Biochemical and histopathological evaluations of chronic renal failure rats treated with pluripotent human stem cells

Abstract Regeneration of damaged kidney cells using stem cells is the current research approach in the treatment of chronic renal failure (CRF). In the present study, the histopathological and biochemical techniques were used to evaluate stem cells' (SCs) role in treatment of CRF. Sixty-four rats were divided into eight groups. Group I (GI): rats were injected with doxorubicin (15 mg/kg) to initiate CRF. GII-GVII: rats were injected with doxorubicin and treated with SCs (1x106 MSCs or/and 2x104 HSCs/rat) with/without growth factors extract (200 µL/rat) and/or immunosuppressor (cyclosporine A, 5 mg/kg/day). GVIII: rats treated with PBS (100 µL/kg/day). Levels of creatinine, urea and uric acid were increased in rats sera after injection with doxorubicin, while blood electrolyte levels of Na, K, P and Mg were decreased. Also, histopathological abnormalities such as hyalinized blood vessels, degenerated hyalinized glomerulus tubules and cell debris in the lumen and degeneration of renal tissues were observed in these rats. After treatment with SCs, all these parameters restore their normal values with regeneration of the damaged cells as demonstrated in histopathology of the treated groups. It can be concluded that, the use of SCs in treatment of kidney diseases is a promising approach and needs more efforts.

Reflection about the hemodialysis water microbiological quality in Brazil

Abstract Dialysis has been widely used in the treatment of patients with chronic kidney diseases and is considered a global public health issue. This treatment, which has changed the prognosis and quality of life in patients with chronic renal failure, can lead to complications that are often fatal. For this reason, there is a need for validation of alternative tests that favor the monitoring of treated water for dialysis in real-time to promote and prevent injuries to patients submitted to this procedure.

Characterization of an experimental model of progressive renal disease in rats

ABSTRACT PURPOSE: To characterize an experimental model of progressive renal disease induced by different degrees of nephrectomy in rats. METHODS: Eighty male Wistar rats were divided into four experimental groups (n=20/group): sham surgery (control group), progressive degrees of nephrectomy leading to mild uremia (group 1), moderate uremia (group 2) and severe uremia (group 3). Ten animals of each group were followed for two or four weeks. At the end, blood and 24-hour urine samples were collected to determine renal function parameters. Urine output and water and food intake were daily monitored. RESULTS: In rats of group 1, serum levels of creatinine and urea and microalbuminuria were increased, while reduced creatinine clearance (p<0.05, compared with control group), without changing blood pressure. Animals of group 2 had more accentuated alterations: increases in urinary output, blood pressure, serum concentrations of urea, creatinine, sodium, potassium, and in microalbuminuria, and reduction of creatinine clearance (p<0.05). Group 3 exhibited even more increased serum concentrations of urea, creatinine, sodium and potassium, blood pressure and microalbuminuria, and decreased creatinine clearance (p<0.05) in comparison with control group and unilateral nephrectomy. CONCLUSION: Progressive nephrectomy in rats seems to be useful to study the physiopathology of chronic kidney disease and its mechanisms of progression.

Glomerulopatia colapsante / Collapsing glomerulopathy

Background: Collapsing glomerulopathy is a cause of nephrotic syndrome with massive proteinuria secondary to podocyte proliferation and glomerular collapse. It is characterized by an almost inevitable progression to end stage renal failure, poor response to treatment and high post-transplant recurrence. Its frequency has increased in recent years due to its common association with Human Immunodeficiency Virus (HIV) infection and the growing recognition of new etiologic agents such as drugs and parvovirus B19. Therefore, it is a disease of growing interest for clinicians. The aim of this review is to update the clinical presentation, diagnosis, pathogenesis and therapeutic alternatives of this disease.

Vascular calcification in patients with chronic kidney disease: types, clinical impact and pathogenesis

Vascular calcification plays a major role in cardiovascular disease, which is one of the main causes of mortality in chronic kidney disease patients. Vascular calcification is determined by prevalent traditional and uraemia-related [non-traditional] risk factors. It occurs mainly in the arteries, which are classified into three types according to their size and structural characteristics. In addition, vascular calcification has been associated with bone loss and fractures in chronic kidney disease patients and the general population, stressing the fact that both disorders can share pathogenetic pathways. The strategies to control vascular calcification involve several measures, chief among them the control of hyperphosphataemia. Furthermore, it has been recently described that strategies that reduce bone resorption and increase bone mineralization may decrease the risk of vascular calcifications; however, this approach still remains controversial. The mechanisms involved in vascular calcification are complex and not yet fully understood. Phosphorus plays a major role, while other factors related to bone formation have been recently identified

Frequência da doença periodontal em pacientes com insuficiência renal crônica / Frequency of periodontal disease in chronic renal insufficiency patients

O objetivo da pesquisa foi verificar a frequência da doença periodontal em pacientes renais crônicos do Hospital Santa Casa de Montes Claros, MG- Brasil, aprovado pelo Comitê de Ética e Pesquisa São Leopoldo Mandic, sob o protocolo n02007j0315. A amostra foi composta por 200 pacientes com o diagnóstico de doença renal crônica, sendo 61% do gênero masculino e 39% do gênero feminino. Todos os pacientes assinaram o termo de consentimento livre e esclarecido, e foram submetidos a um questionário proposto, que forneceu dados pessoais, histórico médico e saúde bucal. Foi realizado exame periodontal por um único examinador, calibrado, em que todos os dentes dos pacientes foram examinados para verificar a profundidade de sondagem, perda de inserção clínica, sangramento à sondagem, presença de placa bacteriana e presença de cálculos. Os resultados demonstraram que 56% escovam os dentes no máximo duas vezes ao dia, mais da metade (66,5%) não usa fio dental e quase a totalidade dos pacientes nunca fizeram tratamento periodontal, A profundidade de sondagem média foi de 2,47 ± 0,76, a perda de inserção foi de 3,72 ± 1,51, presença de sangramento de 0,23 ± 0,16 e de placa de 0,25 ± 0,18. Quase 100% dos pacientes tiveram algum tipo de doença periodontal, sendo a maioria periodontite. Podemos concluir que cabe aos profissionais de saúde bucal, médicos, outros profissionais de saúde e autoridades de saúde pública a missão de alertar todos os pacientes sobre a importância do tratamento periodontal, pois este pode compromenter os canditados ao transplante renal.

The objective of the research was to check the frequency of periodontal disease in chronic renal patients at the Hospital Santa Casa of Montes Claros, MG - Brazil. The sample was composed by 200 patients with diagnosis of chronic renal disease, being 61% male and 39% female gender. Ali the patients signed the term of free and illustrious consent. A questionnaire was applied to collect sociodemographic and medical history. A periodontal examination was carried out to measurement periodontal conditions including probing depth, loss of clinical attachment levei, bleeding sites and presence of dental plaque and calculus. Ali the patients were examination by a calibrated examiner. The study was approved by the Committee of Bioethics in Researches São Leopoldo Mandic, under the protocol n02007j0315. The results have demonstrated 56% brushing ali teeth to the utmost twice a day, 66.5% don't use dental floss and the totality of patients almost never have made periodontal treatment. The medium of periodontal probing was 2.47 ± 0.76, the loss of clinical attachment levei was of 3.72 ± 1.51, presence of bleeding sites were 0.23 ± 0.16 and dental plaque was 0.25 ± 0.18. Approximately, 100% of the patients had some type of periodonta I disease, bei ng the most of ch ronic periodontitis. Conclusion: the professiona I ora I hea Ith, physicians, others health professionals and authorities of public health have the mission to alert ali the patients about the importance of periodontal treatment, because periodontal infection can compromised the candidates to the Renal transplantation.

Doença periodontal em pacientes renais crônicos / Periodontal disease in chronic renal patients

O objetivo deste estudo foi avaliar a frequência, extensão e gravidade da doença periodontal em uma amostra de 200 pacientes com insuficiência renal crônica sob hemodiálise nas cidades de Criciúma (Nefro- clínica e Hospital São João Batista) e na Clínica de hemodiálise de Tubarão (SC). O termo de consentimento livre e esclarecido foi obtido previamente ao preenchimento de um questionário a respeito de características sócio-demográficas, história médica, hábitos nocivos, sinais e sintomas relativos à cavidade bucal e cuidados de saúde bucal. O exame clínico foi realizado para verificar o número de dentes, presença de cálculo, pro- fundidade de sondagem, perda de inserção, sangramento à sondagem e presença de biofilme. Os resultados mostraram que a idade média dos examinados foi de 53,4± 14,8 anos, maioria do gênero masculino (58%), etnia branca (78%), casados (72,5%), com instrução até nível fundamental (63%), não fazendo uso de álcool ou fumo, apresentando hipertensão arterial (35%) e Diabetes (13%). Xerostomia foi relatada por 52,5% dos entrevistados. Quanto à extensão e gravidade da doença periodontal, a maioria dos pacientes apresentou periodontite grave localizada (23,5%). Os valores médios de profundidade de sondagem, perda de inserção, sangramento à sondagem e presença de biofilme foram 1,27 mm ± 0,62; 1,47 mm ± 0,81; 13,4OJo ± 21,4; 28,8% ± 33,2, respectivamente, Este estudo aponta correlação positiva entre doença periodontal e insuficiên- cia renal crônica, com predominância de uma forma localizada de periodontite. Devido à precária condição de saúde bucal, conclui-se que os pacientes nefropatas em hemodiálise precisam de instruçôes de higiene bucal, raspagem supra e subgengival, medidas preventivas no controle de placa e tratamento odontológico, sendo fundamental a participação do cirurgião-dentista no tratamento multidisciplinar para o restabelecimento da saúde destes indivíduos em todo tratamento dialítico...

The aim of this study was to evaluate the frequency, extension and severity of periodontal disease on a sample of patients with chronic renal failure undergoing hemodialysis in three clinics located in the cities of Tubarão and Criciúma - SC - Brazil. A total of 200 patients had been examined between march and august/2oo8. The research was approved by the Ethics Committee of the Faculty of Dentistry and Dental Research Center São Leopoldo Mandic, under registration 07/127 in conformity with the resolution CNS 196/1.996. Informed consent was obtained before the completion of a questionnaire regarding socio-demographic status, medical history, harmful habits, signs and symptoms related to the oral cavity and oral health care. The oral examination was performed by one examiner assessing the number of teeth, presence of calculus, probing depth, attachment 1055, bleeding on probing and presence of biofilm. The results showed mean age of 53.4 ± 14,8 years; most subjects were men (58.0%), white (78%), married (72,5%), with a primary education (63.00f0), not using alcohol nor cigarettes, having diabetes (13%) and hypertension (35.0%). Xerostomia was related by 52.5%. According to periodontal disease extension and severity, the majority of the patients presented periodontitis severe localized (23.5%). The mean values of probing depth, attachment Ioss, bleeding on probing and presence of biofilm had been 1.27mm ± 0.62; 1.47 mm ± 0.81; 13.4 ± 21.40f0; 28.8% ± 33.2%, respectively. Thisstudy points out a positive correlation between periodontal disease and Chronic Renal Failure with predominance of a located form of periodontitis. As for the necessity of periodontal treatment it was noticed that most of the patients undergoing dialysis needed oral hygiene education, prevention means on plaque control and periodontal (odontological) tre- atment, considering of fundamental importance the participation of a dentist on the cross functional...

A dimensão educativa da equipe de nefrologia na promoção de saúde bucal de crianças e adolescentes portadores de doença renal crônica / Educational dimension of the nephrology team in promoting oral health for chronic renal failure children and adolescents

Introdução: Objetivou-se avaliar a dimensão educativa das percepções e atitudes de médicos, enfermeiros e auxiliares de enfermagem na saúde bucal de crianças e adolescentes portadores de insuficiência renal crônica (IRC) em três hospitais do Rio de Janeiro. Métodos: Realizou-se uma entrevista com perguntas abertas e fechadas com 43 profissionais de saúde. os dados foram coletados e tabulados no programa SPSS 13.0. Empregou-se o teste Qui-quadrado, com nível de significância estatística p<0,05. Resultados: A média de idade foi 36,5 anos (+-11,3), com 80% do sexo feminino. A maioria dos médicos (71,4%, n=10) e enfermeiros (72,4%, n=21) acredita que esses pacientes podem ter alguma alteração bucal decorrente da doença, sendo perda de esmalte e descalcificação as mais citadas. Em relação à orientação sobre higiene bucal, pouco mais da metade da amostra respondeu que orienta seus pacientes no sentido de realizar escovação (72,7%, n=16), usar fio dental (9%, n=2), fazer bochecho (18,1%, n=4) e limpar a língua (9%, n=2). Apenas 9% (n=2) orientam a higiene após o uso de medicamentos. Quanto à necessidade de cuidados diferenciados para esses pacientes, 65,5% dos enfermeiros e auxiliares de enfermagem acreditam que estes devam ocorrer. Para a maioria dos médicos (57,1%, n=8), não há necessidade de tais cuidados. Apesar disso, 78,6% (n=11) dos médicos têm o hábito de encaminhar os pacientes a serviços odontológicos. Conclusões: Diante da metodologia empregada, concluiu-se que a maioria dos profissionais de saúde têm algum conhecimento sobre saúde bucal, porém suas atitudes não refletem esse fato.

Introduction: This study aimed to evaluate the educational dimension of perceptions and attitudes of doctors, nurses and nursing assistants in oral health of children and adolescents with chronic renal failure (CRF) in three hospitals in Rio de Janeiro. Methods: We conducted an interview with open questions and closed with 43 health professionals. data were collected and tabulated in SPSS 13.0. We applied the Chi-square test with significance level p <0.05. Results: The mean age was 36.5 years (+ -11.3), with 80% female. Most physicians (71.4%, n = 10) and nurses (72.4%, n = 21) believed that these patients may have some changes due to oral disease, and loss of enamel decalcification and the most cited. In relation to guidance on oral hygiene, just over half the sample responded that guides his patients to hold toothbrush (72.7%, n = 16), floss (9%, n = 2), make mouthwash ( 18.1%, n = 4) and clean the tongue (9%, n = 2). Only 9% (n = 2) underlying the hygiene after using drugs. The need special care for these patients, 65.5% of nurses and nursing assistants believe that they must occur. For most physicians (57.1%, n = 8), there is no need for such care. Nevertheless, 78.6% (n = 11) of doctors are accustomed to refer patients to dental services. Conclusions: Given the methodology, it was concluded that most health professionals have some knowledge about oral health, but their attitudes do not reflect this fact.

Estudo da prevalência de óbitos de pacientes com doença renal crônica associada à doença mineral óssea / Study of the prevalence of deaths of patients with chronic kidney disease associated with bone mineral disease

Introdução: Os disturbios na homeostase do cálcio, do fósforo e do paratormônio (PTH) ocorrem precocemente nos pacientes com doença renal crônica (DRC) e desempenham papel fundamental na fisiopatologia das doenças ósseas que acometem esses pacientes. As desordens do metabolismo mineral e ósseo são modificáveis e podem reduzir os fatores de risco associados a essas alterações que aumentam o risco de mortalidade em pacientes sob diálise. objetivo: identificar e quantificar casos de distúrbio mineral e ósseo (DMO) em pacientes com DRC que vieram a óbito no período de janeiro de 2004 a julho de 2008. Método: foram revisados 87 prontuários médicos dos pacientes que faziam hemodiálise e foram a óbito durante esse período. Foi realizado um registro retrospectivo de dados pessoais, laboratoriais, de morbidade e mortalidade. Resultados: a taxa de mortalidade anual média dos pacientes com DRC, atendidos no período estudado, foi de aproximadamente 16,7%. Do total de óbitos, a prevalecencia de DMO-DRC foi de 67,8%. A principal causa de óbito foi a doença cardiovascular (26,4%) e a doença de base, 52,9%, foi a nefropatia diabética. Dos pacientes que foram a óbito, 45% se apresentaram com os valores de fósforo acima de 5,5mg/dL, 38% com valores de PTH acima de 300pg/mL, 40% com valores de albumina inferior a 3,5g/L e 40,2% com valores de fosfatase alcalina acima de 126 U/L. Conclusão: Os marcadores bioquímicos são úteis para avaliar não apenas o risco de mortalidade na população com DRC, mas também o uso adequado do tipo de tratamento para esse grupo distinto de pacientes.

Introduction: The disturbances in the homeostasis of calcium, phosphorus and parathyroid hormone (PTH) occur early in patients with chronic kidney disease (CKD) and play a key role in the pathophysiology of bone diseases that affect these patients. Disorders of bone and mineral metabolism are modifiable and can reduce the risk factors associated with these changes that increase the risk of mortality in patients on dialysis. goal: to identify and quantify cases of mineral and bone disorder (BMD) in patients with CKD who died during the period from January 2004 to July 2008. METHODS: We reviewed medical records of 87 patients who were hemodialysis and died during that period. We conducted a retrospective record of personal data, laboratory, morbidity and mortality. Results: The average annual mortality rate of patients with CKD treated during the study period was approximately 16.7%. Of the total deaths, to prevailence of CKD-MBD was 67.8%. The main cause of death was cardiovascular disease (26.4%) and underlying disease, 52.9% were diabetic nephropathy. Of the patients who died, 45% presented with P values ​​above 5.5 mg / dL, 38% of patients with PTH above 300pg/mL, 40% with albumin values ​​below 3.5 g / L and 40.2% with alkaline phosphatase values ​​above 126 U / L. Conclusion: Biochemical markers are useful to evaluate not only the risk of mortality in people with CKD, but also the use of appropriate treatment for this distinct group of patients.

Variations in the anatomical position of the normal and diseased parathyroid glands

Despite the availability of expert surgeons and preoperative imaging investigations, some patients require re-operation for persistent or recurrent hyperparathyroidism. Ectopic Parathyroid Glands [PGs] are a cause for failed parathyroid exploration. To evaluate the prevalence and location of normal parathyroid glands and diseased glands taken from subjects with End-Stage Renal Disease [ESRD]. A total of 410 parathyroid glands were recovered from 116 postmortem subjects of whom 37 were diagnosed as suffering from ESRD. In the rest, the death had resulted from disease unrelated to parathyroid disorder. 155 [69.3%] of both normal left and right superior PGs were located at cricothyroid junction; 46 [29.3%] were behind the upper pole of thyroid gland; 2 [2.6%] were behind pharyngoesophageal junction. 68 [47.1%] of the normal inferior PGs were found at the lateroposterior surface of the lower pole of thyroid gland; 62 [43.7%] were within the thymic tongue and 14 [9.7%] along the carotid artery. The normal ectopic PGs were found only in 22 cases. The superior PGs were 4 [18.2%] in an extracapsular posterior position, 2 [9.1%] intrathyroidal and 1 [4.5%] retropharyngeal. The inferior ectopic PGs were 15 [68.2%] and were found within the mediastinal thymus. 19 [51.4%] of the enlarged PGs were found within the thyroid parenchyma, 8 [21.6%] within the thymic tongue, 6 [16.2%] within the thymus, 2 [5.4%] were within the carotid sheath and 1 [2.7%] in the retropharyngeal or retroesophageal position. The presence of ectopic PGs in secondary hyperparathyroidism is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location

Paratiroidectomía total guiada por fluorescencia en el tratamiento del hiperparatiroidismo secundario: primeros casos en América / Parathyroidectomy guided by fluorescence in the treatment of hyperparathyroidism secondary

La fluorescencia con ácido 5-aminolevulínico (ALA) ha sido utilizada como un procedimiento novedoso para identificar a las glándulas paratiroides. En este trabajo se aplicó esta técnica para estudiar sus detalles. Se realizó un estudio experimental no aleatorizado, controlado, descriptivo, a tres pacientes con hiperparatiroidismo secundario por insuficiencia renal crónica. Se administró ALA vía oral exponiendo el comportamiento visceral cervical a la luz blanca y azul (380-440 nm); realizándose luego paratiroidectomía total con timectomía subtotal transcervical. Se intervinieron 3 pacientes, edad media 29.6 años (28-32), con hiperparatiroidismo secundario. Tiempo medio de insuficiencia renal 12 años (10-15), tiempo medio en diálisis 5.6 años (4-8). Hubo fluorescencia selectiva de 4 estructuras que correspondieron a las 4 glándulas paratiroides en los casos 1 y 3, representando una identificación del 100 por ciento, y de 3 estructuras en el caso 2 (identificación 75 por ciento). Los pacientes evolucionaron satisfactoriamente. Efectos adversos: emesis y reacción foto-cutánea, todos autolimitados. La detección de glándulas paratiroides con fluorescencia con ALA pareciera ser efectiva. Hacen falta estudios que evalúen la efectividad, costo-beneficio y otros usos del procedimiento.

Avaliação nutricional de pacientes renais em programa dehemodiálise em um hospital universitário de São Luís do Maranhão / Nutritional assessment of renal patients on hemodialysis ata university hospital in São Luís, Maranhão

Introdução: A desnutrição protéico-calórica é um achado comum entre os pacientes com doença renal crônica em hemodiálise e está associada aoaumento da morbidade e mortalidade. Objetivo: Avaliar o estado nutricional de pacientes em hemodiálise em um hospital universitário. Casuística eMétodos: Estudo transversal de natureza descritiva. Foram avaliados 64 pacientes portadores de doença renal crônica em tratamento hemodialítico.Parâmetros antropométricos e bioquímicos foram utilizados na avaliação do estado nutricional. Resultados: Dos 64 pacientes avaliados, 51,6% eram dosexo masculino e a média de idade foi de 46,2 ± 15,9 anos. Os resultados evidenciaram eutrofia em 68,3% dos pacientes considerando o índice de massacorporal (IMC) como parâmetro e 69,0% considerando o percentual de gordura corporal (%GC). Entretanto, as medidas do braço, tais como, circunferênciado braço (CB), circunferência muscular do braço (CMB) e prega cutânea tricipital (PCT) revelaram prevalência de desnutrição em mais de 60,0% dospacientes. Quanto aos dados bioquímicos, 69,8% dos pacientes apresentaram albumina sérica ≥ 4,0 g/dl, entretanto os níveis séricos de colesterol totalencontrados foram <140 mg/dl em 54,0% dos pacientes estudados. Conclusão: Os pacientes avaliados se mostraram, em sua maioria, eutróficosconsiderando os parâmetros IMC, %GC e albumina. Entretanto, revelaram-se desnutridos quando avaliados pelas medidas do braço, apresentando perdade massa muscular e de tecido adiposo.

Introduction: Protein-caloric malnutrition is a common finding among patients with chronic kidney disease in hemodialysis and is linked to an increase inmorbidity and mortality. Objective: Evaluation of the nutritional state of patients on hemodialysis in a university hospital. Casuistic and Method: Weperformed a cross sectional, descriptive study evaluating 64 patients with chronic kidney disease on hemodialysis. Anthropometric and biochemicalparameters were used in the evaluation of nutritional state. Results: Of the 64 patients evaluated, 51.6% were males and the average age was 46.2 ± 15.9years. The results showed eutrophy in 68.3% of the patients using the body mass index (BMI) as a parameter and 69.0% considering the percentage ofbody fat (%BF). However, arm measurements, such as, the circumference of the arm (AC), midarm muscle circumference (MAMC) and tricipital skin folds(TSF) revealed a prevalence of malnutrition in more than 60.0% of patients. As for the biochemical data, 69.8% of patients presented serum albumin ≥ 4,0g/dl, while the serum levels of total cholesterol found were <140 mg/dl in 54.0%. Conclusion: The majority of the patients evaluated showed eutrophy whenconsidering BMI parameters, %BF, and albumin. However, they appeared malnourished when considering arm measurements due to the loss of musclemass and fatty tissue.

Terapia renal substitutiva em pacientes do interior da Bahia: avaliação da distância entre o município de moradia e a unidade de hemodiálise mais próxima / Renal replacement therapy in the state of Bahia: evaluation of the distance between the patient’s hometown and the nearest hemodialysis unit

Introdução: Este estudo avalia a distância entre o município de moradia de pacientes em terapia renal substitutiva (TRS) na Bahia e a unidade de hemodiálise (HD) mais próxima, estimando o tempo de viagem gasto para manutenção de três sessões semanais de HD. Metodologia: Foram incluídos todos os pacientes provenientes do interior da Bahia que iniciaram HD no Hospital Geral Roberto Santos entre março/2004 e janeiro/2006 e permaneceram em HD de manutenção após alta hospitalar. O cálculo da distância entre os municípios foi realizado através do “Sistema ABCR de Coordenadas Geodésicas e Percursos entre os Municípios Brasileiros” (www.abcr.org.br). O tempo de viagem foi baseado numa velocidade média de 50km/h. Resultados: Foram avaliados 45 pacientes. A idade média foi 44,7±15,6 anos, sendo 55,6% do sexo feminino. A distância média entre o município de residência e o município da unidade de HD mais próxima foi 101,4±76,3km e a estimativa de tempo gasto para percorrer a distância de ida e volta entre os municípios foi de aproximadamente 4 horas. Considerando as unidades de HD para as quais os pacientes foram efetivamente referidos, a distância média entre os municípios foi 175,9±171,2km, com estimativa de tempo gasto para percorrer a distância de ida e volta de aproximadamente 7 horas. Discussão e Conclusão: A grande maioria dos pacientes estudados necessitou sair de seus municípios de residência e percorrer longas distâncias para ter acesso à HD, o que demanda gasto excessivo de tempo e implicações socioeconômicas. Estes resultados demonstram a importância da descentralização da TRS na Bahia.

Introduction: This study aims to evaluate the distance between the patient’s hometown and the nearest hemodialysis (HD) unity in Bahia, and estimate the amount of time spent on commuting three times per week. Methods: We included all patients from the inland of Bahia who initiated HD at Hospital Geral Roberto Santos between March, 2004 and January, 2006 and were discharged on maintenance HD. The distance between towns was calculated using the "ABCR System of Geodesic Coordinates and Routes Between Brazilian Cities" (www.abcr.org.br). Commute time was estimated based on a mean speedof 50 km/h. Results: We evaluated 45 patients. Mean age was 44.7±15.6 years; 55.5% were female. The mean distance between the patients’ hometown and the nearest HD unit was 101.4±76.3 Km. The estimated amount of time spent on commute was 4 hours. When we considered the HD units that patients were actually referred to after discharge, the mean distance between towns was 175.9±171.2 Km, and commute time increased to approximately 7 hours. Discussion and Conclusion: The vast majority of patients studied needed to leave their hometown and travel long distances to undergo HD, which resulted in excessive waste of time. These results demonstrate the need for public policies that stimulate the decentralization of renal replacement therapy in Bahia.

Biochemical-molecular markers in unilateral ureteral obstruction

Congenital obstructive nephropathy is the primary cause of end-stage renal disease in children. Rapid diagnosis and initiation of the treatment are vital to preserve function and/or to slow down renal injury. Obstructive uropathy effects -decline in the plasmatic renal flow and glomerular filtration rate, interstitial infiltrate of leukocytes, significant decrease of the urine concentration, loss of the capacity to concentrate urine as well as fibrosis and apoptosis- are a consequence of a variety of factors that work in complex ways and are still not fully understood. Mediators as angiotensin II, transforming growth factor-beta(TGF-beta) and nitric oxide (NO) have been implicated in congenital obstructive nephropathy. The renin-angiotensin system is regulated in different ways, affecting both renal structure and function, and that it in turn depends upon the duration of the obstruction. On the other hand, the role of nitric oxide in renal injury remains somewhat controversial due to the fact that it can exert opposite effects such as cytoprotective and prooxidant / proapoptotic efects as well as proinflammatory and anti-inflammatory effects. In addition, reactive oxidative species (ROS) might contribute to the progression of renal disease. During unilateral ureteral obstruction induced uncoordinated and aberrant growth may lead to the loss of cellular phenotype and apoptosis. Promoting inflammatory responses, the oxidizers can regulate the adherence of certain molecules and proinflammatory mediators, transcription factors and fibrogenic cytokines, that are clearly involved in the progression of renal disease. The congenital obstructive nephropathy is characterized by tubular atrophy, cellular proliferation, apoptosis and fibrosis; immature kidney is more susceptible than adult kidney to showing the above mentioned alterations.

Morbidade e mortalidade em hemodiálise: importância do seguimento pré-dialítico e da fonte de financiamento / Dialysis mortality: the role of referral time and financial source

Introdução: O referenciamento tardio (RT) para o acompanhamento nefrológico em pacientes com insuficiência renal crônica (IRC) está associado com um aumento da mortalidade. Em nosso meio, há dados escassos sobre o assunto, em especial com respeito à sua relação com a fonte de financiamento do acompanhamento especializado. Método: Análise retrospectiva de dados de pacientes em uma unidade satélite de hemodiálise. Considerou-se RT um período inferior a 120 dias entre o atendimento nefrológico e o início da hemodiálise (HD). Resultados: O RT aconteceu em 36,6% da amostra, foi associado com início de hemodiálise em caráter emergencial, com acesso por cateter venoso central e maior mortalidade (46,7% vs. 19,2%, p < 0,05,comparando ao grupo de eferenciamento precoce). A fonte de financiamento para 1/3 da amostra foi o Sistema Único de Saúde (SUS). Desse grupo, 66,7% foram referenciados tardiamente, apresentaram mortalidade de 21,4% nos primeiros três meses de tratamento, e 71% iniciaram a HD em regime de internação hospitalar. Discussão e Conclusões: Pacientes com insuficiência renal crônica referenciados tardiamente ao tratamento nefrológicoapresentam maior mortalidade, início do tratamento em caráter emergencial por acesso vascular temporário. Houve associação entre referenciamentotardio e o financiamento pelo SUS. Novos estudos são necessários para verificar a disponibilidade de atendimento especializado pelo SUS para a consolidação de uma política pública de atendimento ao renal crônico.

Introduction: Late referral (LR) of chronic renal failure patients to the nephrologist is related to increased mortality. There is little data in our country, particularly related to LR and the financial source of medical treatment. Methods: This was a retrospective analysis of patients’ reports in a non-hospitalhemodialysis unit. LR was defined when there was a period of less than 120 days between referral and initiation of hemodialysis. Results: LR occurred in36.6% of the patients and was related to the need of emergency hemodialysis (HD), use of central venous access, and increased mortality (46.7% vs. 19.2%,p < 0.05, in comparison to the early referral group). The funding for 33.3% of the patients was provided by the public health system (SUS). In this group of patients, 66.7% presented LR and increased mortality in the first 3 months of HD (21.4%). Moreover, 71% initiated HD in a hospital setting. Discussion and Conclusions: Chronic renal failure patients with LR presented increased mortality, need for emergency HD and temporary vascular access. There was an association between LR and public funding. Further studies are necessary to evaluate the availability of nephrology assistance by the public health system, in order to promote better care for the chronic renal failure patient.