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Exercise prescriptions for patients on hemodialysis in Brazil: a scoping review. 巴西血液透析患者的运动处方:范围界定综述。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1590/2175-8239-JBN-2024-0049en
Heitor S Ribeiro, Francini P Andrade, Diogo V Leal, Juliana S Oliveira, Kenneth R Wilund, Maycon M Reboredo, João L Viana

Introduction: Exercise is being incorporated into the treatment of patients on hemodialysis; however, little is known about the major characteristics of these interventions.

Objective: To describe the exercise protocols prescribed for hemodialysis patients in Brazil.

Methods: A scoping review was conducted following JBI and Prisma-ScR guidelines. Searches were carried out in Medline, Embase and three other databases until May 2024. Other sources (websites, books and guidelines) were also investigated. Evidence from patients on hemodialysis describing exercise protocols in all settings and designs in Brazil was included.

Results: Forty-five pieces of evidence were found, resulting in 54 exercise protocols from 16 Brazilian states. Strength exercises (33.3%), followed by aerobic exercises (22.2%), were the most prescribed, mainly to be performed during dialysis (85.2%). The most prevalent professionals supervising the programs were physiotherapists and exercise physiologists (37.0% and 18.5%, respectively). All protocols implemented the principles of type and frequency training, while progression was adopted in only 53.7%. The main prescription was three times per week (88.9%). Exercise intensity was predominantly determined by subjective methods (33.3%).

Conclusion: Aerobic and strength exercises during dialysis were the most commonly prescribed modalities in Brazil, with the majority of programs being properly supervised by qualified professionals. However, existing protocols have not employed systematic progression throughout the intervention, which would be appropriate for providing better physiological responses and adaptations.

导言:运动正被纳入血液透析患者的治疗中;然而,人们对这些干预措施的主要特点知之甚少:描述巴西血液透析患者的运动方案:方法:根据 JBI 和 Prisma-ScR 指南进行了范围界定综述。在 Medline、Embase 和其他三个数据库中进行了检索,检索期至 2024 年 5 月。还调查了其他来源(网站、书籍和指南)。结果:结果:共发现 45 项证据,54 项运动方案来自巴西 16 个州。规定最多的是力量锻炼(33.3%),其次是有氧锻炼(22.2%),主要在透析期间进行(85.2%)。指导这些计划的最普遍的专业人员是物理治疗师和运动生理学家(分别占 37.0% 和 18.5%)。所有方案都贯彻了类型和频率训练原则,只有 53.7% 的方案采用了渐进式训练。主要处方为每周三次(88.9%)。运动强度主要由主观方法决定(33.3%):结论:在巴西,透析期间的有氧运动和力量锻炼是最常见的处方方式,大多数计划都由合格的专业人员进行适当监督。然而,现有的方案并没有在整个干预过程中采用系统的渐进方法,而这种方法适合提供更好的生理反应和适应性。
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引用次数: 0
Translation into Portuguese (Brazil), cultural adaptation and validation of Parathyroid Assessment of Symptoms (PAS) in patients with chronic kidney disease and hyperparathyroidism. 将慢性肾病和甲状旁腺功能亢进症患者的甲状旁腺症状评估(PAS)翻译成葡萄牙语(巴西)、进行文化调整和验证。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1590/2175-8239-JBN-2022-0059en
Rafael Costa E Campos, Rayssa Ruszkowski do Amaral, Marta Ribeiro Hentschke, Marcelo Garcia Toneto, Carlos Eduardo Poli-de-Figueiredo

Introduction: Chronic kidney disease (CKD) is related to high morbidity and mortality and loss of quality of life. Likewise, hyperparathyroidism is associated to progressive loss of renal function, with increased phosphate and decrease calcium levels, which induce the secretion of parathyroid hormone.

Objectives: To translate into Portuguese (Brazil), culturally adapt and validate the questionnaire Parathyroid Symptoms Assessment (PAS), following reliability and validity criteria in patients with chronic kidney disease and hyperparathyroidism.

Methods: Methodological and cross-sectional study, carried out at São Lucas Hospital/PUCRS, Porto Alegre, Brazil. The PAS questionnaire validation process followed protocols from previous studies. After translating into Portuguese, it was applied to 100 patients with secondary (SHPT) and tertiary or persistent (THPT) hyperparathyroidism. For PAS validation data, patients responded to the Short Form Health 36 (SF-36) questionnaire. Reliability criteria were evaluated using intraclass correlation coefficient (ICC) and Cronbach's alpha (α-C). Validity was assessed by Spearman's correlation coefficient between PAS and SF-36 values.

Results: Participant's mean age was 55.6 ± 15.6 years, 61% was male, and 68% was diagnosed with SHPT. Among 100 patients, 53% performed a PAS retest (ICC = 0.83). The internal reliability by α-C was 0.86. Negative correlations were observed between PAS questions and SF-36 physical and mental domains, which ranged from 0.3 to 0.7.

Conclusion: The Brazilian version of the PAS questionnaire was found to be valid and reliable. The PAS questionnaire can be used to evaluate quality of life in Brazilian patients with hyperparathyroidism who speak Portuguese.

导言:慢性肾脏病(CKD)与高发病率、高死亡率和生活质量下降有关。同样,甲状旁腺机能亢进症也与肾功能逐渐丧失、磷酸盐增加和钙水平下降有关,这些因素会诱发甲状旁腺激素的分泌:将甲状旁腺症状评估(PAS)问卷翻译成葡萄牙语(巴西),并按照可靠性和有效性标准对其进行文化适应性调整和验证,适用于慢性肾病和甲状旁腺功能亢进症患者:方法:在巴西阿雷格里港的圣卢卡斯医院/PUCRS开展横断面研究。PAS 问卷的验证过程遵循了以往研究的规程。在翻译成葡萄牙语后,对100名继发性(SHPT)和三级或持续性(THPT)甲状旁腺机能亢进症患者进行了问卷调查。对于 PAS 验证数据,患者回答了健康简表 36(SF-36)问卷。可靠性标准采用类内相关系数(ICC)和克朗巴赫α(α-C)进行评估。通过 PAS 和 SF-36 值之间的斯皮尔曼相关系数评估有效性:参与者的平均年龄为 55.6 ± 15.6 岁,61% 为男性,68% 被诊断为 SHPT。在 100 名患者中,53% 进行了 PAS 重测(ICC = 0.83)。α-C内部信度为0.86。PAS问题与SF-36身体和精神领域之间存在负相关,相关范围为0.3至0.7:巴西版 PAS 问卷有效且可靠。PAS问卷可用于评估讲葡萄牙语的巴西甲状旁腺功能亢进症患者的生活质量。
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引用次数: 0
Effect of urinary tract infection on the outcome of the allograft in patients with kidney transplantation. 尿路感染对肾移植患者异体移植结果的影响。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1590/2175-8239-JBN-2024-0002en
Rahul Sai Gangula, Mahesh Eshwarappa, R Rajashekar, Hamsa Reddy, Pooja Prakash Prabhu, Gireesh M Siddaiah, Gurudev Konana Chennabasappa, Lia Sara Anish, Yousuff Mohammad

Background: Urinary tract infections (UTIs) are the second most common cause of graft dysfunction, accounting for significant morbidity, and are associated with poor graft and patient survival. This study aimed to assess the association between post-renal transplant UTI and graft outcomes.

Methods: We examined the effect of UTIs on graft outcomes in patients who underwent renal transplantation surgery between January 2010 and December 2022. The study population included 349 renal transplantations, of which 74 experienced 140 UTI events. Based on the number of UTI episodes, patients were categorized into three groups.

Results: Of the 349 recipients, 275 (74.4%) had no UTI, 47 (18.8%) had non-recurrent UTIs (NR-UTIs), and 27 (6.8%) had recurrent UTIs (R-UTIs). Kaplan-Meier survival analysis showed that post-KT UTI status was a significant factor in graft survival, death-censored graft survival, and patient survival after a follow up of 5 years (log rank, P < 0.001). R-UTIs were associated with very poor graft survival and patient survival when compared with no UTI after a follow up of 5 years (hazard ratio [HR], 1.506; 95% confidence interval [CI], 1.233-1.840; P < 0.001 & HR, 1.529; 95% CI, 1.227-1.905; P = 0.001). R-UTIs were more likely to be associated with multi-drug resistant Gram-negative organisms (Klebsiella pneumonia or Escherichia coli) with resistance to nitrofurantoin (RR, 2.753; 95% CI, 1.257-6.032; P = 0.01) and carbapenem (RR, 2.064; 95% CI, 0.988-4.314; P = 0.05).

Conclusion: Compared to no UTI, R-UTIs were associated to worse graft and patient outcomes after a follow-up of 5 years, whereas NR-UTIs were associated with poor graft and patient outcomes in the long term.

背景:尿路感染(UTI)是导致移植物功能障碍的第二大常见原因,发病率高,且与移植物和患者存活率低有关。本研究旨在评估肾移植后UTI与移植物预后之间的关系:我们研究了 2010 年 1 月至 2022 年 12 月间接受肾移植手术的患者中,UTI 对移植物预后的影响。研究对象包括 349 例肾移植手术,其中 74 例发生了 140 次 UTI 事件。根据UTI发作次数,将患者分为三组:在 349 名受者中,275 人(74.4%)未发生 UTI,47 人(18.8%)发生非复发性 UTI(NR-UTI),27 人(6.8%)发生复发性 UTI(R-UTI)。Kaplan-Meier 生存分析显示,KT 后 UTI 状态是影响移植物存活率、死亡剪除移植物存活率和随访 5 年后患者存活率的重要因素(对数秩,P < 0.001)。与随访 5 年后未发生 UTI 相比,R-UTI 与极差的移植物存活率和患者存活率相关(危险比 [HR],1.506;95% 置信区间 [CI],1.233-1.840;P < 0.001;HR,1.529;95% 置信区间 [CI],1.227-1.905;P = 0.001)。R-UTI更可能与对硝基呋喃妥因(RR,2.753;95% CI,1.257-6.032;P = 0.01)和碳青霉烯类(RR,2.064;95% CI,0.988-4.314;P = 0.05)耐多种药物的革兰氏阴性菌(肺炎克雷伯菌或大肠埃希菌)有关:结论:与未发生UTI相比,R-UTI与5年随访后较差的移植物和患者预后有关,而NR-UTI与较差的移植物和患者长期预后有关。
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引用次数: 0
Fenofibrate attenuates renal lipotoxicity in uninephrectomized mice with high-fat diet-induced obesity. 非诺贝特能减轻高脂饮食诱发肥胖的未切除肾脏小鼠的肾脏脂肪毒性。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1590/2175-8239-JBN-2023-0148en
Barbara Bruna Abreu Castro, Petrus Ferreira Reno, Bianca Fatima Pereira, Kaique Arriel, Fabiana Bastos Bonato, Fernando Antonio Basile Colugnati, Marcos Antonio Cenedeze, Niels Olsen Saraiva-Camara, Helady Sanders-Pinheiro

Introduction: The objective of this study was to investigate the role of fenofibrate, a peroxisome proliferator-activated receptor-α agonist, in obesity-induced kidney damage (lipotoxicity) in mice with uninephrectomy.

Methods: C57BL/6 mice underwent uninephrectomy and sham surgeries and were fed normocaloric or high-fat diets. After 10 weeks, obese mice were administered 0.02% fenofibrate for 10 weeks. Kidney function and morphology were evaluated, as well as levels of inflammatory and fibrotic mediators and lipid metabolism markers.

Results: High-fat diet-fed mice developed characteristic obesity and hyperlipidemia, with subsequent renal lipid accumulation and damage, including mesangial expansion, interstitial fibrosis, inflammation, and proteinuria. These changes were greater in obese uninephrectomy mice than in obese sham mice. Fenofibrate treatment prevented hyperlipidemia and glomerular lesions, lowered lipid accumulation, ameliorated renal dysfunction, and attenuated inflammation and renal fibrosis. Furthermore, fenofibrate treatment downregulated renal tissue expression of plasminogen activator inhibitor-1, monocyte chemoattractant protein-1, and local expression of fibroblast growth factor-21.

Conclusion: Peroxisome proliferator-activated receptor-α activation by fenofibrate, with subsequent lipolysis, attenuated glomerular and tubulointerstitial lesions induced by renal lipotoxicity, thus protecting the kidneys of uninephrectomy mice from obesity-induced lesions. The study findings suggest a pathway in the pharmacological action of fenofibrate, providing insight into the mechanisms involved in kidney damage caused by obesity in kidney donors.

简介本研究的目的是探讨非诺贝特(一种过氧化物酶体增殖物激活受体-α激动剂)在肥胖引起的未切除肾脏小鼠肾脏损伤(脂肪毒性)中的作用:方法:对 C57BL/6 小鼠进行肾脏未切除手术和假手术,并喂食正常热量或高脂肪饮食。10 周后,给肥胖小鼠服用 0.02% 非诺贝特 10 周。结果:结果:高脂饮食喂养的小鼠出现了特征性肥胖和高脂血症,随后出现了肾脏脂质积累和损伤,包括肾间质扩张、间质纤维化、炎症和蛋白尿。与肥胖假小鼠相比,未切除肾脏的肥胖小鼠的这些变化更大。非诺贝特治疗可预防高脂血症和肾小球病变,降低脂质积累,改善肾功能障碍,减轻炎症和肾脏纤维化。此外,非诺贝特还能下调肾组织中纤溶酶原激活物抑制剂-1、单核细胞趋化蛋白-1和成纤维细胞生长因子-21的局部表达:结论:非诺贝特激活的过氧化物酶体增殖物激活受体-α以及随后的脂肪分解作用减轻了肾脏脂肪毒性引起的肾小球和肾小管间质病变,从而保护了未切除肾脏的小鼠的肾脏免受肥胖引起的病变的影响。研究结果表明了非诺贝特的药理作用途径,有助于深入了解肥胖导致供肾肾脏损伤的相关机制。
{"title":"Fenofibrate attenuates renal lipotoxicity in uninephrectomized mice with high-fat diet-induced obesity.","authors":"Barbara Bruna Abreu Castro, Petrus Ferreira Reno, Bianca Fatima Pereira, Kaique Arriel, Fabiana Bastos Bonato, Fernando Antonio Basile Colugnati, Marcos Antonio Cenedeze, Niels Olsen Saraiva-Camara, Helady Sanders-Pinheiro","doi":"10.1590/2175-8239-JBN-2023-0148en","DOIUrl":"10.1590/2175-8239-JBN-2023-0148en","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to investigate the role of fenofibrate, a peroxisome proliferator-activated receptor-α agonist, in obesity-induced kidney damage (lipotoxicity) in mice with uninephrectomy.</p><p><strong>Methods: </strong>C57BL/6 mice underwent uninephrectomy and sham surgeries and were fed normocaloric or high-fat diets. After 10 weeks, obese mice were administered 0.02% fenofibrate for 10 weeks. Kidney function and morphology were evaluated, as well as levels of inflammatory and fibrotic mediators and lipid metabolism markers.</p><p><strong>Results: </strong>High-fat diet-fed mice developed characteristic obesity and hyperlipidemia, with subsequent renal lipid accumulation and damage, including mesangial expansion, interstitial fibrosis, inflammation, and proteinuria. These changes were greater in obese uninephrectomy mice than in obese sham mice. Fenofibrate treatment prevented hyperlipidemia and glomerular lesions, lowered lipid accumulation, ameliorated renal dysfunction, and attenuated inflammation and renal fibrosis. Furthermore, fenofibrate treatment downregulated renal tissue expression of plasminogen activator inhibitor-1, monocyte chemoattractant protein-1, and local expression of fibroblast growth factor-21.</p><p><strong>Conclusion: </strong>Peroxisome proliferator-activated receptor-α activation by fenofibrate, with subsequent lipolysis, attenuated glomerular and tubulointerstitial lesions induced by renal lipotoxicity, thus protecting the kidneys of uninephrectomy mice from obesity-induced lesions. The study findings suggest a pathway in the pharmacological action of fenofibrate, providing insight into the mechanisms involved in kidney damage caused by obesity in kidney donors.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 4","pages":"e20230148"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
SGLT2 inhibitors and NLRP3 inflammasome: potential target in diabetic kidney disease. SGLT2 抑制剂和 NLRP3 炎症小体:糖尿病肾病的潜在靶点。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1590/2175-8239-JBN-2023-0187en
Paulo André Bispo Machado Júnior, André Lass, Bruna Isadora Pilger, Raphaella Fornazari, Thyago Proença de Moraes, Ricardo Aurino Pinho

Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease (CKD) worldwide. The pathogenesis of DKD is influenced by functional, histopathological, and immune mechanisms, including NLRP3 inflammasome activity and oxidative stress. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown metabolic benefits and the ability to slow the progression of DKD in several clinical studies over the years. Recent studies suggest that the antidiabetic activity also extends to inhibition of the inflammatory response, including modulation of the NLRP3 inflammasome, reduction of pro-inflammatory markers and reduction of oxidative stress. Here we review the efficacy of SGLT2i in the treatment of CKD and discuss the role of the inflammatory response in the development of DKD, including its relationship to the NLRP3 inflammasome and oxidative stress.

糖尿病肾病(DKD)仍然是全球慢性肾病(CKD)的主要病因。DKD 的发病机制受功能、组织病理学和免疫机制的影响,包括 NLRP3 炎性体活性和氧化应激。多年来,钠-葡萄糖共转运体 2 抑制剂(SGLT2i)已在多项临床研究中显示出其代谢优势和减缓 DKD 病程进展的能力。最近的研究表明,其抗糖尿病活性还延伸到抑制炎症反应,包括调节 NLRP3 炎性体、减少促炎症标志物和减少氧化应激。在此,我们回顾了 SGLT2i 治疗慢性肾脏病的疗效,并讨论了炎症反应在慢性肾脏病发展中的作用,包括其与 NLRP3 炎症小体和氧化应激的关系。
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引用次数: 0
An analysis of fellowship training of kidney transplant surgeons in a Brazilian state. 巴西某州肾移植外科医生奖学金培训分析。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1590/2175-8239-JBN-2024-0056en
Salim Anderson Khouri Ferreira, João Henrique Sendrete de Pinho, Juliano Offerni, Helady Sanders-Pinheiro

Introduction: The lack of specialized professionals potentially contributes to the inability to meet the demand for kidney transplantations. Moreover, there is no universal proposal for the training process of transplantation surgeons. We aimed to explore the characteristics of the training program and professional activities of kidney transplantation teams in the state of Minas Gerais, Brazil.

Methods: We invited the surgeons of all 19 active kidney transplantation centers in Minas Gerais to participate in this cross-sectional study. Demographic and professional training data were compared using linear and logistic regression models.

Results: The response rate among the centers was high (89%); half of the surgeons answered the survey (39/78). Most of the centers were public teaching institutions, under a production-based payment contract, with a mean of 6 ± 2.4 surgeons/team; 94.2% of the centers had urologists. The surgeons were 95% male (age of 46.3 ± 9.7 years) and 59% were urologists. Most were involved in organ procurement and transplantation; only one surgeon worked exclusively with transplantation. The mean period since training was 13 ± 9.4 years, with a mean of 10 ± 9.7 years as part of the transplantation team. Only 25.6% had specialized or formal training in transplantation, with only one completing a formal medical residency for kidney transplantation. The lack of training programs was the most frequently cited reason.

Conclusion: Kidney transplantation surgeons are not exclusive and most have not completed a formal fellowship program in transplantation because they are not available. These data indicate the need to improve training programs and facilitate the formation of new kidney transplantation teams.

导言:专业人才的缺乏是无法满足肾移植需求的潜在原因。此外,移植外科医生的培训过程也没有统一的方案。我们旨在探讨巴西米纳斯吉拉斯州肾移植团队的培训计划和专业活动的特点:我们邀请了米纳斯吉拉斯州所有 19 个肾移植中心的外科医生参与这项横断面研究。我们使用线性和逻辑回归模型对人口统计学和专业培训数据进行了比较:各中心的回复率很高(89%);半数外科医生回答了调查(39/78)。大多数中心都是公立教学机构,采用按产量付费的合同,平均每个团队有 6 ± 2.4 名外科医生;94.2% 的中心拥有泌尿科医生。外科医生中 95% 为男性(年龄为 46.3 ± 9.7 岁),59% 为泌尿科医生。大多数外科医生都从事器官获取和移植工作,只有一名外科医生专门从事移植工作。平均受训时间为 13 ± 9.4 年,平均在移植团队工作 10 ± 9.7 年。只有 25.6% 的人接受过移植方面的专业或正规培训,其中只有一人完成了肾移植方面的正规住院医师培训。缺乏培训项目是最常见的原因:结论:肾移植外科医生并不是独一无二的,大多数外科医生没有完成正规的肾移植进修课程,因为他们没有这样的机会。这些数据表明,有必要改进培训计划,促进新肾移植团队的组建。
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引用次数: 0
Safety and feasibility of transcranial direct current stimulation in end-stage renal disease patients undergoing hemodialysis: an exploratory study. 血液透析终末期肾病患者接受经颅直流电刺激的安全性和可行性:一项探索性研究。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-19 eCollection Date: 2024-01-01 DOI: 10.1590/2175-8239-JBN-2024-0010en
Rodrigo Pegado, Monaliza Melo, Tayanne Oehmen, Gianna Mastroianni Kirsztajn, Edson Silva-Filho, Artur Quintiliano

Introduction: Patients with end-stage renal disease often face a challenging routine of hemodialysis, dietary restrictions, and multiple medications, which can affect their hemodynamic function. Home-based, safe, and nonpharmacological approaches such as transcranial direct current stimulation (tDCS) should be combined with conventional treatment.

Objective: To assess the safety and feasibility of tDCS on blood pressure and heart rate in patients with end-stage renal disease undergoing hemodialysis.

Method: This is a parallel, randomized, sham-controlled trial. Patients undergoing hemodialysis for more than three months were included. The patients received ten non-consecutive 2mA tDCS sessions on the primary motor cortex . Each session lasted 20 minutes. At baseline and after each of the ten sessions, blood pressure and heart rate of the patients were measured hourly for four hours.

Results: Thirty patients were randomized to the active or sham group. The mean difference between the groups was calculated as the mean value of the sham group minus the mean value of the active group. Despite there were no statistical changes for all outcomes considering all 10 sessions, we found differences between groups for systolic -10.93 (-29.1;7.2), diastolic -3.63 (-12.4; 5.1), and mean blood pressure -6.0 (-16.3; 4.2) and hear rate 2.26 (-2.5; 7.1). No serious adverse events were found. The active group showed higher blood pressure values at all points, while heart rate was lower in the active group.

Conclusion: tDCS is safe and feasible for patients with end-stage renal disease undergoing hemodialysis. Future studies should investigate whether tDCS could potentially induce a hypotensive protective effect during hemodialysis.

简介终末期肾病患者通常面临着血液透析、饮食限制和多种药物等具有挑战性的日常事务,这些都会影响他们的血液动力学功能。经颅直流电刺激(tDCS)等基于家庭、安全且非药物治疗的方法应与常规治疗相结合:评估经颅直流电刺激对接受血液透析的终末期肾病患者的血压和心率的安全性和可行性:这是一项平行、随机、假对照试验。方法:这是一项平行、随机、假对照试验,纳入了接受血液透析三个月以上的患者。患者在初级运动皮层接受十次不连续的 2mA tDCS 治疗。每个疗程持续 20 分钟。在十次治疗的基线和每次治疗后,每小时测量患者的血压和心率,持续四小时:结果:30 名患者被随机分配到主动组或假动作组。各组之间的平均差异计算方法为假体组的平均值减去活性组的平均值。尽管在所有 10 个疗程中,所有结果均无统计学变化,但我们发现各组之间在收缩压 -10.93 (-29.1; 7.2)、舒张压 -3.63 (-12.4; 5.1)、平均血压 -6.0 (-16.3; 4.2) 和听力 2.26 (-2.5; 7.1) 方面存在差异。未发现严重不良事件。结论:tDCS 对接受血液透析的终末期肾病患者是安全可行的。未来的研究应探讨 tDCS 是否有可能在血液透析期间产生降压保护作用。
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引用次数: 0
Tuberous Sclerosis Complex and the kidneys: what nephrologists need to know. 结节性硬化症复合体与肾脏:肾病学家须知。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-05 eCollection Date: 2024-01-01 DOI: 10.1590/2175-8239-JBN-2024-0013en
Aline Grosskopf Monich, John J Bissler, Fellype Carvalho Barreto

Tuberous sclerosis complex (TSC) is an autosomal dominant disease characterized by the development of hamartomas in the central nervous system, heart, skin, lungs, and kidneys and other manifestations including seizures, cortical tubers, radial migration lines, autism and cognitive disability. The disease is associated with pathogenic variants in the TSC1 or TSC2 genes, resulting in the hyperactivation of the mTOR pathway, a key regulator of cell growth and metabolism. Consequently, the hyperactivation of the mTOR pathway leads to abnormal tissue proliferation and the development of solid tumors. Kidney involvement in TSC is characterized by the development of cystic lesions, renal cell carcinoma and renal angiomyolipomas, which may progress and cause pain, bleeding, and loss of kidney function. Over the past years, there has been a notable shift in the therapeutic approach to TSC, particularly in addressing renal manifestations. mTOR inhibitors have emerged as the primary therapeutic option, whereas surgical interventions like nephrectomy and embolization being reserved primarily for complications unresponsive to clinical treatment, such as severe renal hemorrhage. This review focuses on the main clinical characteristics of TSC, the mechanisms underlying kidney involvement, the recent advances in therapy for kidney lesions, and the future perspectives.

结节性硬化症复合体(TSC)是一种常染色体显性遗传病,其特征是在中枢神经系统、心脏、皮肤、肺部和肾脏等部位出现火腿肠瘤,并伴有癫痫发作、皮质小管、放射状迁移纹、自闭症和认知障碍等其他表现。该病与 TSC1 或 TSC2 基因的致病变异有关,这些变异会导致 mTOR 通路过度激活,而 mTOR 通路是细胞生长和新陈代谢的关键调节因子。因此,mTOR 通路的过度激活会导致组织异常增殖和实体瘤的发生。TSC 肾脏受累的特点是发生囊性病变、肾细胞癌和肾血管脂肪瘤,这些病变可能会发展并引起疼痛、出血和肾功能丧失。mTOR 抑制剂已成为主要的治疗选择,而肾切除术和栓塞术等外科干预则主要用于对临床治疗无反应的并发症,如严重的肾出血。本综述重点介绍 TSC 的主要临床特征、肾脏受累的机制、肾脏病变治疗的最新进展以及未来展望。
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引用次数: 0
Mind the gap in kidney care: translating what we know into what we do. 关注肾脏护理中的差距:将我们的知识转化为我们的行动。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-05 eCollection Date: 2024-01-01 DOI: 10.1590/2175-8239-JBN-2024-E007en
Valerie A Luyckx, Katherine R Tuttle, Dina Abdellatif, Ricardo Correa-Rotter, Winston W S Fung, Agnès Haris, Li-Li Hsiao, Makram Khalife, Latha A Kumaraswami, Fiona Loud, Vasundhara Raghavan, Stefanos Roumeliotis, Marianella Sierra, Ifeoma Ulasi, Bill Wang, Siu-Fai Lui, Vassilios Liakopoulos, Alessandro Balducci

Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

从历史上看,新疗法从临床证据转化为日常实践平均需要 17 年的时间。鉴于目前已有的高效疗法可以预防或延缓肾病的发生和发展,这个时间太长了。现在是缩小我们所知道的与我们所做的之间差距的时候了。对于高血压和糖尿病等肾脏病常见风险因素的预防和管理,已有明确的指导方针,但全世界只有一小部分肾脏病患者被确诊,接受目标治疗的患者则更少。同样,绝大多数肾病患者都不知道自己的病情,因为肾病在早期往往是无声无息的。即使在已经确诊的患者中,许多人也没有接受适当的肾病治疗。考虑到肾病恶化、肾衰竭或死亡的严重后果,必须及早开始适当的治疗。必须从初级保健开始,最大限度地利用早期诊断和治疗肾病的机会。从患者到临床医生,从医疗系统到社会因素,存在着许多系统性障碍。为了维护和改善世界各地每个人的肾脏健康,必须认识到这些障碍中的每一个,以便制定和实施可持续的解决方案,不再拖延。
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引用次数: 0
Practices of dietitians in dialysis units in Brazil: nutritional assessment and intervention. 巴西透析室营养师的工作:营养评估与干预。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0112en
Viviane de Oliveira Leal, Denise Mafra
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引用次数: 0
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Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
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