It is still controversial whether there are synergistic effects among different non-pharmacological interventions used in the treatment of hypertension.
To evaluate the effect of aerobic exercise, oral supplementation of potassium and their combination on blood pressure, glucose metabolism, urinary albumin excretion and glomerular morphology in spontaneously hypertensive rats (SHR).
SHR were divided into groups: Control Group (SHR; standard diet and sedentary, n = 10), Exercise Group (SHR + E; trained on a treadmill, standard diet, n = 10), Potassium Group (SHR + K; sedentary, potassium supplementation, n = 10) and Group Exercise + Potassium (SHR + E + K, exercise, potassium supplementation n = 10). Weekly, body weight (BW) and tail blood pressure (TAP) were measured. At the end of 16 weeks, a Oral Glucose Tolerance Test was performed. Albuminuria was determined in the baseline period, at 8th and at 16th week. After sacrifice, the analysis of glomerular sclerosis index and visceral fat weight was performed.
The TAP and BW did not change significantly. There was improvement in insulin sensitivity in SHR + E and SHR + K, but not in SHR + E + K. At week 16, albuminuria in all groups was significantly lower than the SHR control. The glomerular sclerosis index and visceral fat content were also significantly lower in all groups compared to control.
An oral supplementation of potassium and exercise led to an improvement in glucose metabolism, in albuminuria and glomerular morphology, however, the overlap of the treatments did not show synergism.
Keywords: albuminuria; exercise; hypertension; kidney glomerulus; potassium chloride; rats, inbred SHR;
Acute kidney injury (AKI) in patients receiving cisplatin is common, therefore the evaluation of renal function in patients on use of nephrotoxic drugs is fundamental.
To evaluate the incidence of AKI and the role of lipocalin associated to neutrophil gelatinase (NGAL) in the monitoring of renal function in patients with head and neck cancer (HNC) who received cisplatin.
We prospectively studied 50 patients with HNC treated with three sessions of cisplatin. Blood and urine were collected 24 hours before cisplatin, 24 hours after infusion, 48 hours after each application and 35 days after the end of treatment (urine NGAL, C-reactive protein, creatinine, glomerular filtration rate, plasma lactate dehydrogenase and magnesium).
AKI was observed in 78% of patients. There was increase in creatinine, and decrease in GFR after each cycle of cisplatin, and increased urine NGAL. Positive association was observed between the levels of NGAL, creatinine and C-reactive protein. It was observed an increase in creatinine, NGAL, C-reactive protein and decreased GFR in AKI patients compared to patients without AKI.
AKI was noted in 78% of patients with HNC treated with cisplatin and showed the correlation of NGAL with creatinine and GFR in demonstrating renal injury. NGAL levels may be elevated compared to baseline levels, even before the use of cisplatin.
Keywords: acute kidney injury; cisplatin; lipocalins;
Experimental studies have suggested that indoxyl sulfate (IS), a protein-bound uremic toxin, may be involved in the development of renal osteodystrophy.
evaluate the association between IS levels and biochemical parameters related to mineral metabolism and bone histomorphometry in a cohort of pre-dialysis chronic kidney disease (CKD) patients.
This is a post-hoc analysis of an observational study evaluating the association between coronary calcification and bone biopsy findings in 49 patients (age: 52 ± 10 years; 67% male; estimated glomerular filtration rate: 36 ± 17 ml/min). Serum levels of IS were measured.
Patients at CKD stages 2 and 3 presented remarkably low bone formation rate. Patients at CKD stages 4 and 5 presented significantly higher osteoid volume, osteoblast and osteoclast surface, bone fibrosis volume and bone formation rate and a lower mineralization lag time than CKD stage 2 and 3 patients. We observed a positive association between IS levels on one hand and the bone formation rate, osteoid volume, osteoblast surface and bone fibrosis volume on the other. Multivariate regression models confirmed that the associations between IS levels and osteoblast surface and bone fibrosis volume were both independent of demographic and biochemical characteristics of the study population. A similar trend was observed for the bone formation rate.
Our findings demonstrated that IS is positively associated with bone formation rate in pre-dialysis CKD patients.
Keywords: indoxil sulfato; insuficiência renal crônica; osteodistrofia renal; uremia;
Chronic kidney disease (CKD) affects all age groups, and its prevalence has increased during recent years. CKD is divided into six stages, according to the renal function of patients: 1. Normal renal function without kidney damage; 2. Kidney damage with normal renal function; 3. Mild renal insufficiency; 4. Moderate renal insufficiency or lab tests failure; 5. Severe renal insufficiency or clinical failure; 6. End stage of chronic renal failure.
This study was intended to assess renal function in elderly patients and identifying the presence of factors associated with those changes.
A cross-sectional population-based study was performed. Elderly patients were surveyed between September 2010 and May 2011. Kidney function was assessed by determining of serum creatinine, and estimation of the glomerular filtration rate by the CKD-EPI equation.
In all, 822 elderly were surveyed; 61.6% were women; 92.2% were Causasian; and
most (61.0%) were aged between 60 and 69 years. With regard to the glomerular
filtration rate, 26.2% had a normal rate; 60.2% showed a slight decrease; 13.0% a
moderate decrease; 0.5% severe kidney function decline; and 0.1% extreme fall.
Increasing age was associated with kidney damage by decreased glomerular
filtration rate (
This study found that the great majority of the surveyed elderly had some mild kidney damage, and 13.6% showed moderate to severe dysfunction.
Keywords: aged; creatinine; glomerular filtration rate; kidney function tests; renal insufficiency;
Chronic kidney disease (CKD) has been identified in an increasing number of patients and among its consequences is the anemia.
To verify the occurrence of anemia in patients with CKD undergoing hemodialysis at a Hospital in the South Region, Brazil, as well as their kidney profile and iron profile.
It was performed a retrospective, descriptive and analytical study. It was analyzed 45 patient records with results from the beginning of the hemodialysis treatment until nine months later.
Over 50.0% of the patients had hypertension and diabetes and 68.8% were male. The
anemia was present in 97.8% of the patients and treated with erythropoietin and/or
iron. In the evaluated period occurred increase in median hemoglobin levels
After the Introduction of treatment for anemia occurred increased plasma levels of hemoglobin and clinical improvement, even though not having a complete normalization of these levels.
Keywords: anemia; creatinine; erythropoietin; renal insufficiency, chronic; urea;
Cardiovascular diseases (CVDs) are the leading cause of death in terminal patients with chronic kidney failure (CKF). Diverse risk factors are involved in the pathogenesis, and are classified as traditional, which affect the general population; and non-traditional, which are peculiar to patients with CKF. Secondary hyperparathyroidism, a non-traditional and common factor in CKF, can cause an increased rate of bone absorption with mobilization of calcium and phosphorus. If the product of calcium x phosphorus is increased, the solubility of this ionic pair may be exceeded and deposition of calcium phosphate in cardiac and vascular tissues occur (called metastatic calcification).
To verify eventual relationship between the thickness of the common carotid artery and the levels of PTH in patients with CKF.
Evaluations by Doppler ultrasonography were performed to measure the width of the carotid artery wall and to search for possible correlations between different values of PTH serum levels, mineral disturbances and traditional risk factors in the carotid changes found in individuals with dialytic CKF and secondary hyperparathyroidism.
Differences in the cholesterol level and age were observed in patients with
signals of arterial calcification. A significant relationship was also observed
between the PTH serum levels and the carotid artery wall thickness (r = 0.31,
Data from this study show the possible concomitance of traditional factors and factors related to CKF in the genesis of CVDs in uremia.
Keywords: carotid artery, common; heart diseases; hyperparathyroidism, secondary; kidney failure, chronic;
Chronic renal failure is a disease which prevalence has been increasing in Brazil. Hemodialysis is their primary therapeutic modality and arterio-venous fistula their preferential access. Nevertheless, many patients require the use of double-lumen catheters, either as permanent or temporary access. Vascular complications related to this procedure may occur, and their best method of non-invasive analysis is ultrasound analysis.
To analyze the complications by the use of double-lumen catheter in patients with chronic kidney disease on hemodialysis, at "Santa Casa de Misericordia de Ponta Grossa" hospital, through eco-Doppler exam.
Observational research, analytical, case-control type, to obtain data we used TASY®, interview, physical exam and imaging (eco-Doppler).
None of the variables was significant isolated as a predictor of vascular impact in eco-Doppler, which detected changes in 31.25% of the cases. Physical exam showed poor accuracy compared to Doppler capacity to detect complications (K = -0.123).
We conclude that the vascular effects of the use of CDL are frequent (31.25%). Manifesting itself in the form of occlusions with/without recanalization and stenoses. This leads us to required a prior analysis of the insertion site with Doppler, in order to avoid unnecessary procedures and possible complications.
Keywords: catheters; hemodialysis units, hospital; kidney failure, chronic;
Patients with chronic kidney disease (CKD) who perform renal replacement therapy (RRT) are subject to a higher prevalence of mood disorders.
The aim of this study is to compare the prevalence of anxiety and depression in patients on hemodialysis (HD) and peritoneal dialysis (PD), taking into account comorbidities that may contribute to this.
The study was done in Ponta Grossa with CKD patients, using Beck Depression and Anxiety Inventory (BDI and BAI) and the Hospital Anxiety and Depression Scale (HADS).
We studied 155 patients, 128 in the HD group and 27 in PD. In the first, depression was found in 22.6% of patients in the BDI and 9.3% in HADS, and anxiety 25.7% in the BAI and 11.7% in the HADS. In the PD group, 29.6% of patients had depression in the BDI and 14.8% in HADS, and anxiety 11.1% in the BAI and none in HADS.
The hemodialysis or peritoneal dialysis did not influence the prevalence of anxiety and depression in patients with CKD.
Keywords: anxiety; depression; hemodialysis units, hospital; peritoneal dialysis; renal dialysis; renal insufficiency, chronic;
Evaluate the quality of life of kidney transplant recipients has been a way to determine the impact of transplantation in health care and subsequent treatment of chronic character.
To analyze the association between income, work and quality of life of kidney transplant recipients.
The sample consisted of 147 people, with an average of 74.3 months of realization of the transplantation. Data was collected using the following methods: socioeconomic assessment tool and the Medical Outcome Study 36 - Item Short - Form Health Survey, validated for use in Brazil. A bivariate analysis was performed using the Mann-Whitney's U test.
The average quality of life related to health for the physical component was 63.8 (SD = 29.4), and for the mental component, 65.6 (SD = 29.2). The bivariate analysis showed that the exercise of labor activity and family income higher than three minimum wages were significantly associated with a better quality of life.
Labor activities are significant for kidney transplant recipients and special attention must be given by the multidisciplinary team in the search for strategies that promote and encourage their maintenance and reintegration into the labor market.
Keywords: qualidade de vida; renda; trabalho; transplante de rim;
Kidney transplantation is performed in emergency conditions in a population with high perioperative risk. Instruments for risk assessment before transplantation in this population are scarce.
To develop a score with pretransplant variables to estimate the probability of success of kidney transplantation, defined as survival of the recipient and the graft with creatinine < 1.5 mg/dl at 6 months.
Analysis of variables of patients from a unique kidney transplantation center in São Paulo. Logistic regression was used to construct an equation with variables able to estimate the probability of success. Integer points were assigned to variables for score construction.
Of the 305 patients analyzed, 176 (57.7%) achieved success. Of the 23 variables identified by univariate analysis, 21 were included in the logistic regression model and 10 that remained independently associated with success, were used in the score. Four of these 10 variables were socioeconomic. It was great (area under the ROC curve 0.817) the power of discrimination between groups success and not success and adequate (Hosmer and Lemeshow = 0.672) the agreement between frequencies of the probabilities estimated by equation and frequencies of probabilities actual observed. There were correlation (0.982) between the estimated probability via the scoring system and the estimated probabilities via logistic regression.
Point score simplified risk stratification of transplant candidate according to their probability of success. Socioeconomic variables influence the success, demonstrating the need for creation of prognostic tools utilizing clinical and demographic variables of our population.
Keywords: kidney transplantation; measures of association; exposure; risk; outcome; odds ratio; risk factors;
Mineral bone disorder (MBD) is a common condition in chronic kidney disease (CKD) patients and causes significant morbidity and mortality. Data involving prevalence of alterations in bone histological patterns, impact of different treatments and its repercussion in outcomes, such as bone fractures, hospitalization, cardiovascular disease and mortality, are scarce. Data bank registry can be a valuable tool to understand epidemiological aspects of MBD CKD. The Brazilian Registry of Bone Biopsy (REBRABO) will be a national registry, coordinating by the Brazilian Society of Nephrology - Committee of MBD-CKD.
To describe REBRABO's design, elements of data and methodology.
Will be an online national observational and multicentric data registry divided in two phases (retrospective, 1st phase) and prospective (2nd phase), including information from bone tissue histomorphometric analysis and demographics, clinical and laboratorial data from CKD-MBD patients.
The REBRABO's first phase will explore data on demographics, clinical, laboratorial and bone histomorphometric analysis data from January/1986 to December/2013. The first Results are expected in early 2015.
Studies in the field of CKD-MBD are needed, particularly those analyzing its prevalence, associations between demographic, clinical, histological parameters, and major outcomes. The REBRABO will be a unique retrospective and prospective research platform including bone biopsy data in CKD-MBD patients.
Keywords: bone diseases; electronic health records; renal insufficiency, chronic;
Contrast-induced nephropathy is a common complication of radiographic procedures. Different measures have been used to avoid this damage, but the evidence is controversial. New investigations are required to clarify it. We investigated the efficacy and safety of sodium bicarbonate solution compared with sodium chloride solution to prevent contrast induced nephropathy in patients with or at risk of renal dysfunction.
A prospective, single-center, randomized clinical trial conducted from May 1, 2007 to February 8, 2008. Inpatients in a tertiary center, scheduled to undergo a procedure with the nonionic radiographic contrast agent iohexol. There were 220 patients with serum creatinine levels of at least 1.2 mg/dL (106.1 µmol/L) and/or type 2 diabetics, who were randomized to receive an infusion of sodium chloride (n = 113) or sodium bicarbonate (n = 107) before and after contrast dye administration. The intervention were "A" group received 1 ml/kg/hour of normal saline solution, starting 12 hours before and continuing 12 hours after iohexol contrast. "B" group received 3 ml/kg of sodium bicarbonate solution (150 mEq/L) one hour prior to procedure and then drip rate was decreased to 1 ml/kg/hour until 6 hours post procedure. Our main outcome measure was change in serum creatinine.
The mean creatinine value after the procedure was 1.26 mg/dL in the saline group
and 1.22 mg/dL in the bicarbonate group (mean difference: 0.036; CI 95%: -0.16 to
Our investigation showed that there were no differences between normal saline
solution (extended infusion)
Keywords: bicarbonato de sódio; lesão renal aguda; meios de contraste; solução salina;
Chronic kidney disease (CKD), considered by some authors as an epidemic of this century, relates directly to chronic diseases such diabetes (DM) and high blood pressure (HBP) and increase the life expectancy of the population.
The aim of this study was to delineate epidemiological profile of patients on hemodialysis (HD) in a Brazilian capital.
We conducted a cross-sectional study of a random sample of convenience, using a questionnaire in 245 patients between August 2011 and March 2012. All patients interviewed were in HD program in three Nephrology services at the Unified Health System (UHS) in João Pessoa.
Of the respondents, 61% were male, 66% were married and 44.5% were white. Approximately 50% were aged 40-59 years and 51% were living out of João Pessoa. The main etiologies were HBP (38%) and DM (13%). Main comorbidities were diabetic retinopathy (15.5%) and peripheral neuropathy (13.5%). Ninety-two percent reported an episode of hospitalization. Temporary vascular access was used in 100% of patients in first dialysis.
Results of this study indicate the importance of better monitoring of these pre-dialysis patients, which could reduce morbimortality.
Keywords: health services accessibility; kidney failure, chronic; renal dialysis;
The treatment offered to chronic kidney disease (CKD) patients before starting hemodialysis (HD) impacts prognosis.
We seek differences among incident HD patients according to the distance between home and the dialysis center.
We included 179 CKD patients undergoing HD. Patients were stratified in two
groups: "living near the dialysis center" (patients whose hometown was in cities
up to 100 km from the dialysis center) or as "living far from the dialysis center"
(patients whose hometown was more than 100 km from the dialysis center).
Socioeconomic status, laboratory results, awareness of CKD before starting HD,
consultation with nephrologist before the first HD session, and type of vascular
access when starting HD were compared between the two groups. Comparisons of
continuous and categorical variables were performed using Student's
Ninety (50.3%) patients were classified as "living near the dialysis center" and
89 (49.7%) as "living far from the dialysis center". Patients living near the
dialysis center were more likely to know about their condition of CKD than those
living far from the dialysis center, respectively 46.6%
There are potential advantages of CKD awareness, referral to nephrologists and starting HD through fistula among patients living near the dialysis center.
Keywords: cateteres; diálise renal; fístula arteriovenosa; insuficiência renal crônica; referência e consulta;
Acute kidney injury (AKI) has a high hospital incidence and is associated to significant morbidity and mortality. Sepsis, major surgery and low cardiac output are the main cause of AKI worldwide. In the majority of these situations, volume expansion is part of both prevention and therapeutic management, restoring peripheral perfusion and attenuating drug nephrotoxicity. Early and aggressive volume resuscitation in septic patients halts tissue ischemia and is associated with higher survival. However, a liberal fluid infusion strategy after six hours can cause fluid overload. Fluid overload has been associated with morbidity and mortality increase in critically ill patients. Herein, we present a review of the main studies that assessed the effects of net fluid balance/fluid overload on the morbidity and mortality of critically ill patients. We suggest that positive water balance may be used as a potential early biomarker of AKI in these patients.
Keywords: acute kidney injury; intensive care unit; mortality; water balance;
The diagnosis of urolithiasis during pregnancy is common, even though no additional measures are required in asymptomatic cases. Renal colic or complications of urinary lithiasis occur more frequently during the last months of pregnancy, and there are several particularities for the diagnosis and treatment of this subset of women. The present manuscript aim to review the current knowledge concerning this subject and present authors personal experience.
Keywords: lithotripsy; nephrolithiasis; pregnancy complications; pregnancy trimesters; uretero-lithiasis; urolithiasis;
Neuropsychiatric symptoms are frequently associated to renal dysfunction and may compromise negatively the clinical course as well as the quality of life, and the functional status of the patients. The neuropsychiatric disorders associated with renal disease may present various forms according to the natural history of the disease, and remain underdiagnosed and undertreated. There are few data in the literature regarding the treatment of these patients, and a lot of controversies still exist. The objective of this paper is to describe the most frequent neuropsychiatric disorders in patients with renal diseases.
Keywords: acute kidney injury; anxiety; depression; kidney diseases;
Familial Hypomagnesaemia with hypercalciuria and nephrocalcinosis, with severe ocular impairment secondary to claudin-19 mutation, is a rare recessive autossomic disorder. Its spectrum includes renal Mg2+ wasting, medullary nephrocalcinosis and progressive chronic renal failure in young people.
To report a case of kidney transplantation father to daughter in a familial occurrence of severe bilateral nephrocalcinosis associated with ocular impairment in a non-consanguineous Brazilian family, in which two daughters had nephrocalcinosis and severe retinopathy.
The index case, a 19 years-old female, had long-lasting past medical history of recurrent urinary tract infections, and the abdominal X-ray revealed bilateral multiple renal calcifications as well as ureteral lithiasis, and she was under haemodialysis. She had the diagnosis of retinitis pigmentosa in the early neonatal period. The other daughter (13 years-old) had also nephrocalcinosis with preserved kidney function, retinopathy with severe visual impairment, and in addition, she exhibited hypomagnesaemia = 0.5 mg/dL and hypercalciuria. The other family members (mother, father and son) had no clinical disease manifestation. Mutation analysis at claudin-19 revealed two heterozygous missense mutations (P28L and G20D) in both affected daughters. The other family members exhibited mutant monoallelic status. In despite of that, the index case underwent intrafamilial living donor kidney transplantation (father).
In conclusion, the disease was characterized by an autosomal recessive compound heterozygous status and, after five years of donation the renal graft function remained stable without recurrence of metabolic disturbances or nephrocalcinosis. Besides, donor single kidney Mg2+ and Ca2+ homeostasis associated to monoallelic status did not affect the safety and the usual living donor post-transplant clinical course.
Keywords: calcium metabolism disorders; genetic diseases, inborn; kidney transplantation; distúrbios do metabolismo do cálcio; doenças genéticas inatas; transplante de rim;
Cat Scratch Disease (CSD) is an infectious disorder which appears after cat scratching
particularly in children and adolescents.
Keywords: adolescent; health care (public health); immunosuppression; adolescente; avaliação de processos (cuidados de saúde); imunossupressão;
The potential risks related to drug exposure during pregnancy represent a vast chapter in modern obstetrics and data regarding the safety of antihypertensive drugs during pregnancy are relatively scarce.
A 37-year-old patient discovered her fifth pregnancy at our hospital after 26 weeks and 4 days of gestation. She reported a history of hypertension and was currently being treated with Losartan. Hospitalization was recommended for the patient and further evaluation of fetal vitality was performed. On the fourth day an ultrasound was performed, resulting in a severe oligohydramnios, fetal centralization and abnormal ductus venosus. After 36 hours, the newborn died. Pathologic evaluation: At autopsy, the skullcap had large fontanels and deficient ossification. The kidneys were slightly enlarged. A microscopic examination detected underdevelopment of the tubules and the presence of some dilated lumens. Immunohistochemical detection of epithelial membrane antigen was positive. Immunoreactivity of CD 15 was also assayed to characterize the proximal tubules, and lumen collapse was observed in some regions.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARAs) are among the most widely prescribed drugs for hypertension. They are often used by hypertensive women who are considering become pregnant. While their fetal toxicity in the second or third trimesters has been documented, their teratogenic effect during the first trimester has only recently been demonstrated.
Constant awareness by physicians and patients should be encouraged, particularly in regard to the prescription of antihypertensive drugs in women of childbearing age who are or intend to become pregnant.
Keywords: angiotensin receptor antagonists; hypertension; pregnancy complications; toxicity; antagonistas de receptores de angiotensina; complicações na gravidez; hipertensão; toxicidade;