Joel Paulo Russomano Veiga

Depressed mood and poor quality of life in male patients with chronic renal failure undergoing hemodialysis

OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialitico, correlacionar as alteracoes observadas no humor com os diferentes dominios do questionario de qualidade de vida. METODO: Foram incluidos 47 homens em tratamento hemodialitico estavel ha mais de seis meses. Foram aplicadas a Escala de Hamilton de depressao e o Kidney Disease Quality of Life Questionnaire, questionario de qualidade de vida relacionado a saude, em sua forma traduzida e adaptada para a lingua portuguesa. RESULTADOS: A media da idade dos pacientes era 39,4 ± 8,9 anos. Na avaliacao pela Escala de Hamilton, observou-se em 32 (68,1%) pacientes a presenca de depressao. Encontramos correlacao negativa significativa entre os resultados obtidos na escala de Hamilton e os seguintes parâmetros das dimensoes especificas do Kidney Disease Quality of Life Questionnaire: lista de sintomas e problemas (rs = -0,399; p = 0,005), qualidade da interacao social (rs = -0,433; p = 0,002) e sono (rs = -0,585; p < 0,001). Entre os dominios genericos, o estado de humor apresenta correlacao negativa significativa com a saude geral (rs = -0,475; p < 0,001), o bem-estar emocional (rs = -0,354; p = 0,015), a funcao social e a energia/fadiga (rs = -0,518; p < 0,001). Para os demais parâmetros do Kidney Disease Quality of Life Questionnaire nao foram observadas relacoes significativas com a escala de Hamilton. CONCLUSAO: O estado de humor apresentou correlacao negativa com diversos escores de qualidade de vida avaliados pelo Kidney Disease Quality of Life Questionnaire, sugerindo possivel influencia do estado de humor na qualidade de vida dos pacientes renais em hemodialise.

Avaliação da tolerância e nefrotoxicidade do antimonial pentavalente administrado na dose de 40mg Sb v/kg/dia, de 12/12h, por 30 dias na forma cutaneo-mucosa de leishmaniose

The renal function of eleven patients with mucocutaneous leishmaniasis was analyzed in a prospective study realized at the School Hospital of University of Brasília. The patients were treated with doses of 40 mg/kg/day of pentavalent antimony (Sb V), in a continuous scheme during thirty days. In this study three patients were excluded, one patient with reversible renal failure and two patients with hepatic and cardiac malfunctions. In the other eight patients, severe nephrotoxic effects were observed, like reduction of glomerular filtration rate, reduction of the urinary concentration capacity, evaluated by a sixteen hours hydric fasting and an increase of sodium fractional excretion. An increase in the number of leucocytes and cylinders were observed at the urinary sediment exam. Finally, the results shows that the treatment with pentavalent antimony in doses of 40 mg Sb/kg/day was less tolerated on account of its renal toxic effects. This scheme seems not be superior than the currently preconized scheme of 20 mg of Sb V/kg/day during 30 days.

Pentavalent antimonial nephrotoxicity in the rat

Aspects of the renal function were assessed in rats treated with the pentavalent antimonials Glucantime (Meglumine Antimoniate, Rhodia) or Pentostam (Sodium Stibogluconate, Wellcome). In dose of 30 mg of Sbv (Glucantime or Pentostam) by 100 mg of weight by day for 30 days, renal functional changes were observed consisting of disturbances in urine concentrating capacity. Such disturbances were expressed by significantly low values of urine osmolality as compared to the basal values previous to the drugs. The decrease in urine osmolality was associated to a significant increase in urinary flow and in negative free-water clearance. There was no alteration in osmolar clearance and in fractional excretion of sodium. These observations suggest an interference of the drugs in the action of the antidiuretic hormone. The disturbance in urine concentration was reversible after a seven days period without the drugs administration. No significant histopathological alterations were observed in the kidneys of the rats treated with the drugs. On the other hand, the rats treated with a high dose of Pentostam (200 mg/100 grams of weight/day) showed the functional and the histopathological alterations of the acute tubular necrosis.

Função renal em pacientes com leishmaniose muco-cutânea tratados com antimoniais pentavalentes

The renal function in ten patients with mucocutaneous leishmaniasis treated with Glucantime (meglumine antimoniate, Rhodia) or Pentostam (Sodium Stibogluconate, Wellcome) was assessed. During the use of these drugs a defect in concentrating capacity of the kidney was observed expressed as low values of maximun urinary osmolarity and negative maximun clearance of free water in relation to tests made before treatment. The urinary concentrating capacity returned to normal in 5 of the 8 patients studied 15-30 days after the end of treatment. However the maximal urinary osmolarity values where still inferior to those obtained before treatment. In two patients there was a proteinuria above 150 mg/24 hours after antimoniais which disappeared later. The clearance of endogenous creatinine do not alter significatly with the use of these drugs. The results suggest that pentavalent antimoniais can resue in a defect in urine concentrating capacity which is partially reversible after antimonial therapy has ceased.

Cystatin C, CRP, Log TG/HDLc and Metabolic Syndrome are Associated with Microalbuminuria in Hypertension

Background In patients with systemic hypertension, microalbuminuria is a marker of endothelial damage and is associated with an increased risk for cardiovascular disease. Objective To determine the factors that may lead to the occurrence of microalbuminuria in hypertensive patients with serum creatinine lower than 1.5 mg/dL. Methods This cross-sectional study included 133 Brazilians with essential hypertension followed up at a hypertension outpatient clinic. Those with serum creatinine higher than 1.5 mg/dL, as well as those with diabetes mellitus, were excluded. Systolic and diastolic blood pressures were measured, and body mass index (BMI) and GFR estimated by using the CKD-EPI formula were calculated. The serum levels of the following were assessed: CysC, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C-reactive protein (CRP) and fasting glucose. Microalbuminuria was determined in 24-hour urine. Hypertensive patients were classified according to the presence of one or more criteria for metabolic syndrome. Results In a multiple regression analysis, the serum levels of CysC and CRP, the atherogenic index log TG/HDLc and the presence of three or more criteria for metabolic syndrome were positively correlated with microalbuminuria (r2: 0.277, p < 0.05). Conclusion CysC, CRP, log TG/HDLc, and the presence of three or more criteria for metabolic syndrome, regardless of serum creatinine, were associated with microalbuminuria, an early marker of kidney damage and cardiovascular risk in patients with essential hypertension.

Alcohol acute intoxication before sepsis impairs the wound healing of intestinal anastomosis: rat model of the abdominal trauma patient

IntroductionMost trauma patients are drunk at the time of injury. Up to 2% of traumatized patients develop sepsis, which considerably increases their mortality. Inadequate wound healing of the colonic repair can lead to postoperative complications such as leakage and sepsis.ObjectiveTo assess the effects of acute alcohol intoxication on colonic anastomosis wound healing in septic rats.MethodsThirty six Wistar rats were allocated into two groups: S (induction of sepsis) and AS (alcohol intake before sepsis induction). A colonic anastomosis was performed in all groups. After 1, 3 or 7 days the animals were killed. Weight variations, mortality rate, histopathology and tensile breaking strength of the colonic anastomosis were evaluated.ResultsThere was an overall mortality of 4 animals (11.1%), three in the group AS (16.6%) and one in the S group (5.5%). Weight loss occurred in all groups. The colon anastomosis of the AS group didn’t gain strength from the first to the seventh postoperative day. On the histopathological analysis there were no differences in the deposition of collagen or fibroblasts between the groups AS and S.ConclusionAlcohol intake increased the mortality rate three times in septic animals. Acute alcohol intoxication delays the acquisition of tensile strength of colonic anastomosis in septic rats. Therefore, acute alcohol intoxication before sepsis leads to worse prognosis in animal models of the abdominal trauma patients.

Serum zinc and hormonal profile in male dialysis patients receiving human recombinant erythropoietin

INTRODUCTION: Treatment with recombinant human erythropoietin (rHuEpo) is associated with an improvement in well-being and quality of life in patients submitted to maintenance hemodialysis (HD). OBJECTIVES: The goal of this work was to evaluate the levels of sex hormones, hematocrit, albumin and zinc in HD patients with rHuEpo therapy and compare them with those observed in patients without rHuEpo treatment. MATERIAL AND METHODS: Two groups of twelve male HD patients each were selected for a transversal study; one did not receive rHuEpo (group 1) whereas the other one did (group 2). Levels of hematocrit, albumin, zinc, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and testosterone were determined. RESULTS: Group 2 patients showed significantly higher medians (p < 0.05) of testosterone (4.65 vs. 3.5ng/mL), hematocrit (30.5 vs. 22%), albumin (3,9 vs. 3,7g/dL) and zinc (62.5 vs. 50.5microg/dL) than group 1 patients. DISCUSSION: In this study rHuEpo treatment resulted in higher hematocrit, testosterone, zinc and albumin. It is suggested that, in patients recipients of rHuEpo, higher levels of zinc and testosterone may be factors that contribute to relieve sexual dysfunction and improve quality of life. CONCLUSIONS: In HD patients, hematocrit, albumin, serum zinc and testosterone levels were higher in rHuEpo recipients when compared with patients not receiving this hormone therapy.

Male Gender and Body Mass Index Are Associated With Hypertension and Reduced Kidney Function 5 or More Years After Living Kidney Donation.

BACKGROUND The objective of this study was to evaluate renal function and to explore the relationship between some risk factors in kidney donors 12.37 ± 7.60 years after donation. PATIENTS AND METHODS In a cross-sectional study conducted in a transplant unit, 77 nephrectomized subjects were assessed ≥5 years after donation to evaluate their renal function and the presence or absence of hypertension, dyslipidemia, and microalbuminuria. RESULTS Twenty donors had an estimated glomerular filtration rate of <60 mL/min/1.73 m(2). Nine donors showed urinary albumin excretion of >20 μg/min (11.68%). Subjects with an EGFR of <60 mL/min were predominantly male and hypertensive and showed higher body mass index (BMI), higher uric acid, higher total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C), and logarithm of triglycerides/HDL-C (log TG/HDL-C) ratios than donors with an EGFR of >60 mL/min. Hypertensive donors were older and had higher BMI, higher UA serum values, higher TC/HDL-C and log TG/HDL-C ratios and microalbuminuria than nonhypertensive donors (P < .005). A multivariate analysis was conducted and, after final adjustment, a filtration rate of <60 mL/min was 3.05 times higher in men than women, increased 10% for each 1-unit increase in BMI and was positively associated with log (TG/HDL-C). The frequency of hypertension increased by 10% for each 1-unit increase in BMI and was positively associated with microalbuminuria. CONCLUSION In this sample of kidney donors from a single transplant unit, ≥5 years after donation, male sex and high BMI were positively associated with the presence of kidney failure.

Effect of systemic inflammation on level of ferritin seminal in chronic renal male patient undergoing hemodialysis

Background Most hemodialysis patients present with chronic systemic inflammation characterized by the elevation of serum C-reactive protein (CRP) levels and/or the production of proinflammatory interleukins by the immune system in response to the hemodialysis process. Plasma ferritin(PF) is one of the parameters used to correct anemia. An PF level of >500 ng/mL is not recommended for correction of anemia because of the uncertainty of whether these levels are elevated because of anemia or a mere reaction to inflammation. we aimed to study the effects of inflammation on seminal ferritin (SF) levels and hypothesized that SF is not affected because of the testicular immune privilege. Methods A prospective prevalence study was conducted at the Department of Hemodialysis of the University Hospital of Brasília (HuB) between June 2010 and July 2011. The sample included 60 chronic renal patients undergoing hemodialysis and 20 control subjects from the health promotion general outpatient clinic. All participants were males aged 18–60 years. Inflammation was assessed through serum CRP levels, and the testicular condition was determined by measuring sex hormone levels. In the patient group, inflammation was considered to be present when CRP was >5 mg/L (n = 27) and absent when CRP was ≤5 mg/L (n = 33). Control group (n = 20) CRP was ≤1 mg/L. Blood and semen were collected via arm venoclysis and after voluntary masturbation, respectively. CRP was measured by turbidimetry; PF, SF, and sex hormone levels by immunochemoluminescence. Statistical significance was set at p < 0.05. Results There was no significant difference in mean SF levels among patients with inflammation (295.34 ± 145.39 ng/mL), those without inflammation (324.42 ± 145.51 mg/mL), and controls (335.70 ± 075.90 ng/mL; p = 0.49). There was no correlation between mean SF and PF levels in the patients with and without inflammation). All participants were eugonadal with mean serum FSH, LH, and testosterone levels of 3.76 ± 2.17 mUI/mL, 7.00 ± 3.53 mUI/mL, and 454.18 ± 173.08 ng/dL, respectively. Conclusion Systemic inflammation did not significantly alter SF levels in eugonadal hemodialysis patients.

Associação dos marcadores do estado oxidativo e inflamatório com a desnutrição em pacientes hemodialisados com ferritina menor do que 500 ng/mL

In a cross-sectional survey 35 HD patients (23 with normal nutritional status, 12 with Protein-Energy-Wasting syndrome, PEW), and healthy volunteers (n = 35) were studied. Serum concentration of iron, ferritin, transferrin saturation, ma-londialdehyde (MDA), protein carbonyl (PC), high-sensitive serum C - reactive protein (hs-CRP) and blood counts were determined. The nutritional status was determined by anthropometric and bio-chemical criteria.