Expressão imuno-histoquímica da e-caderina e do CD44v6 em carcinoma epidermóide de lábio inferior e língua

The objective of this study was perform, by the streptoavidin-biotin technique, an immunohistochemical analysis of the E-cadherin and CD44v6 in 15 lower lip squamous cell carcinomas and 15 of tongue, with varied histologic gradation of malignidade, in order to establish a possible relation between the expression these proteins and the anatomical localization of the lesions, metastasis, as well as with the Bryne`s histolologic grading of malignancy system. It was not observed significant statistical association between the localization of the lesions and the malignancy score, however, had a significant correlation between the histologic parameters of malignancy gradation and the total score of malignancy, being that the parameter degree of keratinization presented the highest correlation (r = 0,844). Taking in consideration the anatomical localization of the lesions, it was not significant difference between the profile of expression and the amount of immunopositive cells for Ecaderina and CD44v6. To the metastasis variable, also it was not observed significant difference between the profile of expression and the amount of immunopositive cells for evaluated proteins. However, it was observed a statistical significant difference in relation to the scores of malignancy, being that the low score presented the highest values for the profile of expression and the amount of immunopositive cells for the E-caderina and the CD44v6. It was observed a statistically significant and negative correlation between the expression profile, the amount of E-cadherin and CD44v6 immunopositive cells and the total score of malignancy. Therefore, based in the results of this study, it was concluded that the expression of the immunohistochemical markers E-caderina and CD44v6 did not constitute histological indicator of aggressiveness for the patients with lower lip and tongue squamous cell carcinomas

Estudo in vitro dos efeitos da BMP-2 e do seu antagonista Noggin sobre a proliferação e migração celulares em carcinoma epidermóide de língua

Oral squamous cell carcinoma (OSCC) is the most prevalent malignancy in the oral cavity and reach a large number of individuals, has become an important public health problem. Studies have demonstrated changes in pathway components BMP in various types of cancers as prostate, colon, breast, gastric and OSCCs. Is the current knowledge that these proteins may exert pro-tumor effect in more advanced stages of neoplastic development coming to favor progression and invasion tumor. The inhibition of the signaling pathway BMP-2 through its antagonists, have shown positive results of antitumor activity and use of Noggin may be a novel therapeutic target for cancer. Given this evidence and the few studies with BMP-2, Noggin and OSCC, the objective of this research was to evaluate the effect of BMP-2 and its antagonist Noggin on proliferation and migration cell in line of cell cultures of human tongue squamous cell carcinoma (SCC25). The study was divided in three groups, a control group, where SCC25 cells suffered no treatment, a BMP-2 group, in which cells were treated with 100ng/ml of BMP-2 and a group of cells that were treated with 100ng/ml of Noggin. For the proliferation assay and cell cycle were established three time intervals (24, 48 and 72 hours). Proliferative activity was investigated by trypan blue and cell cycle analysis by staining with propidium iodide flow cytometry. The potential for migration / invasion of SCC25 cells was performing by a cell invasion assay using Matrigel in a 48-hour interval. The proliferation curve showed a higher proliferation in cells treated with BMP-2 in 72 hours (p < 0.05), and lower overgrowth and cell viability in Noggin group. Recombinant proteins favored a greater percentage of cells in cell cycle phase Go/G1 with a statistically significant difference in the interval of 24 hours (p < 0.05). BMP- 2 produced a greater invasion of cells studied as well as its antagonist Noggin inhibits invasion of cells (p < 0.05). Thus, these results indicate that BMP-2 promotes malignant phenotype, dues stimulates proliferation and invasion of SCC25 cells and, its antagonist Noggin may be an alternative treatment, due to inhibit the tumor progression

Consumo e digestibilidade aparente de dietas com níveis crescentes do subproduto do caju em ovinos

The present study was conducted to evaluate the intake and digestibility of diets containing increasing levels of byproduct of cashew in sheep. The animals were distributed in a completely randomized design were evaluated in four levels (0%, 20%, 40%, 60%) by product of cashew with four replicates, making up 16 observations. The indicator used was the Purified Lignin and Enriched - LIPE ®. The scorer was orally administered directly into the mouth of the animals, in the form of capsules 250mg/animal/dia for a period of two days and five days of adaptation samples being the same supplied with the aid of a hose polyethylene and a device allowing the release of the capsule in the esophagus of sheep. With the estimate made by the indicator LIPE was observed a reduction for DM, OM, CP, NDF, EE, NFC and MM along the inclusion of byproduct of cashew. The results of nutrient digestibility were not satisfactory with the inclusion of byproduct of cashew, reducing linearly with the inclusion of the diets. The use of increasing levels of byproduct of cashew in the diets of sheep did not provide satisfactory results, it is not feasible to use the animals studied in this experiment

Fatores que influenciam a cooperação em humanos

Human cooperation is fundamentally affected by reciprocal exchange, but it is also remarkably common on the context of large and symbolically marked in-groups, which promote cooperation through the feeling of belonging to a group. In this thesis, two empirical articles were produced in order to investigate how human cooperation is affected by factors such as reciprocity, in-group behavior, in-group markers and gender. We investigated this subject through the administration of online games consisting of token donations, on which the subjects faced virtual players controlled by the experiment. We found that cooperative behavior is strongly influenced by reciprocity, and it is also affected by the in-group behavior, observed on the context of the social variables place of birth, ethnicity, and religions, once all of them acted as in-group markers. The subjects´ in-group behavior was enhanced when they played with generous in-group opponents, but weakened when their in-group opponents were non-generous. It was also found that cooperation is not affected by gender, but men and women cooperated in different ways under the influence of reciprocity and in-group behavior. Women are much more reciprocal on their cooperative behavior and men are less willing to cooperate with outgroupers, even when they act generously. The overall results contribute to a better understanding of the adaptive value of cooperation, reciprocity and in-group behavior on the solution of important challenges through the human evolutionary history

Aspectos anatômicos do olho e neuroquímicos da retina do mocó (Kerodon rupestris)

The visual system is an important link between the animal and the environment, com profound influences on the habits and lifestyle in various habitats. Adaptive mechanismsto the temporal niche are present in the visual system of many vertebrates, involving changins in ocular dimensios and design, retinal cell distribution and organization of neurochemical circuits related to the retinal resolution or sensitivity. The sensory system of the eye is represented by the retina, whose organization is responsible by receipty, initial analysis, and transmission of the information to the brain. The knowledge of the position of the eyes in the head and the distribution of retinal cells allow to identify adaptive aspects of each species to its visual field, which is characteristic to the ecological niche it occupies. In this research, we study eye anatomical characteristics and retina neurochemical features of the rock cavy (Kerodon rupestris), a tipical Brazilian rodent from the suborder Hystricomorpha, family Caviidae. The rock cavy has lateral eyes well constitute bony orbit and well differentiated extrinsic muscle. The study of the descriptive and morphometric anatomy of the showed mean values of axial diameter 10.7±0,5mm and equatorial diameter 11.6±0.7mm. The pupil is slit shaped and the lens has mean axial diameter 5.4±0.03 mm, corresponding to ~45% of the axial diameter of the eye. The posterior nodal distance and the retinal magnification factor were estimated at 6.74 mm e 118 μm/grau, respectively. Flat mounts were processed for Nissl stain, and the topographic distribution of ganglion cells showed a moderate visual band, just below the optic disc, with higher density in the ventral retina. Retinal vertical sections and flat mounts were processed for immunohistochemistry to visualize tyrosine hydroxilase (TH) and thus two types of TH+ cells were detected. Type 1 cells had strong TH-immunoreactivity, the body cell varied from 120.047 to 269.373 μm2 stratifying in the sublamina 1 of the IPL. Type 2 cells were weakly TH-imunoreactive, had cell body located mostly in the IPL, varying from 54.848 to 177.142 μm2, constituting ~10% of the TH+ cells. Both cell types exhibited similar topographic distribution with higher density found in a horizontal band along of the naso-temporal axis in the dorsal retina. The total population of dopaminergic cells was 2,156±469,4 cells, occupying an average area of 198,164 μm2. The presence of cones and rods was detected by immunohistochemistry in vertical sections and flat mounts. S cones density is around 10 times smaller than L cones, with different degree of spatial organization. Other retinal neuronal populations of the rock cavy were also detected in vertical sections with specific markers. Comparative analysis of the anatomical characteristics of the rock cavy eye 12 suggest that it was designed to acquire higher sensitivity to light, at expense of image sharpness, compatible with a vision at mesopic conditions. Additionally, the distribution of the 2 subtypes of dopaminergic cells in a naso-temporal band in the dorsal retina seems suitable to a gain in sensitivity, coherent with an animal with predominantly crepuscular activity pattern

Caracterização citoarquitetônica, neuroquímica e de aferência óptica do complexo parabraquial do sagui (Callithrix jacchus)

The parabrachial complex (PB) is an area of the brainstem responsible for the processing and transmission of essential physiologic information for the survival of the organisms. This region is subdivided in approximately nine subregions, considering morphology, cytoarchitectural and functional characteristic. Its neurons have an extensive network of connections with other regions of the nervous system. The objective in this work was to map the retinal projection to the PB and make a citoarchitectonic and neurochemical characterization of this region in the common marmoset (Callithrix jacchus), a primate of the New World. The retinal projections were mapped by anterograde transport of the choleric toxin subunit b (CTb). The citoarchitecture was described through the Nissl method, and the neurochemical characterization was made through immunohistochemical technique to the some neurotransmitters and neuroactives substances present in this neural center. In marmoset PB, in the coronal sections labeled by Nissl method, we found a similar pattern to that evidenced in other animal species. The immunoreactivity against CTb was verified in the PBMv in fibers/terminal, characterizing such as retinal innervations in this area. The immunohistochemical technique reveled that the PB contain cells, fibers and/or terminals immunoreactives to the neuronal nuclear protein, Choline acetyl transferase, nitric oxide synthase, serotonin, enkephalin, substance P, Calcium-binding proteins (calbindin, calretinin e parvalbumin), and glial fibrillary acidic protein. The histochemical technique reveled cells and fibers NADPH-diaphorase reactive. Each one of those substances presented a characteristic pattern of demarcation in PB, and some serve as specific markers of subregions

A percepção das características da face infantil por adultos e crianças sob uma perspectiva evolucionista

Child facial cues evoke attention, parental care behaviors and modulate for infant- caretaker interactions. Lorenz described the baby schema ( Kindchenschema ) as a set of infantile physical features such as the large head, round face, high and protruding forehead, big eyes, chubby cheeks, small nose and mouth. Previous work on this fundamental concept was restricted to positive perception to infant face, and did not show consistent results about the development individuals perceptions, regarding the physical attributes that worked as markers of cuteness. Here, we experimentally tested the effects of baby schema on the perception of cuteness of infant faces by children and adults. We used 60 none graphically manipulated photos of different stimulus children faces from 4 to 9 years old. In the first task for the adults experimental subjects, ten stimulus photos were shown, whereas for children experimental subjects, four stimulus photos were shown at a time, with a total of six rounds. The second task involved only adults, who indicated the motivation of affective behaviors and care directed to children through a Likert scale. Our results suggest that both participants judged similarly the cuteness of children's faces, and the physical features markers of this perception were observed only for younger stimulus children. Adults have attributed more motivations of positive behaviors to cuter stimulus children. The recognition of the baby schema by individuals of different ages and genders confers the universality and power of children's physical attributes. From the evolutionary perspective the responsiveness to baby schema is significant to ensure aloparental and parental investment, and the consequent children survival

Carcinoma de pequenas células do esôfago: estudo clínico patológico de dois casos

RACIONAL: O carcinoma de pequenas células primário do esôfago é tumor raro, agressivo, morfologicamente indistinguível de seu correspondente no pulmão. OBJETIVO: Apresentar os aspectos clínico-patológicos de dois pacientes com carcinoma de pequenas células do esôfago. RELATO DE CASOS: Paciente 1: masculino, 56 anos com disfagia progressiva há seis meses e emagrecimento, com antecedentes de tabagismo e etilismo. A endoscopia mostrou lesão vegetante dos 30 aos 40 cm da arcada dentária superior e o exame anatomopatológico, diagnosticou neoplasia maligna indiferenciada de pequenas células com marcadores imunoistoquímicos positivos para cromogranina e sinaptofisina, caracterizando a linhagem neuroendócrina da neoplasia. Após dois ciclos de quimioterapia (cisplatina e etoposide) associada à radioterapia ele apresentou remissão da disfagia. Paciente 2: masculino, 55 anos, com queixas de pirose, disfagia, rouquidão há seis meses, com emagrecimento de 10 kg no período. A endoscopia mostrou lesão vegetante à 30 cm da arcada dentária superior, obstrutiva. O exame anatomopatológico revelou carcinoma de pequenas células, com os mesmos marcadores imunoistoquímicos positivos para linhagem neuroendócrina. Tomografia computadorizada mostrou metástases hepáticas. Frente ao estadio avançado da doença optou-se pela indicação de gastrostomia. O paciente desenvolveu pneumonia e faleceu dois meses após o diagnóstico. CONCLUSÃO: A evolução dos portadores de carcinoma de pequenas células do esôfago depende do estadiamento da doença e apesar da alta agressividade biológica, este tumor apresenta boa resposta à quimioterapia associada à radioterapia.

Ingestão de fibra alimentar e tempo de trânsito colônico em pacientes com constipação funcional

RACIONAL: Pacientes com constipação funcional que não melhoram com suplementação de fibras dietéticas, representam importante problema clínico. OBJETIVOS: Avaliar as relações entre as quantidades de fibras ingeridas, intensidade da constipação e o tempo de trânsito colônico em pacientes com constipação funcional. MÉTODOS: Foram avaliados 30 pacientes constipados funcionais, sem melhoras após suplementação dietética com fibras e 18 pessoas controle, sadias, sem queixas digestivas, utilizando inquéritos individuais quanto à ingestão de fibras e a intensidade da constipação e, por meio da técnica dos marcadores radiopaco, o tempo de trânsito colônico, total e segmentar. RESULTADOS: Apesar da maior ingestão diária de fibras (26,3 ± 12,9 g, constipados x 9,3 ± 5,2 g, controles), os sintomas da constipação mostraram-se intensos nos constipados (escore médio = 21,3 ± 4,07). O tempo normal para o trânsito colônico foi de 58,8h. O trânsito colônico total, em média, foi mais lento nos constipados (41,0 ± 22,8h, constipados x 21,8 ± 18,5h, controles). Constipados com trânsito lento (>58,8h) apresentaram inércia colônica (oito), obstrução de saída (um) e lentificação no cólon esquerdo (um). Constipados com trânsito normal (<58,8h), apresentaram lentificações isoladas no cólon direito (nove), no cólon esquerdo (três) e no segmento retossigmoideano (oito). Não houve correlação entre a quantidade ingerida de fibra, intensidade da constipação e tempo de trânsito colônico nos constipados funcionais. CONCLUSÕES: em constipados funcionais a gravidade da constipação não depende apenas da ingestão de fibras, que, também não é a única contributiva para as variações no tempo de trânsito colônico. Este diferencia os pacientes normais dos constipados e nestes, aqueles com trânsito alterado que exigem abordagens diferentes da suplementação de fibras.

Determinação da expressão da molécula de adesão CD56 em plasmócitos no mieloma múltiplo através de estudo imuno-histoquímico

O papel das moléculas de adesão celular, na fisiopatologia do mieloma múltiplo (MM), tem sido alvo de vários estudos nos últimos anos. A expressão de CD56 pelos plasmócitos tumorais está associada a comportamento clínico menos agressivo da doença, e sua perda tem sido descrita na fase de leucemização plasmocitária. A determinação da expressão da molécula CD56 pelos plasmócitos tumorais pode ser obtida através de citometria em fluxo, revelando positividade em 55% a 78% dos casos. No presente estudo, objetivamos verificar a expressão da molécula CD56 por plasmócitos tumorais na medula óssea de portadores de MM, utilizando o estudo imuno-histoquímico das amostras histológicas obtidas ao diagnóstico. Analisamos as amostras de medula óssea de vinte portadores de MM, e realizamos o estudo imuno-histoquímico para determinação da expressão das cadeias leves kappa e lambda e da molécula CD56 pelos plasmócitos tumorais. A expressão da molécula CD56 foi importante em três casos, moderada em seis, discreta em quatro e negativa em sete. O estudo imuno-histoquímico mostrou-se válido para determinação da expressão de CD56 por plasmócitos tumorais em portadores de MM, fornecendo resultados semelhantes aos descritos para os obtidos por citometria em fluxo. Através do estudo imuno-histoquímico, foi possível observar variações da expressão da molécula CD56.

Comparação entre a relação PCR/albumina e o índice prognóstico inflamatório nutricional (IPIN)

Objetivo: Simplificar o cálculo do índice prognóstico inflamatório nutricional (IPIN) empregando número menor de variáveis com conseqüente redução do custo da análise. Materiais e métodos: Foram estudados 54 pacientes e 12 indivíduos-controle com 48 ± 20 (média ± dp) anos de idade. As principais patologias dos pacientes eram: doença arterial periférica (22), pênfigo foliáceo (7), doença inflamatória intestinal (7), trauma (6) e pós-operatório de ortognatia (3). Foram obtidas amostras de sangue periférico, colhidas em jejum para dosagens de proteínas positivas (+) e negativas (-) de fase aguda (PFA) pelo método nefelométrico. Proteína C reativa (PCR), alfa-1-glicoproteína-ácida (alfa-1-GA), alfa-1-antitripsina (alfa-1-AT) e ceruloplasmina (CER) foram as PFA+ e albumina (Alb), transtiretina (TTR), transferrina (TF) e proteína ligadora do retinol (RBP) foram as representantes das PFA-. Esses valores foram analisados quanto à associação de correlação isolada ou associadamente na fórmula do índice prognóstico inflamatório e nutricional (IPIN = PCR + alfa-1-GA / Alb + TTR). de acordo com o índice prognóstico inflamatório e nutricional, os pacientes foram classificados em grupo-controle (G1); pacientes sem infecção/inflamação (IPIN < 1, G2) ou com risco de inflamação/infecção (IPIN > 1, G3). em seguida os pacientes do G3 foram subdivididos em baixo risco (G3A, n = 16); médio risco ( G3B, n = 10); alto risco (G3C, n = 6) e com risco de morte (G3D, n = 11). Os resultados foram correlacionados entre si (teste de Spearman) ou submetidos às comparações entre grupos (teste de Kruskall-Wallis). Resultados: Houve relação significativa entre as variáveis PCR ´ alfa-1-GA (r = 0,49), Alb ´ TTR (r = 0,60), Alb ´ RBP (r = 0,58), Alb ´ TF (r = 0,39), TTR ´ RBP (r = 0,56) e TTR´ TF (r = 0,43) e as melhores relações encontradas entre PFA+ e PFA- foram: PCR ´ Alb (r = - 0,71), PCR ´ TTR (r = - 0,54), PCR ´ TF (r = - 0,39) e alfa-1-GA ´ Alb (r = - 0,35). Os valores do IPIN mostraram a diferenciação G3 > (G1 = G2) e G3 > G3A. Entre todas as proteínas dosadas apenas PCR, Alb e TTR discriminaram os grupos: sendo G3 > (G1= G2) para PCR e G3< (G1= G2) para Alb e TTR. Apenas PCR, TTR e TF discriminaram a morbimortalidade com G3D > G3A (para PCR) e G3D < G3A (para TTR e TF). PCR/Alb e IPIN apresentaram concordância de valores para os riscos de complicações. Conclusão: Assim, conclui-se pela possibilidade de substituição do IPIN pela relação PCR/albumina, mais simples e de menor custo, mantendo-se o mesmo poder e sensibilidade para diagnóstico dos graus de risco de complicações.

Avaliação do caráter oxidante da violaceína

Violacein is a violet pigment isolated from many gram-negative bacteria, especially from Chromobacterium violaceum, a betaproteobacterium found in the Amazon River in Brazil. It has potential medical applications as an antibacterial, fungicide, anti-tryptanocidal, anti-ulcerogenic and anti-cancer drug, among others. Furthermore, its pro-oxidant activity has been suggested, but only in two specific tumor lineages. Thus, in the present study, the prooxidant effects of violacein were investigated in both normal and tumor cells, seeking to evaluate the cell responses. The evaluation of violacein cytotoxicity using the Trypan blue dye exclusion method indicated that CHO-K1 cells were more resistant than tumor HeLa cells. The oxidative stress induced by violacein was manifested as an increase in intracellular SOD activity in CHO-K1 and MRC-5 cells at a specific concentration range. Nevertheless, a decrease was detected specifically at 6-12 μM in HeLa and MRC-5 cells. Interestingly, the increase in SOD activity was not followed by a concomitant increase in catalase activity. Regarding to oxidative stress biomarkers, increased protein carbonylation and lipid hydroperoxides levels were detected respectively in CHO-K1 and MRC-5 cells treated with violacein at 1.5-3 μM and 3 μM, which may be an evidence that this compound causes oxidative stress specifically in these conditions. Additionally, it is believed that the decline in cell viability observed in MRC-5 cells and HeLa treated with violacein at 6-12 M is due to mechanisms not related to oxidative stress. Moreover, the results suggested that violacein might cause oxidative stress by increasing endogenous levels of O2 -, since the occurrence of an expressive change in SOD activity. In addition, in order to evaluate the antioxidant activity of violacein in the absence of a biological system, the total antioxidant and iron chelating activity were evaluated, so that antioxidant activities were detected at 30 and 60 μM of violacein. Altogether, the results indicate that although oxidative stress is triggered by incubation with violacein, it did not seem to be high enough to cause serious damage to cell biomolecules in HeLa cells and only at specific concentrations in CHOK-1 and MRC-5 cells. Comparing the results obtained in cell culture and the in vitro antioxidant activity evaluation, the results confirmed that violacein presents opposing oxidant features when in presence or absence of a biological system and the antioxidant character only occurs at high concentrations of the pigment.

Análise da estrutura genética populacional da piraúna (cephalopholis fulva: serranidae) ao longo da costa e ilhas oceânicas brasileiras

Brazil has about 8,500 km of coastline and on this scale, fishing is a historically important source of animal protein for human consumption. The national fishing background shows a growth of marine fishery production until 1985 and within this period it was recorded a steady decline. From the year 2003 fishing statistics aim to some "recovery" of the total fisheries production, which probably is related to a change in industry practice. The target of commercial fishing became smaller species with low commercial value, but very abundants. The coney, Cephalopholis fulva (Serranidae), is one of these species that have been suffering a greater fishing pressure in recent years. In order to provide data about the current situation of the genetic diversity of these populations, several molecular markers have been being used for this purpose. The prior knowledge of genetic variability is crucial for management and biodiversity conservation. To this end, the control region sequences (dloop) of mtDNA from Cephalopholis fulva (Serranidae) from five geographical points of the coast of Brazil (Ceará, Rio Grande do Norte, Bahia and Espírito Santo) and the Archipelago of Fernando de Noronha (FN) were sequenced and their genetic diversity analyzed. The FST values were very low (0.0246 to 0.000), indicating high gene flow between the sampled spots. The indices h and indicate a secondary contact between previously allopatric lineages differentiated or large and stable populations with long evolutionary history. Tests of Tajima and Fu showed expansion for all populations. In contrast, the mismatch distribution and SSD indicated expansion just for coastal populations. Unlike other species of the Atlantic which have been deeply affected by events on later Pleistocene, the population-genetic patterns of C. fulva may be related to recent events occurred approximately 130,000 years ago. Moreover, the data presented by geographical samples of the specie C. fulva showed high genetic diversity, also indicating the absence of deleterious effects of over-exploitation on this specie, as well as evidence of complete panmixia between all sampled populations

Eosinófilos e proteína catiônica eosinofílica na urina: uma nova abordagem para o diagnóstico da inflamação renal no lúpus eritematoso sistêmico

Universidade Estadual do Rio Grande do Norte

Aspectos nutricionais na lesão renal aguda

A avaliação nutricional é ferramenta indispensável para a monitoração e acompanhamento clínico do paciente com lesão renal aguda (LRA). A perda aguda da função renal interfere no metabolismo de todos os macronutrientes, propiciando situações pró-inflamatórias, pró-oxidativas e de hipercatabolismo. As principais alterações nutricionais no paciente com LRA são hipercatabolismo, hiperglicemia e hipertrigliceridemia, que, somadas às contribuições da doença de base, complicações e necessidade de terapia renal substitutiva, podem interferir na depleção nutricional do paciente. A desnutrição em pacientes com LRA está associada a maior incidência de complicações, maior tempo de internação e maior mortalidade. Entretanto, existem poucos estudos na literatura avaliando o estado nutricional de pacientes com LRA. Parâmetros antropométricos como índice de massa corporal, circunferência do braço e pregas cutâneas são de difícil interpretação, devido à alteração no estado de hidratação desses pacientes. Os parâmetros bioquímicos geralmente utilizados na rotina clínica também sofrem influência de fatores não nutricionais, como prejuízo da função hepática e estado inflamatório. Embora não existam dados prospectivos sobre o comportamento dos marcadores nutricionais, alguns autores conseguiram demonstrar associações de alguns parâmetros com desfecho clínico. A utilização de marcadores como albumina, colesterol, pré-albumina, IGF-1, aplicação da avaliação subjetiva global e cálculo do balanço nitrogenado parecem ser úteis como parâmetros de triagem para pior prognóstico e maior mortalidade em pacientes com LRA. em pacientes com LRA em terapia renal substitutiva, uma oferta calórica em torno de 25 a 30 kcal/kg e oferta mínima de 1,5 g/kg/dia de proteínas é recomendada a fim de minimizar o catabolismo proteico e prevenir complicações metabólicas.