Acute kidney injury (AKI) is a complication still poorly studied in the setting of obstetric patients, which is associated with increased mortality. Objective: The aim of this study was to investigate the frequency and risk factors of AKI among critically ill obstetric patients.
A cross-sectional study was conducted with all patients admitted to an intensive care unit (ICU) due to obstetric complications, in Fortaleza, Brazil, in the period between January 2012 and December 2014. AKI was defined according to AKIN criteria.
A total of 389 patients were included, aged between 13 and 45 years. The main
causes of ICU admission were pregnancy-related hypertensive syndromes
(54.5%), hemorrhage and hemorrhagic shock (12.3%), heart diseases (9.0%),
respiratory insufficiency (8.2%) and sepsis (5.4%). AKI was found in 92
cases (24%), and this was the most frequent complication. General mortality
was 7.5%, and mortality due to AKI was 21% (
AKI was the main complication among critically ill obstetric patients and it was associated with increased mortality. Most cases were associated with pregnancy-related hypertensive disorders, which are complications that can be easily identified and treated during prenatal care.
Keywords: gravidez; Insuficiência renal; mortalidade; unidades de terapia intensiva;
Adequate hydration status in the sport is essential for good health, yet the relationship between hydration, proteinuria and sports is little studied.
To analyze the influence of an isotonic sports drink as rehydration strategy on the hydration status and proteinuria after karate training.
Ten athletes participated in this study. In the first session of standard training, called observation training session (STO), the athletes hydrated themselves according to their habits, and in the second session of standard training, called nutritional intervention training session (STIN), an ideal practice of hydration protocol was followed, using an isotonic sports drink as a rehydration liquid during the training. The hydration status was verified by monitoring the body weight before and after training, the urine specific gravity pre-and post-training and the urine volume post-training. To observe the influence of practice of hydration on the renal function post exercise proteinuria was measured.
We observed a statistically significant difference in urine density between
the samples pre- and post-exercise only on STIN (
The use of isotonic sports drink as practice of hydration by karate athletes promoted rehydration during one session of training and reduce post-training proteinuria.
Keywords: desidratação, suplementos nutricionais; artes marciais; proteinúria;
Membranous nephropathy (MN) is one of the major causes of nephrotic syndrome. The complement system plays a key role in the pathophysiology of MN.
To identify the complement pathway possibly activated in MN cases and correlate the presence of C4d with more severe clinical and histological markers.
Sixty nine cases from renal biopsy with membranous nephropathy were investigated. The presence of C1q was analyzed by direct immunofluorescence; and expression of C4d by immunohistochemistry. Clinical and epidemiological data were obtained upon biopsy request.
The presence of focal segmental glomerulosclerosis, global glomerulosclerosis, vascular lesions and tubulointerstitial fibrosis were collected by anatomopathological report. C4d(+) was found in 58 (84%), and C1q(+) was found in 12 (17%) of the cases. Twelve patients had C4d(+)/C1q(+), 46 had C4d(+)/C1q(-), and 11 patients had C4d(-)/C1q(-), probably indicating the activation of the classical, lectin and alternative pathways, respectively.
C4d was associated with increased interstitial fibrosis, but not with clinical markers of poor prognosis. Through the deposition of C4d and C1q we demonstrated that all complement pathways may be involved in MN, highlighting the lectin pathway. The presence of C4d has been associated with severe tubulointerstitial lesions, but not with clinical markers, or can be taken as a universal marker of all cases of MN.
Keywords: enzimas ativadoras do complemento; glomerulonefrite membranosa; proteínas do sistema complemento;
A report on the prevalence of glomerular disease diagnosed via renal biopsy in Salvador, BA, Brazil was published in 1973 and showed a predominance of membranoproliferative glomerulonephritis, which was frequently associated with hepatosplenic schistosomiasis.
In this study, we investigate the potential changes in the distribution of glomerular diseases after a period of important epidemiological transition in Brazil.
Pathology reports of all patients subjected to kidney biopsy from 2003 to 2015 in a referral nephrology service were reviewed. Clinical, laboratorial and pathological diagnoses were collected for analysis. Histological slides of the biopsies performed between 2003 and 2006 were reviewed to examine the accuracy of the estimates based on the pathology reports.
Among the biopsies performed during the time period, 1,312 met the inclusion
criteria for the study. Focal and segmental glomerulosclerosis was the most
prevalent diagnosis, followed by lupus nephritis. However, a trend toward a
decrease in the prevalence of focal and segmental glomerulosclerosis was
The data presented herein suggest the occurrence of changes in the distribution of nephrological diseases in Salvador, Brazil. The disease that was most prevalent shifted from membranoproliferative glomerulonephritis to focal and segmental glomerulosclerosis from 1975 to 2006 and from focal and segmental glomerulosclerosis to lupus nephritis from 2006 to 2015.
Keywords: biópsia por agulha; glomerulonefrite; nefropatias;
Chronic kidney disease (CKD) affects 10-12% of the adult population in many countries. In Brazil, there is no reliable information about the actual prevalence of CKD.
To determine the prevalence of CKD by estimated glomerular filtration rate (eGFR) and proteinuria/albuminuria in an urban population randomly selected in Southern Brazil. Patients and
5,216 individuals were randomly selected out of a pool of 10,000 individuals
identified from the database of a local energy company. The screening
consisted of collection of demographic data, history of
The population was predominantly Caucasians (93%), 64% were females and the
mean age of participants was 45 years old (18-87). BMI (kg/m2)
was 27±5. Albuminuria was found in 5.25% of individuals. 88.6% of
this population had no CKD (eGFR > 60 ml/min/1.73m2 &
normoalbuminuria) and 11.4% were identified as having CKD, with majority on
stages 3A (7.2%) and 3B (1.1%). Hypertension, diabetes, older age and
obesity was associated with a higher prevalence of CKD (
The prevalence of CKD in an urban population in southern Brazil mirrors other developed countries and indicates that kidney disease is an important public health problem in Brazil.
Keywords: prevalência; insuficiência renal crônica; creatinina; albuminúria;
Patients on chronic hemodialysis tend to lose lean body mass and have sedentary behavior.
To compare the level of physical activity and the morphology of the muscles pectoralis major and rectus abdominis of patients on hemodialysis with healthy subjects.
We studied 17 patients and 17 healthy individuals. Muscle thickness were evaluated by ultrasound, and the level of physical activity by the International Physical Activity Questionnaire (IPAQ), long version.
The patients had lower thicknesses of the pectoralis major (5.92 ±
Chronic renal failure patients on hemodialysis have sedentary behavior and lower muscle thickness of the trunk.
Keywords: atividade motora; diálise renal; insuficiência renal crônica;
In stage 5D chronic kidney disease (CKD 5D) patients, the encouragement of treatment adherence by health professionals is a significant clinical challenge.
This study evaluates the impact of a nutritional education programme on hyperphosphatemia, utilizing the transtheoretical model of behavior change (TMBC).
A prospective interventional study comprising 179 CKD 5D patients with hypophosphatemia. The 4-month educational programme took place during dialysis sessions. Demographic and laboratory data were evaluated, whilst the TMBC was utilized both pre- and post-intervention.
132 patients showed a positive change and significant reduction in phosphate levels, whilst 47 patients showed a negative change and little reduction in phosphate levels. Positive changes were identified at different levels of literacy. 117/179 participants had ongoing treatment with sevelamer throughout the trial period. 61 patients with intact parathyroid hormone (iPTH) < 300pg/ml showed phosphate level reductions, whilst 118 patients with iPTH > 300 pg/ml also showed a decrease in phosphate levels.
Nutritional education programmes can achieve excellent results when appropriately applied. An education programme may be effective across different literacy levels.
Keywords: educação; hemodiálise; hiperfosfatemia;
Ultrasound is an emerging method for assessing lung congestion but is still seldom used. Lung congestion is an important risk of cardiac events and death in end-stage renal disease (ESRD) patients on hemodialysis (HD).
We investigated possible variables associated with lung congestion among diabetics with ESRD on HD, using chest ultrasound to detect extracellular lung water.
We studied 73 patients with diabetes as the primary cause of ESRD, undergoing regular HD. Lung congestion was assessed by counting the number of B lines detected by chest ultrasound. Hydration status was assessed by bioimpedance analysis and cardiac function by echocardiography. The collapse index of the inferior vena cava (IVC) was measured by ultrasonography. All patients were classified according to NYHA score. Correlations of the number of B lines with continuous variables and comparisons regarding the number of B lines according to categorical variables were performed. Multivariate linear regression was used to test the variables as independent predictors of the number of B lines.
None of the variables related to hydration status and cardiac function were
associated with the number of B lines. In the multivariate analysis, only
the IVC collapse index (b = 45.038;
Clinical evaluation based on NYHA score and measurement of the collapsed IVC index were found to be more reliable than bioimpedance analysis to predict lung congestion.
Keywords: líquido extracelular; falência renal crônica; edema pulmonar; ultrassonografia;
This study evaluated the incidence of CMV events and its effect on outcomes of kidney transplantation in recipients without pharmacological prophylaxis or targeted preemptive treatment.
The study cohort comprised 802 recipients of kidney transplants between
04/30/2014 and 04/30/2015. The majority received induction with
anti-thymocyte globulin (81.5%), tacrolimus and prednisone in combination
with either mycophenolate (46.3%) or azathioprine (53.7%). The overall
incidence of CMV events was 42% (58.6% infection and 41.4% disease).
Patients with CMV showed higher incidence of first treated acute rejection
the incidence of CMV events was high and associated with higher incidence of acute rejection and changes in immunosuppression. Besides traditional risk factors, renal function at 1 month was independently associated with CMV infection.
Keywords: citomegalovírus; imunossupressão; transplante de rim;
Cardiorespiratory and musculoskeletal dysfunctions are common in the postoperative period of kidney transplant patients and are often accompanied by low exercise tolerance.
The purpose of this study was to evaluate the impact of an early physiotherapy program during hospital stay on functional capacity and peripheral and respiratory muscle strength after kidney transplant.
An open, randomized clinical trial was conducted in patients undergoing living donor kidney transplant. Sixty-three patients were included (intervention group-IG: n = 30; control group-CG: n = 33). IG received an early physiotherapy program from first postoperative day until hospital discharge and CG received standard care. The variables of interest were measured preoperatively and at discharge except for respiratory muscle strength and vital capacity (VC), which were also measured on the first postoperative day. Functional capacity was evaluated through six-minute walk test (6MWT); peripheral and respiratory muscle strength using a dynamometer and manovacuometer, respectively; and VC through spirometer.
After surgery, there was a reduction in functional walking capacity and
peripheral muscle strength without different between groups
An early physiotherapy program during hospitalization for patients undergoing living donor kidney transplant caused a lower reduction in respiratory muscle strength and without additional benefits in the functional capacity, when compared to a control group, although the clinical relevance of this finding is uncertain.
Keywords: transplante renal; modalidades de fisioterapia; força muscular; capacidade vital;
The lungs are often involved in a variety of complications after kidney transplantation. Acute respiratory failure (ARF) is one of the most serious manifestations of pulmonary involvement.
To describe the main causes of ARF in kidney transplant patients who require intensive care and identify the factors associated with mortality.
This retrospective study evaluated adult patients with ARF admitted to the intensive care unit of a center with high volume of transplants from August 2013 to August 2015. Demographic, clinical, and transplant characteristics were analyzed. Multivariate logistic regression analysis was performed to identify factors associated with hospital mortality.
183 patients were included with age of 55.32 ± 13.56 years. 126
(68.8%) were deceased-donor transplant, and 37 (20.2%) patients had previous
history of rejection. The ICU admission SAPS3 and SOFA score were 54.39
± 10.32 and 4.81 ± 2.32, respectively. The main cause of
hospitalization was community-acquired pneumonia (18.6%), followed by acute
pulmonary edema (15.3%). Opportunistic infections were common: PCP (9.3%),
tuberculosis (2.7%), and cytomegalovirus (2.2%). Factors associated with
mortality were requirement for vasopressor (OD 8.13, CI 2.83 to 23.35,
Bacterial pneumonia is the leading cause of ARF requiring intensive care, followed by acute pulmonary edema. Requirement for vasopressor, invasive mechanical ventilation and SAP3 were associated with hospital mortality.
Keywords: insuficiência respiratória; transplante de rim; unidades de terapia intensiva;
Most patients with stage 5 CKD start RRT of unplanned manner. Unplanned dialysis, also known as urgent start, may be defined as hemodialysis (HD) started without permanent vascular access, i.e., using a central venous catheter (CVC), or as peritoneal dialysis (PD) started within seven days after implantation of the catheter, without family training. Although few studies have evaluated the PD as an immediate treatment option for patients starting urgent RRT, theirs results suggest that it is a feasible and safe alternative, with infectious complications and survival similar to patients treated with unplanned HD. Given the importance of the social role of urgent start of dialysis and the lack of studies on the subject, this narrative review aims to analyze and synthesize knowledge in published articles, preferably, from last five years in order to unify information and facilitate future studies.
Keywords: diálise peritoneal; insuficiência renal crônica; terapia de substituição renal; unidades hospitalares de hemodiálise;
New classification for membranoproliferative glomerulonephritis has been proposed in the literature. The aim of this study was to compare the clinical, biochemical, etiology and renal biopsy findings of these patients grouped by immunofluorescence as proposed by the new classification.
Patients with renal biopsy-proven membranoproliferative glomerulonephritis unrelated to systemic lupus erythematosus, diagnosed between 1999 and 2014. The patients were divided according to immunofluorescence: Immunoglobulin positive group, C3 positive only and negative immunofluorescence group.
We evaluated 92 patients, the majority of which were in the immunoglobulin positive group. Infectious diseases, hepatitis C virus and schistosomiasis, were the most frequent etiology. A negative immunofluorescence group had more vascular involvement in renal biopsy compare with others groups.
The only difference between the groups was higher vascular involvement in renal biopsy in negative immunofluorescence group. These new classification was satisfactory for the finding of etiology in one part of the cases.
Keywords: epidemiologia; glomerulonefrite, membranoproliferativa; palavra; microscopia, fluorescência; proteínas do sistema complementar;
The pauci-immune crescentic glomerulonephritis (PICGN) is generally associated with small-vessel vasculitis with a few reported cases associated with other autoimmune diseases such as Systemic Lupus Erythematosus (SLE). We present the case of a female 34-year-old patient with acute kidney injury symptoms with indication for renal replacement therapy in the context of clinical SLE diagnosis. A kidney biopsy was conducted and it was found that most glomeruli showed some segmental sclerosis with synechia to the Bowman's capsule. 67% of the glomeruli had fibroepithelial crescents. Moreover, the interstitial space had a moderate lymphomononuclear infiltration and mild fibrosis. In the arterioles, there were walls thickened by subintimal sclerosis. Direct immunofluorescence detected limited IgM and C3 deposits in capillary loops and negative mensangium for IgG, IgA and C1q. A therapy using corticosteroids and intravenous cyclophosphamide was initiated with stable evolution. PICGN associated with SLE is a rare pathology with clinical presentation, varied evolution and without a standard medical treatment.
Keywords: glomerulonefrite; lúpus eritematoso sistêmico; vasculite associada a anticorpo anticitoplasma de neutrófilos;
The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.
Keywords: artéria renal; biópsia guiada por imagem; hematuria;
Primary hyperoxaluria (PH) is a very rare genetic disorder; it is characterized by total or partial deficiency of the enzymes related to the metabolism of glyoxylate, with an overproduction of calcium oxalate that is deposited in different organs, mainly the kidney, leading to recurrent lithiasis, nephrocalcinosis and end stage renal disease (ESRD). In patients with ESRD that receive kidney transplantation alone, the disease has a relapse of 100%, with graft loss in a high percentage of patients in the first 5 years of transplantation. Three molecular disorders have been described in PH: mutation of the gene alanin glioxalate aminotransferase (AGXT); glyoxalate reductase/hydroxy pyruvate reductase (GRHPR) and 4-OH-2-oxoglutarate aldolase (HOGA1). We present two cases of patients with a history of renal lithiasis who were diagnosed with primary hyperoxaluria in the post-transplant period, manifested by early graft failure, with evidence of calcium oxalate crystals in renal biopsy, hyperoxaluria, hyperoxalemia, and genetic test compatible; they were managed with proper diet, abundant oral liquids, pyridoxine, hydrochlorothiazide and potassium citrate; however, they had slow but progressive deterioration of their grafts function until they reached end-stage chronic renal disease.
Keywords: falência renal crônica; hiperoxalúria primária; litíase; nefrocalcinose; transplante de rim;
A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.
Keywords: drogas veterinárias; hipercalcemia; insuficiência renal; vitamina D;
Patients with chronic kidney disease (CDK) can develop several diseases caused by the renal replacement therapy. Here we report a rare complication of peritoneal dialysis, the encapsulating peritoneal sclerosis (EPS) in which the peritoneal tissue is gradually replaced by fibrous tissue. The patient in question, after late loss of renal graft and conversion to peritoneal dialysis, evolved with multiple hospitalizations for spontaneous bacterial infections, in recent admission, he was diagnosed with sub-occlusive abdomen secondary to the EPS. Five days after, presented with intestinal obstruction requiring surgical approach by laparotomy, being performed with right colectomy, enterectomy, enteroraphy and ileostomy with drainage. The patient progressed well and follows on prednisone and tamoxifen-associated with intermittent hemodialysis.
Keywords: diálise peritoneal; fibrose peritoneal; insuficiência renal crônica;
Granulomatous interstitial nephritis is a rare condition, in which renal involvement is uncommon. Its etiology is variable, and may be medicinal, infectious or inflammatory origin.
This is a 65-year-old male patient with renal lesions of unknown etiology, associated with hypercalcaemia. During the investigation, cardiac insufficiency with diastolic dysfunction and interstitial lung involvement on chest tomography were evidenced. Renal function (glomerular filtration rate) has partially improved with clinical measures. Renal biopsy was performed, which showed moderate interstitial lesion with tuberculoid granulomas without caseous necrosis.
The objective of the article was to describe a case of NIG and to alert to the importance of its clinical investigation. In this case, renal biopsy, associated with systemic clinical manifestations, contributed to the diagnosis of sarcoidosis.
Keywords: hipercalcemia; nefrite intersticial; sarcoidose;
Renal vein thrombosis (RVT) is a complication often associated with nephrotic syndrome. It occurs due to a state of hypercoagulability common in the diseases that attend to this syndromic diagnosis. It should be suspected whenever there is nephrotic syndrome associated with sudden flank pain, hematuria and worsening of proteinuria. Bilateral RVT also presents with frequently oliguric renal dysfunction. This case reports a 33-year-old patient hospitalized for a nephrotic syndrome, with etiologic investigation suggestive of primary membranous glomerulopathy, which evolved with bilateral RVT associated with deterioration of renal function and need for renal replacement therapy. He promptly performed angiography with thrombectomy and thrombolysis, evolving with recovery of renal function in two weeks.
Keywords: glomerulonefrite membranosa; trombose venosa; proteinúria;
Hyporeninemic hypoaldosteronism, despite being common, remains an underdiagnosed
entity that is more prevalent in patients with
Keywords: acidose; acidose tubular renal; diabetes mellitus; hiperpotassemia; hipoaldosteronismo;
It is interesting that some of my predictions came true and some did not, but I
think the jury is still out on many of them. I start to remind everyone on the
glorious past of Nephrology, from the physiology, translational and
methodological discoveries that have contributed to the development of our
discipline. I predict that the Academic branch of Nephrology will continue to
excel in three domains:
Keywords: nefrologia; néfrons; fisiologia;