Mycophenolate mofetil (MMF), pro-drug mycophenolic acid (MPA) is an immunosuppressive effective in the prophylaxis of acute rejection, but associated with gastrointestinal adverse events. Mycophenolate sodium (MPS) with enteric coating was developed with intention of reducing such gastrointestinal adverse events associated with MPA.
To evaluate the tolerability of EC-MPS and MMF in renal transplant recipients.
Retrospective, multicenter study, included 1380 patients who underwent a transplant between 07/01/2004 and 31/07/2007 in 18 Brazilian centers.
1380 patients enrolled, 702 received EC-MPS and 678 received MMF. The average age
of patients was 42.3 years, 60% were male and 62.5% of Caucasian ethnicity. The
incidence of events evaluated in the composite endpoint of efficacy was not
different between groups at the end of 24 months follow-up (22.9% for EC-MPS to
There was no statistical difference in the incidence of acute rejection, delayed graft function and gastrointestinal events among treatments. The average tolerated dose of MPA was similar between groups; however, patients treated with MMF underwent more dose reductions and discontinuations of treatment.
Keywords: graft rejection; immunosuppression; kidney transplantation;
There are controversies regarding differences in quality of life (QOL) of chronic renal disease patients treated with different dialytic methods.
To compare QOL among chronic renal disease patients in peritoneal dialysis (PD) and in hemodialysis (HD).
Cross-sectional study in all the three centers of dialysis in Pelotas/Brazil. Patients in PD were interviewed after the monthly-routine-consultation and those in HD between the 1nd-2rd hours of the dialysis session by employing structured questionnaires. QOL was assessed with Short-Form Health Survey (SF-36). Means in the eight SF-36 domains were compared between groups.
Among 345 eligible patients (63 in PD and 282 in HD) 317 were interviewed (8%
losses/refusals). About half of patients in both groups were in dialysis treatment for 3
years at most. There were more women in PD and more men in HD. Patients in PD reported
less "pain" than those in HD (mean scores 76.5 and 64.3, respectively;
Utilization of HD in Pelotas is a bit lower than detected at the Brazilian Dialysis Census (2011), whereas the frequency of PD is similar to frequency observed in some European countries. The higher score on "pain" among patients in PD is consistent with findings from other studies although no difference and even additional advantages of PD over HD have already been reported.
QOL is similar among patients in DP or in HD, except in terms of pain, that was less severe in PD patients.
Keywords: peritoneal dialysis; quality of life; renal dialysis;
The nutritional status (NS) of patients on hemodialysis (HD) is a major concern and challenge. Malnutrition is common in these patients and is related to poorer clinical outcomes.
To assess the association between the NS and the interdialytic weight gain (IDWG) of patients with chronic kidney disease (CKD) on HD.
Cross-sectional study with 322 patients older than 18 years. The NS was assessed by body mass index (BMI), percentage body fat estimated by the sum of four skinfolds (triceps, biceps, subscapular and supra iliac), lean body mass (LBM), serum creatinine and albumin and rate of nitrogen appearance (PNA). The IDWG was evaluated from the sum of the weight difference of 12 hemodialysis sessions (IDWGm).
Considering the sample into quartiles IDWGm, it was found that BMI, LBM, serum
The NS is positively associated with IDWG. The results point to the need for individualized assessment of IDWG and cautious in order not to generalize a recommendation that does not meet the expectations of maintaining and promoting the nutritional status of these patients.
Keywords: malnutrition; nutritional status; renal dialysis;
Chronic Renal insufficiency (CRI) and dialysis treatment lead to a succession of situations for kidney chronic patient, which compromises his aspect, not only physically, and psychologically, with personal, family and social repercussions.
(1) to verify the existence of differences of dyadic adjustment (DA) according to renal replacement treatment (RRT) and (2) verify the existence of differences quality of life (QOL) in accordance with the RRT.
This is a cross-sectional study of a descriptive nature through surveys, exploratory and correlational. The sample consisted of 125 participants. Of these, 31 were to be made RRT by automated peritoneal dialysis (APD) and 94 hemodialysis (HD). Participants were selected from three renal centers: (1) Centro Renal da Prelada (Porto, Portugal), (2) Centrodial (S. João da Madeira, Portugal) and Centro Renal da Misericórdia de Paredes (Paredes, Portugal). The study was carried out for 6 months. The following instruments were applied: Socio-demographic and clinical questionnaire (SDCQ), Dyadic Adjustment Scale (DAS), World Health Organization Quality of Life (WHOQOL-Bref).
The results demonstrate the existence of statistically significant differences between the type of RRT and most areas of QOL, as well as the existence of statistically significant differences between the subscales of the DAS evaluated and the type of RRT.
The present study demonstrates a greater commitment in terms of QOL of individuals undergoing treatment for HD when compared with those subjected to APD. It turns out, also, that DA is most strongly perceived by patients in APD than with HD.
Keywords: ajustamento social; qualidade de vida; terapia de substituição renal;
The need of increasing the number of notifications of potential and actual donors is a worldwide problem. There is still much loss of donors, which can be avoided.
To use instruments adapted from the Model of Quality Management of the Spanish National Organization of Transplants in pilot hospitals in Brazil.
This was a quantitative research developed in three large hospitals in Santa Catarina, The option by the three institutions is related to the number of Intensive Care Unit (ICU) beds and the number of potential donors notifications Central Catchment Notification and Distribution of Organs and Tissues of State (CNCDO-SC). Data collection was performed in medical records from deceased patients in the units of critical patients using two validated instruments, period of three months, in two steps as directed by ONT.
In one of the hospitals, there was a higher percentage of losses due to maintenance problems (17.6%), family refusal (64.3%) and escapes (16.7%), and there also was a lower real effectuation index (29.4%). In 70.3%, losses due to maintenance were associated with irreversible cardiac arrest and hemodynamic instability. Family refusal was associated in 48.4% with the fact that the family was against donation and ample desire to keep the body integrate.
Information obtained allows the manager to administer these data and therefore to implement actions of improvement, increasing the number of donator of organs and tissues.
Keywords: nursing audit; quality of health care; transplantation;
In Peru there are different hospitals and university programs for training of specialists in nephrology.
To assess the perception of physicians who attend such programs.
We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception.
Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates.
The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.
Keywords: education, medical; students, medical; nephrology;
Ventricular hypertrophy is frequent in dialysis patients and is associated with an ominous prognosis. It is not knowledge if this ventricular change is growing or decreasing in hemodialysis patients.
To assess left ventricular hypertrophy behaviour during 17 years in patients of a university dialysis center, as well as to verify the possible causes of this behavior.
There was performed a retrospective longitudinal study that evaluated the echocardiographic left ventricular mass in hemodialysis patients in our dialysis facility over 17 years. Examinations of 250 patients aged 18 years or more who underwent routine echocardiography were included.
There was a progressive reduction of ventricular mass over studied period. This reduction was associated with blood pressure reduction. In multivariate analysis, ventricular mass was associated with blood pressure and hemoglobin.
Left ventricular hypertrophy underwent significant reduction over 17 years in our hemodialysis patients. The factors associated with this reduction that could be identified in the current study were the progressive reduction of blood pressure and hemoglobin increase.
Keywords: echocardiography; hypertension; hypertrophy, left ventricular; renal dialysis; uremia;
The focus in the treatment of CKD is to prevent its progression through optimal medical control. The large number of patients with CKD has pressed nephrologists to assess more patients into ever-smaller periods of consultation. The use of light technologies as a promising form of health care. The internet offers the opportunity to manipulate the doctor in his professional contact with the user.
To develop a web system to attend the patients with CKD not on dialysis and clinically stable stages at distance.
Developed a system using the Java language, MySQL database and PrimeFaces framework; available on a Glassfish application server.
The initial access is performed by the nephrologist, which registers the patients with their personal information and access data. After being registered, the patient (or family doctor) can enter the data of your query and these will be following, passed on to the nephrologist for evaluation. The form with the data of interest is pre-determined, but there is possibility to add free-form information. The system enables, in addition, there is exchange of messages between doctors and patients. In addition, users receive messages via e-mail alerting them of their duties. Confidentiality is guaranteed by individual passwords for doctors and patients.
This tool will enable to increase the coverage area of nephrologists, reduce costs and bring the patient to the primary care physician, using the Family Health Program as an interface between the patient and the nephrology secondary care.
Keywords: home care services; kidney failure, chronic; telemedicine;
Underreporting of energy intake is not much studied in hemodialysis population.
To evaluate the underreporting of energy intake and associated factors in hemodialysis patients.
A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied.
The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m2 (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40).
The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.
Keywords: energy intake; kidney failure, chronic; renal dialysis; self report;
End-stage renal disease (ESRD) is a public health problem and, in Brazil, lacks of data on one of the main treatments, hemodialysis, are still identified.
To determine, through description of resources used in ESRD treatment and its complications, the cost associated to hemodialysis and supplementary medical therapy in patients attended by Brazilian Public Health (SUS).
Methods of cross-sectional and prospective cohort observational analysis were conducted using public data, where information about inpatient and outpatient resource use and patients' characteristics were collected. From described resource use, costs were calculated. In cross-sectional analysis subjects who underwent hemodialysis between January/2008 and November/2012 were considered and in prospective cohort, started in 2009. Descriptive analyses were performed.
91,475 and 118,847 hemodialysis procedures were performed in 2008 and 2012, respectively, and 24.8% of increase was estimated until 2017. Analysis by federation unit showed that São Paulo, Minas Gerais and Rio de Janeiro states represented almost half of the procedures observed, with mean cost per patient of US$ 7,932.52 in 2008 and US$ 9,112.75 in 2011. In the cohort, composed by 96,600 subjects, the most used drug was alfaepoetin and 8% of the sample used calcitriol 1.0 mcg. The occurrence of complications was observed in 28.2% of patients.
After data analysis, different aspects of hemodialysis use were demonstrated, with an increase in amount of procedures and, also, in disease related expenses.
Keywords: calcitriol; costs and cost analysis; kidney failure, chronic; morbidity; renal dialysis;
After the second decade of life, the glomerular filtration rate (GFR) decreases progressively. There is still considerable debate about the importance of this "physiological decrease" in GFR with age in many situations attributed to the effects of concomitant hypertension, atherosclerosis, cardiovascular diseases (among others) observed in the elderly. The GFR is considered the best indicator of renal function and its estimate has been suggested in the guidelines of chronic kidney disease (CKD). However, in the most commonly equations used, the elderly subjects were not included or were underrepresented. The purpose of this is to describe a nomogram based on an equation to estimate GFR based on serum creatinine, age and sex that was developed for the study Berlin Initiative Study (only individuals older than 70 years were included). The performance of the equation, called BIS1 was compared with Hioxal (gold standard), three equations based on serum creatinine (CG, MDRD and CKD-EPI) and three equations based on cystatin C (proposed by the CKD-EPI) and the second showed less bias among that another equations and compared the CG, MDRD and CKD-EPI equations, had the lowest rate of misclassification of CKD in participants with less than 60 mL/min/1.73 m2.
Keywords: aged; glomerular filtration rate; kidney diseases;
to evaluate the knowledge of RRT for the health professionals of Juiz de Fora, São João Nepomuceno e Santos Dumont.
A Cross-sectional study from April 2014 to April 2015 with the population of
health professionals (doctors, nurses and nursing assistance) who worked in the
emergency units (EU) and primary health care (PHC) . Health professionals were
interviewed using a semi-structured questionnaire, based on a clinical case of a
patient diagnosed with
We interviewed 75 professionals from 8 municipalities, 26.7% physicians, 32% nurses and 41.3% of nurse assistance. A mean age was 38 years. Of these 70.7% were working in PHC and 29.3% in EU. Both the EU as in PHC, the frequency of cases care was similar between once a month, once every three months. Most would forward the patient to hospital and indicate RRT. The RRT is most suitable for physicians was HD (> 90% of cases) and less than 10% as first choice indicate was PD. The association of "creatinine" and "renal function" is appropriate in over 90% of respondents, despite no association with the same level of glomerular filtration when this question is asked. More than 90% of non-medical professionals wish to conduct education/training in nephrology/RRT.
We observed that most professionals do not indicate peritoneal dialysis, especially medical professionals from EU or PHC; 90% of them indicated HD. On nurses from PHC 52.1% indicated HD and 9.4% DP. Those EU, 41.6% indicated HD and 26.6% PD. We conclude that minority health professionals indicate PD as first choice and the qualitative question often refer deficit "knowledge in the area" and are interested in conducting training/capacity building.
Keywords: dialysis; knowledge; male, nurses; physicians; transplantation;
In this review, we described the tubular function of each nephron segment followed by the most important changes that may occur in the transporters expressed therein. Thus, knowledge of the changes in renal tubular function allows the understanding and recognition of renal tubular diseases that can cause stillbirth or death in newborns or in childhood. Moreover, children with tubular disorders may progress to chronic renal disease at an early stage of life and they may also show disturbances of growth and development associate or not with neurological dysfunction. Therefore, we used the keyword "inherited tubular disorders" to select the children studies that have been published in the PubMed database since 2006. We hope that this review may help physicians to perform an early diagnosis in patients with tubular disorders allowing a specialized treatment and an improvement in their prognosis and quality of life.
Keywords: acidosis, renal tubular; Bartter syndrome; electrolytes; Fanconi syndrome; Gitelman syndrome; sodium-potassium-exchanging ATPase;
Metabolic dysregulation is the defining characteristic of type 2
A search of the recent published evidence base on the effects of bariatric/metabolic surgery on microvascular complications reveals further evidence that supports the efficacy of surgery in preventing the incidence and progression of albuminuria and preserving renal functional decline.
Data on retinopathy are ambivalent representing the potential in some cases for an influence of reactive hypoglycaemia over the retina but the majority of data emphasize that the metabolic control can halt the progression of the eye disease. A significant gap in the literature remains in relation to the effects of surgery on diabetic neuropathy, although some information sheds a light on the benefits secondary to the surgical metabolic control.
Overall, although data so far is exciting, there is a pressing need for prospective randomized controlled trials examining long-term microvascular outcomes following bariatric/metabolic surgery in patients with T2DM.
Keywords: bariatric surgery; diabetic nephropathies; diabetic neuropathies;
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 refratária; ectasia vascular gástrica antral; eritropoetina; insuficiência renal crônica;
The antineutrophil cytoplasmatic antibody (ANCA) is usually associated with pauci-immune crescentic glomerulonephritis (CrGN). However, the literature show an incidence unexpected high of ANCA in immunocomplex CrNP. The crescent IgA nephropaty is one of CrGN that associated with ANCA
To relate an IgA nephropaty ANCA positive and sign of worse prognosis that improved with immunossupression.
38-year-old pacient with arterial hypertension, renal impairment (CKD-EPI 37 ml/min/1,73 m2), non-nephrotic proteinuria and hematuria. He related occasionally epistaxis, rhnosinusitis and one arthritis episode that spontaneously resolved. During de investigation, the ANCA titles were 1/160 and anti-RP3 was positive, however renal biopsy showed IgA nephropaty with 38% of crescents. Regarding IgA nephropaty ANCA positive as the main diagnosis, immunossupression therapy with corticoids (1g IV methilprednisone for 3 days followed by 1 mg/kg/day prednisone) for 6 months and cyclophosphamide (500 mg initially then raise the dose until reach 750 m2. The patient improved renal function and reduced the proteinuria and ANCA titulation.
The role of the association between IgA nephropathy and ANCA is it aggressive manifestation characterized by the presence of crescents, tubular atrophy and renal dysfunction, which may regress with early onset of immunosuppression treatment.
Keywords: antibodies, antineutrophil cytoplasmic; glomerulonephritis, IgA; immunoglobulin a; renal insufficiency;
The difference between available kidneys and the number of patients on waiting list for kidney transplantation continues to grow. For this reason the trend is to use donors with expanded criteria, such as a pelvic kidney, as we describe below.
Male patient 25 years-old with end-stage kidney disease, receives as a graft a pelvic kidney from his father, 49 years-old, known to have controlled systemic arterial hypertension and nephrolithiasis by history without new episodes in the last 10 years. Function and anatomy of the pelvic kidney were evaluated through magnetic angioressonance, computarized tomography and scintigraphy. After an initial rejection episode promptly treated, the patient has had an uneventful recovery.
To increase the number of kidneys available for transplantation, it is reasonable to use a pelvic kidney, after a thorough investigation.
Keywords: adult; chronic, kidney failure; kidney pelvis; living donors; organ size; pelvis; treatment outcom; urogenital abnormalities;
To determine the effectiveness of 20 twice-weekly sessions of parasacral transcutaneous electrical neural stimulation (TENS) for treatment of urinary urgency and urge-incontinence in children and adolescents.
A Phase II clinical trial was carried out with patients with urinary urgency or urge-incontinence aged between 5 and 14 years. Twenty TENS sessions were conducted, twice weekly, using a Quark® Dualpex 961 apparatus. The variables analyzed were daily micturition, dynamics ultrasonography of the lower urinary tract pre-and post-treatment and responses to a questionnaire on urinary leakage applied during each session.
The mean age of the 25 children participating in the study was 7.80 ± 2.22 years, most
were female (92%) and had urge-incontinence (92%). The difference in urinary leakage
pre- and post-treatment was statistically significant (
The electro-stimulation carried out during the twice weekly sessions appeared to be effective and urinary incontinence declined in half of the patients from the 12th session onwards. However, there is a need for a study involving a larger number of patients to confirm the results obtained.
Keywords: transcutaneous electric nerve stimulation; urinary incontinence; urinary incontinence, urge;