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Background: Catheter implantation techniques for peritoneal dialysis (PD) have advanced significantly in recent years. We aimed to analyze the survival and associated complications of catheters inserted using a new technique that is guided by ultrasound and fluoroscopy and requires minimal tissue dissection. The procedure was performed by nephrologists in the outpatient basis, we compared these results of the minimally invasive insertion with traditional implantation using trocars. Methods: A total of 152 PD catheters were placed in 152 patients with stage 5 chronic kidney disease; 62.5% of the patients were men, with a mean age of 56.6 ± 18.5 years. The following two methods were used: minimally invasive insertion (MI group, n = 73) and trocar insertion (T group, n = 79). Patients in both the groups were followed prospectively for 26 months from the date of the first implantation. Results: Gender, age, and prevalence of diabetes mellitus were not significantly different between the groups, while the body mass index, presence of obesity, and abdominal scars from previous surgeries were higher in the MI group ( p = 0.021). The incidence of catheter dysfunction was lower in the MI group compared to group T (6.8% vs 20.3%; p = 0.019). Exit site infection was also lower with the new technique (4.1% vs. 18.9%; p = 0.005). Further, the cumulative incidence of peritonitis also reduced with MI ( p = 0.034). Finally, the overall catheter survival at 1 year was 89%, which has been shown as higher in group MI (95% vs 82% in group T; p = 0.025). Conclusion: The MI technique for catheter insertion showed low complication rates and excellent catheter survival as compared to traditional implantation methods; thus, it may be an alternative method for PD catheter placement.

BACKGROUND This study aimed to validate the Malnutrition Clinical Characteristics (MCC) compared with the Subjective Global Assessment (SGA), considering anthropometric measures, comorbidities, and mortality in critically ill patients. METHODS This longitudinal observational study included patients admitted to the general intensive care unit (ICU) of a public hospital. SGA was used as the reference standard for diagnosing malnutrition. The inclusion criteria were patients receiving nutrition support therapy and age >18 years. The nutrition therapy was optimized as close as possible to 100% of the patients' energy and protein needs regardless of the access route. Hospital length of stay (LOS), comorbidities on admission, and death were documented during the entire hospitalization of each patient. Body mass index (BMI), midarm circumference (MAC), and calf circumference (CC) were considered anthropometric measures. RESULTS The convenience sample comprised 102 ICU patients. Comparing the original malnutrition classifications of SGA with MCC, the specificity was 87.5%, sensitivity was 100%, accuracy was 93.3%, positive predictive value was 87.5%, and negative predictive value was 100%. When classified in 2 groups, namely "well-nourished" and "malnourished," specificity and sensitivity were 100% between both groups. Malnourished patients had significantly higher mortality rates (P = .006) and longer LOSs (P

This consensus represents the first collaboration between three professional organizations focused on nutrition: Brazilian Association of Nutrition (ASBRAN), Brazilian Society of Nephrology (SBN) and Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE), with the objective of identifying internationally standardized terminology and instruments for the nutrition care process. The focus is to facilitate the training of nutritionists who work with adult patients with chronic kidney diseases (CKD). Eleven issues related to nutrition screening, care and management of outcomes were raised. Recommendations were based on international guidelines and electronic databases such as PubMed, EMBASE™, CINHAL, Web of Science and Cochrane. From the sending of lists of internationally standardized terms, 20 nutrition specialists selected those they considered very clear and relevant for clinical practice with CKD outpatients. The content validity index (CVI) was calculated, with 80% agreement in the responses. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assign evidence strength to the recommendations. A total of 107 terms were selected for Nutrition Assessment and Reassessment, 28 for Nutrition Diagnosis, 9 for Nutrition Intervention, and 94 for Nutrition Monitoring and Evaluation in Nutrition. The list of selected terms and identification of instruments will assist in training planning and implementation of standardized nutrition terminology in Brazil for nutritionists working with CKD patients.

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3–5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3–5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen–Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p

Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization. RESUMO Introdução: As fístulas arteriovenosas (FAV) são a primeira escolha de acesso vascular para hemodiálise. No entanto, elas apresentam uma alta incidência de estenoses venosas levando à trombose. Embora o treinamento em nefrologia intervencionista possa melhorar a acessibilidade para o tratamento das estenoses venosas, há dados limitados sobre a segurança e a eficácia desta abordagem realizada por nefrologistas treinados em países em desenvolvimento e de baixa renda. Métodos: Este estudo apresenta os resultados retrospectivos de angioplastias de FAV realizadas por nefrologistas treinados em um centro ambulatorial brasileiro de nefrologia intervencionista. O desfecho primário foi a taxa de sucesso técnico (conclusão do procedimento com angioplastia de todas as estenoses) e os desfechos secundários foram taxas de complicação e a patência geral das FAV. Achados: Duzentas e cinquenta e seis angioplastias foram realizadas em 160 FAV. A taxa de sucesso técnico foi de 88,77% e a principal causa de falha técnica foi a oclusão venosa (10%). A incidência de complicações foi de 13,67%, com apenas um paciente necessitando de internação e quatro acessos perdidos devido à presença de hematomas e/ou trombose. Hematomas de grau 1 foram a complicação mais frequente (8,2%). A patência geral encontrada foi de 88,2 e 80,9% a 180 e 360 dias após o procedimento, respectivamente. Conclusão: Nossos achados sugerem que a angioplastia de FAV realizada por nefrologistas treinados tem taxas de sucesso e patência aceitáveis, com uma baixa incidência de complicações maiores, bem como uma baixa necessidade de hospitalização.

According to data from the last census of the Brazilian Society of Nephrology (SBN), the prevalence of hepatitis C virus (HCV) in Brazilian hemodialysis units (HU) is 3.3%, about three times higher than what is reported for the Brazilian general population. Often, professionals working in HU are faced with clinical situations that require rapid HCV diagnosis in order to avoid horizontal transmission within the units. On the other hand, thanks to the development of new antiviral drugs, the cure of patients with HCV, both in the general population and in patients with chronic kidney disease and the disease eradication, appear to be very feasible objectives to be achieved in the near future . In this scenario, SBN and the Brazilian Society of Hepatology present in this review article a proposal to approach HCV within HUs. Resumo De acordo com os dados do último censo da Sociedade Brasileira de Nefrologia (SBN), a prevalência de portadores do vírus da hepatite C (HCV) nas unidades de hemodiálise (UH) no Brasil é de 3,3%, cerca de três vezes maior do que é observado na população geral brasileira. Muitas vezes, os profissionais que trabalham nas UH deparam-se com situações clínicas que demandam rápido diagnóstico do HCV, a fim de evitar uma transmissão horizontal dentro das unidades. Por outro lado, a cura dos pacientes portadores do HCV, tanto na população geral como na portadora de doença renal crônica e a erradicação da doença, em virtude do desenvolvimento de novas drogas antivirais, parecem ser objetivos bastante factíveis, a ser alcançados em futuro próximo. Nesse cenário, a SBN e a Sociedade Brasileira de Hepatologia apresentam neste artigo de revisão uma proposta de abordagem do HCV dentro das UH.

Introduction: Point-of-care ultrasonography (US) (POCUS) has been used in several specialties, particularly in medical emergency. Despite the confirmation of its numerous benefits, the use of POCUS is still timid in nephrology. In the present study, we aim to investigate the use of POCUS by Brazilian nephrologists. Methods: A survey carried out among the members of the Brazilian Society of Nephrology, through institutional e-mail, using the SurveyMonkey platform. We included 12 self-administered questions, which answers were given anonymously. Results: It was evident that the majority (64%) of the participants did not have the opportunity to practice US during their nephrological training in their residency, specialization, or even in internships; those with experience with US use the method mainly for implanting central vascular accesses (68%), performing a renal biopsy (58%) and evaluating renal morphology (50%); and the main barriers for nephrologists who do not yet use US are the high price of US machines (26%) and the lack of time to learn about US (23%). Also, POCUS use for examinations of other organs, such as the lung (31%) and heart (18%), which are fundamental in the cardiovascular and volume assessment of patients with kidney diseases, is even more limited. However, 95% of the participants expressed an interest in learning POCUS for use in their medical practice. Conclusion: Most of the Brazilian nephrologists interviewed were not trained in US; however, almost all of the research participants expressed an interest in learning to use POCUS in nephrological practice. Resumo Introdução: A ultrassonografia (US) pointof-care (POCUS) tem sido utilizada emvárias especialidades, particularmente na urgência médica. Apesar da constatação de seus numerosos benefícios, a utilização da POCUS ainda é tímida na nefrologia. No presente estudo, objetivamos fazer um levantamento sobre a utilização da POCUS pelos nefrologistas brasileiros. Métodos: Levantamento realizado entre os sócios da Sociedade Brasileira de Nefrologia, por meio do e-mail institucional, utilizando a plataforma SurveyMonkey. Foram incluídas 12 perguntas autoadministradas, cujas respostas se deram de forma anônima. Resultados: Ficou evidente que a maioria (64%) dos participantes não teve oportunidade de praticar a US durante sua formação nefrológica na residência, especialização ou mesmo em estágios; que aqueles com experiência com a US usam o método, principalmente, para implantação de acesso vascular central (68%), realização de biópsia renal (58%) e avaliação da morfologia renal (50%); e que as principais barreiras para os nefrologistas que ainda não utilizam a US são o preço elevado das máquinas de US (26%) e a falta de tempo para aprender sobre US (23%). Além disso, o uso da POCUS para exames de outros órgãos, como pulmão (31%) e coração (18%), fundamentais na avaliação cardiovascular e volêmica dos pacientes com doenças renais, ainda é mais limitado. Porém, 95% dos participantes expressaram interesse em aprender a POCUS para aplicação na sua prática médica. Conclusão: A maioria dos nefrologistas brasileiros entrevistados não foi treinada em US, contudo, a quase totalidade dos participantes da pesquisa manifestou interesse em aprender a utilizar a POCUS na prática nefrológica.

Nephrology in Brazil was organized as a medical society in 1960. A publicly funded system provides no fee and universal health care for all people within the national territory, including renal replacement therapy, with coverage of renal dialysis and kidney transplantation. With a population of 210 million, 133,464 patients are currently on dialysis. Hemodialysis is the main modality of renal replacement therapy, treating 92% of the patients on chronic dialysis. Peritoneal dialysis and convective therapies are still underutilized. The transplantation program is one of the largest in the world, with about 6000 kidney transplants per year. This chapter presents a general overview of nephrology in Brazil, covering historical aspects, the main renal diseases, and renal replacement therapy, including hemodialysis, peritoneal dialysis, and kidney transplantation.

Em dezembro de 2019, a Covid-19, doenca causada pelo novo betacoronavirus SARS-CoV-2, foi identificada pela primeira vez na China . Em 30 de janeiro de 2020, a Organizacao Mundial da Saude (OMS) declarou que a epidemia pela Covid-19 constituia uma Emergencia de Saude Publica de Importância Internacional (ESPII) . No Brasil, em 3 de fevereiro de 2020, o Ministerio da Saude (MS) declarou Emergencia em Saude Publica de Importância Nacional (ESPIN) . Nesse momento, ainda nao tinham sido notificados casos [...]

Chloroquine and hydroxychloroquine have shown promising preliminary results and have been discussed as therapeutic options for patients with Covid-19. Despite the lack of robust evidence demonstrating the benefits and justifying the use of one of these drugs, the final decision is the responsibility of the attending physician and should be individualized and shared, whenever possible. This position statement recommends dosage adjustment for these drugs in the context of renal impairment.

We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.

Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. However, the potential role of clinical assessment of peripheral perfusion as a possible tool for SA-AKI management has not been established. To address this gap, the purpose of this study was to investigate the prevalence of peripheral hypoperfusion in SA-AKI, its association with mortality, and fluid balance. This observational cohort study enrolled consecutive septic patients in the Intensive Care Unit. After fluid resuscitation, peripheral perfusion was evaluated using the capillary filling time (CRT) and peripheral perfusion index (PI) techniques. The AKI was defined based on both serum creatinine and urine output criteria. One hundred and forty-one patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher peripheral hypoperfusion rates in the SA-AKI group using the CRT (OR 3.6; 95% CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95% CI 1.25-3.08) and PI (RR 1.98; 95% CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI's temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak correlation between PI values and the fluid balance was found over the first 24 h (r = - 0.20; p < 0.05). In conclusion, peripheral perfusion was not different intrinsically between patients with or without SA-AKI. The presence of peripheral hypoperfusion in the SA-AKI group has appeared to be a prognostic marker for mortality. This evaluation maintained its predictive value over the first 72 hours. The fluid balance possibly negatively influences peripheral perfusion in the SA-AKI.

Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. Objective: To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. Methods: Data collection from dialysis units in the country through a completed online questionnaire for 2019. Results: 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. Conclusion: The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality. Resumo Introdução: Dados nacionais sobre o tratamento dialítico crônico são essenciais para a elaboração de políticas de saúde que almejem melhora no tratamento dos pacientes. Objetivo: Apresentar dados do Inquérito brasileiro de diálise de 2019, promovido pela Sociedade Brasileira de Nefrologia. Métodos: Coleta de dados das unidades de diálise do país através de questionário preenchido on-line referente a 2019. Resultados: 314 (39%) centros responderam ao questionário. Em julho de 2019, o número total estimado de pacientes em diálise foi de 139.691. As estimativas das taxas de prevalência e incidência de pacientes em tratamento dialítico por milhão da população (pmp) foram 665 e 218, respectivamente, com médias de aumento anuais de 25 pmp e 14 pmp para prevalência e incidência, respectivamente. A taxa anual de mortalidade bruta foi de 18,2%. Dos pacientes prevalentes, 93,2% estavam em hemodiálise e 6,8% em diálise peritoneal, e 33.015 (23,6%) em fila de espera para transplante. 55% dos centros ofereciam tratamento com diálise peritoneal. Cateter venoso era usado como acesso em 24,8% dos pacientes em hemodiálise. 17% dos pacientes tinham K ≥ 6,0mEq/L, 2,5% necessitaram de transfusão de hemácias em julho/2019 e 10,8% dos pacientes apresentavam níveis séricos de 25-OH vitamina D < 20 ng/mL. Conclusão: O número absoluto de pacientes e as taxas de incidência e prevalência em diálise no país continuam aumentando, assim como o percentual de pacientes em uso de cateter venoso como acesso para diálise. Houve aumento do número de pacientes na lista para transplante e tendência para redução da mortalidade bruta.

Introduction: Anemia is a frequent multifactorial complication of CKD seen in patients on dialysis derived mainly from impaired erythropoietin (EPO) production. A less common cause of anemia in individuals with CKD is pure red cell aplasia (PRCA) secondary to the production of anti-EPO antibodies. Objective: This paper aimed two describe two cases of PRCA secondary to the production of anti-EPO antibodies including choice of treatment, patient progression, and a literature review. Materials: This study included the cases of two patients with CKD on hemodialysis with severe anemia in need of specific investigation and management. Results: Patient 1 with CKD secondary to hypertension treated with EPO for 7 months showed persistent decreases in hemoglobin (Hb) levels despite the subcutaneous administration of increasing doses of EPO; the patient required recurring blood transfusions. Workup and imaging tests were negative for the main causes of anemia in individuals with CKD on dialysis. Patient 2 with CKD secondary to adult polycystic kidney disease had been taking EPO for 2 years. The patient developed severe abrupt anemia the month he was started on HD, and required recurring transfusions to treat the symptoms of anemia. Workup and imaging findings were inconclusive. Specific laboratory tests confirmed the patients had anti-EPO antibodies. After six months of immunosuppressant therapy (corticosteroids + cyclosporine) the patients were stable with Hb > 9.0 g/dl. Conclusion: PRCA is a rare condition among patients on dialysis treated with rhEPO and should be considered as a possible cause of refractory anemia. Treating patients with PRCA may be challenging, since the specific management and diagnostic procedures needed in this condition are not always readily available.

The peritoneal equilibration test (PET) is the most widespread method for assessing water and solute transport across the peritoneal membrane. This study compared three methods: traditional PET (t-PET), mini-PET, and modified PET (mod-PET). Non-diabetic adults (n=21) who had been on peritoneal dialysis (PD) for at least three months underwent t-PET (glucose 2.5%-4 h), mini-PET (glucose 3.86%-1 h), and mod-PET (glucose 3.86%-4 h) to determine dialysate-to-plasma concentration ratio (D/P) for creatinine and dialysate-to-baseline dialysate concentration ratio (D/D0) for glucose. Agreement between methods regarding D/P creatinine and D/D0 glucose was assessed using analysis of variance (ANOVA), Pearson's correlation coefficient, and Bland-Altman analysis. D/P creatinine differed between t-PET and mini-PET (P

Introduction: Pseudoporphyria is a rare photodermatosis with characteristics similar to those of porphyria cutanea tarda, without, however, presenting abnormalities in porphyrin metabolism. Its etiology is related to chronic kidney disease, ultraviolet radiation and certain medications. The aim of the present study is to describe a case of furosemide-related pseudoporphyria in a patient with chronic kidney disease. Case description: A 76-year-old male patient with stage 4 chronic kidney disease and in continuous use of furosemide presented ulcerated lesions with peripheral erythema and central hematic crust in the legs. On a skin infection suspicion, treatment with quinolone and neomycin sulfate was initiated, without improvement. A biopsy of the lesion was performed, with histopathological examination demonstrating findings compatible with porphyria, although the patient did not present high porphyrin levels. The diagnosis of furosemide-induced pseudoporphyria was then established, with medication suspension, and there was a significant improvement of the lesions. Discussion: There are few cases of pseudoporphyria described, but it is believed that this condition is underdiagnosed, especially in patients with chronic kidney disease. Both clinical and histopathological findings closely resemble porphyria, differentiating it from normal levels of porphyrin in plasma, urine, or feces. Conclusions: Although the lesions are mostly benign, they may increase the morbidity and mortality of these patients, so a proper diagnosis and early treatment are extremely important. RESUMO Introdução: A pseudoporfiria é uma fotodermatose rara com características semelhantes às da porfiria cutânea tardia, sem, no entanto, apresentar anormalidades no metabolismo da porfirina. Sua etiologia está relacionada a doença renal crônica, radiação ultravioleta e determinados medicamentos. O objetivo do presente trabalho é descrever um caso de pseudoporfiria relacionada a furosemida em paciente portador de doença renal crônica. Descrição do caso: Paciente masculino, 76 anos, com doença renal crônica estágio 4 e em uso contínuo de furosemida, apresentou lesões ulceradas com eritema periférico e crosta hemática central nas pernas. Por suspeita de infecção de pele, foi iniciado tratamento com quinolona e sulfato de neomicina, sem melhora. Foi realizada então biópsia da lesão, com exame histopatológico demonstrando achados compatíveis com porfiria, sem, no entanto, o paciente apresentar níveis elevados de porfirinas. Foi então estabelecido o diagnóstico de pseudoporfiria induzida por furosemida, com suspensão de medicação , e houve melhora significativa das lesões. Discussão: Há poucos casos de pseudoporfiria descritos, mas acredita-se que essa condição seja subdiagnosticada, principalmente em pacientes com doença renal crônica. Tanto achados clínicos quanto histopatológicos se assemelham muito à porfiria, diferenciando desta por níveis normais de porfirina no plasma, na urina ou nas fezes. Conclusões: Embora as lesões sejam majoritariamente benignas, podem aumentar a morbimortalidade desses pacientes, por isso um diagnóstico adequado e tratamento precoce são de extrema importância.

Background/Aims: Acute kidney injury (AKI) has been reported as a recognized condition among the elderly population; however, its clinical epidemiology is still poorly evaluated. We propose to evaluate the epidemiological profile of AKI in hospitalized elderly patients and the variables associated with renal replacement therapy (RRT) dependency at discharge after an episode of AKI. Methods: This prospective observational study enrolled 286 elderly patients (aged ≥60 years), who had a diagnosis of AKI and were admitted to a tertiary care hospital. Clinical data were analyzed, which included RRT indication, referral time to nephrologist support, standby period in the emergency care units (ECU) before a transfer to an intensive care unit, staff criteria used to indicate palliative care, and the incidence of patients who stayed on chronic dialysis for at least 6 months after discharge. Results: The overall hospital mortality was 56.3%. Acute Kidney Injury Network (AKIN) 3 at the time of admission was significantly higher in patients who underwent RRT. Intrinsic AKI (p < 0.001), AKIN 3 (p < 0.001), RRT (p < 0.001), and increased length of stay in ECUs (p = 0.01) all had a significantly higher prevalence among non-survivors. On multivariate analysis, however, only renal aetiology (intrinsic AKI) was independently associated with mortality (OR 2.88; 95% CI [1.29–6.13]). Approximately 85% of the discharged patients (n = 125) were dialysis free and 36.4% of them who had a previous diagnosis of chronic kidney disease (CKD) upon admission had a worse renal function. Age, AKIN 3, RRT, prior history of CKD, diabetes mellitus, and the number of hemodialysis sessions showed to have an impact on dialysis dependence. Furthermore, 24 of 161 patients who had a dialysis indication were placed on palliative care. Conclusions: The severity of AKI and the need for RRT were risk factors for mortality and dependence on dialysis. Antecedents of CKD seem to be associated with a poor renal outcome following an AKI episode. Starting RRT had an impact on the clinical decision to enroll these patients into palliative care.

Atypical Hemolytic Uremic Syndrome (aHUS) is a rare, life-threatening disease that can occur at any age and be sporadic or familial. aHUS is caused by an uncontrolled activation of the complement system. Plasma Exchange (PE) has been the standard treatment for years with poor results, leading approximately 40% of patients to end-stage renal disease (ESRD) or death during the first clinical manifestation. Eculizumab, an humanized monoclonal antibody directed against complement component C5, has emerged in the last few years as a new therapheutic aproach with promising results. Our goal is to present a case of an adult patient where eculizumab was sucessfully used as upfront therapy avoiding the potential significant morbidity of PE.

Introdução: Tem sido descrito na literatura que pacientes portadores de rim único podem desenvolver perda da função renal tornando-se portadores de doença renal crônica (DRC). Objetivo: Avaliar a função renal em pacientes nefrectomizados e acompanhados no HC-UFPR. Métodos: Estudo retrospectivo, analítico e descritivo. Os pacientes foram selecionados no sistema de informática por meio do CID-Z52.4 (doador renal) e CID-Z90.5 (ausência adquirida do rim). Foram selecionados 28 pacientes, os quais foram acompanhados no período entre 1984 e 2016. Foram coletados dados clínicos e laboratoriais dos prontuários ao longo do acompanhamento. Foi avaliada a função renal por meio da estimativa da Taxa de Filtração Glomerular (TFG), calculada usando a fórmula CKD-EPI (Chronic Kidney Disease – Epidemiology collaboration equation) e pela quantificação de proteinúria. Resultados: A população estudada foi majoritariamente do sexo feminino (67%) e possuía média (±desvio padrão) de idade de 56 ± 12 anos. Deste total, 75% eram doadores renais, 21% foram nefrectomizados por complicações de nefrolitíase e 4% por estenose de junção uretero-piélica. Desses, 57% dos pacientes eram hipertensos e 11%, diabéticos. O tempo de acompanhamento médio foi de 14,64 ± 9,02 anos. Observou-se uma queda insignificante na TFG estimada (79,6 ± 21,95 versus 69,3 ± 20,52 ml/min/1,73m2, p=0,14) no acompanhamento. Entretanto, observou-se aumento prevalência de proteinúria, inicialmente observada em 10,71%, para 39,29% ao final do acompanhamento (p

Background: Sustained Low Efficiency Dialysis (SLED), a hybrid therapy of replacement renal function, has been introduced as an alternative of intermittent and continuous dialysis methods in acute renal failure. Aim: To demonstrate the experience of using SLED in patients admitted at Intensive Care Unit (ICU) and Semi-Intensive Care-Unit (SICU) of the Hospital de Clinicas of Universidade Federal do Parana between April/2013 and October/2014. Methods: Data were collected from medical records of patients admitted to the ICU and SICU submitted to SLED by GENIUS System®, with eight hours session. The following demographic data were included: gender, age, presence of diabetes mellitus (DM), hypertension and chronic kidney disease (CKD), use of vasoactive drugs and mechanical ventilation. It was obtained plasma levels of urea, creatinine, sodium, potassium, phosphorus, magnesium, bicarbonate, glucose, oxygen saturation and oxygen and carbon dioxide partial pressure, in three stages: before, during the 4th hour and after the procedure (8th hour). Results: 41 SLED were performed in 17 patients, 8 women. 88% were under mechanical ventilation and use of vasoactive drugs. The mortality rate in hospital was 76%. Regarding to the presence of comorbidities, 35% of patients had DM, almost 60%, hypertension, and 17%, CKD. Medium percentage urea reduction was 62% ±8.4. Phosphorus (mg/dL) levels had significant reduction between first (4.09 ± 2.28) and eighth hour of treatment (2.03 ±1.04), p value

A progressão da DRC eleva substancialmente os riscos de eventos cardiovasculares e de morte e está associada a elevados níveis de marcadores inflamatórios e de estresse oxidativo, os quais por sua vez estão associados, entre outras condições, à progressão mais rápida para doença renal terminal e aumento na mortalidade de todas as causas. A hipovitaminose D - 25(OH) vitamina D < 30 ng/mL - vem sendo associada a desfechos renais e cardiovasculares desfavoráveis na população geral e em pacientes com DRC e a sua reposição pode melhorar parâmetros de inflamação e em concomitância ao bloqueio farmacológico do sistema renina-angiotensina (SRA) reduz a proteinúria em modelos experimentais e em pacientes com nefropatias. Este estudo avaliou o efeito de seis meses de suplementação oral com colecalciferol para pacientes adultos com DRC não dialítica sobre um painel de biomarcadores inflamatórios (fibrinogênio, proteína C reativa, homocisteína e interleucina-6) e de estresse oxidativo (capacidade antioxidante total plasmática, metabólitos do óxido nítrico e hidroperóxidos) e, também, o efeito da suplementação de colecalciferol sobre a taxa de filtração glomerular estimada (TFGe) nos pacientes que se encontravam utilizando inibidores do SRA (ISRA) concomitantemente. A suplementação foi feita com cápsulas contendo 50.000UI de colecalciferol e teve sua periodicidade definida a partir dos níveis basais de 25(OH) vitamina D. Duzentos e seis pacientes iniciaram o estudo e hipovitaminose D estava presente em 111 pacientes (53,88%). Ao início do estudo, os pacientes dos grupos com e sem hipovitaminose D apresentavam diferenças significativas em algumas variáveis, sendo que os do grupo com baixa vitamina D tinham menores TFGe, níveis tensionais mais elevados e maiores níveis de proteinúria, indicando maior gravidade da DRC neste grupo. Cento e setenta e sete pacientes completaram os 6 meses de estudo (96 no grupo com deficiência de vitamina D e 81 com níveis séricos considerados adequados na situação basal). O esquema terapêutico utilizado foi adequado para normalizar os níveis séricos de vitamina D em 75% dos pacientes, mas com os biomarcadores utilizados, não se observou redução no estresse oxidativo e no estado inflamatório destes pacientes. Analisando a interação entre as variáveis tempo, tratamento com colecalciferol e o uso de ISRA, observou-se que a suplementação de vitamina D concomitante ao uso ISRA esteve associada à significativa preservação da TFGe (mediana inicial de 33 e final de 32 mL/min/1,73m2 – P = 0,056) e queda na TFGe quando não houve suplementação com colecalciferol (mediana inicial de 41 e final de 39 mL/min/1,73m2 – P = 0,032). Pôde-se concluir que seis meses de suplementação com colecalciferol foram suficientes para a obtenção de valores de referência de vitamina D, mas não produziu mudanças significativas nos parâmetros de estresse oxidativo e de inflamação dos pacientes estudados. A suplementação de colecalciferol simultaneamente ao uso de ISRA protegeu os rins da redução na TFGe e pode representar uma estratégia de renoproteção para este grupo de pacientes. Estudos adicionais são necessários para a confirmação destes achados. The progression of CKD substantially increases the risk of cardiovascular events and death and is associated with elevated levels of inflammatory markers and oxidative stress, which in turn are associated with, among other conditions, to more rapid progression to ESRD and increase in mortality from all causes. Vitamin D deficiency - 25(OH) vitamin D < 30 ng/mL - has been associated with adverse renal and cardiovascular outcomes in the general population and in patients with CKD, its replacement may improve inflammation parameters and, concomitantly to pharmacological blockade of the system renin-angiotensin system (RAS), reduces proteinuria in experimental models and in patients with nephropathy. This study evaluated the effect of six months of oral supplementation with cholecalciferol for adult patients with CKD not on dialysis over a panel of inflammatory biomarkers (fibrinogen, C-reactive protein, homocysteine and interleukin -6) and oxidative stress (plasma total antioxidant capacity, metabolites of nitric oxide and hydroperoxides), and also the effect of supplementation of cholecalciferol on estimated glomerular filtration rate (eGFR) in patients who were using RAS inhibitors (ISRA) concurrently. Supplementation was made with capsules containing 50,000 IU of cholecalciferol and had its defined frequency from baseline levels of 25(OH) vitamin D. Two hundred and six patients started the study and vitamin D deficiency was present in 111 patients (53.88 %). At baseline, patients in groups with and without vitamin D deficiency had significant differences in some variables, and the lower the vitamin D group had lower eGFR, higher blood pressure levels and higher levels of proteinuria, indicating greater severity of CKD in this group. One hundred and seventy-seven patients completed the 6-month study (96 in the vitamin D-deficient group and 81 with serum levels considered adequate at baseline). The therapeutic regimen was adequate to normalize the serum levels of vitamin D in 75% of patients, but with the biomarkers used, there was no reduction in oxidative stress and inflammatory status of these patients. Analyzing the interaction between the variables time, cholecalciferol treatment, and the use of ISRA, it was found that vitamin D supplementation concomitantly with ISRA use was associated with significant preservation of eGFR (initial and final median of 33 and 32 mL/min/ 1.73m2, respectively – P = 0.056 ) and a decrease in eGFR when no supplementation with cholecalciferol (initial and final median of 41 and 39 mL /min/1.73m2 - P = 0.032) . It was concluded that six months of supplementation with cholecalciferol was sufficient to obtain a reference value of vitamin D, but did not produce significant changes in parameters of oxidative stress and inflammation in patients. The cholecalciferol supplementation with simultaneous use of ISRA protected the kidneys from reduction in eGFR and may represent a renoprotection strategy for this group of patients. Additional studies are needed to confirm these findings.