O processo de adaptação do paciente para realização da diálise peritoneal no domicílio / El proceso de adaptación del paciente para la realización de la diálisis peritoneal en el domicilio / The process of patient adaptation to perform peritoneal dialysis at home

Objetivos: identificar as estratégias de adaptação no domicílio, utilizadas pelos pacientes para início do tratamento da diálise peritoneal; descrever as principais facilidades e dificuldades encontradas pelos pacientes na realização da diálise peritoneal no domicílio; identificar o entendimento e a aceitação do paciente sobre o método de diálise peritoneal. Método: estudo descritivo, com abordagem qualitativa. Os dados foram coletados através de entrevistas semi-estruturadas, organizadas e analisadas conforme a técnica de análise de conteúdo de Bardin. Resultados: da análise das unidades de significação emergiram três categorias temáticas, sendo elas representações da DP; vivências e sentimentos frente à doença e na escolha do método; (re) conhecendo aspectos facilitadores e dificultadores diante a diálise peritoneal em casa; identificando as estratégias para adequação do cotidiano à diálise peritoneal. Conclusão: após o reconhecimento da necessidade da utilização da diálise peritoneal para manutenção da vida, o paciente desenvolve uma série de adaptações para viabilizar o tratamento diário em domicílio.

Objetivos: identificar las estrategias de adaptación en el domicilio, utilizadas por los pacientes para iniciar el tratamiento de la diálisis peritoneal; describir las principales facilidades y dificultades encontradas por los pacientes en la realización de la diálisis peritoneal en el domicilio; identificar la comprensión y aceptación del paciente sobre el método de diálisis peritoneal. Método: estudio descriptivo, con enfoque cualitativo. Los datos fueron recogidos a través de entrevistas semi-estructuradas, organizadas y analizadas conforme a la técnica de análisis de contenido de Bardin. Resultados: del análisis de las unidades de significación emergieron tres categorías temáticas, siendo ellas representaciones de la DP; vivencias y sentimientos frente a la enfermedad y en la elección del método; (re) conociendo aspectos facilitadores y dificultadores ante la diálisis peritoneal en casa; identificando las estrategias para adecuación del cotidiano a la diálisis peritoneal. Conclusión: tras el reconocimiento de la necesidad de la utilización de la diálisis peritoneal para el mantenimiento de la vida, el paciente desarrolla una serie de adaptaciones para viabilizar el tratamiento diario en domicilio.

Objectives: to identify the strategies of adaptation at home, used by patients to begin treatment of peritoneal dialysis; to describe the main facilities and difficulties encountered by patients in performing peritoneal dialysis at home; to identify the patient's understanding and acceptance of the peritoneal dialysis method. Method: descriptive study with qualitative approach. Data were collected through semi-structured interviews, organized and analyzed according to Bardin's content analysis technique. Results: three thematic categories emerged from the analysis of the units of meaning, which were representations of PD; experiences and feelings regarding the disease and the choice of method; (re)knowing aspects that facilitate and hinder peritoneal dialysis at home; strategies for the adaptation of daily life to peritoneal dialysis. Conclusion: after recognizing the need to use peritoneal dialysis for life maintenance, the patient develops a series of adaptations to enable daily treatment at home.

The physical deterioration of dialysis patients-Ignored, ill-reported, and ill-treated.

The progressive physical deterioration of dialysis patients is apparent to all who are involved in their care. Exercise can help stem this decline, yet exercise uptake in chronic and end-stage kidney disease is low. The involvement of exercise professionals has been shown to significantly increase patients' physical function and improve their quality of life. However, exercise professionals are scarce in renal programs, far less than dietetic and social work services. A review of 10 years of renal exercise publications in the physical therapy and rehabilitation literature found that only 0.4% (7 out of a total of 1763) of all published articles were focused on people with kidney disease. This compared with stroke (44%, n=883), arthritis/bone (29%, n=458), cancer (9%, n=168), respiratory (8%, n=106), cardiac (5%, n=82), and diabetes (3%, n=45). These results reflect the low emphasis placed on renal rehabilitation by the physical therapy professions and the low renal content in physical therapy tertiary education programs. This is likely to have an impact on the level of involvement of physical therapists in renal programs leading to lower physical function and poorer quality of life for renal patients.

Forma física y calidad de vida en pacientes trasplantados de riñón: estudio de casos y controles / Fitness and quality of life in kidney transplant recipients: case-control study

Antecedentes y objetivos: El objetivo del estudio fue analizar los niveles de forma física, estructura muscular y calidad de vida de adultos con trasplante de riñón y adultos sanos. Pacientes y métodos: En este estudio participaron 16 trasplantados renales y 21 controles. Se evaluó la forma física, la fuerza isocinética de flexión y extensión de rodilla, así como el cuestionario de calidad de vida SF-36. Además, se realizó una ecografía muscular para analizar la estructura muscular. Resultados: Se observaron valores inferiores en el grupo de trasplantados en los test de agilidad y sentarse y levantarse de la silla (p < 0,001) y en todos los parámetros de estructura muscular, fuerza y potencia. Los pacientes evaluaron peor su calidad de vida en todos los niveles, encontrándose diferencias significativas con respecto a los pacientes en los dominios de función física, rol físico, salud general y la función social (p < 0,001). Discusión: La forma física, fuerza y masa muscular y calidad de vida de personas trasplantadas de riñón está disminuida, situación que podría conllevar un mayor riesgo para su salud (AU)

Background and objectives: We analyzed the levels of fitness, muscle structure and quality of life of adults after kidney transplant and healthy adults. Patients and methods: A total of 16 kidney transplant patients and 21 healthy controls performed several fitness test, isokinetic evaluation of knee flexion and extension and ultrasonography muscle thickness assessment. They also completed the quality of life questionnaire SF-36. Results: Physical fitness, muscle structure and quality of life of the kidney transplant recipients were significantly poorer than the controls. The transplant patients performed less well in the "get up and go" and "sit to stand" test (p < .001) as well as in assessments of muscle structure, strength and power. The patients had a poorer score in their quality of life assessments, differing from the controls in domains of physical function, physical role, general health and social function (p < .001). Discussion: Fitness, strength and muscle mass are diminished in kidney transplant patients, resulting in a poorer quality of life which might entail an increased risk to their health (AU)

Cognitive function and exercise training for chronic renal disease patients: A literature review.

OBJECTIVE: Cognitive impairment is very often noted in patients with Chronic Kidney Disease (CKD). Even though, exercise is considered to be a quantifiable activity that improves cognition in animals and humans, it seems that few studies have examined the relationship between cognitive function and CKD from the perspective of physical activity and cognitive performance. Thus, this evidence based review summarizes the present level of knowledge regarding the effects of exercise training on cognitive function in CKD patients. DATA SOURCES: A comprehensive literature search was conducted in PubMed and Scopus from May 2014 through June 2014, by using the Cochrane and PRISMA guidelines. REVIEW METHODS: Eligibility of the studies based on titles, abstracts and full-text articles was determined by two reviewers. Studies were selected using inclusion and exclusion criteria. We included only those studies that: assessed cognitive function in humans and animals using validated neuropsychological methods in chronic renal diseases patients; used exercise training protocols; addressed randomized control trials or controlled trials or clinical trials designed to evaluate cognitive impairment; and articles that were written in English. Studies were excluded when they concerned behavioral approaches and underpowered studies. RESULTS: According to the current review only a few studies have examined the issue of cognitive function in CKD patients. These studies indicate that these patients often exhibit cognitive impairment, which is highly associated with poor outcomes. It has been supported that exercise training can induce positive changes in brain metabolism favoring better scores in cognitive function in Chronic Kidney Disease patients although the physiological mechanisms, which explain the influence of physical activity on cognition, have focused on changes in neurotransmitters, neurotrophins and vasculature. CONCLUSION: Systematic exercise training seems to improve cognitive function in Chronic Kidney Disease patients but further research is warranted to further clarify the mechanisms involved.

First-trimester Down syndrome screening in renal-transplanted pregnant women: a model for adjusting the false-positives rates.

OBJECTIVE: This study aimed to develop a model to adjust the increased ß-hCG levels observed in renal-transplanted women, leading to increased false-positive rates in Down syndrome screening. METHODS: Detailed data from 11 renal-transplanted and a nested-cohort of 70 pregnant women, matched by age, parity and gestational age were retrieved from our hospital records. Patient's age, multiples of the median (MoM) values for freeß-hCG, pregnancy-associated plasma protein-A, nuchal translucency, and creatinine concentration and clearance were noted. Freeß-hCG levels were adjusted according to the deviation of serum creatinine concentration by means of three different methods (median, proportionality and regression). Subsequently, Down syndrome risk was estimated with the three resulting adjusted fß-hCG values. RESULTS: After adjustment, the median ß-hCG MoM decreased from 2.15 MoM to 1.00 MoM (median method), 1.61 MoM (proportionality method) or 1.16 MoM (regression method). The non-adjusted 27% false-positive rate dropped to 18% (median method) and 10% (proportionality or regression methods) after re-estimation of the Down syndrome risk. In controls, the observed median for ß-hCG MoM was 1.12, and the false-positive rate was 5.7%. CONCLUSIONS: In first-trimester Down syndrome screening, fß-hCG adjustment by the regression method appears to be the best to match with controls.

Effects of exercise on kidney function among non-diabetic patients with hypertension and renal disease: randomized controlled trial.

BACKGROUND: Chronic kidney disease is an important public health threat. Such patients present high morbidity and mortality due to cardiovascular disease, with low quality of life and survival, and also high expenditure resulting from the treatment. Arterial hypertension is both a cause and a complication of kidney disease; also, arterial hypertension is a risk factor for cardiovascular disease among patients with kidney diseases. There is some evidence that exercise interventions may be beneficial to chronic kidney disease patients, but previous studies included only end-stage patients, i.e. those undergoing dialysis. This study aims to evaluate the effect of exercise on kidney function, quality of life and other risk factors for cardiovascular disease among non-diabetic chronic hypertensive kidney disease patients who are not undergoing dialysis. METHODS: The participants will be located through screening hypertensive patients attended within the public healthcare network in Pelotas, a city in south of Brazil. Eligible individuals will be those with glomerular filtration rate between 15 and 59 ml/min x 1.73 m(2). The randomization will be done in fixed-size blocks of six individuals such that 75 participants will be allocated to each group. At baseline, information on demographic, socioeconomic, behavioral, anthropometric, blood pressure and quality-of-life variables will be collected, and laboratory tests will be performed. The intervention will consist of three weekly physical exercise sessions lasting 60-75 minutes each, with a total duration of 16 weeks. The outcomes will be the kidney function progression rate, quality of life, blood pressure, lipid profile, hemoglobin level, ultrasensitive C-reactive protein level, and ankle-arm index. The patients in both groups (intervention and control) will be reassessed and compared partway through the study (8th week), at the end of the intervention (16th week) and in the 8th week after the end of the intervention. DISCUSSION: There is still a scarcity of data relating to the effect of physical exercise among the most numerous group of individuals with kidney disease, i.e. patients undergoing conservative treatment. In particular, there is a lack of randomized controlled studies. This study will help fill this gap.

Exercise training for adults with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem. In the National Kidney Foundation Disease Outcomes Quality Initiative guidelines it is stressed that lifestyle issues such as physical activity should be seen as cornerstones of the therapy. The physical fitness in adults with CKD is so reduced that it impinges on ability and capacity to perform activities in everyday life and occupational tasks. An increasing number of studies have been published regarding health effects of various regular exercise programmes in adults with CKD and in renal transplant patients. OBJECTIVES: We aimed to: 1) assess the effects of regular exercise in adults with CKD and kidney transplant patients; and 2) determine how the exercise programme should be designed (e.g. type, duration, intensity, frequency of exercise) to be able to affect physical fitness and functioning, level of physical activity, cardiovascular dimensions, nutrition, lipids, glucose metabolism, systemic inflammation, muscle morphology and morphometrics, dropout rates, compliance, adverse events and mortality. SEARCH STRATEGY: We searched the Cochrane Renal Group's specialised register, CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, Biosis, Pedro, Amed, AgeLine, PsycINFO and KoreaMed. We also handsearched reference lists of review articles and included studies, conference proceeding's abstracts. There were no language restrictions.Date of last search: May 2010. SELECTION CRITERIA: We included any randomised controlled trial (RCT) enrolling adults with CKD or kidney transplant recipients undergoing any type of physical exercise intervention undertaken for eight weeks or more. Studies using less than eight weeks exercise, those only recommending an increase in physical activity, and studies in which co-interventions are not applied or given to both groups were excluded. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study and data quality were performed independently by the two authors. Continuous outcome data are presented as standardised mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CI). MAIN RESULTS: Forty-five studies, randomising 1863 participants were included in this review. Thirty two studies presented data that could be meta-analysed. Types of exercise training included cardiovascular training, mixed cardiovascular and resistance training, resistance-only training and yoga. Some studies used supervised exercise interventions and others used unsupervised interventions. Exercise intensity was classed as 'high' or 'low', duration of individual exercise sessions ranged from 20 minutes/session to 110 minutes/session, and study duration was from two to 18 months. Seventeen per cent of studies were classed as having an overall low risk of bias, 33% as moderate, and 49% as having a high risk of bias.The results shows that regular exercise significantly improved: 1) physical fitness (aerobic capacity, 24 studies, 847 participants: SMD -0.56, 95% CI -0.70 to -0.42; walking capacity, 7 studies, 191 participants: SMD -0.36, 95% CI-0.65 to -0.06); 2) cardiovascular dimensions (resting diastolic blood pressure, 11 studies, 419 participants: MD 2.32 mm Hg, 95% CI 0.59 to 4.05; resting systolic blood pressure, 9 studies, 347 participants: MD 6.08 mm Hg, 95% CI 2.15 to 10.12; heart rate, 11 studies, 229 participants: MD 6 bpm, 95% CI 10 to 2); 3) some nutritional parameters (albumin, 3 studies, 111 participants: MD -2.28 g/L, 95% CI -4.25 to -0.32; pre-albumin, 3 studies, 111 participants: MD - 44.02 mg/L, 95% CI -71.52 to -16.53; energy intake, 4 studies, 97 participants: SMD -0.47, 95% CI -0.88 to -0.05); and 4) health-related quality of life. Results also showed how exercise should be designed in order to optimise the effect. Other outcomes had insufficient evidence. AUTHORS' CONCLUSIONS: There is evidence for significant beneficial effects of regular exercise on physical fitness, walking capacity, cardiovascular dimensions (e.g. blood pressure and heart rate), health-related quality of life and some nutritional parameters in adults with CKD. Other outcomes had insufficient evidence due to the lack of data from RCTs. The design of the exercise intervention causes difference in effect size and should be considered when prescribing exercise with the aim of affecting a certain outcome. Future RCTs should focus more on the effects of resistance training interventions or mixed cardiovascular- and resistance training as these exercise types have not been studied as much as cardiovascular exercise.

[Actual vitamin and main foodstuffs consumption by recovered patients suffered from hemorrhagic fever with renal syndrome].

Actual consumption of vitamins A, E, beta-carotene, ascorbic acid, thiamin, pyridoxine and main foodstuffs by recovered patients suffered from hemorrhagic fever with renal syndrome has been given. Frequency analysis of foodstuffs consumption was used to study actual nourishment of recovered patients. Surplus consumption of fat mainly due to the use of saturated fatty acids, deficiency of poly unsaturated fatty acids, surplus sugar consumption and predominance of proteins of animal origin over proteins of vegetable origin in ration has been revealed. Deficiency of water soluble vitamins equals to 41,6-78,7% of all examined patients, deficiency of fat water soluble vitamins is lower (21,4-38,3%).

Rasgos de personalidad, edad, cultura y restricciones hídricas y dietéticas en pacientes en hemodiálisis / Personality traits, age, culture and hydric and dietetic restrictions in patients undergoing haemodialysis

Queda mucho por investigar y comprender alrededor de la interacción entre lo físico y lo mental. Los pacientes sometidos a hemodiálisis debido a su enfermedad, deben cumplir una serie de normas dietéticas, de cuidado de su acceso vascular, etc. Pensamos que los rasgos de la personalidad, la edad, la cultura, pueden influir en la aceptación de la enfermedad de nuestros pacientes renales en tratamiento sustitutivo con hemodiálisis, y por lo consiguiente en el cumplimiento de las normas dietéticas, lo cual se vería reflejado en sus resultados analíticos pre-HD (niveles de potasio, de fósforo, ganancia interdiálisis), aunque también somos conscientes de que pueden influir otras variables, como es el nivel de afectación renal, nivel sociocultural, etc. La muestra del estudio la constituyeron 35 pacientes de la unidad de diálisis de Melilla, de diferentes edades (mayores de 18 años) y de ambos sexos. Para conocer los rasgos de personalidad de nuestros pacientes, se les realizó un cuestionario validado de personalidad. Los datos registrados fueron: edad, sexo, cultura, rasgo de personalidad, potasio, fósforo, ganancia interdiálisis. No hemos hallado correlación significativa entre los rasgos de personalidad, la cultura frente a la ganancia de peso interdiálisis, niveles de fósforo y potasio, pero sí hemos hallado correlación significativa negativa entre la variable edad frente a la ganancia interdiálisis y los niveles de fósforo, aunque no así en los niveles de potasio, dé tal manera que se ve reflejado que a mayor edad, presentan menos ganancia interdiálisis y menos niveles de fósforo (AU)

Much has still to be investigated and understood about the interaction between the physical and the mental. Patients undergoing haemodialysis because of their illness have to comply with a series of dietetic rules, care of their vascular access, etc. We think that personal traits, age, culture can influence the acceptance of the illness by our renal patients receiving substitute treatment with haemodialysis, and therefore the compliance with dietetic rules, which would be reflected in their pre-HD analysis results (levels of potassium, phosphorous, interdialysis weight gain), although we are also aware that other variables can have an influence, such as the level of renal affectation, sociocultural level, etc. The sample in the study was made up of 35 patients of the dialysis unit in Melilla, of different ages (over 18) and of both sexes. To determine the personality traits of our patients, a validated personality questionnaire was used. The data recorded were: age, sex, culture, personality trait, potassium, phosphorous, interdialysis weight gain. We have not found a significant correlation between personality traits, culture compared to interdialysis weight gain, phosphorous and potassium levels, but we did find a significant negative correlation between the age variable and interdialysis weight gain and phosphorous levels, although not in potassium levels, so that the older the patient, the lower the interdialysis weight gain and the phosphorous levels (AU)

Predictors of health-related quality of life recovery following laparoscopic simple, radical and donor nephrectomy.

OBJECTIVES: To objectively quantify the recovery of health-related quality of life (HRQL) in patients undergoing laparoscopic nephrectomy. To determine which factors are predictive of a more expedited recovery. MATERIALS AND METHODS: Patient recovery was prospectively measured among patients undergoing laparoscopic simple (n= 12), radical (n= 42) and donor (n= 95) nephrectomy. All procedures were performed using a 3- or 4-trocar, transperitoneal fully-laparoscopic technique with intact specimen extraction using impermeable sacs for simple and radical nephrectomy, and hand extraction for donor nephrectomy. Postoperative recovery and quality of life were measured using the Postoperative Recovery Scale (PRS) administered preoperatively, immediately postoperatively and as an outpatient at 4, 8, 12, and 16 weeks postoperatively. ANOVA and Pearson's χ² tests were performed on demographic data. Multivariate logistic regression analysis was used to calculate odds ratios for factors predictive of recovery. RESULTS: Statistically significant differences were found at baseline for age (P = 0.02), gender (P < 0.01), body mass index (BMI; P = 0.03), surgical side (P < 0.01) and activity-based lifestyle (P = 0.04) across the three groups. Minimal adverse events were seen. Factors predictive of expedited recovery include age < 50 years (OR: 2.1, P < 0.01), body-mass index (BMI) < 30 kg/m² (OR: 1.7, P < 0.01), active lifestyles (OR: 1.3, P < 0.01) and those patients undergoing nephrectomy for benign or malignant indications rather than for organ donation (OR: 1.4, P < 0.01). There was a significant delay in the donor group vs the non-donor group with respect to the median number of days both groups took to recover 75% and 90% of their baseline PRS scores (11 days, P = 0.02; 20 days, P = 0.02, respectively). CONCLUSIONS: Predictive factors of recovery from laparoscopic nephrectomy include age, BMI, lifestyle and surgical indication. Differences between HRQL recovery following donor vs non-donor laparoscopic nephrectomy are significant, and suggest the possible interplay of underlying psychological factors.

Rehabilitation in the renal population: barriers to access.

Administrative data suggest familiar socioeconomic, race, sex, and age disparities in renal patients' receipt of services such as cardiac rehabilitation. Dialysis facility characteristics and disparities in access to transplantation, home-based dialysis, and more frequent dialysis also may influence patients' access to rehabilitation opportunities. Tested models exist for interdisciplinary inpatient rehabilitation, exercise/physical conditioning programs, and psychosocial interventions, and several of these programs consider the special needs of particular age groups. Recognition of the importance of physical activity/exercise and depressed mood as predictors of patient outcomes, and research addressing the concept of frailty, effectively may increase the salience of rehabilitation objectives throughout the renal community.

Effect of childhood kidney transplantation on puberty.

OBJECTIVE: To evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyclosporine A, low-dose prednisolone and azathioprine. STUDY DESIGN: Prospective case-control study. SETTING: University-affiliated urology and nephrology center, obstetric and gynecology departments. PATIENT(S): Eighteen girls and 21 boys with successful KTX before the age of 16 years. Controls were healthy and age matched (200 girls and 171 boys). INTERVENTION(S): Assessment of sexual maturation by Tanner staging and linear growth by height standard deviation score (HSDS) and height increment (HI). MAIN OUTCOME MEASURE(S): Pubertal age in KTX vs. control, ratios of KTX with normal and retarded sexual maturation and linear growth. RESULT(S): Puberty in KTX children was significantly delayed compared with controls. Delayed sexual maturation was found in 22.2% of girls and 19.1% of boys, and poor HSDS was found in 38.9% of girls and 33.3% of boys. Improvement in HSDS was significantly lower in girls compared with boys. Improvement in HSDS did not significantly differ in prepubertal vs. pubertal children. Prepubertal HI was significantly higher than pubertal HI in boys, but not in girls. Significant negative correlation was found between HI, duration of immunosuppression, and serum creatinine level. CONCLUSION(S): KTX children receiving cyclosporine A, low-dose prednisolone, and azathioprine showed acceptable sexual and physical maturation in a majority of cases. Impaired sexual and linear growth after receiving KTX is related to poor graft function, post-KTX interval, and gender.

Restorative physical and occupational therapy: a critical need for patients with chronic kidney and end-stage renal disease.

Patients with CKD and ESRD present with many health problems, which may lead to increased mortality and dysfunction. Numerous comorbidities may contribute toward physical, emotional, and social problems and a decreased quality of life. Difficulty ambulating, balance deficits, joint pain and stiffness, muscle spasm and weakness, fatigue, neuropathy, and difficulty with activities of daily living (ADLs) may contribute to a decrease in functional independence. Physical therapy (PT) and occupational therapy (OT) aim to restore physical functioning, facilitate independence in ADLs, and promote functional independence by using various therapeutic procedures. PT and OT are the usual services of choice to address impaired function associated with acute and chronic pathology. The purpose of this article is multifold: (1) to describe specific interventions provided by PTs and OTs that may be beneficial to individuals with CKD and ESRD, (2) to identify and describe the potential benefits of rehabilitation for these patient populations, and (3) to provide programmatic rehabilitation recommendations for patients with CKD and ESRD.

Implementing exercise: what do we know? Where do we go?

Exercise capacity, physical functioning, and physical activity are all low in patients with CKD treated with dialysis. Although there is robust evidence that these patients benefit from regular exercise training and/or increasing physical activity, the nephrology community has not adopted recommendations and encouragement for physical activity as a part of the routine care plan. This article reviews what is known regarding the implementation of exercise and provides suggestions as to how exercise counseling might become a routine part of the care of patients with CKD.

Insuficiência renal aguda secundária à sarcoidose / Acute renal failure secondary to sarcoidosis

A sarcoidose é uma doença sistêmica de etiologia desconhecida, caracterizada pela inflamação crônica granulomatosa, que acomete com maior frequencia os pulmões, a pele e os olhos e, muito raramente, detectamos envolvimento renal na patologia. relatamos aqui o caso de uma paciente de 47 anos, branca, internada em uma unidade de emergência de Hospital Universitário, devido a sintomas e achados radiológicos sugestivos de pneumonia. Desde o início da internação ela se apresentava com quadro laboratorial de insuficiência renal aguda, inicialmente atribuída ao histórico recente de uso abusivo de anti-inflamatórios. No entanto, devido à evolução arrastada e aparentemente desfavorável, inclusive com necessidade de terapia renal substitutiva (TRS), a paciente foi submetida a uma biópsia renal para esclarecimento diagnóstico e avaliação prognóstica. A descrição histológica mostrava um quadro de nefrite intersticial aguda granulomatosa, característico de sarcoidose renal, diagnóstico confirmado após revisão do prontuário médico, que revelava internação anterior devido a evento pulmonar da doença. Iniciado tratamento com prednisoma 1mg/kg/dia, a paciente evoluiu com melhora do quadro de insuficiência renal aguda, não mais necessitando de TRS. Atualmente, a paciente é mantida em acompanhamento ambulatorial com função renal estável.

The Sarcoidosis is a systemic disease of unknown etiology characterized by chronic granulomatous inflammation, which affects most frequently the lungs, skin and eyes and very rarely detected renal involvement in pathology. report here the case of a 47 year old white, admitted in an emergency unit of University Hospital because of symptoms and radiological findings suggestive of pneumonia. Since the beginning of hospitalization she performed with a laboratory diagnosis of acute renal failure, initially attributed to the recent history of abuse of anti-inflammatory drugs. However, due to unfavorable prolonged evolution and apparently, also in need of renal replacement therapy (RRT), the patient underwent renal biopsy for diagnosis and prognostic assessment. Histology showed a picture of acute interstitial nephritis, granulomatous characteristic of renal sarcoidosis, confirmed after review of medical records, which revealed previous hospitalization due to lung of the disease. Treatment with Prednisone 1mg/kg/day, the patient presented improvement of acute renal failure, no longer requiring RRT. Currently, the patient is maintained as an outpatient with stable renal function.