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

Introduction: Leishmaniasis is a potential concern for solid organ transplant (SOT) recipients, particularly those from endemic regions. Among SOT procedures, kidney transplantation (KT) is the most common. This study aims to synthesize the evidence about visceral leishmaniasis (VL) in KT candidates and recipients, with a focus on risk factors and associated outcomes.

Methods: This integrative review analyzed studies from the past 20 years, focusing on disease profile, treatment, prognosis, and risk of asymptomatic infection.

Results: A total of 32 articles were included. Of the KT recipients, 85.7% were male, with an average age of 42.5 years. The average timespan since symptom onset was 54.7 months. Renal function impairment was reported in 64% of patients, with an associated mortality rate of 15%. Post-treatment relapse occurred in 10-37.5% of patients. Among KT candidates, 13.9% were seropositive for Leishmania spp.

Conclusion: VL is an infrequent condition among KT recipients, limiting the quality of the available evidence. Early detection and prompt treatment are crucial for improving outcomes. While renal function impairment is common, it rarely leads to graft rejection. In the reviewed studies, the coexistence of VL and cutaneous or mucocutaneous forms was linked to higher mortality. Recurrences are common and require individualized management strategies. Hemotransfusion poses a potential infection risk, although routine screening in blood banks is not yet recommended.

Background: Data on parathyroid hormone (PTH) levels at hemodialysis (HD) initiation and during the first year of therapy are still scarce. We hypothesized that high baseline PTH levels contribute to more severe hyperparathyroidism during this period.

Methods: Incident HD patients (n = 1,973) were divided into 3 groups according to PTH values (<150, 150-600, and > 600 pg/mL).

Results: PTH levels at baseline and at 1 year were 273 (133-508) and 255 (128-471) pg/mL, respectively (p = 0.291). PTH < 150, 150-600 and >600 pg/mL were found in 28.1, 53.5 and 18.4%, respectively, at baseline and 30.7, 52.5 and 16.8% after 1 year (p = 0.015). Younger age, absence of diabetes, high baseline alkaline phosphatase and PTH were independent risk factors for PTH > 600 pg/mL after 1 year of HD.

Conclusion: High PTH at the beginning and after 1 year of HD indicate poor conservative management before and during dialysis, and put patients at risk of requiring parathyroidectomy later.

Introduction: Mineral and bone meta-bolism disorders in chronic kidney disease (CKD-MBD) are one of the most significant complications of CKD. The objective of this study was to describe the types of renal osteodystrophy (ROD) and the clinical and osteometabolic profiles of dialysis patients undergoing bone biopsy in Pernambuco.

Methods: A cross-sectional, retrospective study that assessed patients biopsied between January 2004 and September 2021 was conducted. Patients receiving conservative treatment for CKD, kidney transplant recipients, and those with inadequate biopsies were excluded. All clinical and laboratory parameters were from the time of biopsy.

Results: We assessed 250 patients with median age of 48 years (57.6% women) and on dialysis for a median time of 108 months. Regarding the diagnosis of ROD, the prevalence was: osteitis fibrosa (54.5%), mixed disease (30.4%), adynamic bone disease (12.4%), and osteomalacia (3.2%). The prevalences of osteoporosis, aluminum toxicity, and iron toxicity were 43.6%, 46.8% and 27.5%, respectively.

Conclusions: We demonstrated a high prevalence of diseases related to high bone turnover and aluminum toxicity.

Introduction: Chronic kidney disease (CKD) may lead to secondary hyperparathyroidism (SHP) and its treatment is based on the control of hyperphosphatemia, hypocalcemia, and serum parathormone hormone levels (PTH) levels. Despite the advances in SHP treatment, therapeutic failure is frequent and CKD patients on dialysis require parathyroidectomy (PTx).

Aim: To update the 2011 survey, estimate the current prevalence of SHP in Brazilian dialysis centers, verify access to drugs, and identify obstacles to performing PTx.

Methods: A questionnaire was sent to active dialysis facilities. The results were compiled and statistically compared (p < 0.05).

Results: A total of 114 facilities successfully responded to the questionnaire, most of them in the Southeast region. Approximately 9% of the individuals (23,535) had serum PTH levels measurements above 1,000 pg/mL (10.7% were reported in the 2011 survey). A considerable number of the reported difficulties indicated limited availability of pivotal medications for SHP management and the associated complications. Of note, only 2.7% of the individuals were submitted to PTx. For those with PTx indication, the waiting time for the procedure was over two years in 28% of the cases. The main barriers to performing PTx were reported to be the long waiting time for PTx, the shortage of head and neck surgeons, and the lack of ward beds for hospital admissions.

Conclusion: Some aspects have improved since 2011. However, SHP remains highly prevalent in Brazil, and a significant number of individuals do not have access to PTx or experience long waiting times for this surgical procedure while facing substantial difficulties in obtaining clinical treatment.

Introduction: Renal neoplasia is a complex and heterogeneous disease, characterized by high morbidity and mortality.

Objective: To analyze the temporal trend of hospitalization rates (HRs) for renal neoplasia in Brazil, segmented by region, states (UFs, Unidades da Federação in Portuguese), and population characteristics, from 2013 to 2023.

Methods: Ecological study using data from the Hospital Information System, by analyzing Hospital Admission Authorizations, covering the period from 2013 to 2023. The annual trend of HRs was analyzed using generalized linear regression with the Prais-Winsten method by calculating the Annual Percentage Change (APC), considering sex, age, race/color, and region/state (UF). A significance level of 5% was adopted for the analyses.

Results: A total of 31,388 hospitalizations for renal neoplasia were recorded in Brazil during the period, showing a significant upward trend in HRs (APC: 9.12; 95%CI: 5.30; 13.1; p < 0.001). The increase was observed in both sexes and in all regions. Among the states, most showed stationary trends. The highest average HRs were identified among young elderly individuals (3.31/100,000) and long-lived elderly individuals (2.51/100,000).

Conclusion: HRIs due to renal neoplasia in Brazil showed a significant upward trend between 2013 and 2023, with regional variations, a predominance in males, and a higher incidence in the over-60 age group.

Introduction: Patients with solitary functioning kidney (SFK) have glomerular hyperfiltration, hypertension, proteinuria and impaired renal function resulting in microvascular atherosclerotic abnormalities. This condition leads to an increase in arterial stiffness. In this study, we aimed to investigate the usefulness of non-invasive renal Doppler ultrasonography hemodynamic parameters in demonstrating arterial stiffness in pediatric patients with SFK.

Methods: The study included 59 children aged 6-18 years who were diagnosed with SFK. Demographic, biochemical, anthropometric, and blood pressure data were recorded. The renal Doppler ultrasound hemodynamic parameters renal resistive index (RRI), renal pulsatility index (RPI), carotid-femoral pulse wave velocity (cfPWV), central augmentation index (cAIx) and carotid intima media thickness (cIMT) were evaluated.

Results: Eighteen (30.5%) cases with acquired SFK and 41 (64.5%) cases with congenital SFK were detected. Central augmentation indices were higher in children with congenital SFK than in children with acquired SFK (p = 0.038). CkiD-eGFR-SCr-CysC was lower in patients with acquired SFK (p = 0.011). LDL cholesterol levels were higher in children with acquired SFK (p = 0.018). We found a significant correlation between RPI and cfPWV with a correlation coefficient (r) of 0.321 and a statistically significant p-value of 0.013.

Conclusions: Congenital SFK is associated with increased microvascular atherosclerotic burden. RPI assessment with renal Doppler ultrasound may be a non-invasive method to identify arterial stiffness.

Introduction: The annual Brazilian Dialysis Survey (BDS) supports and contributes to the development of national health policies. Objective: To report the 2023 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN).

Methods: A survey was carried out in a voluntary sample of Brazilian chronic dialysis centers using an online questionnaire covering clinical and epidemiological aspects of patients on chronic dialysis, and characteristics of dialysis centers. For estimates of prevalence, incidence, and source of payment for dialysis, data were obtained from a random sample of dialysis centers.

Results: A total of 37.5% (n = 332) of the centers voluntarily responded to the online questionnaire, and 124 were randomly selected for specific estimates of prevalence and incidence rates. It was estimated that on July 1, 2023, the total number of patients on dialysis was 157,357 and 51,153 started dialysis in 2023. The estimated prevalence and incidence rates of patients per million population (pmp) were 771 and 251, respectively. Of the prevalent patients, 88.2% were on hemodialysis, 8.0% on hemodialfiltration, and 3.8% on peritoneal dialysis. The prevalence of anemia (Hb <10g/dL) was 29% and hyperphosphatemia (P >5.5mg/dL), 30%. There was an increase in the frequency of use of cinacalcet and paricalcitol. The estimated overall crude annual mortality rate was 16.2%.

Conclusions: Estimates from a random sample of dialysis facilities show that the absolute number and the prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were undergoing hemodiafiltration and using cinacalcet and paricalcitol for hyperparathyroidism treatment.

Collapsing glomerulopathy (CG) has a severe course typically associated with viral infections, especially HIV and parvovirus B19, systemic lupus erythematosus (SLE), among other etiologies. A 35-year-old woman with recent use of a JAK inhibitor due to rheumatoid arthritis presented with a 2-week history of fever, cervical adenopathy, and facial erythema. After admission, anemia, hypoalbuminemia, proteinuria, and severe acute kidney injury were noted. SLE was diagnosed and parvovirus B19 DNA was detected in serum samples. Kidney biopsy showed CG without any typical features of lupus nephritis. The patient was treated with prednisone and presented marked improvement of anemia and kidney function after a few weeks. In this case, the patient with SLE presented CG possibly caused by parvovirus B19 infection associated with homozygous apolipoprotein 1 (APOL1) G1 genotype, which has been described as a determinant risk factor for this glomerulopathy. It is not clear whether SLE had a causal relationship with glomerular disease or was a concurrent cause. Treatment can be challenging in such a context, as no antiviral drug is efficient and immunosuppression has no discernable benefit, although steroid use was efficient in treating renal manifestations in this case.

Chronic kidney disease (CKD) management has traditionally emphasized dietary protein restriction to slow disease progression and delay end-stage renal disease (ESRD). However, evidence from trials questions the supposed efficacy of this approach and also highlights potential risks such as malnutrition and reduced quality of life. This review discusses the rational for protein restriction in CKD, critiques the existing evidence, and advocates for personalized care that focuses on nutritional adequacy and effective pharmacotherapy. Important advances in CKD treatment, including ACE inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists, are discussed to propose a comprehensive strategy that optimizes patient outcomes.