João Tomás de Abreu Carvalhaes

Universidade Federal de São Paulo, San Paulo, São Paulo, Brazil

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Publications (19)35.17 Total impact

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    ABSTRACT: Cardiac disease frequently occurs in children with chronic kidney disease (CKD) undergoing dialysis (DI), but it is not well studied in patients undergoing conservative treatment (CT). The aim of our study was to use echocardiography to analyze and compare the cardiac involvement of children with CKD undergoing DI or CT. Methods: Seventy-one children with CKD were included; 41 undergoing DI and 30 undergoing CT. There were 33 controls. Measurements of arterial pressure and structural and functional echocardiographic variables were obtained; the children were followed up for 18 months. Tests of comparison and multiple regression were used; significant if P < 0.05. Results: Arterial hypertension (AH) was present in 37 of 71 (52%) children with CKD: 27 (65.8%) in DI and 10 (33.3%) in CT (X-2 = 8.7; P = 0.003). An abnormal left ventricular geometric pattern was present in 37/41 (90.3%) undergoing DI, 33 had left ventricular hypertrophy (LVH), and in 14/30 (46.7%) undergoing CT, 5 had LVH. Ejection fraction was normal in all groups; diastolic function alteration (DFA) occurred in 28/41 (68.3%) children on DI and in 10/30 (33.3%) on CT (X-2 = 9.2; P = 0.002). For children with CKD, DI (P = 0.002) and hypertension (P = 0.04) were associated with LVH; among those on DI, only AH was associated with LVH (P = 0.02). During the follow-up, 18 (43.9%) children undergoing DI had at least one cardiovascular event. Conclusion: Children with CKD undergoing CT had less cardiac involvement than those undergoing DI. LVH was associated with DI and AH in all children with CKD and with AH in those on DI.
    Echocardiography 02/2014; 31(9). DOI:10.1111/echo.12525 · 1.25 Impact Factor
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    ABSTRACT: The bloodstream infection surveillance system proposed by the Centers for Disease Control and Prevention (CDC) was prospectively conducted in a pediatric hemodialysis unit. Thirty patients were included; 73% had a catheter for vascular access at enrollment. Vascular access infection rate was 21.1 per 100 patient-months, well above those observed in adult patient surveys. Staphylococcus aureus was most frequently isolated (23%).
    Infection Control and Hospital Epidemiology 05/2012; 33(5):521-3. DOI:10.1086/665312 · 3.94 Impact Factor
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    ABSTRACT: Purpose. To analyze the epidemiological, clinical, and laboratory characteristics of hemolytic-uremic syndrome (HUS) in Uberlandia, MG, Brazil. Methods. A historical cohort study was performed encompassing a ten-year period from January 1994 to January 2004 in the Department of Pediatric Nephrology at a full-service hospital; demographic factors, triggering factors, time of hospitalization, supportive therapy, and disease progression were analyzed. Results. Twenty-seven children aged 5 to 99 months (median age of 14 months) were studied; 70.4% were male. Of the 27 patients, 77.8% were from urban areas and 18.5% were from rural areas. Eight of the patients (29.6%) were reported to drink raw milk, and clinical diarrhea was reported in 81.5% of cases. The most common signs and symptoms were fever and vomiting (85.1%), anuria (63.0%), seizure (33.0%), cardiac involvement (11.0%), and acute pulmonary edema (7.4%). Dialysis was performed on 20 patients (74%). The mean hospital stay was 24 days (range: 13 to 36 days). While monitoring the patients, 2 died (7.4%), 3 developed chronic kidney disease (11.0%), and 21 (77.8%) developed hypertension. Conclusion. Our results emphasize the possibility of diagnosing HUS as a cause of renal failure in childhood in both typical (postdiarrheal) and atypical forms and suggest that an investigation of the etiological agent should be made whenever possible.
    12/2011; 2011:651749. DOI:10.5402/2011/651749
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    ABSTRACT: The hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) is one of the most frequent causes of pediatric acute renal failure. The aim of this study was to report the clinic and microbiologic features associated with 13 post-diarrheal HUS cases identified in pediatric intensive care units in the city of São Paulo, Brazil, from January 2001 to August 2005. Epidemiologic, clinic, and laboratorial information, along with fecal and serum samples, were collected for identifying the genetic sequences of Stx and for studying antibodies directed against LPS O26, O111 and O157. STEC was isolated from three patients, and serotypes O26:H11, O157:H7 and O165:H- were identified. In nine patients, high levels of IgM against LPS O111 (n=2) and O157 (n=7) were detected. Dialysis was required in 76.9% of the patients; arterial hypertension was present in 61.5%, neurological complications were observed in 30.7%, and only one patient died. During a 5-year follow-up period, one patient developed chronic kidney disease. The combined use of microbiologic and serologic techniques provided evidence of STEC infection in 92.3% of the HUS cases studied, and the importance of O157 STEC as agents of HUS in São Paulo has not been previously highlighted.
    The Open Microbiology Journal 07/2011; 5:76-82. DOI:10.2174/1874285801105010076
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    ABSTRACT: OBJETIVO: A síndrome de Bartter é uma doença rara, porém uma das mais frequentes condições congênitas perdedoras de cloro. Este trabalho teve como objetivo relatar a evolução de dez pacientes com a síndrome. MÉTODOS: Estudo observacional, descritivo, realizado pela análise de prontuários médicos relatando o perfil metabólico, a depuração de creatinina, o estado nutricional e pôndero-estatural de dez pacientes atendidos no Serviço de Nefrologia da Universidade Federal de São Paulo com características clínico-laboratoriais da síndrome de Bartter, seguidos por um período médio de 43 meses (3-76 meses). Durante o acompanhamento, o tratamento consistiu na administração de suplemento de potássio (100%), magnésio (60%), anti-inflamatórios não hormonais (90%), inibidores de enzima conversora de angiotensina (40%) e espironolactona (50%). A análise estatística constou da comparação dos dados da primeira e da última consulta, utilizando-se o teste de Wilcoxon. RESULTADOSs: Observou-se melhora dos valores absolutos dos itens avaliados e do desenvolvimento pôndero-estatural com a terapêutica empregada, porém apenas a calemia [mediana inicial 3,05mEqL e final 3,25mEqL (p=0,01)] e o escore Z de peso idade [mediana inicial -2,47 e final -1,35 (p=0,02)] apresentaram melhora significante. Dos dez pacientes estudados, dois apresentavam diminuição da depuração de creatinina com doença renal crônica estágio 2 no final do acompanhamento (ambos tinham iniciado o acompanhamento com depuração renal comprometida). CONCLUSÕES: Há necessidade da instituição terapêutica precoce para melhorar os níveis séricos dos eletrólitos e o estado nutricional dos pacientes acometidos, sem comprometer a depuração de creatinina.
    Revista Paulista de Pediatria 06/2011; 29(2):146-151. DOI:10.1590/S0103-05822011000200003
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    ABSTRACT: This cross-sectional study set out to compare total and acyl ghrelin levels in children with mild chronic kidney disease (CKD) undergoing conservative treatment (n = 19) with children with end-stage renal disease (ESRD) undergoing hemodialysis (n = 24), and with healthy controls (n = 20). The relationship between ghrelin levels and parameters of renal function, nutritional status, and selective hormones were investigated. ESRD patients had higher total ghrelin levels than those with mild CKD or control individuals. However, acyl ghrelin did not differ between groups, indicating that the excess circulating ghrelin was desacylated. Since desacyl ghrelin has been shown to inhibit appetite, increased levels might contribute to protein-energy wasting in pediatric renal patients. When all 43 renal patients were combined, multiple regression analysis found age and glomerular filtration rate (GFR) to be significant negative predictors of total ghrelin. Acyl ghrelin was influenced negatively by age and positively by energy intake. Acyl to total ghrelin ratio related positively to GFR and energy intake. The results indicate that total but not acyl ghrelin is influenced by low GFR in children with CKD and suggests that ghrelin activation may be impaired in these patients. Since energy intake is a positive predictor of acyl ghrelin, the physiological control of ghrelin secretion appears to be altered in pediatric renal patients.
    Pediatric Nephrology 12/2010; 25(12):2477-82. DOI:10.1007/s00467-010-1628-5 · 2.88 Impact Factor
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    ABSTRACT: Lowe Syndrome, or Oculocerebrorenal Dystrophy (OCRL), has a recessive inheritance linked to X chromosome. It presents cataracts and glaucoma, delay in neuropsychomotor development, cognitive deficits, and renal Fanconi syndrome. Describe five patients with OCRL, attended at Tubulopathy outpatient clinic. We performed a retrospective assessment of 5 male patient clinical charts of OCRL patients. Mean age at first consultation was 76.5 and mean follow up interval was 30.5 months (8-53 months). Symptoms and clinical signs included cataracts and nystagmus. Neuropsychomotor development and weight and height deficits were present in whole cases, as well as polyuria, polydipsia, and intestinal constipation, metabolic acidosis, phosphaturia, bicarbonaturia, proteinuria, hypercalciuria, hyperuricosuria. Nephrocalcinosis was identified in one, renal lithiasis in three, and reduced kidney size in two patients. We found pathological fractures and rachitism in two, bone rarefaction and delay of bone age in all of the patients. One patient presented a reduction in the rhythm of glomerular filtration. Therapeutically, all patients received alkali, phosphorus and vitamin D reposition in addition to a dietary orientation adequate to their needs. This study emphasizes the importance of early diagnosis and medico-nutritional followup, to avoid complications related to metabolic disturbances.
    Jornal Brasileiro de Nefrologia 06/2010; 32(2):216-22.
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    Ana Paula Weiss, Maria Cristina de Andrade, João Tomas de A. Carvalhaes
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    ABSTRACT: Objective: To describe the case of a patient with Joubert syndrome associated with renal impairments. Case description: A 2 month-old patient was admit- ted with hypotonia and hyperpneia. At the physical exam, besides irregular breathing pattern, abnormal eye move- ments and arterial hypertension without abnormalities in cardiac or pulmonary sounds were observed. At the initial clinical and laboratorial investigations, cardiac and pulmo- nary causes were excluded. The diagnostic hypothesis was: neurological illness associated with renal disease. Labo- ratorial analysis showed respiratory alkalosis, metabolic acidosis and hyperkalemia, with normal renal function. In the magnetic resonance, images of neurological alterations were compatible with the "molar tooth sign", frequently associated with Joubert syndrome. Renal investigation was performed and cystic images in renal parenchyma were found. Comments: Cardiac and pulmonary illness are frequently associated with clinical manifestations such as tachypnea and metabolic alterations. Nevertheless, neurological investigation may be necessary, since some diseases that affect the central nervous system may manifest these signs and symptoms. Association between renal alterations and central nervous system malformations are frequent in sev- eral diseases and should be investigated. Joubert syndrome and its associated disorders are characterized by aplasia of the cerebellar vermis, ataxia, abnormal eye movements and irregular breathing pattern with psychomotor and mental delay. The most frequent renal problems associated with the disease are renal cysts and nephronophtisis that can progress to end-stage renal failure.
    Revista Paulista de Pediatria 06/2009; 27(2). DOI:10.1590/S0103-05822009000200016
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    ABSTRACT: OBJECTIVE:Malnutrition is a frequent complication among children with renal diseases. Short stature is the main clinical sign. The aim of this study is to analyze the nutritional status of children with renal disease using anthropometry. METHODS: This cross sectional study enrolled 21 (43%) boys and 28 (57%) girls with age ranging from 5.3 to 19.5 years. They were divided in three groups based on their creatinine clearance (mL/min/1.73m2): Group 1, >37 (n=19); Group 2, between 15 and 37 (n=9) and Group 3, <15 (n=21). Weight and height were obtained in order to calculate the following indexes: Weight/age (W/A), height/age (H/A) and body mass index (BMI); then, Z scores were obtained. Malnutrition was defined as Z scores below -2. ANOVA test was used to compare groups. RESULTS: There were no differences among the groups for anthropometric data. 19 patients (38.8%) presented short-stature and 22 (44.8%) low-weight. Z scores were similar among groups relative to W/A, H/A and BMI values. W/A Z score values were: Group 1: -1.9±1.8; Group 2: -2.6±3.1 and Group 3: -2.5±1.4 (p=0.47). H/A Z scores values were: Group 1: -1.5±1.2; Group 2: -2.3±1.8 and Group 3: -2.1±1.1 (p=0.18). The calculated BMI Z scores were: Group 1: -1.2±1.4; Group 2: -1.7±3.9 and Group 3: -1.6±1.3 (p=0.82). 19 children presented short stature and 22 presented low weight. There were no differences between the studied groups. CONCLUSIONS: The sample presented high prevalence of malnutrition. Even considering the disease stage, there were no nutritional differences between the studied groups.
    Revista Paulista de Pediatria 06/2009; 27(2):148-153. DOI:10.1590/S0103-05822009000200005
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    ABSTRACT: Bone mineral density (BMD) at the lumbar vertebrae (L(1)-L(4)) was assessed by dual-energy X-ray absorptiometry (DXA) in 20 children with chronic kidney disease (CKD) on dialysis, and its results were compared with bone biopsy and biochemical parameters. Biopsy specimens provided evidence of hyperparathyroid bone disease in eight cases (40%), and low bone turnover in 12 (60%). For BMD, expressed as Z-scores relative to normal, median Z-scores were -1.05 (range -2.36 to 1.06) for hyperparathyroid patients and -1.05 (range -4.40 to -0.03) for low bone turnover patients, with no statistical differences between groups (P = 0.512). In relation to BMD, of the whole sample, five (25%) had a Z-score under -2.0. When it was corrected for height, BMD was in the normal range. Additionally, there were no significant differences in single samples of serum calcium, alkaline phosphatase, phosphorus and intact parathyroid hormone (PTH) between groups with high or low bone turnover. Assessment of nutritional status, through height/age, showed that ten patients had Z-scores below -2.0 (median -2.12, range -7.13 to 0.73). In conclusion, renal osteodystrophy (ROD) seems to have a high prevalence among CKD pediatric patients, although only approximately a quarter of them developed changes in BMD. In children with CKD, measurements of bone mineral density may not be used for classification of various forms of ROD.
    Pediatric Nephrology 11/2007; 22(10):1767-72. DOI:10.1007/s00467-007-0546-7 · 2.88 Impact Factor
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    ABSTRACT: The urinary activity of the angiotensin-converting enzyme (U(ACE)) is not yet completely documented in human neonates. We measured the U(ACE) in 36 premature neonates on the 1st day and in the 1st, 2nd, 3rd, and 4th weeks of life, in 22 full-term neonates between the 1st and 2nd days, and in 30 nursing and preschool children between 1 month and 6 years of age. The urinary excretion of sodium (U(Na)/U(Cr)) and the potassium/sodium index (U(K)/U(Na)) were analyzed in the neonates. U(ACE) was greater in premature than in full-term neonates and greater in both than in older children (p<0.001). In the premature neonates, U(ACE) peaked at the 2nd week, the U(Na)/U(Cr) index decreased, and the U(K)/U(Na) index increased between the 1st day and the 2nd week (p<0.001). The U(Na)/U(Cr) index on the 1st day and in the 1st and 2nd weeks was greater in premature than in full-term neonates (p<0.001). There was no significant correlation between the U(ACE) and the U(Na)/U(Cr) index. In conclusion, the U(ACE) profile was shown to be age dependent and related to the postnatal renal development. The increase in U(ACE) activity may reflect the high activity of the neonatal intrarenal renin-angiotensin system (RAS).
    Pediatric Nephrology 09/2006; 21(8):1138-43. DOI:10.1007/s00467-006-0160-0 · 2.88 Impact Factor
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    ABSTRACT: Nephrotic syndrome in infancy and childhood is known to be associated with a hypercoagulable state and thromboembolic complications, but cerebral sinovenous thrombosis (CST) is a very rare and serious one, with only a few isolated reports in the literature. A case is presented of a 9-year-old boy with nephrotic syndrome that acutely developed signs and symptoms of intracranial hypertension syndrome. CST was diagnosed on cranial CT and MRI and he gradually recovered after treatment with anticoagulants. The diagnosis of CST should be considered in any patient with nephrotic syndrome who develops neurologic symptoms. The discussion of this case, coupled with a review of the literature, emphasizes that early diagnosis is essential for institution of anticoagulation therapy and a successful outcome. This report also illustrates the difficulties that may be encountered in managing such a patient.
    Arquivos de Neuro-Psiquiatria 01/2004; 61(4):1026-9. DOI:10.1590/S0004-282X2003000600027 · 1.01 Impact Factor
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    ABSTRACT: Tubular function of 17 pediatric patients with a mild form of acute post-infectious glomerulonephritis was prospectively evaluated by assessment of the urinary activity of proximal and distal tubule enzymes. Neutral-like endopeptidase (NEP-like) and angiotensin-converting enzyme (ACE) were the proximal tubule enzymes assessed, while prolyl-endopeptidase (PE) and serine-endopeptidase H1 and H2 were the distal tubule enzymes analyzed. Urine was collected at diagnosis (T0) and after 2 (T2) and 6 (T6) months of follow-up. NEP-like enzyme activity (nmol/mg creatinine; median+/-quartile range) was increased at diagnosis, and this remained stable during the first 6 months (T0 18.30+/-83.26, T2 17.32+/-49.56, T6 23.38+/-107.18). Urinary activity of the other enzymes was as follows: ACE (mU/ml per mg creatinine) T0 0.08+/-0.16, T2 0.06+/-0.10, T6 0.18+/-0.29; PE (nmol/mg creatinine) T0 6.70+/-84.87, T2 9.55+/-69.00, T6 13.67+/-28.70; serine-endopeptidase H1 (nmol/mg creatinine) T0 7.86+/-26.95, T2 17.17+/-59.37, T6 18.19+/- 79.14; and serine-thiol-endopeptidase H2 (nmol/mg creatinine) T0 3.06+/-21.97, T2 12.06+/-32.42, T6 16.22+/- 44.06. Thirty other healthy children matched for age and gender were considered as a control group. This group was assessed once and the results were: NEP-like activity 6.05+/-10.54, ACE 0.11+/-0.22, PE 7.10+/-13.36, H1 5.00+/-17.30, and H2 6.00+/-20.16. In conclusion, we observed that NEP-like and H1 enzymes exhibited significant increased urinary activity 6 months after the diagnosis. This increase occurred in spite of the disappearance of clinical symptoms, which occurred 2 months after the diagnosis. We believe that the increase in urinary enzymatic activity could be a manifestation of a silent tubular dysfunction following an episode of acute post-infectious glomerulonephritis.
    Pediatric Nephrology 10/2001; 16(9):719-22. DOI:10.1007/s0046710160719 · 2.88 Impact Factor
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    ABSTRACT: Tubular function of 17 pediatric patients with a mild form of acute post-infectious glomerulonephritis was prospectively evaluated by assessment of the urinary activity of proximal and distal tubule enzymes. Neutral-like endopeptidase (NEP-like) and angiotensin-converting enzyme (ACE) were the proximal tubule enzymes assessed, while prolyl-endopeptidase (PE) and serine-endopeptidase H1 and H2 were the distal tubule enzymes analyzed. Urine was collected at diagnosis (T0) and after 2 (T2) and 6 (T6) months of follow-up. NEP-like enzyme activity (nmol/mg creatinine; median±quartile range) was increased at diagnosis, and this remained stable during the first 6 months (T0 18.30±83.26, T2 17.32±49.56, T6 23.38±107.18). Urinary activity of the other enzymes was as follows: ACE (mU/ml per mg creatinine) T0 0.08±0.16, T2 0.06±0.10, T6 0.18±0.29; PE (nmol/mg creatinine) T0 6.70±84.87, T2 9.55±69.00, T6 13.67±28.70; serine-endopeptidase H1 (nmol/mg creatinine) T0 7.86±26.95, T2 17.17±59.37, T6 18.19± 79.14; and serine-thiol-endopeptidase H2 (nmol/mg creatinine) T0 3.06±21.97, T2 12.06±32.42, T6 16.22± 44.06. Thirty other healthy children matched for age and gender were considered as a control group. This group was assessed once and the results were: NEP-like activity 6.05±10.54, ACE 0.11±0.22, PE 7.10±13.36, H1 5.00±17.30, and H2 6.00±20.16. In conclusion, we observed that NEP-like and H1 enzymes exhibited significant increased urinary activity 6 months after the diagnosis. This increase occurred in spite of the disappearance of clinical symptoms, which occurred 2 months after the diagnosis. We believe that the increase in urinary enzymatic activity could be a manifestation of a silent tubular dysfunction following an episode of acute post-infectious glomerulonephritis.
    Pediatric Nephrology 08/2001; 16(9):719-722. DOI:10.1007/s004670100643 · 2.88 Impact Factor
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    ABSTRACT: Objective: To evaluate dietary and oral supplement vitamin intake in children submitted to dialysis (peritoneal dialysis and hemodialysis).Design: Prospective clinical trial in a 12-month follow-up period.Setting: Children with end-stage renal disease (ESRD) who attended the pediatric nephrology clinic of Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil.Patients: Thirty children (18 girls, 23 in peritoneal dialysis, 7 in hemodialysis) with age 9.3 ± 7.4 years.Intervention methodology: Six successive assessments of both anthropometric indexes and 3-day dietary diaries in children receiving a daily dose of oral water-soluble vitamin supplement.Main outcome measures: Anthropometric indexes (weight/age [], height/age [], midarm muscle area/age [], and fat area/age []) and dietary adequacy-% recommended dietary allowance (RDA) (computerized nutritional analysis from 3-day dietary intake diary).Results: Anthropometric indexes analysis showed that 53% of children were <−2.0 standard deviation score (SDS) of , 63% were <−2.0 SDS of , and 43.3% were <−1.65 SDS of , suggesting growth deficit and low muscle wasted. Total caloric intake was lower than 100% of RDA in 90% of children. Dietary intake of water-soluble vitamins was <100% of RDA in the majority of children, as follows: vitamin C (), B1 (), B2 (), B3 (), B6 (), B12 (), pantothenic acid (), and folic acid (). The combined dietary and vitamin supplement intake resulted in excessive oral intake for almost all the vitamins.Conclusion: Dietary intake of water-soluble vitamins is lower than the RDA in the majority of children with ESRD; supplementation is necessary to reach the RDA. The use of the available vitamin supplement resulted in vitamin intakes that exceeded the RDA for almost all of the vitamins. However, we do not know if these intakes exceeded the children's requirements, nor whether they had any clinically significant harmful effects.
    Journal of Renal Nutrition 01/2000; DOI:10.1016/S1051-2276(00)90019-0 · 2.55 Impact Factor
  • A M Pereira, N Hamani, P C Nogueira, J T Carvalhaes
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    ABSTRACT: To evaluate dietary and oral supplement vitamin intake in children submitted to dialysis (peritoneal dialysis and hemodialysis). Prospective clinical trial in a 12-month follow-up period. Children with end-stage renal disease (ESRD) who attended the pediatric nephrology clinic of Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil. Thirty children (18 girls, 23 in peritoneal dialysis, 7 in hemodialysis) with age 9.3 +/- 7.4 years. INTERVENTION METHODOLOGY: Six successive assessments of both anthropometric indexes and 3-day dietary diaries in children receiving a daily dose of oral water-soluble vitamin supplement. Anthropometric indexes (weight/age [W/A], height/age [H/A], midarm muscle area/age [MAMA/A], and fat area/age [FA/A]) and dietary adequacy-% recommended dietary allowance (RDA) (computerized nutritional analysis from 3-day dietary intake diary). Anthropometric indexes analysis showed that 53% of children were <-2.0 standard deviation score (SDS) of W/A, 63% were <-2.0 SDS of H/A, and 43.3% were <-1.65 SDS of MAMA/A, suggesting growth deficit and low muscle wasted. Total caloric intake was lower than 100% of RDA in 90% of children. Dietary intake of water-soluble vitamins was <100% of RDA in the majority of children, as follows: vitamin C (24/30), B1 (28/30), B2 (22/30), B3 (27/30), B6 (26/30), B12 (1/30), pantothenic acid (24/30), and folic acid (9/30). The combined dietary and vitamin supplement intake resulted in excessive oral intake for almost all the vitamins. Dietary intake of water-soluble vitamins is lower than the RDA in the majority of children with ESRD; supplementation is necessary to reach the RDA. The use of the available vitamin supplement resulted in vitamin intakes that exceeded the RDA for almost all of the vitamins. However, we do not know if these intakes exceeded the children's requirements, nor whether they had any clinically significant harmful effects.
    Journal of Renal Nutrition 01/2000; 10(1):24-9. DOI:10.1053/JREN01000024 · 2.55 Impact Factor
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    ABSTRACT: In chronic uremia (CRF), malnutrition is an important determinant of morbidity in adults and impaired growth in children. Causes of malnutrition include anorexia and abnormal protein and amino acid metabolism. To determine how different levels of dietary protein and CRF interact to influence growth and nutritional status, CRF and sham-operated, pair-fed control rats were fed isocaloric diets containing 8, 17, or 30% protein for 21 d to mimic dietary regimens recommended for CRF patients: the minimum daily requirement; the recommended daily allowance; or an excess of dietary protein. Serum creatinine did not differ between groups of CRF rats but blood urea nitrogen was lowest in CRF rats fed 8% protein (P < 0.001). CRF rats eating 30% protein gained less weight and length compared to their controls or CRF rats fed 8 or 17% protein (P < 0.05); they also had acidemia. CRF rats fed 8% protein had the highest efficiency of utilization of protein for growth, while 17% protein promoted the highest efficiency of utilization of food and calories for growth. Notably, CRF rats eating 30% protein had the lowest protein efficiency; their calorie intake was also the lowest because of anorexia. Plasma branched-chain amino acids were progressively higher in control rats eating 8, 17, or 30% protein. CRF rats fed 8 or 17% protein had lower branched-chain amino acid concentrations compared with CRF rats fed 30% protein. In CRF, it is concluded that excessive dietary protein impairs growth but a low-protein diet does not impair nutritional responses and permits utilization of protein for growth if calories are sufficient.
    Journal of the American Society of Nephrology 11/1999; 10(11):2367-73. · 9.47 Impact Factor
  • Maria Cristina de Andrade, João Tomás de A. Carvalhaes, Aluizio Barbosa Carvalho
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    ABSTRACT: Objective: To evaluate the presence of osteodystrophy in children with chronic kidney disease, comparing results of bone biopsy with biochemical and hormonal parameters of bone meta- bolism, and to evaluate the nutritional status of these children. Methods: Sixteen patients (nine males) with creatinine clearance