54, p = 0.0001), serum albumin (r = -0.32, p = 0.02) and %BF (r = -0.61, p = 0.001). Multiple linear regression analysis revealed that NF-κB expression was independently associated with CI (ß: -0.8, p = 0.013) and %BF (ß: -0.42, p = 0.04). There was no correlation among Nrf2 and anthropometric and biochemical variables. CONCLUSION: The classical NF-κB activation seems to be associated with poor nutritional status in HD patients; however, the exact underlying mechanisms deserve further studies.

In Hemodialysis Patients, Intradialytic Resistance Exercise Improves Osteoblast Function: A Pilot Study.

OBJECTIVE: Abnormalities in mineral and bone metabolism are frequent in chronic kidney disease patients. Physical exercise can improve many indicators of physical functioning, and recent studies showed beneficial effects on bone mineral density in the general population. The aim of this study was to evaluate the effects of resistance exercise training on bone markers and body composition in hemodialysis (HD) patients. DESIGN: This was a randomized controlled trial. SUBJECTS: The study included 13 HD patients (46.2% men). INTERVENTION: Patients were divided into a control group and an exercise group, which performed 8 weeks of intradialytic resistance exercise. Serum sclerostin, bone alkaline phosphatase (BAP), insulin, leptin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and body composition were measured before and after the exercise period. RESULTS: In the exercise group, BAP levels increased from 11.4 ± 6.5 to 14.6 ± 6.4 U/L (P < .05) and serum 1,25-dihydroxyvitamin D levels from 46.0 ± 23.5 to 87.2 ± 31.8 ng/mL (P < .05). After exercise, serum BAP levels were inversely correlated with serum sclerostin (r = -0.96, P < .05). There was no change in body composition in either group. CONCLUSION: Resistance exercise training appears to be an interesting approach for stimulating BAP production in HD patients and may prevent bone loss and stimulate bone formation.

Exercise Training Alters the Bone Mineral Density of Hemodialysis Patients.

Marinho, SM, Moraes, C, Barbosa, JEdSM, Eduardo, JCC, Fouqe, D, Pelletier, S, and Mafra, D. Exercise training alters the bone mineral density of hemodialysis patients. J Strength Cond Res 30(10): 2918-2923, 2016-Patients with chronic kidney disease undergoing hemodialysis (HD) frequently present low bone mineral density (BMD), and exercise may be useful for treating bone loss. This study aimed to assess the effects of an intradialytic resistance exercise training program (RETP) on BMD in HD patients. Twenty-one patients were enrolled into 2 groups; 10 patients performed exercise (80.0% men; 46.9 ± 12.1 years; 27.0 ± 3.4 kg·m) and 11 patients were in the control group (54.5% men; 50.5 ± 11.5 years; 24.1 ± 8.7 kg·m). Dual-energy x-ray absorptiometry was used to measure the BMD, lean mass, and body fat before and after the supervised RETP (performed with elastic bands and ankle cuffs in both lower limbs 3 times a week for 24 weeks-72 sessions). In the exercise group, 30.0% of patients presented with osteopenia and 20.0% osteoporosis and in the control group, 45.5% osteopenia and 36.4% osteoporosis. Only in the exercise group, the osteoporosis percentage was reduced to 10.0% and the femoral neck BMD and T-score improved from 0.89 ± 0.1 to 0.93 ± 0.1 g·cm and from -1.3 ± 0.8 to -1.0 ± 0.8 g·cm (p ≤ 0.05), respectively, after the intervention. In contrast, these parameters were reduced in the control group. The results suggest that resistance exercise may be useful for improving the BMD in HD patients. In summary, 24 weeks of the supervised RETP played a role in improving the BMD of HD patients.

Proteína C-Reativa Ultrassensível em Pacientes Submetidos a Exames Contrastados / High-Sensitivity C-Reactive Protein in Patients Undergoing Contrast Studies

A utilização de agentes iodados em exames radiológicos pode causar nefropatia induzida porcontraste (NIC) na presença de fatores de risco clássicos, como doença renal prévia e diabetes. Recentemente,níveis séricos elevados de proteína C-reativa ultrassensível (PCR-us) têm sido descritos como indicadores de maior risco de NIC. Independente da ocorrência de NIC, a PCR-us pode elevar-se após exames contrastados.Objetivo: Investigar o comportamento da PCR-us em pacientes submetidos à administração parenteral de agentede contraste iodado. Métodos: Estudo observacional, transversal, prospectivo, realizado no Hospital Universitário Antônio Pedro, de 2007 a 2014, envolvendo 51 pacientes, 30 homens e 21 mulheres, média de idade 60,19±20,0 anos, submetidos aexames com contraste de baixa osmolalidade (Iopamidol 612 mg/mL).Resultados: NIC ocorreu em 15 pacientes (29,4%). Não houve correlação entre a PCR-us aumentada e a ocorrência de NIC. O aumento percentual da PCR-us foi significativamente maior entre os pacientes submetidos ao cateterismocardíaco (p=0,0044). O aumento médio da PCR-us nos pacientes submetidos ao cateterismo cardíaco e naquelessubmetidos à administração do contraste iodado por veia periférica foi 100,3% e 13,8%, respectivamente.Conclusão: Os achados sugerem que o aumento da PCR-us após cateterismo cardíaco não pode ser atribuído aoagente de contraste iodado...

Background: The use of iodinated agents in radiological studies can cause contrast-induced nephropathy (CIN) in the presence of classic risk factors such as previous renal disease and diabetes. High serum levels of high-sensitivity C-reactive protein (CRP) have been described as indicators of increased risk of CIN. Regardless of the occurrence of CIN, hs-CRP may rise after contrast studies. Objective: To investigate the behavior of hs-CRP in patients undergoing parenteral administration of iodinated contrast agent. Methods: Observational cross-sectional prospective study held at Hospital Universitário Antônio Pedro from 2007 to 2014 involving 51 patients, 30 men and 21 women, mean age 60.19±20.0, undergoing tests with low-osmolality contrast (Iopamidol 612mg/ml).Results: CIN occurred in 15 patients (29.4%). There was no correlation between increased hs-CRP and occurrence of CIN. The percentage increase in hs-CRP was significantly higher among patients undergoing cardiac catheterization (p=0.0044). The mean increase in hs-CRP in patients undergoing cardiac catheterization and in those submitted to administration of iodinated contrast by peripheral vein was 100.3% and 13.8%, respectively.Conclusion: The findings suggest that increased hs-CRP after cardiac catheterization cannot be attributed to iodinated contrast agente...

Urinary tract infection and indwelling urinary catheters: prospective study in gynecological surgery with antibiotic prophylaxis / Infecção do trato urinário e cateter vesical de demora: um estudo prospectivo em cirurgia ginecológica com antibioticoprofilaxia

ABSTRACT CONTEXT AND OBJECTIVES: Urinary tract infections are the most common cause of hospital-acquired infections, and the use of indwelling urinary catheters is a predisposing factor for their development. The aims of this study were to estimate the frequency of pre and postoperative bacteriuria, identify the microorganisms involved, count the colony-forming units, determine the antibiotic sensitivity profile and compare the results from pre and postoperative urinalyses among women undergoing gynecological surgery with implantation of a urinary catheter. DESIGN AND SETTING: Non-controlled prospective observational single-cohort epidemiological study carried out at a university hospital. METHODS: Urine samples were collected before and 24 hours after catheterization for urinalysis, culturing and antibiotic sensitivity testing. Pre and postoperative urinalyses were compared using Wilcoxon and McNemar non-parametric tests. RESULTS: Fifty-one women participated in the study. Escherichia coligrew in six preoperative samples (11.8%) and Klebsiella pneumoniae in one (1.9%), but bacterial growth did not occur in any postoperative sample. Urinalysis showed lower number of pus cells in the postoperative urine samples (P < 0.05). There were no differences in red blood cell counts or in the nitrite and leukocyte esterase tests, between the samples. CONCLUSION: Bacteriuria was found in 13.7% of the preoperative samples. Gram-negative bacteria sensitive to most antibiotics were identified. In the postoperative samples, no bacterial growth was observed. Urinalysis only showed significant reduction of leukocyturia in the postoperative period.

RESUMO CONTEXTO E OBJETIVOS: As infecções urinárias são a causa mais comum de infecções hospitalares, e o uso de cateteres de demora é fator predisponente para o seu desenvolvimento. Os objetivos deste estudo foram estimar a frequência de bacteriúria pré e pós-operatória, identificar os germes encontrados, a contagem de unidades formadoras de colônias e o perfil de sensibilidade aos antibióticos, além de comparar os resultados dos exames de urina pré- e pós-operatórios em mulheres submetidas a cirurgias ginecológicas com cateterismo vesical. TIPO DE ESTUDO E LOCAL: Estudo epidemiológico, observacional, de coorte única, prospectivo, não controlado, realizado em hospital universitário. MÉTODOS: Amostras de urina foram colhidas antes da cateterização e após 24 horas para urinálise, cultura e antibiograma. Os resultados da urinálise no pré- e pós-operatório foram comparados utilizando-se os testes não paramétricos de Wilcoxon e McNemar. RESULTADOS: Participaram do estudo 51 mulheres. Houve crescimento de Escherichia coli em seis amostras pré-operatórias (11,8%) e deKlebsiella pneumoniae em uma (1,9%), mas não houve crescimento bacteriano em nenhuma amostra pós-operatória. A urinálise mostrou menor quantidade de piócitos na amostra de urina pós-cirúrgica (P < 0,05). Não houve diferença quanto ao número de hemácias e às reações para nitrito e leucocitesterase, entre as amostras. CONCLUSÃO: Houve bacteriúria em 13,7% das amostras pré-operatórias, sendo identificadas bactérias Gram-negativas sensíveis à maioria dos antibióticos. Não foi observado crescimento bacteriano nas amostras pós-operatórias. A urinálise mostrou somente redução significativa da leucocitúria no pós-operatório.

Urinary tract infection and indwelling urinary catheters: prospective study in gynecological surgery with antibiotic prophylaxis.

CONTEXT AND OBJECTIVES: Urinary tract infections are the most common cause of hospital-acquired infections, and the use of indwelling urinary catheters is a predisposing factor for their development. The aims of this study were to estimate the frequency of pre and postoperative bacteriuria, identify the microorganisms involved, count the colony-forming units, determine the antibiotic sensitivity profile and compare the results from pre and postoperative urinalyses among women undergoing gynecological surgery with implantation of a urinary catheter. DESIGN AND SETTING: Non-controlled prospective observational single-cohort epidemiological study carried out at a university hospital. METHODS: Urine samples were collected before and 24 hours after catheterization for urinalysis, culturing and antibiotic sensitivity testing. Pre and postoperative urinalyses were compared using Wilcoxon and McNemar non-parametric tests. RESULTS: Fifty-one women participated in the study. Escherichia coligrew in six preoperative samples (11.8%) and Klebsiella pneumoniae in one (1.9%), but bacterial growth did not occur in any postoperative sample. Urinalysis showed lower number of pus cells in the postoperative urine samples (P < 0.05). There were no differences in red blood cell counts or in the nitrite and leukocyte esterase tests, between the samples. CONCLUSION: Bacteriuria was found in 13.7% of the preoperative samples. Gram-negative bacteria sensitive to most antibiotics were identified. In the postoperative samples, no bacterial growth was observed. Urinalysis only showed significant reduction of leukocyturia in the postoperative period.

Is there association between uric acid and inflammation in hemodialysis patients?

BACKGROUND: Elevated serum uric acid has been associated with a variety of cardiovascular disease and with inflammation, but these have been little explored in chronic kidney disease (CKD). Elevated uric acid levels are common in CKD patients and could be involved in inflammatory milieu; our aim was to analyze the association between uric acid and inflammatory markers in hemodialysis (HD) patients. DESIGN: This was a cross-sectional study. SETTING: This study was conducted from private clinic, Rio de Janeiro, Brazil. PATIENTS: This study included 50 HD patients and 21 healthy subjects. METHODS AND PROCEDURES: This study included 50 HD patients [62% men, 54.3 ± 12.6 years, 57.5 ± 50.1 months on dialysis, and body mass index (BMI), 24.4 ± 4.1 kg/m2] and 21 healthy individuals (45% men, 50.7 ± 15.7 years and BMI, 25.5 ± 4 kg/m2). Uric acid was measured using uricase-PAP method; inflammatory [tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)] and atherosclerosis markers [intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein-1 (MCP-1), plasminogen activator inhibitor-1 (PAI-1)] were measured by a multiplexed assay. RESULTS: PATIENTS presented high levels of TNF-α, IL-6, CRP, VCAM-1, ICAM-1 (5.5 ± 2.1 pg/mL, 4.1 ± 1.6 pg/mL, 0.32 ± 0.30 mg/mL, 48.5 ± 8.5 ng/mL, 20.5 ± 15.9 ng/mL, respectively), compared with healthy individuals (2.4 ± 1.1 pg/mL, 2.7 ± 0.4 pg/mL, 0.11 ± 0.12 mg/mL, 23.8 ± 5.5 ng/mL, 7.2 ± 1.2 ng/mL, respectively) ( p < 0.04). Uric acid levels were also higher in HD patients (5.4 ± 1.3 mg/dL) than in healthy individuals (3.9 ± 0.9 mg/dL) ( p < 0.02). There was a positive correlation between uric acid and inflammatory markers, IL-6 (r = 0.30, p = 0.01), CRP (r = 0.37, p = 0.003), TNF-α (r = 0.40, p = 0.001), ICAM-1 (r = 0.53, p = 0.0001), and VCAM-1 (r = 0.45, p = 0.0001). CONCLUSION: These original data suggest that uric acid may have a role in inflammation and atherosclerosis in HD patients. However, further prospective studies involving intervention trials should be conducted in order to search for actual causality relationship between these markers.

Resveratrol: why is it a promising therapy for chronic kidney disease patients?

Resveratrol, a phenolic compound found in various plants, including grapes, berries, and peanuts, shows promise for the treatment of cancer, aging, type 2 diabetes, and cardiovascular diseases. Resveratrol can promote transcription factor nuclear factor-erythroid 2-related factor 2 (Nrf2) activation, increase the expression level of SIRT-1, which is a sirtuin family protein, and reduce mTOR pathway signaling. This compound has anti-inflammatory properties in that it inhibits or antagonizes the nuclear factor-κB (NF-κB) activity, which is a redox-sensitive transcription factor that coordinates the inflammatory response. Inflammation and oxidative stress, which are common features in patients with chronic kidney disease (CKD), are interrelated and associated with cardiovascular disease and the progression of CKD itself. Because of the modulation of the mechanisms involved in the inflammatory-oxidative stress cycle, resveratrol could play an important role in controlling CKD-related metabolic derangements. Although resveratrol supplementation in theory is a promising therapy in this patient group, there are no studies evaluating its effects. Thus, the present review aims to describe the role of resveratrol in inflammation and oxidative stress modulation and its possible benefits to patients with CKD.