Endothelial dysfunction is important in the pathogenesis of cardiovascular disease (CVD) related to chronic kidney disease (CKD). Stromal cell-derived factor-1 (SDF-1) is a chemokine which mobilizes endothelial progenitor cells (EPC) and together with interleukin-8 (IL-8) may be used as markers of tissue injury and repair.
This study investigated
Systemic inflammation was assessed by C-reactive protein (CRP) and interleukin-6
(IL-6). IL-8 and SDF-1 were measured as markers of endothelial dysfunction and
tissue repair, respectively, by ELISA.
The study included 26 hemodialysis (HD) patients (17 ± 3 months on dialysis, 52 ±
2 years, 38% men and 11% diabetic). Serum concentrations of CRP, IL-6, SDF-1 and
IL-8 were 4.9 ± 4.8 mg/ml, 6.7 ± 8.1 pg/ml, 2625.9 ± 1288.6 pg/ml and 128.2 ±
206.2 pg/ml, respectively. There was a positive correlation between CRP and IL-6
(ρ = 0.57,
We suggest that SDF-1 and IL-8 in HD patients can be used to measure the extent of damage and subsequent vascular activation in uremia.
Keywords: chemokine CXCL12; chemokines; endothelium, vascular; interleukin-8; renal insufficiency, chronic; uremia;
There is little information in the literature relating supplementary oral usage of vitamin D and calcium to the development of kidney stones.
To evaluate the effect of high dose, 200 IU of vitamin D3 (V) with calcium supplementation (Ca).
Experimental model consists of insertion of pellets into the bladder of rats. V was administered for 30 days with or without Ca. The rats were divided in 6 groups: 1. Sham, 2. Pellets control; 3. V control; 4. Pellets + V; 5. Pellets + Ca and 6. Pellets + Ca + V.
50% and 17% decreases bladder stones formation in groups 5 and 6,
The administration of the V associated with Ca significantly decreased the formation of stones and caused a significant reduction in urinary calcium, suggesting a protection in the lithogenic pathophysiology.
Keywords: 25-hydroxyvitamin D 2; nephrolithiasis; vitamin D; vitamin D deficiency;
There is great interest in the use of animal models in the study of renal pathophysiology requires standardization of parameters.
Standardize assessment of renal function in rats from in the Center for Reproductive Biology of Federal University of Juiz de Fora's colony.
Thirty Wistar rats were used and performed measurements of creatinine (serum
and urine), serum urea and proteinuria. Were evaluated: the urine collection
interval in metabolic cages (24 hours or 12 hours), the need for 12-hour
fast, the need of urine and serum deproteinization for creatinine
measurement, need of serum deproteinization in animals with acute kidney
injury to a spectrophotometer and ELISA, and the comparison of 24-hour
proteinuria (PT 24 hours) with the protein/creatinine ratio (rP/C). Means
were compared by the
The 24 hours urine output was greater than 12 hours, interfering with the creatinine clearance calculation. In the fasting group showed less water intake and lower urinary creatinine. There was great variability for the deproteinized whey and readings performed in the two devices were similar. There was a strong correlation between PT 24 hours and rP/C and the equation was generated: PT 24 hours = (8.6113 x rP/C) + 1.0869.
Was standardized: 24-hour urine collection without fasting. The deproteinization showed no benefit. The measurements were performed with spectrophotometer reliability. It generated a practical formula for estimating PT 24 hours through rP/C.
Keywords: creatinine; kidney function tests; proteinuria; rodentia; specimen handling;
Continuous exposition of the peritoneal membrane to conventional dialysis solutions is an important risk factor for inducing structural and functional alterations.
Experimental study to compare the effects of a conventional standard or a neutral-pH, low-glucose degradation products peritoneal dialysis solution on the viability of exposed fibroblasts in cell culture. Both solutions were tested in all the commercially available glucose concentrations. Cell viability was evaluated with tetrazolium salt colorimetric assay.
Fibroblast viability was significantly superior in the neutral pH solution in
comparison to control, in all three glucose concentrations (Optical density in
nm-means ± SD: 1.5% 0.295 ± 0.047
Cell viability was better in neutral pH dialysis solution, especially in the lower glucose concentration. A more physiological pH and lower glucose degradation products may be responsible for such results.
Keywords: diálise peritoneal; fibroblastos; teste de materiais; técnicas de cultura de células;
A dysfunctional autonomic nervous system (ANS) has also been recognized as an important mechanism contributing to the poor outcome in CKD patients, with several studies reporting a reduction in heart rate variability (HRV).
Evaluate the sympathovagal balance in patients with chronic kidney disease on conservative treatment.
In a cross-sectional study, patients with CKD stages 3, 4 and 5 not yet on dialysis (CKD group) and age-matched healthy subjects (CON group) underwent continuous heart rate recording during two twenty-minute periods in the supine position (pre-inclined), followed by passive postural inclination at 70° (inclined period). Power spectral analysis of the heart rate variability was used to assess the normalized low frequency (LFnu), indicative of sympathetic activity, and the normalized high frequency (HFnu), indicative of parasympathetic activity. The LFnu/HFnu ratio represented sympathovagal balance.
After tilting, CKD patients had lower sympathetic activity, higher parasympathetic activity, and lower sympathovagal balance than patients in the CON group. Compared to patients in stage 3, patients in stage 5 had a lower LFnu/HFnu ratio, suggesting a more pronounced impairment of sympathovagal balance as the disease progresses.
CKD patients not yet on dialysis have reduced HRV, indicating cardiac autonomic dysfunction early in the course of CKD.
Keywords: doenças cardiovasculares; insuficiência renal crônica; nefrologia; nefropatias;
The life expectancy of individuals with Chronic Kidney Disease (CKD) on hemodialysis has increased, however, with over years in treatment, there is impairment of cognitive function that affect adherence to therapy and dialysis.
To evaluate the cognitive ability of individuals on hemodialysis through the Mini Mental State Examination (MMSE) and the relation to sociodemographic and clinical characteristics of these individuals.
We obtained demographic and clinical information of 75 individuals. To assess memory and cognition MMSE was applied, which was analyzed according to the different cutoff points proposed in the literature. After classifying the participants according to proposal of different studies, the causes of CKD and sociodemographic characteristics, individuals were divided into groups with and without cognitive impairment in an attempt to identify differences between them.
Most participants were men with a mean age of 59.2 years. The mean MMSE score was
24.16 points and there was no difference (
The average MMSE score declined with increasing age and increased with years of
schooling and income
Keywords: cognition; dialysis; kidney failure, chronic; quality of life;
Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD).
To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD.
Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions.
LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric
pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by
cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The
following were the sensitivity, specificity and accuracy, respectively, for the
variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and
index of left ventricular mass (LVMI) was 0.552 (
Chest radiography is a safe and useful as a diagnostic tool of LVH in CKD patients on HD.
Keywords: chest radiography; chronic renal disease; hemodialysis; left ventricular hypertrophy;
The 7 point subjective global assessment (7p-SGA) and the malnutrition inflammation score (MIS) are tools commonly applied for the assessment of nutritional status in dialyzed patients. Both were developed in English and require translation to Portuguese to be applied in Brazil. The cross-cultural equivalence process ensures semantic and measurement equivalence of a translated tool.
To perform the cross-cultural adaptation to Portuguese of the 7p-SGA and MIS.
Semantic equivalence was performed by the back-translation method and by assessing the degree of similarity between the original instrument and that back-translated from Portuguese to English (Back-translation). The assessment of the equivalence measurement was made by evaluating the intern reliability (Cronbach's α) and interobserver reliability (two observers). One-hundred and one elderly patients on hemodialysis (HD) were included.
Both instruments showed a high degree of semantic similarity with results close to the maximum value (7p-SGA 96.8 ± 7.8 and MIS 99.6 ± 1.4). The intern consistency showed a Cronbach's α value for 7p-SGA of 0.72 and of 0.53 for MIS. The interobserver reproducibility of 7p-SGA was moderate (intraclass coefficient [ICC] = 0.74 [95% CI: 0.58; 0.84]), while for MIS was strong (ICC = 0.88 [95% CI: 0.81; 0.93]).
The 7p-SGA and MIS translated into Portuguese can be applied for assessing the nutritional status of elderly patients on HD. Studies testing the applicability of these instruments in adult patients on HD and in peritoneal dialysis should yet be performed.
Keywords: dialysis; malnutrition; nutrition assessment;
Pre-implantation kidney biopsy is a decision-making tool when considering the use of grafts from deceased donors with expanded criteria, implanting one or two kidneys and comparing this to post-transplantation biopsies. The role of histopathological alterations in kidney compartments as a prognostic factor in graft survival and function has had conflicting results.
This study evaluated the prevalence of chronic alterations in pre-implant biopsies of kidney grafts and the association of findings with graft function and survival in one year post-transplant.
110 biopsies were analyzed between 2006 and 2009 at Santa Casa de Porto Alegre, including live donors, ideal deceased donors and those with expanded criteria. The score was computed according to criteria suggested by Remuzzi. The glomerular filtration rate (GFR) was calculated using the abbreviated MDRD formula.
No statistical difference was found in the survival of donors stratified according to Remuzzi criteria. The GFR was significantly associated with the total scores in the groups with mild and moderate alterations, and in the kidney compartments alone, by univariate analysis. The multivariate model found an association with the presence of arteriosclerosis, glomerulosclerosis, acute rejection and delayed graft function.
Pre-transplant chronic kidney alterations did not influence the post-transplantation one-year graft survival, but arteriosclerosis and glomerulosclerosis is predictive of a worse GFR. Delayed graft function and acute rejection are independent prognostic factors.
Keywords: biópsia; prognóstico; rejeição de enxerto; taxa de filtração glomerular; transplante de rim;
A progressive improvement in kidney transplant outcomes has been achieved over the last decades.
To determine the degree to which this has occurred in our center, we conducted an outcome analysis of our kidney transplant program during three different time periods, especially focusing on patient and graft survival.
The 600 kidney transplants performed at Botucatu Medical School/UNESP up to December 2011 were examined. Three different time periods were chosen to correspond with major shifts in immunosuppressant usage: Era 1 (1987-2000), cyclosporine and azathioprine usage (n = 180); Era 2 (2001-2006), cyclosporine and mycophenolate mofetil usage (n = 120); and Era 3 (2007-2011), tacrolimus and mycophenolate (n = 300).
Compared with the first era, mean recipient age, diabetes prevalence, and
the number of living donor transplantations (60%) were increased in the
third era. Induction therapy was used in 75% of the cases in Era 3, 46.6% in
Era 2, and in 3.9% in Era 1 (
Significant differences were observed over time. The percentage of living donors decreased as that of deceased donors increased. Survival after deceased donor transplants was greatest in Era 3, probably due to the improved experience of the medical team, and to the use of tacrolimus and mycophenolate mofetil combination with induction.
Keywords: immunosuppression; kidney transplantation; survival analysis;
Vascular calcifications has been associated with bone and mineral disorders. The alterations in the serum level of calcium concentrations and phosphate are importants factors implicated in the arterial calcification in chronic kidney disease. The pathogenesis of vascular calcification is a complex mechanism and not completely clear, being able to correspond to an active process of cellular transformation and heterotopic ossification. Beyond the hypercalcemia and hyperphosphatemia, they are involved in this process changes in the metabolism of inhibitors and promoters of calcification such as fetuin A, osteopontin, osteoprotegerin, and matrix gla protein. For the diagnosis of the calcified arterial injury are available several complementary methods, a method of estimate of the cardiovascular risk based on plain radiographs of the lumbar column and another method based on simple x-rays of the pelvis and hands. Below, we will present a review approching the link between vascular calcifications and mineral disorders.
Keywords: bone diseases, metabolic; cardiovascular abnormalities; renal insufficiency, chronic;
There is a group of diseases that may manifest with thrombotic microangiopathy and present clinical overlap. Among these we emphasize the thrombotic thrombocytopenic purpura and Hemolytic Uremic Syndrome, and the latter can occur by the action of toxins, systemic diseases, overactivation of the alternative complement system pathway, which can occur due to changes in regulatory proteins (atypical HUS) and finally, idiopathic. You must carry out a series of tests to differentiate them. aHUS is a diagnosis of exclusion of other causes of MAT. The treatment of aHUS with plasma therapy, results in most cases with good shortterm response, especially hematological; however, it is a progressive and devastating disease and can lead to death and terminal chronic renal disease. Treatment with plasma displays great recurrence of long-term disease and renal insufficiency. Eculizumab, a monoclonal antibody anti-C5, has been associated with hematological remission, benefits on renal function and no need of plasma therapy.
Keywords: acute kidney injury; anemia; child; chronic disease;
Chronic kidney disease is characterized by a progressive reduction of glomerular filtration rate and/or the appearance of proteinuria, and subsequently the progressive retention of organic waste compounds called uremic toxins (UT). Over the last decades, a large number of such compounds have been identified and their effects on organs and tissues, especially the cardiovascular system, has been demonstrated. In this review, we present the current classification of UT, as proposed by the EUTox Group, and the effects of some of the probably most important UTs, such as phosphate, FGF-23, PTH, AGEs, indoxyl sulfate and para-cresyl sulfate. We provide an overview on therapeutic approaches aimed to increase their extracorporeal removal via convective and/or adsorptive strategies and to lower their intestinal production/ absorption via dietetic and pharmacological interventions. The recognition that multiple toxins contribute to the uremia supports the need for new therapeutic targets, with a potentially positive impact on CKD progression and survival.
Keywords: diálise; doenças cardiovasculares; falência renal crônica; uremia;
Up to now, there is no single method that provides complete and unambiguous assessment of the nutritional status in chronic kidney disease (CKD). Therefore, it has been recommended the use of many nutritional markers. The subjective global assessment (SGA) contains questions regarding the clinical history and physical examination. Subsequently, other versions of the SGA were developed. The malnutrition inflammation score (MIS) was also developed from the original version of the SGA and consists of 70% of the items common to SGA in addition to objective questions. Since many modifications were proposed in the original form of SGA, the use of these questionnaires in CKD patients has increased substantially in clinical practice. Therefore, this paper aims to review the applicability of the SGA and MIS when applied to assess the nutritional status of CKD patients.
Keywords: dialysis; malnutrition; nutrition assessment; renal insufficiency, chronic;
Impairment of cognitive functions occurs frequently in chronic kidney disease (CKD). The conditions most associated with this decline are depression, delirium, mild cognitive impairment and dementia. The mechanisms involved have not been established yet, but some factors, as neuronal damage by uremic toxins, cerebrovascular ischemic lesions, oxidative stress, chronic inflammation, anemia, hyperhomocysteinemia, the endothelial dysfunction may play a critical role. The neuropsychological performance improves with the initiation of dialysis, although some cognitive dysfunctions remain even after treatment, especially in the areas of attention, cognitive flexibility, memory and learning. Kidney transplantation may improve and even reverse some cognitive deficits detected in the dialysis period, despite some compromise in verbal memory and executive functions remain after transplantation. The diagnosis of cognitive decline in patients with CKD may have an important impact on the management and prognosis. This paper presents an update on the decline of cognitive function in patients with CKD.
Keywords: cognition disorders; dialysis; kidney failure, chronic; kidney transplantation;
The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.
Keywords: frutas; lesão renal aguda; oxalato de cálcio; acute kidney injury; calcium oxalate; fruit;
Bardet-Biedl syndrome is rare. Although its diagnosis depends on cardinal clinical manifestations which appear in childhood, we report four cases of Bardet-Biedl syndrome lately diagnosed in a dialysis center. Three cases were diagnosed in end-stage renal disease patients when they started maintenance hemodialysis, and one case was diagnosed through screening among hemodialysis patients' relatives. Although pediatricians have more opportunity to diagnose the syndrome, nephrologists are important during the treatment, since renal failure is the main cause of death among Bardet-Biedl syndrome patients. Moreover, late diagnosis of the syndrome among patients with end-stage renal disease can help to detect new cases through the screening among hemodialysis patients' relatives.
Keywords: Bardet-Biedl syndrome; genetic diseases, inborn; kidney failure, chronic; renal dialysis; diálise renal; doenças genéticas inatas; falência renal crônica; síndrome de Bardet-Biedl;