World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.
Obesity is a disease in which inflammation is directly involved and can lead to impaired renal function.
To evaluate the influence of short term exposure to cafeteria diet on kidney tissue inflammation and advanced glycation end products (AGEs) in the rat plasma.
Male Wistar rats (10 weeks of age, weighing 350 g) were assigned to receive commercial chow diet (C; n = 8 animals/group, 5% of energy from fat) or cafeteria diet (CAF-D, n = 8 animals/group: 29% energy fat) and sucrose in drinking water (300 g/L) for 6 weeks.
adiposity index at six weeks was higher in CAF-D group compared to C. The same behavior was observed for plasma levels of glucose, triglycerides, leptin, insulin and AGEs. The gene expression of IL-6 and TNF-α in renal tissue was higher in CAF-D group and no significant difference in adipose tissue. There was no increase of these cytokines in plasma and kidney or histologically. There was a significant decrease of adiponectin in the CAF-D group.
The short exposure CAF-D reflects changes in metabolism, increased plasma levels of AGEs, which may reflect the increased expression of inflammatory cytokines in the kidney.
Keywords: inflammation; obesity; oxidative stress;
Chronic kidney disease (CKD) screening is advisable due to its high morbidity and mortality and is usually performed by sampling blood and urine.
Here we present an innovative and simpler method, by measuring creatinine on a dry blood spot on filter paper.
One-hundred and six individuals at high risk for CKD were enrolled. The creatinine values obtained using both tests and the demographic data of each participant allowed us to determinate the eGFR. The adopted cutoff for CKD was an eGFR < 60 ml/min.
Mean age was 57 ± 12 years, 74% were female, 40% white, and 60% non-white. Seventy-six percent were hypertensive, 30% diabetic, 37% had family history of CKD, and 22% of smoking. The BMI was 29.5 ± 6.9 kg/m2, median systolic blood pressure was 125 mmHg (IQR 120-140 mmHg) and median diastolic blood pressure was 80 mmHg (IQR 70-80 mmHg). According to MDRD equation, sensitivity was 96%, specificity 55%, predictive positive value 96%, predictive negative value 55% and accuracy 92%. By the CKD-EPI equation the sensitivity was 94%, specificity 55%, predictive positive value 94%, predictive negative value 55% and accuracy 90%. A Bland and Altman analysis showed a relatively narrow range of creatinine values differences (+ 0.68mg/dl to -0.55mg/dl) inside the ± 1.96 SD, without systematic differences.
Measurement of creatinine on dry blood sample is an easily feasible non-invasive diagnostic test with good accuracy that may be useful to screen chronic kidney disease.
Keywords: creatinine; dried blood spot testing; mass screening; renal insufficiency, chronic;
Chronic Kidney Disease (CKD) is an important Brazilian public health issue
that has as main etiologies, arterial hypertension and
Identify the prevalence and the associated factors to the CKD among adults served by the Family Health Strategy (FHS).
Cross-sectional study with epidemiological, descriptive and observational design, realized with 511 adults older than 20 years, served by the FSH in a region of Goiania. CKD was defined as GFR < 60 mL/min/1.73m2 and/or albuminuria ≥ 30 mg/g. The GFR was estimated by the Cockcroft-Gault equation and albuminuria by the ratio of albumin and urinary creatinine in the urine sample. The independent variables were age, sex, blood pressure, alcohol comsumption, DM, smoking and overweight/obesity.
The CKD prevalence was 32,53%. While GFR < 60ml/min/1.73 m2
occurred in 10,64% and albuminuria in 25,29% of the sample. The analysis
identified a significant association between the ages ≥ 60 and GFR
< 60ml/min/1.73 m2 (
There was a high prevalence of CKD's early stages on FHS, taking in consideration the risk factors of age ≥ 60 years old, masculine gender, DM and alcohol consume. Therefore, a CKD screening and monitoring is suggested in adults who are served by the FHS.
Keywords: chronic kidney disease; prevalence; primary health care; risk factors;
Individuals with chronic kidney disease (CKD) are at higher risk of developing cognitive impairment (CI), initially mild (MCI), potentially identifiable, but still poorly diagnosed and treated. The Montreal Cognitive Assessment (MoCA) has been indicated for MCI screening in CKD.
To assess MCI in patients with CKD not yet on dialysis.
Study conducted in 72 non-elderly subjects with pre-dialysis CKD. The neuropsychological assessment included: The global cognitive assessment test MoCA; the clock drawing (CD); the digit span forward (DSF) and reverse (DSR); phonemic verbal (VF) fluency (FAS) and semantics (animals); the fist-edge-palm (FEP); and the memory 10 pictures.
The average age of the participants was 56.74 ± 7.63 years, with
predominance of male sex (55.6%), mainly with ≥ 4 years of education
(84.3%), with CKD cathegories 1, 2 and 3a and 3b (67.6%), hypertension
The MCI is common in non-elderly patients with CKD not yet on dialysis. Together, the CD, DSR and FEP showed similar performance in identify MCI in this population when compared to MoCA, suggesting impairment of executive functions.
Keywords: kidney failure, chronic; mild cognitive impairment; neuropsychological tests;
The glomerulopathies are the most common biopsy-proven kidney diseases. The epidemiological investigation of glomerulopathies allows the identification of their distribution and main causes and enables the development of prevention and treatment strategies.
This study aims to identify the frequency and clinical-pathological correlation of glomerular diseases diagnosed at the HC-UFPR over the period of 5 years.
131 biopsies were performed between January 1, 2008 and December 31, 2012 and were analysed by light and immunofluorescence microscopy. Histopathological slides were reviewed by a pathologist. Clinical and laboratory data and the immunofluorescence microscopy results were extracted from medical records. The findings were tabulated and analysed.
128 of 131 cases were reanalysed. 46.5% were obtained from men. Patients' age averaged 43 years for men and 38 for women. In 99 cases, the indication of biopsy was identified; 49.5% cases presented nephrotic syndrome, 17.17%, acute renal failure and 15.15%, chronic renal failure; 8.08%, nephritic syndrome; 6.06%, isolated proteinuria and 4.04% isolated hematuria. In 61.21% an underlying disease related to the glomerulopathy could be identified; 33.62% corresponded to primary disease and in 5.17% of cases the nature of the glomerulopathy could not be determined. Among secondary glomerulopathies, the most frequent was Lupus Nephritis (49.29%), and among the primary, Focal Segmental Glomerulosclerosis (30.77%) and Membranous Nephropathy (25.64%).
The average patient with glomerulopathy in this service is an adult with nephrotic syndrome. Unlike other reports, secondary glomerulopathies were predominant. These findings may reflect the tertiary characteristic of the assistance at HC-UFPR.
Keywords: epidemiology; biopsy; nephrotic syndrome; lupus nephritis; glomerulonephritis; membranous; glomerulosclerosis, focal segmental;
Fabry disease is a lysosomal storage disorder due to abnormalities in the GLA gene (Xq22). Such changes result in the reduction/absence of activity of the lysosome enzyme α-GAL, whose function is to metabolize globotriaosylceramide (Gb3). Renal disease is a major clinical outcome of the accumulation of Gb3. Podocyte injury is thought to be a major contributor to the progressive loss of the renal function and may be found altered even before the onset of microalbuminuria.
The aim of this study was to quantify the urinary excretion of podocytes in Fabry disease patients (V269M, n = 14) and healthy controls (n = 40), and to correlate podocyturia with the variables gender, age, time of therapy and albumin: creatinine ratio (ACR).
Urinary podocytes were stained using immunofluorescence to podocalyxin and DAPi. The number of podocalyxin-positive cells was quantified and the average number was taken (normal range 0-0.6 podocytes/mL).
The average number of podocytes in the urine of Fabry disease patients was
significantly higher than in healthy controls (
Podocyturia is an important parameter in the assessment of renal disease in general, and it may serve as an additional early tool for monitoring Fabry disease nephropathy even before changes in ACR are seen. This may prove to be a useful tool to assess disease progression in patients expected to have a more aggressive phenotype.
Keywords: fabry disease; fluorescent antibody technique, indirect; podocytes;
National chronic dialysis data have had impact in the treatment planning.
To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2014.
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.
Three hundred twelve (44%) of the dialysis units in the country answered the questionnaire. In July 2014, the total estimated number of patients on dialysis was 112,004. The estimated prevalence and incidence rates of chronic maintenance dialysis were 552 (range: 364 in the North region and 672 in the Southeast) and 180 patients per million population (pmp), respectively. The annual incidence rate of patients with diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19%. For prevalent patients, 91% were on hemodialysis and 9% on peritoneal dialysis, 32,499 (29%) were on a waiting list of renal transplant, 37% were overweight/obese, 29% were diabetics, 16% had PTH levels > 600 pg/ml and 26% hemoglobin < 10 g/dl. A venous catheter was the vascular access for 17% of the hemodialysis patients.
During 2011-2014 the prevalence and incidence rates of patients on dialysis tended to increase, while the gross mortality rate remained stable. In 2014, diabetes was the primary renal disease in 42% of the new dialysis patients.
Keywords: Brazil; census data; dialysis; epidemiology; kidney failure, chronic;
Medical organizations have proposed indices to assess the quality of dialytic therapy offered to patients with chronic kidney disease (CKD). Recently, the Ministry of Health of Brazil published the ordinance n° 389/2014, which establishes targets in the care of patients with CKD.
We evaluate the performance of hemodialysis (HD) clinics in relation to the goals established in this ordinance.
Cross-sectional study, prospective, observational, involving 1,633 patients with CKD on HD in eight clinics. Demographic characteristics, Kt/V, hemoglobin, phosphorus, parathormone (PTH) and the mortality rate were recorded. The results were compared to the goals established in the ordinance No. 389/2014: Kt/V > 1.2 in more than 70% of patients, hemoglobin between 10 and 12 g/dl in more than 80%, phosphorus between 3.5 and 5.5 mg/dl in more than 50%, and PTH < 600pg/ml in more than 80% of patients.
The age was 56.4 ± 15.2 years, the median time on dialysis was 28.4
months. The HD session time was 3.74 ± 0.31 hours. For Kt/V, six
clinics reached the goal. For hemoglobin, none of the clinics reached the
goal. For phosphorus, only two clinics meet the goal and for PTH four
clinics. Six clinics hit two goals and two clinics did not achieve any goal.
Mortality was lower in clinics that reached targets (10.2
For Kt/V most clinics reached the goal established by the ordinance. For hemoglobin and phosphorus, the objectives were not achieved in many clinics. For PTH, the response was variable and dependent on clinical features.
Keywords: guidelines as topic; kidney failure, chronic; mortality; renal dialysis;
Anemia, inflammation and hypoalbuminemia are frequent disorders among patients underwent hemodialysis. There are few national data, particularly from Northeast region where anemia and malnourished were common findings, analyzing the association between these conditions and clinical outcomes.
The aim of this study was to evaluate the impact of the presence of anemia, inflammation and hypoalbuminemia on clinical outcomes (death and hospitalization) of hemodialysis patients.
In this prospective observational study 221 adult patients were evaluated, considering the presence of anemia (hemoglobin ≤ 10 g/dL), inflammation (C-reactive protein (CRP) ≥ 0,5 mg/dL) and hypoalbuminemia (albumin < 3,8 g/ dL) at baseline. Clinical outcomes were recorded over 13 months.
The occurrence of hospitalization and death did not differ between the groups with and
without anemia or inflammation. Patients with hypoalbuminemia had more hospitalizations,
and the presence of hypoalbuminemia was associated with shorter hospitalization
event-free time (
The presence of hypoalbuminemia, but not anemia or inflammation, was able to predict hospitalization in hemodialysis patients.
Keywords: anemia; dialysis; hypoalbuminemia; inflammation;
Anemia is a common complication in dialysis patients, scare studies have evaluated anemia in patients undergoing peritoneal dialysis (PD).
This study aimed to investigate the prevalence of anemia and its associated factors in patients undergoing PD in a single center where patients have free access to agents stimulating erythropoiesis (ESA) and intravenous iron supplementation.
Cross-sectional study analyzing the demographic, clinical and laboratory variables of 120 patients. Anemia was defined as hemoglobin (Hb) < 11 g/dl.
Patients were on PD for 17 months, and the majority of them (86%) received automated
PD. The mean age was 58 ± 16.5 years, and 52% were female and 29% were diabetes. Anemia
was present in 34 (28%) patients. When compared with those without anemia, patients with
anemia received a higher dose of iron (p = 0.02) and had a lower concentration of
triglycerides (p = 0.01). Hb levels correlated negatively with iron (r = -0.20;
Almost 30% of PD patients had anemia, even with free access to erythropoietin and intravenous iron. The transferrin saturation and nutritional status assessed by albumin, were the factors associated with the occurrence of anemia in this population.
Keywords: anemia; iron; malnutrition; peritoneal dialysis;
Sensitization is associated with worse clinical outcomes after kidney transplantation (KT), including increased incidence of delayed graft function, acute rejection (AR) and graft loss.
To evaluate 1-year efficacy and safety outcomes in sensitized KT recipients receiving antithymocyte globulin (ATG) induction and compare them to non-sensitized patients.
Deceased donors KT recipients transplanted between January 1998 and December 2009 were divided into 5 groups: control group 1 -n = 89, PRA negative, without induction therapy; control group 2 - n = 94, PRA negative, basiliximab induction; control group 3 - n = 81, PRA negative, ATG induction; test group 4 - n = 64, PRA 1-49%, ATG induction; test group 5 -n = 118, PRA ≥ 50%, ATG induction.
There was no difference in the incidence of AR among patients sensitized and
non-sensitized, except for group 1, with highest incidence of AR (20.2%,
Sensitized patients induced with ATG presented similar or lower incidence of AR when compared with non-sensitized patients not induced. Besides, these patients had similar safety profile and graft and patient survivals at 1 year.
Keywords: graft rejection; immunosuppression; kidney transplantation; survival;
Pediatric urolithiasis has become more prevalent in recent decades, with high recurrence rates and considerable morbidity. Most children with idiopathic urolithiasis have an underlying metabolic abnormality and proper research provides therapeutic interventions to reduce the formation of new stones and its complications.
To identify demographic and clinical characteristics of pediatric urolithiasis, etiology, treatment management, disease recurrence and patient outcomes in a tertiary care pediatric hospital.
A retrospective descriptive study of pediatric patients admitted to the Hospital Infantil Joana de Gusmão in Florianópolis, SC, Brazil, who were diagnosed with urolithiasis, from January 2002 to December 2012. Data were obtained from medical records. Those patients with diagnosis confirmed by imaging and 24hr urine or single sample urine were included.
We evaluated 106 pediatric patients (65% M). Average age at diagnosis was 8.0 ± 4.2 and 85% of them had positive family history of urolithiasis. Abdominal pain, renal colic and urinary tract infection were the main manifestations. 93.2% had metabolic abnormality and hypercalciuria was the most common. Pharmacological treatment was established in 78% of cases. Potassium citrate and hydrochlorothiazide were used. Surgical treatment was performed in 38% of patients. There was response to treatment in 39% of patients with recurrence of urolithiasis in 34.2% of them. Only 4.7% of patients continued follow-up, 6.6% were referred to other services, 8.5% were discharged and 73.8% lost follow-up.
Pediatric urolithiasis deserves a detailed metabolic evaluation after their initial presentation for treatment, monitoring and prevention of its formation and its complications.
Keywords: abdominal pain; hematuria; hypercalciuria; urolithiasis;
The prevalence of kidney stone disease is increasing worldwide with significant health and economic burden. Newer research is finding that stones are associated with several serious morbidities. Yet, few randomized clinical trials or high quality observational studies have assessed whether clinical interventions decrease the recurrence of kidney stones. Therefore, in this review we analyze the available evidence on medical expulsive therapy for ureteral stones; describe the evidence about non-pharmacological stone therapy including dietary modifications and citrus juice-based therapy; and discuss the efficacy of thiazide diuretics for the treatment of hypercalciuria in recurrent nephrolithiasis.
Keywords: citric acid; hypercalciuria; kidney calculi; nephrolithiasis; potassium citrate;
This review updates current concepts of the genetic risk factors, etiologic events, nephtitogenic responses and treatment of the major immunologically mediated types of glomerulonephritis (GN). These include post-infectious GN, IgA nephropathy, anti-glomerular basement membrane (GBM) antibody disease, ANCA-associated vasculitis (AAV) and lupus nephritis. Although the etiology(s) of most GNs remain undefined, many are now believed to be initiated by environmental insults, particularly infectious processes, that trigger host responses in genetically susceptible individuals which lead to GN. Mechanistic concepts of these diseases have evolved from earlier views that most were consequent to glomerular trapping of preformed immune complexes to the current view that most of these diseases are auto-immune in nature mediated by both antibodies and T cells reactive with self-antigens. Therapy of GN has lagged behind advances in understanding pathogenesis. Newly appreciated roles for older mediators like complement and complement regulatory proteins offer new therapeutic targets.
Keywords: glomerulonephritis; glomerulonephritis, IGA; lupus nephritis; nephritis;
Hydatid disease is a zoonosis caused by the parasite
14-year-old male with hydatid disease of the kidney. The diagnosis was established by imaging studies and specific serologic testing. Treatment consisted of four 4-week cycles of albendazol and resulted in a progressive reduction of the cyst as well as in a negative specific serology.
Even though the recommended treatment is surgical excision, studies have demonstrated that medical treatment may be an alternative allowing for organ preservation.
Keywords: child; echinococcosis; kidney;
Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac,
digestive, cutaneous or neurologic chronic lesions. Latin American countries have the
majority of infected or at risk people. Transplanted patients using immunosuppressive
agents may develop severe and even fatal forms of the disease. The available treatment
causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and
positive serology for Chagas` disease, but without any clinical manifestation of this
pathology, underwent kidney transplantation from a cadaveric donor and displayed three
months later a thigh panniculitis from which a biopsy unveiled amastigote forms of
Keywords: Chagas disease; immunosuppressive agents; kidney transplantation;
Tubulointerstitial nephritis and uveitis syndrome (TINU Syndrome) is an uncommon clinical entity, and the majority of patients are adolescents and young women. The case reported refers to an elderly patient with ophthalmologic symptoms detected earlier than kidney manifestations, being probably the first case described in Brazil.
Female patient, 60 years-old, sought medical attention for complaints of "red eye". Three months after the first episode of eye manifestation, the patient presented with systemic symptoms and renal dysfunction. Renal biopsy showed tubulointerstitial nephritis with signs of activity.
The pathophysiology of TINU Syndrome remains poorly understood, probably involving both cellular and humoral immunity. This syndrome can be differentiated from systemic conditions associated with nephritis and uveitis, and prior exclusion of other diseases is necessary to confirm diagnosis, especially in the presence of ophthalmologic findings.
The clinical suspicion and the knowledge of the management of the disease by nephrologists, internists and ophthalmologists is mandatory in the treatment of patients with TINU Syndrome.
Keywords: acute kidney injury; autoimmune diseases; interstitial; nephritis; uveitis;
Atypical Hemolytic Uremic Syndrome (aHUS) is a rare, life-threatening disease that can occur at any age and be sporadic or familial. aHUS is caused by an uncontrolled activation of the complement system. Plasma Exchange (PE) has been the standard treatment for years with poor results, leading approximately 40% of patients to end-stage renal disease (ESRD) or death during the first clinical manifestation. Eculizumab, an humanized monoclonal antibody directed against complement component C5, has emerged in the last few years as a new therapheutic aproach with promising results. Our goal is to present a case of an adult patient where eculizumab was sucessfully used as upfront therapy avoiding the potential significant morbidity of PE.
Keywords: acute kidney injury; hemolyticuremic syndrome; thrombotic microangiopathies;