Elvino José Guardão Barros

Protective effect of allopurinol in the renal ischemia–reperfusion in uninephrectomized rats

The effect of allopurinol (an inhibitor of xanthine oxidase) on oxidative stress, renal dysfunction, and histologic alterations was evaluated during the renal ischemia--reperfusion in uninephrectomized rats. Renal malondialdehyde and serum creatinine levels significantly increased after renal ischemia--reperfusion. However, the pretreatment with allopurinol demonstrated a protector effect in these parameters. Renal ischemia--reperfusion provoked a significant renal damage in the operated group. Tubular atrophy and interstitial fibrosis were attenuated by allopurinol when given prior to the surgery. In our study, allopurinol had a strong tendency to exert a beneficial effect during renal ischemia--reperfusion in uninephrectomized rats.

Renal tuberculosis in the modern era.

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The disease remains as an important public health problem in developing countries. Extrapulmonary TB became more common with the advent of infection with human immunodeficiency virus and by the increase in the number of organ transplantation, which also leads to immunosuppression of thousand of persons. Urogenital TB represents 27% of extrapulmonary cases. Renal involvement in TB can be part of a disseminated infection or a localized genitourinary disease. Renal involvement by TB infection is underdiagnosed in most health care centers. Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection. The first choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin. Awareness of renal TB is urgently needed by physicians for suspecting this disease in patients with unexplained urinary tract abnormalities, mainly in those with any immunosuppression and those coming from TB-endemic areas.

Risk factors for postoperative acute renal failure at a new orthotopic liver transplantation program.

ACUTE RENAL failure (ARF) is a frequently observed complication during the postoperative period of orthotopic liver transplantation (OLT) when the rate of reported renal failure varies according to the postoperative period and serum creatinine levels considered. Although some patients require dialysis, most recover normal renal function. ARF is one of the most frequent causes of morbidity and mortality after OLT, and Nuno et al indicate a 7.8 higher probability of mortality in patients who have undergone ARF, and 15 times higher than that for those patients who required dialysis. Various factors are outstanding in the preoperative and postoperative periods, as well as during surgery, which could explain the occurrence of ARF. Preoperative factors include: diabetes mellitus, a history of ascites and encephalopathy, and previous kidney lesion. Crawford et al described the occurrence of glomerular lesions as universal to all patients with end-stage liver disease. During surgery, hypovolemia, the number of packed red blood cell (PRBC) units required and the time of total ischemia are described as associated factors. Several series correlate the use of nephrotoxic drugs, such as cyclosporine A (CyA), as a factor which could contribute to renal lesions. However, this may also be the result of complications such as sepsis and multiorgan failure. The purpose of this study is to assess the factors associated with the development of renal failure during the immediate postoperative period of an initial OLT program.

Fabry Disease in Hemodialysis Patients in Southern Brazil: Prevalence Study and Clinical Report

Background. Fabry disease (FD) is a lysosomal storage disorder caused by a deficiency of α-Galactosidase A (α-Gal A). Fabry nephropathy typically progresses throughout the fifth decade to end-stage renal disease (ESRD), requiring hemodialysis and/or kidney transplantation. Objective. To estimate the prevalence of FD among ESRD males on hemodialysis treatment in Rio Grande do Sul, the southernmost state of Brazil. Methods. Screening for α-Gal A activity was performed by a dried blood spot (normal reference value: >1.5 nmoles/hour/mL). Positive screening results were confirmed by plasma α-Gal A activity assay (reference value: >3.3 nmoles/hour/mL). Results. Five hundred fifty-eight male patients on hemodialysis were evaluated. Of these, only two had low α-Gal A activity and were diagnosed with Fabry disease (0.36%). One of these, age 42, had left ventricular hypertrophy and renal manifestations of Fabry disease without the classic symptoms. The other, age 46, had the classical manifestations of angiokeratomas, acroparesthesias, hypohidrosis, and ocular opacities. Conclusions. Although the prevalence of Fabry disease was very low in our study (0.36%), routine screening of male hemodialysis patients would enable earlier identification of many other affected relatives in their families who might benefit from specific clinical treatment.

Randomized, Controlled Trial of Hydralazine Versos Nifedipine in Preeclamptic Women with Acute Hypertension

We studied 37 nulliparous women with late-onset gestational hypertension and significant proteinuria, with a diastolic blood pressure of 110 mmHg or higher. They were randomly assigned to receive intravenous hydralazine (5 ou 10 mg) plus an oral placebo; or oral nifedipine (10 or 20 mg) plus an intravenous placebo, with the goal of maintaining diastolic blood pressure at or below 100 mmHg. All drugs were administered in a double-blind fashion. Hydralazine decreased mean arterial pressure from 136± mmHg to 106±7 mmHg, while nifedipine decreased it from 135±8 mmHg to 109±10 mmHg. The incidence of adverse maternal and fetal effects were similar in the two treatment groups. This randomized trial contained a limited number of subjects and, therefore, did not have the statistical power to detect small differences between hydralazine and nifedipine. However, we have demonstrated that a trial of drug therapies for acute hypertension in pregnancy can be successfully blinded, and this approach would be valuable in ...

Reported Calcium Intake is Reduced in Women with Preeclampsia

Objective: The purpose of this trial is to investigate the relationship between dietary calcium content and incidence of preeclampsia, comparing diet calcium content in normotensive and preeclampsia patients. Dietary calcium was measured by a dietary interview conducted at the day after delivery. Methods: This is a prospective cross-sectional study involving 1092 patients who delivered at Hospital de Clínicas de Porto Alegre – Brazil. Results: The average diet calcium content in the studied population was 1038 mg. The average calcium intake in the normotensive group was 1057 mg, in chronic hypertension group was 962 mg, in transient hypertension group was 963 mg, in mild preeclampsia was 902 mg and in severe preeclampsia group was 755 mg. The results of this study show that pregnant women who develop severe preeclampsia have a significant lower diet calcium intake when compared to normotensive women (P = 0.018). Conclusion: The results of the present study can provide the foundations for prospective trials, including randomised clinical trials involving only patients with a low content of calcium in their diet.

Nutritional and epidemiological aspects of patients with chronic renal failure undergoing hemodialysis from Brazil, 2010

INTRODUCTION The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.

Health-Related Quality of Life and Dialysis Dependence in Critically Ill Patient Survivors of Acute Kidney Injury

Background: Acute kidney injury is a common disorder in critical ill patients and it is associated with high mortality. Few studies focus on long-term perspectives such as health-related quality of life (HRQOL) and dialysis dependence. Methods: Prospective cohort study at the intensive care unit (ICU) of a Brazilian tertiary hospital. All patients requiring dialysis over a 2-year enrollment period were included. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) assessed the HRQOL along with patient status and dialysis dependence. Results: 408 patients (11%) required dialysis. ICU, hospital, and after-hospital cumulative fatality rates were 70%, 74%, and 80%, respectively. A total of 68 of 82 eligible patients were interviewed in an average of 256 days after hospital discharge, while 8 patients (11.8%) were in regular dialysis. There was no association between Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, mechanical ventilation, creatinine, number of dialysis, and SF-36 scores. Better HRQOL was associated with previous conditions, as younger age and no chronic kidney disease; condition related to severity of acute illness, as have not had sepsis, short period at ICU, and hospital; and conditions after discharge, considered working currently. Conclusions: Previous chronic kidney disease was strongly associated with permanence in dialysis and lower further HRQOL. Younger survivors who have not had sepsis or long stays at hospitals, able to return to their jobs, had better HRQOL.

Kidney Function and 24-Hour Proteinuria in Patients with Fabry Disease during 36 Months of Agalsidase Alfa Enzyme Replacement Therapy: A Brazilian Experience

Background. Prior to the introduction of enzyme replacement therapy (ERT), management of Fabry disease (FD) consisted of symptomatic and palliative measures. ERT has been available for several years using recombinant human agalsidase alfa, an analogue of alpha-galactosidase A (GALA). However, the limitations of ERT in improving kidney function have not been established. This study evaluates the safety and therapeutic effect of agalsidase alfa replacement in terms of kidney function and reduction in 24-hour proteinuria. Methods. During the period between January 1, 2002, and August 1, 2005, nine Fabry patients (7 male, 2 female) were treated according to protocol, receiving 0.2 mg/kg agalsidase alfa IV every two weeks. Kidney function was evaluated by measuring the glomerular filtration rate (GFR) using chromium ethylene diamine tetra-acetate clearance (51Cr-EDTA mL/min/ 1.73 m2) at baseline, 12, 24, and 36 months. 24-hour proteinuria was measured at baseline, 3, 6, 12, 18, 24, and 36 months of ERT. Kidney disease was classified according to National Kidney Foundation Disease Outcome Quality Initiative (NKF/DOQI) Advisory Board criteria, which define stage I chronic kidney disease (CKD) as GFR ≥ 90mL/min/1.73 m2, stage II as 60–89 mL/min/1.73m2, stage III as 30–59 mL/min/1.73 m2, stage IV as 15–29 mL/min/1.73m2, and stage V as < 15 mL/min/1.73m2. Results. Six patients completed 36 months of therapy, 2 patients completed 18 months, and 1 patient completed 12 months. Mean patient age at baseline was 34.6 ± 11.3 years. During the study period, kidney function remained stable in patients with stages I, II, or III CKD. One patient, who entered the study with stage IV CKD, progressed to end-stage chronic kidney disease, beginning hemodialysis after 7 months and receiving a kidney transplant after 12 months of ERT. Proteinuria also remained stable in the group of patients with pathologic proteinuria. The use of agalsidase alfa was well tolerated in 99.5% of the infusions administered. Conclusion. Over the course of 36 months of ERT, there was no change in kidney function and 24-hour proteinuria. This suggests that agalsidase alfa may slow or halt the progression of kidney disease when used before extensive kidney damage occurs. No significant side effects were observed with ERT during the course of the study.

Frequency and Clinical Profile of Patients with Polycystic Kidney Disease in Southern Brazil

Background. Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic nephropathies, affecting one in every 800–1000 individuals in the worldwide general population and 5–10% of hemodialysis patients. Little data concerning the prevalence of ADPKD in Brazil are available. Thus, the aim of the present study was to investigate both the frequency and clinical profile of ADPKD among hemodialysis patients in south of Brazil. Methods. This cross-sectional study consisted of patients from 24 hemodialysis centers. Patients were screened for ADPKD by clinical, laboratorial, and image examination in medical records. Results. Of 1326 patients on hemodialysis in the south of Brazil that composed this study, 99 (7.5%) had polycystic kidney as primary cause for chronic renal failure. Comparisons between ADPKD and non-ADPKD patients revealed no differences regarding mean age, gender, and ethnicity. Conclusions. Our data revealed that ADPKD is prevalent among patients on hemodialysis in the south of Brazil. In addition, the clinical profile of ADPKD is similar to reported data from North America and Europe, putatively due to the similar ethnic composition mainly based on European descents.