Avaliação do consumo de fósforo, potássio e alimentos processados e ultraprocessados em pacientes com doença renal crônica / Evaluation of the consumption of phosphorus, potassium and processed and ultra-processed foods by patients with chronic kidney disease

Introdução: Pacientes com doença renal crônica em hemodiálise necessitam orientações adequadas quanto a escolha de uma alimentação equilibrada, pois a qualidade da dieta pode influenciar diretamente no curso da doença. Objetivo: Caracterizar e avaliar o consumo de alimentos processados e ultraprocessados, fósforo e potássio em relação às recomendações para pacientes com doença renal crônica em hemodiálise. Métodos: Estudo transversal e quantitativo, realizado em uma Clínica de Nefrologia, no Vale do Taquari/RS, Brasil. A amostra foi por conveniência, composta por 47 pacientes. Foi utilizado registro alimentar de três dias não consecutivos, sendo avaliado o consumo de carboidrato, proteína, lipídios, fósforo e potássio para posteriormente serem comparados aos valores preconizados para pacientes com doença renal crônica renal. Para avaliar o consumo de alimentos processados e ultraprocessados, foi avaliada a frequência dos alimentos correspondentes encontrados no registro alimentar, utilizando como recomendação o Guia Alimentar para a População Brasileira. Resultados: Constatou-se um consumo inferior significativamente ao recomendado para carboidrato e lipídio (p ≤ 0,01), significativamente superior (p ≤ 0,01) em relação às proteínas. A ingestão de potássio estava abaixo da recomendação e do fósforo dentro das recomendações. Para os alimentos processados e ultraprocessados, o consumo médio foi de 17,70% das calorias totais ingeridas. Conclusão: O consumo de carboidrato, proteína, lipídios e potássio foi inadequado, quando comparado às recomendações preconizadas para os pacientes com doença renal crônica em hemodiálise. Quanto aos alimentos processados e ultraprocessados, o percentual encontrado é preocupante, visto que a qualidade desses alimentos pode trazer prejuízos ao estado nutricional e consequentemente ao tratamento dos pacientes avaliados.

Introduction: Patients with chronic kidney disease undergoing hemodialysis require adequate guidelines for the choice of a balanced diet, since diet quality may directly influence the course of the disease. Objective: Tocharacterize and evaluate the consumption of processed and ultra-processed foods, phosphorus and potassium in relation to recommendations for individuals with chronic kidney disease on hemodialysis. Methods: This is a cross-sectional and quantitative study performed at a Nephrology Clinic, in a city at Vale do Taquari/RS. The convenience sampling consisted of 47 patients. The food recall of three-day non-consecutive was used and the values obtained were compared with the values recommended for patients with chronic kidney disease for carbohydrate, protein, lipids, phosphorus and potassium. To evaluate the consumption of processed and ultra-processed foods, the frequency of the corresponding foods found in the food register, we used the recommendations from the Food Guide for the Brazilian Population. Results: It was found a consumption significantly lower than the recommended for carbohydrate and lipid (p ≤ 0.01), and significantly higher for protein (p ≤ 0.01). The potassium intake was below the recommendation and the phosphorus within the recommendations. For processed and ultra-processed foods, the average consumption was 17.70% of the total calories consumed. Conclusion: The consumption of carbohydrate, protein, lipids and potassium was inadequate according to recommendations for patients with chronic kidney disease on hemodialysis. In relation to be processed and ultra-processed foods, the percentage found is worrisome, since the quality of these foods can damage the nutritional status and consequently, the treatment of the evaluated patients.

Cecum perforation associated with a calcium polystyrene sulfonate bezoar - a rare entity / Perfuração do ceco associada a bezoar de poliestirenossulfonato de cálcio - uma entidade rara

Abstract Hyperkalemia is one of the most common electrolyte disorders, responsible for a high number of adverse outcomes, including life-threatening arrhythmias. Potassium binders are largely prescribed drugs used for hyperkalemia treatment but unfortunately, there are many adverse events associated with its use, mostly gastrointestinal. Identification of patients at highest risk for the serious complications associated with the current potassium binders, such as colon necrosis and perforation, could prevent fatal outcomes. The authors present a case of a 56-year-old man with secondary diabetes and chronic renal disease that was treated for hyperkalemia with Calcium Polystyrene Sulfonate (CPS). He later presented with acute abdomen due to cecum perforation and underwent ileocecal resection but ultimately died from septic shock a week later. During surgery, a solid white mass was isolated in the lumen of the colon. The mass was identified as a CPS bezoar, a rare drug-mass formed in the gastrointestinal tract that contributed to the perforation. A previous history of partial gastrectomy and vagothomy was identified as a probable risk factor for the CPS bezoar development. Hopefully, the two new potassium binders patiromer and (ZS-9) Sodium Zirconium Cyclosilicate will help treat such high-risk patients, in the near future.

Resumo A hipercalemia é um dos distúrbios eletrolíticos mais comuns, responsável por um grande número de desfechos adversos, incluindo arritmias potencialmente fatais. Quelantes de potássio são amplamente prescritos para o tratamento da hipercalemia, mas infelizmente são muitos os eventos adversos associados ao seu uso, em particular os gastrointestinais. A identificação de pacientes com risco mais elevado para complicações graves associadas aos quelantes de potássio atualmente em uso, como necrose e perfuração do cólon, pode evitar desfechos fatais. O presente artigo descreve o caso de um homem de 56 anos com diabetes secundário e doença renal crônica em tratamento por hipercalemia com poliestirenossulfonato de cálcio (PSC). Posteriormente o paciente apresentou abdômen agudo devido a perfuração do ceco e foi submetido a uma ressecção ileocecal, mas acabou indo a óbito por choque séptico uma semana mais tarde. Durante a cirurgia, uma massa branca sólida foi isolada no lúmen do cólon. A massa foi identificada como um bezoar de PSC, uma massa de fármaco de rara ocorrência formada no trato gastrointestinal que contribuiu para a perfuração. História pregressa de gastrectomia parcial e vagotomia foi identificada como provável fator de risco para o desenvolvimento do bezoar de PSC. Espera-se que os dois novos quelantes de potássio - patiromer e ciclossilicato de zircônio sódico - ajudem a tratar pacientes de alto risco em um futuro próximo.

Antibiotic sensitivity pattern of bacterial isolates in patients with chronic rhinosinusitis in Kaduna, Nigeria

Introduction: A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective: To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods: This was a prospective cross-sectional study in which endoscopically guided middlemeatal swabs (IBMSpss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results: There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%- 18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. Themost common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to bemost effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order (AU)

Report of 73 cases of cutaneous sporotrichosis in Mexico

Abstract: We report 73 cases of cutaneous sporotrichosis from the Community Dermatology program, at the central and mountain areas of the state of Guerrero, Mexico. A similar number of cases was found between children and adults, mostly peasants and school-age children with rural occupations. Upper limbs were the mostly affected and the predominant clinical form was lymphocutaneous (56.16%). All cultures corresponded to Sporothrix schenckii (sl). Treatment was done with potassium iodide in 54 patients, achieving clinical and mycological cure in all cases.

Aspectos clínicos, fisiopatológicos e genéticos das tubulopatias hereditárias na infância / Clinical, pathophysiological and genetic aspects of inherited tubular disorders in childhood

ResumoNesta revisão, descrevemos a função tubular de cada segmento do néfron seguida das descrições das principais alterações moleculares que possam ocorrer nos transportadores expressos nestes locais. Assim, o conhecimento das modificações na função tubular renal permite o entendimento e o reconhecimento clínico das doenças tubulares renais que podem causar a morte fetal, neonatal ou infantil. Além disso, as crianças com tubulopatias podem evoluir para doença renal crônica terminal numa fase precoce da vida e também podem apresentar distúrbios do crescimento e do desenvolvimento acompanhados ou não de alterações neurológicas. Então, nós utilizamos o unitermo "inherited tubular disorders" a fim de selecionar na base de dados do PubMed os estudos publicados desde 2006. Esperamos que a leitura desta revisão auxilie no rápido diagnóstico dos pacientes com tubulopatias, o que poderá permitir o tratamento especializado e a possível melhora do prognóstico e qualidade de vida destes indivíduos.

AbstractIn this review, we described the tubular function of each nephron segment followed by the most important changes that may occur in the transporters expressed therein. Thus, knowledge of the changes in renal tubular function allows the understanding and recognition of renal tubular diseases that can cause stillbirth or death in newborns or in childhood. Moreover, children with tubular disorders may progress to chronic renal disease at an early stage of life and they may also show disturbances of growth and development associate or not with neurological dysfunction. Therefore, we used the keyword "inherited tubular disorders" to select the children studies that have been published in the PubMed database since 2006. We hope that this review may help physicians to perform an early diagnosis in patients with tubular disorders allowing a specialized treatment and an improvement in their prognosis and quality of life.

Esporotricosis granulomatosa: presentación de dos casos inusuales / Granulomatous sporotrichosis: report of two unusual cases

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix complex, endemic in Abancay, Peru. Is acquired by traumatic inoculation with plant material. Common clinical presentations are lymphatic cutaneous and fixed cutaneous disease. We report 2 cases of fixed cutaneous sporotrichosis with granulomatous appearance. The first case was a patient of 65 years old with no risk factors and the second case was a 67 year old diabetic patient. Subjects underwent mycological culture with Sabouraud agar, with isolation of Sporothrix schenckii and clinical dignosis of fixed cutaneous sporotrichosis with granulomatous appearance. One patient received oral treatment with saturated solution of potassium iodide (SSKI) with a initial dose of 3 drops tid up to a maximum dose of 40 drops tid. Mycological and clinical cure was achieved after 2 months of treatment. We should consider the unusual clinical presentations of fixed cutaneous sporotrichosis with granulomatous appearance that present morphological and clinical features in diabetic and nondiabetic patients older than 60 years from endemic areas and communicate adequate response to treatment with SSKI in one case.

La esporotricosis es una micosis subcutánea ocasionada por el complejo Sporothrix, endémica en Abancay, Perú. Se adquiere por inoculación traumática con material vegetal. Las formas clínicas comúnmente descritas son la cutánea linfática y cutánea fija. Presentamos dos casos de pacientes adultos con una esporotricosis cutánea fija granulomatosa. El primer caso era una paciente de 65 años de edad, sin antecedentes de riesgo y el segundo era una paciente de 67 años, diabética. El diagnóstico se realizó por cultivo micológico aislándose Sporothrix schenckii. Un caso se trató con solución saturada de yoduro de potasio (SSKI), vía oral, alcanzando la cura micológica y clínica tras dos meses de tratamiento. La otra paciente no acudió a tratamiento. Se revisan las presentaciones clínicas inusuales de la esporotricosis cutánea fija y la forma granulomatosa que presenta características morfológicas y clínicas poco habituales en pacientes diabéticos y no diabéticos mayores de 60 años provenientes de zonas endémicas.

Prevalencia de pseudohipercaliemia en pacientes con enfermedad renal crónica en terapia hemodialítica / Prevalence of pseudohyperkalemia in patients with chronic renal disease in hemodialysis therapy

Objetivo: determinar si a la hipercaliemia prolongada en pacientes en hemodiálisis con enfermedad renal crónica (ERC) contribuye en valor significativo la presencia de pseudohipercaliemia (diferencia entre potasio sérico a plasmático mayor a 0.5 mEq/L) Pacientes: aquellos con ERC en terapia hemodialítica por más de 12 meses de evolución en quienes se detectara hipercaliemia persistente por más de tres meses. Material y métodos: determinación simultánea de potasio sérico y plasmático, y adicionalmente las variables sodio sérico, gases arteriales, cuadro hemático completo, glucemia en ayunas, Kt/v y electrocardiograma Resultados: en 110 pacientes evaluados 17 cumplieron los criterios de inclusión, en ellos en 13 (76.47%) se detectó pseudohipercaliemia y en 4 (23.52%) hipercaliemia verdadera (diferencia entre potasio sérico a plasmático menor a 0.5 mEq/L). No se detectaron diferencias significativas entre grupos en las variables analizadas Conclusión: la pseudohipercaliemia representa un porcentaje muy importante del reporte de hipercaliemias en pacientes con ERC en terapia hemodialítica, y lo ideal en ellos es siempre determinar potasio plasmático. (Acta Med Colomb 2013; 38: 12-15).

Objective: determine if to prolonged hyperkalemia in hemodialysis patients with chronic kidney disease (CKD) contributes significantly the presence of pseudohyperkalemia (difference between serum to plasma potassium greater than 0.5 mEq/L) Patients: those with CKD on hemodialysis therapy for more than 12 months duration in whom persistent hyperkalemia is detected for more than three months. Materials and methods: simultaneous determination of serum and plasma potassium and in addition the variables serum sodium, arterial blood gases, complete blood count, fasting blood glucose, Kt / v and electrocardiogram Results: in 110 patients evaluated 17 met the inclusion criteria. In 13 of them (76.47%) we detected pseudohyperkalemia and in 4 (23.52%) true hyperkalemia (difference between serum to plasma potasium less than 0.5 mEq / L ). No significant differences between groups in the variables analyzed were detected. Conclusion: the pseudohyperkalemia represents a very important percentage of the report of hiperkalemias in CKD patients on hemodialysis therapy, and ideally plasma potasium has to be determined always in these patients. (Acta Med Colomb 2013; 38: 12-15).

Ocorrência familiar de esporotricose zoonótica / Familial occurrence of zoonotic sporotrichosis

A esporotricose é micose subaguda ou crônica, causada pelo fungo dimórfico Sporothrix schenckii, endêmica no Brasil e transmitida principalmente através da inoculação traumática de seu agente causal na pele. A transmissão zoonótica, especialmente por gatos infectados, tem sido demonstrada em diversos relatos e séries de casos. Nós descrevemos a ocorrência simultânea da doença em três membros de uma mesma família através da arranhadura por gato doméstico infectado. Dois pacientes desenvolveram a forma cutânea-linfática e apenas um desenvolveu a forma cutânea fixa. Dois pacientes foram tratados com sucesso, com solução saturada de iodeto de potássio; entretanto, o terceiro caso apresentou efeitos colaterais e teve seu tratamento substituído por itraconazol, com resolução de suas lesões.

Sporotrichosis is a subacute or chronic mycosis caused by the dimorphic fungus Sporothrix schenckii which is endemic in Brazil and is transmitted primarily through traumatic inoculation of its causative agent into the skin. The zoonotic transmission, especially from infected cats, has been demonstrated in several reports and case series. We present simultaneous occurrence of the disease in three members of the same family by scratches from an infected domestic cat. Two patients developed the lymphocutaneous form and one only developed the fixed cutaneous form. Two patients were successfully treated with saturated solution of potassium iodide; however, the third case reported side effects and had his therapy substituted for itraconazole, with resolution of his lesions.

Cutaneous sporotrichosis treatment with potassium iodide: a 24 year experience in São Paulo state, Brazil / Tratamento da esporotricose cutânea com sski: experiência de 24 anos no estado de São Paulo, Brasil.

BACKGROUND: Sporotrichosis is a subacute or chronic disease caused by a dimorphic fungus, Sporothrix schenckii. The first and most traditional treatment is potassium iodide in satured solution (SSKI) used by DE BEURMANN in 1907. For its effectiveness, it is still used for cutaneous sporotrichosis. OBJECTIVE: To evaluate the treatment of cutaneous sporotrichosis with SSKI in relation to clinical cure, side effects, length of treatment and reactivation. METHODS: We conducted a retrospective analysis of medical records over a 24-year period (1981-2005). Patients of all ages who were treated in the hospital´s division of dermatology were included in the study providing that they had a positive culture of S. schenckii. Satured solution of potassium iodide (3 to 6g per day) was the treatment prescribed. For children, half of the dose was prescribed. RESULTS: The lymphocutaneous disease was prevalent, the cure rate was 94.7 percent, side effects were described in 5.5 percent of the cases, mean length of treatment was 3.5 months and possible reactivation was observed in 11.1 percent. CONCLUSION: SSKI is an effective drug, with many side effects, but with low frequency. Resolution was for maximum six months of treatment. SSKI has been found to be a very effective drug in this retrospective study of culture-proven cases of cutaneous and lymphocutaneous sporotrichosis. It should be used as first drug of choice especially in resource-limited settings.

FUNDAMENTOS: Esporotricose é doença subaguda ou crônica causada pelo fungo dimórfico Sporothrix schenckii. O primeiro e mais tradicional tratamento é o iodeto de potássio em solução saturada (SSKI) usado por De Beurmann em 1907. Por ser eficaz,ainda é muito utilizada no nosso meio para o tratamento da esporotricose cutânea. OBJETIVOS: Avaliar o tratamento da esporotricose cutânea com SSKI em relação à cura clínica, efeitos colaterais, tempo de tratamento e recidiva. MÉTODOS: A partir da revisão dos resultados de exames do laboratório de Micologia da Clínica de Dermatologia da Santa Casa de SP, durante 1981 a 2005, foram incluídos pacientes de qualquer idade com lesão cutânea sugestiva de esporotricose e cultura positiva para S. schenckii. Em todos pacientes o tratamento prescrito foi SSKI na dose de 3 a 6g/dia para adultos, por um período de até duas semanas após cura clínica. Em crianças foi utilizada a metade da dose. RESULTADOS: Houve predomínio da forma cutânea localizada, taxa de cura de 94,7 por cento, efeitos colaterais em 5,5 por cento, média de tempo de tratamento de 3,5 meses e 11,1 por cento de provável recidiva. CONCLUSÃO: A SSKI é eficaz, com diversos efeitos colaterais, porém de baixa frequência, permanecendo indicada para as formas cutâneas da esporotricose.

Avaliação da resposta terapêutica ao iodeto de potássio na esporotricose felina / Evaluation of therapeutic response to potassium iodide in feline sporotrichosi

A esporotricose é uma micose subaguda ou crônica ca usada pelo fungo dimórfico Sporothrix schenckii que infecta o ser humano e uma variedade de animais . O felino doméstico é o animal mais susceptível à doença e desempenha um papel importante na transmissão zoonótica, especialmente no Rio de Janeiro, onde ocorre uma epidemia envolvendo os seres humanos, cães e gatos desde 1998. A efetividade do iodeto de potássio foi avaliada em uma coorte longitudinal constituída por gatos com esporotricose confirmada pelo isolamento de S. schenckii em cultura. Os gatos foram acompanhados no Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto de Pesquisa Clínica Evandro Chagas, Fiocruz, entre abril de 2010 e julho de 2011 e fora m submetidos à terapia com iodeto de potássio (KI) em cápsulas na dose entre 2,5 mg/kg e 20 mg/kg, a cada 24 horas. A cura clínica foi obtida em 47,9 por cento dos gatos, em 37,5 por cento ocorreu falência terapêutica, 10,4 por cento abandonaram o tratamento e 4,2 por cento foram a óbito. Efeitos adversos clínicos foram observados em 52,1 por cento dos casos. Treze gatos apresentaram leve aumento nos níveis das transaminases hepáticas durante o tratamento, dos quais, seis apresentavam sinais clínicos sugestivos de hepatotoxicidade. Em comparação com estudos prévios realizados com itraconazol e solução saturada de iodeto de potássio, o tratamento com KI em cápsulas é uma alternativa promissora no tratamento da esporotricose felina.

Sporotrichosis is a subacute or chronic mycosis caused by the dimorphic fungus Sporothrixschenckii, which infects man as well as other mammals. The domestic cat is the animal most affected by this mycosis and plays an important role in the zoonotic transmission of this disease especially in Rio de Janeiro, Brazil, with a large number of cases involving man, dogs and cats since 1998. In order to evaluate the effectiveness of potassium iodide treatment, an observational cohort was conducted in 48 cats with sporotrichosis confirmed by isolation of S.schenckii in culture at Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz between April 2010 and July 2011. All cats received potassium iodide capsules,2.5mg/kg to 20mg/kg, once a day. The cure rate was 47.9 percent, treatment failure 37.5 percent,treatment abandonment 10.4 percent and death 4.2 percent. Clinical adverse effects were observed in52.1 percent of the cases. Thirteen cats had a mild increase in hepatic transaminase levels during the treatment, six of them presented clinical signs suggestive of hepatotoxicity. Compared to previous studies with itraconazole and iodide (SSKI), potassium iodide capsules are analternative for feline sporotrichosis treatment.

Alteración del sodio y potasio en pacientes hospitalizados por insuficiencia cardíaca / Alteration of sodium and potassium levels in patients hospitalized for heart failure

La insuficiencia cardíaca es un síndrome ocasionado por múltiples factores y va produciendo un proceso de remodelado ventricular. Es un verdadero problema de salud pública que incrementa el número de hospitalizaciones. Los diuréticos siguen siendo útiles en el tratamiento, aún así se producen alteraciones de los electrólitos que pueden ocasionar arritmias, empeoramiento de la insuficiencia cardíaca y disminución de la fracción de eyección. Este trabajo evalúa la alteración del sodio y potasio en pacientes hospitalizados por este síndrome. Se revisaron las historias de pacientes con insuficiencia cardíaca ingresados al servicio de Cardiología, registrando datos en base a un protocolo. Se revisaron 33 historias de las cuales 11 pacientes eran mujeres y 22 eran hombres, con un promedio de edad de 72,64 y 71,52 años respectivamente. Días de hospitalización promedio de 14,91 días. Todos los pacientes tenían dieta hiposódica excepto uno debido a diarrea. El 57,6% tenían una sola patología y el resto dos o tres. La hipertensión arterial es la patología más frecuente en un 81,8%, seguido de cardiopatía isquémica en un 30,3%. Recibieron tres diuréticos (furosemida, espirolactona, hidroclorotiazida) el 48,5% de los pacientes y dos diuréticos el 48,5%. El 51,5% de los pacientes tenían potasio bajo y el 57,6% sodio bajo. En un 50% de los pacientes se encuentra que el potasio y sodio están bajos que se relaciona con el uso de diuréticos y una dieta hiposódica. Habría que considerar el uso de suplemento de potasio en estos casos.

Heart failure a syndrome caused by multiple factors engenders a process of ventricular remodeling. It is an enormous public health problem, with an increasing number of hospitalizations. Diuretics, still useful for treatment, produce electrolyte abnormalities can cause arrhythmias, worsening heart failure and larger reduction in the ejection fraction. This study evaluated the alteration of sodium and potassium levels in patients hospitalized with this syndrome. We reviewed the charts of patients with heart failure admitted to the cardiology service, recording data with the use of a standardized form. We reviewed 33 records for 11 women and 22 men with a mean age of 72.64 and 71.52 years respectively. The average number of days of hospitalization was 14.91 days. All patients had a low sodium diet except one because of diarrhea. A single pathology was present in 57.6% with the rest having two or three. Hypertensión was the most frequent pathology in 81.8% , followed by ischemic heart disease in 30.3%. Three diuretics (furosemide, spironolactone, hydrochlorothiazide) were used in 48.5% of patients and two diuretics in 48.5%. In 51.5 of patients there was low potassium and in 57.6% low sodium. Potassium and sodium were low in 50% of patients, which was associated with the use of diuretics and a low salt diet. Potassium supplements should be considered in these cases.

Role of 11â-hydroxysteroid dehydrogenase 2 renal activity in potassium homeostasis in rats with chronic renal failure

Aldosterone concentrations vary in advanced chronic renal failure (CRF). The isozyme 11â-hydroxysteroid dehydrogenase 2 (11â-HSD2), which confers aldosterone specificity for mineralocorticoid receptors in distal tubules and collecting ducts, has been reported to be decreased or normal in patients with renal diseases. Our objective was to determine the role of aldosterone and 11â-HSD2 renal microsome activity, normalized for glomerular filtration rate (GFR), in maintaining K+ homeostasis in 5/6 nephrectomized rats. Male Wistar rats weighing 180-220 g at the beginning of the study were used. Rats with experimental CRF obtained by 5/6 nephrectomy (N = 9) and sham rats (N = 10) were maintained for 4 months. Systolic blood pressure and plasma creatinine (Pcr) concentration were measured at the end of the experiment. Sodium and potassium excretion and GFR were evaluated before and after spironolactone administration (10 mg·kg-1·day-1 for 7 days) and 11â-HSD2 activity on renal microsomes was determined. Systolic blood pressure (means ± SEM; Sham = 105 ± 8 and CRF = 149 ± 10 mmHg) and Pcr (Sham = 0.42 ± 0.03 and CRF = 2.53 ± 0.26 mg/dL) were higher (P < 0.05) while GFR (Sham = 1.46 ± 0.26 and CRF = 0.61 ± 0.06 mL/min) was lower (P < 0.05) in CRF, and plasma aldosterone (Pald) was the same in the two groups. Urinary sodium and potassium excretion was similar in the two groups under basal conditions but, after spironolactone treatment, only potassium excretion was decreased in CRF rats (sham = 0.95 ± 0.090 (before) vs 0.89 ± 0.09 µEq/min (after) and CRF = 1.05 ± 0.05 (before) vs 0.37 ± 0.07 µEq/min (after); P < 0.05). 11â-HSD2 activity on renal microsomes was lower in CRF rats (sham = 0.807 ± 0.09 and CRF = 0.217 ± 0.07 nmol·min-1·mg protein-1; P < 0.05), although when normalized for mL GFR it was similar in both groups. We conclude that K+ homeostasis is ...