Renal deficit and associated factors in children born with low birth weight / Déficit renal e fatores associados em crianças nascidas com baixo peso

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos.

Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review.

Large-scale COVID-19 vaccination has been one of the most effective strategies to control the spread of the SARS-CoV-2 virus. However, several cases of glomerular injury related to the COVID-19 vaccine have been described in the literature. We report two cases of a tip lesion variant of focal segmental glomerulosclerosis (FSGS), which presented with significant proteinuria and improved after immunosuppression. In our literature review, the tip lesion variant of FSGS is currently the most frequent variant associated with vaccination against COVID-19. Prognosis is favorable and without significant alterations in the tubulointerstitial or vascular compartments. Adverse effects of vaccines need to be recognized early and will help us to understand the immune and pathological mechanisms of kidney damage.

Renal deficit and associated factors in children born with low birth weight.

INTRODUCTION: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. METHODS: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. RESULTS: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. DISCUSSION: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination: a case report and literature review.

With the coverage of COVID-19 vaccination, it has been possible to observe the potential side effects of SARS-CoV-2 vaccines, with the most common ones being fever, myalgia, headache, and fatigue. However, an association has been observed between new and recurrent kidney injuries, mainly glomerulonephritis and lupus nephritis associated with ANCA, with the Pfizer-BioNTech, Moderna, Sinovac, and AstraZeneca vaccines, although the relationship between them is not clear. We report a case of ANCA-related vasculitis and lupus glomerulonephritis after the second dose of the AstraZeneca vaccine. The elderly patient presented significant worsening of kidney function after immunosuppression and complications after a new onset COVID-19 infection that led to death. We provide a literature review about kidney damage related to ANCA vasculitis after COVID-19 vaccine, aiming for a better understanding of the pathophysiological mechanism of kidney injury, its presentation, and treatment.

Efeitos da terapia renal substitutiva no sistema auditivo: uma revisão de escopo / Effects of renal replacement therapy on the auditory system: a scoping review / Efectos del tratamiento renal sustitutivo sobre el sistema auditivo: una revisión general

Objetivo: responder as seguintes questões: A) Quais os efeitos no sistema auditivo da terapia renal substitutiva em pacientes dialíticos? B) Quais os principais métodos utilizados para avaliar o sistema auditivo de pacientes dialíticos? Método: Revisão de escopo realizada no mês de janeiro de 2023, utilizando as bases PubMed, Scielo e Medline. Foram utilizados descritores a partir dos seguintes eixos temáticos: terapia renal substitutiva e alterações no sistema auditivo. Resultados: Foram encontrados 358 artigos. Após critérios de elegibilidade, 15 foram incluídos neste estudo. A maioria dos estudos (66,6%) apresentou alteração auditiva para indivíduos que estavam em terapia renal substitutiva, destes (20,0%) descreveram alteração coclear. A perda do tipo neurossensorial nas altas frequências foi a mais frequente com respostas ausentes para as emissões otoacústicas. Foram identificados oito diferentes métodos para avaliação auditiva desta população, sendo o mais utilizado para acompanhamento auditivo a audiometria tonal (73,3%) e a imitânciometria (33,3%). O teste de emissões otoacústicas é o mais citado para diagnóstico precoce. Conclusão: Pacientes em TRS apresentam perda auditiva do tipo neurossensorial nas frequências altas, com grau variando de acordo com o número de terapia renal duração da insuficiência renal. Curvas timpanométricas do tipo A e ausência de respostas nas EOA. O teste mais utilizado para acompanhamento auditivo desta população é a Audiometria Tonal, porém as EOA são os testes mais citados para diagnóstico precoce.

Aim: to answer the following questions: A) What are the effects on the auditory system of renal replacement therapy in dialysis patients? B) What are the main methods used to evaluate the auditory system in dialysis patients? Method: Scoping review conducted in January 2023 using PubMed, Scielo and Medline. Descriptors were used from the following thematic axes: renal replacement therapy and auditory system changes. Results: 358 articles were found. After eligibility criteria, 15 were included in this study. Most studies (66.6%) presented hearing loss in individuals who were on renal replacement therapy, and of these (20.0%) described cochlear alteration. The sensorineural type loss in the high frequencies was the most frequent with absent responses for otoacoustic emissions. Eight different methods were identified for hearing assessment in this population, with tonal audiometry (73.3%) and immittance audiometry (33.3%) being the most used for hearing monitoring. The otoacoustic emissions test is the most cited for early diagnosis. Conclusion: Patients on SRT have sensorineural hearing loss in the high frequencies, with the degree varying according to the number of renal therapy duration of renal failure. Type A tympanometric curves and absence of OAE responses. The most commonly used test for auditory monitoring in this population is Tonal Audiometry, but OAE is the most cited test for early diagnosis.

Objetivo: responder a las siguientes preguntas: A) ¿Cuáles son los efectos sobre el sistema auditivo del tratamiento renal sustitutivo en pacientes en diálisis? B) ¿Cuáles son los principales métodos utilizados para evaluar el sistema auditivo en pacientes en diálisis? Método: Revisión exploratoria realizada en enero de 2023, utilizando las bases de datos PubMed, Scielo y Medline. Se utilizaron descriptores de los siguientes ejes temáticos: terapia renal sustitutiva y alteraciones del sistema auditivo. Resultados: Se encontraron 358 artículos. Tras los criterios de elegibilidad, se incluyeron 15 en este estudio. La mayoría de los estudios (66,6%) presentaban hipoacusia en individuos en tratamiento renal sustitutivo, de éstos (20,0%) describían alteración coclear. La hipoacusia neurosensorial en altas frecuencias fue el tipo más frecuente, con ausencia de respuestas para las otoemisiones acústicas. Se identificaron ocho métodos diferentes para la evaluación auditiva en esta población, siendo la audiometría tonal (73,3%) y la audiometría de inmitancia (33,3%) los más utilizados para el control auditivo. La prueba de otoemisiones acústicas es la más citada para el diagnóstico precoz. Conclusión: Los pacientes en TRS presentan hipoacusia neurosensorial en las frecuencias agudas, variando el grado según el número de tratamientos renales y la duración de la insuficiencia renal. Curvas timpanométricas de tipo A y ausencia de respuestas OAE. La audiometría tonal es la prueba más utilizada para el control auditivo en esta población, pero la OAE es la prueba más mencionada para el diagnóstico precoz.

Kidney injury associated with COVID-19 infection and vaccine: A narrative review.

The respiratory tract is the main infection site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in many admissions to intensive care centers in several countries. However, in addition to lung involvement, kidney injury caused by the novel coronavirus has proven to be a significant factor related to high morbidity and mortality, alarming experts worldwide. The number of deaths has drastically reduced with the advent of large-scale immunization, highlighting the importance of vaccination as the best way to combat the pandemic. Despite the undeniable efficacy of the vaccine, the renal side effects associated with its use deserve to be highlighted, especially the emergence or reactivation of glomerulopathies mentioned in some case reports. This study aimed to identify the main renal morphological findings correlated with COVID-19 infection and its vaccination, seeking to understand the pathophysiological mechanisms, main clinical features, and outcomes.

Case report: Isolated tubular basement membrane deposits in a patient with systemic lupus erythematosus - A diagnostic challenge.

Lupus nephritis is one of the most serious and frequent manifestations of systemic lupus erythematosus. It usually presents in the first years of the disease, which suspicion should be raised in cases of elevated serum creatinine, presence of proteinuria above 500 mg/day or active urinary sediment, in the absence of other apparent causes such as urinary tract infection and use of nephrotoxic drugs. In most cases, it affects the glomerulus, and its presentation is rare in the form of isolated tubulo-interstitial disease. In this report, we describe a case of lupus nephritis diagnosed after 2 years of illness, in the form of atypical isolated tubular disease, characterized by massive deposits in the tubular basement membrane. Clinically, there were altered renal function, subnephrotic proteinuria, and evolution to a complete clinical response after immunosuppressive treatment.

Membranous Nephropathy Secondary to Graves' Disease: A Case Report.

Membranous nephropathy (MN) is a form of kidney disease that is idiopathic in 70%-80% of cases. Glomerular involvement in autoimmune thyroiditis can occur in 10%-30% of patients, and MN manifests in association with Hashimoto thyroiditis in up to 20% of the cases with glomerular involvement. Reports of MN associated with Graves' disease (GD) are extremely rare in the current literature. Herein, we report the case of a 46-year-old man admitted to the hospital with nephrotic syndrome and symptomatic hyperthyroidism due to GD. Kidney biopsy revealed a secondary MN pattern. Immunohistochemical staining for PLA2R was negative, and thyroglobulin showed weak and segmental staining along the glomerular capillary. Anti-thyroid peroxidase (TPO) antibody test was not performed. The patient was treated for GD with methimazole and prednisone, and despite reaching clinical improvement after 8 months, proteinuria remained close to nephrotic levels. In this scenario, the patient was submitted to radioactive iodine, and there was a dramatic reduction in proteinuria levels after treatment. In conclusion, GD association with MN is rare, and when present, diagnosis using PLA2R and immunohistochemistry can be useful in determining association. In addition, radioactive iodine therapy can be an effective treatment modality when preceded with immunosuppressive corticosteroid therapy.

Correlation of sleep quality and cardiac autonomic modulation in hemodialysis patients.

Objectives: Sleep disorders in patients on hemodialysis are frequent, but few studies correlate these disorders with autonomic dysfunction in these patients. This study aimed to verify whether clinical and laboratory variables and heart rate variability are associated with worse sleep quality verified by the Pittsburg subjective scale in patients on hemodialysis. Material and Methods: A cross-sectional study was performed on forty-eight patients. Epidemiological, clinical, and laboratory data were collected. After were performed by recording the heart rate variability and applied Pittsburg questionnaires, Beck anxiety index (BAI), and Beck depression index (BDI). The global PSQI score >5 indicates that a person is a poor sleeper, the patients were divided according to the scores in the Pittsburg questionnaire into good and poor sleepers and the differences between all variables were analyzed. Results: Forty-eight patients were evaluated and the prevalence of 68.7% (n=33) of poor sleep quality was verified. From the depression and anxiety questionnaires, it was found that only 18.7% (n=9) had criteria for depression. In the analysis of the sympathetic dysfunction parameters, it was found that in the group with good sleep quality in the frequency domain (HFm2) and the LFnu in the group with worse sleep quality. There was a positive correlation between sleep quality scores the anxiety and depression scores. It is also verified that the variables LFnu had a positive correlation with higher scores of quality of sleep and HFnu had a negative correlation with the highest scores of quality of sleep. Conclusion: In patients undergoing hemodialysis, the poorest quality of sleep is correlated with worse cardiac autonomic modulation as well as higher scores on the depression and anxiety scales.

Collapsing Glomerulopathy: A Review by the Collapsing Brazilian Consortium.

Collapsing glomerulopathy (CG) is a clinicopathologic entity characterized by segmentar or global collapse of the glomerulus and hypertrophy and hyperplasia of podocytes. The Columbia classification of 2004 classified CG as a histological subtype of focal segmental glomerulosclerosis (FSGS). A growing number of studies have demonstrated a high prevalence of CG in many countries, especially among populations with a higher proportion of people with African descent. The present study is a narrative review of articles extracted from PubMed, Medline, and Scielo databases from September 1, 2020 to December 31, 2021. We have focused on populational studies (specially cross-sectional and cohort articles). CG is defined as a podocytopathy with a distinct pathogenesis characterized by strong podocyte proliferative activity. The most significant risk factors for CG include APOL1 gene mutations and infections with human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2. CG typically presents with more severe symptoms and greater renal damage. The prognosis is notably worse than that of other FSGS subtypes.

Non-lupus full-house nephropathy: a case series / Nefropatia "full-house" não relacionada ao lúpus: uma série de casos

Abstract Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.

Resumo O lúpus eritematoso sistêmico (LES) é uma doença inflamatória crônica autoimune multissistêmica. Alguns pacientes, contudo, podem exibir um padrão histológico de lesão renal, com características indistinguíveis da nefrite lúpica, porém sem apresentar quaisquer sintomas extrarrenais ou sorologias sugestivas de LES. Tal acometimento tem sido recentemente denominado nefropatia "full-house" não relacionada ao lúpus. O objetivo é relatar uma série de casos clínicos encaminhados ao Laboratório da Universidade Federal do Maranhão que receberam o diagnóstico de nefropatia "full-house" não relacionada ao lúpus à imunofluorescência e discutir sua evolução e desfechos. A nefropatia "full-house" não relacionada ao lúpus representa um desafio diagnóstico e terapêutico por ser uma entidade nova, que ainda necessita de maiores estudos e pode ser a manifestação inicial do LES, manifestação isolada do LES ou uma patologia nova não relacionada ao LES.

Association of insufficient practice of physical activity with demographic, anthropometric and biochemical factors in hypertensive patients / Fatores associados à atividade física em pacientes com hipertensão tratados e monitorados pelo Hiperdia

Resumo Introdução Considerando-se a magnitude da hipertensão arterial sistêmica e suas complicações, assim como a importância da atividade física regular na sua prevenção e/ou tratamento, é necessário identificar os fatores associados à prática de atividade física insuficiente. Objetivo Analisar os fatores associados à atividade física insuficiente em hipertensos atendidos na atenção primária à saúde. Método Estudo transversal realizado com amostra aleatória de 305 hipertensos em três unidades de saúde de São Luís (MA). Foi realizada análise bivariada, com estimativas de razões de prevalência, intervalos de confiança e análise multivariada por regressão de Poisson. Resultados A atividade física insuficiente foi observada em 38,7% da amostra. Atividade física insuficiente foi associada a menos de 8 anos de educação formal (razão de prevalência - RP = 1,58; intervalo de confiança de 95% - IC = 1,04-2,39), colesterol total ≥200 mg/dL (RP = 0,78; IC 95% = 0,58 -1,04), lipoproteína de baixa densidade colesterol-LDLc ≥100 mg/dL (RP = 0,79; IC 95% = 0,53-0,95) e lipoproteína de alta densidade colesterol-HDLc <40 mg / dL entre homens e <50 mg/dL entre mulheres (RP = 1,21; IC 95% = 0,90-1,64). A escolaridade <8 anos (RP = 1,50; IC 95% = 0,99-2,29) e LDLc ≥100 mg/dL (RP = 0,72; IC 95% = 0,54-0,96) também estiveram associados na regressão multivariada. Conclusão Observou-se alta prevalência de atividade física insuficiente e sua associação com baixa escolaridade e LDLc alterado em hipertensos.

Abstract Background Considering the magnitude of systemic hypertension (SH) and its complications, as well as the importance of regular physical activity in its prevention and/or treatment, there is a necessity to identify the factors associated with insufficient practice of physical activity. Objective To analyze factors associated with insufficient physical activity in hypertensive patients treated at Primary Health Care (PHC). Method This cross-sectional study was performed with a random sample of 305 hypertensive patients in three PHC units in São Luis, state of Maranhão, Brazil. A bivariate analysis was performed with estimates of prevalence ratios and confidence intervals, and multivariate analysis using Poisson regression. Results Insufficient physical activity was observed in 38.7% of the sample. Insufficient physical activity was associated with having <8 years of formal education (prevalence ratio-PR=1.58; 95% confidence interval-CI=1.04-2.39), total cholesterol ≥200 mg/dL (PR=0.78; 95% CI=0.58-1.04), low-density lipoprotein cholesterol-LDL ≥100 mg/dL (PR=0.79; 95% CI=0.53-0.95), and high-density lipoprotein cholesterol-HDL <40 mg/dL among men and <50 mg/dL among women (PR=1.21; 95% CI=0.90-1.64). Length of education <8 years (PR=1.50; 95% CI=0.99-2.29) and LDL ≥100 mg/dL (PR=0.72;95% CI=0.54-0.96) were also associated in the multivariate regression. Conclusion High prevalence of insufficient physical activity and its association with low education level and altered LDL serum levels were observed in hypertensive patients.

Recurrent respiratory papillomatosis: clinical characteristics and viral genotyping in a Brazilian population.

This study presents 25 cases of recurrent respiratory papillomatosis (RRP) that occurred in Sao Luis, Maranhao State, Northeast region, Brazil, between January 2007 and December 2018. Sociodemographic and clinical profile of patients as well as human papillomavirus (HPV) infection status were evaluated. Clinical and histopathological data were collected from the patients' medical records. For the HPV infection analysis, DNA was extracted and subjected to amplification by a nested polymerase chain reaction. Viral genotyping was performed by automated sequencing. The median age of patients was 12.40 ± 12.6. years, and the juvenile form of the disease (68%) was the predominant form of disease. Female participants were predominant (60%), and they were from cities located in the interior of the State (60%). The most common clinical manifestation was dysphonia; recurrence was observed in most cases (56%), and tracheostomy was necessary in seven patients (26.9%). When comparing the RRP forms, patients in the juvenile-RRP group had higher recurrence rates and need of tracheostomy than those in the adult-RRP group. The viral genotyping analysis revealed that 47.8% of patients had low-risk HPVs, whereas 13.1% had high-risk HPVs, and in 39.1% of patients the viral genotype was not obtained. HPV-6 was the most prevalent type and Juvenile-RRP was more prevalent in our population. HPV was present at a high rate, and HPV-6 was the predominant genotype. This study serves as the basis for further studies to be conducted in the Brazilian population. Our findings aid the better understanding of RRP, possibly suggesting some prognostic factors associated with the disease aggressiveness.

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Nondialysis Chronic Kidney Patients.

BACKGROUND: The Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR) are inflammatory biomarkers for several diseases, such as cancer and cardiovascular morbidities; however, there are currently few studies on kidney diseases. We aimed to evaluate nondialysis patients and determine the association of NLR and PLR with inflammation in these patients. METHODS: A prospective cross-sectional study was conducted with 85 patients at different stages of chronic kidney disease (CKD), treated at the Kidney Disease Prevention Center of the University Hospital of the Federal University of Maranhão. This study included adult nondialysis patients diagnosed with CKD. The participants' blood samples were collected for a high-sensitivity C-reactive protein (hs-CRP) test and blood count. They were divided into two groups according to the presence or absence of inflammation based on the hs-CRP value (<0.5 mg/dL). NLR and PLR were calculated based on the absolute number of neutrophils, lymphocytes, and platelets and were compared between them and with hs-CRP. Statistical analysis was performed using the Stata software, with the Shapiro-Wilk, Mann-Whitney, Spearman's Correlation, and receiver operating characteristic curve tests. This study was approved by the local ethics committee. RESULTS: The participants were categorized into two groups: with inflammation (n = 64) and without inflammation (n = 21). The mean age was 61.43 ± 14.63 y. The NLR and PLR values were significantly different between the groups with and without inflammation (p=0.045and p=0.004, respectively). However, only PLR showed a significant positive correlation with hs-CRP (p=0.015). The best cutoff point for NLR to detect inflammation was 1.98, with 76.19% sensitivity and 48.44% specificity. For PLR, it was 116.07, with 85.71% sensitivity and 51.56% specificity. There was no significant difference between the area under the NLR and PLR curve (0.71 vs. 0.64; p=0.186) for this population. CONCLUSIONS: This study showed that PLR was positively correlated with hs-CRP in nondialysis CKD patients and can be used to identify inflammation in this population.

Renal Morphology in Coronavirus Disease: A Literature Review.

Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.

FGF21 and Chronic Kidney Disease.

The global nephrology community recognizes the increasing burden of kidney disease and its poor health outcomes in the general population. Given this, strategies to establish early diagnosis, improve understanding of the natural course and develop novel therapeutic interventions to slow progression and reduce complications are encouraged. Fibroblast growth factor 21 (FGF21), a member of the endocrine FGF subfamily, has emerged as a master homeostasis regulator of local and systemic lipid, glucose and energy metabolism. In addition, FGF21 should be considered an autonomic and endocrine regulator of stress responses in general. Promising results has been shown in both dysmetabolic animal models and metabolic disease patients after pharmacological administration of FGF21 analogs. The association of FGF21 with renal function has been studied for more than ten years. However, the functional role of FGF21 in the kidney is still poorly understood. This review summarizes the biological effects of FGF21 and discusses what is currently known about this hormone and chronic kidney disease, highlighting important gaps that warrant further research.

Variability in Hemoglobin Levels and the Factors Associated with Mortality in Hemodialysis Patients: A 78-Month Follow-Up Study.

Some studies have described that when the hemoglobin levels of chronic kidney disease (CKD) patients change, especially in those taking erythropoiesis-stimulating agents (ESA), they are associated with unfavorable outcomes such as increased morbidity and mortality, mainly due to cardiovascular events. This prospective cohort study included patients with end-stage renal disease currently undergoing hemodialysis. The initial 6-month clinical evaluation provided data of the variability in hemoglobin, associated blood parameters, and the use of erythropoietin. Subsequently, the patients were followed up for 78 months to evaluate mortality-associated factors. In total, 133 patients completed the 6-month follow-up with a mean age of 47.1 (±13.2) years. The majority were women (51.9%). Six-month hemoglobin levels were as follows: always low (18.0%), intermediate/target (1.5%), always high (0.8%), low-amplitude fluctuation/Hb low (n = 37; 27.8%), low-amplitude fluctuation/Hb high (13.53%), and high-amplitude fluctuation (38.6%), among end-stage renal disease patients. At the end of 78 months, 50 (37.6%) patients died; 70% of deaths were attributed to cardiovascular etiologies. A high variability was observed in hemoglobin levels, which was not associated with mortality. Among all the variables evaluated, age, erythropoietin dose, and transferrin saturation were associated with a higher mortality. Thus, this study suggests that greater attention to erythropoietin doses and transferrin saturation levels may improve the survival of dialysis patients.

Non-lupus full-house nephropathy: a case series.

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.

Brazilian Consortium for the Study on Renal Diseases Associated With COVID-19: A Multicentric Effort to Understand SARS-CoV-2-Related Nephropathy.

Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2.

Correlation Between Parathyroid Hormone Levels with Urinary Magnesium Excretion in Patients with Non-Dialysis Dependent Chronic Kidney Disease.

BACKGROUND: Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis dependent CKD. METHODS: Cross-sectional study. Concentrations of creatinine, magnesium, calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase (ALP) were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). RESULTS: The study evaluated 163 patients with a mean age of 60.7 ± 11.7 years and 51.0% were male. In the highest quartile of PTH (>89.5pg/mL), the mean levels of FEMg and ALP were higher (p<0.05). In the unadjusted regression analysis, the following variables were related to serum PTH levels: FEMg (odds ratio (OR) = 1.12; 95% confidence intervals (CI): 1.02-1.23), calcium (OR = 0.45; 95% CI: 0.22-0.90), ALP (OR = 1.02; 95% CI: 1.00-1.03) and eGFR (OR = 0.92; 95% CI: 1.00-1.03). After an adjusted analysis, only one FEMg and ALP will remain correlated with PTH. CONCLUSION: In patients with non-dialysis dependent CKD, FEMg and ALP were some variables that remained associated with PTH.