Efeitos de diferentes doses de hemodiálise convencional diária na sobrevida de pacientes com injúria renal aguda

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prevenção do estresse oxidativo na síndrome de isquemia e reperfusão renal em ratos com suplementação nutricional com antioxidantes

OBJETIVO: Verificar o potencial efeito protetor de suplementação com vitaminas antioxidantes em um modelo de síndrome de isquemia-reperfusão renal em ratos. MÉTODOS: Foram utilizados 29 ratos Wistar, divididos em três grupos: Grupo I e II (n=10 cada), submetidos a indução do estresse oxidativo pela aplicação de 60 minutos de isquemia renal, seguidos de 10 minutos de reperfusão; adicionalmente, os animais do Grupo II foram pré-tratados por doze dias com vitaminas antioxidantes (vitamina C 11,43mg/kg e vitamina E 28,57mg/kg) antes da submissão à isquemia; Grupo III (n=9), correspondendo aos animais Sham, que foram manipulados de forma equivalente aos outros grupos, porém sem indução do estresse oxidativo e sem suplementação antioxidante. Findo isso, as amostras de sangue e os rins foram colhidos para avaliação dos níveis do malondialdeído, do ácido úrico e da capacidade antioxidante total. RESULTADOS: Para o malondialdeído e ácido úrico do Grupo I foi observado um aumento estatisticamente significante (p<0,01) em relação ao Grupo III, o qual não apresentou diferença em relação ao Grupo II. Para os níveis de capacidade antioxidante total, foi encontrada uma diminuição nos animais do Grupo I em relação aos Grupos II e III (p<0,01). CONCLUSÃO: Esses dados confirmam não apenas a efetiva participação do estresse oxidativo neste modelo de síndrome de isquemia e reperfusão renal em ratos, como também que o uso de vitaminas antioxidantes, associadas à dieta, pode proteger os animais das alterações oxidativas.

Predictors of Beta-Blocker Intolerance and Mortality in Patients After Acute Coronary Syndrome

Purpose: To investigate the predictors of intolerance to beta-blockers treatment and the 6-month mortality in hospitalized patients with acute coronary syndrome (ACS).Methods: This was a single-center, prospective, and longitudinal study including 370 consecutive ACS patients in Killip class I or II. BBs were prescribed according to international guidelines and withdrawn if intolerance occurred. The study was approved by the institutional ethics committee of our university. Statistics: the clinical parameters evaluated at admission, and the related intolerance to BBs and death at 6 months were analyzed using logistic regression (p<0.05) in PATIENTS.Results: BB intolerance was observed in 84 patients and was associated with no prior use of statins (OR: 2.16, 95%CI: 1.26-3.69, p= 0.005) and Killip class II (OR: 2.5, 95%CI: 1.30-4.75, p=0.004) in the model adjusted for age, sex, blood pressure, and renal function. There was no association with ST-segment alteration or left anterior descending coronary artery plaque. Intolerance to BB was associated with the greatest risk of death (OR: 4.5, 95%CI: 2.15-9.40, p<0.001).Conclusions: After ACS, intolerance to BBs in the first 48 h of admission was associated to non previous use of statin and Killip class II and had a high risk of death within 6 months.

Aspectos Nutricionais na Doença Renal Crônica em Cães

It is understood by Chronic Renal Failure (CRF) or Stage IV Chronic Kidney Disease (CKD) the morbid state in which there is a substantial and irreversible loss of functional capacity, metabolic and endocrine function in both kidneys, leading to a framework of dehydration, azotemia, electrolyte imbalance, anemia, uremic syndrome, secondary hyperparathyroidism, among other conditions that make the patient's life without treatment unfeasible. An adequate nutritional support to patients with CKD at any stage aims to maintain a good clinical condition and an attempt to delay the progression of the disease. The basis of a diet for patients with CKD is the restriction in this protein being of high biological value, low-phosphorus, high energy density, fiber and antioxidants combined with a good dietary practices that allow the patient a good quality of life

Síndrome urêmica em cães com doença renal crônica

Uremic syndrome, arising from kidney malfunction, consists of a set of systemic changes caused by the accumulation of toxic substances to the body. Since, with the advance of medicine, the animals lived more reaching advanced age and entering thus on track of senility, chronic renal disease, became a common complaint in the routine of the ambulatory. This high rate of morbidity generates an increased need for clarification of pathophysiology involved in this disease. The components of the uremic syndrome include water and sodium imbalance, anemia, intolerance to carbohydrate, neurological disorders, disorders of the gastrointestinal tract, osteoarthritis, immunological incompetence and metabolic acidosis. The clinical manifestations occur in isolation or in combination. In most cases canines patients are subject to an assessment when the kidney disease has evolved to the final stage with uremic syndrome and installed already, under these conditions, the prognosis is reserved

Insuficiência renal crônica em cães

The kidneys, for his anatomical and functional characteristics, are sensitive to affections that take the liberation of renal toxins or the blood supply, causing irreversible injuries to his renoparenchymal tissue that is substituted by fibrous tissue. Even after the resolution of the basic cause, there will be the loss of a significant number of his functional unity, renal adaptations will take place in the attempt of maintaining the renal function. These adaptations produce additional injuries, perpetuating to loss of renoparenchymal tissue and the reduction of the renal function. The renal insufficiency (IR) takes place after the loss of 3/4 of the number of his functional unities. Before the progression to the phase of IR, the animal shows up practically without symptoms, but for the gradual increase of the urinary and of the ingestion of water. The reduction of the degree of renal function leads to alterations system compensatory for the accumulation of substances that would suffer renal excretion. The progression of IR leads to the phase of the syndrome urêmica. In this phase the animal presents innumerable clinical signs that can take it to the death. The treatment is symptomatic and dietetic, but depending on the phase not much efficient. Because of being progressive and insidious, the IRC demands the preparation of campaigns and programs of explanation for the veterinary doctors who aim for the consciousness and/or sensibility of the owners to carry out periodic examinations of selection that precociously detect the renal dysfunction. The diagnosis in the beginning IR enables the efficiency of the treatment in stop or slowing his progression, extending the time and quality of life of the patient

Fatores de risco nutricionais associados à mortalidade em pacientes com lesão renal aguda de acordo com os critérios do Acute Kidney Injury Network (AKIN)

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Fatores de risco nutricionais associados à mortalidade em pacientes com lesão renal aguda de acordo com os critérios do Acute Kidney Injury Network (AKIN)

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Associations among genotype, clinical phenotype, and intracellular localization of trafficking proteins in ARC syndrome

Arthrogryposisrenal dysfunctioncholestasis (ARC) syndrome is a rare autosomal recessive multisystem disorder caused by mutations in vacuolar protein sorting 33 homologue B (VPS33B) and VPS33B interacting protein, apicalbasolateral polarity regulator (VIPAR). Cardinal features of ARC include congenital joint contractures, renal tubular dysfunction, cholestasis, severe failure to thrive, ichthyosis, and a defect in platelet alpha-granule biogenesis. Most patients with ARC do not survive past the first year of life. We report two patients presenting with a mild ARC phenotype, now 5.5 and 3.5 years old. Both patients were compound heterozygotes with the novel VPS33B donor splice-site mutation c.1225+5G>C in common. Immunoblotting and complementary DNA analysis suggest expression of a shorter VPS33B transcript, and cell-based assays show that c.1225+5G>C VPS33B mutant retains some ability to interact with VIPAR (and thus partial wild-type function). This study provides the first evidence of genotypephenotype correlation in ARC and suggests that VPS33B c.1225+5G>C mutation predicts a mild ARC phenotype. We have established an interactive online database for ARC (https://grenada.lumc.nl/LOVD2/ARC) comprising all known variants in VPS33B and VIPAR. Also included in the database are 15 novel pathogenic variants in VPS33B and five in VIPAR. Hum Mutat 33:16561664, 2012. (c) 2012 Wiley Periodicals, Inc.

Renal Function at Hospital Admission and Mortality Due to Acute Kidney Injury after Myocardial Infarction

Background: The role of an impaired estimated glomerular filtration rate (eGFR) at hospital admission in the outcome of acute kidney injury (AKI) after acute myocardial infarction (AMI) has been underreported. The aim of this study was to assess the influence of an admission eGFR<60 mL/min/1.73 m(2) on the incidence and early and late mortality of AMI-associated AKI. Methods: A prospective study of 828 AMI patients was performed. AKI was defined as a serum creatinine increase of >= 50% from the time of admission (RIFLE criteria) in the first 7 days of hospitalization. Patients were divided into subgroups according to their eGFR upon hospital admission (MDRD formula, mL/min/1.73 m(2)) and the development of AKI: eGFR >= 60 without AKI, eGFR<60 without AKI, eGFR >= 60 with AKI and eGFR<60 with AKI. Results: Overall, 14.6% of the patients in this study developed AKI. The admission eGFR had no impact on the incidence of AKI. However, the admission eGFR was associated with the outcome of AMI-associated AKI. The adjusted hazard ratios (AHR, Cox multivariate analysis) for 30-day mortality were 2.00 (95% CI 1.11-3.61) for eGFR, 60 without AKI, 4.76 (95% CI 2.45-9.26) for eGFR >= 60 with AKI and 6.27 (95% CI 3.20-12.29) for eGFR, 60 with AKI. Only an admission eGFR of <60 with AKI was significantly associated with a 30-day to 1-year mortality hazard (AHR 3.05, 95% CI 1.50-6.19). Conclusions: AKI development was associated with an increased early mortality hazard in AMI patients with either preserved or impaired admission eGFR. Only the association of impaired admission eGFR and AKI was associated with an increased hazard for late mortality among these patients.

Pharmacokinetics of cyclosporin - a microemulsion in children with idiopathic nephrotic syndrome

OBJECTIVE: We present a prospective study of a microemulsion of cyclosporin to treat idiopathic nephrotic syndrome in ten children with normal renal function who presented cyclosporin trough levels between 50 and 150 ng/ml and achieved complete remission with cyclosporin. To compare the pharmacokinetic parameters of cyclosporin in idiopathic nephrotic syndrome during remission and relapse of the nephrotic state. METHOD: The pharmacokinetic profile of cyclosporin was evaluated with the 12-hour area under the time-concentration curve (auc0-12) using seven time-point samples. This procedure was performed on each patient during remission and relapse with the same cyclosporin dose in mg/kg/day. The 12-hour area under the time-concentration curve was calculated using the trapezoidal rule. All of the pharmacokinetic parameters and the resumed 4-hour area under the time-concentration curve were correlated with the 12-hour area under the time-concentration curve. ClinicalTrials.gov: NCT01616446. RESULTS: There were no significant differences in any parameters of the pharmacokinetic of cyclosporin during remission and relapse, even when the data were normalized by dose. The best correlation with the 12-hour area under the time-concentration curve was the 4-hour area under the time-concentration curve on remission and relapse of the disease, followed by the 2-hour level after cyclosporin (c2) dosing in both disease states. CONCLUSIONS: These data indicate that the same parameters used for cyclosporin therapeutic monitoring estimated during the nephrotic state can also be used during remission. Larger controlled studies are needed to confirm these findings.

Moderate/severe erectile dysfunction in patients with antiphospholipid syndrome

Purpose: To evaluate sexual function of antiphospholipid syndrome (APS) patients using the Brazilian version of the validated International Index of Erectile Function (IIEF). Materials and methods: Eleven APS male patients (Sapporo criteria) were age and race-matched with 22 healthy controls. Demographic and clinical data, drug use and antiphospholipid antibodies were evaluated. The IIEF was also self-applied. Results: Mean age (p = 0.114), frequency of Caucasian race (p = 1.00) and married status (p = 0.438) were similar in APS and controls. Mean disease duration was 8.8 +/- 4.6 years. Erectile dysfunction (ED) was frequently observed in APS versus controls (45.5 vs. 4.5%, p = 0.0096), especially moderate/severe ED (p = 0.0081). The total IIEF score (49.6 vs. 67.1, p = 0.019), erectile function (19.6 vs. 28.1, p = 0.005) and intercourse satisfaction (7.8 vs. 11.9, p = 0.009) were lower in patients than in controls. No differences were seen in orgasmic function (p = 0.114), sexual desire (p = 0.123) or overall satisfaction (p = 0.097) between the groups. The comparison between APS patients with ED (n = 5) and without ED (n = 6) revealed more arterial events in APS with ED (100 vs. 16.7%, p = 0.0152), and also longer disease duration (12 [7-16] vs. 5.5 [2-13] years, p = 0.031). A trend towards lower venous events (20 vs. 83.3%, p = 0.0801) and higher renal thrombotic microangiopathy (60% vs. 0, p = 0.0606) was observed in APS patients with ED. Demographics, clinical manifestations, smoking and antiphospholipid antibodies positivity were similar in both groups. Conclusion: To our knowledge, this was the first study that demonstrated moderate/severe ED in almost 50% of cases of a rare autoimmune disease. This alteration was linked to arterial events and longer disease duration. Lupus (2012) 21, 319-323.

Pharmacokinetics of cyclosporin: a microemulsion in children with idiopathic nephrotic syndrome

OBJECTIVE: We present a prospective study of a microemulsion of cyclosporin to treat idiopathic nephrotic syndrome in ten children with normal renal function who presented cyclosporin trough levels between 50 and 150 ng/ml and achieved complete remission with cyclosporin. To compare the pharmacokinetic parameters of cyclosporin in idiopathic nephrotic syndrome during remission and relapse of the nephrotic state. METHOD: The pharmacokinetic profile of cyclosporin was evaluated with the 12-hour area under the timeconcentration curve (auc0-12) using seven time-point samples. This procedure was performed on each patient during remission and relapse with the same cyclosporin dose in mg/kg/day. The 12-hour area under the timeconcentration curve was calculated using the trapezoidal rule. All of the pharmacokinetic parameters and the resumed 4-hour area under the time-concentration curve were correlated with the 12-hour area under the timeconcentration curve. ClinicalTrials.gov:NCT01616446. RESULTS: There were no significant differences in any parameters of the pharmacokinetic of cyclosporin during remission and relapse, even when the data were normalized by dose. The best correlation with the 12-hour area under the time-concentration curve was the 4-hour area under the time-concentration curve on remission and relapse of the disease, followed by the 2-hour level after cyclosporin (c2) dosing in both disease states. CONCLUSIONS: These data indicate that the same parameters used for cyclosporin therapeutic monitoring estimated during the nephrotic state can also be used during remission. Larger controlled studies are needed to confirm these findings.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997-2003

Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in childhood. In its typical presentation, it is preceded by an episode of diarrhea mostly due to Shiga-toxin-producing Escherichia coli. There is important geographical variation of many aspects of this syndrome. Nationwide data on childhood HUS in Switzerland have not been available so far. In a prospective national study through the Swiss Pediatric Surveillance Unit 114 cases (median age 21 months, 50% boys) were reported between April 1997 and March 2003 by 38 pediatric units (annual incidence 1.42 per 10(5) children < or =16 years). Shiga-toxin-producing E. coli were isolated in 32 (60%) of tested stool samples, serotype O157:H7 in eight. Sixteen children presented with only minimal renal involvement, including three with underlying urinary tract infection. Six patients presented with atypical hemolytic-uremic syndrome, and six with HUS due to invasive Streptococcus pneumoniae infection. Mortality was 5.3%, including two out of six children with S. pneumoniae infection. The severity of thrombocytopenia and the presence of central nervous system involvement significantly correlated with mortality. In conclusion, childhood HUS is not rare in Switzerland. Contrasting other countries, E. coli O157:H7 play only a minor role in the etiology. Incomplete manifestation is not uncommon.