Congenital Solitary Functioning Kidney: A Review.

BACKGROUND: Solitary functioning kidney (SFK) is a subgroup of the Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT). Although the prognosis of these patients was considered good in the past, numerous studies have shown different levels of kidney damage associated with this condition. Serum creatinine measurement is still the most used marker to assess renal function, even though the limitations are widely known. OBJECTIVE: The present review aims to summarize and update the scientific literature on congenital SFK, discussing its pathophysiology, diagnosis, complications, prognosis, role of novel urinary biomarkers, treatment, and follow-up. RESULTS: The natural history of congenital SFK is still an unresolved issue due to several factors. Although it has not yet been proven in humans, Brenner's hyperfiltration hypothesis is the most concrete theory to explain the poor renal outcomes of patients born with one functioning kidney. The search for novel urinary biomarkers capable of assessing renal function and predicting renal outcomes has already started, but there are still few studies on this specific population. Among the most studied markers, Cystatin C, EGF and NGAL have shown potential usefulness for the follow-up of these patients. The treatment still relies on the search for kidney injury and general renoprotective measures. CONCLUSION: Further research with a longer follow-up duration is needed to better understand the natural course of congenital SFK and the role of novel urinary biomarkers in this specific population. Thus, it will be possible to improve the prognosis of these patients.

Surveillance of surgical site infection after cesarean section and time of notification.

BACKGROUND: Cesarean section is a surgical procedure the main complication of which is surgical site infection (SSI), which is related to maternal morbidity and mortality. OBJECTIVE: To evaluate active monitoring by telephone to identify infection and time of SSI report in postpartum women and associated risk factors. METHODS: We conducted a prospective observational study from 2013-2014, at a referral service for high-risk pregnancies. Surveillance was conducted via telephone at least 30 days after cesarean delivery. Incidence ratio and time of infection occurrence (days) was analyzed. Survival analysis was conducted to assess the temporal distribution of the development of infection. RESULTS: Of a total of 353 patients, 14 (4%) cases of SSI were reported, and 10 (7.4%) of the reported cases occurred within 15 days after cesarean and average time of infection was12.21 days. American Society of Anesthesiologists score was the only risk factor associated with SSI after cesarean section. CONCLUSIONS: The prevalence of SSI after cesarean section via telephone is similar to several services with different methods of surveillance, considering it could be used by services with limited resources. Superficial incisional SSI was the most common type of infection, time of infection report was mainly before the 15th day postprocedure, and American Society of Anesthesiologists score of 2 or less was protective against SSI. Telephone calls can be a viable method to identify women with infection briefly after discharge, particularly at-risk patients.

Estudo transversal do perfil das infecções congênitas atendidas entre 2012 e 2014 em um centro de referência em Belo Horizonte, Minas Gerais / Cross-sectional study of clinical and laboratorial aspects of congenital infections attended at a reference Center in Belo Horizonte, MG, 2012-2014

Introdução: as infecções congênitas são resultantes da transmissão vertical de microrganismos de gestantes infectadas para seus conceptos. Apesar dessas infecções, em geral, cursarem com pouca ou nenhuma manifestação clínica nas gestantes, a infecção fetal pode trazer morbimortalidade perinatal e na infância. Objetivo: identificar a prevalência das infecções congênitas encaminhadas ao Centro de Referência e Treinamento em Doenças Infecciosas e Parasitárias Orestes Diniz (CTR/DIP Orestes Diniz) e avaliar os métodos laboratoriais usados para o diagnóstico. Métodos: estudo transversal realizado em ambulatório de referência em doenças infecciosas, a partir de coleta de dados de prontuários de crianças com diagnóstico suspeito de infecção congênita. A confirmação diagnóstica baseou-se em testes sorológicos ou de biologia molecular, além de descrição de sintomatologia da criança. Resultados: um total de 513 crianças foram identificadas, sendo que 41,3% tiveram o diagnóstico confirmado, a maioria foi de toxoplasmose (45,35%) e sífilis (15,98%). Entre as crianças com diagnóstico confirmado, 28,85% apresentaram manifestações clínicas, enquanto que no grupo com diagnóstico indeterminado ou suspeito o percentual foi de 16,38%. As principais manifestações identificadas foram acometimento do sistema nervoso central (n=39) e alterações visuais (n=30). Conclusão: a confirmação de infecção foi definida em aproximadamente metade dos pacientes avaliados e a maioria das crianças foi assintomática ao nascimento. O pré-natal de qualidade e a propedêutica e tratamento precoce das crianças identificadas podem reduzir o impacto dessas infecções no nosso meio.(AU)

Introduction: congenital infections are results of microorganisms transmitted to the fetus by the infected pregnant. Most newborn infants infected during pregnancy or labor have no sings of congenital disease. However, these infections may cause perinatal and infancy morbidity and mortality. Objective: to determine the prevalence of congenital infections in newborns and infants attended at the CTR/DIP Orestes Diniz (Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias Orestes Diniz) and to analyse the laboratorial methods used for diagnosis of congenital disease of assisted children. Methods: cross-sectional study conducted in an Infectious Diseases Reference Center where it was evaluated the charts of infants with suspected congenital infection. Diagnosis confirmation was based on serological tests, molecular biology and signs and symptoms described in the charts. Results: A total of 41,3% of the 513 children identified have had a defined diagnosis. Most of them had toxoplasmosis (45,35%) and syphilis (15,98%). Clinical manifestations was observed in 28,85% of children with defined diagnosis of congenital infection, and in 16,38% of children with uncertain diagnosis. Central Nervous System (n=39) and ocular (n=30) manifestations were the most frequent findings. Conclusions: Defined diagnosis was possible in about half of cases and most of them were asymptomatic at birth. An appropriate prenatal care and early diagnosis and treatment of congenital infections may reduce the impact of disease in the population.(AU)