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

Introduction: Interdialytic weight gain (IDWG) is a risk factor for cardiovascular complications and mortality in hemodialysis (HD) patients. Sodium and fluid intake are important modifiable risk factors for these outcomes, and the role of the nutritionist as educator is essential in this process. However, patient adherence is often low, representing a significant challenge. Recent recommendations suggest personalizing the education process, but there is limited data on how to effectively carry out this adaptation. The present study aimed to assess the effectiveness of a personalized nutritional intervention based on learning style using the VARK tool with the goal of reducing IDWG in HD patients.

Objective: This was a randomized crossover clinical trial. Patients in the intervention group received individualized nutritional guidance based on their learning style, as determined by the VARK questionnaire. The control group received standard guidance without any personalization or educational materials.

Results: A total of 21 chronic HD patients participated in the study. On average, the baseline IDWG in the population was 2.61 ± 1.08 liters, and we did not observe any significant pattern of change in either IDWG (p = 0.55) or systolic blood pressure (p = 0.44) over the study period.

Conclusion: Tailored nutritional counseling based on the patient's learning style did not lead to an improvement in IDWG in our population.

[This corrects the article doi: 10.1590/2175-8239-JBN-2021-0231en] [This corrects the article doi: 10.1590/2175-8239-JBN-2021-0231pt].

Introduction: In the northwest of Portugal, AA amyloidosis was reported as the most frequent amyloid nephropathy, but it is unclear if the disease's incidence and outcomes have changed. The authors studied the changing epidemiology, aetiologies, and outcomes of patients with renal AA amyloidosis over the last 40 years.

Methods: This is a retrospective single-center cohort study involving patients with renal biopsy-proven AA amyloidosis diagnosed in the northwest of Portugal between 1978 and 2019. The patients were grouped into 14-year cohorts based on the year of diagnosis (CA 1978-1991; CB 1992-2005; CC 2006-2019), and clinical course and outcomes were analyzed.

Results: Sixty-nine AA amyloidosis patients were included. The incidence of the disease remained stable in CA (64%) and CB (62.7%) as opposed to the significant decrease in the most recent cohort (44%, p = 0.027). The mean age at presentation increased by ten years from CA to CC. Overall, infections were the leading cause of death, with a significant rise over time (9.1% in CA to 76.9% at CC, p = 0.002). There were no significant global and renal survival differences between the three cohorts. However, the CC patients died at an older age (61.4 years) than the CA (52.3 years).

Conclusion: The incidence of AA amyloidosis has been declining over the last 40 years. In contrast, the age at presentation of amyloid nephropathy has been increasing. Global and renal outcomes did not improve, but the average life expectancy increased, suggesting progress in general management and supportive care of renal and underlying pathology.

Atypical hemolytic uremic syndrome (aHUS) is a rare cause of thrombotic microangiopathy (TMA) caused by the dysregulation of the alternative complement pathway. The diagnosis of TMA is made clinically by the triad: microangiopathic hemolytic anemia, thrombocytopenia, and organ damage (mainly acute kidney injury). The heterogeneity of clinical manifestation and the lack of a gold standard diagnostic test makes the precise diagnosis of aHUS a challenging process that may impact patient management. Until one decade ago, there was no specific treatment for aHUS and patients were submitted to plasma therapy (plasma exchange and/or plasma infusion) and/or liver transplantation, procedures that are not free of serious complications and that do not address the underlying pathophysiology of the disease. Since 2011, an anti-C5 complement monoclonal antibody has been approved by the Food and Drug Administration (FDA) for aHUS patients beginning a new era in treatment. Clinical trials on new complement inhibitors may also add to the treatment portfolio in the future. The Brazilian population is a mixed race with a unique genetic and clinical profile. This consensus aims to offer recommendations for the diagnosis and treatment of patients with aHUS in this population based on expert experience, data from the aHUS Brazilian Registry and literature review. The GRADE system was used to classify the quality of the evidence.

Introduction: Virtual reality (VR) has been used as an effective tool for improving patient adherence to intradialytic exercise programs. This study evaluated the perception and satisfaction of patients and healthcare professionals regarding an intradialytic VR exercise program.

Methods: The VR protocol included lower limb resistance and endurance training. Patients' perception and satisfaction, as well as the perception of healthcare professionals, were assessed using questionnaires.

Results: Of the 27 patients who participated in the exercise program, most evaluated the experience as very good and easy to perform. Of the 24 patients who completed the program, most described the experience as beneficial. Most of the healthcare professionals reported that the protocol did not affect their work routine.

Conclusion: The intradialytic VR exercise program was well accepted by patients and healthcare professionals.

The prevalence of nephrolithiasis has been increasing in recent years, affecting appro-ximately 10% and 15% of the population. Kidney stone disease is associated with syste-mic comorbidities such as cardiovascular dis-ease, diabetes mellitus, and obesity. The first Nephrolithiasis Guideline by the Brazilian Society of Nephrology was published in 2002, and since then, the accumulation of new clinical studies and guidelines has justified a review of the subject. This updated document, prepared by the Nephrolithiasis Committee of the Brazilian Society of Nephrology, reflects the advances in the management of patients with kidney stones. The guideline aims to provide recommendations for the diagnosis, prevention, and treatment of nephrolithiasis, based on the best available evidence. Topics covered include clinical evaluation, laboratory and imaging tests, as well as dietary and pharmacological interventions, and follow-up strategies.

[This corrects the article doi: 10.1590/2175-8239-JBN-2023-0193en] [This corrects the article doi: 10.1590/2175-8239-JBN-2023-0193pt].