Frequency of coronary artery disease in patients with renal artery stenosis without clinical manifestations of coronary insufficiency

Atherosclerotic renal artery stenosis (RAS) and coronary artery disease (CAD) arise from the same multiple risk factors. The purpose of this study was to assess the frequency of previously undiagnosed CAD in patients with angiographically confirmed RAS, by conducting coronary arteriography in the same setting. of 57 consecutive patients referred for renal arteriography on clinical grounds during a 14-month period, 28 had no RAS and 6 had RAS, but previously documented CAD. of the remainder 23 patients. 17 (74%; CI 56%-92%) had both RAS and CAD (7 single vessel, 4 two-vessel, and 7 multivessel disease). The clinical characteristics, such as age, blood pressure (BP) levels, signs of heart failure, were no different between those with and without CAD, although the 4 diabetic patients, the 4 patients with fundoscopic findings of grade III retinopathy, 11 of 14 with peripheral arterial disease, and 7 of 8 patients with prior stroke belonged in the CAD group. None developed complications as a result of the two consecutive procedures. The data suggest that in patients with RAS the frequency of silent CAD is high and cannot be predicted on clinical grounds alone, therefore coronary angiography should be routinely recommended in the same setting.

O EEG na insuficiencia renal cronica. I. Atividade de fundo em repouso e durante ativacao

We examined the EEG of 88 patients with chronic renal failure (80 adults and 8 children) submitted to different types of treatment such as hemodialysis, peritoneal dialisys, renal transplantation, and ambulatory follow-up. The main alteration observed was diffuse disorganization of background activity. The following features were detected in decreasing order of frequency: low-voltage EEG, triphasic waves, abnormal waking reactions, and paradoxal alpha rhythm. The children showed abnormal alpha rhythm. The alterations induced by intermittent photic stimulation in our patients were minimal, and this was the main difference in relation to data reported by other authors in EEG studies on patients with chronic uremia.

O EEG na insuficiencia renal cronica. II. Atividades paroxisticas

The authors describe paroxismal epileptiform EEG abnormalities in patients with chronic renal failure. One patient presented paroxismal epileptiform abnormalities in the right parietal region which proceded partial oculo-clonic motor seizures followed by a stroke localized in the same region. This was the main electroclinical correlation found, which, however, was not observed in other patients. Dialysis sessions may improve or worsen these paroxismal epileptiform abnormalities.

O EEG na insuficiencia renal cronica. III. Valor prognostico

In 1983 and 1984 we performed a longitudinal 1-year follow-up study of 15 patients with chronic renal failure, 8 of whom were on hemodialysis and 7 on peritoneal dialysis. The EEG abnormalities of these patients were catalogued and filed and the patients' medical records were examined 5 years later for an analysis of their clinical evolution. Old age EEG findings were detected in young patients with chronic renal failure who died. We conclude that old age EEG findings in patients of any age with chronic renal failure represent a poor prognosis. In contrast, EEG asynchronies are associated with severe uremic encephalopathy but are reversible, since these phenomena were fully reversed together with all clinical alterations in a patient who later received a renal transplant.

Acute renal failure in renal allograft recipients and patients with native kidneys

In order to evaluate the role of underlying disease in the high mortality observed in acute renal failure (ARF) and risk factors related to the development of oliguric ARF in renal allograft recipients, two groups were selected: 34 patients with native kidneys, aged 16 and 57 years, and presenting ischemic ARF caused by cardiovascular collapse, with no signs of infection at the time of diagnosis; and 34 renal allograft recipients who developed ARF immediately after transplantation, without rejection. ARF was defined either as 30% increase of basal plasmatic creatinine in patients with native kidneys or non-normalization of plasmatic creatinine at day 5 after transplantation in renal allograft recipients; oliguria as diuresis ≤ 400 mL/24 h. There were no differences in age, male frequency, oliguria presence and duration, need for dialysis, and infection episodes for renal allograft recipients and patients with native kidneys. The development of sepsis (3% and 41%) and death rate (3% and 44%) were higher in patients with native kidneys (p < 0.01). The renal allograft recipients with both oliguric (n = 18) and nonoliguric (n = 16) ARF were evaluated and no difference was observed in the recipient's age, donor's age, cold ischemia time, time elapsed until plasmatic creatinine normalization, donor's plasmatic creatinine or urea, and mean arterial pressure. No differences were observed between the groups regarding frequency of infection episodes during ARF and frequency of death. In conclusion, renal allograft recipients presented a lower death rate and were less susceptible to sepsis. Cold ischemia time, age, and hemodynamic characteristics of the donor did not affect the development of oliguria.

Tempo de latencia e duracao do efeito do brometo de rocuronio no paciente submetido ao transplante renal

Background and Objectives - Successful cadaver kidney transplantation relies on a fast procedure. Patients with chronic renal failure may present with a delayed gastric emptying making it critical a fast tracheal intubation and airway maintenance. Rocuronium a recently introduced nondepolarizing neuromuscular blocker with a fast onset. The aim of this study was to evaluate onset time and duration of rocuronium effects in patients undergoing renal transplantation. Methods - Sixty patients were allocated into two groups of 30: Group R (GR) = patients undergoing renal transplantation and Group N (GN) = patients with normal renal function. All patients were premedicated with oral midazolam (15 mg) and anesthesia was induced with 30 μg.kg-1 alfentanil, 0.3 mg.kg-1 etomidate and 0.6 mg.kg-1 rocuronium injected through a central venous catheter. neuromuscular block was monitored by acceleromyography in the ulnar nerve pathway. The following parameters were evaluated: time between administration of rocuronium and first twitch reduction to 5% after supra-maximal stimulation (T1) (onset time = OT); time for first twitch to return to 25% (clinical duration = R25); time elapsed between 25% and 75% recovery of first twitch (relaxation recovery time = R25-75). Heart rate (HR) and mean blood pressure (MBP) were recorded in 6 moments. Results - Median OT was 31 sec. in GR and 47 sec. in GN. Median R25 was 51.5 min in GR and 33.5 min in GN. Median R25-75 was 28 min in GR and 20 min in GN. MBP and HR were higher in GR. Tracheal intubation conditions were excellent for most patients in both groups. Conclusions - These results open the possibility of 0.6 mg.kg-1 rocuronium being injected through a central venous catheter when a faster onset is needed. Due to wide differences in individual responses, monitoring of neuromuscular block is recommended.

Peritoneal dialysis in acute renal failure

The definition of adequate dialysis in acute renal failure (ARF) is complex and involves the time of referral to dialysis, dose, and dialytic method. Nephrologist experience with a specific procedure and the availability of different dialysis modalities play an important role in these choices. There is no consensus in literature on the best method or ideal dialysis dose in ARF. Peritoneal dialysis (PD) is used less and less in ARF patients, and is being replaced by continuous venovenous therapies. However, it should not be discarded as a worthless therapeutic option for ARF patients. PD offers several advantages over hemodialysis, such as its technical simplicity, excellent cardiovascular tolerance, absence of an extracorporeal circuit, lack of bleeding risk, and low risk of hydro-electrolyte imbalance. PD also has some limitations, though: it needs an intact peritoneal cavity, carries risks of peritoneal infection and protein losses, and has an overall lower effectiveness. Because daily solute clearance is lower with PD than with daily HD, there have been concerns that PD cannot control uremia in ARF patients. Controversies exist concerning its use in patients with severe hypercatabolism; in these cases, daily hemodialysis or continuous venovenous therapy have been preferred. There is little literature on PD in ARF patients, and what exists does not address fundamental parameters such as adequate quantification of dialysis and patient catabolism. Given these limitations, there is a pressing need to re-evaluate the adequacy of PD in ARF using accepted standards. Therefore, new studies should be undertaken to resolve these problems. Copyright © Informa Healthcare.

Estresse oxidativo nos estágios finais da doença renal crônica em pequenos animais

The chronic kidney disease (CKD) it is characterized by irreversible structural lesions that can develop progressively for uremia and chronic renal failure (CRF). In the CRF it happens the incapacity of executing the functions of maintenance of the electrolyte balance and acid-base, catabolitos excretion and hormonal regulation appropriately. When the mechanism basic physiopathology of the renal upset is analyzed, it is observed that present factors, predispose to the unbalance oxidative. Most of the time, the renal patient comes badly nurtured, with lack in reservations of vitamins and minerals, what reduces the antioxidant defense mechanisms, what favors the installation of the renal oxidative stress, with the formation of species you reactivate of reactive oxygen species (ROS), substances these potentially harmful to the organism. The reduction of the glomerular filtration rate (GFR) in the evolution of CKD in dogs and cats is a component for the installation of the renal oxidative stress. The ROS possesses important action in the kidneys, and these substances are highly reactivate, and when presents in excess damage lipids, proteins, DNA and carbohydrate, driving functional and structural abnormalities taking the cellular apoptosis and necrosis. Against the harmful potential action of these substances you reactivate, she becomes fundamental a delicate control of his production and consumption in the half intracellular, in other words, a balance of his concentration intra and extracellular. That is possible due to the activity of the antioxidants. Like this, to present literature revision had as objective describes the participation of the oxidative stress in CRF, as well as the mechanisms defenses against the harmful action of those substances.

Avaliação da taxa de filtração glomerular e excreção fracionada de eletrólitos de cães com doença renal crônica tratados com dimetilsulfóxido (DMSO)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estresse oxidativo, produção de superóxido e a apoptose de neutrófilos de cães com insuficiência renal crônica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Erliquiose monocítica canina subclínica, naturalmente adquirida: diagnóstico, aspectos clínico-laboratoriais, envolvimento renal e evolução com o tratamento

Pós-graduação em Medicina Veterinária - FCAV

Histopatologia da série eritróide da medula óssea e do tecido renal de cães com insuficiência renal crônica

Pós-graduação em Medicina Veterinária - FMVZ

Perfil eletroforético de proteínas séricas e urinárias de cães normais e de portadores de insuficiência renal crônica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)