In chronic kidney disease (CKD), it has been suggested that alterations
within the gut are associated with an inflammatory state and uremic
toxicity. Studies suggest that uremia may impair the function of the
intestinal barrier via the promotion of increased intestinal permeability.
To understand the mechanisms that are involved in intestinal barrier damage
in the setting of uremia, we evaluated the
Pools of serum from healthy individuals, patients not on dialysis, and patients on hemodialysis (Pre-HD and Post-HD) were prepared. T84 cells were incubated for 24 h in medium, of which 10% consisted of the pooled serum from each group. After incubation, the TER was measured and the following parameters were determined by flow cytometry: expression of toll-like receptors (TLRs), production of reactive oxygen species (ROS), and apoptosis. The level of IL-6 in the culture supernatant was determined by ELISA.
No difference was observed among the groups with respect to TER, apoptosis,
and ROS or the expression of TLR-2, TLR-4, and TLR-9. IL-6 secretion was
The results that were obtained from this model suggest that uremic serum
Keywords: Uremia; Intestino Grosso; Insuficiência Renal Crônica;
Chronic Kidney disease (CKD) patients have a high prevalence of cardiovascular mortality, and among the risk factors are dyslipidemia and obesity, common findings in the early stages of CKD. The aim of this study was to evaluate the effects of low protein diet (LPD) on the lipid and anthropometric profile in non-dialysis CKD patients.
Forty CKD patients were studied (20 men, 62.7 ± 15.2 years, glomerular filtration rate (GFR) 26.16 ± 9.4 mL/min/1.73m2). LPD (0.6g/kg/d) was prescribed for six months and, biochemical and anthropometric parameters like body mass index (BMI), waist circumference and body fat mass (assessed by dual X-ray absorptiometry - DXA) were evaluated before and after six months with LPD.
After six months of nutritional intervention, patients presented reduction on
BMI (from 28.1 ± 5.6 to 27.0 ± 5.3 Kg/m2,
LPD prescribe to non-dialysis CKD patients for six months was able to improve some cardiovascular risk factors as overweight and plasma lipid profile, suggesting that LPD can be also an important tool for protection against cardiovascular diseases in these patients.
Keywords: Falência Renal Crônica; Dieta com Restrição de Proteínas; Doenças Cardiovasculares; Dislipidemias; Sobrepeso; Obesidade;
The world population is aging and diseases such as diabetes mellitus and systemic arterial hypertension are increasing the risk of patients developing chronic kidney disease, leading to an increase in the prevalence of patients on dialysis. The expansion of health services has made it possible to offer dialysis treatment to an increasing number of patients. At the same time, dialysis survival has increased considerably in the last two decades. Thus, patients on dialysis are becoming more numerous, older and with greater number of comorbidities. Although dialysis maintains hydroelectrolytic and metabolic balance, in several patients this is not associated with an improvement in quality of life. Therefore, despite the high social and financial cost of dialysis, patient recovery may be only partial. In these conditions, it is necessary to evaluate the patient individually in relation to the dialysis treatment. This implies reflections on initiating, maintaining or discontinuing treatment. The multidisciplinary team involved in the care of these patients should be familiar with these aspects in order to approach the patient and his/her relatives in an ethical and humanitarian way. In this study, we discuss dialysis in the final phase of life and present a systematic way to address this dilemma.
Keywords: diálise renal; qualidade de vida; cuidados paliativos; insuficiência renal crônica; planejamento antecipado de cuidados;
IgA nephropathy (IgAN) is the most prevalent primary glomerulopathy in the world, but great variation is reported in different countries. In Brazil, the reported prevalence is high in the Southeastern States and low in Salvador, Bahia State, Brazil.
This study investigated the clinical and histological patterns of patients with IgAN in Salvador, Brazil.
This is a descriptive study that included all patients with a diagnosis of IgAN performed in native kidney biopsies collected from referral nephrology services of public hospitals in Salvador between 2010 and 2015. Results: Thirty-two cases of IgAN were identified, corresponding to 6% of primary glomerulopathies. There was a slight male predominance (56%) and the median age was 30 [22-40] years. Hematuria was present in 79%, non-nephrotic proteinuria was present in 61%, and hypertension was present in 69% of patients. Segmental sclerosis (S1 lesions) was present in 81% of cases, and chronic tubulo-interstitial lesions (T1 and T2 lesions) were present in 44% of cases. Patients with M1 and T2 MEST-C scores exhibited higher serum urea and creatinine than other patients.
The prevalence of IgAN was lower in Salvador than other regions of Brazil. Chronic histological lesions and laboratory markers of severe disease were frequent. M1 and T2 MEST-C scores were correlated with markers of renal dysfunction.
Keywords: Glomerulonefrite; Glomerulopatia, IgA; Classificação;
Excessive salt intake is a risk factor for the development of chronic kidney disease (CKD). Objective: To evaluate the association between estimated glomerular filtration rate (eGFR) and sodium excretion in urine samples of Brazilians of African ancestry.
Cross-sectional, population-based study of 1,211 Brazilians of African ancestry living in Alcântara City, Maranhão, Brazil. Demographic, nutritional, clinical, and laboratory data were analyzed. The urinary excretion of sodium was estimated using the Kawasaki equation. Calculations of eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation. Multivariate linear-regression model was used to identify the relationship between sodium excretion and eGFR.
Mean age was 37.5±11.7 years and 52.8% were women. Mean urinary excretion of sodium was 204.6±15.3 mmol/day and eGFR was 111.8±15.3 mL/min/1.73m2. According to multivariate linear regression, GFR was independently correlated with sodium excretion (β=0.11; p<0.001), age (β=-0.67; p<0.001), female sex (β=-0.20; p<0.001), and body mass index (BMI; β=-0.09; p<0.001).
The present study showed that age, female sex, BMI, and correlated negatively with eGFR. Sodium excretion was the only variable that showed a positive correlation with eGFR, indicating that high levels of urinary sodium excretion may contribute to hyperfiltration with potentially harmful consequences.
Keywords: Sódio; Taxa de Filtração Glomerular; Doença Renal Crônica; Populações Vulneráveis;
Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates.
Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically.
Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA
radionuclide imaging. In ten patients (76.9%), open surgical intervention
for stones were needed during follow-up. Significant difference was not
detected between eGFR before and after surgical intervention (mean 92
Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.
Keywords: Cistinúria; Urolitíase; Cirurgia; Infância; Cicatrizes Renais;
Children with solitary functioning kidney (SFK) are prone to develop long term problems, which are not well represented in the literature. The extent to which the presence of associated congenital anomalies of kidney and urinary tract (CAKUT) further de-stabilize renal function is to be addressed.
This study was conducted to evaluate the etiology, presentation, presence of CAKUT, and renal damage in children with SFK.
All children with SFK who presented to the department of pediatric surgery from March 2014 to May 2016 were included in the study. Children with malignancy were excluded from the study.
Of the 20 patients with SFK, 14 (70%) had primary SFK (8 with agenesis and 6 with multicystic dysplastic kidney), 6 (30%) belonged to secondary SFK group, among them 3 had pelviureteric junction obstruction, 2 had posterior urethral valves and 1 had vesicoureteric reflux. Eight (40%) had associated CAKUT, 4 (20%) were asymptomatic while 8 (40%) had UTI and 6 (30%) had hypertension. Ten (50%) patients had reduced glomerular filtration rate (GFR) suggesting compromised renal function.
Children with SFK have high morbidity especially when associated with ipsilateral CAKUT. Long-term periodical follow up is essential in these patients to improve clinical outcome.
Keywords: Nefropatias; Repertório: Seção Rins; Rim; Anormalidades Congênitas; Insuficiência Renal;
The incidence of gastrointestinal disorders among patients with chronic kidney disease (CKD) is high, despite the lack of a good correlation between endoscopic findings and symptoms. Many services thus perform upper gastrointestinal (UGI) endoscopy on kidney transplant candidates.
This study aims to describe the alterations seen on the upper endoscopies of 96 kidney-transplant candidates seen from 2014 to 2015.
Ninety-six CKD patients underwent upper endoscopic examination as part of the
preparation to receive kidney grafts. The data collected from the patients'
medical records were charted on Microsoft Office Excel 2016 and presented
descriptively. Mean values, medians, interquartile ranges and 95% confidence
intervals of the clinic and epidemiological variables were calculated.
Possible associations between endoscopic findings and infection by
Males accounted for 54.17% of the 96 patients included in the study. Median
age and time on dialysis were 50 years and 50 months, respectively. The most
frequent upper endoscopy finding was enanthematous pangastritis (57.30%),
followed by erosive esophagitis (30.20%). Gastric intestinal metaplasia and
peptic ulcer were found in 8.33% and 7.30% of the patients, respectively.
Abnormal upper endoscopy findings were detected in all studied patients. This study suggested that upper endoscopy is a valid procedure for kidney transplant candidates. However, prospective studies are needed to shed more light on this matter.
Keywords: insuficiência renal crônica; transplante de rim; diálise renal; endoscopia do sistema digestório; Helicobacter pylori;
Chronic kidney disease (CKD) is a multifactorial pathophysiologic irreversible process that often leads to a terminal state in which the patient requires renal replacement therapy. Most cases of CKD are due to chronic-degenerative diseases and endothelial dysfunction is one of the factors that contribute to its pathophysiology. One of the most important mechanisms for proper functioning of the endothelium is the regulation of the synthesis of nitric oxide. This compound is synthesized by the enzyme nitric oxide synthase, which has 3 isoforms. Polymorphisms in the NOS3 gene have been implicated as factors that alter the homeostasis of this mechanism. The Glu298Asp polymorphisms 4 b/a and -786T>C of the NOS3 gene have been associated with a more rapid deterioration of kidney function in patients with CKD. These polymorphisms have been evaluated in patients with CKD of determined and undetermined etiology and related to a more rapid deterioration of kidney function.
Keywords: Insuficiência Renal, Crônica; Sintase do Óxido Nítrico; Polimorfismo, Genética;
Chronic kidney disease (CKD) is a syndrome caused by the progressive reduction of renal function. This study aimed to systematically examine the effects of supplementation with probiotics in the treatment of CKD. Searches were carried out on databases MEDLINE (PubMed), SciELO, Cochrane, and Clinical Trials. Two independent reviewers selected the studies from which data was extracted. The search included papers written in English and Portuguese published in the 2012-2016 period describing randomized clinical trials. Eight of the 82 eligible articles met the inclusion criteria. Sample size ranged from 18 to 101 individuals with CKD. The duration of the included studies varied from four to 24 weeks. Most of the included articles reported positive effects in renal function and decreased levels of urea, blood urea nitrogen, ammonia, plasma p-cresol, p-cresyl sulfate, and indoxyl sulfate.
Keywords: Insuficiência Renal Crônica; Probióticos; Lactobacillus;
Pseudoporphyria is a rare photodermatosis with characteristics similar to those of porphyria cutanea tarda, without, however, presenting abnormalities in porphyrin metabolism. Its etiology is related to chronic kidney disease, ultraviolet radiation and certain medications. The aim of the present study is to describe a case of furosemide-related pseudoporphyria in a patient with chronic kidney disease.
A 76-year-old male patient with stage 4 chronic kidney disease and in continuous use of furosemide presented ulcerated lesions with peripheral erythema and central hematic crust in the legs. On a skin infection suspicion, treatment with quinolone and neomycin sulfate was initiated, without improvement. A biopsy of the lesion was performed, with histopathological examination demonstrating findings compatible with porphyria, although the patient did not present high porphyrin levels. The diagnosis of furosemide-induced pseudoporphyria was then established, with medication suspension, and there was a significant improvement of the lesions.
There are few cases of pseudoporphyria described, but it is believed that this condition is underdiagnosed, especially in patients with chronic kidney disease. Both clinical and histopathological findings closely resemble porphyria, differentiating it from normal levels of porphyrin in plasma, urine, or feces.
Although the lesions are mostly benign, they may increase the morbidity and mortality of these patients, so a proper diagnosis and early treatment are extremely important.
Keywords: Porfirias; Insuficiência Renal Crônica; Furosemida;
Sarcoidosis is a systemic inflammatory disease of unknown etiology, characterized by the presence of non-caseating granulomas in several organs; renal impairment alone is a rare condition. When it affects the kidneys, the most prevalent manifestations are hypercalcemia and hypercalciuria. This paper aims to address the topic of renal sarcoidosis, by means of a case report, and reinstate the importance of histopathology in its diagnosis.
The data came from an observational clinical study with a qualitative approach, through an interview with the renal sarcoidosis patient and data from her medical records.
Patient D.M.S., 50 years old, Caucasian, presented with reddish eyes and body pains lasting for fifteen days as first manifestations of the disease. Upon kidney ultrasound scan, we found renal parenchymal nephropathy. Serial renal function and metabolic tests reported anemia and progressive urea and creatinine changes, as well as hypercalcemia and hypercalciuria, confirming acute kidney failure (AKF). A histopathological examination suggested the diagnosis, which was confirmed by clinical, laboratory and histopathological data. There was therapeutic resolution after steroid therapy.
The symptomatology of sarcoidosis is diverse and often non-specific. Renal manifestation, which usually occurs after organ involvement, is present in less than 5% of patients, and about 1% to 2% of these patients may develop AKF.
The use of histopathology together with clinical and laboratory data to diagnose isolated renal sarcoidosis, rule out other etiologies and introduce early treatment is of paramount importance.
Keywords: Sarcoidose; Nefrologia; Histologia;
Tubulointerstitial nephritis and uveitis syndrome is a rare and probably underdiagnosed condition. Renal and ocular manifestations may not occur simultaneously, making the diagnosis more difficult. Nephritis may be asymptomatic; therefore, renal function evaluation is essential for diagnosis. Urinary β2-microglobulin levels may be particularly useful. Uveitis, mostly anterior, nongranulomatous and bilateral, occurs usually after the onset of nephritis. Treatment includes corticosteroids and, eventually, other immunosuppressant agents. Renal disease is usually benign and resolves spontaneously or after treatment with systemic corticosteroids. Uveitis, however, may be chronic or recurrent. The authors described the cases of three pediatric patients diagnosed with tubulointerstitial nephritis and uveitis syndrome. The goal of this paper was to warn the medical community over the need to screen patients with uveitis for renal disease.
Keywords: Microglobulina-2 beta; Nefrite Intersticial; Uveíte;
Proton pump inhibitors (PPIs) bind to enzyme H+/K+-ATPase and inhibit its activity in the stomach, thus decreasing the secretion of gastric acid. PPIs may trigger acute interstitial nephritis, a potentially severe adverse event commonly associated with acute kidney injury. Studies have found that prolonged use of PPIs may increase the risk of chronic kidney disease (CKD). The increase in prescription and inadequate use of this class of medication calls for studies on the effects of prolonged PPI therapy on renal function. Therefore, this review aimed to analyze recent studies on the matter and discuss the possible consequences of the long-term use of PPIs on renal function.
Keywords: Inibidores da Bomba de Prótons; Insuficiência Renal Crônica; Nefrite Intersticial; Lesão Renal Aguda;