Impact of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure / 中华肝脏病杂志

Objective: To investigate the effects of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure. Methods: The patients with renal insufficiency [baseline estimated glomerular filtration rate < 60 ml·min-1·(1.73 m2)-1] and heart failure followed-up for more than 2 years and hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to June 30, 2019 were enrolled in this retrospective cohort study. The patients were divided into three groups based on the baseline left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF < 40%) group, heart failure with mildly reduced ejection fraction (HFmrEF, 40% ≤ LVEF < 50%) group, and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) group. Clinical data were collected and endpoint events (adverse renal outcome: the composite outcome of all-cause death or worsening renal function) were recorded through the electronic medical record system. Kaplan-Meier survival curve was used to analyze the incidence of endpoint events of different heart failure subgroups. Cox regression model was performed to analyze the risk factors of endpoint events. Results: A total of 228 patients with renal insufficiency complicated with heart failure were included, with age of (68.14±14.21) years old and 138 males (60.5%). There were 85 patients (37.3%) in the HFrEF group, 40 patients (17.5%) in the HFmrEF group, and 103 patients (45.2%) in the HFpEF group. There were statistically significant differences in age, proportion of age > 65 years old, sex distribution, systolic blood pressure, pulmonary artery pressure, serum sodium, serum calcium, hemoglobin, serum cholesterol, low-density lipoprotein cholesterol, serum uric acid, troponin I, hypersensitive C-reactive protein, LVEF, ventricular septal thickness, left ventricular end-diastolic diameter, B-type natriuretic peptide, estimated glomerular filtration rate, and proportions of using beta blockers, using spirolactone, myocardial infarction, hypertension, cardiomyopathy and atrial fibrillation (all P < 0.05). During the median follow-up of 36.0 (28.0, 46.0) months, 73 patients (32.0%) had adverse renal outcomes. The total incidences of adverse renal outcomes were 32.9% (28/85) in the HFrEF group, 35.0% (14/40) in the HFmrEF group, and 30.1% (31/103) in the HFpEF group. Kaplan-Meier survival curve showed that there was no significant difference in the incidence of endpoint events among the three groups (log-rank test χ2=0.17, P=0.680). Multivariate Cox regression analysis showed that HFpEF (HFrEF as reference, HR=2.430, 95% CI 1.055-5.596, P=0.037) was an independent influencing factor of endpoint events. Conclusions: The long-term renal prognosis of patients with renal insufficiency and heart failure is poor. Compared with HFrEF, HFpEF is an independent risk factor of poor long-term renal prognosis in renal insufficiency patients with heart failure.

Análisis geográfico de nefropatía diabética e insuficiencia renal en el primer nivel de atención, IMSS 2019 / Geographic analysis of diabetic nephropathy and renal insufficiency in the primary care, IMSS 2019

Introducción: en un contexto donde la prevalencia de diabetes mellitus e hipertensión arterial ha aumentado significativamente en años recientes, las enfermedades renales adquieren importancia por la potencial demanda de atención especializada y de recursos en salud que requieren. Objetivo: analizar la distribución geográfica de la nefropatía diabética (ND) y la insuficiencia renal (IR) con base en las consultas otorgadas en unidades de primer nivel del Instituto Mexicano del Seguro Social (IMSS) durante 2019, para identificar las unidades médicas con mayor carga de atención. Material y métodos: estudio ecológico-exploratorio en el que se estimaron indicadores por cada mil derechohabientes en relación a las consultas otorgadas por ND e IR según la ocasión de servicio, la unidad médica familiar (UMF) de primer nivel y la representación. Se utilizó estadística espacial para analizar dichos indicadores. Resultados: el 45% de las consultas otorgadas fue por ND y el 52.4% por IR. La mayor carga por ND se registró en la UMF No. 50 de Cd. Juárez (Chihuahua) y en la No. 49 Gabino Barreda (Veracruz Sur), con 1.7 consultas de primera vez y 148.3 subsecuentes por mil derechohabientes, respectivamente. Mientras que en la UMF No. 40 Manlio Fabio Altamirano y No. 25 Cotaxtla, en Veracruz Norte, la mayor carga fue por IR, con 4.9 consultas de primera vez y 134.2 subsecuentes por mil derechohabientes, respectivamente. Conclusiones: los resultados podrían contribuir al fortalecimiento de las unidades médicas que así lo requieran y en la distribución eficiente de los recursos disponibles para atender la demanda de servicios de salud de ND e IR en el IMSS

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required. Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care. Material and methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level. Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively. Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS.

Prevalence of latent tuberculosis and associated factors in patients with chronic kidney disease on hemodialysis / Prevalência de tuberculose latente e fatores associados em pacientes com doença renal crônica em hemodiálise / Prevalencia de tuberculosis latente y factores asociados en pacientes con enfermedad renal crónica en hemodiálisis

Objective: to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors. Method: a cross-sectional study conducted with 176 patients with chronic kidney disease on hemodialysis. The tuberculin test was performed with the standardized antigen, distributed by the Brazilian Ministry of Health, and the reading occurred after 72 to 96 hours of the application. An association test (Chi-square, Fisher's exact), prevalence ratio, and multivariate regression tests were performed. Results: the prevalence of latent tuberculosis diagnosed through Tuberculosis Skin Test was 8.5% (15/176). The "has/has had diabetes" (aOR: 0.117; 95%CI: 0.015-0.92) and "having regular garbage collection (aOR: 0.076; 95%CI: 0.008-0.702) factors were associated with a lower probability of having a Positive skin test. Conclusion: the low prevalence of latent tuberculosis identified and the factors associated with it reinforce the need for screening for latent tuberculosis infection for diabetics combined with an analysis of previous risk factors and comorbidities.

Objetivo: identificar a prevalência de tuberculose latente em pacientes com doença renal crônica em hemodiálise e fatores associados. Método: estudo transversal realizado com 176 pacientes com doença renal crônica em hemodiálise. O teste tuberculínico foi realizado com o antígeno padronizado, distribuído pelo Ministério da Saúde do Brasil, e a leitura ocorreu após 72 a 96 horas da aplicação. Foram realizados teste de associação (Qui-quadrado, exato de Fisher), razão de prevalência e regressão multivariada. Resultados: a prevalência de tuberculose latente (teste tuberculínico positivo) foi de 8,5% (15/176). Os fatores "tem/teve diabetes" (ORa:0,117; IC95% 0,015-0,92) e "ter coleta de lixo regular" (ORa:0,076; IC95% 0,008-0,702) foram associados a menores probabilidades de ter teste tuberculínico positivo. Conclusão: a baixa prevalência de tuberculose latente identificada e os fatores associados à mesma reforçam a necessidade de uma triagem da infecção latente por tuberculose para diabéticos combinada com a análise de fatores de risco e comorbidades prévias.

Objetivo: identificar la prevalencia de tuberculosis latente en pacientes con enfermedad renal crónica en hemodiálisis y factores asociados. Método: estudio transversal realizado con 176 pacientes con enfermedad renal crónica en hemodiálisis. La prueba cutánea de la tuberculina se realizó con el antígeno estandarizado, distribuido por el Ministerio de Salud de Brasil, y la lectura se realizó después de 72 a 96 horas de la aplicación. Se realizaron pruebas de asociación (Chi-cuadrado, exacta de Fisher), razón de prevalencia y regresión multivariante. Resultados: la prevalencia de tuberculosis latente (prueba de tuberculina positiva) fue de 8,5% (15/176). Los factores "tiene/ha tenido diabetes" (ORa: 0,117; IC del 95%: 0,015-0,92) y "tener recolección regular de residuos" (ORa: 0,076; IC del 95%: 0,008-0,702) se asociaron con menores probabilidades de tener una prueba de tuberculina positiva. Conclusión: la baja prevalencia de tuberculosis latente registrada y sus factores asociados refuerzan la necesidad del cribado de la infección tuberculosa latente en diabéticos combinado con el análisis de factores de riesgo y comorbilidades previas.

Insuficiencia renal oculta y factores asociados en pacientes con enfermedades crónicas / Occult renal failure and associated factors in patients with chronic conditions

Resumen Introducción: El diagnóstico oportuno y la intervención terapéutica temprana disminuyen la mortalidad prematura asociada con insuficiencia renal crónica. Objetivo: Identificar la prevalencia y factores asociados con insuficiencia renal oculta en pacientes con enfermedades crónicas. Método: Estudio transversal de 1268 pacientes con diabetes mellitus tipo 2 e hipertensión arterial sistémica. Se usó un instrumento de medición con preguntas sobre factores asociados como artrosis, tratamiento de padecimiento crónico, tabaquismo, ingesta de analgésicos, alcoholismo, índice de masa corporal, actividad física y niveles séricos de glucosa, colesterol y triglicéridos. Resultados: La prevalencia de insuficiencia renal oculta fue de 13.2 % (167/1268), 13.4 % en pacientes diabéticos (117/876) y 14.9 % en hipertensos (150/1010). En el analisis multivariado, los factores asociados con insuficiencia renal oculta fueron edad > 60 años (RMa = 1.96, IC 95 % = 1.22-2.49), sexo femenino (RMa = 2.17, IC 95 % = 1.30-2.82), padecer hipertensión arterial sistémica (RMa = 1.96, IC 95 % = 1.22-2.50) y no tener sobrepeso u obesidad (RMa = 0.49, IC 95 % = 0.41-0.8). Conclusiones: La prevalencia de insuficiencia renal oculta fue de 13 %. Los pacientes mayores de 60 años, con sobrepeso u obesidad e hipertensión arterial sistémica deben ser examinados detalladamente por el médico familiar para la detección temprana de insuficiencia renal oculta.

Abstract Introduction: Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. Objective: To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. Method: Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. Results: The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). Conclusions: The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.

Protocolos de Vigilancia Centinela de enfermedad renal crónica y manual de registro guatemalteco de diálisis y trasplante renal. No. 12 / Sentinel Surveillance Protocols of chronic kidney disease and manual of Guatemalan dialysis and renal transplantation. No. 12

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. Por otra parte, en el documento se afirma que "en el marco de la "Reunión de Alto Nivel sobre Enfermedad Renal Crónica de Causas no Tradicionales en Centroamérica" (ERCnT), celebrada en abril del 2013, los Estados Miembros de Centroamérica y la República Dominicana, que forman parte del Sistema de la Integración Centroamericana (SICA) y la Comisión de Ministros de Salud de Centroamérica y República Dominicana (COMISCA) a través de la "Declaración de San Salvador" reconocen que la enfermedad renal crónica es un problema de salud pública importante en Centroamérica y requiere de una acción urgente."

Características clínicas de los pacientes con diagnóstico de pie diabético internados y que acuden a la consulta en el Hospital Regional de Coronel Oviedo, 2017 / Clinical characteristics of patients diagnosed with hospitalized diabetic foot and who attend the consultation at the Regional Hospital of Coronel Oviedo, 2017

Introducción: La Organización Mundial de la Salud define al pie diabético como la infección, ulceración y destrucción de tejidos profundos de la extremidad inferior, asociadas con alteraciones neurológicas y diversos grados de enfermedad vascular periférica. Es una complicación crónica de la diabetes mellitus, la cual puede producir discapacidad al paciente. Objetivos: Describir las características clínicas de los pacientes con diagnóstico de pie diabético internados y que acuden a la consulta en el Hospital Regional de Coronel Oviedo, 2017. Materiales y métodos: Estudio observacional descriptivo, retrospectivo con enfoque cuantitativo, la población estuvo compuesta por 310 pacientes con diagnóstico de pie diabético internados y que acudieron al consultorio en el Hospital Regional de Coronel Oviedo durante el 2017.( Para obtener los datos, se revisaron las historias clínicas de los pacientes). Resultados: El promedio de edad de los participantes fue de 49±12,8 años, el 57% del sexo masculino y 57% procedentes del área rural, el 73% estuvo internado de 1 a 5 días, el 43% padece de diabetes mellitus tipo 2 únicamente, 26% presentaron diabetes con hipertensión e insuficiencia cardíaca, el 73% recibió tratamiento farmacológico y el 23% de los pacientes presentaron úlceras superficiales correspondientes a Wagner grado 1. Conclusión: En relación a los pacientes con diagnóstico de Pie Diabético se presentó la Hipertensión Arterial junto con la Diabetes Mellitus tipo 2 como comorbilidad predominante, el tratamiento más utilizado fue el farmacológico y los tipos de lesión 0y 1 los más resaltantes para la escala de Wagner.

Sobrecarga hídrica y falla renal en niños con sepsis grave y shock séptico: un estudio de cohortes / Fluid overload and kidney failure in children with severe sepsis and septic shock: A cohort study

Introducción. En niños con sepsis, la sobrecarga hidrica como resultado de una terapia de resucitación agresiva o por la administración excesiva de fluidos puede afectar la función renal y aumentar la mortalidad. Objetivo. Determinar la asociación entre la sobrecarga hidrica y la tasa de falla renal en un grupo de niños con sepsis grave y shock séptico. Población y métodos. Estudio de cohortes prospectivo realizado en la Unidad de Cuidados Intensivos del Hospital Universitario de Pediatría "Dr. Agustín Zubillaga" (Barquisimeto, Estado Lara, Venezuela), entre marzo de 2013 y mayo de 2016, en niños con sepsis grave o shock séptico. Resultados. Un total de 149 niños fueron incluidos en el análisis. La sepsis predominó en el 59,7% de los casos; el promedio de edad fue 6,4 ± 3,3 años; el peso promedio fue 17,8 ± 3,6 kg; en el 30,2%, hubo sobrecarga hidrica y la mortalidad general fue 25,5%. Hubo falla renal en el 16,1% de los casos. Mediante un modelo de regresión logística binaria, se identificaron como predictores independientes de falla renal sobrecarga hidrica (OR 1,5; IC 95%: 1,2-4,9; p= 0,028) y shock mayor de dos días (OR 1,7; IC 95%: 1,3-6,3; p= 0,039). Además, se observó un incremento significativo del riesgo de mortalidad en los niños con falla renal y sobrecarga hidrica, según el método de Kaplan-Meier (p= 0,019). Conclusión. La sobrecarga hidrica y una duración del shock mayor de dos dias incrementan el riesgo de falla renal en niños criticamente enfermos con sepsis grave y shock séptico.

Introduction. In children with sepsis, fluid overload as a result of an aggressive fluid replacement or excessive fluid administration may result in kidney impairment and increased mortality.Objective. To determine the association between fluid overload and the rate of kidney failure in a group of children with severe sepsis and septicshock. Population and methods. This was a prospective cohort study conducted in the intensive care unit of Hospital Universitario de Pediatría Dr. Agustín Zubillaga (Barquisimeto, Lara State, Venezuela), between March 2013 and May 2016, in children with severe sepsis or septic shock.Results. One hundred and forty-nine patients were included in the analysis. Sepsis predominated in 59.7% of cases; patients' average age was 6.4 ± 3.3 years old, their average weight was 17.8 ± 3.6 kg, 30.2% had fluid overload, and overall mortality was 25.5%. Kidney failure occurred in 16.1% of cases. A binary logistic regression model was used to identify fluid overload (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-4.9, p = 0.028) and shock for more than 2 days (OR: 1.7; 95% CI: 1.3-6.3, p = 0.039) as independent predictors of kidney failure. In addition, a significant increase in the risk of mortality among children with kidney failure and fluid overload was observed as per the Kaplan-Meier method (p= 0.019). Conclusion. Fluid overload and shock for more than 2 days increase the risk for kidney failure in critically ill children with severe sepsis and septic shock.

Complicaciones digestivas y renales por indometacina e ibuprofeno en prematuros extremos con ductus arterioso permeable / Digestive and Kidney Complications by indomethacin and ibuprofen in extreme preterm infants with patent ductus arteriosus

El ductus arterioso permeable sintomático (DAPs) es frecuente en prematuros extremos (PE), siendo importante su cierre para disminuir la repercusión hemodinámica. Para ello se usa indometacina o ibuprofeno con los riesgos subyacentes. OBJETIVO: Caracterizar las complicaciones digestivas y renales en PE tratados por DAPs. PACIENTES Y MÉTODO: Estudio retrospectivo en PE nacidos entre enero de 2004 y diciembre de 2013. Según diagnóstico se distribuyeron en 3 grupos: sin DAPs, con DAPs tratados con indometacina y con ibuprofeno. Se excluyeron PE con otras complicaciones graves. Se evaluaron complicaciones digestivas y renales graves. Se usó significación estadistica con p ≤ 0,05. RESULTADOS: Se enrolaron 599 PE; 33,1% recibió tratamiento por DAPs, 66,9% no lo requirió. Hubo asociación estadística entre DAPs y menor edad gestacional, depresión neonatal y distrés respiratorio. Del grupo no tratado, el 5% presentó enterocolitis y el 0,25% falla renal; entre los tratados el 2,5% presentó enterocolitis y el 1,0% falla renal. No hubo diferencias estadísticas significativas considerando ambas complicaciones (p = 0,17), sólo enterocolitis (p = 0,11) o sólo falla renal (p = 0,33) entre tratados y no tratados; tampoco las hubo al comparar complicaciones entre tratados con indometacina o ibuprofeno. CONCLUSIONES: Los resultados en nuestra población demuestran que el tratamiento médico del DAPs, en ausencia de otras complicaciones clínicas, no representa un mayor riesgo de complicaciones graves digestivas o renales. No se demostraron ventajas entre la indometacina e ibuprofeno.

The symptomatic patent ductus arteriosus (sPDA) is common in extremely premature infants (EPI). In order to decrease the hemodynamic repercussion and avoid complications it is necessary to close it. Indomethacin or ibuprofen are used for this purpose with its associated risks. OBJECTIVE: Characterize digestive and renal complications in EPI who received indomethacin or ibuprofen as sPDA treatment. PATIENTS AND METHOD: Retrospective study on EPI between January-2004 and December-2013. Three groups were compared: treated with indomethacin or ibuprofen and a non-treated group. EPI with other serious complications were excluded. The primary outcomes on each group were digestive and/or renal complications. Statistical significance was p < 0.05. RESULTS: 599 EPI were included, 33.1% with PDA received treatment and 66.9% did not need it. A statistical association was found between sPDA and lower gestational ages, neonatal depression and respiratory distress. In the non-treated group, 5% presented enterocolitis and 0.25% renal failure; on the treated group, 2.5% presented enterocolitis and 1.0% renal failure. No significant differences were found between the treated and non-treated groups in relation to complications considering enterocolitis (p = 0.11) or renal failure (p = 0.33) alone, or combined (p = 0.17). No difference were detected either between those treated with indomethacin or ibuprofen. CONCLUSIONS: The results show that in absence of other clinical complication, medical treatment of sPDA with indomethacin or ibuprofen, do not increase the risk of serious digestive or renal disorders. There were no advantages of using indomethacin or ibuprofen over the other.

Epidemiologia da injúria renal aguda: estudo prospectivo, multicêntrico e populacional no estado do Acre / Epidemiology of acute kidney injury prospective, multicenter and population based study in Acre

A epidemiologia da injúria renal aguda (IRA) nos países desenvolvidos e em desenvolvimento ainda não foi sistematicamente examinada. Estudos epidemiológicos da incidência de IRA nos países em desenvolvimento são escassos e mais raros são estudos populacionais prospectivos na Amazônia brasileira. No capítulo I descreveu-se uma revisão sistemática de estudos sobre a epidemiologia da IRA em pacientes internados em unidades de terapia intensiva (UTI) publicados (2005-2015) nas bases de dados PUBMED, CENTRAL, LILACS e IBECs. Foram examinadas as diferenças na incidência de IRA, a severidade e a mortalidade; seguindo a divisão dos países de acordo com os critérios da Organização das Nações Unidas. Identificaram-se 92 estudos: 59 de países desenvolvidos, 32 de países em desenvolvimento e um estudo com dados de ambos os grupos de países. Dos estudos avaliados, 78 por cento usaram critérios padrão para definição da IRA (RIFLE, AKIN ou KDIGO). Entretanto, encontramos 11 diferentes definições para oligúria e 23 diferentes definições para a creatinina basal. Ambos os grupos relataram ocorrência de IRA na UTI de até 40 por cento . No entanto, a necessidade de diálise, tempo de permanência na UTI e as taxas de mortalidade foram maiores nos países em desenvolvimento, o que pode refletir diferenças nas condições sociais e na infraestrutura hospitalar nesses países. No capítulo II foi realizado um estudo prospectivo em todas as UTIs da cidade de Rio Branco, que atendem a cerca de 75 por cento da população do estado do Acre. Os dados foram coletados durante 18 meses nos anos 2014 e 2016. Pacientes com menos de 18 anos, doença renal crônica dialítica, transplante renal ou internação na UTI < 48 horas foram excluídos. A IRA foi diagnosticada pelo KDIGO e a mortalidade foi avaliada durante a internação na UTI, 30 e 180 dias após a alta da UTI. Dos 1494 pacientes admitidos, 1073 preencheram os critérios de inclusão A incidência de IRA foi de 52,8 por cento , e a prevalência foi de 67,3. A diálise foi oferecida a 8,2 por cento dos pacientes que fizeram IRA na UTI. Apenas 2,2 por cento das internações foram devidas às doenças tropicais. Os fatores de risco para IRA foram: balanço hídrico positivo maior que 1500 ml / 24h (OR 2,98, p <0,001), pacientes não cirúrgicos (OR 1,69; p = 0,001), aumento de idade (OR 1,16 para aumento de 10 anos; p <0,001) e aumento do escore APACHE II (OR 1,06 para aumento de uma unidade; p <0,001). Em comparação com pacientes que não tiveram IRA, o tempo de permanência na UTI (7 vs 5 dias, p <0,001), assim como as mortalidades na UTI e no hospital (43,4 por cento vs 14 por cento , p <0,001 e 52 por cento vs 18,5 por cento , p <0,001, respectivamente) foram maiores nos pacientes que fizeram IRA na UTI. Foram fatores de risco para mortalidade nos pacientes com IRA na UTI: aumento da idade, sepse, KDIGO estágio 3, uso de ventilação mecânica, de drogas vasoativas e choque. A mortalidade precoce e tardia (até 30 ou 180 dias após a alta na UTI, respectivamente) se associou à presença de IRA. Portanto a IRA é comum em pacientes de UTI nessa região, com poucas internações por doenças tropicais e similares etiologias e fatores de risco com os países desenvolvidos; contudo, com taxas de mortalidade mais altas, o que pode representar as condições econômicas e a dificuldade no acesso aos sistemas de saúde

The epidemiology of Acute Kidney Injury (AKI) in the developed and developing world has not been systematically examined. Epidemiological studies of AKI incidence in developing countries are still scantier and scarcer are prospective population-based studies in Brazilian Amazon, a peculiar region, epidemiologically different from the others. On chapter I we describe a systematic review of published studies (20052015) identified in PUBMED, CENTRAL, LILACS, and IBECs databases using the search terms defining acute kidney injury (AKI) and intensive care unit (ICU). We examined the differences in ICUAKI incidence, severity, associated mortality and describe geographic variations based on the gross national income. We identified 92 studies: 59 from developed countries and 32 from developing countries. One study had data from both group of countries. Of these, 78 per cent used standard criteria (RIFLE, AKIN, KDIGO); however, we found 11 different definitions for oliguria and 23 different definitions for baseline creatinine. Both groups related ICUAKI incidence up to 40 per cent . However, the need for RRT, ICU length of stay and mortality rates were higher in developing countries. Despite the attempt to standardize the criteria for defining AKI, there is still no uniformity in the settings for baseline creatinine, oliguria and timeframe for AKI assessment. Differences in ICU length of stay need for RRT and mortality rates may reflect differences in the entry criteria and the social conditions, access to health care and hospital infrastructure. On chapter II, we did a prospective study on all adult patients admitted in all ICUs of Rio Branco, a western amazon region (600 square kilometers and 800,000 inhabitants). Data were collected for 18 months during the years 2014 and 2016. Patients with age under 18, chronic kidney disease stage 5, kidney transplant or ICU stay < 48 hours were excluded. AKI was diagnosed by KDIGO and mortality was assessed 30 and 180 days after ICU discharge. Of 1494 patients admitted, 1073 fulfilled selection criteria. AKI incidence was 52.8 per cent , and the prevalence was 67.3 per cent . Only 2.2 per cent had tropical diseases. Risk factors for AKI were positive fluid balance over 1500 ml/24h (OR 2.98; p <0,001), nonsurgical patients (OR 1.69; p =0,001), increased age for 10 years interval (OR 1,16; p <0,001) and increased APACHE II score (OR 1,06; p <0,001). ICU length of stay was higher in ICUAKI patients (7 vs 5 days, p <0,001), as well as ICU and hospital mortality (43.4 per cent vs 14 per cent , p <0,001 and 52 per cent vs 18.5 per cent , p <0,001, respectively) compared with no AKI patients. Risk factors for mortality in patients with AKI during ICU stay were: age, presence of sepsis, KDIGO stage 3, use of mechanical ventilation, vasoactive drugs and shock. In conclusion, we observed that AKI is common in ICU patients in the western Brazilian Amazon with few hospitalizations for tropical diseases and similar etiologies, risk factors and outcomes as in developed countries; however, with higher mortality rate that may be due to the local economic conditions and poor access to health care

Síndrome de nefritis tubulointersticial y uveítis / Interstitial Tubule Nephritis Syndrome and Uveitis

El síndrome de nefritis tubulointersticial y uveítis es una causa infrecuente de disfunción renal aguda en los adultos. El diagnóstico puede hacerse difícil, pues con frecuencia no coinciden temporalmente los síntomas oculares y renales. Se presentaron dos casos de síndrome de nefritis tubulointersticial y uveítis en adultos, con evolución favorable con tratamiento esteroideo sistémico(AU)

Tubulointerstitial nephritis syndrome and uveitis is an uncommon cause of acute renal dysfunction in adults. The diagnosis can be difficult, as ocular and renal symptoms often do not coincide temporarily. Two cases of tubulointerstitial nephritis syndrome and uveitis in adults, with favorable evolution with systemic steroid treatment are presented in this paper(AU)

Insuficiencia renal en pacientes cardiológicos: buscar para encontrar / Frequency of kidney failure in cardiologic patients: the need to search

Background: Chronic kidney disease is a major health problem since it is associated with a high cardiovascular risk, total morbidity and mortality, increasing prevalence and high cost treatment. Aim: To assess the frequency of chronic kidney disease among patients consulting in a cardiology clinic. Material and Methods: Cross-sectional assessment of 649 patients attended at a cardiology clinic. Demographic, clinical, electrocardiographic, echocardiographic and laboratory variables were registered. Patients were considered to have a kidney failure when their estimated glomerular filtration rate was < 60 ml/min/1.73 m² according to the Modification of Diet in Renal Disease (MDRD) formula. Kidney failure was considered chronic if this alteration lasted ≥ 3 months and hidden when serum creatinine levels were normal. Results: The frequency of kidney failure was 20.8% (28.4% in patients ≥ 65 years old). The mean age of patients with the disease was 71.5 ± 9.1 years and 52% were women. Eighty seven percent were in stage 3, 10% in stage 4 and 3% in stage 5. Among patients with kidney failure, in 114 (84%) it was chronic and in 28%, hidden. The latter was observed almost exclusively in women with creatinine levels of approximately 1 mg/dl. Hypertension (Odds ratio (OR) 4.2), age (OR 1.1), ventricular ejection fraction (OR 0.97) and low hemoglobin (OR 0.735) were the risk factors for kidney failure detected in the multivariate analysis. Conclusions: The frequency of kidney failure (chronic or hidden) was high in this group of cardiologic patients. Most patients had a mild to moderate failure and the risk factors were hypertension, age, low ventricular ejection fraction and low hemoglobin levels.

Estimación indirecta de la función renal y mortalidad por insuficiencia cardíaca: buscando el mejor predictor / Estimation of renal function and mortality in congestive heart failure: a search for the best indicator

Antecedentes: Uno de los principales predictores de eventos adversos en pacientes con insuficiencia cardíaca (IC) es el deterioro de función renal luego de una hospitalización. Estudios recientes han cuestionado la utilidad de la fórmula de Cockroft-Gault (CG) para estimar la función renal en estos pacientes. Objetivo: Evaluar la utilidad de distintos modelos para determinación indirecta de función renal como pre-dictores de mortalidad alejada en sujetos con IC. Método: Estudio descriptivo analítico. Se incorporaron en forma consecutiva pacientes admitidos de 14 hospitales chilenos con el diagnóstico de IC descompensada entre enero 2002 y julio 2012. Las características de los pacientes se compararon mediante t de Student o chi cuadrado según correspondía. En base a la creatininemia al alta se estimó la tasa de filtración glomerular mediante las formulas CG, MDRD-4 y CKD-Epi. El acuerdo entre los resultados de cada fórmula se analizó mediante kappa de acuerdo para clasificación en estadios de función renal y según el método de Bland-Alt-man. Los pacientes se clasificaron por cuartiles según la estimación de cada fórmula; la sobrevida se analizó con el método de Kaplan-Meier y la capacidad de cada fórmula para predecir eventos mediante un modelo de riesgo proporcional de Cox. La mortalidad al fin del seguimiento se determinó por la base de datos del Servicio Nacional de Registro Civil e Identificación. Resultados: Se incluyeron 1584 pacientes, 45,3 por ciento de sexo femenino. La edad promedio fue de 70,5+/-20 años. La creatinina al ingreso fue 1,63+/-1,48 mg/dL y al egreso de 1,59+/-1,41 mg/dL (p=NS). Todos los modelos estimaron un porcentaje similar de población con falla renal al momento del alta (Cl Crea < 60 ml/min/1.73m2): CG 57,3 por ciento, MDRD-4 54,9 por ciento y CKD-Epi 54,9 por ciento. El clearance de creatinina estimado por CG (59,4+/-30,4 mL/min/1,74) fue mayor al estimado por CKD-Epi o MDRD-4 (54,2+/-25,1 y 57,8+/-27 mL/min/1,73m2)...

Background. One of the best predictors of adverse events in patients with congestive heart failure (CHF) is the deterioration of renal function following hospitalization. Recent studies have questioned the usefulness of the Cockroft-Gault (CG) formula to estimate renal function in these patients. Aim: To evaluate the usefulness of different indirect methods for estimation of renal function in the prediction of late mortality in patients with CHF. Method: Consecutive patients admitted for CHF in 14 different hospitals from January 2002 and July 2012 were analyzed. Student’s t or Chi square were used as appropriate for statistical comparisons. The serum creatinine level at the time of discharge was used to estimate glomerular filtration rate (GFR) from 3 different formulae: CG, MDRD-4 and CKD-Epi. Agreement among methods for different assignment to different stages of renal failure was evaluated by the "kappa" statistics and the Bland- Altmann method. Survival according to the estimation from each formula was compared by the log-rank statistics on Kaplan-Meier’s survival curves. The ability of each formula to predict adverse events was evaluated by a Cox proportional hazards method. Mortality was obtained from de National Identification Registry. Results: 1548 patients were included, 45.3 percent of them females. Mean age was 70.5 years (SD 20). Creatinine level was 1,63+/-1,48 mg/dL at admission and 1,59+/-1,41 mg/dL at discharge (p=NS). The proportion of patients with renal failure ( creatinine clearance < 60ml/min/1.73 m2) was similar for all methods (CG: 57.3 percent, MDRD-4 54.9 percent and CKD-Epi 54.9 percent). Creatinine clearance by CG (59,4+/-30,4 mL/min/1,73m2) was higher than that estimated by CKD-EPI (54,2+/-25,1/1.73 m2) or MDRD-4 (57,8+/-27 mL/min/1,73m2). Both CKD-Epi and MDMD-4 correctly identified a subgroup of patients with lower late mortality (CKD-Epi quartiles 3 and 4, OR 0,5 IC95 percent 0,35-0,72; MDRD-4 quartiles 3 and 4...

Función renal en pacientes pediátricos con trasplante alogénico de progenitores hematopoyéticos / Renal function in pediatric patients with allogeneic hematopoietic progenitor cell transplantation

Patients with hematopoietic stem cell transplantation can develop some degree of renal failure. The aim of this descriptive study is to evaluate markers of kidney injury in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation between 1991 and 2011. Patients and Method: A descriptive study of pediatric patients with allogeneic transplant of hematopoietic precursors between 1991 and 2011. The patients were between 1 month and 18 years of age at the time of the study and had at least 6 months of follow up. Clinical and nutritional history, continuous blood pressure monitoring (ABPM), urine tests, proteinuria, creatinine and renal and bladder ultrasonography imaging were evaluated. Results: During this period 65 patients were transplanted, of which 13 patients were included. 46% (n = 6) showed diverse degrees of renal compromise defined by altered renal parenchymal echogenicity, clinic or masked hypertension and/or microalbuminuria. Conclusion: In this clinical group, almost half of the patients patients had some degree of renal injury in their evolution. We consider essential to assess the renal function in the follow-up of these patients.

Introducción: Los pacientes con trasplante de progenitores hematopoyéticos pueden evolucionar con algún grado de compromiso renal. El objetivo de este estudio descriptivo fue evaluar marcadores de injuria renal en pacientes pediátricos sometidos a trasplante alogénico de progenitores hematopoyéticos entre 1991 y 2011. Pacientes y Método: Estudio descriptivo en pacientes pediátricos con Trasplante alogénico de Precursores Hematopoyéticos entre los años 1991 y 2011 con edad entre 1 mes y 18 años al momento de realizar el estudio y que tuviesen al menos 6 meses de seguimiento. Se evaluaron antecedentes clínicos, nutricionales, presión arterial por monitoreo continuo (MAPA), exámenes de orina, proteinuria, creatininuria y estudio de imágenes por ecotomografía renal y vesical. Resultados: Durante este período se trasplantaron 65 pacientes, de los cuales se incluyeron 13 pacientes. Un 46% (n = 6) presentó compromiso renal de grado variable definido por alteración en la ecogenicidad del parénquima renal, hipertensión arterial clínica o enmascarada y/o microalbuminuria. Conclusión: En la serie clínica estudiada con el 50% de los pacientes presentó algún grado de injuria renal en su evolución. Consideramos importante evaluar función renal en el seguimiento de este grupo de pacientes.

Prevalence of renal insufficiency in elderly cancer patients in a tertiary cancer center / Prevalência de insuficiência renal em pacientes idosos com câncer em um centro de tratamento oncológico

Objective To estimate the prevalence of abnormal glomerular filtration rate in elderly patients with solid tumors. Methods A retrospective study with patients aged >65 years diagnosed with solid tumors between January 2007 and December 2011 in a cancer center. The following data were collected: sex, age, serum creatinine at the time of diagnosis and type of tumor. Renal function was calculated using abbreviated Modification of Diet in Renal Disease (MDRD) formulae and then staged in accordance with the clinical practice guidelines published by the Working Group of the National Kidney Foundation. Results A total of 666 patients were included and 60% were male. The median age was 74.2 years (range: 65 to 99 years). The most prevalent diagnosis in the study population were colorectal (24%), prostate (20%), breast (16%) and lung cancer (16%). The prevalence of elevated serum creatinine (>1.0mg/dL) was 30%. However, when patients were assessed using abbreviated MDRD formulae, 66% had abnormal renal function, stratified as follows: 45% with stage 2, 18% with stage 3, 3% with stage 4 and 0.3% with stage 5. Conclusion To the best of our knowledge, this was the first study to estimate the frequency of renal insufficiency in elderly cancer patients in Brazil. The prevalence of abnormal renal function among our cohort was high. As suspected, the absolute creatinine level does underestimate renal function impairment and should not be used as predictor of chemotherapy metabolism, excretion and consequent toxicity. .

Objetivo Estimar a prevalência de taxa de filtração glomerular alterada em pacientes idosos diagnosticados com tumores sólidos. Métodos Estudo retrospectivo de pacientes com mais de 65 anos de idade, diagnosticados com tumores sólidos entre janeiro de 2007 e dezembro de 2011 em um centro de tratamento oncológico. Foram coletados dados sobre sexo, idade, creatinina sérica à época do diagnóstico e tipo de tumor. A função renal foi calculada utilizando a versão simplificada da equação MDRD (Modification of Diet in Renal Disease) e depois estratificada de acordo com as diretrizes de prática clínica do Working Group of the National Kidney Foundation. Resultados Foram incluídos 666 pacientes, sendo 60% do sexo masculino. A idade mediana foi 74,2 anos (variação de 65 a 99 anos), e os diagnósticos mais prevalentes na população do estudo foram câncer colorretal (24%), de próstata (20%), mama (16%) e pulmão (16%). A prevalência de creatinina sérica elevada (>1,0mg/dL) foi 30%. No entanto, quando os pacientes foram avaliados utilizando a forma abreviada da equação MDRD, 66% tinham uma função renal anormal assim estratificada: 45% em estádio 2, 18% em estádio 3, 3% em estádio 4 e 0,3% em estádio 5. Conclusão Até onde sabemos, este foi o primeiro estudo a estimar a frequência de insuficiência renal em pacientes idosos com câncer no Brasil. A prevalência de função renal alterada na coorte estudada foi alta. Como suspeitávamos, o nível absoluto de creatinina subestima a alteração na função renal e não deve ser usado como preditor de metabolismo, excreção e consequente toxicidade dos agentes quimioterápicos. .

Síndrome hemolítico urémico en niños en los últimos 10 años en el hospital Gustavo Fricke / Hemolytic Uremic Syndrome in Children in the last 10 years at hospital Gustavo Fricke

El síndrome hemolítico urémico se caracteriza por la presencia de anemia hemolítica microangiopática, trombocitopenia e injuria renal aguda. Es una de las causas más frecuentes de falla renal aguda en pacientes pediátricos. Objetivo: Conocer las características clínicas y la evolución de los pacientes con SHU hospitalizados en nuestro hospital. Material y Método: Se revisaron 55 historias clínicas de los pacientes egresados con el diagnostico de SHU en el Hospital Dr. Gustavo Fricke entre el año 2001 y 2011 y se extrajo la información más relevante sobre la presentación clínica y la evolución de esta enfermedad durante la hospitalización. Resultados: 4 pacientes fallecieron (5,7 por ciento). Un 62 por ciento presentó una diarrea aguda disentérica; 30,9 por ciento hipertensión arterial y 11 por ciento convulsiones. Un 84 por ciento fue transfundido con glóbulos rojos, 45 por ciento requirió terapia de sustitución renal. La duración de la hospitalización fue de 14 días en promedio. Al año solo un 66 por ciento permanecían en control médico. Conclusiones: El SHU continúa siendo una de las causas más frecuentes de injuria renal aguda con requerimiento de diálisis en nuestro hospital. La mayoría de los pacientes sufre anemias severas con necesidad de trasfusión de glóbulos rojos. La mortalidad es similar a la reportada en otros centros...

Hemolytic Uremic Syndrome (HUS) is characterized by the presence of hemolytic microangiopathic anemia, thrombocytopenia and acute renal failure. Is one of the most frequent causes of acute renal failure in pediatric patients. Objective: Know clinical characteristics and evolution of patients with HUS hospitalized at Hospital Dr. Gustavo Fricke. Material and Methods: 55 medical records of discharged patients with the diagnosis of HUS in Dr. Gustavo Fricke Hospital between 2001 and 2011 were reviewed. We extracted the most relevant information on clinical presentation and evolution of this disease during hospitalization. Results: 4 patients died (5.7 percent). 62 percent presented an acute dysenteric diarrhea; 30.9 percent evolved with hypertension and 11 percent presented seizures. 84 percent were transfused with red blood cells, 45 percent required renal replacement therapy. The hospital stay was 14 days on average. After one year, only 66 percent remained in medical control. Conclusions: HUS remains one of the most frequent causes of acute kidney injury who required dialysis at our hospital. Most patients have severe anemia requiring transfusion of RBCs. Mortality is similar to that reported in other centers...

Rhabdomyolysis in Falciparum Malaria with Acute Renal Failure.

Acute renal failure is an important complication of falciparum malaria. Though rhabdomyolysis has been reported in falciparum malaria occasionally, its role in the causation of acute renal failure in malaria has not been investigated. Therefore, we have undertaken this research to study skeletal involvement in malaria and to correlate it to acute renal failure. Material and Methods: Sixty patients of malaria were included in this study. Of them there were 23 (38.3%) patients of cerebral malaria with renal failure (Group A), 15 (25.0%) patients with cerebral malaria without renal failure (Group B), and 22 (36.6%) patients of uncomplicated malaria (Group C). The diagnosis of malaria was done by Giemsa stained peripheral blood smear or QBC. All patients were subjected to detailed investigations. In addition serum creatine kinase (CK) and myoglobin (Mb) levels were estimated. Muscle biopsy was performed in 10 cases and tissue specimens were stained with hematoxylin-eosin stain. Results: The mean serum CK level (IU/L) in Group A, Group B and Group C were 406.8 ± 290.8 IU/L, 127.4 ± 112.1 IU/L, 110.4 ± 99.0 IU/L respectively. The mean serum Mb level (ng/ml) in Group A, Group B and Group C were 344.6 ± 260.1 ng/ml, 103.9 ± 97.0 ng/ml and 45.9 ± 45.4 ng/ml respectively. Serum Mb concentration was significantly high in cerebral malaria with renal failure. Significant correlation had been observed between serum CK and Mb level (r = 0.71 for 60 patents; p = <0.001; 95% Cl = 0.55 to 0.82). Serum CK correlated well with parasitemia (r = 0.56, p<0.001).There was a significant correlation between serum Mb concentration with the simultaneous serum creatinine level (r = 0.46; p value = 0.001). There was significant association observed between muscle injury and renal failure (Chi square =6.72, p = 0.01). There was no evidence of muscle necrosis in any of the biopsy specimens examined. Conclusion: The present study showed that biochemical evidence of muscle injury was found in patients of falciparum malaria with renal failure. Therefore myoglobin may have a pathogenetic role in malarial acute renal failure.

Differences in Clinical Manifestations and Outcomes between Adult and Child Patients with Henoch-Schonlein Purpura

We aimed to investigate differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schonlein purpura (HSP), and to analyze the factors associated with poor prognosis for HSP nephritis. This retrospective 10-yr study enrolled 160 patients with HSP who visited Severance Hospital. Purpura was mostly detected in lower extremities, but purpura in upper extremities was more frequently observed in adults than children (41.7% vs 19.3%). Children had a greater frequency of arthralgia (55.4% vs 27.1%), while adults had a greater frequency of diarrhea (20% vs 1.6%). Anemia, elevated C-reactive protein, and level of IgA were more frequently observed in adults (25% vs 7.1%, 65.6% vs 38.4%, 26.3% vs 3.5%). Renal involvement in adults was more severe than in children (79.2% vs 30.4%). Chronic renal failure showed a significant difference in outcomes of HSP between adults (10.4%) and children (1.8%) after a follow up period of an average of 27 months. Furthermore, renal insufficiency at diagnosis was significantly related to the progression to chronic renal failure. Our results showed several differences in the clinical features of HSP between adults and children. Adults with HSP had a higher frequency of renal insufficiency and worse renal outcomes than children. Renal insufficiency at diagnosis might be of predictive value for the progression to chronic renal failure in HSP patients.

Perfil epidemiológico dos óbitos em terapia renal substitutiva e custo do tratamento / Epidemiological profile of deaths in renal replacement therapy and cost of treatment

OBJETIVO: Descrever o perfil epidemiológico dos óbitos de pacientes em terapia renal substitutiva e o custo do tratamento. MÉTODOS: Estudo transversal e retrospectivo realizado com os dados da Base Nacional de Terapia Renal Substitutiva. Foram incluídos 2029 óbitos por insuficiência renal. Os dados foram analisados por inferência estatística e estatística não paramétrica. RESULTADOS: Houve maior número de óbitos entre os pacientes do sexo masculino e da raça branca. O custo do tratamento aumentou 6,7% nos gastos do estado e 45,3% no município. CONCLUSÃO: O maior número de óbitos ocorreu no sexo masculino, raça branca, variações bruscas nas taxas de mortalidade hospitalar e aumentou o custo do tratamento nos últimos três anos.

OBJECTIVE: Determine the epidemiological profile of patient deaths related to renal replacement therapy and the cost of treatment. METHODS: Cross-sectional retrospective study carried out with data from the National Renal Replacement Therapy Database. It included 2009 deaths due to renal failure. Data were analyzed using statistical inference and nonparametric statistics. RESULTS: A greater number of deaths was observed among white, male patients. The cost of treatment increased 6.7% in the state and 45.3% in the city. CONCLUSION: The highest number of deaths occurred among white males; there were marked variations in hospital mortality rates; and the cost of treatment increased over the past three years.

Crescentic glomerulonephritis: A clinical and histomorphological analysis of 46 cases.

Background: Crescentic glomerulonephritis (CrGN), defined as crescents involving more than 50% of the glomeruli, includes pauci-immune, immune complex-mediated and anti-glomerular basement membrane disease. Objectives: The present study was aimed at evaluating the various clinical, biochemical and histological parameters in CrGN with respect to these categories and clinical outcome. Materials and Methods: Renal biopsies diagnosed as CrGN between Jan 2008 and Feb 2010 were included. Clinical and laboratory parameters were retrieved along with the therapeutic approach and clinical outcome, wherever available. Renal biopsy slides were evaluated for various glomerular, tubulo-interstitial and arteriolar features. Appropriate statistical tests were applied for significance. Results: A total of 46 cases of CrGN were included; majority (71.7%) of cases were pauci-immune (PI) while 28.3% were immune complex-mediated (IC). Among clinical features, gender ratio was significantly different between PI and IC groups (P = 0.006). The various histological parameters, including proportion of cellular crescents, tuft necrosis and Bowman's capsule rupture, were similar in both the groups. Four unusual associations, including idiopathic membranoproliferative glomerulonephritis (MPGN), multibacillary leprosy, acute lymphoblastic leukemia and C1q nephropathy were detected. Adequate follow-up information was available in 21 (46%) of the patients. Of these, 11 (52.4%) were dialysis-dependent at the last follow-up. Adult patients required renal replacement therapy more frequently than pediatric cases (P = 0.05). Presence of arteriolar fibrinoid necrosis also showed association with poor clinical outcome (P = 0.05). Conclusions: Crescentic glomerulonephritis remains one of the main causes of acute renal failure with histological diagnosis. Immunohistologic examination is essential for accurate classification into one of the three categories. This condition should be considered in rare causal associations like leprosy or MPGN with renal failure, to allow for timely performed renal biopsy and appropriate aggressive therapy.