Luiz Carlos Ferreira de Andrade

Identification of periodontal pathogens and severity of periodontitis in patients with and without chronic kidney disease

OBJECTIVE In this study of patients with chronic periodontitis (CP), the severity of the disease and the main periodontal pathogens identified in patients with chronic kidney disease (CKD) were compared with those detected in individuals without systemic disease. DESIGN Nineteen patients with CP without evidence of systemic disease (control group), 25 patients with CP and CKD who were in the pre-dialysis stages (pre-dialysis group), and 22 patients with CP and CKD who were on renal replacement therapy (RRT group) were examined. The severity of CP was based on the investigation of probing depth (PD) and clinical attachment level (CAL). The definition and stage of CKD were based on the criteria proposed by the Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation. Glomerular filtration rate (GFR) was estimated using the equation of Modification of Diet in Renal Disease and the identification of microorganisms in subgingival plaque was performed using polymerase chain reaction (PCR). RESULTS Candida albicans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were more common in patients who were on RRT and pre-dialysis than in control subjects. CP was more severe in patients with CKD. A strong association was observed between the frequency of C. albicans (P = 0.056), P.gingivalis (P = 0.008), T. denticola (P = 0.013) and CAL, when CKD patients were compared with the control group. CONCLUSION CP is more severe and is associated with increased frequency of C. albicans, P. gingivalis, T. forsythia, and T. denticola in patients with CKD.

Association of hypovitaminosis D with Systemic Lupus Erythematosus and inflammation.

INTRODUCTION Nowadays it is described a high prevalence of hypovitaminosis D in Systemic Lupus Erythematosus (SLE), which is associated with some clinical manifestations and increased inflammatory activity. OBJECTIVE To evaluate the association between vitamin D insufficiency with SLE and inflammatory markers. METHODS Cross-sectional study, in which have been evaluated 45 SLE patients and 24 controls without the disease. Levels of 25-hydroxyvitamin D [25(OH) D] less than 30 ng/mL were considered inadequate. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). High sensitivity C reactive protein (hsCRP) and interleukin-6 (IL-6) were evaluated for verification of the inflammatory status. For assessment of renal involvement, analysis of abnormal elements and urinay sediment (AES), quantitative hematuria and pyuria, proteinuria and creatinine clearance in 24-hour urine and serum anti-double stranded DNA were performed. RESULTS The prevalence of 25(OH)D insufficiency was 55% in SLE patients and 8% in the controls participants (p = 0.001). The median of 25(OH)D was lower in patients than in controls. Patients with insufficient 25(OH)D had higher levels of IL-6 and higher prevalence of hematuria in the AES. There was no correlation between vitamin D and SLEDAI or lupus nephritis. CONCLUSION In our study, vitamin D deficiency was more prevalent in patients with SLE and was associated with higher levels of IL-6 and hematuria.

Serum levels of vitamin D and chronic periodontitis in patients with chronic kidney disease

INTRODUCTION Concomitance of chronic periodontitis (CP) in patients with chronic kidney disease (CKD) have been associated with adverse outcomes. Vitamin D (25(OH)D) deficiency my play a role in CP and inadequate vitamin D status is common among patients with CKD. OBJECTIVE To examine the relationship between vitamin 25(OH)D and CP in patients with CKD not yet on dialysis. METHOD A case-control study was conducted. Cases and controls were defined as patients with CKD with and without CP, respectively. The demographic, clinical and laboratory data were obtained when the patient was attended in the outpatient clinic. CKD was defined and staged according to the NKF QDOKI TM. Serum 25(OH) D levels were measured by chemiluminescence when assessing the CP, which was definined according to the American Academy of Periodontoly (1999). Serum 25(OH)D levels were stratified into deficient (< 14 ηg/mL), insufficient (15-29 ηg/mL) and sufficiency (> 30 ηg/ mL). RESULTS A total of 15 cases were compared with 14 controls. Cases had lower median 25(OH)D levels than controls (22.6 versus 28.6 ηg/mL, p < 0.01) and were more likely to be categorized as vitamin D insufficiency/deficiency (93,3% versus 57,1%, p < 0,004). On the other hand, the percentage of controls with vitamin D sufficiency was higher then cases (42,9% versus 6,7%, p < 0,004). CONCLUSION In patients with CKD not yet on dialysis, vitamin D deficiency is associated with CP.INTRODUCAO A concomitância de periodontite cronica (PC) em pacientes com doenca renal cronica (DRC) tem sido associada a desfechos adversos. A deficiencia de vitamina D (25(OH)D) parece desempenhar papel importante na PC e niveis inadequados de vitamina D tem sido descritos em pacientes com DRC. OBJETIVO: Examinar a relacao entre niveis sericos de vitamina D e PC em pacientes com DRC pre-dialitica. METODO: Estudo de caso-controle, definidos, respectivamente, como pacientes com DRC e PC e DRC sem PC. Os dados demograficos, de exame fisico e laboratoriais foram obtidos no dia da consulta. A DRC foi definida e estagiada segundo a NKF QDOKITM. Os niveis sericos de 25(OH) D foram dosados por quimioluminescencia quando da avaliacao da PC, a qual foi caracterizada segundo os criterios de Academia Americana de Periodontologia (1999). Os resultados de 25(OH)D foram estratificados em deficiencia ( 30 ηg/mL). RESULTADOS: Um total de 29 pacientes foram estudados, 15 no grupo caso e 14 no grupo controle. Os pacientes casos apresentaram mediana de 25(OH) D inferior a dos pacientes controles (22,6 vs. 28,6 ηg/mL; p < 0,01). A frequencia de pacientes casos com insuficiencia/deficiencia de vitamina D foi maior do que entre os pacientes controles (93,3% vs. 57,1%, p < 0,004). Por outro lado, o percentual de pacientes com suficiencia de vitamina D foi maior entre os controles se comparados aos integrantes do grupo casos (42,9% vs. 6,7%, p < 0,004). CONCLUSAO: Em pacientes com DRC, a deficiencia de vitamina D se associa com PC.

Translation, cultural adaptation, and validation of the Screening For Occult Renal Disease (SCORED) questionnaire to Brazilian Portuguese

Screening Chronic Kidney Dis- ease (CKD) allows early interventions, which may alter the natural course of the disease, including cardiovascular morbid- ity and mortality. Screening for Occult Renal Disease (SCORED) is questionnaire with nine questions with different weights, and predicts a 20% chance for CKD if a individual score ≥ 4 points. Aim: Translate to Portuguese, perform the adaptation to the Brazilian culture and validate the orig- inal version of SCORED questionnaire. Methods: Steps of the process: Translation from English into Brazilian Portuguese; back-translation into English; application to a population sample; and Proof-reading and completion. The translations and re- views were made by professionals experts in Portuguese and English. The question- naire was applied to 306 participants and CKD was diagnosed as suggested by the NKF KDOQI™. Results: The participants mean age was 49 ± 13 years, 61% were women, 69% were white, and 68% had education below high school, 38.5% had hypertension, and 12.3% diabetics. The final Brazilian Portuguese version of the SCORED questionnaire was well under- stood. CKD was diagnosed in 20 (6.5%) of the participants. The Brazilian version of the SCORED questionnaire showed sensitivity of 80%, specificity of 65%, positive predictive value of 14%, negative predictive value of 97%, and accuracy of 66%. Conclusion: The steps used for the translation, transcultural adaptation, and validation allowed a Brazilian Portuguese version of the SCORED questionnaire which was well understood, acceptable and costless, characteristics that make it a useful tool in the identification of people that chance of having CKD. AbstRAct Palavras-chave: comparacao transcultural, insuficiencia renal cronica, questionarios.