Sepsis, an extremely prevalent condition in the intensive care unit, is usually associated with organ dysfunction, which can affect heart and kidney.
To determine whether the cardiac dysfunction and the Troponin I forecast the occurrence of acute renal failure in sepsis.
Cardiac dysfunction was assessed by echocardiography and by the serum troponin I levels, and renal impairment by AKIN criteria and the need of dialysis. Twenty-nine patients with incident sepsis without previous cardiac or renal dysfunction were enrolled.
Patients averaged 75.3 ± 17.3 years old and 55% were male. Median APACHE II
severity score at ICU admission was 16 (9.7 - 24.2) and mortality rate in 30 days
was 45%. On the fifth day, 59% had ventricular dysfunction. Troponin serum levels
on day 1 in the affected patients were 1.02 ± 0.6 ng/mL compared with 0.23 ± 0.18
ng/mL in patients without heart dysfunction (
We found that an elevation in serum troponin levels, while guarding a relationship with ventricular dysfunction, can be a precious tool to predict the need for dialysis in sepsis patients.
Keywords: lesão renal aguda; sepse; troponina;
The prevention of contrast-induced nephropathy (CIN) is difficult in emergency situations, making it essential to study CIN in patients submitted to urgent angioplasty.
To determine the incidence and associated factors to CIN in patients with myocardial infarction (MI) submitted to primary angioplasty in the first 12 hours after onset of symptoms.
We studied 201 consecutive cases of MI with ST-segment elevation with less than 12 hours of evolution. All patients were submitted to the same angioplasty protocol. CIN was defined as an absolute increase of creatinine of at least 0.5 mg/dL and/or a relative increase of creatinine of 25% in relation to baseline in a period between 48 and 72 hours after contrast administration. The variables that differed between patients with and without CIN in univariate analysis were analyzed by logistic regression.
The sample was formed by 135 (67.2%) men and 66 (32.8%) women, with mean age of 66.6 ± 11.7 years. The incidence of CIN was 23.8%. In univariate analysis the patients with CIN were older and had higher frequency of left ventricular ejection fraction ≤ 40% and Killip classification ≥ 2. In multivariate analysis, we did not find independent predictors of CIN.
CIN occurred in ¼ of the patients with MI submitted to angioplasty without predictor variables. This finding highlights the need for CIN preventive measures after contrast use in emergency angioplasty.
Keywords: acute kidney injury; angioplasty, balloon, coronary; contrast media; myocardial infarction;
Polimyxins were originally abandoned due to high rates of nephrotoxicity. However they have been recently reintroduced due to activity against carbapenem-resistant Gram-negative organisms. Recent literature suggests a lower rate of nephrotoxicity than historically reported.
To determine the rate of polymixins-associated nephrotoxicity as defined by the RIFLE criteria.
A retrospective cohort of all adult patients who received polymixin B at a terciary hospital from December 2010 to March 2011was performed.
61 patients (43%) fulfilled the RIFLE criteria for renal injury and 28 patients
(13.7%) needed dialysis. Independent predictors for nephrotoxicity were
hypotension (OR, 2.79; CI 1.14-5.8;
In this retrospective cohort, nephrotoxicity (as defined by RIFLE criteria) occurred among 43% of treated patients. The concomitant use of vancomycin and hypotension were independent risk factors of nephropathy. Further studies are needed, particularly with polymyxin B, to clarify if the characteristics of this drug and colistin are overlapping.
Keywords: polymyxin B; dialysis; acute kidney injury; risk factors;
Handgrip strength (HGS) is a simple and reliable method with a good predictive clinical value for assessing muscle function of patients undergoing hemodialysis (HD). However, there is no consensus regarding the appropriate moment for performing the HGS measurement since the performance of the HGS can be influenced by fluid, electrolyte and blood pressure changes that affect patients on HD.
To investigate the impact of the dialysis session on the HGS in patients undergoing HD.
This is a cross-sectional study with 156 patients [57.7% male, median age of 56.5 (42-67) years old, 28.8% diabetes, mean BMI of 24.75 ± 4.5 kg/m2 and HD vintage of 38 (19.25 to 72.75) months]. Measures of HGS were performed with a dynamometer during the initial minutes of the HD session and at the end of the session. The values obtained were compared with a national standard reference. Clinical, demographic and laboratory data were collected from medical records.
A significant reduction of HGS was observed after the HD session (28.6 ± 11.4 kg
to 27.7 ± 11.7 kg;
These findings show that the HD procedure affects negatively the HGS.
Keywords: dialysis; hand strength; muscle strength; muscle strength dynamometer; nutrition assessment;
Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients.
To assess the prevalence of metabolic acidosis in hemodialysis and search their association with nutritional status.
A cross-sectional study was performed in hemodialysis patients at a single center. Nutritional status was assessed by anthropometric, biochemical and multifrequency bioelectrical impedance analysis. Metabolic acidosis was defined as serum bicarbonate (BIC) < 22 mEq/L and patients were divided into 3 groups according to BIC (< 15.15 to 21.9 and ≥ 22). The association between BIC and continuous variables was investigated using the Kruskal Wallis test. The linear correlation between BIC and the variables of the study was also tested.
We studied 95 patients, 59% male, mean age 52.3 years. The prevalence of metabolic acidosis was 94.7%. BMI, interdialytic weight gain and PTH were significantly different among the 3 groups of BIC. The BIC was negatively correlated with urea, phosphorus and interdialytic weight gain. There was no significant correlation with albumin, phase angle and lean body mass index.
The prevalence of metabolic acidosis was high in this population, and a lower BIC correlated with higher levels of urea, PTH, phosphorus, interdialytic weight gain and lower BMI. The evaluation of acid-basic status should be routinely implemented in dialysis patients by considering the negative effects of acidosis on the nutritional status, inflammation and bone disease.
Keywords: acidosis; nutrition assessment; protein-energy malnutrition; renal dialysis;
Chronic kidney disease (CKD) compromises the health and routine of the patient. On the fifth stage of CKD, the patient becomes eligible to start renal replacement therapy: hemodialysis (HD), peritoneal dialysis (PD) or kidney transplantation. The type of CKD treatment is essential to improving quality of life of the patient.
To compare the quality of life of CKD stage 5 patients who perform HD and home PD.
Cross-sectional study with data collection, by convenience, through the application of socioeconomic and KDQOL SF-36 questionnaires in HD and PD patients of the Pro-Renal Foundation and satellite clinics in Curitiba-PR.
The sample was 338 patients, 222 HD and 116 PD. Average age: 54.4 years for HD
group (± 15.28) and 58.00 for the DP group (± 13.99). The variables: work status
Objectively, PD was more favorable regarding quality of life, for the large number of items with significant results when compared to HD. However, the two variables of greatest significance found in HD (physical functioning and emotional functioning) ended up having a much greater impact on well-being and daily-life of the patient in the environment external to the clinic than those who were higher in DP, making HD the most favorable for patient quality of life.
Keywords: peritoneal dialysis; quality of life; renal dialysis;
There is scarce data on the clinical profile of adult Brazilian patients with nephrotic syndrome caused by minimal change disease (MCD) and focal segmental glomerulosclerosis.
We evaluated the clinical characteristics and response to treatment in adult patients with nephrotic syndrome having a histological diagnosis of MCD or FSGS.
This is a retrospective analysis of 50 patients with MCD and 120 with FSGS. All patients were initially treated with steroids. The study outcomes were: steroid responsiveness, prevalence of total remission, progression to chronic renal failure and need of renal replacement therapy due to end-stage renal disease (ESRD).
Initial serum creatinine level was 24% higher among patients with FSGS
A positive response to steroid therapy was the most important factor related with preservation of renal function and FSGS was related with less steroid responsiveness.
Keywords: glomerulosclerosis, focal segmental; glucocorticoids; nephrotic syndrome; renal insufficiency; steroids; therapeutics;
Proteinuria after kidney transplantation (Tx) has variable incidence and is associated with cardiovascular risk and graft survival.
To evaluate the prevalence of proteinuria after kidney Tx and its associated factors.
The prevalence of PTN was evaluated according to definition ≥ 500 mg/24 hours.
Patients were divided into 3 groups: group A, < 500 mg, B, 500-1000 mg and C,
> 1000 mg. We tested the association between PTN and: age/gender of the donor
and recipient, type of donor, delayed graft function, acute rejection,
hypertension and creatinine. The variables with a
173 recipients were evaluated, mean age 39 years, 57.2% male and 60.7% deceased donor. The prevalence of PTN after kidney Tx was 24.3%. The distribution of patients according to PTN was 75.7% for group A, 15.6% for group B and 8.7% for group C. The following factors were associated with higher risk of PTN: male recipients, living donor and hypertension. Creatinine at month 12 moths post-Tx was higher among patients with proteinuria. 60% of patients with PTN ≥ 500 mg/24 hours were treated with ACEI/ARB.
The prevalence of PTN after kidney Tx varied between 24.3%, according to the definition used. The male gender of the recipient, living donor and hypertension were associated with the occurrence of PTN after kidney Tx. Blockade of the renin-angiotensin system must be prescribed to more patients.
Keywords: kidney transplantation; prevalence; proteinúria; risk factors;
Keywords: diabetes mellitus; fragilidade óssea; insuficiência renal crônica;
Pheochromocytoma is a catecholamine-producing adrenal tumor, being a rare cause of hypertension in pregnancy. It's prevalence in hypertensive patients is 0.2%, and 0.002% of pregnancies. We follow hypertensive pregnant 24 year old on her third pregnancy, admitted to 33 weeks with hypertensive emergency cesarean section indicated by fetal distress evolving with acute pulmonary edema in the post-partum period. Indicated laparoscopy after 13 days for acute abdominal pain, with no significant finding. In the postoperative, due a severe and resistant hypertension, suspected of pheochromocytoma and confirmed by biochemical tests and imaging. Performed unilateral adrenelectomia with cure of hypertension. The pathology and immunohistochemistry confirmed the diagnosis. We conclude that atypical cases of hypertension in pregnancy should be investigated early and differentiated pre-eclampsia. Despite the low prevalence, pheochromocytoma in pregnancy increases fetal maternal morbidity and mortality and the early recognition and treatment drastically change their outcome.
Keywords: hypertension; pheochromocytoma; pregnancy;
Takayasu arteritis is a rare disease of unknown etiology that affects the aorta and its main branches. It is a condition, geographically more common in Southeast Asia, which mainly affects women of reproductive age. The clinical presentation is nonspecific, with signs and symptoms that vary according to the affected arterial segment. The most commonly affected vessel is the subclavian artery, while renal artery stenosis is relatively uncommon. Cardiac involvement and association with other diseases may also be present. We present in this report the case of an elderly patient with late diagnosis of Takayasu's arteritis and various comorbidities or related complications.
Keywords: aged; chronic, kidney failure; takayasu arteritis;
Coverage of renal replacement therapies (RRT) in Peruvian Ministry of Health is poor. There is an unequal distribution of TRR in the country, and is possible that up to 50% of the population does not have access to any kind of TRR. A multi-institutional approach to address this problem is necessary as it has been in consistent with the economic improvement of the country.
Keywords: chronic, renal dialysis; health services accessibility; kidney failure;