Lavado vesical de bovinos com hematúria enzoótica: padronização de técnica de colheita, obtenção de amostras e avaliação citopatológica / Bovine urinary bladder washing with enzootic hematuria: standardization of harvesting technique, sample collection and cytopathological evaluation

A hematúria enzoótica bovina é uma doença crônica que causa neoplasias na bexiga, e o exame citopatológico poderia auxiliar no diagnóstico precoce. Objetivou-se padronizar a técnica de colheita, obtenção de amostras e avaliação citopatológica do lavado vesical de bovinos com hematúria enzoótica bovina. Foram utilizadas 10 vacas, adultas, distribuídas em dois grupos. No grupo A foi recuperado todo o líquido vesical infundido, no grupo B foi recuperado apenas o último lavado. Os lavados foram submetidos à avaliação citopatológica. Apesar do volume final de líquido vesical ter sido maior no grupo A, em relação ao número de células, não houve diferença significativa (p > 0,05) entre os grupos. A quantidade de células inflamatórias e células epiteliais obtidas por amostra revelou que nos dois grupos todos os animais apresentavam mais células inflamatórias do que epiteliais, entretanto, não houve diferença entre o tipo de colheita realizada. As células epiteliais foram encontradas em 60% dos casos e as alterações morfológicas observadas foram discretas, não sendo possível classificar nenhuma amostra como hiperplásica ou neoplásica. Os dados deste estudo permitiram concluir que o exame citopatológico do lavado vesical de bovinos pode auxiliar no diagnóstico da hematúria enzoótica bovina e que os dois métodos de colheita empregados mostraram-se adequados para obtenção de amostras viáveis. A avaliação citopatológica permitiu a identificação de lesões não neoplásicas predominantemente inflamatórias. Acredita-se que a utilização de técnicas moleculares com biomarcadores em amostras citológicas seria importante para detectar precocemente lesões pré-neoplásicas ou neoplásicas nesses animais.(AU)

The bovine enzootic hematuria is a chronic disease that causes tumors in the bladder, and the cytophatologic test could assist in the early diagnosis. Aimed to standardize the technique of harvesting, obtaining samples and cytophatologic evaluation of bovine urinary bladder washing with bovine enzootic hematuria, 10 adult cows were divided into two groups: A (all the liquid infused in the bladder was recovered) and B (only the latter liquid was recovered). Liquids recovered were subjected to cytophatological evaluation. It was observed that the final volume of bladder liquid was higher in group A, however, in relation to the number of cells, no significant difference (p > 0.05) was observed between groups. The amount of inflammatory cells and epithelial cells obtained per sample revealed that in both groups all animals had more inflammatory cells than epithelial cells, however, there was no difference between the type of washing done. The epithelial cells were found in 60% of cases, the alterations observed were discretes and it was not possible to classify any sample as hyperplastic or neoplastic. Data from this study showed that the cytophatological examination of bovine urinary bladder washing may aid in the diagnosis of bovine enzootic hematuria and the two harvesting methods employed were adequate for obtaining viable samples. Cytopathological evaluation allowed the identification of non-neoplastic lesions predominantly inflammatory. It is believed that the use of molecular markers in cytological samples is important for early detection of pre-neoplastic or neoplastic lesions in these animals.(AU)

Glomerulonefritis rapidamente progresiva en el niño: análisis de la casuística de un quinquenio 2004-2009: [revisión] / Rapidly progressive glomerulonephritis in children: analysis of the data of a five-year period 2004-2009: [review]

La glomerulonefritis rápidamente progresiva (GNRP) es una entidad poco frecuente; el diagnóstico precoz es importante con fines terapéuticos y pronósticos. El objetivo del presente trabajo es reportar la casuística del GNRP en el Servicio de Nefrología del Hospital de Niños "Jorge Lizarraga" entre enero 2004 y enero 2009. Estudio retrospectiva y descriptivo con la revisión de las historias clínicas de 8 pacientes con edades entre 3-13 años. Seis pacientes correspondieron al sexo femenino. La edad promedio fue de 11 ± 3.5 años. La mayoría presentó un foco infeccioso previo con mayor frecuencia en piel (6 casos), y en faringe un caso. Las manifestaciones clínicas y los hallazgos de laboratorio se caracterizaron por: edema, hipertensión, hematuria, retención azoada progresiva, proteinuria e hipocomplementaria. Se realizó biopsia renal en todos los casos, observandose glomerulonefritis proliferativa endo y extracapilar en 6 casos y glomerulonefritis membranoprolirativa en 2 casos. La terapéutica se basó en tratar la infección y el fallo renal agudo. Se aplicaron pulsos de metilprednisolona a todos los pacientes y 6 pacientes ameritaron diálisis peritoneal. Seis pacientes sobrevivieron (2 egresaron con función renal normal y 4 progresaron a enfermedad renal crónica) y 2 pacientes fallecieron. La GNRP es una condición que se presenta esporadicamente; su evolución depende de la severidad del compromiso renal, extensión de las lesiones histopatológicas y precocidad en la terapéutica farmacológica y dialítica. La mayoría de los pacientes sobrevive, un porcentaje importante progresa a enfermedad renal crónica, lo cual eventualmente amerita terapia substitutiva con dialisis y trasplante renal.

Rapidly progressive glomerulonephritis (RPGN) is a rate entity; early diagnosis is important for adequate and prompt treatment. The objetive of this paper is to report the casuistic of RPGN in the Department of Nephrology of the Hospital de Niños "Jorge Lizarraga" between January 2004 and January 2009. Retrospective and descriptive study collecting data of the medical records of 8 pantients, ages 3-13 years. Six patients were females and the average for age was 11 ± 3.5 years. The majority presented a previous infection (skin in 6 and pharynx in 1). Clinical manifestations and laboratory findings were: edema hypertensión, hematuria, progressive azotemic retentions, proteinuria and hypocomplementemia. Renal biopsy was performed in all patients with the following results: endo and extracapillary proliferative glomerulonephritis in 6 cases and membranoproliferative glomerulonephritis in 2. Therapeutic measures were aimed to the treatment of infection acute renal failure. Methylprednisolone boluses were indicated in all patients, 6 patients were submitted to peritoneal dialysis. Six patients survived (2 with normal renal function and 4 with progression to chronic kidney disease), and 2 died. RPGN is a condition that occurs sporadically: its evolution depends of the severity of renal involvement, the extension of histological lesions and the precocity with which pharmacological and dialytic treatment are installed. Most patients survive but a significant number progresss to chronic kidney disease.

Enfermedad renal crónica: Clasificación, identificación, manejo y complicaciones / Clinical guidelines on identitication, management and complications of chronic kidney disease

The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10 percent, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.

Hepatite C e nefropatia / Hepatitis C and nephropathy

Vários estudos associam a infecção crônica pelo vírus da hepatite C a manifestações extra-hepáticas, incluindo glomerulopatias. O objetivo deste artigo é fazer uma breve revisão da literatura sobre as manifestações renais da hepatite C e apresentar os resultados sumarizados de estudo que buscou avaliar a associação de alterações urinárias assintomáticas em doadores de sangue com anticorpos anti VHCHC positivo ...