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1.
Sci Rep ; 11(1): 24439, 2021 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-34952908

RESUMO

Acute kidney injury (AKI) is frequently associated with COVID-19 and it is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting in-hospital mortality in COVID-19 patients with AKI (AKI-COV score). This was a cross-sectional multicentre prospective cohort study in the Latin America AKI COVID-19 Registry. A total of 870 COVID-19 patients with AKI defined according to the KDIGO were included between 1 May 2020 and 31 December 2020. We evaluated four categories of predictor variables that were available at the time of the diagnosis of AKI: (1) demographic data; (2) comorbidities and conditions at admission; (3) laboratory exams within 24 h; and (4) characteristics and causes of AKI. We used a machine learning approach to fit models in the training set using tenfold cross-validation and validated the accuracy using the area under the receiver operating characteristic curve (AUC-ROC). The coefficients of the best model (Elastic Net) were used to build the predictive AKI-COV score. The AKI-COV score had an AUC-ROC of 0.823 (95% CI 0.761-0.885) in the validation cohort. The use of the AKI-COV score may assist healthcare workers in identifying hospitalized COVID-19 patients with AKI that may require more intensive monitoring and can be used for resource allocation.


Assuntos
Injúria Renal Aguda/complicações , COVID-19/patologia , Mortalidade Hospitalar , Aprendizado de Máquina , Idoso , Área Sob a Curva , COVID-19/complicações , COVID-19/mortalidade , COVID-19/virologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sistema de Registros , Fatores de Risco , SARS-CoV-2/isolamento & purificação
2.
Contrib Nephrol ; 199: 339-350, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34344005

RESUMO

The study of kidney diseases has been described since the Hippocratic era, but nephrology as a medical specialty dates from the mid-20th century. Despite all interesting aspects of nephrology, there is a lack of interest by young physicians for the specialty worldwide. Great discoveries have been made throughout the years, leading to great achievements in diagnosis, classification, and treatment of kidney diseases. There is a current interest in the search for novel biomarkers for early detection of kidney dysfunction, and, in the future, there will be novel diagnostic tests for kidney diseases. There have been significant improvements in dialysis and transplant techniques, and novel modalities are being studied, including new renal replacement therapy modalities, such as the wearable artificial kidney. Another trend in the contemporary world, and one that should increase in the future, is the increasing patient connectivity, using novel technologies that will allow access to healthcare and improve outcomes.


Assuntos
Nefropatias , Nefrologia , Humanos , Nefropatias/diagnóstico , Nefropatias/terapia , Nefrologia/história , Saúde Pública , Diálise Renal , Terapia de Substituição Renal
3.
Contrib Nephrol ; 199: 188-200, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34348258

RESUMO

Clinical Background: Cigarette smoking is one of the leading causes of preventable deaths, including cardiovascular diseases and cancer. However, the effects of tobacco use on chronic kidney disease (CKD) are less widespread. Epidemiology: Smoking tobacco is associated with proteinuria and attenuation of glomerular filtration rate in the general population of different ethnicities. Smoking also accelerates the progression of established CKD and aggravates proteinuria along the wide spectrum of causes determining kidney disease. Furthermore, smoking worsens the survival of kidney transplant recipients and shortens graft survival. Most of the effects of tobacco exposure are dose and time dependent and could be ameliorated with smoking cessation. Challenges: In the last decades, tobacco use policies and regulations were implemented around the world obtaining a global 6% reduction in smoking prevalence. However, the reduction was not proportionally equal in all the geographical areas around the world. The region of Americas experimented the most positive result in reducing smoking prevalence. Smoking trends in South East Asian and Eastern Mediterranean regions show minor decrease or increased rates. The World Health Organization projected reaching a global target prevalence of 15% by 2025. Prevention and Treatment: The results showing smoking cessation slows the progression of kidney disease in smokers should drive our effort to help our patients quit smoking. Smoking prevention at the population level, and particularly in those at risk of CKD or with established CKD should be part of health policies and regulations all around the world.


Assuntos
Insuficiência Renal Crônica , Uso de Tabaco , Progressão da Doença , Humanos , Rim , Política Pública , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia
4.
Clin Kidney J ; 14(7): 1731-1737, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34221380

RESUMO

Chronic kidney disease (CKD) has become one of the most important public health problems worldwide. Analysis, and understanding, of this global/national/regional reality would benefit from renal registry databases. The implementation of a CKD registry (including all categories) is difficult to achieve, given its high cost. On the other hand, patients with end-stage kidney disease (ESKD) are easily accessible and constitute the most severe subgroup in terms of comorbidities and healthcare costs. A kidney replacement therapy registry (KRTR) is defined as the systematic and continuous collection of a population-based data set from ESKD patients treated by dialysis/kidney transplant. The lack of available data, particularly in emerging economies, leaves information gaps on healthcare and outcomes in these patients. The heterogeneity/absence of a KRTR in some countries is consistent with the inequities in access to KRT worldwide. In 2014, the Pan American Health Organization (PAHO) proposed to determine the prevalence of patients on dialysis for at least 700 patients per million inhabitants by 2019 in every Latin American (LA) country. Since then, PAHO and the Sociedad LatinoAmericana de Nefrología e Hipertensión have provided training courses and certification of KRTR in LA. The purpose of this manuscript is to provide guidance on how to set up a new KRTR in countries or regions that still lack one. Advice is provided on the sequential steps in the process of setting up a KRTR, personnel requirements, data set content and minimum quality indicators required.

6.
Kidney Int Suppl (2011) ; 11(2): e35-e46, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33981469

RESUMO

Latin America is a region with a widely variable socioeconomic landscape, facing a surge in noncommunicable diseases, including chronic kidney disease and kidney failure, exposing significant limitations in the delivery of care. Despite region-wide efforts to explore and address these limitations, much uncertainty remains as to the capacity, accessibility, and quality of kidney failure care in Latin America. Through this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to report on these indicators to provide a comprehensive map of kidney failure care in the region. Survey responses were received from 18 (64.2%) countries, representing 93.8% of the total population in Latin America. The median prevalence and incidence of treated kidney failure in Latin America were 715 and 157 per million population, respectively, the latter being higher than the global median (142 per million population), with Puerto Rico, Mexico, and El Salvador experiencing much of this growing burden. In most countries, public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) care, with patients incurring at least 1% to 25% of out-of-pocket costs. In most countries, >90% of dialysis patients able to access kidney replacement therapy received hemodialysis (n = 11; 5 high income and 6 upper-middle income), and only a small minority began with peritoneal dialysis (1%-10% in 67% of countries; n = 12). Few countries had chronic kidney disease registries or targeted detection programs. There is a large variability in the availability, accessibility, and quality of kidney failure care in Latin America, which appears to be subject to individual countries' funding structures, underreliance on cheap kidney replacement therapy, such as peritoneal dialysis, and limited chronic kidney disease surveillance and management initiatives.

8.
In. Fernández, Anabela. Manejo de la embarazada crítica y potencialmente grave. Montevideo, Cuadrado, 2021. p.421-434, tab.
Monografia em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1377846
9.
Clin Nephrol ; 93(1): 55-59, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31793873

RESUMO

End-stage kidney disease (ESKD) represents a major challenge for Latin America (LA). The Latin American Dialysis and Renal Transplantation Registry (LADRTR) has published several reports, and its continuity has implied a sustained effort of the nephrology community to improve care of ESKD in the region; this paper summarizes results of the year 2014. Methods have been reported previously; participant countries complete annual surveys collecting data on incident and prevalent patients undergoing renal replacement therapy (RRT) in all modalities. 20 countries participated in the surveys (more than 90% of the region). Prevalence of treated ESKD in RRT increased from 119 patients per million population (pmp) in 1991 to 709 pmp in 2014; hemodialysis continues to be the treatment of choice in the region (68%). A wide variation was observed in the incidence rate, from 421 pmp in Jalisco (Mexico) to 23 pmp in Paraguay; diabetes was the cause of 36% of incident cases. Additionally, great heterogeneity was observed in the number of nephrologists by country, from 2 pmp in Colombia to 53 pmp in Uruguay. Heterogeneity, or even absence of registries in some LA countries, is concordant with inequities in RRT access as well as with the limited availability of qualified personnel. The LADRTR is leading the personnel training to develop and strengthen national dialysis and transplant registries in LA within the frame of the Pan-American Health Organization (PAHO) - Sociedad Latinoamericana de Nefrología e Hipertension (SLANH) cooperation program.


Assuntos
Falência Renal Crônica/terapia , Terapia de Substituição Renal/estatística & dados numéricos , Efeitos Psicossociais da Doença , Humanos , América Latina/epidemiologia , Prevalência , Sistema de Registros
10.
In. Noya Pena, Beatriz Silvia; Illescas Caligaris, María Laura. Perioperatorio del paciente con enfermedades asociadas. Montevideo, BiblioMédica, 2019. p.93-104, tab.
Monografia em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1342522
12.
Arch. med. interna (Montevideo) ; 23(1): 11-21, mar. 2001. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-332762

RESUMO

El compromiso túbulointersticial en las nefropatías es uno de los mecanismos responsables de la progresión a la insuficiencia renal extrema. Las pruebas funcionales renales pueden ser un instrumento útil para el diagnóstico y el seguimiento de este compromiso tubulointersticial. Los objetivos de este trabajo son evaluar un conjunto simplificado de pruebas de función tubular en el estudio de nefropatías tubulointersticiales y en glomerulopatías. Se estudiaron 75 pacientes, 38 con diagnóstico probable de nefropatía tubulointeristicial y 37 glomerulopatías. Se evaluó presencia de diskalemia, glucosurina, alteración de equilibrio ácido base y capacidad de concentración urinaria. La disfunción tubular fue frecuente en los pacientes con glomerulopatías (0,65) aún en aquellos pacientes con creatininemia menor 1.4 mg por ciento (0,45). Mediante estas pruebas es posible topografiar el sector nefronal comprometido


Assuntos
Humanos , Nefropatias , Testes de Função Renal , Túbulos Renais/fisiopatologia
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