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BACKGROUND AND AIMS HIV patients have an increased risk of chronic kidney disease (CKD) development. Endothelial dysfunction was previously associated with kidney dysfunction markers. This study aims to investigate the association between renal markers and renal dysfunction biomarkers among outpatient HIV patients. METHOD Cohort study carried out with HIV patients in chronic use of Antiretroviral therapy followed up at a public outpatient service located in northeastern Brazil. Clinical and laboratory parameters of HIV patients were evaluated annually between 5 years: 2015 and 2019. Kidney dysfunction markers were blood creatinine and estimated glomerular filtration rate (GFR). Urinary kidney biomarkers NGAL, MCP-1, KIM-1 and serum endothelial biomarkers Syndecan-1 (glycocalyx), ICAM-1 and E-selectin were quantified in first-year using ELISA assays. RESULTS In total 66 patients completed the follow-up. Most patients were male (77.3%), of mixed race/color (57.6%), aged 39.33 ± 9.04 years. No patient had CKD development. However, Syndecan-1 showed a significant correlation with maximum creatinine (P < 0.001) and minimum GFR (P 0.003) over the years. Moreover, both creatinine and GFR in the last year had a significant association with syndecan-1 levels quantified 4 years ago. Multivariate linear regression with confounders showed a significant and independent association of syndecan-1 levels, current age and CD4 + count with minimum GFR. CONCLUSION HIV patients in chronic use of Antiretroviral therapy and glycocalyx injury may have an increased risk for long-term impacts on renal tissue. These data reinforce that endothelial impacts evaluation using biomarkers is a way to optimize the diagnosis and prognosis of kidney diseases, promoting the prevention of complications.

BACKGROUND AND AIMS The use of probiotics in chronic kidney disease (CKD) is hypothesized to contribute to decrease inflammation and endothelial injury, thus preventing cardiovascular disease. The aim of this study was to investigate the effects of probiotics supplementation on biomarkers of endothelial injury (syndecan-1) and inflammation (C-reactive protein), as well as overall biochemical parameters of patients with CKD on hemodialysis. METHOD This is a double-blind, randomized clinical trial, with 80 patients with CKD on hemodialysis in a specialized healthcare clinic at Fortaleza, northeast Brazil, from February to June 2021, of which 40 were allocated to the placebo group and 40 were allocated to receive the probiotics supplementation. The supplementation consisted of the following encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus Rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium Longum A101 in a concentration of 1 billion colony-forming unity (CFU), totaling 4 billion CFU in each capsule. The dosage consisted of ingesting 1 capsule of the supplement daily, after dinner, for 3 months. Pre-dialysis blood collections were performed before and after the treatment period. The ELISA technique was applied to measure the serum syndecan-1 biomarker and PCR. Total blood count, fast glucose and body mass index (BMI) were also investigated. RESULTS About 80% of the recruited patients in the study group completed the trial. When compared with the placebo group, the group that received the probiotics had a significant reduction in syndecan-1 levels (184.3 ± 106 versus 239.48 ± 113.6 ng/mL; P = 0.005) and PCR (1626 ± 617.5 versus 898 ± 313 ng/mL; P = 0.001), increase in hematocrit and hemoglobin, respectively (33.5 ± 5.1 versus 37.1 ± 5.4; P = 0.011; 11.1 ± 1.8 versus 12 ± 1.5; P = 0.036) and decrease in fast glucose levels (146.5 ± 74.6 versus 162.7 ± 112.6 mg/dL; P = 0.026). The BMI classifications did not present significant differences between the groups. CONCLUSION Probiotics supplementation for patients with CKD on hemodialysis evidenced benefits, including a decrease in endothelial injury biomarker (syndecan-1) and inflammation (PCR), as well as improvement in biochemical parameters (hematocrit/hemoglobin and fast glucose). Further studies are required to investigate long-term effects of probiotics among CKD patients, including all stages of the disease.

BACKGROUND AND AIMS The aim of the study was to evaluate the early association of urinary cystatin-C (uCysC) (proximal tubular injury biomarkers) with sepsis and longer hospital stay in premature newborns (NBs) with neonatal infection. METHOD This is a prospective study with NBs from Neonatal Intensive Care Unit (nUTI), between August 2019 and September 2020. Three groups were constructed: healthy NBs, NBs with neonatal infection without sepsis and NBs with sepsis. Premature newborns with kidney disease, renal malformation, insufficient data in the medical record, or samples with scarce volume were excluded. Urine samples were collected for biomarkers measurements. Urinary cystatin-C was quantified in the urine and expressed with or without ratio by urinary creatinine to investigate the urinary concentration bias. RESULTS In total, 62 NBs were included: 27 healthy, 24 with neonatal infection without sepsis and 11 with sepsis. No acute kidney injury (AKI) was found in NBs and 22 (63%) had longer hospital stay (˃ 30 days). Higher levels of urinary cystatin-C, both adjusted for urinary creatinine, were elevated in NBs's sepsis group. Moreover, in NBs with a longer hospital stay, there was an elevated level of urinary cystatin-C, which was capable to predict the need for ˃ 30 days of hospital stay (AUC-ROC = 0.783, P = .01). CONCLUSION Our study demonstrated that kidney tubular damage biomarker, such as uCysC, was associated with early sepsis in premature NBs and was useful to prognosis evaluation.

BACKGROUND AND AIMS High-intensity exercise modalities such as Crossfit have increased the number of practitioners due to the benefits such as weight loss. However, high-intensity exercise can induce renal and endothelial damage. The objective was to verify the main acute effects of high-intensity exercise on renal and endothelial function of Crossfit athletes. METHOD The study was conducted by evaluating 10 high-performance Crossfit athletes, performing pre- and 24-h post-competition test collection. The athletes were evaluated using biomarkers for kidney injury, such as lipocalin associated with neutrophil gelatinase (NGAL), creatine kinase (CK), albumin, creatinine and estimated glomerular filtration rate (eGFR). Endothelial damage was evaluated using serum enzymatic markers, intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1) and Syndecan-1. In addition, athletes' physical and social evaluation questionnaires measuring body composition data and socioeconomic conditions were used. Statistical analysis was performed with Shapiro-Wilk and Student t test for parametric values and Wilcoxon for non-parametric data. Pearson and Spearman tests were used for data with normality and non-normality, respectively. RESULTS There was a significant increase in creatinine (1.03 ± 0.24 versus 1.36 ± 0.34 mg/ dL, P = .001) and CK [median 302.40 (115.75–474.00) versus 2048.80 (542.75–3391.25) U/L, P = .005] 24 h after the activity, and reduced eGFR (91.55 ± 21.15 versus 66.45 ± 20.6 mL/min/1.73 m², P = .000). The values of ICAM-1, VCAM-1, Syndecan-1 and NGAL did not show statistically significant variations. There was a strong positive correlation between syndecan-1 and CK (P = .000, r = 0.953). CONCLUSION The study showed that high performance exercise performed by athletes does not cause significant acute changes in renal function, but its intensity was able to cause muscle damage and endothelial changes in the participants.

BACKGROUND AND AIMS Few studies have investigated the physiological alterations provoked by ultramarathon competition, particularly those related to redox balance, kidney function and NGAL regulation. A better understanding of the dynamics of these biomarkers during ultramarathons could be useful in the search of new biomarkers in the context of exercise physiology. Thus, the aim of this study was to evaluate the relationship between oxidative stress and NGAL levels in blood and urine of amateur athletes before and after a 100-km ultramarathon. METHOD The sample was composed of seven athletes between the ages of 21 and 60 years, submitted to anthropometric evaluation, ergoespirometric testing, urine and blood sampling, biochemical and hormonal measurements, body weight measurement and subjective perception of effort (SPE)—–the perception was evaluated through a scale from 6 to 19 [1], along with verification of competition duration, besides the heart rate (HR), energy expenditure and oxygen consumption (VO2) during the event. The duration, the energy expenditure and the average HR of the competition were measured by a frequency meter (Polar, m200). The data provided was analyzed by the Polar Flow app platform. RESULTS The sample had an average BMI of 25.75 ± 3.20, a body fat percentage of 18.54% ± 4.35% and a VO2max of 48.87 ± 4.78. In the pre-competition period, no significant correlations (P > .05) were found between NGAL levels, in blood and urine and blood and urine biomarkers. In relation to the results obtained after competition, there were no significant correlations among of the NGAL levels and plasma biomarkers, except for the serum creatinine level (P CONCLUSION The data presented here did not support our initial hypothesis that the ultramarathon would cause oxidative stress and acute kidney injury. In addition, there was no significant correlation between oxidative stress biomarkers and NGAL in serum and urine, which suggests that NGAL is more sensitive to the inflammatory process than ROS levels.

Background and Aims Hyponatremia is associated with severe complication in tropical diseases and may be associated with higher mortality. The aim of this study was to investigate the association between hyponatremia and disease severity in patients with leptospirosis. Method This is a retrospective study including patients with confirmed diagnosis of leptospirosis admitted to three reference hospitals in Fortaleza, northeast Brazil, in the period from 1985 to 2018. Demographic, clinical and laboratory data were analyzed, and the incidence of unfavorable outcomes were investigated: acute kidney injury (AKI) – defined according to KDIGO criteria, hemodialysis need and death. Patients were divided in groups according to the levels of sodium at hospital admission (< or ≥135mEq/L). Statistical analysis was done with the SPSS program version 23.0. Results A total of 319 patients were included. Hyponatremia was found in 163 cases (51%) at hospital admission. Patients’ mean age was 37±15 years, and 84% were male. The group with hyponatremia had higher frequency of some symptoms and signs, such as disorientation (8.1% vs 1.3%, p=0.047) and jaundice (76% vs 54%, p Conclusion Hyponatremia in patients with leptospirosis, at hospital admission, is associated with worse prognosis and can be an important parameter to guide clinical care in this group of patients.

Background and Aims Acute kidney injury (AKI) is a frequent and potentially fatal complications of snakebites. Coagulation disturbances are observed and have a high probability to be involved in AKI pathogenesis. Novel endothelial inflammation biomarkers are capable of predicting disease severity and could be used in the setting of snakebites. Method This is a prospective study conducted at the Instituto Dr. José Frota, a reference hospital for toxicological assistance in Fortaleza, Northeast Brazil. Blood and urine samples were collected from patients admitted after snakebite accident, without comorbidities, in 3 different time-points post-bite: on admission (until 8h post-bite), 12 to 16h, and 24-48h. The samples were stored in microtubes, frozen in a freezer (-80ºC) until performance of the laboratory tests. To measure the novel biomarkers the following ELISA kits were used: Angiopoietin-1 (R&D Systems–Duoset DY623), Angiopoietin-2 (R&D Systems–Duoset DY623) and Vascular cell adhesion protein 1 (VCAM-1) (Abcam–ab47355). All procedures were conducted according to the manufacturer’s guidelines. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were divided in 2 groups: with and without AKI. Results A total of 26 patients were included in the study:23 (88.5%) victims of Bothrops accident and 3 (11.5%) Crotalus accidents. AKI was observed in 11 cases. The 2 groups did not differ in age, gender, electrolytes levels, creatine kinase (CK), hemoglobin and hematocrit levels. There were significant differences regarding the levels of angiopoietin 1 (16.39±8.1 vs 4.35±7.36; p=0.0054) and VCAM-1 (1293±528 vs 811.3±234; p=0.0175), both in the second sample (12-16h after bite). The analysis of ROC curve revealed that angiopoietin 1 (AUC: 0.8182, 95% CI0.63–0.99, p=0.0064) and VCAM-1 (AUC: 0.77, 95% CI0.57–0.97, p=0.0182) presented good accuracy for AKI prediction in the studied population. Conclusion Endothelial inflammation biomarkers (VCAM-1 and angiopoietin 1) have good accuracy for snakebites-associated AKI diagnosis. The time 12-16h after the bite had the best result in predicting AKI in this setting.

Background and Aims Kidney biomarkers improve early and specific AKI detection and also poor outcomes in different clinical contexts. Kidney disease is an important risk factor for poor outcomes in COVID-19. The aim of this study was to evaluate association of early levels of kidney biomarkers with poor outcomes in hospitalized patients with COVID-19. Method This is a prospective study conducted at the Instituto Dr. Jose Frota Hospital, an important public reference hospital for COVID-19 in northeast Brazil. Medical records with clinical, epidemiologic, laboratory and outcomes were collected. The urinary NGAL, KIM-1, MCP-1 and nephrin were the kidney biomarkers quantified at hospital admission. ELISA assays were used for analysis and biomarkers urinary concentrations were adjusted for urinary creatinine. Data were expressed as mean± standard deviation or median. Results A total of 69 patients collected urine and were included in this study. Male gender was predominant (65%) and mean age was 56±19 years. Regarding outcomes, the group had 62% of death, 92% of ICU admission and 65% of invasive respiratory support in ICU. Urinary NGAL and MCP-1 were significantly elevated in patients that needed invasive respiratory support in comparison with non-invasive support: uNGAL (median=104 [IQR=74-153] vs 71 [31-79] ng/mg-Cr, p=0.013), and uMCP-1 (3055 [1127-5008] vs 1315 [574-2127] pg/mg-Cr, p=0.027). Urinary nephrin and KIM-1 was also elevated, however with no statistical significance. Moreover, all urinary biomarkers were higher in ICU admission group and death group, but with p>0.05. In ROC curve analysis for prediction of invasive respiratory support, uNGAL had AUC=0.696 (0.565-0.827),p=0.012 and cut-off=78 ng/mg-Cr; uMCP-1 had AUC=0.676 (0.539-0.813), p=0.023 and cut-off=1354 pg/mg-Cr. In survival analysis, patients with uNGAL >78 ng/mg-Cr had worse prognosis and died more quickly (19 vs 48 days, log-rank test; p=0.01). In patients with uMCP-1 >1354 pg/mg-Cr, they also died more quickly, but with no significance (25 vs 48 days, log-rank test; p=0.08). Conclusion Urinary biomarkers NGAL and MCP-1 quantified at hospital admission were associated with poor outcomes, mostly with needed of invasive respiratory support in ICU. Prediction cut-off values for invasive respiratory support was useful to determine the survival prognosis.

Background and Aims Leprosy may present important renal and endothelial abnormalities, and this can worse patients’ prognosis. However, renal and vascular involvement in these patients has been poor investigated. The aim of this study was to investigate if higher systemic endothelial biomarkers levels are associated with renal abnormalities and clinical aspects of leprosy. Method This is a cross-sectional study with leprosy patients before initiation of multidrug therapy enrolled in January 2017 to December 2018 in Fortaleza, northeast Brazil. Leprosy-associated clinical and epidemiological data were collected. Two groups were constructed: Paucibacillary (PB) and Multibacillary (MB) for comparisons. Serum and urine samples were obtained for laboratory analysis. In urine the following parameters were evaluated: creatinine, proteinuria and albuminuria. In serum the endothelial biomarkers were evaluated: VCAM-1 and ICAM-1, using ELISA assay. Results A total of 101 leprosy patients were included, with mean age of 48±15 years, and 71 (70%) were male. The multibacillary form occurred in 81 cases (80%), where 22 had a Virchowian form. VCAM-1 was elevated in MB group and was correlated with the bacteriological index (skin smear) (r = 0.372, p 15 mg/g of creatinine, VCAM-1 showed a significant correlation (r = 0.341, p Conclusion Multibacillary leprosy patients present high systemic levels of VCAM-1, associated with leprosy clinical features and increased albuminuria, an important marker of kidney disease progression. Further prospective studies are necessary to establish a cause-effect relation and evaluate the preventive role of these biomarkers, aiming to improve clinical care.

Background and Aims The incidence and prevalence of chronic kidney disease (CKD) is increasing worldwide, and health literacy is an important goal of any program of health care. The aim of this study is to investigate the knowledge of the population in Brazil about CKD and the ways of prevention, as well as the use of novel technologies to achieve knowledge and get awareness on CKD. Method This is a population-based study conducted in two large urban centers in Northeast Brazil (Fortaleza city, Ceara, and Maceio city, Alagoas). We have applied a questionnaire with questions regarding the knowledge about CKD, its preventive measures, causes, and ways of diagnose (for example, what is “creatinine”?). We have also investigated the use of novel technologies, focused on applications (apps) to achieve information related to health (if the interviewed) already uses to get health information through apps and if they would like to. Sociodemographic information was also collected. Exclusion criteria were: people from the healthcare sector (because they would already have specialized knowledge about CKD, and we aimed to know what the general population know about CKD), people with CKD, other kidney diseases or medical conditions that could lead to the knowledge about CKD. Results A total of 1,147 individuals were interviewed, with a mean age of 38.7±16.0 years, and 621 (54.1%) were female. Regarding the questions about the knowledge about CKD (“Do you know what is chronic kidney disease?”), 442 (38.5%) was found to answer yes. When asked if they know what is creatinine, only 176 (15.3%) said yes. In relation to the risk factors for CKD, 466 (40.6%) answered to know which factors were associated with increased risk for CKD, and 587 (51.1%) said to know how to prevent CKD. Another question was about the use of applications (app) to healthcare, and 358 individuals (31.2%) said to use some type of app to take care of their health. We have also questioned if the interviewed would use applications to get information regarding CKD, and 773 (67.3%) said yes, they would like to. Conclusion CKD is a Public Health problem in Brazil, with huge costs to the health system. Prevention is the key determinant to decrease the disease burden to everyone, people, society and healthcare players. Awareness of CKD seem to be slowly increasing in our country, once a significant percentage of interviewed said to know the ways of prevention, but it is still far from ideal. Technology seem to be an interesting solution to achieve our goals in terms of prevention and treatment of CKD.

Background and Aims Leptospirosis has a broad clinical spectrum. Many patients present a severe disease, with potentially fatal outcomes. Novel biomarkers of endothelial activation are being studied in order to predict the severity of disease and to establish early assistance to the patients. Method For the analysis of biomarkers, blood samples were collected at hospital admission, in proper material for serum isolation. Aliquots were frozen at -80 ºC until the analysis was done. To quantify the biomarkers, ELISA kits were used: Syndecan-1 (Abcam–ab47352), ICAM-1 (Abcam–ab47349) e VCAM-1 (Abcam–ab47355), Angiopoietin-2 (R&D Systems–Duoset DY623) e FGF-23 (R&D Systems–Duoset DY2604). Results A group of 27 patients was evaluated. 24 (88.9%) were males and 3 (11.1%) were females. Mean age was 39.1 ± 17.6 years. 14 (53.8%) required dialysis. Patients who required dialysis presented higher levels of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/mL; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/mL; p = 0.01), and FGF-23 (291 [56-2,031] vs. 10 [10-806] pg/mL; p = 0.021). There were no significant differences in the levels of VCAM-1 and ICAM-1 between the two groups. Syndecan-1 showed significant correlation with the levels of creatinine at hospital admission (r = 0.546; p = 0.05) and total bilirubin at hospital admission (r = 0.534; p = 0.013). Angiopoietin-2 showed significant correlation with the levels of creatinine at hospital admission (r = 0.513; p = 0.009) and the number of hemodialysis sessions (r = 0.406; p = 0.049). No correlation was shown concerning FGF-23. Conclusion Novel biomarkers revealed leptospirosis-associated endothelial activation and were significantly increased in patients with renal involvement. Therefore, they may be useful for establishing early identification and assistance in those patients.

Background and Aims Chronic kidney disease (CKD) have been affecting a large number of patients worldwide and presents increasing numbers. Beyond professional intervention, it is extremely necessary to have patients’ involvement in treatment. One useful way to disseminate CKD knowledge is the social network, through which we can not only reach a large public interested on the posts, but also influence the routine quality of a CKD patient. The aim of this study is to present the creation of an Instagram profile named “Renal Health”, which focuses on providing specific information for patients with CKD to help them improve the quality of treatment results and maintain a healthy lifestyle, as well as to analyze the spontaneous comments and feedbacks received from its followers. Method The Renal Health project started in 2015, in Fortaleza, Brazil, aiming to create technological tools to help CKD patients cope with the disease and increase adherence to treatment. The research team has a multi-professional background, from Health, Information Technology, Computer Science and Communication fields, and also aims to create educational tools to increase health literacy focusing on kidney disease and its prevention. An Instagram profile (https://www.youtube.com/channel/UC3-GHeHAndcrRmbE4I_qE_w) have been created to provide people with access to these specialized contents. Within that context, we collected spontaneous comments and feedbacks from 4,229 followers from the Renal Health Instagram posts from June 2018 (when the profile was created) to December 2019. Results We have reached a total of 4,229 followers. There were 505 posts, 16 (3.16%) about medication, 65 (12.87%) about nutrition, 12 (2.3%) about physical exercise, 132 (26.13%) about kidney disease and comorbidities, 82 (16.23%) about CKD treatment, 61 (12.07%) about kidney transplant and organ donation, and 137 (27.12 %) about other subjects, including motivational messages. Of a total of 1,560 comments, we have identified 543 profiles, of these 88 (16.2%) were men, and 412 (75.8%) women, noting the prevalence of women among the comments made. Among those comments, 223 were regarding congratulations on the profile. We have identified 99 patients with kidney diseases, mainly CKD; 81 (81.81%) spontaneously reported their illnesses in their comments, being 46 (56.8%) on dialysis, 13 (16.4%) transplanted patients, 5 (6.7%) glomerulonephritis, 4 (4.9%) kidney stones and 4 (4.9%) renal cysts. In the group of 46 patients on dialysis, we have identified 105 comments, of which 14 were regarding the value of the information on the posts, followed by 71 comments on personal experiences on the subject and 20 comments containing questions about the topic, which we had prompt answered. Among the group of 13 renal transplanted patients, 12 comments demonstrated their happiness after the transplant and their experiences on the subject, and 1 comment containing a question about kidney transplant. We have also identified other health professionals interacting with the profile, declaring that it was helpful to guide their patients. Furthermore, this platform had crossed the borders, being identified comments by people from around the world, such as other South American countries, the Middle East and Europe. The most recent posts can be seen in Figure 1. Conclusion Through the analysis of the comments we noticed the possibility of better knowing the followers of the project, enabling the development of personalized information for each patient. Social networks, such as the Instagram, seem to be great tools for health education and interaction between health care team and patients. In addition, the use of digital platforms to share trusted health information can reach a broad audience.

Background and Aims Patients with Chronic Kidney Disease (CKD) on dialysis and Diabetes Mellitus type 2 (DM2) may develop dysfunction in several systems, including the respiratory system. The aim of this study is to investigate if there is a relationship between endothelial lesion and pulmonary dysfunction in patients with CKD in hemodialysis with and without DM2. Method This is a cross-sectional study, from October 2017 to August 2018, including 60 patients divided into three groups: patients on hemodialysis (HD) without DM2 (HD in NDM = 30); HD with DM2 (HD in DM = 15); Non-hemodialysis with DM2 (DM without HD = 15) aged 40 to 60 years, regardless of gender. Analyzed pulmonary function were: maximal inspiratory and expiratory pressures (MIP and MEP) and measures of lung capacities and volumes: Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). Results In the DM group in HD: MIP, MEP, FVC and FEV1 showed significant differences (p = 0.008; and p = 0.000; p = 0.000; p = 0.000), respectively. In the HD without NDM group: only the MIP parameter showed no significant difference (p = 0.256), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.001; p = 0.000; p = 0.000), respectively. In the DM group without HD: only MIP showed no statistically significant difference (p = 0.491), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.000; p = 0.008; p = 0.000), respectively when compared to their predicted value. Significant difference was detected between the groups regarding VCAM-1 only between DM in HD and DM without HD (p = 0.040). Syndecan-1 and Angiopoietin-2 plasma levels were statistically different when compared between the groups (p = 0.000) for the two biomarkers, this difference was observed only between the dialysis groups and the diabetic group without dialysis. In the multivariate regression analysis, when the fact that the individual had DM was also added, there was a greater association of VCAM-1 with the fact that the patient did not reach the predicted MEP, this value increased to OR = 8.762 (CI = 2.317 - 33.136) times of chance of not achieving the expected (p = 0.001). However, no statistically significant difference was found when the fact that the patient underwent hemodialysis was included (p = 0.885). Regarding Spearman correlation between MIP and VCAM-1 / Syndecan-1 / angiopoietin-2 there was no significant difference. However, in the correlation between MEP and endothelial lesion biomarkers, there was a significant difference only when compared with VCAM-1 (r = -0.287, p = 0.036). The FEV1 and FVC parameters obtained statistically significant results when correlated only with angiopoietin-2 (r = -0.309; -0.361), respectively. Conclusion Inspiratory muscle strength is reduced only when DM and HD are present when compared to their predicted. Expiratory muscle strength is reduced in all three groups and this parameter is most affected in diabetic individuals undergoing hemodialysis. Pulmonary function is compromised in all three groups equally. Endothelial glycocalyx lesion biomarkers (Angiopoietin-2 and Syndecan-1) are increased mainly in subjects on hemodialysis. Endothelial dysfunction is evidenced in HD group DM by increased VCAM-1 levels. There is a relationship between the lack of expected expiratory muscle strength with high values of VCAM-1 and when added the fact of having DM this relationship increases, however when added the fact of being dialytic there is no significant relationship. There is an inversely proportional correlation between expiratory muscle strength with the adhesion molecule marker (VCAM-1) and between pulmonary function with the endothelial lesion marker (Angiopoietin-2).

Background and Aims High intensive sports athletes are under risk of muscular injuries and likely renal damage secondary to it. As CrossFit is becoming more popular in last years, few consistent studies are available evaluating renal damage associated to this sport. The purpose of this study was to compare proteinuria levels between recreational and professional CrossFit athletes who were under training for a local competition. Method These athletes were invited to answer a survey. After this step, they were submitted to proteinuria analysis through urine dipstick reading. They also were divided into two groups (professional X recreational athletes) and the results were compared using chi-square test. Results A total of 99 athletes have concluded all the steps of the study. Among professional athletes, age average was 34.1 +3.9 year old, body mass index (BMI) 27.14 + 3.14 kg/m2 while in the recreational group the age average was 28.7 + 5.9 and BMI 26.49 + 4.56 kg/m2. Comparing proteinuria analysis, 44.4% of professional group have shown levels between 300 and 1000mg/dL and 14.8% have reached levels above 1000mg/dL, while only 2.8% among recreational ones have reached levels above 300mg/dL (p=0.001) with no one in this groups showing levels > 1000mg/dL. Conclusion This study has shown high proteinuria levels among professional CrossFit athletes comparing to recreational ones. As the literature is scarce in showing long-term kidney damage among CrossFit athletes, epidemiological studies warn about likely kidney damage related to this practice, a fact that can suggest better medical follow-up for CrossFit athletes.

Background and Aims The World Health Organization defines eHealth as the use of information and communication technologies for health purposes. One of its 4 components, mHealth or mobile health, refers more specifically to the provision of health information and services through mobile and wireless technologies. With approximately 7 billion mobile subscriptions worldwide, in many places people are more likely to have access to a smartphone than to drinking water. The aim of this study was to investigate the acceptability of renal transplanted patients to the use of eHealth technologies for their treatment. Method This is a cross-sectional study, performed in a reference hospital located in northeastern Brazil, from January to March 2019, including renal transplant patients older than 18 years old. Data collection was performed through interviews at the post-transplant outpatient clinic in the period preceding the follow-up appointments. The following variables were studied: sociodemographic (gender, age, marital status, race, religion, origin, education, occupation and income), use of technologies (communication devices ownership and / or internet access mobile or at home), purpose and frequency of use, reasons for non-use, and interest in using eHealth tools to assist in post-transplant treatment. We have also interviewed physicians and nurses from the renal transplantation unit regarding this subject. Results A total of 147 patients were interviewed, 63.2% were male, age varied from 13 to 45.1±13 years old, 41.5% were single, with 4 to 10 years of schooling, family income of 2 to 3 minimum wages in Brazil (approximately 400 to 700 US dollars). The patients had had been transplanted around 5 to 6 years ago. As for handset ownership, 90.5% had a smartphone, 39.5% a notebook, 36% a home computer and 12.2% a tablet. As for use, 13% used only for calls. Among the other purposes, 85% used for messaging, 72.1% for internet searches and 74.8% for social networks. Regarding frequency of use, 61.2% used these technologies many times a day. Concerning their interest in using eHealth tools, 93.2% pointed that they would like the tool to be developed for smartphones, and 96.6% said they would use eHealth tools to help them cope with their treatment. The health professionals (10 physicians and 3 nurses) pointed as the main barriers that difficult treatment post-renal transplantation were: patient’s adherence to treatment (76.9%) and low health literacy (53.8%). These professionals pointed that the eHealth technologies can help to increase patients’ adherence, and 23% of them had doubts about effective acceptability by patients. Conclusion To our knowledge, this is the first study in Brazil that addresses the acceptability of eHealth tools among kidney transplanted patients. Transplant recipients were found to already use information technology and are interested in using eHealth tools to help them with the treatment. Health professionals support this initiative and believe these technological tools can increase patient compliance. The next steps of this study are to develop and test eHealth technologies directed for kidney transplanted patients.

Background and Aims Visceral leishmaniasis (VL) is a serious illness if untreated. Liposomal Amphotericin B (L-AMB) is the more effectiveness treatment against LV and less nephrotoxic formulation. We aim to evaluate expression of kidney transporters in VL patients before and during L-AMB use. Method This is a prospective study with 9 selected VL patients that used only L-AMB during hospital stay. Renal transporter analyzes were from before and during the treatment and compared with a control group composed by healthy people. The urine transporters (AQP2, aquaporin 2; NKCC2, Na-K-2Cl cotransporter; NHE3, Na/H exchanger) and a constitutive exosome marker (TSG 101) expressions were measured after urinary exosomes isolation. Results No significant increase of TSG 101 was observed in all comparisons, including between both times and vs healthy controls. Additionally, were observed increased urinary protein expression in VL patients in both times (before and after L-AMB use) in comparison with healthy controls of the AQP2: (105.32 (22.90 – 140.27) vs 1362.97 (627.93-2620.09) or 846,20(552.60-1249.14) %, p Conclusion We suggest that despite less nephrotoxic, the L-AMB use may be monitored to investigate patients at risk of hydroelectrolytic and acid-base disorders.

Background and Aims Chronic kidney disease (CKD) have been considered, worldwide, an important public health problem due to its increasing prevalence and its potential consequence in reducing the time and quality of life of affected patients. In addition, the number of individuals with CKD will continue to increase if no strategies are adopted for preventing and delaying the progression of CKD. Thus, corroborating this strategic thinking and the spread of the internet around the world, we developed the Renal Health mobile app (Oliveira et al. Kidney Int Rep. 2019 Jan 28;4(4):609-613). Because it is easily accessible, free of charge and has essential tools for the promotion of renal health, such as diet therapy guidelines, it has conquered users throughout Brazil, connecting patients and health professionals. From this perspective, the objective of this study was to statistically analyze Renal Health application downloads in 16 Brazilian states, where the app was found to be in use. Method Using the Power BI tools and Dashboards it was possible to extract statistical data from the Renal Health application, since its last updated version, last year, to January 2020. Power BI software is a set of analysis and data sharing tools where the main purpose is to generate reports along with Dashboards which is a kind of graphical interface that provides visualizations of key metrics and performance indicators of a mobile application. This way, from this toolkit, it was possible to obtain a real-time and transparent progress report on the number of Renal Health application downloads, with no personal identification of users. Results The 16 Brazilian states under analysis make up a total of 526 Renal Health application downloads by January 2020. Among these states, São Paulo obtained a total of 129 downloads (24.53%), being the place with the largest number of Renal Health users. The second largest state in number of downloads was Ceara, with a total of 111 (21.10%). The states of Rio de Janeiro, Acre and Minas Gerais also obtained a significant number of downloads of the Renal Health application, totaling 53 (10.08%), 48 (9.13%) and 45 (8.56%), respectively (Figure 1). Comparing the results of this study with the last Brazilian Dialysis Survey, which is coordinated by the Brazilian Society of Nephrology, we can observe the coherence of these results, since the states of São Paulo, Minas Gerais and Rio de Janeiro were cited by this survey as the states with the largest prevalence rates of patients undergoing dialysis, evidencing a possible correlation between the use of this type of technological tool (Renal Health) and the highest prevalence of dialytic CKD, once the Renal Health application is a good way to improve patients’ adherence to treatment and help them cope with the disease. Conclusion The Renal Health application is becoming better known by CKD patients in Brazil, and, based on the number of users currently presented in this study, we conclude that there is a growing search for CKD patients for knowledge about kidney disease on mobile platforms. Therefore, there is a challenge to improve new tools with increasingly interactive content and accessible language, as our team intend to do in the next versions of this app.

Background and Aims Drug-induced acute kidney injury (AKI) is a health problem that increases morbidity and mortality rates as well as costs to health systems. Amphotericin B (AnB) is a widely used antifungal, which its therapy is closely associated with nephrotoxicity. The mechanisms of nephrotoxicity are not yet fully understood and there is a need to search for substances that prevent and / or reverse the associated renal damage. (-) - α-Bisabolol (BIS) has been demonstrated nephroprotective effect due to its antioxidant action. Thus, the aim of this study was to evaluated the effect of BIS as a protective substance on renal cell injury induced by amphotericin B. Method LLC-MK2 tubular renal cells were treated with different concentrations of BIS and AnB and its viability was measured by MTT assay to define the working concentrations of BIS and AnB. Then, cells were pretreated or post treated with BIS (31.25 - 125 μM) and AnB (13.97 μM) for 24 hours to evaluate the protective effect of BIS. Control (CT) was treated with sterile PBS. The experimental groups were further submitted to flow cytometry assays for membrane integrity evaluation using 7-AAD and measurement of cytoplasmic ROS production using DCFH-DA. The experiments were performed in triplicate (n = 3), and the data analyzed by One-Way ANOVA with Bonferroni post-test. Results BIS concentrations from 31.25 to 125 μM were selected, as well as the IC50 for AnB (13.97 ± 1.45 μM) for the furthers assays. Pretreatment with BIS increased cell viability by about 10% (31.25 – 63.31 ± 2.04%; 62.5 – 64.75 ± 2.10%; 125 – 63.92 ± 2.72%) compared to the AnB-only group (49.79 ± 1.25%), which had its cell viability reduced by about 50% (CT – 100.70 ± 0.83%). BIS was also able to increase the whole cell population at concentrations of 62.5 (83.10 ± 1.10%) and 125 μM (84.67 ± 0.98%) when compared to the AnB group (76.54 ± 1.18%). In DCF labeling, it was observed that AnB increased the production of ROS in 20% (IFR = 1.21 ± 0.02) when compared to the control (IFR = 1.00 ± 0.01), and BIS (31.25 μM) was able to reduce in 41% (IFR = 0.79 ± 0.01) when compared to the AnB group. Conclusion The (-)-α-bisabolol was able to prevent the renal cytotoxicity induced by amphotericin.