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An image of a giant brown tumor due to severe secondary hyperparathyroidism. 严重的继发性甲状旁腺功能亢进症导致的巨大褐色肿瘤的图像。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0083en
Ana Carolina de Lima, Ana Claudia Siqueira Marques, Rodrigo Bueno de Oliveira
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引用次数: 0
Hashimoto's thyroiditis masquerading as acute tubular injury and rhabdomyolysis. 伪装成急性肾小管损伤和横纹肌溶解症的桥本氏甲状腺炎。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0022en
Gerry George Mathew, Varadharajan Jayaprakash

Hashimoto's thyroiditis manifesting as hypothyroidism has been implicated in glomerular disorders due to autoantibody formation. Here we present the case of a 26-year-old male without any comorbidities presenting with easy fatiguability and weight gain for 2 months. He was found to have a creatinine of 2.1 mg/dL with a history of rhinitis treated with anti-histaminic three days prior to the hospital visit. He had symptoms of intermittent myalgia for the past two weeks. On laboratory evaluation, he was found to have raised CPK, elevated TSH, low normal T4, and positive anti-TPO and anti-Tg antibodies. Neck ultrasound revealed linear echogenic septations in the thyroid gland. Renal biopsy revealed acute tubular injury. Appropriate thyroxine supplementation was started and his creatinine decreased to 1.2 mg/dL after 1 month. It is important that clinicians should be aware of this rare kidney presentation in Hashimoto's thyroiditis.

表现为甲状腺功能减退的桥本氏甲状腺炎与自身抗体形成导致的肾小球功能紊乱有关。在此,我们介绍了一例 26 岁男性患者的病例,该患者无任何并发症,2 个月来表现为易疲劳和体重增加。他的血肌酐为 2.1 mg/dL,入院前三天有鼻炎病史,曾服用抗组胺药。过去两周,他出现了间歇性肌痛症状。实验室检查发现,他的肌酸激酶(CPK)升高,促甲状腺激素(TSH)升高,T4正常值偏低,抗TPO和抗Tg抗体阳性。颈部超声波检查发现甲状腺有线状回声隔膜。肾活检发现急性肾小管损伤。患者开始适当补充甲状腺素,1个月后肌酐降至1.2毫克/分升。临床医生必须认识到桥本氏甲状腺炎这种罕见的肾脏表现。
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引用次数: 0
Transitioning to peritoneal dialysis: it does not matter where you come from. 向腹膜透析过渡:来自哪里并不重要。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2023-0139en
Diogo Francisco, Andreia Carnevale, Gonçalo Ávila, Ana Rita Calça, Patrícia Matias, Patrícia Branco

Introduction: Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality.

Methods: We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first.

Results: Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups.

Conclusions: PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences.

导言:终末期肾病(ESRD)患者由于医疗或社会原因经常更换肾脏替代(RRT)治疗方式。我们的目的是评估腹膜透析(PD)患者根据之前的 RRT 治疗方式所获得的疗效:我们对 2010 年 1 月 1 日至 2017 年 12 月 31 日期间流行的腹膜透析患者进行了一项回顾性单中心观察研究,随访 60 个月或直到他们退出腹膜透析。根据之前的 RRT 将患者分为三组:之前接受过血液透析(HD)、肾移植(KT)失败和首次接受 PD:结果:在 152 名患者中,115 人首先接受了 PD,22 人从 HD 过渡而来,15 人从失败的 KT 过渡而来。从 HD 过渡而来的患者发生超滤失败的比例更高(27.3% vs. 9.6% vs. 6.7%,P = 0.07)。未接受过 RRT 治疗的组别中,残余肾功能得到了更好的保护(p < 0.001)。在既往接受过 KT 治疗的患者组中,腹膜炎的年发生率呈上升趋势(每名患者每年发生 0.70 例腹膜炎 vs. 0.10 例 vs. 0.21 例,p = 0.065)。13名患者(8.6%)发生了重大心血管事件,其中5名患者是从失败的KT转来的(p = 0.004)。在死亡和技术存活率方面,首次使用PD、之前使用KT和之前使用HD的患者之间没有差异(分别为p = 0.195和p = 0.917),所有组别的PD疗效都很好:结论:对于 ESRD 患者来说,无论之前是否接受过 RRT 治疗,PD 都是一种合适的选择,应根据患者的临床和社会状况及偏好提供给他们。
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引用次数: 0
Nephrology and experimental medicine in vivo, in vitro, and in silico. 肾脏病学和实验医学的体内、体外和硅学研究。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0004en
Mauricio Younes-Ibrahim

Experimental medicine has formed the basis for generating medical knowledge for several centuries. The development of various experimental tools introduced at different times in medical practice has allowed the acquisition of knowledge with increasingly sophisticated scientific bases. Consequently, through in vivo, in vitro and, more recently, in silico experiments, we have witnessed an uninterrupted collection of experimental data potentially valuable for medicine, especially for Nephrology. We are gradually contemplating the uniqueness of individuals for the benefit of life and human dignity.

几个世纪以来,实验医学一直是产生医学知识的基础。随着医学实践中不同时期引入的各种实验工具的发展,人们得以获得具有日益复杂的科学基础的知识。因此,通过体内、体外以及最近的硅学实验,我们不断收集到对医学,尤其是肾脏病学有潜在价值的实验数据。为了生命和人类尊严的利益,我们正在逐渐思考个体的独特性。
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引用次数: 0
Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention. 巴西透析室营养师的实践:营养评估和干预。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2023-0092en
Fabiana Baggio Nerbass, Aline de Araujo Antunes, Lilian Cuppari

Introduction: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals.

Objective: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition.

Methodology: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements.

Results: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions.

Conclusion: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

简介:在巴西,透析室营养师的重要性毋庸置疑,而且是强制性的,但人们对这些专业人员所采取的做法却知之甚少:了解常规营养护理中采用的方法,重点是营养评估工具和针对高危人群或确诊为营养不良人群的治疗策略:通过社交媒体和信息应用程序发布电子问卷。其中的问题包括营养师的人口和职业概况特征、透析单位、营养评估工具的使用情况和频率、有营养不良风险或诊断出营养不良时的营养干预策略、口服营养补充剂的处方和获取途径:24%的巴西透析单位(n = 207)通过电子方式进行了回复。无论是否预先确定频率,使用最多的营养评估工具是膳食调查(96%)和主观全面评估(83%)。在有营养不良风险或存在营养不良的情况下,使用频率最高(几乎总是/总是)的策略是指导患者从食物中增加能量和蛋白质的摄入(97%),以及增加就诊频率(88%)。开具标准配方和专用配方的商业补充剂的频率相当接近。不同地区的公共医疗系统向患者提供膳食补充剂的情况各不相同:大多数营养师在出现营养风险或营养不良的情况下会使用各种营养评估工具和干预策略;但是,使用这些工具和策略的频率存在很大差异。
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引用次数: 0
Obituary of Dr. Julio Toporovski. 胡利奥-托波洛夫斯基博士的讣告。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-IM003en
Maria Helena Vaisbich, Olberes Vitor Braga de Andrade, Maria Goretti Moreira Guimarães Penido
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引用次数: 0
The role of podocyte injury in the pathogenesis of Fabry disease nephropathy. 荚膜损伤在法布里病肾病发病机制中的作用。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0035en
José Tiburcio do Monte Neto, Gianna Mastroianni Kirsztajn

Renal involvement is one of the most severe morbidities of Fabry disease (FD), a multisystemic lysosomal storage disease with an X-linked inheritance pattern. It results from pathogenic variants in the GLA gene (Xq22.2), which encodes the production of alpha-galactosidase A (α-Gal), responsible for glycosphingolipid metabolism. Insufficient activity of this lysosomal enzyme generates deposits of unprocessed intermediate substrates, especially globotriaosylceramide (Gb3) and derivatives, triggering cellular injury and subsequently, multiple organ dysfunction, including chronic nephropathy. Kidney injury in FD is classically attributed to Gb3 deposits in renal cells, with podocytes being the main target of the pathological process, in which structural and functional alterations are established early and severely. This configures a typical hereditary metabolic podocytopathy, whose clinical manifestations are proteinuria and progressive renal failure. Although late clinical outcomes and morphological changes are well established in this nephropathy, the molecular mechanisms that trigger and accelerate podocyte injury have not yet been fully elucidated. Podocytes are highly specialized and differentiated cells that cover the outer surface of glomerular capillaries, playing a crucial role in preserving the structure and function of the glomerular filtration barrier. They are frequent targets of injury in many nephropathies. Furthermore, dysfunction and depletion of glomerular podocytes are essential events implicated in the pathogenesis of chronic kidney disease progression. We will review the biology of podocytes and their crucial role in regulating the glomerular filtration barrier, analyzing the main pathogenic pathways involved in podocyte injury, especially related to FD nephropathy.

肾脏受累是法布里病(FD)最严重的病症之一,法布里病是一种多系统溶酶体贮积病,具有 X 连锁遗传模式。该病是由 GLA 基因(Xq22.2)的致病变体引起的,该基因编码产生α-半乳糖苷酶 A(α-Gal),负责糖磷脂代谢。这种溶酶体酶的活性不足会产生未加工的中间底物沉积,尤其是球糖基甘油三酯(Gb3)及其衍生物,引发细胞损伤,进而导致多器官功能障碍,包括慢性肾病。FD的肾损伤通常归因于肾细胞中的Gb3沉积,荚膜细胞是病理过程的主要目标,其结构和功能的改变发生得早且严重。这就是典型的遗传代谢性荚膜细胞病,其临床表现为蛋白尿和进行性肾衰竭。虽然这种肾病的晚期临床结果和形态学变化已得到证实,但引发和加速荚膜细胞损伤的分子机制尚未完全阐明。荚膜细胞是高度特化和分化的细胞,覆盖在肾小球毛细血管的外表面,在维护肾小球滤过屏障的结构和功能方面起着至关重要的作用。在许多肾病中,绒毛膜细胞经常成为损伤的目标。此外,肾小球荚膜细胞的功能障碍和耗竭也是慢性肾病进展的重要发病机制。我们将回顾荚膜细胞的生物学特性及其在调节肾小球滤过屏障中的关键作用,分析荚膜细胞损伤所涉及的主要致病途径,尤其是与 FD 肾病相关的途径。
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引用次数: 0
Common arboviruses and the kidney: a review. 常见虫媒病毒与肾脏:综述。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2023-0168en
Gabriel Rotsen Fortes Aguiar, Geraldo Bezerra da Silva Júnior, Janaína de Almeida Mota Ramalho, Nattachai Srisawat, Elizabeth de Francesco Daher

Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given.

虫媒病毒在多个国家流行,是一个令人担忧的公共卫生问题。其中最重要的疾病是登革热,其发病率持续上升,自过去十年以来,巴西每年的发病人数已达数百万。其他引起公共卫生关注的虫媒病毒有基孔肯雅热和寨卡热,这两种病毒最近都造成了流行病,还有黄热病,它也在我国造成了流行病的爆发。与大多数传染病一样,虫媒病毒有可能通过多种机制影响肾脏。这些机制包括病毒的直接作用、全身炎症、出血现象和其他并发症,此外还有治疗药物的毒性。在这篇综述文章中,探讨了巴西和这些疾病流行的其他国家的主要虫媒病毒的流行病学方面、临床方面和发现的主要实验室变化,包括肾功能的变化。报告还介绍了虫媒病毒在肾移植患者中的表现。描述了与虫媒病毒相关的肾损伤的病理生理机制,最后给出了每种疾病的建议治疗方法以及在这种情况下的肾支持建议。
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引用次数: 0
Sodium-glucose cotranspor ter 2 (SGLT2) inhibitors in nephrolithiasis: should we "gliflozin" patients with kidney stone disease? 钠-葡萄糖共转移酶 2 (SGLT2) 抑制剂在肾结石中的应用:我们是否应该为肾结石患者 "格列氯嗪"?
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2023-0146en
Mauricio de Carvalho, Ita Pfeferman Heilberg

The prevalence of nephrolithiasis is increasing worldwide. Despite advances in understanding the pathogenesis of lithiasis, few studies have demonstrated that specific clinical interventions reduce the recurrence of nephrolithiasis. The aim of this review is to analyze the current data and potential effects of iSGLT2 in lithogenesis and try to answer the question: Should we also "gliflozin" our patients with kidney stone disease?

肾结石的发病率在全球范围内不断上升。尽管人们对肾结石发病机制的认识有所进步,但很少有研究表明特定的临床干预措施能减少肾结石的复发。本综述旨在分析 iSGLT2 在碎石发病机制中的现有数据和潜在作用,并尝试回答这一问题:我们是否也应该对肾结石患者进行 "格列酮嗪 "治疗?
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引用次数: 0
Predictors of autosomal dominant polycystic kidney disease progression: a Brazilian single-center cohort. 常染色体显性多囊肾进展的预测因素:巴西单中心队列。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.1590/2175-8239-JBN-2023-0040en
Igor Hitoshi Nishimoto, Andrey Gonçalves Santos, Júlia Mandelbaun Bianchini, Luiz Gustavo Brenneisen Santos, Maria Carolina Rodrigues Martini, Vanessa Dos Santos Silva, Luis Cuadrado Martin

Introduction: Identifying risk factors for autosomal dominant polycystic kidney disease (ADPKD) progression is important. However, studies that have evaluated this subject using a Brazilian sample is sparce. Therefore, the aim of this study was to identify risk factors for renal outcomes and death in a Brazilian cohort of ADPKD patients.

Methods: Patients had the first medical appointment between January 2002 and December 2014, and were followed up until December 2019. Associations between clinical and laboratory variables with the primary outcome (sustained decrease of at least 57% in the eGFR from baseline, need for dialysis or renal transplantation) and the secondary outcome (death from any cause) were analyzed using a multiple Cox regression model. Among 80 ADPKD patients, those under 18 years, with glomerular filtration rate <30 mL/min/1.73 m2, and/or those with missing data were excluded. There were 70 patients followed.

Results: The factors independently associated with the renal outcomes were total kidney length - adjusted Hazard Ratio (HR) with a 95% confidence interval (95% CI): 1.137 (1.057-1.224), glomerular filtration rate - HR (95% CI): 0.970 (0.949-0.992), and serum uric acid level - HR (95% CI): 1.643 (1.118-2.415). Diabetes mellitus - HR (95% CI): 8.115 (1.985-33.180) and glomerular filtration rate - HR (95% CI): 0.957 (0.919-0.997) were associated with the secondary outcome.

Conclusions: These findings corroborate the hypothesis that total kidney length, glomerular filtration rate and serum uric acid level may be important prognostic predictors of ADPKD in a Brazilian cohort, which could help to select patients who require closer follow up.

导言:确定常染色体显性多囊肾病(ADPKD)恶化的风险因素非常重要。然而,利用巴西样本对这一主题进行评估的研究却很少。因此,本研究旨在从巴西的 ADPKD 患者队列中找出肾脏疾病和死亡的风险因素:2002年1月至2014年12月期间首次就诊的患者,随访至2019年12月。采用多元 Cox 回归模型分析了临床和实验室变量与主要结果(eGFR 从基线持续下降至少 57%、需要透析或肾移植)和次要结果(任何原因导致的死亡)之间的关系。在 80 名 ADPKD 患者中,18 岁以下、肾小球滤过率结果:与肾脏结果独立相关的因素有:肾脏总长度--调整后危险比(HR),95% 置信区间(95% CI):1.137(1.057-1.224);肾小球滤过率--HR(95% CI):0.970(0.949-0.992);血清尿酸水平--HR(95% CI):1.643(1.118-2.415)。糖尿病--HR(95% CI):8.115(1.985-33.180)和肾小球滤过率--HR(95% CI):0.957(0.919-0.997)与次要结果相关:这些研究结果证实了一个假设,即在巴西队列中,肾脏总长度、肾小球滤过率和血清尿酸水平可能是 ADPKD 的重要预后预测指标,有助于选择需要更密切随访的患者。
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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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