Sandra Maria Rodrigues Laranja

Evaluation of acute administration of natural products with potential diuretic effects, in humans

In order to evaluate the potential diuretic effect of two natural products, Elephantopus scaber and Alpinia speciosa, a trial administration was carried out in ten healthy volunteers and the effects compared to the those of a placebo. The substances were given on different days, with a seven day interval between doses. The amount of substance administered to the subjects was five times the usual dose i.e. 7.5 g/100 ml and 0.8 g/100 ml respectively. The following parameters were measured: urinary and plasma sodium, potassium, uric acid, calcium, phosphate, urea, creatinine. The subjects were also examined clinically and total urinary volume was assessed. The only significant findings (p < 0.05) was a slight diuresis with Alpinia speciosa, which also lowered the diastolic (p < 0.05) and systolic (p < 0.01) blood pressures. No effect on electrolytes or renal function parameters was observed, and this probably excludes any renal tubular or glomerular effect from these substances.

Nephrotoxicity of Low-Osmolality Contrast Media

To evaluate renal function after the use of a low-osmolality radiological contrast medium (CM), we prospectively analyzed 39 patients submitted to the following examinations: arteriography (n = 32), phlebography (n = 3), computed tomography (n = 3), angioplasty (n = 1), and retrograde pyelography (n = 1). The patients were divided into three groups: group 1, control, formed by renal donors (CT, n = 11 and 11 exams); group 2, hypertensive patients (HYPT, n = 15 and 16 exams); and group 3, patients with diseases of multiple etiologies (MIX, n = 13 patients and 13 exams). Additionally, the patients were divided according to their renal function into: group 4, with a moderate deficit of renal function, creatinine clearance (CrCl) 25 to 60 mL/min (n = 15 patients and 15 exams); and group 5, with a mild deficit of renal function, CrCl > or = 60 mL/min (n = 14 patients and 14 exams). The CM utilized was ioxaglic acid (Hexabrix) the incidence of acute renal failure (ARF) among the patients studied was 12.5% (5/40), and CrCl was the best parameter to monitor the alterations in renal function, which occurred in 35% of the patients, although the changes were mild, reversible, and did not need any therapeutic interventions. The triggering of ARF in these patients may have been due to multiple factors presented at time of CM examination. Thus, it is not possible to identify a single risk factor. However, it is probable that previous important impairment of renal function was the most expressive risk factor.

Star fruit as a cause of acute kidney injury

The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.

Reasons of unsuccessful implantation of short-term hemodialysis catheters in jugular veins using real-time ultrasound

Purpose:Real-time ultrasound is indicated for hemodialysis catheters’ insertion in internal jugular veins. We evaluated unsuccessful implantation of short-term hemodialysis catheters in internal jugular veins using real-time ultrasound between patients with and without previous short-term catheters.Methods:Observational open-label study of unsuccessful implantation of short-term hemodialysis catheters in internal jugular veins using real-time ultrasound from July 2013 to August 2014.Results:A total of 185 procedures were compared in 122 individuals; 120 (64.86%) had previously used short-term catheters. There were 5 (8%) unsuccessful implantation among 62 catheterizations without previous short-term catheter and 41 (33.6%) among 122 with previous short-term catheter (p = 0.001 Pearson’s chi-squared, odds ratio = 5.77, 95% confidence interval = 2.15–15.50, p = 0.001). Non-progressing guidewire occurred in 2 (3.2%) of 62 patients without previous short-term catheter and in 18 (14.8%) of 122 with previous sh...

Risk factors for the progression of chronic kidney disease after acute kidney injury

INTRODUCTION The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear. OBJECTIVE To investigate the association between AKI and its progression to CKD and the risk factors involved. METHODS An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearsons correlation, were performed using SPSS. RESULTS The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of the male patients exhibited decreased renal function and CKD (vs. 60.4% of the female patients). The progression of AKI to CKD was more frequent in patients admitted to wards (63.8%), cancer patients (74.19%), patients with sepsis (67.18%) and patients with obstruction (91.66%). Dialyses were performed in 16.4% of the patients, but this was not correlated with the progression of CKD. CONCLUSIONS Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.

Risk factors for the progression of chronic kidney disease afteracute kidney injury

INTRODUCTION The incidence of chronic kidney disease (CKD) is increasing with the increasing age of the population and the increasing number of elderly survivors of acute kidney injury (AKI). The risk factors for the progression of CKD after AKI are unclear. OBJECTIVE To investigate the association between AKI and its progression to CKD and the risk factors involved. METHODS An observational, retrospective study of AKI patients followed from 2009 to 2012 was carried out. We evaluated the etiology of AKI, the use of vasoactive drugs and mechanical ventilation, the need for dialysis, the presence of comorbidities, the glomerular filtration rate (GFR), the length of stay and the progression of CKD. Statistical analyses, including the Chi-square test and Pearsons correlation, were performed using SPSS. RESULTS The 207 patients analyzed had a mean age of 70.1 ± 13.1, and 84.6% of the male patients exhibited decreased renal function and CKD (vs. 60.4% of the female patients). The progression of AKI to CKD was more frequent in patients admitted to wards (63.8%), cancer patients (74.19%), patients with sepsis (67.18%) and patients with obstruction (91.66%). Dialyses were performed in 16.4% of the patients, but this was not correlated with the progression of CKD. CONCLUSIONS Being an elderly male patient with AKI due to sepsis and obstruction was correlated with progression to CKD following discharge.

Laboratory correlation between vancomycin levels and serum creatinine in the nephrotoxicity of vancomycin

Abstract Reports about relationship on renal function and vancomycin exposure are conflicted and limited. Goals: To identify if high serum vancomycin levels precede changes in serum creatinine or if it is secondary to reduced glomerular filtration and to analyze associated clinical conditions. Methods: retrospective cohort study, initially of 56.555 measurements of vancomycin levels from 511 patients admitted from December 2011 to June 2012 was analyzed. Patients with uncompleted dates were excluded and the correlation analysis was performed in 127 patients that were divided into four groups based on vancomycin levels (20 mg/mL) and creatinine (1.4 mg/dL) levels. After that, 80 medical charts of these patients was reviewed for the presence of comorbidities, sepsis, acute kidney injury and use of other nephrotoxic drugs. Results: there was a significant increase in vancomycin levels, when creatinine > 1.4 mg/dL and vancomycin ≤ 20 mg/mL (Group 3) on the first measurement. It was identified there was a significant association between creatinine > 1.4 mg/mL and vancomycin > 20 mg/mL, n = 7 (Group 4) in patients aged 50–59 years. Acute kidney injury was present in patients with previous higher vancomycin levels. Conclusions: Impaired renal function occurred before vancomycin levels measurements were taken, influencing the serum levels of vancomycin in the following days. In these patients the elevation of vancomycin did not lead to a worsening in renal function. There was a positive correlation between elevated creatinine and vancomycin levels in elderly, male and septic. Patients who need more attention were those with acute kidney injury who have previous higher vancomycin levels.

Case Report. Star fruit as a cause of acute kidney injury

The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.

Carambola como causa de lesão renal aguda

The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.The star fruit belongs to the family Oxalidacea, species Averrhoa carambola. It is rich in minerals, vitamin A, C, B complex vitamins and oxalic acid. Recent studies show that the toxicity of the fruit differs between the patients and may be explained by single biological responses, age, and the intake quantity of the neurotoxin in each fruit in addition to glomerular filtration rate given by each patient. Additionally, the nephrotoxicity caused by the fruit is dose-dependent and may lead to the deposition of crystals of calcium oxalate intratubular, as well as by direct injury to the renal tubular epithelium, leading to apoptosis of the same. We report the case of a patient who after ingestion of the juice and fresh fruit, developed acute renal failure requiring dialysis, evolving with favourable outcome and recovery of renal function.

Assessment of epidemiological profile of patients and their difficulties for the first query in the screening ambulatory of Nephrology UNIFESP-EPM

INTRODUCTION The aim of this study was to evaluate the epidemiologic profile of patients and difficulties of patients referred by basic health units (UBS) or other hospitals, outpatient screening of the Division of Nephrology, Hospital São Paulo (UNIFESP) for evaluation and treatment kidney disease. METHODS From February to September 2009, has been evaluated 341 patients referred from UBS in São Paulo and other parts of the Country. RESULTS Of these patients, 26% (86/341) required for new tests to confirm the diagnosis doubtful for referrals, incomplete, or because of the waiting period for the care and exams, which ranged from one week to three years, and part of them did not bring any kind of examination for the evaluation, 12% (45/341) returned for follow-up at the unit location, 13% (46/341) were referred for treatment site closest to their residence, 47% (164/341) for our sub-specialty Clinics of Nephrology (HSP): 24% (82/341) uremia, 8% (27/341) with polycystic kidney disease, 7% (23/341) for hypertension, 4% (16/341) renal Lithiasis and 4% (16/341) nephritis. CONCLUSION Our results suggest investments investment in infrastructure in the training of officials of UBS and HSP, reorganization of central references for better management and referral of patients, humanization of care and training of health professionals for outpatient care at UBS in preventive work and basic monitoring of patients, particularly those with diabetes mellitus and hypertension, which can lead to the development of chronic kidney disease (CKD).INTRODUCAO: O objetivo deste estudo foi avaliar o perfil epidemiologico dos pacientes e das dificuldades dos pacientes encaminhados, pelas unidades basicas de saude (UBS) ou outros hospitais, ao ambulatorio de triagem da disciplina de Nefrologia do Hospital Sao Paulo (UNIFESP) para avaliacao e tratamento de doencas renais. METODOS: No periodo de fevereiro a setembro de 2009, foram avaliados 341 pacientes encaminhados das UBS da cidade de Sao Paulo e de outras localidades do Pais. RESULTADOS: Desses pacientes, 26% (86/341) necessitaram de novos exames para definicao do diagnostico por encaminhamentos duvidosos, incompletos, ou devido ao periodo de espera para a realizacao dos exames e o atendimento, que variou de uma semana ate tres anos. Parte deles nao trouxe nenhum tipo de exame para essa avaliacao, 12% (45/341) retornaram para acompanhamento na propria unidade local, 13% (46/341) foram encaminhados para local de tratamento mais proximo de sua residencia, 47% (164/341) para nosso ambulatorio de subespecialidades: 24% (82/341) uremia, 8% (27/341) rins policisticos, 7% (23/341) hipertensao, 4% (16/341) litiase renal e 4% (16/341) nefrites. CONCLUSAO: Nossos resultados sugerem investimentos em infraestrutura na capacitacao dos funcionarios das UBS e do HSP, reorganizacao das centrais de referencias para melhor gerenciamento e encaminhamentos dos pacientes, humanizacao no atendimento e capacitacao dos profissionais de saude para o atendimento ambulatorial nas UBS, particularmente naqueles com diabetes mellitus e hipertensao arterial, que podem levar ao desenvolvimento da doenca renal cronica (DRC).