Pub Date : 2024-07-01DOI: 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?
{"title":"Sodium-glucose cotranspor ter 2 (SGLT2) inhibitors in nephrolithiasis: should we \"gliflozin\" patients with kidney stone disease?","authors":"Mauricio de Carvalho, Ita Pfeferman Heilberg","doi":"10.1590/2175-8239-JBN-2023-0146en","DOIUrl":"10.1590/2175-8239-JBN-2023-0146en","url":null,"abstract":"<p><p>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?</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20230146"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158165","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}
Pub Date : 2024-07-01DOI: 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.
{"title":"Common arboviruses and the kidney: a review.","authors":"Gabriel Rotsen Fortes Aguiar, Geraldo Bezerra da Silva Júnior, Janaína de Almeida Mota Ramalho, Nattachai Srisawat, Elizabeth de Francesco Daher","doi":"10.1590/2175-8239-JBN-2023-0168en","DOIUrl":"10.1590/2175-8239-JBN-2023-0168en","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20230168"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792557","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}
Pub Date : 2024-06-24eCollection Date: 2024-01-01DOI: 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.
{"title":"Predictors of autosomal dominant polycystic kidney disease progression: a Brazilian single-center cohort.","authors":"Igor Hitoshi Nishimoto, Andrey Gonçalves Santos, Júlia Mandelbaun Bianchini, Luiz Gustavo Brenneisen Santos, Maria Carolina Rodrigues Martini, Vanessa Dos Santos Silva, Luis Cuadrado Martin","doi":"10.1590/2175-8239-JBN-2023-0040en","DOIUrl":"https://doi.org/10.1590/2175-8239-JBN-2023-0040en","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20230040"},"PeriodicalIF":1.3,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468060","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}
Pub Date : 2024-06-17eCollection Date: 2024-01-01DOI: 10.1590/2175-8239-JBN-2023-0066en
André Murad Nagahama, Vanessa Dos Santos Silva, Vanessa Burgugi Banin, Roberto Jorge da Silva Franco, Pasqual Barretti, Silmeia Garcia Zanati Bazan, Luis Cuadrado Martin
Introduction: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM).
Objectives: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM.
Methodology: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs.
Results: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments.
Conclusion: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.
{"title":"Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters.","authors":"André Murad Nagahama, Vanessa Dos Santos Silva, Vanessa Burgugi Banin, Roberto Jorge da Silva Franco, Pasqual Barretti, Silmeia Garcia Zanati Bazan, Luis Cuadrado Martin","doi":"10.1590/2175-8239-JBN-2023-0066en","DOIUrl":"10.1590/2175-8239-JBN-2023-0066en","url":null,"abstract":"<p><strong>Introduction: </strong>Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM).</p><p><strong>Objectives: </strong>The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM.</p><p><strong>Methodology: </strong>This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs.</p><p><strong>Results: </strong>Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments.</p><p><strong>Conclusion: </strong>Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20230066"},"PeriodicalIF":1.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11205976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419175","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}
Pub Date : 2024-05-24eCollection Date: 2024-01-01DOI: 10.1590/2175-8239-JBN-2024-E006en
Roberto Pecoits Filho
{"title":"Charting the future of kidney care in Brazil: insights and evolution through the Brazilian Dialysis Survey.","authors":"Roberto Pecoits Filho","doi":"10.1590/2175-8239-JBN-2024-E006en","DOIUrl":"10.1590/2175-8239-JBN-2024-E006en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 2","pages":"e2024E006"},"PeriodicalIF":1.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092738","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}
Pub Date : 2024-05-24eCollection Date: 2024-07-01DOI: 10.1590/2175-8239-JBN-2023-0142en
Elke Kathrin Franke, Ulrich Paul Hinkel, Christian Albert
{"title":"Flow problems during implantation of a peritoneal dialysis catheter: building a capnoperitoneum using the peritoneal dialysis catheter.","authors":"Elke Kathrin Franke, Ulrich Paul Hinkel, Christian Albert","doi":"10.1590/2175-8239-JBN-2023-0142en","DOIUrl":"10.1590/2175-8239-JBN-2023-0142en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20230142"},"PeriodicalIF":1.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11203940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092665","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}
Pub Date : 2024-05-24eCollection Date: 2024-07-01DOI: 10.1590/2175-8239-JBN-2023-0088en
Rafael Peixoto Lima Dias, Daniella Bezerra Duarte, Danilo de Castro Bulhões Mascarenhas Barbosa, Rodrigo Peixoto Campos
Introduction: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality.
Methods: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant.
Results: A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality.
Conclusion: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.
导言:非老年患者在住院患者中所占比例不断上升,急性肾损伤(AKI)在这一人群中很常见。因此,分析这一人群的临床特征及其对死亡率的影响非常重要:方法:对一家三甲医院 2013 年至 2022 年间的非高龄急性肾损伤患者进行回顾性研究。仅考虑最近一次入院的患者,排除数据不完整的患者。通过逻辑回归分析确定死亡风险因素。P值小于0.05为具有统计学意义:共纳入 150 名患者,中位年龄为 93.0 岁(91.2-95.0),男性占样本的 42.7%。败血症是导致急性肾损伤的最常见原因(53.3%),其次是脱水/低血容量(17.7%)和心力衰竭(17.7%)。39.3%的患者住进了重症监护室,14.7%的患者接受了机械通气,22.7%的患者使用了血管加压药,6.7%的患者接受了肾脏替代治疗(RRT)。56.7%的患者死亡。作为 AKI 病因的脱水/低血容量与较低的死亡风险相关(OR 0.18; 95% CI 0.04-0.77, p = 0.020)。KDIGO3期(OR 3.15;95% CI 1.17-8.47,p = 0.023)、入住ICU(OR 12.27;95% CI 3.03-49.74,p <0.001)和少尿(OR 5.77;95% CI 1.98-16.85,p = 0.001)与死亡率相关:结论:患有 AKI 的非老年患者死亡率很高,AKI KDIGO 3 期、少尿和入住 ICU 与死亡有关。
{"title":"Acute kidney injury in nonagenarians: clinical characteristics and mortality.","authors":"Rafael Peixoto Lima Dias, Daniella Bezerra Duarte, Danilo de Castro Bulhões Mascarenhas Barbosa, Rodrigo Peixoto Campos","doi":"10.1590/2175-8239-JBN-2023-0088en","DOIUrl":"10.1590/2175-8239-JBN-2023-0088en","url":null,"abstract":"<p><strong>Introduction: </strong>Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality.</p><p><strong>Methods: </strong>Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality.</p><p><strong>Conclusion: </strong>AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20230088"},"PeriodicalIF":1.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092705","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}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1590/2175-8239-JBN-2024-0012en
Carolina Figueiredo, Ana Margarida Rocha, Liane Correia-Costa, Maria do Sameiro Faria, Teresa Costa, Conceição Mota
Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center.
Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments).
Results: Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2).
Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.
简介急性肾损伤(AKI)是指肾功能突然恶化。在全球范围内,无论是危重病人还是非危重病人,小儿急性肾损伤的发病率都在不断上升。我们的目的是描述一家三级医疗中心收治的儿科患者 AKI 的表现、病因、演变和预后:我们对 2012 年 1 月至 2021 年 12 月期间在儿科肾内科住院的 29 天至 17 岁、365 天内诊断为 AKI 的患者进行了单中心回顾性观察研究。AKI严重程度根据肾脏疾病改善全球结局(KDIGO)标准进行分类。考虑的结果是死亡或后遗症(蛋白尿、高血压或3至6个月随访评估中肾功能的变化):共纳入 46 名患者,中位年龄为 13.0(3.5-15.5)岁。约半数患者(24 人,52.2%)有可识别的诱发 AKI 的风险因素。13 名患者(28.3%)无尿,所有这些患者都被归类为 AKI KDIGO 3 期(P < 0.001)。近四分之一的患者(10 人,21.7%)需要进行肾脏替代治疗。约 60% 的患者(n = 26)至少有一种后遗症,其中蛋白尿最常见(n = 15,38.5%;中位数(P25-75)尿蛋白与肌酐比值为 0.30 (0.27-0.44) mg/mg),其次是肾小球滤过率(GFR)降低(n = 11,27.5%;中位数(P25-75)GFR 为 75 (62-83) mL/min/1.73 m2):结论:小儿 AKI 与大量发病有关,可能导致蛋白尿和肾功能损害,并对长期预后产生相关影响。
{"title":"Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology.","authors":"Carolina Figueiredo, Ana Margarida Rocha, Liane Correia-Costa, Maria do Sameiro Faria, Teresa Costa, Conceição Mota","doi":"10.1590/2175-8239-JBN-2024-0012en","DOIUrl":"10.1590/2175-8239-JBN-2024-0012en","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center.</p><p><strong>Methods: </strong>We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments).</p><p><strong>Results: </strong>Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2).</p><p><strong>Conclusions: </strong>Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20240012"},"PeriodicalIF":1.3,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945076","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}
Pub Date : 2024-04-29eCollection Date: 2024-01-01DOI: 10.1590/2175-8239-JBN-2024-0023en
Rodrigo Bueno de Oliveira, Aluízio Barbosa Carvalho, Vanda Jorgetti
In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.
{"title":"Bone aluminum accumulation in the current era.","authors":"Rodrigo Bueno de Oliveira, Aluízio Barbosa Carvalho, Vanda Jorgetti","doi":"10.1590/2175-8239-JBN-2024-0023en","DOIUrl":"10.1590/2175-8239-JBN-2024-0023en","url":null,"abstract":"<p><p>In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 3","pages":"e20240023"},"PeriodicalIF":1.3,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11203949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945080","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}
Pub Date : 2024-04-08eCollection Date: 2024-01-01DOI: 10.1590/2175-8239-JBN-2024-E005en
Eduardo Leal Adam
{"title":"Progression of valvular heart disease in dialysis patients: how to stop it?","authors":"Eduardo Leal Adam","doi":"10.1590/2175-8239-JBN-2024-E005en","DOIUrl":"10.1590/2175-8239-JBN-2024-E005en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 2","pages":"e2024E005"},"PeriodicalIF":1.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850967","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}