Jornal Brasileiro de Nefrologia (J Bras Nefrol)

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ISSN 2175-8239

Publications in this journal

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    ABSTRACT: Gitelman's Syndrome (GS) is a rare autosomal recessive salt-wasting nephropathy, classically characterized by hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis and low blood pressure. Fatigue, muscle weakness and muscle paralysis are common symptoms. Besides the typical electrolyte disturbances, others laboratory findings include hyperreninemia and secondary hyperaldosteronism. Bilateral nephrocalcinosis may occur. The treatment consists of potassium replacement and use of aldosterone antagonists. The best approach to pregnant women with GS is yet to be defined. However, we emphasize the need for ions supplementation, weight control as a clinical tool for assessing the water balance, and frequent monitoring of the fetus and amniotic fluid levels. The surgical risk associated with cesarean section in a patient with GS is not yet defined. Despite the risks related to symptomatic episodes of hypokalemia/hypomagnesemia, GS has a good prognosis when treated properly. Pregnancy imposes the need for more intensive control of the disease, but has a good prognosis for the mother and neonate.
    Jornal Brasileiro de Nefrologia 04/2015; 37(2):264-7. DOI:10.5935/0101-2800.20150040
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    ABSTRACT: The number of elderly patients with chronic kidney disease increases progressively, challenging the allocation algorithms in a scenario of organ shortage for transplantation. To evaluate the impact of age on patient and graft survival. Evolution of all 366 patients greater than 60 years transplanted between 1998 and 2010 was analyzed versus a control group of 366 younger patients matched for gender, type of donor (living or deceased) and year of transplantation. Diabetes mellitus (HR 1.8; IC 1.2-2.6; p = 0,003) and prioritization (HR 2.9; IC 1.2-2.6; p < 0,001), but not age, were independent factors for kidney graft loss. Advanced age was not related to negative outcomes after kidney transplantation, after excluding recipient death as a cause of allograft loss. Higher mortality rate in this group was associated to a higher frequency of comorbidities, especially diabetes mellitus.
    Jornal Brasileiro de Nefrologia 04/2015; 37(2):212-220. DOI:10.5935/0101-2800.20150034
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    ABSTRACT: We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients. Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause. 1,679 incident patients were included. They were 52 ± 15 years old, 58.7% male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923 patients had sAlb < 38 g/L (Low sAlb Group) and 756 ones had sAlb > 38.0 g/L (Adequate sAlb Group). The mortality was significantly higher in Low sAlb Group (17% vs. 11%, p < 0.001). Early changes in sAlb significantly affected two-year mortality. Factoring the Kaplan Meier curve of Low sAlb Group by the presence of an increase in sAlb uncovered of a statistically significant difference in mortality favoring the ones whose sAlb went up (19% vs. 15%, p = 0.043). Differently, patients from Adequate sAlb Group with a decrease in their sAlb had a statistically higher mortality rate (13% vs. 8%, p = 0.029). Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb.
    Jornal Brasileiro de Nefrologia 04/2015; 37(2):198-205. DOI:10.5935/0101-2800.20150032
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    ABSTRACT: This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):115-20. DOI:10.5935/0101-2800.20150016
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    ABSTRACT: The anabolic steroid have been used as a therapeutic tool in various clinical conditions. However, indiscriminate use associated with other nutritional supplements has generated serious adverse effects. Male, 21 years old, admitted with nausea, fatigue, appetite loss, headache and hypertension. Blood tests showed Cr: 3.9 mg% U: 100 mg% and Total Calcium 14 mg/dl. Ultrasonography and renal biopsy were consistent with nephrocalcinosis. There has been gradual improvement in renal function and calcium levels after vigorous hydration and furosemide. However, after 1 year, renal calcium deposits persist, corticomedullary ratio reduced in ultrasound and stable creatinine of 1.4 mg/dl. Previous cases showed acute tubular necrosis and interstitial nephritis with little calcium deposits in the renal interstitium. In this case we found severe nephrocalcinosis associated with nephrosclerosis. Our objective is to report the occurrence of acute kidney Injury with nephrocalcinosis associated with use of anabolic steroid and provide a review of the matter.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):135-40. DOI:10.5935/0101-2800.20150020
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    ABSTRACT: Leprosy is still a public health concern in Brazil, where more than 30,000 new cases are detected every year. There are few reports of this mycobacteriosis in imunossupressed pacients, despite the increasing number of solid organ transplantation and the use of post-transplant drugs in this country. The autors describe a case of multibacillary leprosy in a renal transplant recipient, detected 12 years after the procedure, and discuss the therapy, adverse effects and management of leprosy reactions in pacients imunosupressed by drugs.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):131-4. DOI:10.5935/0101-2800.20150019
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    ABSTRACT: Chronic kidney disease (CKD) is a major public health problem worldwide. Nonetheless, little is known about its features in Brazil. To identify prevalence and factors associated with CKD among hospitalized patients in a university hospital. We randomly selected 826 medical records of patients admitted in 2009 in the medical inpatient unit. We defined CKD as the presence of medical diagnosis or personal history. We collected a number of clinical and demographic information and these variables were compared between patients with and without CKD. CKD prevalence was 12.7%. Patients with CKD differed from patients without (p < 0.05) regarding to: living with a partner (59.8% vs. 47.3%), older age (65.8 ± 15.6 vs. 55.3 ± 18.9 years-old), more comorbidities as hypertension (75.2% vs. 46.3%), diabetes (49.5% vs. 22.4%), dyslipidemia (23.8% vs. 14.9%), acute myocardial infarction (14.3% vs. 6.0%) and congestive heart failure (18.1% vs. 4.3%); length of hospitalization (11 (8-18) vs. 9 (6-12) days); and death occurrence (12.4% vs. 1.4%). The logistic regression analysis showed an independent association (OR, odds ratio, CI, confidence interval 95%) of CKD with age (OR 1.019, CI 1.003 to 1.036), hypertension (OR 2.032, CI 1.128 to 3.660), diabetes (OR 2.097, CI 1.232 to 3.570) and congestive heart failure (OR 2.665, CI 1.173 to 6.056). CKD prevalence among patients in a medical inpatient unit was high and CKD patients were more complex, as they were older and had a great number of co-morbidities, reflecting a greater risk of death during hospitalization.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):91-97. DOI:10.5935/0101-2800.20150013
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    ABSTRACT: Chronic kidney disease (CKD) infers directly in functional capacity, independence and therefore quality of life (QOL). To compare the physical fitness and quality of life of patients with chronic kidney disease submitted on hemodialysis (G1) and predialysis treatment (G2). A cross-sectional study, 54 patients with CKD, 27 of the G1 group (58.15 ± 10.84 years), 27 of G2 group (62.04 ± 16.56 years). There were cardiovascular risk factors, anthropometric measurements, respiratory muscle strength was measured by the inspiratory pressure (MIP) and expiratory (MEP) maximum measured in the manometer, six-minute walk (TC6'), cardiopulmonary exercise test, sit and stand one minute test (TSL1') and the Short-Form Questionary (SF-36) to assess QOL. The patients presented disease of stage between 2 and 5. It was applied the Kolmogorov-Smirnov normality test and used the t (Student) test or the U (Mann Whitney) test to compare the means of quantitative variables and the chi-square Pearson test and Fisher's exact test for qualitative variables. Pearson's or Spearman's test was used to identify correlations. No statistically significant difference was found between G1 and G2 in VO2peak (p = 0,259) in TC6' (p = 0,433) in the MIPmáx (p = 0,158) and found only in the MEPmáx (p = 0,024) to G1. The scores of the SF-36 in both groups showed a worse health status as evidenced by the low score in scores for QOL. Patients with CKD had reduced functional capacity and QOL, and hemodialysis, statistically, didn't have showed negative repercussions when compared with pre-dialysis patients.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):47-54. DOI:10.5935/0101-2800.20150008
  • Jornal Brasileiro de Nefrologia 01/2015; 37(1):7-8. DOI:10.5935/0101-2800.20150001
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    ABSTRACT: To compare clinical characteristics and outcomes of patients with and without acute kidney injury (AKI), to evaluate the incidence and mortality of AKI and predictors of AKI and death in patients hospitalized in an Intensive Care Unit (ICU). A retrospective study analyzed 152 patients admitted to a single ICU. We assessed age, gender, reason for hospitalization, risk factors for ARF, laboratory data, the need for renal therapy substitutive and mortality. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) and RIFLE were recorded on the day of ICU admission. We determined the incidence of AKI, mortality and the independent predictors of AKI and death using logistic regression model. Mean age was 57.1 ± 20 years, ranging between 19 to 88 years, and 60.1% were male. Non-dialysis dependent AKI occurred in 81 patients (53.2%) while the ARF requiring dialysis occurred in 19 patients (12.4%). The overall mortality rate in the ICU was 35.9%, whereas the mortality rate in patients with non-dialysis dependent AKI was 43.2% and the IRA with dialysis of 84.2%. In multivariate analysis, invasive mechanical ventilation, elevated creatinine and urea at admission were independent risk factors for AKI, whereas clinical diagnosis, invasive mechanical ventilation, increased lactate and urea and hypernatremia were independent risk factors for ICU mortality. The incidence and mortality of AKI in ICU were high in this study, despite the advances that have been emerging in their management.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):38-46. DOI:10.5935/0101-2800.20150007
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    ABSTRACT: Recent studies show increased prevalence of Cognitive Dysfunction in patients with Chronic Kidney Disease. To evaluate this association in users enrolled in the Family Health Unit Ponte. We studied a sample of 246 elderly. We assessed cognitive function using the Mini Mental State Examination and the Glomerular Filtration Rate using the equation Modification of Diet in Renal Disease. The Glomerular Filtration Rate values obtained (ml/min/1,73 m2) were divided into three categories: < 60.00, 60 to 89.99 and ≥ 90. We collected additional variables from the Medical Support Service and studied the data using bivariate analyzes and logistic regression models. The groups with Glomerular Filtration Rate < 60 and ≥ 90 had a higher prevalence of Cognitive Dysfunction, irrespective of other factors. The odds ratios were, respectively, of 4.534 (95%CI: 1.257 to 16.356) and 3.302 (95% CI: 1.434 to 7.607). According to the literature, we found higher prevalence of Cognitive Dysfunction in the group with Glomerular Filtration Rate < 60. The high prevalence of Cognitive Dysfunction in users with GFR ≥ 90 is described in some studies and may be caused by situations that lead to overestimation of that rate, as the states of cachexia, or situations of glomerular hyperfiltration. The relationship between renal function and the prevalence of Cognitive Dysfunction was not linear, but rather in a parabolic shape. Further studies are needed to explain this relationship and to determine the need for monitoring Cognitive Dysfunction in patients with impaired renal function.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):79-90. DOI:10.5935/0101-2800.20150012
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    ABSTRACT: To describe the clinical and laboratory profile of focal segmental glomerulosclerosis (FSGS) of the collapsing subtype in association with infection by parvovirus B19 (PVB19). Female patient, 37 years old, mulatto, developed pharyngalgia and fever with partial improvement after penicillin. After one week we observed reduced urinary output and lower limb edema. Smoker, family and personal history negative for hypertension, diabetes or kidney disease. Patient presented with olyguria, hypertension and edema, also hypochromic microcytic hypoproliferative anemia, nephritic range proteinuria, microscopic hematuria and renal dysfunction. All rheumatologic investigation, HIV and hepatitis serology were negative. Unremarkable renal ultrasound. PCR positive for PVB19 in bone marrow aspirate and blood and renal biopsy conclusive of collapsing FSGS subtype. Spontaneous remission occurred within two weeks of the profile. The blood PVB19 PCR was repeated within a month and resulted negative. This finding demonstrated PVB19 acute infection or viral reactivation in association with collapsing FSGS. There is demonstrated the temporal association of PVB19 viremia and collapsing FSGS, due primary infection or viral reactivation. The association of collapsing FSGS and PVB19 is described in the literature, demonstrating virus presence in kidney tissue, but the real relationship of virus in the pathogenesis of this glomerulopathy remains unclear.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):121-6. DOI:10.5935/0101-2800.20150017
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    ABSTRACT: Resveratrol (RESV) is a polyphenolic compound found in various plants, including grapes, berries and peanuts, and its processed foods as red wine. RESV possesses a variety of bioactivities, including antioxidant, anti-inflammatory, cardioprotective, antidiabetic, anticancer, chemopreventive, neuroprotective, renal lipotoxicity preventative, and renal protective effects. Numerous studies have demonstrated that polyphenols promote cardiovascular health. Furthermore, RESV can ameliorate several types of renal injury in animal models, including diabetic nephropathy, hyperuricemic, drug-induced injury, aldosterone-induced injury, ischemia-reperfusion injury, sepsis-related injury, and endothelial dysfunction. In addition, RESV can prevent the increase in vasoconstrictors, such as angiotensin II (AII) and endothelin-1 (ET-1), as well as intracellular calcium, in mesangial cells. Together, these findings suggest a potential role for RESV as a supplemental therapy for the prevention of renal injury.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):106-14. DOI:10.5935/0101-2800.20150015
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    ABSTRACT: To report the use of Eculizumab in atypical hemolytic uremic syndrome (aHUS) after renal transplantation. A 16 year-old patient diagnosed with chronic kidney disease since 2010, due to aHUS, under dialysis. kidney transplantation by deceased donor: February/2012. She showed good clinical evolution until the 14th postoperative day, when he developed a fever, oliguria, worsening of renal function [serum creatinine (CRs): 4.0 mg/dl] and signs of hemolysis [platelets: 110,000 mm3; hemoglobin (Hb): 4.5 g/dL; LDH: 3366 U/L]. Renal biopsy of the graft: thrombotic microangiopathy. Treated with handling blood products (fresh plasma) and plasmapheresis, with improvement of renal function (serum creatinine: 1.46 mg/dl). A week after this complication, fever anemia, signs of hemolysis and ITU restarted then it was handled with ciprofloxacin, methylprednisolone pulse therapy and plasma transfusion (Platelets: 43,000 mm3; Hb: 6.0 mg/dl, reticulocytes; 1.3%, haptoglobin < 5.8 mg/dl, HDL: 1181 U/L). After clinical worsening, it was started a therapy with Eculizumab, 900 mg in every five days for two weeks. There was some progress with good clinical response, characterized by improved renal function, stabilization of aHUS and discharged in five days. Since then, she keeps using Eculizumab 900mg each 15 days with the renal and haematological normalization (Platelets: 160,000 mm3; Hb: 11.4 g/dL). The use of Eculizumab was useful in controlling the ongoing manifestation of aHUS and transplant preservation.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):127-30. DOI:10.5935/0101-2800.20150018
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    ABSTRACT: Chronic Kidney Disease (CKD) is associated with high rates of morbidity and mortality, especially in dialyses population. To determine the overall survival rate; the epidemiological and clinical profiles; the comorbidities and the variables associated with survival of the patients undergoing hemodialysis. This is a longitudinal and descriptive study with 162 patients undergoing hemodialysis, at the University Hospital. The categorical variables were described by frequency and percentage; numerical variables by mean and standard-deviation. The analysis by Cox Regression model was used to study the influence of several clinical and demographic variables in survival rates. Kaplan Meyer model was used to construct the survival curves of the significant variables. The mean age was 48.09 years, and the monthly family income and level of education were reduced in most of the patients studied. Hypertension was the main comorbidity associated with CKD in this population, followed by Diabetes Mellitus. The variables that negatively influenced the survival rates were advanced age at the beginning of therapy and low hemoglobin and albumin levels. The overall survival was 84.41% and 63.32% in one and five years, respectively. The rate of survival was considered low compared others studies and was decreasing over the years, not representing improvements despite technological advances in diagnostic and therapeutic approachs. Advanced age, hypoalbuminemia and anemia are strong predictors of mortality.
    Jornal Brasileiro de Nefrologia 01/2015; 37(1):64-71. DOI:10.5935/0101-2800.20150010