To evaluate the reliability of the translation and cultural adaptation of the Pediatric Quality of Life Inventory (PedsQLTM) - End Stage Renal Disease (ESRD) - version 3.0 - children/adolescents and parents reports in Brazilian children with ESRD.
A group of 24 children and adolescents with ESRD, followed at Unidade de Nefrologia Pediátrica do Instituto da Criança - HCFMUSP and 32 primary caregivers were interviewed according to the me methodology proposed by the creator of the original questionnaire.
Statistical analysis using Cronbach's alpha resulted in values between 0.39 and 0.89 for all domains in initial statistical analysis. The domains that presented values lower than 0.5 were recalculated by age group, resulting in higher Cronbach´s alpha values demonstrating the influence of the age in the perception of quality of life in ESRD patients. The overall rating of Cronbach´s alpha values resulted in values of 0.81 and 0.71 in patients and PC reports, respectively, demonstrating good internal consistency.
Ours results show that the Brazilian version of the questionnaires is valid, reliable and useful for measure HRQoL of children and adolescents ESRD, according to patients and PC reports.
Keywords: child; quality of life; questionnaires; renal insufficiency;
Currently, the elderly population of Brazil is suffering significant increase. Aging is a physiological process that causes changes in various organs, including the kidney. A kidney biopsy is of paramount importance to clarify the morphological changes of these entities.
The aim of this work was to conduct a clinical epidemiological analysis of elderly patients and evaluate the prevalence of major glomerulopathies that affect.
This is a retrospective and descriptive, with a review of 104 reports of renal biopsies of elderly aged over 60 years, performed in the Nefropatologia Federal University of Triângulo Mineiro (UFTM), between periods January 1996 and December 2010. Patients were grouped according to clinical syndrome.
We reviewed 104 biopsies of elderly patients. Of these, 52.94% were male. The Hypertension was found in 50.54% of patients. The clinical syndrome was the predominant nephrotic syndrome (42.17%). Most disease was glomerular origin. The glomerulopathy was the most prevalent (34.07%).
Through this review, we noted that the nephrotic syndrome was the main clinical syndrome and Podocytophaties glomerulopathies were more prevalent in the group of elderly patients undergoing renal biopsy. The analysis of renal biopsies of elderly patients is of paramount importance, since knowledge of the clinical manifestations of major glomerulopathies that affect this group, to assist in establishing the diagnosis and therapeutic management.
Keywords: aged; epidemiology; kidney;
Iron supplementation is one of the recommendations found in patients with chronic kidney disease (CKD), however, an overload of this mineral can contribute to oxidative stress, a condition closely related to the cardiovascular risk in these patients, as well as disease progression.
The objective of this study was to investigate whether ferritin levels are associated with oxidative stress marker MDA in patients on hemodialysis (HD).
Twenty HD patients (55.0 ± 15.2 years, time of dialysis 76.5 ± 46.3 months, BMI 23.6 ± 3.0 kg/m2) were compared with 11 healthy subjects (50.9 ± 8.0 years, BMI 23.8 ± 1.9 kg/m2). Malondialdehyde (MDA) was measured by reaction with thiobarbituric acid and routine biochemical data were obtained from medical records.
MDA levels were significantly higher in HD patients compared to the control group
(13.2 ± 5.3 nmol/mL vs. 5.1 ± 2.7nmol/mL,
The excess iron stores in HD patients results in increased lipid peroxidation, and consequently contributes to increased oxidative stress in these patients.
Keywords: ferritins; malondialdehyde; oxidative stress; renal dialysis;
Human immunodeficiency virus (HIV) the causative agent of Acquired immunodeficiency syndrome (AIDS) is an important cause of renal diseases in sub-Saharan Africa. There is paucity of studies on the burden of chronic kidney disease (CKD) among patients with HIV/AIDS in the North-Central zone of Nigeria.
This is a cross-sectional study of 227 newly-diagnosed, antiretroviral naïve
patients with HIV/AIDS seen at the HIV clinic of the Medical Out-patient
Department (MOPD) of University of Ilorin Teaching Hospital (UITH). They were
matched with 108 control group. Laboratory investigations were performed for the
participants. CKD was defined as estimated glomerular filtration rate (eGFR)
There were 100 (44%) males among the patients and 47 (43.5%) among the control
group. The mean ages of the patients and controls were 40.3 ± 10.3 years
and 41.8 ± 9.5 years respectively. CKD was observed in 108 (47.6%) among
the patients and 18 (16.7%) of the controls (
CKD is very common among patients with HIV/AIDS in Ilorin. Screening and early intervention for CKD should be part of the protocols in the management of these patients.
Keywords: doenças renais; nefropatia associada à aids; prevalência;
Among the increasing chronic degenerative diseases, chronic kidney disease (CKD) is a major public health challenge facing the 21st century.
To estimate the GFR by using the CKD-EPI formula among subjects aged 18-59 years, and to identify factors associated with glomerular filtration rate (GFR).
A cross-sectional population-based study was conducted on adults between November
2011 and March 2012. We collected sociodemographic, anthropometric, clinical, and
laboratory tests to build a database. The Pearson's chi-square test was used to
assess the association between variables, and the Student's
A cohort of 371 adults was surveyed (63.8% women; 86.3% Whites). The mean age was
40.4 years (SD ± 12.3). Of the total, 76.8% had normal GFR; 21.8% showed a
slight decline, 1.1% a moderate decline, and 0.3% a significant decline in GFR.
There were significant differences related to age and obesity, because the greater
the age or the higher the body mass index, the lower the GFR of participants.
Individuals with systemic hypertension showed a tendency towards a reduction in
GFR compared to non-hypertensive population (
This study concluded that the vast majority of the surveyed subjects had normal GFR levels, and that only 1.4% (95% CI: 0.3 - 2.4) had moderate or severe dysfunction.
Keywords: creatinine; glomerular filtration rate; kidney function tests; renal insufficiency;
The Peruvian Ministry of Health does not have a national program of hemodialysis and hospitals that offer it have coverage problems, which may result in increased mortality.
We evaluated mortality of a population with incident hemodialysis in a Peruvian public hospital as well as its associated factors.
Retrospective and descriptive study of a population over 18 years-old who started treatment between January 1, 2012 and December 31, 2013 with the final follow-up day on31 March 2014. We used bivariate and multivariate logistic regression models to evaluate factors associated with mortality and Kaplan Meier curves were used to determine the probability of survival.
We included 235 patients with a mean age of 56.4 ± 15.8 years. Median follow-up was 0.6 years (IQR 0.3 to 1.5). 50% of years withdrew from therapy during the study for lack of financial resources or space available. The third month mortality was 37.7% (95% CI 4.7 to 48.5) and 49.5% (95% CI 5.8 to 61.4) at 7 months. There was a trend towards lower mortality when patients had more than 6 months with a diagnosis of chronic kidney disease (CKD) (OR = 0.39 [95% CI 0.12 to 1.27]) and when the patient was admitted with scheduled dialysis (OR = 0.28 [95% CI 0.01 to 2.28]).
Half of patients died within seven months of follow-up. Scheduled dialysis and having longer time with CKD diagnosis tend to be associated with lower mortality
Keywords: hemodialysis units; hospital; mortality; renal dialysis;
We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients.
Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause.
1,679 incident patients were included. They were 52 ± 15 years old, 58.7%
male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923
patients had sAlb
Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb.
Keywords: albumina sérica; diálise renal; falência renal crônica; mortalidade;
Indications for induction therapy is not consensual in living donors.
The objective of this study was compare no induction with thymoglobulin and basiliximab induction in the incidence of acute rejection in kidney transplantation with living donor.
We select all cases of renal transplantation with living donor performed in Hospital das Clínicas de Botucatu da UNESP during the period of January 2010 to December 2013. The group was divided by the type of medication used for induction.
A total of 90 patients were evaluated. There were no differences in baseline
characteristics of age and underlying disease. The rate of biopsy-proven acute
rejection was higher in the group without induction (42.9%) compared to
basiliximab group (20%) and Thymoglobulin (16.7%),
The haploidentical patients without induction were those with higher rates of acute rejection. The group of patients induced with Thymoglobulin had a higher immunological risk, however showed low rates of rejection.
The use of induction therapy resulted in lower rates of rejection in transplantation with living donor.
Keywords: graft rejection; immunosuppression; living donors;
The number of elderly patients with chronic kidney disease increases progressively, challenging the allocation algorithms in a scenario of organ shortage for transplantation.
To evaluate the impact of age on patient and graft survival.
Evolution of all 366 patients greater than 60 years transplanted between 1998 and
2010 was analyzed
Advanced age was not related to negative outcomes after kidney transplantation,
after excluding recipient death as a cause of allograft loss. Higher mortality
rate in this group was associated to a higher frequency of comorbidities,
Keywords: aged; graft survival; kidney transplantation; long-term effect; risk factors; survival analysis;
Currently, permanent catheters (pCVC) are becoming an alternative vascular access for long-stay patients in whom arteriovenous access cannot be made. Occlusion is a commun mechanical complication related to pCVC, leading to inadequate dialysis dose and frequent changes of local catheter location, which can cause exclusion of vascular sites. The aim of this study was to perform a narrative review of treatment of pCVC thrombotic occlusion in HD patients. The treatment of CVCP thrombosis typically consists on the saline infusion or administration of thrombolytics such as tissue plasminogen activated, reteplase and urokinase. There are few studies on the use of alteplase in pCVC clogged in oncology area and in dialysis population, and they all report success with the use of thrombolytic therapy ranging from 80-95% of cases, using 1mg/ml. Due to the high cost of alteplase, studies have suggested that cryopreservation and fractionated alteplase dose have made its use financially viable.
Keywords: catheter obstruction; central venous catheters; hemodialysis units, hospital; kidney failure, chronic;
The combination of immunosuppressive drugs is part of the treatment regimen of patients undergoing kidney transplantation (RT). Thymoglobulin®, a rabbit immunoglobulin directed against human thymocytes, is the most commonly agent used for induction therapy in RT in the US. In Brazil, Thymoglobulin® is approved by ANVISA for the use in patients who underwent kidney transplantation and despite being widely used, there are controversies regarding the drug administration. We prepared a systematic review of the literature, evaluating studies that used Thymoglobulin® for induction and for acute rejection treatment in patients undergoing RT. The review used the computadorized databases of EMBASE, LILACS and MedLine. Data were extracted from the studies concerning general features, methodological characteristics and variables analyzed in each study. From the results, a practical guide was prepared analyzing various aspects on the use of Thymoglobulin® in patients submitted to RT.
Keywords: antilymphocyte serum; immunoglobulins, intravenous; kidney transplantation;
New studies have shown the mechanism by which the star fruit (
Keywords: food; kidney; neurotoxins; nutritional sciences;
Renal cancer is a complex and multifactorial oncourologic disease.
To conduct a meta-analysis in order to investigate the association of
Case-control studies in humans, published from 1999 to 2013, that investigated the
Ten articles were selected on the subject proposed. No associations were found
between polymorphisms of
Based on the results obtained, we conclude that the
Keywords: kidney neoplasms; metaanalysis; polymorphism, genetic;
The prevalence of kidney chronic disease (CKD) has increased in recent years and
several risk factors have been associated with the onset and progression of CDK, such
as obesity, hypertension and
Keywords: anemia; cytokines; erythropoietin; inflammation; polymorphism, genetic; renal insufficiency, chronic;
Gitelman's Syndrome (GS) is a rare autosomal recessive salt-wasting nephropathy, classically characterized by hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis and low blood pressure. Fatigue, muscle weakness and muscle paralysis are common symptoms. Besides the typical electrolyte disturbances, others laboratory findings include hyperreninemia and secondary hyperaldosteronism. Bilateral nephrocalcinosis may occur. The treatment consists of potassium replacement and use of aldosterone antagonists. The best approach to pregnant women with GS is yet to be defined. However, we emphasize the need for ions supplementation, weight control as a clinical tool for assessing the water balance, and frequent monitoring of the fetus and amniotic fluid levels. The surgical risk associated with cesarean section in a patient with GS is not yet defined. Despite the risks related to symptomatic episodes of hypokalemia/hypomagnesemia, GS has a good prognosis when treated properly. Pregnancy imposes the need for more intensive control of the disease, but has a good prognosis for the mother and neonate.
Keywords: gravidez; hipopotassemia; síndrome de gitelman; gitelman syndrome; hypokalemia; pregnancy;
Visceral leishmaniasis (VL) is a severe and potentially fatal disease caused by
different Leishmania species,
Keywords: gravidez; leishmaniose visceral; terapêutica; transplante de rim; kidney transplantation; leishmaniasis, visceral; pregnancy; therapeutics;
We observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.
Keywords: anemia; chronic; erythropoietin; gastric antral vascular ectasia; kidney failure; anemia refratária; ectasia vascular gástrica antral; eritropoetina; insuficiência renal crônica;
Warfarin therapy can provoke severe hematuria and acute kidney injury with the presence of occlusive red blood cell casts. These findings are compatible with a recently described disease entity, warfarin related nephropathy, which adversely affects renal and patient outcome.
We report a 74-year-old man with chronic kidney disease stage 3 A, who developed a decline in glomerular filtration rate (GFR) after the initiation of warfarin therapy due to of atrial fibrillation. The diagnosis could be confirmed by renal histology which showed occlusion of renal tubules by red blood cells and casts consistent with this diagnosis. The patient did not recover the GFR and started renal replacement therapy in June (fourteen months after starting warfarin) 2014.
The aim of the present report is to alert for this drug recognized complication and reinforce the need of carefully motorization of kidney function and coagulation parameters in patients treated with warfarin. The pathogenesis and outcome of warfarin-related nephropathy is also discussed here.
Keywords: diálise; insuficiência renal crônica; uso de medicamentos; dialysis; kidney failure, chronic; medication therapy management;
Renal transplantation without maintenance immunosuppression has been sporadically reported in the literature. The cases include non-adherent patients who discontinued their immunosuppressive medications, transplantation between identical twins, kidney transplantation after a successful bone marrow graft from the same donor and simultaneous bone marrow and kidney transplantation for the treatment of multiple myeloma with associated renal failure. There are also ongoing clinical trials designed to induce donor specific transplant tolerance with infusion of hematopoietic cells from the same kidney donor. Here we describe two cases of renal transplantation without immunosuppression as examples of situations described above.
Keywords: imunossupressores; tolerância imunológica; transplante de rim; immune tolerance; immunosuppressive agents; kidney transplantation;