The relationship between urinary tract infections and primary vesicoureteral reflux may lead to permanent renal damage. In the literature an increasing number of spontaneous cure of vesicoureteral reflux in children and the significant decrease in surgical therapy has been observed.
To study the evolution of primary vesicoureteral reflux associated with recurring urinary tract infections settings in patients of the Pediatric Nephrology department of our institution, evaluating cases in which cure was achieved through conservative therapy only and those in which surgical intervention was required.
We analyzed records and collected data refers to parameters: sex, age upon the diagnosis of primary urinary infection, age upon diagnosis of vesicoureteral reflux, number of urinary tract infections, vesicoureteral reflux grade; renal function, renal scaring, other malformation of urinary tract, and surgical or conservative intervention. Statistical analysis was descriptive and conducted with the SPSS program.
Within the subgroup of patients with grade IV and V, 63.6% of the cases evolved to surgical intervention and 36.4% to conservative intervention. In those with grades I, II, and III, 38.5% evolved to surgical treatment against 61.5% for conservative approach. Among those with bilateral vesicoureteral reflux, 72.7% had to undergo surgical intervention. No relationship was observed between the vesicoureteral reflux grade and the presence of renal scaring.
Patients with low grade vesicoureteral reflux and recurring urinary tract infections tend to experience spontaneous reflux resolution with good renal evolution in the long term in a way that surgical intervention becomes limited to high grade reflux or when followed by other clinical issues.
Keywords: pediatrics; urinary tract infections; vesico-ureteral reflux;
Autosomal dominant polycystic kidney disease is the most common hereditary renal disease in humans.
To examine the prevalence, clinical and laboratory characteristics of patients with polycystic kidneys and relate disease manifestations by gender.
This was an observational and retrospective study. All the medical records of patients with polycystic kidneys who initiated hemodialysis between 1995 and 2012, in four centers that treat patients of the coverage area of the 15th regional health Paraná (Brazil), were analyzed.
The study included 48 patients with polycystic kidneys, the primary cause of stage 5 CKD. Disease prevalence was one in 10,912 people. The average age of dialysis initiation was 50.7 years and the follow-up time on dialysis until transplantation (36.5 months) was lower among men. Hypertension was the most frequent diagnosis in 73% of patients, predominantly in women (51.4%). The liver cyst was the most frequent extrarenal manifestations in men (60.0%). The death occurred in 10.4% of patients using hemodialysis, and 60% of men. The class of antihypertensive drug used was that acts on the renin-angiotensin system with higher frequency of use among women (53.3%). The post-dialysis urea was significantly higher in men.
The prevalence of the disease is low among hemodialysis patients in southern Brazil. The differences observed between genders, with the exception of the post-dialysis urea, were not significant. The findings are different from those reported in North America and Europe.
Keywords: autosomal dominant; chronic; dialysis; epidemiology; kidney failure; polycystic kidney; renal replacement therapy;
Drug interactions (DIs) are common in clinical practice and are directly related to factors such as polypharmacy, aging, hepatic metabolism and decreased renal function. Individuals with chronic kidney disease (CKD) often require multiple classes of drugs being at important risk for the development of DIs.
Identify potential interactions among drugs prescribed to patients with CKD on conservative treatment, and factors associated with their occurrence.
Observational cross-sectional study, with analysis of 558 prescriptions. Potential DIs were identified by the database MICROMEDEX®, software that provides an internationally known pharmacopoeia.
There was a predominance of males (54.7%), seniors (69.4%), stage 3 CKD (47.5%), overweight and obese patients (66.7%). The most prevalent comorbidities were hypertension (68.5%) and diabetes mellitus (31.9%). Potential DIs were detected in 74.9% of prescriptions. Among the 1364 DIs diagnosed, 5 (0.4%) were contraindicated and 229 (16.8%) of greater severity, which need immediate intervention. Interactions of moderate and low severity were identified in 1049 (76.9%) and 81 (5.9%) prescriptions, respectively. The probability of one DI increased by 2.5 times for each additional drug (CI = 2.18 to 3.03). Obesity, hypertension, diabetes as well as advanced stage of CKD were risk factors strongly associated with DI occurrence.
Drug associations in individuals with CKD were related to high prevalence of serious DIs, especially in the later stages of the disease
Keywords: drug combinations; drug interactions; kidney failure, chronic;
Increased carotid intima-media thickness (IMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events in general population. The prognostic value of IMT in patients with early-stage chronic kidney disease (CKD) has not been clearly established.
We aimed to evaluate the association between IMT and cardiovascular (CV) events and mortality in CKD patients.
A cohort of CKD patients in stage 2-4 was evaluated the occurrence of CV events and death in a 24 months follow-up. Laboratory data, carotid ultrasound and coronary computed tomography were performed at baseline.
A total of 117 patients (57 ± 11 years-old, 61% male) were evaluated. Mean
glomerular filtration rate (eGFR) was 36 ± 17 mL/min, 96% of patients had
hypertension, 23% diabetes and 27% were obese. Coronary calcification was found in
48% of the patients, with higher prevalence among CKD stage 4 (
IMT in early-stage CKD patients was related to coronary calcification, but not with the occurrence of cardiovascular events or death.
Keywords: cardiovascular diseases; carotid intima-media thickness; mortality; renal insufficiency; chronic;
Cutaneous and mucosal disorders are the most common problems in patients on long-term hemodialysis. The dialysis prolongs the life expectancy, giving time of these changes to manifest. The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal disease (CRD) undergoing hemodialysis.
One hundred forty-five patients with chronic renal disease undergoing
hemodialysis were studied. All patients were thoroughly examined for skin changes,
hair, nails and mucous membranes by a single examiner and laboratory tests were
assessed. The data were stored in a database Microsoft Excel and analyzed using
descriptive statistics. The continuous variables were compared using
The study included 145 patients, mean age of 53.6 ± 14.7 years, predominantly
male (64.1%) and caucasian (90.0%). The average time of dialysis was 43.3 ± 42.3
months. The main underlying diseases were: hypertension in 33.8%,
Our study showed the presence of more than one alteration per patient. Cutaneous alterations are frequent in patients on dialysis. Further studies are needed to better characterization and management of these dermatosis.
Keywords: dialysis; kidney failure; chronic; skin diseases;
National chronic dialysis data are fundamental for treatment planning.
To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2012.
A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units in Brazil.
255 (31.9%) of the dialysis units in the country answered the questionnaire. In July 2012, the total estimated number of patients on dialysis in the country was 97,586. The estimated prevalence and incidence rates of chronic kidney disease on maintenance dialysis were 503 and 177 patients per million population, respectively. The estimated number of new patients starting dialysis in 2012 was 34,366. The annual gross mortality rate was 18.8%. For prevalent patients, 31.9% were aged 65 years or older, 91.6% were on hemodialysis and 8.4% on peritoneal dialysis, 30,447 (31.2%) were on a waiting list of renal transplant, 28.5% were diabetics, 36.6% had serum phosphorus > 5.5 mg/dl and 34.4% hemoglobin < 11 g/dl. A venous catheter was the vascular access for 14.5% of the hemodialysis patients.
The prevalence and incidence rates of chronic kidney disease patients on dialysis increased, while the mortality rate tended to decrease compared with 2011. The indicators of the quality of maintenance dialysis remained stable with a trend towards decrease in levels of anemia. The data highlight the importance of the census to guide chronic dialysis therapy.
Keywords: Brazil; census data; chronic; dialysis; epidemiology; kidney failure;
The purpose of this study was to evaluate the impact of donor and recipient characteristics on duration of delayed graft function (DGF) and 1-year serum creatinine (SCr), as a surrogate endpoint for allograft survival.
We reviewed 120 first cadaver kidney transplants carried out consecutively at our center to examine the effect on 1-year SCr of the presence and duration of DGF.
DGF rate was 68%, with a median duration of 12 days (range, 1-61). Forty-four
(38%) patients presented DGF lasting 12 or more days (prolonged DGF group). Mean
donor age was 43 ± 13 years, 37% had hypertension and in 59% the cause of brain
death was cardiovascular accident. The mean cold ischemia time was 23 ± 5 hours.
Twenty-seven (23%) donors were classified as expanded-criteria donors according to
OPTN criteria. The mean recipient age was 51 ± 15 years. The recipients median
time in dialysis was 43 months (range, 1-269) and 25% of them had panel reactive
antibodies > 0%. Patients with prolonged DGF presented higher 1-year SCr in
comparison with patients without DGF (1.7
The presence of vasculopathy in the kidney allograft at time of transplantation was identified as an important factor independently associated with prolonged DGF. Prolonged DGF negatively impacts 1-year graft function.
Keywords: delayed graft function; ischemia; kidney transplantation; reperfusion injury;
During the last decade, several major breakthroughs have led to the identification of human podocyte membrane antigens. Experimental involving antipodocyte antibodies in human membranous nephropathy (MN) have opened a new line of thinking about this disease, relating as an autoimmune kidney disease. In this setting, the M-type phospholipase A2 receptor (PLA2R) was identified as the first major antigen target in human primary MN. Studies have demonstrated anti-PLA2R antibodies against PLA2R ranging from 70 to 89% in patients with MN, but not in those with secondary MN. It has been suggested that the serum level of anti-PLA2R could be used for the diagnosis of idiopathic MN and for the monitoring of response to treatment. However, the coexistence of autoantibodies suggests a complex pathogenic pathway that involves different podocyte targets. New experimental models are needed to elucidate the appearance time and the role of each anti-podocyte antibody in MN development and progression.
Keywords: autoimmune diseases; glomerulonephritis membranous; receptors; phospholipase A2;
The authors of this "fast reading" present the data they have considered as more relevant in the KDIGO 2012 as concerned to evaluation and management of chronic kidney disease. The text does not correspond to their opinion, it is a brief presentation of guidelines that could be useful in clinical practice.
Keywords: anemia; creatinine; glomerular filtration rate; kidney failure, chronic;
In this review, phenomena involved in fluid and solute exchange through the peritoneal membrane, both in the physiologic and in the peritoneal dialysis settings, are explained. For that purpose, mathematical models developed for the study of molecule transport through the membrane, such as the "Pore Model" and the "Distributive Model" are used. Scientific accomplishments in the field are described and areas that require additional research are also cited. Knowledge about the physiologic mechanisms involved in this renal replacement therapy modality, concerning events directly related to the peritoneal membrane itself, is synthesized in this manuscript.
Keywords: epithelium; peritoneal dialysis; peritoneal fibrosis;
Although long-term cardiovascular, renal and bone/mineral effects are unknown SGLT-2 inhibitors, if used with caution and in the proper patient provide a unique insulin-independent therapeutic option in the management of obese type 2 diabetes patients.
Keywords: diabetes mellitus, type 2/therapy; glycosuria; kidney, sodium-glucose transporter 2; diabetes mellitus tipo 2/terapia; glicosúria; rim; transportador 2 de glucose-sódio;
Lipoprotein glomerulopathy (LPG) is a rare autosomal recessive glomerulopathy associated with the deposition of lipoprotein thrombi in the capillary lumina due to apoE gene mutations. Abnormal plasma lipoprotein profile and marked increase in serum apoliprotein E (apoE) are characteristic clinical data. The compromised patients can present nephrotic syndrome, hematuria, and progressive renal failure. Herein, the authors present the first described case of LPG in a Brazilian male patient, 11 years, who presented with a steroid-resistant nephrotic syndrome. Renal function was normal. Kidney biopsy showed markedly enlarged glomerulus, with dilated capillary loops and weak eosinophilic lipoprotein thrombi in the capillary lumina. Interstitium, tubules, arteries, and veins showed normal histologic aspect. Genotypic study for the apoE gene showed the presence of the alleles E3 and E4. The diagnosis of LPG was then performed. The patient received lipid-lowering treatment. After 2 years of follow-up, renal function is gradually decreasing, with persisting heavy proteinuria, despite a marked decrease in serum cholesterol and triglycerides levels.
Keywords: apolipoproteins E; kidney; lipoproteins; nephrotic syndrome; pathology; apolipoproteínas E; lipoproteínas; patologia; rim; síndrome nefrótica;
Launching in 2013, CKDopps Brazil will study advanced CKD care in a random selection of nephrology clinics across Brazil to gain understanding of variation in care across the country, and as part of a multinational study to identify optimal treatment practices to slow kidney disease progression and improve outcomes during the transition period to end-stage kidney disease.
Keywords: estudo multicêntrico; insuficiência renal crônica; protocolos clínicos; resultado de tratamento;
Although the National Committee of Medical Residency (CONAREME) has increased the number of nephrology residency positions in Peru, the increase has not been proportional to the number of applicants. This is worrisome in an environment lacking of nephrologists, like our country. The Peruvian Society of Nephrology (SPN) should take the measures to make this specialty more attractive to Peruvian physicians.
Keywords: educação médica; nefrologia; treinamento de resistência; education, medical; nephrology; resistance training;