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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
Transition between modalities of renal replacement therapy. 肾脏替代疗法模式之间的转换。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-E008en
Thyago Proença de Moraes, Caio Pellizzari
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引用次数: 0
Erratum: Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology. 勘误:急性肾损伤:儿科肾病学三级中心的经验。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0012eren

[This corrects the article doi: 10.1590/2175-8239-JBN-2024-0012en] [This corrects the article doi: 10.1590/2175-8239-JBN-2024-0012pt].

[This corrects the article doi: 10.1590/2175-8239-JBN-2024-0012en] [This corrects the article doi: 10.1590/2175-8239-JBN-2024-0012pt].
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引用次数: 0
COVID-19 Computed tomography patterns in renal replacement therapy patients. COVID-19 肾脏替代疗法患者的计算机断层扫描模式。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2023-0029en
Gabriel Assis Lopes do Carmo, Mariana Paiva Oliveira, Anna Luiza Lino Campos, Bráulio Roberto Gonçalves Marinho Couto, Lilian Pires de Freitas do Carmo, Tiago Lemos Cerqueira, Camila Alencar Monteiro de Souza, Yan Lopes Goll, Vitor Santos de Souza, Mariana Oliveira Guimarães Vieira, Pedro Alves Soares Vaz de Castro, Pedro Augusto Botelho Lemos, Ana Cristina Simões E Silva

Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19.

Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients.

Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002).

Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

简介:肺部疾病在终末期肾病(ESKD)患者中很常见,因此与 COVID-19 的鉴别诊断是一项挑战。本研究描述了住院接受肾脏替代治疗(RRT)的 ESKD 患者因临床怀疑 COVID-19 而进行肺部胸部断层扫描(CT)的结果:方法:招募临床怀疑患有 COVID-19 的 18 岁以上 ESKD 患者到急诊科就诊。从电子健康记录中提取流行病学基线临床信息。肺部 CT 被分为典型、不确定、不典型或阴性。然后,我们比较了 COVID-19 阳性和阴性患者的 CT 结果:我们在 2020 年 3 月至 12 月间招募了 109 名患者(62.3% COVID-19 阳性),平均年龄为 60 ± 12.5 岁,43% 为女性。ESKD最常见的病因是糖尿病。透析时间中位数为 36 个月,四分位数间距为 12-84 个月。CT 上最常见的肺部病变是磨玻璃不透明。典型的 CT 模式在 COVID-19 患者中更为常见(40 例(61%)与非 COVID-19 患者的 0 例(0%)相比,P < 0.001)。敏感性为 60.61%(40/66),特异性为 100%(40/40)。阳性预测值和阴性预测值分别为 100%和 62.3%。非典型CT模式在COVID-19阴性患者中更常见(9(14%) vs 24(56%),P < 0.001),而不确定模式在两组中相似(13(20%) vs 6(14%),P = 0.606),阴性模式在COVID-19阴性患者中更常见(4(6%) vs 12(28%),P = 0.002):结论:在接受 RRT 的 ESKD 住院患者中,非典型胸部 CT 图谱不能充分排除 COVID-19 的诊断。
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引用次数: 0
Hospital do Rim: 25 years as the global leader in kidney transplants. Hospital do Rim:25 年来在全球肾移植领域一直处于领先地位。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-01 DOI: 10.1590/2175-8239-JBN-2024-0076en
Maria Lúcia Vaz, Lúcio Requião-Moura, José Medina Pestana
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引用次数: 0
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
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Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
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