Nefrologia
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- 8-ZONE LUNG ULTRASOUND AND BIOIMPEDANCE ANALYSIS FOR ASSESSMENT OF HYDRATION STATUS IN HEMODIALYSISPublication . Curto, Andreia; Campos, Pedro; Ramos, Mariana; Domingos , Fernando; Alexandre, Inês; Brás, Ana catarina; Santos, Afonso; Serra, Adelaide; Verdelho, Miguel; Pires, AnaThe 8-zone Lung US protocol is efficient to evaluate patients prior to HD sessions. There is a good correlation between the total number of B lines determined by the 8-zone protocol and bioimpedance parameters such as TBW, ECW, and normalized OH. This demonstrates that the 8-zone protocol can effectively be used in routine evaluations of HD patients. Although these techniques reflect different over-fluid compartments, they have a complementary role for fluid overload determination and dry weight guidance.
- Acessos vasculares definitivos para hemodiálise: abordagem multidisciplinarPublication . Madeira, C; Gomes, A; Germano, A; Aleluia, C; Nunes, V; Correia, P
- Acute Kidney Injury Biomarkers: from bench to clinical usePublication . Soto, K; Devarajan, P
- Anemia na goença renal crónicaPublication . Rodrigues, B
- Association between transient acute kidney injury and morbidity and mortality after lung transplantation: a retrospective cohort study.Publication . Fidalgo, P; Ahmed, M; Myer, S; Lien, D; Weinkauf, J; Kapasi, A; Cardoso, F; Jackson, K; Bagshaw, SAcute kidney injury (AKI) is a common occurrence after lung transplantation (LTx). Whether transient AKI or early recovery is associated with improved outcome is uncertain. Our aim was to describe the incidence, factors, and outcomes associated with transient AKI after LTx. MATERIALS AND METHODS: We performed a retrospective cohort study of all adult recipients of LTx at the University of Alberta between 1990 and 2011. Our primary outcome transient AKI was defined as return of serum creatinine below Kidney Disease-Improving Global Outcome AKI stage I within 7days after LTx. Secondary outcomes included occurrence of postoperative complications, mortality, and long-term kidney function. RESULTS: Of 445 LTx patients enrolled, AKI occurred in 306 (68.8%) within the first week after LTx. Of these, transient AKI (or early recovery) occurred in 157 (51.3%). Transient AKI was associated with fewer complications including tracheostomy (17.2% vs 38.3%; P<.001), reintubation (16.4% vs 41.9%; P<.001), decreased duration of mechanical ventilation (median [interquartile range], 69 [41-142] vs 189 [63-403] hours; P<.001), and lower rates of chronic kidney disease at 3 months (28.5% vs 51.1%, P<.001) and 1 year (49.6% vs 66.7%, P=.01) compared with persistent AKI. Factors independently associated with persistent AKI were higher body mass index (per unit; odds ratio [OR], 0.91; 95% confidence interval, 0.85-0.98; P=.01), cyclosporine use (OR, 0.29; 0.12-0.67; P=.01), longer duration of mechanical ventilation (per hour [log transformed]; OR, 0.42; 0.21-0.81; P=.01), and AKI stages II to III (OR, 0.16; 0.08-0.29; P<.001). Persistent AKI was associated with higher adjusted hazard of death (hazard ratio, 1.77 [1.08-2.93]; P=.02) when compared with transient AKI (1.44 [0.93-2.19], P=.09) and no AKI (reference category), respectively. CONCLUSIONS: Transient AKI after LTx is associated with fewer complications and improved survival. Among survivors, persistent AKI portends an increased risk for long-term chronic kidney disease.
- Atypical renal presentation of antiphospholipid syndromePublication . Gaspar, A; Manso, RT; Pereira, F; Cunha, L; Inchaustegui, L; Serra, A; Rodrigues, B; Correia, PAntiphospholipid syndrome (APS) is a systemic autoimmune disease which can occur as a primary disease or in association with other autoimmune diseases, the most frequent being Systemic Lupus Erythematosus (SLE). Although renal manifestations of SLE are well known, antiphospholipid syndrome renal manifestations such as antiphospholipid syndrome nephropathy and glomerulopathies have yet to be better characterized. The authors present the case of a 39 -year -old Caucasian woman with antiphospholipid syndrome diagnosis and a previous history of deep venous thrombosis and intermittent polyarthralgia, who was referred to a nephrology consultation for proteinuria and microscopic haematuria with preserved renal function. The renal biopsy showed a pattern of membranous glomerulopathy and thrombotic microangiopathy in association with antiphospholipid syndrome nephropathy. This case report illustrates a complex clinical and anatomopathological case of a 39 - year -old woman with a previous antiphospholipid syndrome diagnosis who presented with unspecific manifestations such as proteinuria and microscopic haematuria and preserved renal function. The histological findings alert us to the range of possible renal manifestations of APS and the need to better characterize these patients by preforming renal biopsy.
- Avaliação Metabólica da LCIR na população portuguesaPublication . Serra, MA; Domingos, F
- Avaliação morfológica e funcional por ecografia e doppler como fator preditivo da permeabilidade aos 12 meses em acessos vasculares proximais.Publication . Gomes, A; Germano, A; Sousa, M; Rocha, R; Marinho, R; Campos, P; Fragoso, M; Pignatelli, N; Nunes, VIntrodução: O mapeamento vascular por ecografia e doppler é crucial no planeamento de um acesso vascular para hemodiálise. O objectivo deste estudo é avaliar quais das variáveis anatómicas e hemodinâmicas arteriais e venosas, medidas por ecografia e Doppler, se associam a permeabilidade global aos 12 meses nos acessos vasculares proximais. Material e Métodos: Estudo observacional, analítico, longitudinal, com colheita retrospetiva de dados. Foram incluídos os doentes admitidos no nosso hospital entre Janeiro de 2011 e Junho de 2013 para a criação de acesso vascular proximal para hemodiálise como primeiro acesso, com mapeamento vascular por ecografia e doppler. Foram comparados os doentes com permeabilidade de acesso aos 12 meses com os doentes com falência de acesso até aos 12 meses. Foi feita análise univariada e multivariada. Foi utilizada estatística não paramétrica com significância para α=0,05. Resultados: Foram incluídos 61 doentes com idade média de 66,5±13,5 anos, 26 do sexo feminino, 18 fístulas umerobasílicas, 65,6% de permeabilidade global aos 12 meses. O diâmetro da artéria umeral (AU), o diâmetro da veia, o índice de resistência e a distensibilidade venosa não foram diferentes entre os grupos. O fluxo da AU (0,19l/min±0,11 vs 0,16l/min±0,06; U=215,0; df=59; p<0,05), a velocidade picosistólica da AU (78,77m/s±23,20 vs 65,47m/s±18,47; U=210,2; df=59; p<0,05) e a distância entre a artéria e a veia (31,73±11,9mm vs 17,75±8,61mm U=101,0; df=59; p<0,05) associaram-se a permeabilidade global aos 12 meses. A Diabetes Mellitus tipo II (DMII) foi mais prevalente entre os doentes com falência aos 12 meses (p<0,05). O diâmetro da AU correlacionou-se positivamente com o débito e a velocidade picosistólica da AU. A distensibilidade da veia correlacionou-se negativamente com o seu diâmetro sem garrote. Na análise por regressão logística, apenas a DMII demonstrou significância estatística, associando-se negativamente com permeabilidade aos 12 meses. Conclusões: Nos doentes estudados, o fluxo arterial, a velocidade picosistólica e a distância entre artéria e veia são superiores entre os doentes com permeabilidade global aos 12 meses quando comparados com os doente com falência de acesso. A DMII mostrou ser um factor de risco independente para falência de acesso aos 12 meses.
- Avanços no diagnóstico e tratamento do síndroma hemolítico urémicoPublication . Fidalgo, P; Soto, K
- Candida species contamination of preservation fluid-outcome of renal transplantation in 6 patientsPublication . Rodrigues, B; Natário, A; Vizinho, R; Jorge C, C; Weigert, A; Martinho, A; Toscano, C; Marques, T; Machado, DBACKGROUND: Fungal infections are a rare but important cause of morbidity and mortality in kidney transplantation. Fungal contamination of the kidney preservation fluid may, sometimes, be the cause of these infections. However, the clinical consequences of fungal contamination of this fluid are not completely understood and literature on this topic is controversial. The purpose of this study was to determine the incidence of preservation fluid contamination by fungi and its clinical consequences. METHODS: From June 2010 to September 2011, a prospective cohort analysis was conducted at our center, enrolling all patients who received a renal allograft and whose perfusion fluid was analyzed for microbiology sterility. Patients with perfusion fluids positive for fungi were further studied: the patients' status was assessed during regular visits and data were recorded, including clinical characteristics, infections, graft function, immunosuppressive regimen and outcomes. RESULTS: Microbiologic, cultures of 70 kidney perfusion fluids using specific mycologic media, obtained from 74 cadaveric renal transplants (4 fluids were unsuitable for analysis), were evaluated. Six samples were positive for yeasts (8.6%), with 4 isolates of Candida albicans and 2 isolates of Candida glabrata. Four patients had no evidence of fungal infection during the follow-up period (median 321 days); conversely, 2 patients developed severe mycotic vascular complications leading to transplantectomy. CONCLUSIONS: Perfusion fluid contamination by fungi is an elusive situation that can lead either to an unremarkable clinical course or to graft loss life-threatening situations. Routine culture of kidney perfusion fluid is critical for prompt diagnosis and early implementation of appropriate treatment.