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Severe chronic kidney disease may lead to disturbances, such as hyperphosphatemia, increased secretion of fibroblast growth factor -23 (FGF -23) and vitamin D deficiency. These may increase plasmatic levels of parathyroid hormone, and decrease plasmatic levels of calcium. Altogether, these may contribute to the development of secondary hyperparathyroidism, and to abnormalities in mineral metabolism. Kidney transplantation is the best option to improve longevity and quality of life in end -stage chronic kidney disease patients. Vitamin D deficiency has been associated with cardiovascular disease, which is the leading cause of death in chronic kidney disease. Therefore, diagnosing this deficiency may be pivotal for minimizing mortality in chronic kidney disease, because pharmacological treatments for this deficiency may be prescribed. Calcitriol is indicated for the treatment of vitamin D deficiency, both in chronic kidney disease and in kidney transplanted patients. However, calcitriol may increase the plasmatic levels of calcium and phosphorous, which can lead to vascular calcifications, that have been associated with cardiovascular mortality. Selective vitamin D receptor activators are indicated for the treatment of vitamin D deficiency in chronic kidney disease. These have the advantage of being associated with lower increases of plasmatic levels of calcium and phosphorous. These drugs also seem to have additional effects that may minimise patient morbidity and mortality, especially due to potentially reducing cardiovascular events. Unfortunately, there are few studies about the use of these drugs in kidney transplanted patients. Here we present a review about the physiology of vitamin D, the consequences of its deficiency in chronic kidney disease and in kidney transplanted patients, and about the diagnosis and treatment of this deficiency. Finally, we discuss the new line of research about the efficacy and safety of selective vitamin D receptor activators in kidney transplanted patients.

OBJETIVO: Estudar as variações do peptídio natriurético atrial (PNA) introduzidas pela circulação extracorpórea (CEC) durante operação cardíaca e testar a hipótese de que existe correlação entre os níveis plasmáticos de PNA, pressão atrial direita (PAD) pressão atrial esquerda (PAE), diurese e natriurese. MÉTODO: Estudo de coorte de 15 pacientes submetidos a revascularização do miocárdio com CEC. Os intervalos de tempo de observação foram: t0 = 10 minutos antes da CEC (valor controle); t1 = 10 minutos depois de fluxo total em CEC; t2 30 minutos em fluxo total em CEC; t3 = fase final da CEC em temperatura nasofaringeana de 36° C; e t4 = 30 minutos após o término da CEC. RESULTADOS: Os valores do PNA, PAE e PAD variaram significativamente (pOBJECTIVE: To study the variations of the atrial natriuretic peptide (ANP) introduced by extracorporeal circulation (ECC) during cardiac surgery, and to test the hypothesis that there is a correlation between the ANP plasma levels, right atrial pressure (RAP), left atrial pressure (LAP), diuresis and natriuresis. METHOD: Study of a cohort of 15 patients submitted to myocardial revascularization using ECC. The intervals of the observation times were: t0= 10 minutes before ECC (control value); t1= 10 minutes after total flow in ECC; t2=30 minutes into total flow in ECC; t3= end stage of ECC at a nasopharingeal temperature of 36º C; and t4= 30 minutes after ECC has ended. RESULTS: The ANP, LAP and RAP values varied significantly (p

In a clinical, radiological and electrocardiographical, follow-up study of the "case control" type performed in Virgem da Lapa, Minas Gerais State, Brazil, 124 chagasic patients were followed during six years. The results of the patients, the majority in the indeterminate form, did not register any change, in 32.2% there was a progress in the disease and in 5.6% the electrocardiogram returned to normal. These results when compared to that achieved by the control group, composed of pairs of non chagasic persons with the same age and sex, was shown to be 27.4% higher than among patients with positive serology. This factor represents the excess risk or exclusively chagasic component in the development of the disease. No differences were observed by sex related to the development of the disease. It was more premature and seven times more frequent however when related to the cardiopathy than to the megaesophagus. Both conditions occurring mainly in slight or moderate degree. In 192 chagasic patients and 188 non chagasic persons observed in that area in the same period, the mortality was 3.6 times higher among the chagasic patients with a letality due to cardiopathy of 8.9% without difference between sexes but more premature among the males. Sudden death was more frequent than that one caused by cardiac insufficiency. The prognostic was good for the patients with indeterminate and digestive forms and reserved for patients with the highest degree of cardiopathy.