Navegando por Palavras-chave "chronic kidney failure"
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- ItemAcesso aberto (Open Access)Achados histopatológicos renais em idosos(Sociedade Brasileira de Nefrologia, 2010-09-01) Carmo, Priscylla Aparecida Vieira do; Mastroianni Kirsztajn, Gianna [UNIFESP]; Carmo, Wander Barros do; Franco, Marcello Fabiano de [UNIFESP]; Bastos, Marcus Gomes; Fundação IMEPEN; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Juiz de Fora Faculdade de MedicinaINTRODUCTION: The elderly population has significantly increased worldwide and recent studies have evidenced a 10-year increase in Brazilian life expectancy. Similarly to other comorbidities, glomerular diseases are also observed in the elderly, and, in that age group, kidney biopsy emerges as a fundamental diagnostic tool to help disease management, preventing unnecessary therapies. OBJECTIVE: To establish the frequency of histological diagnoses in the elderly undergoing kidney biopsy, with an emphasis on glomerulopathies (GPs), at two Brazilian universities. METHODS: Retrospective assessment of kidney biopsy reports of the Department of Pathology of UNIFESP (patients aged 60 years or above, from 01/01/1996 to 12/31/2003) and of the outpatient clinic of GPs of NIEPEN. The studies of transplanted kidneys and nephrectomies were excluded. The following data were analyzed: age; sex; clinical syndrome at presentation; and histological diagnosis (light microscopy and immunofluorescence). Nephropathies were classified as primary GPs, secondary kidney diseases, nonglomerular diseases, and others. RESULTS: One hundred and thirteen biopsies were assessed, the mean age of patients was 66.0 ± 6.0 years, and the male sex prevailed (54.8%). The most common clinical presentation was nephrotic syndrome (32.7%), followed by acute and chronic kidney failure (18.6%, each). Glomerular diseases were as follows: membranous nephropathy (MN), 15%; hypertensive nephrosclerosis, 11.5%; focal segmental glomerulosclerosis and vasculitis/crescentic GN, 9.7% each; amyloidosis, chronic glomerulonephritis, and minimal change disease, 7.1% each; diffuse proliferative GN, 4.4%; IgA nephropathy and lupus nephritis, 2.7% each. Primary GPs predominated (45.2%) as compared with other nephropathies. CONCLUSION: Nephrotic syndrome was the major indication for kidney biopsy. Regarding the kidney histological diagnoses, glomerular diseases predominated, in particular MN and hypertensive nephrosclerosis, findings compatible with previous studies in the area, but rarely assessed among us. It is clear that the diversity of diagnoses and differentiated treatments justify kidney biopsy for decision making in that group of patients.
- ItemAcesso aberto (Open Access)Ansiedade, depressão e qualidade de vida em pacientes com glomerulonefrite familiar ou doença renal policística autossômica dominante(Sociedade Brasileira de Nefrologia, 2011-06-01) Barros, Bruna Paes de [UNIFESP]; Nishiura, José Luiz [UNIFESP]; Heilberg, Ita Pfeferman [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Psychological aspects and quality of life are often evaluated in patients under renal replacement therapy, but studies about anxiety, de>pression, and quality of life in familial renal diseases are lacking. OBJECTIVES: To evaluate the frequency of anxiety, depression, and quality of life (QOL) and their eventual associations with the main laboratory, clinical, socioeconomic, and cultural parameters in familial glomerulonephritis (GN) or autosomal dominant polycystic kidney disease (ADPKD). METHODS: Ninety adult patients (52 familial GN and 38 ADPKD) completed the questionaires of State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and QOL-Short-Form SF-36, and were also submitted to a short interview. RESULTS: Moderate anxiety was detected in both groups. Depression was found in 34.6% of familial GN and 60.5% of ADPKD patients. Anxiety and depression were more associated with female gender in familial GN, and with poorer schooling in ADPKD. Patients of both groups presented two quality of life unfavorable dimensions: emotional role function and general health perception. In addition, quality of life was worse among females, unmarried, and Caucasian subjects, and those individuals with a poorer educational level. CONCLUSION: The use of these instruments allows one to appreciate the frequency and levels of anxiety, depression, and quality of life in patients with familial renal diseases that could affect their compliance to treatment. These findings can contribute to planning a better multidisciplinary assistance to such groups of patients.
- ItemAcesso aberto (Open Access)Censo Brasileiro de Diálise, 2009(Sociedade Brasileira de Nefrologia, 2010-12-01) Sesso, Ricardo de Castro Cintra [UNIFESP]; Lopes, Antonio Alberto; Thomé, Fernando Saldanha; Lugon, Jocemir Ronaldo; Burdmann, Emmanuel A; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Faculdade de Medicina da Bahia Departamento de Medicina; Universidade Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Medicina Interna; Universidade Federal Fluminense Faculdade de Medicina Departamento de Medicina Clínica; Universidade de São Paulo (USP)INTRODUCTION: National dialysis data are fundamental for treatment planning. OBJECTIVE: To report data of the annual survey of the Brazilian Society of Nephrology about chronic renal failure patients on dialysis in January 2009. METHODS: A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out by the dialysis units in Brazil. RESULTS: 427 (69.8%) of the dialysis units in the country answered the questionnaire. National data were estimated for the overall dialysis population. In January 2009, the total estimated number of patients on dialysis was 77,589. The estimated prevalence and incidence rates of chronic renal failure on maintenance dialysis were 405 and 144 patients per million population, respectively. The estimated number of new patients starting dialysis program in 2009 was 27,612. The annual gross mortality rate was 17.1%. For prevalent patients, 39.9% were aged 60 years or older, 89.6% were on hemodialysis and 10.4% on peritoneal dialysis, 30,419 (39.2%) were on a waiting list of renal transplant, 27% were diabetics, 37.9% had serum phosphorus > 5.5 mg/dL and 42.8% hemoglobin < 11 g/dL. A venous catheter was the vascular access for 12.4% of the hemodialysis patients. CONCLUSIONS: The prevalence of chronic renal failure on maintenance dialysis is increasing in Brazil, although in 2009 the estimate is lower than in 2008. The data call attention to indicators of the quality of maintenance dialysis that need to be improved and highlight the importance of the census to guide chronic dialysis therapy.
- ItemSomente MetadadadosDecreased resting energy expenditure in non-dialysed chronic kidney disease patients(Oxford Univ Press, 2004-12-01) Avesani, Carla Maria [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Kamimura, Maria Ayako [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Colugnati, Fernando Antonio Basile [UNIFESP]; Cuppari, Lilian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background. Non-dialysed chronic kidney disease (CKD) patients may have altered resting energy expenditure (REE) because of the important metabolic functions of the kidneys. the aim of the present study was to evaluate whether REE in clinically stable, non-diabetic and non-dialysed CKD patients with no clinical signs of inflammation, was different from that of gender and age pair-matched healthy controls.Subjects and methods. REE in 45 patients (20 male and 25 female; age 44.9 +/- 11.7 years; mean +/- SD) and 45 healthy individuals (20 male and 25 female; age 44.6 +/- 11.5 years) was measured by indirect calorimetry after a 12-h fast. in both groups, body composition was assessed by bioelectrical impedance. Glomerular filtration rate was assessed by creatinine clearance only in the CKD patients.Results. the mean creatinine clearance and serum creatinine of the CKD patients were 29.1 +/- 14.6 ml/min/1.73m(2) and 3.48 +/- 2.48 mg/dl, respectively. Body fat (BF) and lean body mass (LBM) were similar between the two groups (CKD patients: BF 28.6 +/- 11.3%. LBM 46.9 +/- 10.0 kg; and healthy individuals: BF 28.1 +/- 7.54%. LBM 49.5 +/- 10.5 kg). REE of CKD patients was significantly lower than that of healthy individuals (1325 +/- 206 vs 1448 +/- 258 kcal/day; P = 0.01, respectively) even after adjusting for LBM by multiple regression analysis. in fact, the presence of chronic renal insufficiency reduced REE by 103.2 kcal/day (P = 0.02; 95% confidence interval (-15.9; 190.5)).Conclusion. REE of clinically stable non-dialysed, nondiabetic patients in stages 2-5 of CKD was lower than that of age and gender pair-matched healthy individuals. Although the cause of reduced REE was unclear, it may be related to decreased food intake and to metabolic disturbances inherent with deterioration of renal function. Further studies will be necessary to clarify this issue.
- ItemAcesso aberto (Open Access)Fórum nacional de discussão das diretrizes do KDIGO para o distúrbio mineral e ósseo da doença renal crônica (DMO-DRC): uma análise crítica frente à relidade Brasileira(Sociedade Brasileira de Nefrologia, 2010-09-01) Moysés, Rosa Maria Affonso; Cancela, Ana Ludimila Espada; Gueiros, José Edvanilson Barros; Barreto, Fellype Carvalho; Neves, Carolina Lara; Canziani, Maria Eugênia Fernandes [UNIFESP]; Oliveira, Rodrigo Bueno de; Jorgetti, Vanda; Carvalho, Aluizio Barbosa de [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de Pernambuco Hospital das Clínicas; Universidade de Picardie; Universidade Federal da Bahia; Universidade Federal de São Paulo (UNIFESP)On November 14th, 2009, the Brazilian Society of Nephrology coordinated the Brazilian Discussion Meeting on the new KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. The purpose of this meeting, which was attended by 64 nephrologists, was to discuss these new guidelines from the Brazilian perspective. This meeting was supported by an unrestricted grant of the biotechnology company Genzyme, which did not have access to the meeting room or to the discussion sections. This article brings a summary of the KDIGO guidelines and of the discussions by the attendees.
- ItemAcesso aberto (Open Access)Hipertrofia ventricular esquerda em pacientes com doença renal crônica em tratamento conservador(Sociedade Brasileira de Nefrologia, 2010-03-01) Bregman, Rachel; Lemos, Carla; Pecoits Filho, Roberto; Abensur, Hugo; Draibe, Sergio Antonio [UNIFESP]; Bastos, Marcus Gomes; Canziani, Maria Eugênia Fernandes [UNIFESP]; Universidade do Estado do Rio de Janeiro; Pontifícia Universidade Católica do Paraná Centro de Ciências Biológicas e da Saúde; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Juiz de ForaCardiovascular disease (CVD) remains the major cause of death in patients with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is present in 75% of patients starting dialysis, suggesting that LVH might be present from an early stage of CKD. Few studies have addressed the predialysis prevalence of LVH. This study evaluated 309 clinically stable patients under treatment for at least three months at five Brazilian centers. Biochemical profile and inflammatory markers were assessed. Data were shown as mean ± SD. Left ventricular hypertrophy was present in 53% of the patients, whose mean age was 60 ± 13years. The mean age of those without LVH was 55 ± 14 years. Diabetes mellitus was the underlying disease in 35% of the patients in both groups. Estimated glomerular filtration rate was 30 ± 11 and 32 ± 12 mL/min for patients with and without LVH, respectively (p = 0.19). The distribution of patients showed that 60% of those with LVH were in stage 4. Multivariate logistic regression analysis indicated the following independent determinants for LVH: age (p < 0.001); calcium (p < 0.001); hemoglobin (p < 0.048); and diastolic blood pressure (p < 0.001). Systolic blood pressure, lipids, and inflammatory markers showed no correlation with LVH. In conclusion, the incidence of LVH was high even among patients under conservative treatment, and, except for age, LVH correlated with reversible factors. The need for strictly diagnosing CKD and preventing LVH in the predialysis phase is emphasized to decrease mortality due to CVD in that population.
- ItemSomente MetadadadosHistological evolution of hepatitis C virus infection after renal transplantation(Wiley-Blackwell, 2012-11-01) Oliveira Uehara, Silvia Naomi de [UNIFESP]; Emori, Christini Takemi [UNIFESP]; Pereira, Patrícia da Silva Fucuta [UNIFESP]; Perez, Renata M.; Medina Pestana, Jose Osmar; Lanzoni, Valeria Pereira; Souza e Silva, Ivonete Sandra [UNIFESP]; Benedito Silva, Antonio Eduardo [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)Background: information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce. Aims: To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx.Methods: Twenty-two HCV-infected patients submitted to liver biopsy pre- and post-RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared.Results: Patients were mostly men (73%) with mean age of 36 +/- 9 yr. Time post-transplant was 4 +/- 2 yr and time between biopsies was 5 +/- 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. the histological progression occurred even among those without significant histological lesions in pre-transplant biopsy.Conclusion: the findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.