Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia最新文献

Introduction: The investigation of circulating microRNAs (miRNAs) and inflammatory response associated with the different stages of chronic kidney disease (CKD) may reveal biomarkers of disease pathogenesis. Our goal was to identifying differences in the circulating miRNAs expression between peritoneal dialysis (PD) and non-dialytic (ND) patients and determine the regulatory miRNA-target gene networks and pathways potentially involved in disease pathogenesis.

Methods: This was an exploratory cross-sectional study that included ND and PD patients with CKD stage 5 over 18 years of age. Inflammatory biomarkers and circulating miRNA expression profiles were evaluated.

Results: The study included 20 patients (57.2 ± 11.8 years). Levels of high-sensitivity C-reactive protein [0.37 (0.07-1.40) vs. 3.90 (2.50-5.79), p = 0.038] and interleukin-6 [3.35 ± 3.08 vs. 6.82 ± 4.08, p = 0.046] were significantly lower in the ND group in comparison to the PD group, respectively. Nine miRNAs were significantly deregulated (fold change (FC) ≥ 2 and p ≤ 0.05) in the PD compared to the ND group. Computational analyses showed a large number of target genes commonly regulated by at least two of the identified miRNAs. Pathway enrichment analysis showed that G protein-coupled receptor (GPCR) signaling, insulin secretion/resistance, and energy metabolism were among significant pathways regulated by miRNA target genes.

Conclusions: Patients on PD treatment showed deregulated circulating levels of the 9 identified miRNAs and higher serum inflammatory biomarkers, compared to ND patients. Genes regulated by miRNAs are mainly associated with GPCR signaling, insulin resistance, and energy metabolism, playing roles in fibrosis and inflammatory-associated functions.

Introduction: The impact of curcumin on the gut microbiota of chronic kidney disease (CKD) patients is not well known. The aim of this study was to evaluate the effect of Curcuma longa L. on the gut microbiota of CKD patients undergoing hemodialysis (HD).

Methods: This was a secondary analysis of data from a randomized, double-blind, placebo-controlled trial. Patients received 100 mL of orange juice, 12 grams of carrot, and 2.5 grams of Curcuma longa L. three times a week after the HD session (Curcuma group) or the same juice without added curcumin (control group) for 12 weeks. The fecal microbiota composition was estimated using short-read sequencing of the V4 region of the 16S rRNA gene on the Illumina platform.

Results: Eleven patients participated in this study, five in the curcumin group (66.7% male, 59 ± 16.7 years old, HD vintage of 97 ± 62.6 months, BMI 25.3 ± 2.9 kg/m2) and six in the control group (60% male, 57.5 ± 12.5 years old, HD vintage of 48.3 ± 32.2 months, BMI 25.2 ± 3.1 kg/m2). Supplementation with Curcuma longa L. extract did not modify alpha biodiversity or the taxonomic composition of individuals at the phylum, family, and genus levels.

Conclusion: Supplementation with 2.5 g of Curcuma longa L. extract three times per week for 12 weeks was inefficient in modulating the gut microbiota of CKD patients undergoing HD. These results should be interpreted taking into account the small sample size, and future studies with larger cohorts are encouraged.

Introduction: The medical residency (MR) curriculum underwent a reformulation, and in 2021, the competency matrix for MR in nephrology was published. This study aimed to evaluate nephrologists' perceptions of the competencies acquired during residency and their relevance in clinical practice.

Method: This was a cross-sectional study conducted using a self-administered electronic questionnaire, which included demographic data, information on professional practice, and an assessment of both the learning and the usefulness of the skills acquired during the MR program in nephrology. Participants responded to questions on a five-point Likert scale. Only nephrologists who had graduated from programs accredited by the Brazilian Ministry of Education were included.

Results: A total of 163 nephrologists from different states in Brazil were included. Most considered the clinical skills acquired to be useful for practice, except for palliative care, in which 54% felt capable, although 93.2% considered it essential. Procedures for which usefulness exceeded self-reported competence included fundoscopy, insertion of permanent hemodialysis catheters, insertion of peritoneal dialysis catheters, and ultrasonography. Furthermore, less than 40% of participants reported feeling prepared to engage in management, clinical research, and teaching activities, despite perceiving their relevance.

Conclusion: The study highlights nephrologists' perceptions of competencies acquired during MR and underscores the need for improvements in nephrology training, particulary in management, teaching, and research.

The increase use of vaping, especially in the younger population, has led to increased scrutiny of its health effects, particularly on renal function. This article reviews the current literature on the association between vaping, nicotine exposure, and renal impairment, focusing on the development of acute kidney injury (AKI) and chronic kidney disease (CKD). Nicotine and other chemicals in e-liquids may induce microangiopathy, leading to vasoconstriction and reduced renal perfusion, thus contributing to AKI. Chronic exposure to nicotine also promotes an inflammatory response, increasing the risk of interstitial nephritis. Additionally, glomerular damage due to continuous use of vapers has been linked to albuminuria and progression of focal segmental glomerulosclerosis (FSGS), a condition that can lead to CKD. This article highlights the need for further research to clarify the kidney risks associated with vaping and provides information for public health policies on nicotine use.

Introduction: Given the relevance of renal involvement in systemic lupus erythematosus (SLE) and new approaches to the disease and its treatment, this article aimed to synthesize the main updates in the diagnosis, management, and treatment of lupus nephritis (LN), based on recent publications of international reference guidelines in nephrology and rheumatology, in addition to highlighting aspects of interest from the 2024 national guidelines of the Brazilian Society of Rheumatology (SBR). The treatments for each class of lupus nephritis are described, as well as the therapeutic targets, underlining similarities and differences between the guidelines. In general, they recommend that induction ("initial") treatment of proliferative classes be performed with monotherapy using mycophenolate or intravenous cyclophosphamide, or with multitarget regimens, using corticosteroids, mycophenolate or cyclophosphamide, and a calcineurin inhibitor or belimumab as a third drug. A change in therapy should be considered if the expected response target is not achieved, which presents subtle differences among current consensus guidelines. Maintenance ("subsequent") treatment should preferably be performed with mycophenolate, azathioprine, or multi-target therapies. Emerging scientific evidence has provided treatment options that impact the management of lupus nephritis, thereby justifying the publication of new guidelines in recent months. Critically analyzing these guidelines may assist in decision-making for the individualized treatment of individuals with this disease.

Introduction: Atherosclerotic renovascular disease (ARVD) can cause renal artery stenosis, hypertension, and chronic kidney disease. As revascularization procedure for ARVD is controversial, a risk score was developed to predict mortality in affected patients, which requires validation in different populations. The original risk score did not include statin use; therefore, the aim of this study was to evaluate the accuracy of the risk score in ARVD patients according to statins intake.

Methods: Longitudinal retrospective study involving 136 patients with angiographic diagnosis of RAS > 60% from January 1996 to October 2008. Cox regression analysis was performed to assess all-cause mortality associations. To evaluate the discriminatory power of the risk score, ROC curves were constructed for mortality at 1, 5, and 10 years for those with and without statin use.

Results: 103 patients were included, 69 of whom were taking statins. After 1, 5, and 10 years, survival rates predicted by the risk score for patients using statins were, respectively, 0.87 (95% CI [0.76;0.97]), 0. 45 (95% CI [0.37;0.55]), and 0.15 (95% CI [0.09;0.22]). Actual survival rates were 0.95, 0.88, and 0.72. For the 34 patients who did not use statins, predicted survival rates were 0.84 (95% CI [0.71;0.97]), 0.43 (IC 95% [0.32;0.55]), and 0.14 (95% CI [0.05;0.22]); actual survival rates were 0.83, 0.36, and 0.29.

Conclusion: Patients receiving statins had greater survival rate after 5 and 10 years when compared to calculations by the risk score. The 34 patients who did not use statins had survival rates close to the predicted survival. Therefore, the risk score should be modified to include use of statins.