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Effect of octreotide on oxidative stress in the erythrocyte and kidney tissue in adriamycin-induced experimental nephrotic syndrome model. 奥曲肽对阿霉素诱导的实验性肾病综合征模型中红细胞和肾组织氧化应激的影响
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2022-0180en
Sibel Cavdar, Alev Garip Acar, Asuman Camyar, Ender Hür, Eser Yıldırım Sozmen, Sait Sen, Melih Ozısık, Yasemin Delen Akcay, Elif Duman, Sena Gönen, Fehmi Akcicek, Soner Duman

Introduction: Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model.

Methods: Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated.

Results: There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group.

Conclusions: Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option.

导言:肾病综合征(NS)是导致终末期肾病的原因之一,阐明其发病机制并提供新的治疗方案非常重要。氧化应激可能引发全身或肾脏的发病。奥曲肽具有有益的抗氧化作用。我们旨在研究氧化应激的来源以及OCT对实验性NS模型的影响:方法:24 只非尿毒症 Wistar 白化大鼠分为 3 组。对照组:2 mL生理盐水肌肉注射;NS组:阿霉素5 mg/kg静脉注射;NS治疗组:阿霉素5 mg/kg静脉注射和OCT 200 mcg/kg肌肉注射。21 天结束时,测量 24 小时尿样中的肌酐和蛋白质水平。测量红细胞和肾脏过氧化氢酶(CAT)和硫代巴比妥酸活性物质(TBARS)。还对肾组织学进行了评估:结果:3 组红细胞中的 CAT 和 TBARS 无明显差异。NS 组的肾脏 CAT 水平最低,明显低于对照组。与 NS 组相比,治疗组的 CAT 水平明显升高。在肾脏组织学方面,各组的肾小管和肾间质评价相似。NS组的肾小球评分明显高于对照组,而治疗组则明显低于NS组:结论:NS中的氧化应激可能是由于肾脏抗氧化保护机制下降所致。结论:NS的氧化应激可能是由于肾脏抗氧化保护机制下降所致,奥曲肽可改善肾组织的抗氧化水平和组织学,可能是一种治疗选择。
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引用次数: 0
Education and advocacy in acute kidney injury in children: a call for action. 儿童急性肾损伤的教育和宣传:行动呼吁。
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2023-E016en
Marcelo de Sousa Tavares
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引用次数: 0
Case fatality rate among COVID-19 patients treated with acute kidney replacement therapy. 急性肾替代疗法治疗的COVID-19患者病死率
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2022-0161en
Gabriel Martins Nogueira, Paulo Novis Rocha, Constança Margarida Sampaio Cruz

Introduction: Acute kidney injury (AKI) is a frequent complication of severe COVID-19 and is associated with high case fatality rate (CFR). However, there is scarcity of data referring to the CFR of AKI patients that underwent kidney replacement therapy (KRT) in Brazil. The main objective of this study was to describe the CFR of critically ill COVID-19 patients treated with acute kidney replacement therapy (AKRT).

Methods: Retrospective descriptive cohort study. We included all patients treated with AKRT at an intensive care unit in a single tertiary hospital over a 15-month period. We excluded patients under the age of 18 years, patients with chronic kidney disease on maintenance dialysis, and cases in which AKI preceded COVID-19 infection.

Results: A total of 100 out of 1479 (6.7%) hospitalized COVID-19 patients were enrolled in this study. The median age was 74.5 years (IQR 64 - 82) and 59% were male. Hypertension (76%) and diabetes mellitus (56%) were common. At the first KRT prescription, 85% of the patients were on invasive mechanical ventilation and 71% were using vasoactive drugs. Continuous veno-venous hemodiafiltration (CVVHDF) was the preferred KRT modality (82%). CFR was 93% and 81 out of 93 deaths (87%) occurred within the first 10 days of KRT onset.

Conclusion: AKRT in hospitalized COVID-19 patients resulted in a CFR of 93%. Patients treated with AKRT were typically older, critically ill, and most died within 10 days of diagnosis. Better strategies to address this issue are urgently needed.

急性肾损伤(AKI)是重症COVID-19的常见并发症,与高病死率(CFR)相关。然而,关于在巴西接受肾脏替代治疗(KRT)的AKI患者的CFR的数据缺乏。本研究的主要目的是描述重症COVID-19患者接受急性肾脏替代治疗(AKRT)的CFR。方法:回顾性描述性队列研究。我们纳入了在一家三级医院重症监护室接受AKRT治疗超过15个月的所有患者。我们排除了18岁以下的患者、维持透析的慢性肾脏疾病患者以及在COVID-19感染之前出现AKI的病例。结果:1479例COVID-19住院患者中有100例(6.7%)纳入本研究。中位年龄为74.5岁(IQR 64 - 82), 59%为男性。高血压(76%)和糖尿病(56%)是常见的。在第一次KRT处方时,85%的患者使用有创机械通气,71%的患者使用血管活性药物。持续静脉-静脉血液滤过(CVVHDF)是首选的KRT方式(82%)。CFR为93%,93例死亡中有81例(87%)发生在KRT发病的前10天内。结论:AKRT在住院COVID-19患者中的CFR为93%。接受AKRT治疗的患者通常年龄较大,病情危重,大多数在诊断后10天内死亡。迫切需要更好的战略来解决这一问题。
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引用次数: 0
Crystals unveiled: looking at urine can be quite useful. 揭开晶体的面纱:观察尿液是非常有用的。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2023-0160en
Filipa Ferreira, Núria Paulo, Altin Ndrio
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引用次数: 0
Pediatric nephrologist-intensivist interaction in acute kidney injury. 急性肾损伤中儿科肾病医师与重症监护医师之间的互动。
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2022-0158en
Cassio Rodrigues Ferrari, Carlos Eduardo Lopes, Vera Maria Santoro Belangero

Introduction: Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods.

Methods: Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016).

Parameters studied: frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05.

Results: 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development.

Conclusion: Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.

导言:重症监护病房(ICU)中的急性肾损伤(AKI)诊断和管理概念以水平衡为评估要点。在我们的重症监护病房,从 2004 年到 2012 年,肾脏科医生的参与都是按需进行的;从 2013 年开始,他们开始持续参与病例讨论会议。本研究旨在确定在这两个观察期内,肾内科医师与重症监护医师之间的密切互动如何影响透析指征、体液平衡和 pRIFLE 分类的频率:研究参数:透析前24小时内的适应症频率、持续时间和输液量;每8小时的利尿和水平衡。非参数统计,P≤0.05.结果:53名患者(2013年前47名,2013年后6名)。不同时期的住院或心脏手术次数无明显差异。2013年后,透析指征/年数量明显减少(5.85 vs. 1.5;p = 0.000);输液量明显减少(p = 0.02);透析持续时间明显延长(p = 0.002);在AKI发展过程中,pRIFLE利尿成分的辨别能力有所提高:结论:重症监护室和儿科肾脏内科团队在病例的常规讨论中进行整合,重点关注水平衡,这对改善重症监护室的 AKI 管理至关重要。
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引用次数: 0
Demographic and occupational profile of dietitians working in dialysis centers in Brazil. 巴西透析中心营养师的人口和职业概况。
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2023-0017en
Fabiana Baggio Nerbass, Aline de Araujo Antunes, Lilian Cuppari

Introduction: In 2004, the Ministry of Health stipulated that dialysis centers were required to have at least one dietitian on their staff. However, the regulation did not include recommendations regarding the number of dietitians or the workload based on the number of patients assisted.

Objective: To describe the demographic and occupational profiles of dietitians working in dialysis centers in Brazil.

Methodology: An electronic questionnaire was disseminated in social media and messaging apps with questions about the demographic and occupational profile of dietitians working in dialysis centers and matters related to patient care.

Results: A total of 207 questionnaires were answered, covering 24% of the dialysis centers in Brazil. More than half of the dietitians (58%) had worked for more than five years in dialysis centers, and 83% reported additional training in Nephrology. The median (interquartile range) number of patients per monthly working hour was 1.6 (1.0-2.3). Considering all dialysis centers, 64% of the patients were seen at least once a month. Differences in demographic/occupational profiles and patient care were associated with workload, the main source of dialysis funding, and Brazilian geographical region.

Conclusion: Most dietitians were experienced and trained in Nephrology. Substantial variability was found in the number of patients per dietitian workload, and proportion of patients receiving monthly nutritional care. Further studies are needed to discuss the demands of dietitians, dialysis centers, and patients.

简介2004 年,卫生部规定透析中心必须至少配备一名营养师。然而,该规定并未包括有关营养师人数或根据受助患者人数确定工作量的建议:描述在巴西透析中心工作的营养师的人口和职业概况:在社交媒体和信息应用程序上发布了一份电子问卷,内容涉及在透析中心工作的营养师的人口和职业概况以及与患者护理相关的问题:共收回 207 份问卷,覆盖巴西 24% 的透析中心。一半以上的营养师(58%)在透析中心工作了五年以上,83%的营养师接受过肾脏病学方面的额外培训。每个月每小时工作病人数的中位数(四分位数间距)为 1.6(1.0-2.3)。在所有透析中心中,64% 的患者每月至少就诊一次。人口统计学/职业概况和患者护理方面的差异与工作量、透析资金的主要来源和巴西的地理区域有关:结论:大多数营养师经验丰富,受过肾脏病学培训。结论:大多数营养师经验丰富,接受过肾脏病学方面的培训。营养师工作量所涉及的患者人数和每月接受营养护理的患者比例存在很大差异。需要进一步开展研究,讨论营养师、透析中心和患者的需求。
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引用次数: 0
Cardiorespiratory fitness and mortality risk in patients receiving hemodialysis: a prospective cohort. 血液透析患者的心肺功能与死亡风险:一项前瞻性队列研究。
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2022-0124en
Francini Porcher Andrade, Carolina Ferraro Borba, Heitor Siqueira Ribeiro, Paula Maria Eidt Rovedder

Background: Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severely low CRF and all-cause mortality risk in HD patients.

Methods: This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test, and the peak oxygen uptake (VO2peak) value was used to determine severely low CRF (< 15 mL∙kg-1∙min-1). Cox regression and univariate Kaplan-Meier analysis were used to evaluate the association of severely low CRF with mortality risk and survival rate.

Results: Forty-eight patients were followed-up for a median of 33.0 [14.3 - 49.3] months. A total of 26 patients had severely low CRF. During the follow-up period, 11 patients (22.92%) died from all causes. From these, eight (30.8%) had severely low CRF. Even so, severely low CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.18; CI 95% 0.58-8.23) nor in adjusted (HR 1.32; CI 95% 0.31-5.59) Cox proportional hazard models. As a continuous variable, VO2peak was not associated with mortality risk (HR 1.01; CI 95% 0.84-1.21). Univariate Kaplan-Meier analysis showed that patients with severely low CRF did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186).

Conclusion: Our findings indicated that severely low CRF was not associated with all-cause mortality in patients on HD. Despite severely low CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.

背景:与普通人群相比,肾衰竭会使预期寿命缩短三分之一,而心血管并发症和心肺功能低下(CRF)是主要原因。我们的目的是评估严重低CRF与肾脏衰竭患者全因死亡风险之间的关系:这项观察性前瞻性队列研究对 2015 年 8 月至 2022 年 3 月期间接受 HD 治疗的患者进行了随访。通过心肺运动测试评估心肺功能,并用峰值摄氧量(VO2peak)值确定严重低CRF(< 15 mL∙kg-1∙min-1)。采用Cox回归和单变量Kaplan-Meier分析评估严重低CRF与死亡风险和存活率的关系:对 48 名患者进行了中位数为 33.0 [14.3 - 49.3] 个月的随访。共有 26 名患者的 CRF 严重偏低。在随访期间,11 名患者(22.92%)死于各种原因。其中,8 名患者(30.8%)的 CRF 严重偏低。即便如此,无论是在未调整的(HR 2.18;CI 95% 0.58-8.23)还是在调整的(HR 1.32;CI 95% 0.31-5.59)Cox 比例危险模型中,严重低 CRF 与按 CRF 水平分层的患者的粗死亡率无关(p = 0.189)。作为一个连续变量,VO2 峰值与死亡风险无关(HR 1.01;CI 95% 0.84-1.21)。单变量 Kaplan-Meier 分析显示,严重低 CRF 患者的生存率并不比轻度-中度 CRF 患者差很多(P = 0.186):我们的研究结果表明,在接受 HD 治疗的患者中,严重低 CRF 与全因死亡率无关。结论:我们的研究结果表明,在接受 HD 治疗的患者中,严重低 CRF 与全因死亡率无关。尽管严重低 CRF 很普遍,但仍需要进行更大规模的队列研究,才能就其与全因死亡率的关系得出有力的结论。
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引用次数: 0
Waiting time for kidney transplantation based on calculated panel reactive antibodies: experience of a southern Brazilian center. 基于计算的群体反应性抗体的肾移植等待时间:巴西南部一个中心的经验。
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2022-0132en
Lisianara Acosta Ramos, Tiago Schiavo, Juliana Montagner, Cristiane Bundcher, Roger Kist, Valter Duro Garcia, Jorge Neumann, Elizete Keitel

Introduction: The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes.

Methods: One thousand six hundred forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation.

Results: The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA).

Conclusion: Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.

引言:本研究的目的是根据候选群体反应性抗体(cPRA)及其结果分析我院肾移植的等待名单。方法:纳入2015年至2019年间在等待名单上的一千六百四十名患者。在分析中,根据面板反应性和移植后移植物丢失和死亡的HR,通过Fine和Gray回归模型估计移植的风险比(HR)。结果:平均年龄45.39±18.22岁。男性占主导地位(61.2%),但这一比例随着cPRA的增加而线性下降(p<0.001)。根据面板的患者分布为:0%(n=390)、1%-49%(n=517)、50%-84%(n=269)和≥85%(n=226)。85.5%的样本在中位时间8个月内完成了移植(CI 95%:6.9-9.1)。随访期间移植的估计HR分别为2.84(95%CI:2.51-3.34)、2.41(95%CI:2.07-2.80)和2.45(95%CI:2.08-2.90),cPRA范围分别为0%、1%-49%和50%-84%,而cPRA≥85(p<0.001)。移植后,不同cPRA组移植物丢失的HR相似,但经年龄、性别和供体特异性抗体(DSA)调整后,0%cPRA组的死亡HR(0.46 95%CI 0.24-0.89 p=0.022)较低。结论:cPRA低于85%的患者接受肾移植的可能性是cPRA患者的两倍多,等待时间更短。不同cPRA组移植后移植物丢失的风险相似,非敏感受体的调整后死亡风险较低。
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引用次数: 0
Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort. 肾切除术后肾脏代偿能力降低的风险因素:对亚马逊群组中活体肾脏捐献者的分析。
IF 1.3 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2023-0134en
Luan Moraes Ferreira, Gisela Gomes Batista, Leoneide Érica Maduro Bouillet, Emanuel Pinheiro Esposito

Introduction: Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified.

Objective: To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy.

Methods: This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected.

Results: The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]).

Conclusion: Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.

简介活体肾移植被认为是最理想的肾脏替代疗法,因为它的并发症发生率较低,并能有效满足医疗系统对移植肾的大量需求。谨慎选择和充分监测供体是移植的关键因素。必须识别肾切除术后出现肾功能障碍风险较大的个体:确定肾切除术后 12 个月肾代偿率 (CR) 低于 70% 的相关风险因素:这项观察性回顾纵向研究纳入了2016年至2022年期间在亚马逊河下游地区医院随访的活体肾脏捐献者。研究收集了与社会人口学变量、合并症和肾功能参数相关的数据:研究共纳入 32 名患者。14人(43.75%)在肾脏捐献12个月后CR<70%。逻辑回归发现肥胖(Odds Ratio [95%CI]:10.6 [1.7-65.2])、白蛋白尿(Odds Ratio [95%CI]:2.41 [1.2-4.84])和蛋白尿(Odds Ratio [95%CI]:1.14 [1.03-1.25])是风险因素。肾小球滤过率是一个保护性因素(Odds Ratio [95%CI]: 0.92 [0.85-0.99]):结论:肥胖、白蛋白尿和蛋白尿对短期肾脏代偿率有不利影响。结论:肥胖、白蛋白尿和蛋白尿对短期肾脏代偿率有不利影响,需要进一步研究以揭示这些风险因素对预后的影响。我们的研究结果还表明,有必要对潜在捐献者进行仔细的个体化评估,并对高风险人群进行更密切的监测。
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引用次数: 0
Low birth weight and renal consequences: knowing about it means preventing it. 低出生体重和肾脏后果:了解它就意味着预防它。
IF 1.2 Q3 Medicine Pub Date : 2024-01-01 DOI: 10.1590/2175-8239-JBN-2023-E013en
Maria Cristina de Andrade, Nilzete Liberato Bresolin, Ana Paula Brecheret
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引用次数: 0
期刊
Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
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