Albumin-to-protein ratio in spot urine samples for analysis of proteinuria selectivity in chronic kidney disease / Razão albumina/proteína em amostras isoladas de urina para análise da seletividade de proteinúria na doença renal crônica

ABSTRACT Introduction: The albumin-to-creatinine ratio and total protein-to-creatinine ratio in spot urine samples have already been validated as surrogates for 24-hour albuminuria and proteinuria measurements. Thus, we hypothesized that the type of proteinuria, detected by the electrophoretic pattern of 24-hour urine, could be predicted by the simple proportion of albumin in the total urine protein content, using the albumin-to-protein ratio (APR). Our study sought to validate the use of APR as a cheaper substitute for urinary protein electrophoresis (UPE). Methods: Using different mathematical models, we compared, the albumin fraction in 24-hour urine samples by electrophoresis and the APR ratio in spot samples from 42 outpatients with chronic kidney disease (CKD). Results: A strong log-order correlation r = 0.84 (0.75-0.92; 95% CI, p = 0.001) was observed between APR and the albumin fraction in the UPE. Conclusion: The APR can substitute electrophoresis in CKD outpatients.

Resumo Introdução: A utilização da razão albumina/creatinina e da razão proteína total/creatinina em amostras isoladas de urina já foram validadas como substitutos para a albuminúria e proteinúria em 24 horas. Assim, nossa hipótese é que o tipo de proteinúria, dado pelo padrão eletroforético da urina de 24 horas, poderia ser previsto pela simples proporção de albumina no conteúdo total de proteínas na urina, utilizando a razão albumina/proteína (RAP). O presente estudo procurou validar o uso da RAP como um substituto mais prático e de menor custo da eletroforese de proteínas urinárias (EPU). Métodos: Foram utilizados diferentes modelos matemáticos a fim de comparar a fração de albumina pela eletroforese em amostras de urina de 24 horas e a RAP em amostras isoladas em 42 pacientes ambulatoriais com doença renal crônica. Resultados: Foi observada uma forte correlação logarítmica r = 0,84 (0,75-0,92; 95% CI, p = 0,001) entre a RAP e a fração de albumina pela EPU. Conclusão: A RAP pode substituir a eletroforese urinária em pacientes renais crônicos ambulatoriais.

Chronic kidney disease prevention campaign: relationship between proteinuria and elderly people / Campanha de prevenção de doença renal crônica: relação entre proteinúria e idosos

ABSTRACT Objective: To verify the relationship between the presence of proteinuria as a renal injury marker in elderly without history of systemic arterial hypertension and cardiovascular diseases. A cross-sectional study was developed from January 2014 to December 2019, through kidney disease prevention campaigns promoted by the Federal University of Ceará in the city of Fortaleza. Methods: The sample consisted of 417 elderlies. A questionnaire was used to characterize individuals and assess previous diseases, and urinalysis reagent strips were used to assess proteinuria. Results: Statistically significant differences (p < 0.05) and moderate effect sizes were found for blood pressure levels (CI 0.53-0.93), systolic blood pressure, and diastolic blood pressure (CI 0.21-0.61). Significant differences in capillary glycemia were also found between groups (p = 0.033), but with a low effect size (0.02-0.42). The group with comorbidities was 2.94 times more likely to have proteinuria than those without comorbidities (OR 2.94, CI 1.55-4.01; p < 0.05). In the group without cardiovascular disease/high blood pressure, a statistically significant association was found for previous diabetes and proteinuria (p = 0.037), presenting 2.68 times higher risk of proteinuria in those with diabetes mellitus (OR 2.68, CI 1.05-6.85). Significant association was also found between age groups, with the older group having 2.69 times higher risk of developing proteinuria (75 to 90 compared to 60 to 74 years) (CI 1.01-7.16; p = 0.045). Conclusion: Even without systemic arterial hypertension or cardiovascular disease, diabetes and older age can be considered high risk factors for proteinuria.

Resumo Objetivo: Verificar a relação entre a presença de proteinúria como marcador de lesão renal em idosos sem histórico de hipertensão arterial sistêmica e doenças cardiovasculares. Um estudo transversal foi desenvolvido de Janeiro de 2014 a Dezembro de 2019, por meio de campanhas de prevenção a doenças renais promovidas pela Universidade Federal do Ceará, na cidade de Fortaleza. Métodos: A amostra foi composta por 417 idosos. Um questionário foi usado para caracterizar indivíduos e avaliar doenças prévias, e foram utilizadas tiras reagentes de urinálise para avaliar proteinúria. Resultados: Diferenças estatisticamente significativas (p < 0,05) e tamanhos de efeito moderados foram encontrados para níveis de pressão arterial (IC 0,53-0,93), pressão arterial sistólica e pressão arterial diastólica (IC 0,21-0,61). Também foram encontradas diferenças significativas na glicemia capilar entre grupos (p = 0,033), mas com um tamanho de efeito baixo (0,02-0,42). O grupo com comorbidades apresentou 2,94 vezes mais probabilidade de ter proteinúria do que aqueles sem comorbidades (OR 2,94; IC 1,55-4,01; p < 0,05). No grupo sem doença cardiovascular/hipertensão, foi encontrada uma associação estatisticamente significativa para diabetes anterior e proteinúria (p = 0,037), apresentando risco 2,68 vezes maior de proteinúria naqueles com diabetes mellitus (OR 2,68; IC 1,05-6,85). Também foi encontrada uma associação significativa entre faixas etárias, com o grupo mais velho apresentando risco 2,69 vezes maior de desenvolver proteinúria (75 a 90 em comparação com 60 a 74 anos) (IC 1,01-7,16; p = 0,045). Conclusão: Mesmo sem hipertensão arterial sistêmica ou doença cardiovascular, o diabetes e a idade avançada podem ser considerados fatores de alto risco para proteinúria.

Twin pregnancy after kidney transplantation: case report and systematic review / Gravidez gemelar após transplante renal: relato de caso e revisão sistemática

Abstract Background: Kidney transplantation is associated with fertility restoration in more than 50% of women with chronic kidney disease. Pregnancy after transplantation may affect women's health and fetal development, with higher rates of abortion, fetal growth restriction, and neonatal deaths. Twin pregnancy is a condition of high-risk for adverse maternal and perinatal outcomes, and its occurrence in women with previous kidney transplantation is rare. Case: 32-year-old woman, recipient of living donor kidney transplantation, with a history of one pregnancy prior to transplantation, with current normal allograft function and no use of contraceptive method. At ten weeks of amenorrhea, ultrasound investigation showed a dichorionic diamniotic twin pregnancy. The following evaluation showed Chiari type II features in one fetus, and no detectable abnormality in the other one. There was appropriate blood pressure control with no need for an antihypertensive drug, and renal function remained normal without proteinuria. Calcium and a low dose of acetylsalicylic acid were used as preeclampsia prophylaxis. At 33 weeks of gestation, she presented premature rupture of membranes with spontaneous preterm labor. A cesarean section was performed due to the breech presentation of the first fetus. The patient persisted with normal graft function and without graft rejection during follow-up. Discussion and conclusion: Twin pregnancies after kidney transplantation are rare, and it is most frequently associated with preterm birth. We reported a successful twin pregnancy after kidney transplantation, with good perinatal and maternal outcomes, and without graft rejection or dysfunction.

Resumo Introdução: O transplante renal está associado à restauração da fertilidade em mais de 50% das mulheres com doença renal crônica. A gravidez após o transplante pode afetar a saúde das mulheres e o desenvolvimento fetal, com taxas mais altas de aborto, restrição de crescimento fetal e óbitos neonatais. A gravidez gemelar é uma condição de alto risco para as mães e de desfechos adversos perinatais, e sua ocorrência em mulheres com transplante renal prévio é rara. Caso: mulher de 32 anos de idade, receptora de transplante de rim de doador vivo, com histórico de uma gravidez antes do transplante, com função atual normal do enxerto e sem uso de método contraceptivo. Após 10 semanas de amenorréia, a investigação por ultrassonografia mostrou uma gravidez diamniótica dicoriônica. A avaliação a seguir mostrou características de Chiari tipo II em um feto e nenhuma anormalidade detectável no outro. Houve controle adequado da pressão arterial sem necessidade de medicamento anti-hipertensivo e a função renal permaneceu normal sem proteinúria. Cálcio e uma dose baixa de ácido acetilsalicílico foram usadas como profilaxia pré-eclâmpsia. Com 33 semanas de gestação, apresentou ruptura prematura de membranas com trabalho de parto prematuro espontâneo. Uma cesariana foi realizada devido à apresentação pélvica do primeiro feto. A paciente persistiu com função normal do enxerto e sem rejeição do enxerto durante o seguimento. Discussão e conclusão: gestações gemelares após transplante renal são raras e estão mais frequentemente associadas ao parto prematuro. Relatamos uma gravidez bem-sucedida após o transplante renal, com bons desfechos perinatais e maternos e sem rejeição ou disfunção do enxerto.

Enfermedad renal crónica y COVID-19: la importancia de la hidratación / Chronic kidney disease and COVID-19: the importance of hydration

Resumen Como es bien sabido, desde el mes de diciembre se encendieron las alarmas por la aparición de la enfermedad COVID-19 (Coronavirus 2019) en China, la cual es causada por el virus SARS-CoV-2 y se ha expandido a nivel mundial. Entre los síntomas frecuentes encontramos fiebre, fatiga, mialgias, tos seca, anorexia, disnea y producción de esputo y síntomas menos comunes como cefalea, odinofagia, rinorrea y otra sintomatología diferente a la respiratoria, como síntomas gastrointestinales dados por náuseas y diarrea. La proteinuria en cualquier grado, la hematuria de cualquier grado, el aumento de la elevación de la creatinina en pacientes con creatinina basal elevada y la generación de AKI 2 y 3 son los directamente relacionados con la mortalidad intrahospitalaria desde el punto de vista renal, lo que hace que debamos estudiar más aun la enfermedad renal crónica, para poder tomar las medidas necesaria de prevención. En cuanto a la hidratación, se considera, por lo tanto, que si el paciente presenta buena diuresis, los 2 litros de excreción serían necesarios para eliminar los solutos no necesarios del cuerpo, considerando que esta cantidad se logra sumando también las pérdidas extrarrenales; entonces, si el paciente mantiene una función urinaria adecuada a pesar de su grado de insuficiencia renal, una ingesta de líquidos entre 2,5 y 3,5 litros logra las metas. Los pacientes con enfermedad renal crónica deben tomar las medidas de prevención, aún más por ser población de riesgo, recordando por lo tanto algunas, las cuales son la mejor estrategia para evitar la transmisión viral: lavado frecuente de manos, distanciamiento social, evitar contacto con personas infectadas o con sospecha de infección por el virus SARS-CoV-2, usar tapabocas, mantener higiene en su domicilio, lavar superficies o limpiarlas con sustancias a base de alcohol, y algo que no se puede olvidar: estamos aprendiendo del virus, y debemos mantenernos informados del comportamiento del mismo y de los cambios que este pueda generar en la población y en el comportamiento de la enfermedad, para así mismo tomar las medidas.

Abstract As is well known since December, alarms went off for the appearance of the COVID-19 disease (Coronavirus 2019) in China, which is caused by the SARS-CoV-2 virus and has spread worldwide. Frequent symptoms include fever, fatigue, myalgia, dry cough, anorexia, dyspnea and sputum production, and less common symptoms such as headache, odynophagia, rhinorrhea, and other symptoms other than breathing, such as gastrointestinal symptoms due to nausea and diarrhea. Proteinuria in any degree, hematuria of any degree, increased creatinine variation in a patient with elevated baseline creatinine, and the generation of AKI 2 and 3 are those directly related to in-hospital mortality from the renal point of view, which means that we must study chronic kidney disease even more, in order to take the necessary preventive measures. Regarding hydration, it is considered, therefore, that if the patient presents good diuresis, the 2 liters of excretion would be necessary to eliminate the unnecessary solutes from the body, considering that this amount is achieved by also adding extrarenal losses. Therefore, if the patient maintains adequate urinary function despite his degree of kidney failure, a fluid intake of between 2.5 and 3.5 liters achieves the goals, also taking into account. Patients with chronic kidney disease should take preventive measures, even more so as they are a risk population, therefore remembering some, which are the best strategy to avoid viral transmission: frequent hand washing, social distancing, avoiding contact with people infected or suspected of infection with the SARS-CoV-2 virus, wearing face masks, maintaining hygiene at home, washing surfaces or cleaning them with alcohol-based substances and something that cannot be forgotten, remember that we are learning from the virus and that we must keep us informed of the behavior of the same and of the changes that it may generate in the population and in the behavior of the disease, so as to take the measures.

Electrophoretic analysis (sds-page) of canine urinary proteins according to the stage of chronic kidney disease / [Análise eletroforética (SDS-PAGE) de proteínas urinárias de cães de acordo com o estágio da doença renal crônica]

Glomerular proteinuria is characterized by the loss of high-molecular-weight proteins (HMWPs), while tubulointerstitial proteinuria is characterized by the loss of low-molecular-weight proteins (LMWPs). The objective was to assess the molecular weight of urinary proteins (MWUP) in dogs with naturally acquired CKD and determine the proportion of HMWPs and LMWPs according to CKD stage. Twenty-eight dogs with CKD were recruited and divided into 4 groups based on serum creatinine (Cr) levels (group1: Cr<1,4, n=8; group2: 1,45,0, n=5). The control group consisted of 5 healthy dogs. The MWUP was determined by SDS-PAGE. The urinary protein-to-creatinine ratio (UP/C) was used to quantitatively assess proteinuria. The electrophoresis pattern revealed a proportionally greater loss of HMWPthan of LMWP in all groups with CKD and an increased loss of LMWP in group 4 (P<0.05). These results suggest a predominance of glomerular injuries throughout all stages of CKD in these dogs and an increase in tubulointerstitial injury towards the end-stage of the disease. The results of the present study support the recommendation of SDS-PAGE as an effective technique for the qualitative assessment of proteinuria, as well as a method for assessing the severity and location of renal injury.(AU)

A proteinúria glomerular é caracterizada pela perda de proteínas de alto peso molecular (PAPM), enquanto a proteinúria tubulointersticial se caracteriza pela perda de proteínas de baixo peso molecular (PBPM). O objetivo do trabalho foi determinar o peso molecular das proteínas urinárias (PMPU) de cães com DRC naturalmente adquirida e a proporção de PAPM e PBPM de acordo com o estágio da DRC. Foram utilizados 28 cães com DRC, divididos em quatro grupos, de acordo com o nível sérico de creatinina (cr) (grupo 1: cr<1,4, n=8; grupo 2: 1,45,0, n=5). O grupo controle era composto por cinco cães saudáveis. O PMPU foi determinado por SDS-PAGE. A relação proteína:creatinina urinária (RPCU) foi utilizada como um método quantitativo de proteinúria. A eletroforese revelou uma perda proporcionalmente maior de PAPM, quando comparada às PBPM, em todos os grupos de DRC, bem como uma perda crescente de PBPM no grupo 4 (P<0,05). Esses resultados sugerem uma predominância de lesão glomerular em todos os estágios de DRC nesses cães e uma progressão crescente na lesão túbulo-intersticial no estágio terminal da doença. Os resultados deste estudo reafirmam a recomendação de que a eletroforese de proteínas urinárias é uma técnica qualitativa efetiva de avaliação da proteinúria, bem como um método que permite avaliar a extensão e a localização da lesão renal.(AU)

Presencia de células tubulares renales reactivas en pacientes con enfermedad renal crónica / Presence of reactive renal tubular cells in patients with chronic kidney disease

Resumen En pacientes con enfermedad renal se ha reportado la presencia de células renales reactivas, cuyas alteraciones morfológicas severas dificultan su clasificación e interpretación. El conocimiento de las características morfológicas y los patrones de sedimentos en donde se presentan pueden ser de ayuda para su manejo en los departamentos médicos correspondientes. Aquí, nosotros reportamos la presencia de células agrupadas en acinos, con abundante citoplasma, cariomegalia, contornos nucleares irregulares y nucléolos prominentes, acompañados de cilindruria y cuerpos ovales grasos en el sedimento urinario de dos pacientes con diabetes mellitus, las cuales fueron sugestivas de células renales reactivas.

Abstract In patients with kidney disease, the presence of reactive renal cells has been reported. These cells show several morphological alterations that difficult their classification and interpretation. Therefore, the knowledge of its morphological characteristics and sediments patterns where they can be found will helpful for their correct management by medical departments. Here, we reported the presence of renal cells grouped in acinus with abundant cytoplasm, cariomegaly, irregular nuclear contours and prominent nucleoli, accompanied with cilindruria and fatty oval bodies in the urinary sediment of two patients with Diabetes Mellitus, these cells were named as reactive renal cells.

Proteinuria en habitantes de una aldea costera de Santa Rosa, Guatemala / Proteinuria in inhabitants of a coastal village of Santa Rosa, Guatemala

Objetivo: determinar la presencia de proteinuria en habitantes de una aldea de la región costera de Santa Rosa, Guatemala, julio del año 2019. Material y métodos: estudio descriptivo y transversal, en una muestra de 575 habitantes de la aldea Casas Viejas, captada por durante cuatro jornadas médicas. Las muestras de orina fueron analizadas con tiras reactivas. Resultados: de los habitantes que participaron, 55.48 % (319) fueron de sexo femenino, la mediana de edad fue de 24 años, el 39.820% (229) estudiante y el 85.2 % (490) sin antecedentes patológicos. De los factores predisponentes de enfermedad renal, el 56.170% (323) consume antiinflamatorios no esteroideo -AINES-, el 82.26 % (473) bebidas carbonatadas, el 13.570% (78) bebidas alcohólicas; la mediana de consumo de agua fue de 6 vasos diarios y 13.22 % (76) han estado expuestos a agroquímicos. Proteinuria se documentó en 8.87 % (51) de los habitantes. Conclusiones: más de la mitad de los sujeto de estudio son de sexo femenino y sin antecedentes patológicos; de los factores predisponentes a enfermedad renal los más frecuentes son el consumo de -AINES-, bebidas carbonatadas y la hidratación inadecuada. Nueve de cada cien sujetos de estudio presentan proteinuria.

Objetive: to establish urine protein presence in inhabitants of a small village of the coastal region in Santa Rosa, Guatemala. July 2019. Material y methods: Descriptive and transversal study performed on 575 persons from Casas Viejas village, using a nonprobabilistic sampling. Proteinuria was determined by urine test strips. Results: Of the persons studied, 55.48% (319) were female, mean age was 24 years old, 39.82% (229) were students and 85.25% had no pathological background. Predisposing factors of kidney disease were noted, 56.17% (323) consumed Non-steroidal Anti-inflammatory Drugs (NSAIDs), 82.26% (473) consumed carbonated drinks, 13.57% (78) alcoholic beverages, the mean water consumption was 6 glasses per day, and 13.22% (76), were exposed to agrochemical pesticides. Proteinuria was found in 8.87% (51) of the sample. Conclutions: more than half of population were female and didn´t showed pathological signs. Predisposing factors to kidney disease were, frequent NSAIDs use, carbonated drinks consumption a no adequate hydration. Nine of each one hundred people studied presented urine protein.

Thrombin generation and thromboelastometry tests in dogs with chronic kidney disease / Testes de geração de trombina e tromboelastometria em cães com doença renal crônica

Patients with chronic kidney disease (CKD) have paradoxical hemostatic potential because they have bleeding episodes but are also prone to thrombosis. Few studies have evaluated blood viscoelastic properties in dogs with kidney disease; on the other hand, hypercoagulability has been observed in these patients. It is also emphasized that the platelet function and its participation in this process have not yet been fully understood. The objective of this study was to evaluate and compare the Thrombin Generation Test (TGT) and also viscoelastic properties of the blood measured by thromboelastometry (TEM) in dogs with proteinuria in CKD. Twenty healthy dogs (Control Group) and 19 dogs with CKD in stage III or IV, classified according to International Renal Interest Society - IRIS, were selected, and the reference test of urine protein:creatinine ratio (UPCR) should be greater than one (CKD group). Blood samples for TEM, thrombin generation, Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and fibrinogen concentration was collected at a single time for both groups after inclusion criteria being confirmed. Statistical analysis was performed according to the distribution of variables at 5% significance level. Differences were observed between healthy dogs and those with proteinuria in CKD noted in TEM. The TGT was unable to differentiate between sick and healthy groups. However, when the nephropathy was stratified, increases in TTP and peak thrombin concentration by TGT were observed in females and dogs over 30 days of diagnosis of CKD. Both tests signaled a discrete state of hypercoagulability. In fact, TEM is more sensitive to detect hypercoagulability in dogs with CKD. However, the TGT has potential clinical application by allowing long-term sample storage.(AU)

Os pacientes com doença renal crônica (DRC) apresentam um potencial hemostático paradoxal, pois apresentam episódios de sangramento, mas também são propensos à trombose. Poucos estudos avaliaram as propriedades viscoelásticas sanguíneas em cães com doenças renais, entretanto, a hipercoagulabilidade já foi observada nestes pacientes. Ressalta-se ainda que a função plaquetária e sua participação neste processo ainda não foram totalmente esclarecidas. O objetivo foi avaliar e comparar o teste de geração de trombina (TGT) e as propriedades viscoelásticas sanguíneas medidas pela tromboelastometria (TEM) em cães com DRC proteinúrica. Foram selecionados 20 cães saudáveis (grupo controle) e 19 cães com DRC em estágios III ou IV classificados segundo o IRIS e a relação proteína/creatinina urinária maior que um (grupo DRC). As amostras de sangue para a realização da tromboelastometria (TEM), geração de trombina, tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e concentração de fibrinogênio foram colhidas em momento único para ambos os grupos após os critérios de inclusão confirmados. A análise estatística foi realizada de acordo com a distribuição das variáveis, ao nível de 5% de significância. Foi observada diferença entre os cães saudáveis e os com DRC proteinúrica observados na TEM. O teste de geração de trombina não foi capaz de diferenciar os grupos doente e saudável. Entretanto, quando os nefropatas foram analisados de forma estratificada, foram observados aumentos do ETP e da concentração máxima de trombina (peak) pelo TGT em fêmeas e em cães com mais de 30 dias de diagnóstico da DRC. Ambos os testes sinalizando para um discreto estado de hipercoagulabiliade. A tromboelastometria é mais sensível para detectar a hipercoagulabilidade em cães com DRC. Entretanto, o teste de geração de trombina tem melhor aplicabilidade por permitir o armazenamento da amostra em longo prazo.(AU)

Caracterización de las complicaciones renales en pacientes con anemia de células falciformes / Characterization of kidney complications in patients with sickle cell anemia

Resumen: Introducción: La nefropatía falciforme (NF) es una complicación poco estudiada en la edad pediátrica, que se manifiesta en diferentes formas, incluyendo la glomerulopatía y la tubulopatía. Objetivo: Descri bir las complicaciones renales agudas y crónicas de niños con anemia de células falciformes (ACF). Pacientes y Método: Estudio de cohorte restrospectiva. Se incluyeron pacientes pediátricos con diagnóstico confirmado de enfermedad de células falciformes que tuvieran estudio nefro-urológico. Se consignó patrón electroforético de hemoglobina, presencia y tipo de afectación renal, y presencia de compromiso cardiológico. Se realizó análisis bivariado para comparar pacientes con y sin NF. Resultados: Se incluyeron 79 pacientes, 59.5% hombres, siendo el patrón electroforético más fre cuente Hb-SS (60.9%). La NF se presentó en el 70% de ellos, con una edad de 114 meses (RIQ 65-157). Las alteraciones más frecuentemente encontradas fueron hiperfiltración glomerular, mi croalbuminuria, lesión renal aguda, hipertensión arterial e hipostenuria. En el análisis bivariado, un ecocardiograma anormal fue más frecuente en los pacientes con NF (84,8% vs 54,3% p = 0,01), así como tuvieron una tendencia a mayor uso de medicamentos nefrotóxicos (74,5% vs 54,2% p = 0,07). Conclusiones: Nuestros hallazgos sugieren que la nefropatía falciforme puede presentarse a tempra na edad, siendo muy frecuente la hiperfiltración glomerular. Las complicaciones cardiopulmonares en ACF se podrían asociar con la presencia NF.

Abstract: Introduction: Sickle cell nephropathy (SCN) is a poorly studied complication of pediatric patients. It appears in different forms, including glomerulopathy, and tubulopathies. Objective: To describe acute and chronic renal complications in patients with sickle cell anemia (SCA). Patients and Method: Re trospective study. Pediatric patients with confirmed diagnosis of sickle cell disease were included who had a nephro-urology study. Hemoglobin electrophoresis pattern, presence and type of renal involvement, and presence of cardiac involvement were recorded. Bivariate analysis was perfor med to compare patients with and without SCN. Results: 79 patients were included, 59.5% of them were men, and the most frequent electrophoresis pattern was Hb-SS (60.9%). The SCN oc curred in 70% of patients with an average age of 114 months (RIQ 65-157). The most frequently observed alterations were glomerular hyperfiltration, microalbuminuria, acute kidney injury, ar terial hypertension, and hyposthenuria. In the bivariate analysis, an abnormal echocardiogram result was presented more frequently in patients with SCN (84.8% vs. 54.3% p = 0.01), as well as more frequent use of nephrotoxic drugs (74.5% vs. 54.2% p = 0.07). Conclusions: Our findings suggest that sickle cell nephropathy may occur at an early age, where glomerular hyperfiltration is very common. Cardiopulmonary complications in patients with SCA may be related to the presence of SCN.

Fabry disease: genetics, pathology, and treatment

SUMMARY Fabry disease (FD) is a recessive monogenic inheritance disease linked to chromosome X, secondary to mutations in the GLA gene. Its prevalence is estimated between 1:8,454 and 1:117,000 among males and is probably underdiagnosed. Mutations in the GLA gene lead to the progressive accumulation of globotriaosylceramide (Gb3). Gb3 accumulates in lysosomes of different types of cells of the heart, kidneys, skin, eyes, central nervous system, and gastrointestinal system, and may lead to different clinical scenarios. The onset of symptoms occurs during childhood, with acroparesthesia, heat intolerance, and gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, and neuropathic pain. Subsequently, symptoms related to progressive impairment appear, such as angiokeratomas, cornea verticillata, left ventricular hypertrophy, myocardial fibrosis, proteinuria, and renal insufficiency. The latter being the main cause of death in FD. The gold standard for diagnosis is the genetic analysis in search of mutation, in addition to family history. In homozygous patients, the enzyme activity can also be used. Once the diagnosis is confirmed, the patient and their family should receive genetic counseling. The treatment, in turn, currently focuses mainly on replacing the enzyme that is absent or deficient by means of enzyme replacement therapy, with the purpose of avoiding or removing deposits of Gb3. Chaperones can also be used for the treatment of some cases. It is considered that the specific treatment should be initiated as soon as a diagnosis is obtained, which can change the prognosis of the disease.

Caracterización clínica de pacientes con nefropatía lúpica en Santander, la importancia de la biopsia renal / Clinical and epidemiological characterization of patients with lupus nephropathy in Santander, Colombia: the importance of the renal biopsy

Resumen Introducción: el lupus eritematoso sistémico (LES) presenta diferentes manifestaciones clínicas, un de estas es la nefropatia lúpica (NL), que se asocia con progresión a enfermedad renal crónica (ERC) avanzada y mortalidad. Objetivo: determinación de las características clínicas y epidemiológicas de la NL en Santander. Métodos: estudio observacional descriptivo tipo serie de casos en pacientes con NL evaluados por primera vez, entre enero de 2017 a enero 2018, en consulta de nefroprevención. Según criterios de inclusión y exclusión se definieron variables cualitativas y cuantitativas. Se revisaron historias clínicas y el análisis de datos se realizó por medio de SPSS®. Resultados: se estudiaron 14 pacientes (85 % mujeres), la edad promedio de diagnóstico de NL fue de 36 años, con ERC 1 y 2 (72 %) y con proteinuria A3 (85 %). Se obtuvo biopsia renal en 64 %, con resultado concluyente en el 50 %, la clase histopatológica IV de NL fue la más común. La terapia de mantenimiento más frecuente fue corticoide en monoterapia (36 %), seguido de la combinación de corticoide y micofenolato (29 %). Conclusión: la NL predomina en mujeres jóvenes, en estadios tempranos de ERC con altos grados de proteinuria, por lo que se debe realizar una evaluación minuciosa en búsqueda de NL a todos los pacientes con LES, mediante programas de detección y seguimiento nefrológico temprano. El grado histopatológico IV fue el más frecuente, similar a lo reportado en Latinoamérica. Existen dificultades administrativas y técnicas en la toma de biopsias renales, se debe hacer énfasis en la necesidad de su realización, por su primordial importancia para definir el tratamiento.

Abstract Introduction: Systemic Lupus Erythematosus (SLE) has different clinical manifestations, being very relevant lupus nephropathy (NL) because is associated with progression to advanced chronic kidney disease (CKD) and mortality. Objective: Determination of the clinical and epidemiological characteristics of the NL in Santander. Methods: A descriptive observational study of a series of cases in patients with NL diagnosis, evaluated between January 2017 and 2018 for the first time in a nephroprotection consultation. Qualitative and quantitative variables are defined according to the inclusion and exclusion criteria. Electronic medical records were reviewed, and data analysis was performed through SPSS®. Results: 14 patients (85% women) were studied. The average age of diagnosis of NL was 36 years, mostly with stages of CKD 1 and 2 (72%) with proteinuria A3 (85%).Biopsy renal was performed in the 64%, a conclusive result in the 50%, being the histopathological grade IV of NL the most common. The most frequent maintenance therapy was corticosteroid alone (35.7%), followed by the combination of corticosteroid and mycophenolate (28.5%). Conclusion: NL predominates in young women, and presenting in early stages of CKD, with high degrees of proteinuria, so a thorough evaluation should be performed in search of NL in all patients with SLE through early nephrological screening and monitoring programs. The histopathological grade IV found is like that reported in Latin America. There are administrative and technical difficulties in the performance of renal biopsies, emphasis should be placed on the realization of this procedure because it takes a primary role in defining the treatment.

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

ABSTRACT Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

Protein-to-creatinine urinary in the early diagnosis of renal injury in canine pyometra / Relação proteína-creatinina-urinária no diagnóstico precoce de lesão renal em cadelas com piometra

Kidney disease that affects bitches with pyometra may lead patients to develop chronic renal failure even after pyometra treatment. Therefore, several studies have sought to clarify the gaps in the understanding of the pathogenesis of renal injury in pyometra. Identification of early detection markers for renal damage, which can predict and identify the prognosis of the disease, is very important. Proteinuria analysis can diagnose kidney damage, since proteins such as albumin are not filtered through the glomerulus and those that undergo glomerular filtration are almost completely reabsorbed by tubular cells. The objective of this study was to evaluate whether the urinary protein-to-creatinine ratio (UPC) can detect renal injury in bitches with pyometra before development of azotemia. For this, 44 bitches with pyometra were divided into two groups: bitches with azotemic piometra (A, n=15, creatinine >1.7) and bitches with non-azotemic pyometra (NA, n=29). The two groups were compared to the control group (CG, n=12), which had no signs of systemic disease. All animals underwent blood and urine tests. Leukocytosis was more evident in bitches in the A group than in the other groups. This shows that the inflammatory response may be associated with the pathogenesis of renal injury. The median UPC in bitches with pyometra was significantly higher than in the CG, with a median above the reference values. In conclusion, the UPC can be used in bitches with pyometra to detect renal damage before the development of azotemia. It has been suggested that the UPC of bitches with pyometra should be followed through during the postoperative period so that permanent renal lesions secondary to pyometra can be diagnosed and treated properly before the development of azotemia.(AU)

A doença renal que afeta cadelas com piometra pode levar a insuficiência renal crônica mesmo após o tratamento. Portanto, vários estudos procuraram esclarecer as lacunas na compreensão da patogênese da lesão renal na piometra. A identificação de marcadores de lesão renal precoce, que podem prever e identificar o prognóstico da doença é muito importante. A análise da proteinúria pode diagnosticar lesão renal, uma vez que proteínas como a albumina não são filtradas através do glomérulo e aquelas que sofrem filtração glomerular são quase completamente reabsorvidas pelas células tubulares. O objetivo deste estudo foi avaliar se a relação proteína-creatinina urinária (UPC) pode detectar lesão renal em cadelas com piometra antes do desenvolvimento de azotemia. Para isso, 44 cadelas com piometra foram divididas em dois grupos: cadelas com piometra azotêmica (A, n=15, creatinina >1,7) e cadelas com piometra não azotêmica (NA, n=29). Os dois grupos foram comparados ao grupo controle (CG, n=12), que não apresentaram sinais de doença sistêmica. Todos os animais foram submetidos a exames de sangue e urina. A leucocitose foi mais evidente nas cadelas do grupo A do que nos outros grupos. Isso mostra que a resposta inflamatória pode estar associada à patogênese da lesão renal. A mediana da UPC em cadelas com piometra foi significativamente maior que no CG, com uma mediana acima dos valores de referência. Em conclusão, a UPC pode ser usada em cadelas com piometra para detectar lesões renais antes do desenvolvimento de azotemia. Sugeriu-se que a UPC de cadelas com piometra deve ser acompanhada durante o pós-operatório, de modo que as lesões renais permanentes secundárias à piometra possam ser diagnosticadas e tratadas adequadamente antes do desenvolvimento de azotemia.(AU)

Glomerulopatía colapsante con insuficiencia renal terminal de rápida progresión / Collapsing glomerulopathy with rapid progression to terminal renal failure

La glomerulopatía colapsante (GC) constituye una variedad de la glomeruloesclerosis focal y segmentaria. Afecta tanto a la población adulta (40%) como a la infantil (20%); presentándose con mayor frecuencia en hombres jóvenes y afrodescendientes. Clínicamente se presenta como un síndrome nefrótico, con niveles elevados de úrea y creatinina. Se presenta el caso de paciente femenino de 22 años, quien acude por presentar fiebre, edema matutino en miembros inferiores, e intolerancia oral de 9 días de evolución. Al examen físico: Hipertensión arterial y ascitis. La GC es una entidad poco diagnosticada, que progresa rápidamente a insuficiencia renal terminal a pesar de recibir cualquier tratamiento sistémico descrito hasta la actualidad, por lo que amerita mayor investigación en el ámbito terapéutico(AU)

Collapsing glomerulopathy (GC) is a variety of focal segmental glomerulosclerosis. It affects both adult population (40%) and children (20%); it occurs most often in young people, male and of African descent. Clinically it is presented as a nephrotic syndrome, with high levels of urea and creatinine serum. There is insufficient evidence regarding the treatment of this entity, so that steroids and immunosuppressants are used at high doses. We present the case of a 22-year old female, who presented fever, edema in the lower limbs and oral intolerance of 9 days of evolution. Physical examination showed: high blood pressure and ascitis. This nephropathy is an underdiagnosed entity rapidly progressing to kidney failure despite receiving any systemic treatment described until now, so it merits further research in the therapeutic field(AU)

Biochemistry and Renal Function: Use of Inquiry-Based Teaching Sequences for Retrieval of Specific Concepts / Bioquímica e Função Renal: Utilizações de Sequências Didáticas com Enfoque Investigativo para Reaproximação de Conceitos Específicos

ABSTRACT Current teaching proposals involve teaching strategies that seek to assist and encourage the construction of knowledge by the students, turning them into active participants during the learning process and these have been the subject of several researches. This article reports a didactic sequence carried out with students of applied training for the first year Medical Sciences USP - Bauru, and proposes, as part of its pedagogical design, Problem Based Learning (PBL) as the main teaching strategy. In this didactic sequence we used experimental investigative activities. A didactic sequence that includes investigative activities can be characterized as a gradual evolutionary process, with the objective of intertwining the scientific perspective and the students' conceptions, through well-planned teaching and learning activities contextualized and empirically adapted to the student's reasoning. The objective of this work is to share an assertive experience of the application of a contextualized research didactic sequence that involved concepts ranging from the simplest chemical properties of biomolecules and ions to the association and discussion of a hypothetical clinical case involving proteinuria. Its pathophysiology consists of the excretion of protein in the urine, mainly albumin, and occurs when there is some damage to the kidneys. Therefore, the dosage of the protein fraction in urine (albuminuria) is mainly used for the early detection of chronic or acute kidney disease and can also be an instrument for the diagnosis of cardiovascular diseases. Therefore, one should be aware of the possible interferences and the various causes of errors inherent to this examination. In this way, through a didactic resource involving contextualized research experimental activities, having proteinuria as the key problem, we were able to re-approximate specific concepts and to value procedural and attitudinal knowledge, which is important for students in this training phase. In this proposal, the students were protagonists of the learning process, where they were able to raise and test their hypotheses, interconnecting knowledge, acquiring specific skills and competences, allowing reflection on the importance of fundamentals and applications of the basic sciences. The purpose of the investigative and contextualized didactic sequences is to form autonomous subjects, who know how to make decisions and work in teams and have a sound and critical understanding of how scientific knowledge evolves and is related.

RESUMO As propostas de ensino atuais envolvem estratégias de ensino que auxiliam e incentivam a construção do conhecimento, fazendo com que o aluno seja um participante ativo do processo de aprendizagem, e têm sido alvo de diversas pesquisas. Este artigo relata, aula a aula, uma sequência didática realizada com alunos em fase inicial de formação, aplicada à primeira turma do curso de Ciências Médicas da USP - Bauru, que propõe em seu projeto pedagógico o Aprendizado Baseado em Problemas (PBL) como principal estratégia de ensino. Nesta sequência didática, utilizamos atividades experimentais investigativas. A característica principal de uma sequência didática que inclui atividades investigativas é seu processo evolutivo gradual, com o objetivo de entrelaçar a perspectiva científica e as concepções dos estudantes por meio de atividades de ensino-aprendizagem bem planejadas, contextualizadas e empiricamente adaptadas ao raciocínio do aluno. O objetivo deste trabalho é compartilhar uma vivência assertiva da aplicação de uma sequência didática de caráter investigativo contextualizada, que envolveu conceitos que foram desde as propriedades químicas mais simples das biomoléculas/íons até a associação e discussão de um caso clínico hipotético envolvendo proteinúria. Essa fisiopatologia consiste na excreção de proteína na urina, principalmente albumina, e ocorre quando há algum dano nos rins. Sendo assim, a dosagem da fração proteica na urina (albuminúria) é utilizada principalmente para detecção precoce de doença renal crônica e pode ser também um instrumento para o diagnóstico de doenças cardiovasculares. Portanto, deve-se estar atento aos possíveis elementos interferentes e às variadas causas de erros inerentes a esse exame. Desta maneira, por meio de um recurso didático que envolve atividades experimentais investigativas contextualizadas, tendo como questão problematizadora um caso de proteinúria, pudemos nos reaproximar de conceitos específicos e valorizar os saberes procedimentais e atitudinais, o que é importante para os alunos nesta fase de formação. Nesta proposta, os alunos foram protagonistas do processo de aprendizagem, no qual puderam levantar e testar suas hipóteses, interligando conhecimentos e adquirindo habilidades e competências específicas, o que possibilitou uma reflexão sobre a importância dos fundamentos e aplicações das ciências básicas. O propósito das sequências didáticas investigativas e contextualizadas é formar sujeitos autônomos, que saibam tomar decisões e trabalhar emequipe, seguros e críticos, compreendendo como os saberes científicos evoluem e estão relacionados.

Características clínicas e histológicas de las enfermedades parenquimatosas renales en una muestra de biopsias renales obtenidas entre el año 2002 y el 2017 en el departamento de Caldas, Colombia / Clinical and Histologic Characteristic of Renal Parenchymal Diseases in a Renal Biopsy Sample since 2002 to 2017 in Caldas - Colombia

Resumen Antecedentes: los síndromes renales son manifestaciones clínicas y de laboratorio que indican alteraciones funcionales y morfológicas. La biopsia renal es fundamental en el diagnóstico de enfermedades renales parenquimales y aporta información valiosa sobre la incidencia, distribución y posible control de la enfermedad. Objetivo: describir las características clínicas e histológicas de las enfermedades del parénquima renal en una muestra de biopsias renales. Métodos: se incluyeron 269 pacientes mayores de 14 años, a quienes se les realizó biopsia renal por cualquier método. Se clasificaron por indicación de biopsia y por tipo de lesión renal primaria o secundaria. Resultados: el promedio de edad fue de 57,04 (DE ± 17,17 años). La mediana de creatinina fue 1,51 mg/dl (RIC=1,22 - 2,01); y la de TFG por CKD-EPI, de 42,7 mil/minuto (RIC= 30,6 - 56,5). Las indicaciones de biopsia renal más frecuentes fueron enfermedad renal crónica sin causa clara (46,8 %), proteinuria no nefrótica (20,1 %), síndrome nefrítico (8,2 %), lesión renal aguda (7,1 %), hematuria glomerular con cambio en el patrón (7,1 %), síndrome nefrótico (6,7 %) y tasa de filtración glomerular estimada baja para la edad sin causa clara (4,1 %). Los hallazgos encontrados fueron: nefropatía por IgA (20,9 %), nefropatía hipertensiva (19 %), glomeruloesclerosis focal y segmentaria (11,6 %), nefritis tubulointersticial (9,7 %), glomerulopatía diabética (8,6 %), glomerulonefritis membranoproliferativa (3,7 %) y glomerulonefritis proliferativa extracapilar (3,4 %). Conclusiones: la nefropatía por IgA y la glomeruloesclerosis focal y segmentaria son las principales glomerulopatías primarias. La nefropatía hipertensiva y la nefritis tubulointersticial son las principales etiologías secundarias.

Abstract Background: Renal syndromes are clinical and laboratory manifestations that indicate functional and morphological alterations. Renal biopsy is essential in the diagnosis of kidney parenchymal diseases and provides valuable information in incidence, distribution and possible control of the disease. Objective: To describe the clinical and histological characteristics of renal parenchymal diseases in a sample of renal biopsies. Methods: We included 269 patients older than 14 years who underwent renal biopsy by any method. They were classified by indication of biopsy and by type of primary or secondary kidney injury. Results: The average age was 57, 04 (SD ± 17, 17 years). The median creatinine was 1, 51 mg / dL (RIC=1, 22 - 2,01) and the GFR for CKD-EPI was 42,7 mil/minute (RIC=30,6 - 56,5). The most frequent renal biopsy indications were unexplained chronic kidney disease (46,8 %), non-nephrotic proteinuria (20,1 %), nephritic syndrome (8,2 %), acute kidney injury (7,1 %), glomerular hematuria with change in the pattern (7,1 %), nephrotic syndrome (6,7 %) and unexplained low glomerular filtration for age (4,1 %). The most frequent finding were IgA nephropathy (20,9 %), hypertensive nephropathy (19 %), focal and segmental glomerulosclerosis (11,6 %), tubulointerstitial nephritis (9,7 %), diabetic glomerulopathy (8,6 %), membranoproliferative glomerulonephritis (3,7 %), extracapillary proliferative glomerulonephritis (3,4 %). Conclusions: IgA nephropathy and focal segmental glomerulosclerosis are the main primary glomerulopathies. Hypertensive nephropathy and tubulointerstitial nephritis are the main secondary etiologies.

Proteinuria persistente en pacientes pediátricos, caracterización histopatológica y su influencia en la progresión de la enfermedad renal crónica / Persistent proteinuria in pediatric patients, histopathological characterization and its influence on chronic kidney disease progression / Proteinúria persistente em pacientes pediátricos, caracterização histopatológica e sua influência na progressão da doença renal crónica

Objetivo: describir los hallazgos histopatológicos y la progresión a enfermedad renal crónica de los pacientes sometidos a biopsia renal en un hospital de referencia de la ciudad de Medellín entre 2005 y 2014. Metodología: estudio descriptivo retrospectivo. Se revisaron historias clínicas de pacientes menores de 18 años con diagnóstico de proteinuria persistente, a quienes se les realizó biopsia renal durante el período 2005-2014 en el Hospital Pablo Tobón Uribe. Se analizaron variables sociodemográficas, clínicas, histológicas y de laboratorio. Resultados: se incluyeron 71 pacientes. La edad promedio del diagnóstico de proteinuria persistente fue 10.07 años. El 69.1% y 20.6% de los pacientes presentaron hematuria e hipertensión arterial respectivamente. La glomerulonefritis por IgA fue el hallazgo histológico más frecuente (21.13%), seguido de la nefropatía lúpica (18.31%). Del total de pacientes, 69.0% recibieron inhibidores de la enzima convertidora de angiotensina y el 15.9% presentaron deterioro de la función renal al cuarto año de seguimiento. Conclusiones: la prevalencia de glomerulopatías en niños con proteinuria persistente fue alta. Se sugiere la realización de la biopsia renal con el fin de detectar tempranamente glomerulopatías primarias o secundarias asociadas para así instaurar un tratamiento oportuno que controle o retarde el deterioro de la función renal.

Objective: To describe the histopathological findings and their progression of chronic kidney disease in pediatric patients who underwent kidney biopsy due to persistent proteinuria during 2005-2015 at a high-complexity hospital in Medellin, Colombia. Methods: A retrospective, cohort study was carried out; the medical records of children under 18 with diagnosis of persistent proteinuria were reviewed. Sociodemographic, clinical, and histopathological variables were analyzed. Results: A total of 71 patients were included. The mean age at the diagnosis of persistent proteinuria was 10.07 years old. 69.1% and 20.6% of the patients had hematuria and hypertension, respectively. Overall, the predominant pathological diagnosis in the current study was IgA nephropathy (21.13%) followed by lupus nephropathy (18.31%). 69.0% of the patients received angiotensin-converting enzyme inhibitors. At the last follow-up, 15.9% presented impaired renal function. Conclusion: In our cohort, the prevalence of glomerulopathies in children with persistent proteinuria was high. We recommended performing kidney biopsy in children with persistent proteinuria. This allows early detection of primary or secondary glomerulopathies to retard progression of renal damage.

Objetivo: descrever os descobrimentos histopatológicos e a progressão a doença renal crónica dos pacientes submetidos a biopsia renal num hospital de referência da cidade de Medellín entre 2005 e 2014. Metodologia: estudo descritivo retrospectivo. Se revisaram histórias clínicas de pacientes menores de 18 anos com diagnóstico de proteinuria persistente, a quem se lhes realizou biopsia renal durante o período 2005-2014 no Hospital Pablo Tobón Uribe. Se analisaram variáveis sócio-demográficas, clínicas, histológicas e de laboratório. Resultados: se incluíram 71 pacientes. A idade média do diagnóstico de proteinúria persistente foi de 10.07 anos. 69.1% e 20.6% dos pacientes apresentaram hematúria e hipertensão arterial respectivamente. A glomerulonefrite por IgA foi a descoberta histológico mais frequente (21.13%), seguido da nefropatia lúpico (18.31%). Do total de pacientes, 69.0% receberam inibidores da enzima convertedora de angiotensina e 15.9% apresentaram deterioro da função renal ao quarto ano de seguimento. Conclusões: a prevalência de glomerulopatias em crianças com proteinúria persistente foi alta. Se sugere a realização da biopsia renal com o fim de detectar precocemente glomerulopatias primárias ou secundárias associadas para assim instaurar um tratamento oportuno que controle ou retarde o deterioro da função renal.

Prevalence of Chronic Kidney Disease among Patients Attending an HIV Outpatient Clinic in Kingston, Jamaica / Prevalencia de la enfermedad renal crónica entre los pacientes que asisten a una clínica ambulatoria de VIH en Kingston, Jamaica

ABSTRACT The medical records of 983 patients diagnosed with the human immunodeficiency virus (HIV) were reviewed, 501 of whom were female and 482 were male. The mean age was 42.1 years, the mean number of years since diagnosis of HIV was 7.4, and the average duration of highly active antiretroviral therapy (HAART) was 51.7 months. The mean CD4 count at diagnosis was 268.5 cells/μL, but the most recent CD4 count was 461 cells/μL, and 85.8% of the patients were on HAART. The mean CD4 count was lower in those with a glomerular filtration rate (GFR) of < 60 ml/minute/1.73m2 compared to those patients with only proteinuria and a GFR of > 60 ml/minute/1.73m2. In the sample population, 76.9% of the patients had chronic kidney disease stage 3, 7.7% were in stage 4 and 15.4% in stage 5. There were 3.1% of patients with persistent proteinuria. Hypertension and diabetes mellitus were co-morbidities.

RESUMEN Se revisaron las historias clínicas de 983 pacientes diagnosticados con el virus de la inmunodeficiencia humana (VIH), 501 de los cuales eran mujeres, y 482 hombres. La edad promedio fue de 42.1 años, el número promedio de años a partir del diagnóstico de VIH fue 7.4, y la duración promedio de la terapia antirretroviral altamente activa (TARAA) fue de 51.7 meses. El conteo de CD4 promedio en el momento del diagnóstico fue de 268.5 células/μl pero el más reciente conteo de CD4 fue de 461 células/μl y el 85.8% de los pacientes se encontraban bajo terapia TARAA. El conteo de CD4 promedio fue menor en aquellos pacientes con una tasa de filtrado glomerular (TFG) de < 60 ml/minuto/1.73 m2, en comparación con los pacientes que tenían sólo proteinuria y una TFG de > 60 ml/minute/1.73 m2. En la población de la muestra, el 76.9% de los pacientes tenía enfermedad renal crónica en etapa 3, el 7.7% estaba en la etapa 4, y el 15.4% en la etapa 5. Había 3.1% de pacientes con proteinuria persistente. La hipertensión y la diabetes mellitus fueron comorbilidades.

Increased nitric oxide plasma concentration in dogs with naturally acquired chronic renal disease / Aumento da concentração plasmática de óxido nítrico em cães com doença renal crônica naturalmente adquirida

This study aimed to determine the amount of plasma nitric oxide in clinically stable dogs at different stages of chronic kidney disease (CKD). Five groups of dogs were studied, aged from 4 to 18, comprising of a control group composed of healthy animals (control n=17), group CKD stage 1 (DRC-1, n=12), group CKD stage 2 (CKD-2, n=10) group, CKD stages 3 (CRD-3, n=13) and Group CKD stage 4 (DRC-4, n=10). Dogs with CKD were clinically stable and received no treatment. Two blood samples were collected at 24 hours intervals (repeated measures) to obtain serum and plasma. The serum creatinine values were used to classify dogs as CG, CKD-1, CKD-2, CKD-3 and CKD-4, and were (1.02±0.02mg/dL), (1.07±0.04mg/dL), (1.81±0.03mg/dL), (3.40±0.15mg/dL) and (6.00±0.20mg/dL) respectively. The determination of nitric oxide (NO) was performed by dosing nitrate/nitrite indirectly, and used for measurement of nitrate according to the NO/ozone chemiluminescence. The data were submitted to ANOVA for nonparametric analysis(Kruskal-Wallis) (P<0.05). The concentration of plasmatic NO did not differ significantly among GC (10.81±0.51µM), CKD-1 (15.49±1.97µM) and CKD-2 (19.83±3.31µM) groups. The plasma concentration of CKD-3 (17.02±1.73µM) and CKD-4 (83.56±13.63µM) was significantly higher compared with healthy dogs. In conclusion, the NO plasma concentration can increase in dogs with CKD and become significantly higher in stage 3 and 4 dogs.(AU)

A determinação de óxido nítrico no plasma em cães clinicamente estáveis em diferentes estágios da doença renal crônica (DRC) não foi estudada, constituindo este o objetivo do presente estudo. Foram estudados cinco grupos de cães, com idade variando entre quatro a 18 anos, compreendendo o grupo controle, composto por animais sadios (controle, n=17), grupo com DRC estágio 1 (DRC-1, n=12), grupo com DRC estágio 2 (DRC-2, n=10), grupo com DRC estágio 3 (DRC-3, n=13) e grupo com DRC estágio 4 (DRC-4, n=10). Os cães com DRC estavam com o quadro clínico estável e sem receber qualquer tipo de tratamento. Foram estudados cinco grupo de cães, com idade variando entre quatro a 18 anos, compreendendo o grupo controle, composto por animais sadios (controle, n=17), grupo com DRC estágio 1 (DRC-1, n=12), grupo com DRC estágio 2 (DRC-2, n=10), grupo com DRC estágio 3 (DRC-3, n=13) e grupo com DRC estágio 4 (DRC-4, n=10). Os animais sadios ou com DRC foram submetidos a duas coletas de sangue, com intervalo de 24 horas (amostras repetidas), para obtenção de soro e plasma. Os valores de creatinina sérica, que definiram a classificação dos pacientes do controle, DRC-1, DRC-2, DRC-3 e DRC-4, que foram 1,02±0,02mg/dL; 1,06±0,05mg/dL; 1,80±0,03mg/dL; 3,39±0,21mg/dL e 6,00±0,28mg/dL, respectivamente. A determinação plasmática indireta de óxido nítrico (NO) foi realizada por meio da dosagem de nitrato/nitrito, através da técnia de quimioluminescência NO / ozono. Os dados foram submetidos à ANOVA para análise não paramétrica (Kruskal-Wallis) (P <0,05). Os resultados das concentrações plasmáticas de NO não diferiram significativamente quando comparados os dados do controle (10,81±0,51µM), DRC-1 (15,49±1,97µM), DRC-2 (19,82±3,31µM). No entanto, o NO plasmático do grupo DRC-3 (17,01±1,73µM) e DRC-4 (83,55±13,63µM), foi significativamente maior, em relação às médias dos cães sadios. Concluímos que a concentração plasmática de NO pode aumentar em cães com DRC e torna-se significativamente mais elevada nos estágios 3 e 4 da doença.(AU)

The Oxford Classification predictors of chronic kidney disease in pediatric patients with IgA nephropathy / Preditores da doença renal crônica segundo a Classificação de Oxford em pacientes pediátricos com nefropatia por IgA

Abstract Objective: The Oxford Classification for Immunoglobulin A nephropathy (IgAN) identifies pathological variables that may predict the decline of renal function. This study aimed to evaluate the Oxford Classification variables as predictors of renal dysfunction in a cohort of Brazilian children and adolescents with IgAN. Methods: A total of 54 patients with IgAN biopsied from 1982 to 2010 were assessed. Biopsies were re-evaluated and classified according to the Oxford Classification. Multivariate analysis of laboratory and pathological data was performed. The primary outcomes were decline of baseline estimated glomerular filtration rate (eGFR) greater than or equal to 50%. Results: Mean follow-up was 7.6 ± 5.0 years. Mean renal survival was 13.5 ± 0.8 years and probability of decline ≥50% in baseline eGFR was 8% at five years of follow-up and 15% at ten years. Ten children (18.5%) had a decline of baseline eGFR ≥ 50% and five (9.3%) evolved to end-stage renal disease. Kaplan-Meier analysis showed that baseline proteinuria, proteinuria during follow-up, endocapillary proliferation, and tubular atrophy/interstitial fibrosis were associated with the primary outcome. Multivariate Cox analysis showed that only baseline proteinuria (HR, 1.73; 95% CI, 1.20-2.50, p = 0.003) and endocapillary hypercellularity (HR, 37.18; 95% CI, 3.85-358.94, p = 0.002) were independent predictors of renal dysfunction. No other pathological variable was associated with eGFR decline in the multivariate analysis. Conclusion: This is the first cohort study that evaluated the predictive role of the Oxford Classification in pediatric patients with IgAN from South America. Endocapillary proliferation was the unique pathological feature that independently predicted renal outcome.

Resumo Objetivo: A Classificação Oxford para a Nefropatia por Imunoglobulina A (IgAN) identificou variáveis patológicas de risco para disfunção renal. O presente estudo teve como objetivo avaliar as variáveis da Classificação de Oxford como preditores de disfunção renal em crianças brasileiras com IgAN. Métodos: Foram analisados 54 pacientes com diagnóstico de IgAN entre 1982-2010. As biópsias renais foram reavaliadas pela Classificação de Oxford. Foram feitas análises uni e multivariada das variáveis clínicas e patológicas. O desfecho primário foi queda da taxa de filtração glomerular (TFG) ≥ 50% da filtração basal. Resultados: O acompanhamento médio foi de 7,6 ± 5,0 anos. A sobrevida renal média foi de 13,5 ± 0,8 anos e a probabilidade de atingir o desfecho primário foi de 8% em cinco anos e 15% em 10 anos de seguimento. Dez crianças (18,5%) apresentaram queda na TFG basal ≥ 50% e cinco (9,3%) evoluíram para doença renal crônica terminal. A análise de Kaplan-Meier mostrou que a proteinúria basal e de seguimento, a proliferação endocapilar e a atrofia tubular/fibrose intersticial foram associadas com o desfecho primário. A análise multivariada de Cox mostrou que a proteinúria basal (HR = 1,73; IC95% 1,20-2,50, p = 0,003) e a proliferação endocapilar (HR = 37,18; IC95% 3,85-358,94, p = 0,002) foram preditores independentes de disfunção renal. Nenhuma outra variável patológica foi associada com declínio da TFG na análise multivariada. Conclusão: Este é o primeiro estudo brasileiro que avaliou a Classificação Oxford em crianças com IgAN. A proliferação endocapilar foi a única característica patológica capaz de predizer independentemente o declínio da função renal.