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Background Early reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19. Methods We conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality. Results The average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p

Global prevalence of chronic kidney disease (CKD) has increased considerably in the recent decades. Overactivity of the renin-angiotensin-aldosterone system (RAAS), associated to renal inflammation and fibrosis contribute to its evolution. The treatments currently employed to control CKD progression are limited and mainly based on the pharmacological inhibition of RAAS, associated with diuretics and immunosuppressive drugs. However, this conservative management promotes only partial deceleration of CKD evolution, and does not completely avoid the progression of the disease and the loss of renal function, which motivates the medical and scientific community to investigate new therapeutic approaches to detain renal inflammation / fibrosis and CKD progression. Recent studies have shown the application of mesenchymal stem cells (mSC) to exert beneficial effects on the renal tissue of animals submitted to experimental models of CKD. In this context, the aim of the present study was to evaluate the effects of subcapsular application of adipose tissue-derived mSC (ASC) in rats submitted to the 5/6 renal ablation model, 15 days after the establishment of CKD, when the nephropathy was already severe. We also verify whether ASC associated to Losartan, would promote greater renoprotection when compared to the respective monotherapies. Animals were followed until 30 days of CKD, when body weight, systolic blood pressure, biochemical, histological, immunohistochemical and gene expression analysis were performed. The combination of ASC and Losartan was more effective than Losartan monotherapy in reducing systolic blood pressure and glomerulosclerosis, and also promoted the complete normalization of proteinuria and albuminuria, a significant reduction in renal interstitial macrophage infiltration and downregulation of renal IL-6 gene expression. The beneficial effects of ACS are possibly due to the immunomodulatory and anti-inflammatory role of factors secreted by these cells, modulating the local immune response. Although studies are still required, our results demonstrated that a subcapsular inoculation of ASC, associated with the administration of Losartan, exerted additional renoprotective effect in rats submitted to a severe model of established CKD, when compared to Losartan monotherapy, thus suggesting ASC may be a potential adjuvant to RAAS-blockade therapy currently employed in the conservative management of CKD.

Introduction: Aging is a global phenomenon. Recent forecasts indicate that Brazil will be the sixth country in population of elderly individuals in 2020. The incidence of acute kidney injury (AKI) among the elderly varies, but studies have indicated that older individuals are more prone to developing AKI and have higher mortality rates than the general population with renal disease. The impact of dialysis in elderly patients with AKI - and critically ill individuals with multiple dysfunctions - has been discussed for years. Evidence indicates that for this group of patients dialysis does not positively impact survival and, in some situations, it might even accelerate death. This study investigated a population of elderly individuals with AKI seen in intensive care units to assess, through Propensity Score Matching, the impact dialysis has had for them. Methods: Data from the charts of patients aged 60 years or older seen at the intensive care unit of a general hospital between January 2012 and December 2014 and diagnosed with AKI were collected. Results: The study included 329 patients with a mean age of 75.4 ± 9.3 years. Ischemic AKI was the most prevalent disease (54.7%) and 28.9% of the patients needed dialysis. No difference was seen in the death rates of dialysis and non-dialysis patients aged 70+ years. Conclusions: The data suggested that dialysis did not seem to impact the death rates of critically ill patients with AKI aged 70+ years. RESUMO Introdução: O crescimento da população idosa é um fenômeno mundial. Projeções recentes demonstram que o Brasil será o sexto país do mundo em número de idosos no ano de 2020. A incidência de injúria renal aguda (IRA) nos idosos varia de acordo com a população estudada, mas vários estudos têm sugerido que os idosos são mais suscetíveis ao desenvolvimento de IRA e apresentam maior mortalidade que a população geral. Há anos se discute o real impacto da instituição da diálise em pacientes idosos com IRA, principalmente em pacientes críticos com múltiplas disfunções. Há evidências de que o início da diálise nesses indivíduos não tenha impacto positivo na sobrevida e, em algumas situações, até acelere o óbito. O objetivo deste estudo foi analisar uma população de idosos que desenvolveu IRA em unidades de terapia intensiva e avaliar, através do Propensity Score Matching, o impacto da diálise nesses indivíduos. Métodos: Foram coletados dados de prontuários de idosos acima dos 60 anos, internados na UTI de um hospital geral, de janeiro de 2012 a dezembro de 2014, e que evoluíram com IRA. Resultados: Foram incluídos 329 pacientes, com idade média de 75,4 ± 9,3 anos. A IRA isquêmica foi a mais prevalente (54,7%), e 28,9% necessitaram de diálise. Nos indivíduos acima de 70 anos, não foi observada diferença na mortalidade entre os pacientes que realizaram ou não diálise. Conclusões: Esses dados sugerem que a diálise parece não apresentar impacto sobre a mortalidade de pacientes críticos com IRA, acima de 70 anos.

Sepsis is the leading cause of acute kidney injury (AKI) and lung injury worldwide. Despite therapeutic advances, sepsis continues to be associated with high mortality. Because Brazilian green propolis (GP) has promising anti-inflammatory, antioxidant, and immunomodulatory properties, we hypothesized that it would protect kidneys and lungs in rats induced to sepsis by cecal ligation and puncture (CLP). Male Wistar rats were divided into groups—control (sham-operated); CLP (CLP only); and CLP + GP (CLP and treatment with GP at 6 h thereafter)—all receiving volume expansion and antibiotic therapy at 6 h after the procedures. By 24 h after the procedures, treatment with GP improved survival, attenuated sepsis-induced AKI, and restored renal tubular function. Whole-blood levels of reduced glutathione were higher in the CLP + GP group. Sepsis upregulated the Toll-like receptor 4/nuclear factor-kappa B axis in lung and renal tissues, as well as increasing inflammatory cytokine levels and macrophage infiltration; all of those effects were attenuated by GP. Treatment with GP decreased the numbers of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling-positive cells in renal and lung tissue, as well as protecting the morphology of the renal mitochondria. Our data open the prospect for clinical trials of the use of GP in sepsis.

Introduction Physical inactivity in hemodialysis patients is associated with increased mortality. The objective of this study was evaluated the effect of an intradialytic resistance exercise program on chronic kidney disease (CKD) patients on hemodialysis. Methods One hundred seven patients were included in the study. They were aged 18-60 years, of both sexes, had undergone hemodialysis treatment for at least 1 year, sedentary. Patients were randomly divided into two groups: stretching (STG) and resistance exercise (REG). Intervention programs were performed for 8 weeks, three times a week. The evaluations were performed before and after the training programs. The primary outcome was functional capacity using the 6-minute walk test (6MWT). Secondary outcomes were peripheral muscle strength, respiratory muscle strength, spirometric respiratory function, and laboratory data. Findings Comparisons between groups revealed the following clinically relevant results in favor of REG: lower limb muscle strength (mean difference [MD] = -1.99, 95% confidence interval [CI] = -2.77 to -1.21; d = -0.53), distance walked in the 6MWT (MD = -26.27, 95% CI = -45.40 to -7.14; d = -0.46), creatinine (MD = -1.52, 95% CI = -2.49 to -0.54; d = -0.66), and calcium (MD = -0.44, 95% CI = -0.78 to -0.10; d = -0.49). Discussion CKD patients on hemodialysis have reduced functional capacity compared to healthy sedentary individuals. In turn, this reduction appears to be associated with a lower survival rate and affects the performance of their daily living activities. Thus, resistance exercise performed in the intradialytic phase is an effective therapeutic strategy for CKD patients, mainly because it increases functional capacity and lower limb muscle strength.

INTRODUCTION / AIMS Chronic kidney disease (CKD) is considered a public health problem with epidemic proportions worldwide. Overactivity of the renin-angiotensin-aldosterone system (RAAS), associated to the establishment of a chronic self-sustained renal inflammation, are the main factors which contribute to the progression of CKD, leading to tissue fibrosis and loss of function. Consequently, RAAS inhibitors, such as the AT-1 receptor antagonist, Losartan, are among the most currently employed therapeutic strategies to slow down CKD progression, although the renoprotection afforded by these drugs is not complete. The association of anti-inflammatory and immunosuppressive drugs to RAAS inhibition is limited to the treatment of specific nephropathies, and its safety is still not entirely known. In this context, experimental application of mesenchymal stem cells (mSC) as a treatment to control renal inflammation and fibrosis have been showing promising results in studies with animal models of CKD. The aim of the present study was to analyze the renoprotective effects of subcapsular application of adipose-tissue derived mSC (ASC), associated to Losartan treatment, in rats submitted to 5/6 nephrectomy, after the establishment of CKD. METHODS ASC were isolated from gonadal adipose tissue from male Wistar rats, cultured until P4 and characterized by flow cytometry and in vitro differentiation. Male Wistar rats underwent 5/6 nephrectomy and were followed for 15 days to confirm the establishment of the nephropathy (CKD 15d). After this period, animals underwent a new surgery in which they received a subcapsular injection of 10 μL of sterile PBS (vehicle), or 2x106 ASC diluted in 10 μL of sterile PBS. Part of these animals were than treated orally with 50 mg/kg/day of Losartan (LOS) for further 15 days (groups CKD + LOS 30d and CKD + LOS + ASC 30d). A group of animals that received only subcapsular vehicle were kept untreated for the same period (CKD 30d). Sham-operated rats, euthanized at days 15 (Sham 15d) and 30 (Sham 30d), were used as controls. Survival rate, body weight (BW), systolic blood pressure (BP), 24h urinary protein (24h UPE) and albumin (24h UAE) excretion, serum creatinine (SCr) and blood urea nitrogen (BUN) concentrations, percentage (GS%) and index (GSI) of glomerulosclerosis, percentage of tubulointerstitial fibrosis (INT%) and renal infiltration by macrophages (CD68) were assessed 15 and 30 days after 5/6 nephrectomy. The obtained results are presented as Mean ± SE. Differences among groups were analyzed by one-way ANOVA. RESULTS The renal subcapsular application of ASC after the establishment of severe CKD improved the renoprotection obtained with the classic treatment with LOS. The association of LOS + ASC significantly improved animal’s survival, reduced blood pressure, proteinuria and albuminuria, prevented the development of glomerular structural damage and interstitial fibrosis, and inhibited renal inflammation by normalizing renal macrophage infiltration in the CKD + LOS + ASC group. CONCLUSIONS Our preliminary results demonstrate that the application of ASC, associated to the oral administration of LOS exerted additional renoprotection in the 5/6 renal ablation model, compared to LOS monotherapy. These findings suggest that ASC therapy could be employed as a therapeutic additive together with the traditional RAAS blockade, to detain the progression of CKD.

INTRODUCTION / AIMS Chronic kidney disease (CKD) is a progressive, debilitating condition of high lethality, which prevalence have been increasing considerably in recent decades. CKD can be triggered by many different factors, such as genetic predisposition, systemic hypertension, diabetes mellitus and autoimmune diseases. It is characterized by the gradual loss of renal function, leading to kidney failure and the need for renal replacement therapy for the maintenance of life. Regardless of the etiology of CKD, the establishment of local renal inflammation, with leucocyte recruitment, cell proliferation, extracellular matrix accumulation, glomerular and tubulointerstitial fibrosis, contribute significantly to its establishment and evolution. Due to its known pathophysiology, the primary aim when clinically treating CKD is to slow the progression of renal function loss and the advance of inflammation. However, until the present moment, there is no efficient pharmacological treatment to completely arrest the aggravation of renal inflammation and, specially, renal fibrosis. This motivates the scientific community to develop experimental research in order to test new therapeutic approaches to stunt renal fibrosis. In this context, experimental application of mesenchymal stem cells (mSC) as a treatment to control renal inflammation have been showing promising results in studies with animal models of CKD. The aim of the present study was to analyze the renoprotective effects of subcapsular application of Adipose Tissue-derived mSC (ASC), in rats submitted to 5/6 nephrectomy, after the establishment of the disease (15 days after CKD induction), in order to more closely resemble the clinical settings in humans. METHODS ASC were obtained from gonadal adipose tissue from healthy male Wistar rats. These cells were cultured until P4 when characterization by flow cytometry and in vitro differentiation were performed. Male Wistar rats underwent 5/6 nephrectomy and were followed for 15 days until the complete establishment of CKD (group CKD 15d). At this time, animals underwent a new surgery in which they received a subcapsular injection of 2x106 ASC diluted in 10 μL of sterile PBS (group CKD + ASC 30d), or only 10 μL of sterile PBS (group CKD 30d). Sham-operated rats, euthanized at day 15 (Sham 15d) and 30 (Sham 30d) were used as controls. Survival rate, body weight (BW), 24h urinary protein (24h UPE) and albumin (24h UAE) excretion serum creatinine (SCr) and blood urea nitrogen (BUN) concentration, percentage (GS%) and index (GSI) of glomerulosclerosis, tubulointerstitial fibrosis (INT%) and renal infiltration by macrophages (CD68) were studied at 15 and 30 days after 5/6 nephrectomy. Our results are presented as Mean ± SE. Differences among groups were analyzed by one-way ANOVA. RESULTS ASC injection significantly improved the survival rate of CKD + ASC 30d animals, compared to the observed in the untreated group. Moreover, ASC treatment markedly reduced protein and albumin urinary excretion, prevented the development of glomerulosclerosis, both the percentage of sclerotic glomeruli and the index of glomerular damage, numerically reduced interstitial fibrosis and significantly avoided renal inflammation by halting the progression of renal cortical macrophage infiltration. CONCLUSIONS According to our results, subcapsular ASC application promoted considerable renoprotection in the 5/6 renal ablation model, even after the complete establishment of severe CKD, suggesting that experimental therapy with these cells could be associated to the current pharmacological treatments employed to detain the progression of CKD. Figure

Background and Aims End-stage chronic kidney disease is associated with the condition of chronic inflammation, impacting increased cardiovascular mortality in this specific population. Patients on hemodialysis are known to be predisposed to several factors that predispose to inflammation: dialysis membranes, central venous catheters, oxidative stress, fluid overload, sodium overload, uraemic toxins. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties. The aim of this study was to evaluate the impact of Brazilian green propolis extract on inflammation in hemodialysis patients. Here we present preliminary results of the trial NCT04072341. Method We performed a prospective trial, open-label 9-week crossover study examining the effect of Brazilian green propolis (250mg/day, in capsules) on inflammation in hemodialysis patients. We included patients over 18 years, under intermittent hemodialysis (thrice per week), on hemodialysis for at least 1 month and until now 37 patients were included. We excluded pregnant women, cancer carried and patients who developed infection or underwent any surgical procedure during the study period. Each period was 4 weeks in duration with a 1-week washout period in between. The primary end point was change in serum level of high-sensitivity c-reactive protein (HsCRP). Secondary end point evaluated the safety of propolis use in hemodialysis patients. Results Their mean age was 58.6 ± 15.2 years (mean ± SD), and 22 (59.4%) were men. The proportion of patients with hypertension was 14 (37.8%) and diabetes was 9 (24.3%). The number of patients using arteriovenous fistula were 26 (70.2%). The HsCRP presented (mean ± SE) 5.31 ± 1.02 mg/L at baseline, 4.26 ± 0.76 mg/L after propolis period and 4.56 ± 1.32 mg/L in control period, p = 0.0042. Safety parameters were analyzed such as amylase, aspartate aminotransferase (AST) and creatine phosphokinase (CPK); there was no difference between them before and after the use of propolis. None of the participants reported any adverse effects or allergic reactions during the treatment. Conclusion Patients on hemodialysis have an increased inflammatory state. For the best of our knowledge it was the first clinical trial who demonstrated the safety of propolis in hemodialysis patients. Brazilian green propolis demonstrated a tendency to reduce inflammation in these patients.

Urinary tract infection is a serious public health issue that predominantly affects women. In men, it is more often associated with prostatic hyperplasia and bladder catheterization. Urogenital tuberculosis presents with nonspecific with nonspecific symptoms and the diagnosis can be made in the presence of sterile leukocyturia and recurrent infection with acid urine. Non-tuberculous mycobacteria or other non-tuberculosis mycobacteria are opportunistic pathogens that inhabit the soil, water or environment surfaces, and usually cause diseases in immunocompromised individuals. Mycobacterium abscessus is an agent that causes lung, skin and soft tissue hospital infections. Urinary tract infections by this pathogen are rare. Resumo Infecção do trato urinário é um sério problema de saúde pública que acomete predominantemente as mulheres. Em homens, está mais relacionada com hiperplasia prostática e cateterismo vesical. A tuberculose urogenital cursa com sintomas inespecíficos e o diagnóstico pode ser aventado na presença de leucocitúria estéril, e infecção recorrente com urina ácida. Micobactérias não tuberculosas ou mycobacteria other than tuberculosis são patógenos oportunistas que habitam o solo, a água ou superfícies do meio ambiente, e geralmente causam doenças em imunodeprimidos. Mycobacterium abscessus é um agente que causa infecções nosocomiais, pulmonares, de pele e de tecidos moles. Infecção urinária decorrente desse patógeno é considerada rara.

SUMMARYBackground The increase in candidates for kidney transplant has led to growth in the number of living donor transplants. Therefore, studies that adequately evaluate the possible long-term consequences of elective transplant nephrectomy are needed. Objective To evaluate the possible long-term adverse effects of transplant nephrectomy on the renal function of living kidney donors. Design A cross-sectional study. Participants Thirty-three living kidney donors registered in the transplant programme of a centre in Alagoas, Brazil. Measurements Demographic characteristics, anthropometric measures, clinical data and biomarkers (creatinine, eGFR, microalbuminuria, cholesterol and triglycerides) were measured. Creatinine clearance was calculated using the Cockcroft-Gault and Modification of Diet in Renal Disease formulae. Results Of the 33 individuals, 63.63% were female, and the median age was 45 years. Additionally, 24.24% of these individuals had altered blood pressure, 39.39% had altered abdominal circumference (AC) and 36.36% were obese, with a body mass index ≥30. Furthermore, 33.33% of these individuals had elevated triglyceride levels. The average eGFR was 97.33 (33.03–175.9) ml/min/1.73 m2 (CG) and 84.14 (29.4–131) ml/min/1.73 m2 (MDRD). The microalbuminuria level was altered in 12.12% patients. Conclusion Kidney donation is unquestionably a safe procedure. However, a better understanding of the long-term consequences of living donor kidney transplantation is still needed. This knowledge may have important implications for the follow-up of these patients. Our study has demonstrated a non-negligible presence of an early marker of glomerular injury and a decrease in the GFR of some patients, thereby reinforcing the proposal for long-term follow-up of living kidney donors.

Chronic kidney disease (CKD) is a public health problem worldwide, and proteinuria is a well-established marker of disease progression in CKD patients. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties, as well as having been shown to have an antiproteinuric effect in experimental CKD. The aim of this study was to evaluate the impact of Brazilian green propolis extract on proteinuria reduction and the changes in the estimated glomerular filtration rate (eGFR). This was a randomized, double-blind, placebo-controlled study including patients with CKD caused by diabetes or of another etiology, 18–90 years of age, with an eGFR of 25–70 ml/min per 1.73 m2 and proteinuria (urinary protein excretion > 300 mg/day) or micro- or macro-albuminuria (urinary albumin-to-creatinine ratio > 30 mg/g or > 300 mg/g, respectively). We screened 148 patients and selected 32, randomly assigning them to receive 12 months of Brazilian green propolis extract at a dose of 500 mg/day (n = 18) or 12 months of a placebo (n = 14). At the end of treatment, proteinuria was significantly lower in the propolis group than in the placebo group—695 mg/24 h (95% CI, 483 to 999) vs. 1403 mg/24 h (95% CI, 1031 to 1909); P = 0.004—independent of variations in eGFR and blood pressure, which did not differ between the groups during follow-up. Urinary monocyte chemoattractant protein-1 was also significantly lower in the propolis group than in the placebo group—58 pg/mg creatinine (95% CI, 36 to 95) vs. 98 pg/mg creatinine (95% CI, 62 to 155); P = 0.038. Brazilian green propolis extract was found to be safe and well tolerated, as well as to reduce proteinuria significantly in patients with diabetic and non-diabetic CKD. Trial Registration. ( ClinicalTrials.gov number NCT02766036. Registered: May 9, 2016).

Chronic kidney disease is associated with a high prevalence of depression, which increases inversely with the glomerular filtration rate. This paper aims to evaluate the factors associated with a low quality of life and depression in patients on haemodialysis. Two hundred patients undergoing haemodialysis answered the Medical Outcomes Study 36 - Item Short - Form Health Survey (SF-36) and Beck Depression Inventory (BDI). Clinical and laboratory variables were analysed and correlated with these two tools. The prevalence of depression was 29%. Anaemia and hypoalbuminemia were independent risk factors for depression. All SF-36 domains showed worse results in patients with depression, and the pain domain presented the highest correlation. Our findings provide evidence that patients on haemodialysis have a low quality of life and a high prevalence of depression. A greater number of comorbidities, an excessive number of medications, diabetes mellitus, anaemia and hypoalbuminemia were associated with a reduced quality of life.

Background and objectives AKI is associated with short- and long-term mortality. However, the exact contribution of AKI complications to the burden of mortality and whether RRT has any beneficial effect on reducing mortality rates in critically ill AKI patients are unknown. Design, setting, participants, & measurements This was a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II project. A total of 18,410 adult patients were enrolled from four intensive care units from a university hospital from 2001 to 2008. Results Overall, 10,245 patients developed AKI. After adjustments, the odds ratios (ORs) for hospital mortality were 1.73 (95% confidence interval [95% CI], 1.52 to 1.98) for AKI stage 1, 1.88 (95% CI, 1.57 to 2.25) for stage 2, and 2.89 (95% CI, 2.41 to 3.46) for stage 3. Totals of 33%, 59%, and 70% of the excess mortality rates associated with AKI stages 1, 2, and 3, respectively, were attenuated by the inclusion of each AKI-related complication in the model. The main burden of excess hospital mortality associated with AKI was attenuated by metabolic acidosis and cumulative fluid balance. Long-term mortality was not attenuated by any of the associated complications. Next, we used two different approaches to explore the associations between RRT, AKI complications, and hospital mortality: multivariate analysis and propensity score matching. In both approaches, the sensitivity analysis for RRT was associated with a better hospital survival in only the following AKI-related subgroups: hyperkalemia (OR, 0.55; 95% CI, 0.35 to 0.85), metabolic acidosis (OR, 0.70; 95% CI, 0.53 to 0.92), cumulative fluid balance >5% of body weight (OR, 0.60; 95% CI, 0.40 to 0.88), and azotemia (OR, 0.57; 95% CI, 0.40 to 0.81). Conclusions A majority of the excess risk of mortality associated with AKI was attenuated by its fluid volume and metabolic complications, particularly in severe AKI. In addition, this study demonstrated that RRT is associated with a better outcome in patients with AKI-related complications.

In recent years, the diagnosis of acute kidney injury (AKI) has been based on classifications such as RIFLE, AKIN and KDIGO, which has the goal of world standardization and timely recognition of the disease. It is essential that intensivists be aware about these classifications, because most of the time, they will have the first opportunity to diagnose AKI. However, it is still very common that the nephrologist consultation be performed in advanced stages of the AKI, when the interventions to halt the progression are very limited. We recently assessed intensivist on AKI diagnostic criteria, with emphasis on RIFLE, and observed a very low level of knowledge and lack of use in daily practice. Faced with the constant search for new biomarkers of kidney injury, these and other evidences, highlights the urgency of simple actions, such as the beginning of educational interventions in order to familiarize the intensivist with the latest clinical tools for AKI diagnosis. Resumo Nos últimos anos, o diagnóstico da injúria renal aguda (IRA) vem sendo baseado em classificações como as de RIFLE, AKIN E KDIGO, que têm o objetivo de uma padronização mundial e maior agilidade no reconhecimento da doença. É essencial que os intensivistas estejam familiarizados com estas classificações, porque, na maioria das vezes, eles terão a primeira oportunidade de diagnosticar a IRA no paciente crítico. No entanto, ainda é muito comum que a chamada do nefrologista para avaliar pacientes em UTIs seja feita em estágios muito avançados da IRA, quando as medidas para evitar a progressão da doença são bastante limitadas. Recentemente, avaliamos intensivistas sobre os critérios diagnósticos de IRA, com ênfase no RIFLE, e observamos um baixíssimo grau de conhecimento, além de pouco uso dessas classificações na prática diária. Diante da busca constante por novos biomarcadores de lesão renal, estas e outras evidências indicam a necessidade urgente de ações simples, como o início de medidas educativas, no intuito de familiarizar os intensivistas com os instrumentos clínicos mais recentes para o diagnóstico da IRA.

The increase in candidates for kidney transplant has led to growth in the number of living donor transplants. Therefore, studies that adequately evaluate the possible long-term consequences of elective transplant nephrectomy are needed.To evaluate the possible long-term adverse effects of transplant nephrectomy on the renal function of living kidney donors.A cross-sectional study.Thirty-three living kidney donors registered in the transplant programme of a centre in Alagoas, Brazil.Demographic characteristics, anthropometric measures, clinical data and biomarkers (creatinine, eGFR, microalbuminuria, cholesterol and triglycerides) were measured. Creatinine clearance was calculated using the Cockcroft-Gault and Modification of Diet in Renal Disease formulae.Of the 33 individuals, 63.63% were female, and the median age was 45 years. Additionally, 24.24% of these individuals had altered blood pressure, 39.39% had altered abdominal circumference (AC) and 36.36% were obese, with a body mass index ≥30. Furthermore, 33.33% of these individuals had elevated triglyceride levels. The average eGFR was 97.33 (33.03-175.9) ml/min/1.73 mKidney donation is unquestionably a safe procedure. However, a better understanding of the long-term consequences of living donor kidney transplantation is still needed. This knowledge may have important implications for the follow-up of these patients. Our study has demonstrated a non-negligible presence of an early marker of glomerular injury and a decrease in the GFR of some patients, thereby reinforcing the proposal for long-term follow-up of living kidney donors.

An autochthonous case of paracoccidioidomycosis was reported in a city of north Iran. This condition is a well-known endemic fungal infection highly prevalent in Latin American countries, with an incidence of 1 to 3.7 cases per 100.000 annually in Brazil. The classical features are cutaneous lesions, lymph node, and pulmonary involvements, while typical oral changes are superficial ulcers with hemorrhage and moriform aspect. Herein is reported an adult male patient with characteristic oral and pulmonary lesions. Rural environment, male gender, cigarette smoking, and alcohol abuse were risk factors; and clinical history, imaging studies, and histopathologic data established the diagnosis. The patient improved well by administration of sulfamethoxazole plus trimethoprim. The aim of this case study is to enhance the awareness of generalists about this mycosis.

The pathogenic role of inflammation and oxidative stress in chronic kidney disease (CKD) is well known. Anti-inflammatories and antioxidant drugs has demonstrated significant renoprotection in experimental nephropathies. Moreover, the inclusion of natural antioxidants derived from food and herbal extracts (such as polyphenols, curcumin and lycopene) as an adjuvant therapy for slowing CKD progression has been largely tested. Brazilian propolis is a honeybee product, whose anti-inflammatory, antimicrobial and antioxidant effects have been widely shown in models of sepsis, cancer, skin irritation and liver fibrosis. Furthermore, previous studies demonstrated that this compound promotes vasodilation and reduces hypertension. However, potential renoprotective effects of propolis in CKD have never been investigated. The aim of this study was to evaluate the effects of a subtype of Brazilian propolis, the Red Propolis (RP), in the 5/6 renal ablation model (Nx). Adult male Wistar rats underwent Nx and were divided into untreated (Nx) and RP-treated (Nx+RP) groups, after 30 days of surgery; when rats already exhibited marked hypertension and proteinuria. Animals were observed for 90 days from the surgery day, when Nx+RP group showed significant reduction of hypertension, proteinuria, serum creatinine retention, glomerulosclerosis, renal macrophage infiltration and oxidative stress, compared to age-matched untreated Nx rats, which worsened progressively over time. In conclusion, RP treatment attenuated hypertension and structural renal damage in Nx model. Reduction of renal inflammation and oxidative stress could be a plausible mechanism to explain this renoprotection.

OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p

OBJECTIVE: Bixa orellana (annatto) is a natural pigment and food colorant that has been used for a variety of therapeutic purposes. It has been suggested that annatto could have the property of reducing blood glucose levels. However, most previous studies have demonstrated a hypoglycemic effect in non-diabetic animals. We evaluated the impact of annatto on blood glucose levels in an experimental model of diabetes mellitus. METHOD: Male Wistar rats were made diabetic by a single dose of60 mg/kg streptozotocin, injected intraperitoneally. One group of diabetic animals was treated with annatto, 540 mg/kg, administered via gavage. RESULTS: Annatto treated diabetic animals showed significantly lower blood sugar levels than untreated diabetics. The blood glucose curve showed that the hypoglycemic effect of annatto lasted for the twelve hours of evaluation. However, the most significant reduction on blood glucose took place two hours after drug administration. Annatto did not prevent the weight loss that is characteristic of decompensated diabetes mellitus. CONCLUSION: Annatto has a hypoglycemic property in rats with severe diabetes mellitus. Such an effect had a relatively long duration, but is more pronounced two hours after drug administration. RESUMO OBJETIVO: Bixa Orellana (annatto) é um pigmento natural e corante alimentar, que tem sido proposto para uma variedade de usos terapêuticos. Foi sugerido que o annatto tem a propriedade de reduzir a glicemia. No entanto, a maioria dos estudos anteriores demonstrou um efeito hipoglicêmico em animais não diabéticos. Avaliamos o impacto do annatto sobre níveis sanguíneos de glicose num modelo experimental de diabetes mellitus. MÉTODO: Ratos Wistar machos foram tornados diabéticos por uma única dose, 60 mg / kg de estreptozotocina, injetada por via intraperitoneal. Um grupo de animais diabéticos foi tratado com annatto, 540 mg / kg, administrado por meio de sonda gástrica: RESULTADOS: Os animais diabéticos tratados com annatto exibiram níveis de glicemia significativamente mais baixos do que os diabéticos não tratados. Uma curva glicêmica revelou que o efeito hipoglicêmico do annatto perdurou durante as 12 horas de avaliação. No entanto, a redução glicêmica mais significativa ocorreu duas horas após a administração da droga. O annatto não impediu a perda de peso que é característica do diabetes mellitus descompensado. CONCLUSÃO: O annatto apresenta propriedade hipoglicemiante em ratos com diabetes mellitus pós estreptozotocina. Este efeito teve uma duração relativamente longa, mas foi mais pronunciado duas horas após a administração da droga.

Introduction Acute kidney injury (AKI) remains a great problem in clinical practice. Renal ischemia/reperfusion (I/R) injury is a complex pathophysiological process. Propolis is a natural polyphenol-rich resinous substance collected by honeybees from a variety of plant sources that has anti-inflammatory and anti-oxidative properties. Red propolis (RP) protection in renal I/R injury was investigated. Methods Male Wistar rats underwent unilateral nephrectomy and contralateral renal I/R (60 min). Rats were divided into four groups: (1) sham group, (2) RP group (sham-operated rats treated with RP), 3) IR group (rats submitted to ischemia) and (4) IR-RP (rats treated with RP before ischemia). At 48 h after reperfusion, renal function was assessed and kidneys were removed for analysis. Results I/R increased plasma levels of creatinine and reduced creatinine clearance (CrCl), and RP provided protection against this renal injury. Red propolis significantly improves oxidative stress parameters when compared with the IR group. Semiquantitative assessment of the histological lesions showed marked structural damage in I/R rats compared with the IR-RP rats. RP attenuates I/R-induced endothelial nitric oxide-synthase down regulation and increased heme-oxygenase expression in renal tissue. Conclusion Red propolis protects kidney against acute ischemic renal failure and this protection is associated with reduced oxidative stress and eNOS and heme-oxygenase up regulation.

Este artigo científico trata do princípio da transparência fiscal em correlação com as contribuições sociais pagas por servidores públicos federais ao Regime Próprio de Previdência Social (RPPS). Este princípio é implícito na CF de 1988, e permeia toda a legislação infraconstitucional, especialmente a Lei Complementar 101/2000 (Lei de Responsabilidade Fiscal), exigindo-se que a Administração Pública seja clara na feitura e na execução do orçamento. No entanto, aquele tributo é pago todos os meses, mas não se tem a certeza se realmente o produto de sua arrecadação é vinculado a uma despesa no RPPS, tal como preveem os artigos 149 e 167, XI, da CF. Por isto se propõe que a União faça a carimbação do tributo em questão, para que seja possível aos servidores-contribuintes e a toda a sociedade seguir toda a “trilha orçamentária” das contribuições sociais, desde o seu recolhimento até o pagamento da despesa. Certo é que os sindicatos e associações de classe de servidores públicos poderiam ajuizar ações civis públicas, após pesquisa com seus associados, para que se desse cumprimento ao princípio da transparência em relação a estas contribuições, já que este não resta atendido somente com os dados fornecidos pelos diversos sistemas disponíveis na Rede Mundial de Computadores. Após a carimbação, caso ficasse comprovada alguma tredestinação, os servidores-contribuintes teriam como pedir a restituição do indébito tributário, tendo em vista o desvio de finalidade na despesa da contribuição, o que parece ser respaldado pelo que decidiu o STF na Ação Direta de Inconstitucionalidade nº 2.925, na qual a Suprema Corte fez uma interpretação conforme à CF da Lei nº 10.640/2003, a qual poderia dar ensejo à desvinculação das receitas da “CIDE-combustíveis”.

O presente trabalho foi conduzido com o objetivo de estudar a influencia de diferentes pre-tratamentos na cinetica de secagem de banana da variedade Terra ( Musa sapientum, Linneo ). Os frutos de banana foram submetidas a tres pre-tratamentos: primeiramente as frutas foram descascadas e fatiadas em espessuras de 2 e 4 mm, posteriormente branquedas e nao branqueadas e finalmente submetidas a uma desidratacao osmotica em dois niveis de concetracao(2 e 5% de NaCl). As secagens foram realizadas utilizando-se um secador descontinuo de bandejas em escala de bancada. As temperaturas do ar de secagem foram entre 60 e 80oC e a velocidade foi de aproximadamente 1 m.s -1 . A fim de avaliar e selecionar o modelo apropriado para a secagem, quatro diferentes modelos empiricos foram ajustados aos dados experimentais de umidade e comparados. Para analisar os efeitos dos pre-tratamentos na cinetica secagem de banana da variedade terra, utilizou-se um planejamento experimental fracionario 2 III 4-1 , com quatro fatores e dois niveis de variacao, para a constante de secagem (K). Com os resultados obtidos, pode-se concluir: que o modelo matematico de Midilli e Kucuk , foi o que melhor ajustou-se aos dados experimentais; a espessura das amostras e a temperatura de operacao do secador influenciaram significativamente (p=0,05) na constante de secagem, sendo a magnitude da mesma diretamente proporcional ao aumento da temperatura de operacao do secador e inversamente proporcional a espessura das amostras .

O presente artigo tem por objetivo verificar a aplicação dos princípios que norteiam a Produção mais Limpa (P+L) no processo de clarificação do caldo de cana para produção de açúcar. A P+L divide seus objetivos em três níveis: nível 1 (evitar resíduos e emissões), nível 2 (retorno dos resíduos ao processo produtivo) e nível 3 (reciclagem externa e deposição final de resíduos). O processo de clarificação tradicional utilizado pelas agroin- dústrias sucroalcooleiras é caracterizado por uma etapa conhecida por sulfitação, onde ocorre a introdução do enxofre (SO2), sendo este um insumo que libera resíduos prejudiciais à saúde do ser humano e ao meio ambiente. No entanto, a necessidade de produzir um açúcar de boa qualidade e livre de resíduos tóxicos vem incentivando as empresas deste segmento a buscarem alternativas que sejam viáveis do ponto de vista técnico, para substituir este produto no processo produtivo. Neste trabalho, são apresentadas duas alternativas tecni- camente viáveis à substituição do enxofre (o ozônio e os bicarbonatos) no processo de clarificação, com intuito de minimizar os resíduos e emissões, atendendo ao nível 1 dos níveis de aplicação da P+L, reduzindo, na fonte geradora, os poluentes e modificando o processo de sulfitação através da substituição do insumo (SO2). Palavras-chaves: Produção mais Limpa; Clarificação do caldo; Açúcar. This paper’s objective is to verify the application of those principles that guide cleaner production of sugar. Cleaner production divides its objectives into three levels: level 1 (avoid waste and emissions), level 2 (return wastes to the production process) and level 3 (external recycling and final disposal of wastes). The traditional clarification process used for sugar and alcohol agribusiness is characterized by a step known as sulphiting, where sulphur (SO2) is introduced, and this is an input that releases residue which is harmful to human health and the environment. However, the need to produce high quality sugar and free of toxic residue, is encoura- ging factories in this segment to seek alternatives that are technically viable to substitute this product in the production process. In this study, two technically viable alternatives were presented to replace sulphur, ozone and bicarbonates in the clarification process, in order to minimize residues and emissions. This meets level 1 for cleaner production applications, reducing pollutants at the source and modifying the sulphiting process by replacing the input (SO2). Keywords: Cleaner Production; Gravy clarification; Sugar.