ABSTRACT Sarcopenia is a progressive age‑related loss of muscle mass associated with a decline in muscle function and physical performance. Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. Indeed, with the progression of chronic kidney disease, skeletal muscle dysfunction contributes to mobility limitation, loss of functional independence, and vulnerability to disease complications. There is a lack of robust data on the negative effect of the impact of kidney disease on skeletal muscle dysfunction, as well as on screening and treatment strategies that can be used in clinical practice to prevent functional decline and disability. Therefore, sarcopenia may be na underestimated condition with major implications for people with chronic kidney disease, even before the start of dialysis, which makes research into this topic necessary. The purpose of this review is to expand on some fundamental topics of sarcopenia, with an emphasis on the setting of chronic kidney disease patients.

RESUMO A doença de lesões mínimas é responsável por até 25% dos casos de síndrome nefrótica na população adulta. O mecanismo alérgico tem sido associado à doença de lesão mínima a associada a alérgenos, como picadas de insetos. Apresentamos um caso de uma mulher com início recente de síndrome nefrótica após picada de inseto não himenóptero, com doença de lesões mínimas comprovada por biópsia, acompanhada por um processo de tromboembolismo pulmonar. A paciente teve remissão completa com glicocorticoides, com resposta sustentada por 6 meses após a interrupção do tratamento. Uma nova exposição à picada de inseto na mesma região geográfica e estação do ano provocou uma recaída da síndrome nefrótica. Evitar o local subsequentemente resultou em remissão sustentada por mais de 4 anos.

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

Resumo Uma das causas mais comuns da glomerulonefrite rapidamente progressiva (GNRP) é a glomerulonefrite crescêntica (GNC) pauci-imune. Na maioria dos casos, a patologia apresenta um marcador sorológico positivo, o anticorpo anticitoplasma de neutrófilos (ANCA), mas em cerca de 10% dos pacientes não há ANCAs circulantes, perfazendo um subgrupo da patologia conhecido como GNC pauci-imune ANCA-negativa. A GNRP pode estar associada a doenças sistêmicas, mas são poucos os relatos de caso que descrevem sua associação com doença mista do tecido conjuntivo (DMTC). O presente artigo relata um caso de GNC ANCA-negativa associada a DMTC.

Abstract One of the most common causes of rapidly progressive glomerulonephritis (RPGN) is pauci-immune crescentic glomerulonephritis (CrGN). In the majority of cases, this condition has a positive serologic marker, the anti-neutrophil cytoplasmic antibodies (ANCAs), but in approximately 10% there are no circulating ANCAs, and this subgroup has been known as the ANCA-negative pauci-immune CrGN. RPGN can be associated with systemic diseases, but there are only few case reports describing the association with mixed connective tissue disease (MCTD). The authors report a case of ANCA-negative CrGN associated with a MCTD.

Chronic kidney disease is increasing in prevalence, especially among older people. The development of integrated strategies between primary health care and hospital care is crucial to curb the growth of this pathology, already considered a public health problem. Telemedicine approaches the different levels of care and creates a great confidence in managing CKD in the community, with a beneficial and real patient-centered care. Other strategies that lead to empowerment of the primary care medical doctors should also be considered. This manuscript summarizes some of these aspects and lists the benefits of its implementation in Portugal.

RESUMO A doença renal ateroembólica (DRAE) é uma manifestação renal da aterosclerose enquanto patologia sistêmica. A DRAE é definida como uma disfunção renal secundária à embolização de cristais de colesterol seguida da oclusão da vascularização renal. O presente relato descreve o caso de um paciente com vários fatores de risco, porém sem um evento precipitante, que se apresentou com um curso clínico bastante atípico de doença ateroembólica grave de evolução espontânea e silenciosa.

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.

Após duas décadas de intensa investigação no domínio da genética e da fisiopatologia da doença poliquística renal autossómica dominante foram publicados os resultados de alguns ensaios clínicos aleatorizados e controlados envolvendo milhares de doentes. Neste artigo os autores revêm e discutem os resultados clínicos, os efeitos adversos e as limitações destes estudos bem como antevêm as futuras linhas de investigação neste domínio.

After two decades of major achievements in the understanding of genetics and pathophysiology of autosomal dominant polycystic kidney disease (ADPKD) several Stage III randomized and controlled clinical trials involving thousands of patients had the results published recently. In this article, the authors review the results of the major clinical trials discussing the clinical outcomes, adverse effects and limitations as well as the future directions in this exciting investigation.