Antiviral therapies are associated with an increased risk of acute rejection in transplant patients. The aim of the present study was to evaluate the efficacy and safety of lamivudine therapy for hepatitis B virus (HBV) infection in renal transplant patients. Six patients were included in this study. They received 150 mg/day of lamivudine during a follow-up period of 24 months. The laboratory tests monitored were HBV DNA, HBsAg, HBeAg, ALT, gamma-GT, serum creatinine and blood cyclosporine levels. The HBV DNA became undetectable in four patients as early as in the third month of treatment. After six months, the viral load was also negative in the other two patients, and remained so until 18 months of follow-up. The medication was well tolerated with no major side effects. Lamivudine was safe and effective in blocking HBV replication in renal transplant patients without any apparent increase in the risk of graft failure for the 24-month period of study.

OBJETIVOS: O objetivo deste estudo foi analisar as causas e o prognóstico de pacientes idosos (>70 anos de idade) com IRA tratados em nosso Serviço. CASUÍSTICA E MÉTODOS: Dos 361 pacientes adultos e portadores de IRA, atendidos em nosso serviço no período de janeiro/95 a dezembro/96, acompanhamos 130 pacientes (36%) com idade superior a 70 anos (média de 76,0 ± 4,7 anos, variando de 70 a 94 anos). Destes, 84 (65%) eram do sexo masculino e 66 (51%) estavam no pós-operatório de cirurgias diversas. Os dados foram obtidos através de formulários padronizados usados no Serviço. RESULTADOS: As causas mais freqüentes foram: isquêmicas 48 (38%), sepsis 40 (31%), nefrotóxicas 46 (35%) e obstrutivas 10 (7,7%); em outros 14 (11%) foram diagnosticados mais de um agente causal. IRA não-oligúrica ocorreu em 81 pacientes (62,8%) e em 50 pacientes (39%) houve necessidade de diálise. A mortalidade na população com idade abaixo de 70 anos foi 43% e nos idosos 53,1%, não havendo diferença estatística entre os grupos (p=0,085). A mortalidade foi maior (p<0,0001) nos pacientes idosos oligúricos (86%) do que nos idosos não-oligúricos (32%); maior em casos de IRA cirúrgica (66,7%) do que em IRA de origem médica (41,8%), e em pacientes internados em UTI (69%) do que nos internados em enfermaria (17%). O número de óbitos também foi maior (p<0,0001) no grupo que necessitou de diálise (84%) do que nos não dialisados (33%). CONCLUSÃO: Concluímos que o percentual de pacientes idosos com IRA é elevado; apresentaram mortalidade ao redor de 50%, não superior ao observado na população mais jovem; oligúria, cirurgia, necessidade de tratamento em UTI e necessidade de diálise foram fatores de prognóstico desfavorável nesta casuística.

The prolonged life span of populations is the obvious reason for an increasing proportion of elderly patients with acute renal failure (ARF). The role of age as a factor indicative of a poor prognosis is a matter of controversy. OBJECTIVE: To evaluate this role we have analyzed the final outcome of elderly patients with ARF treated in our Nephrology Service. MATERIAL AND METHODS: Among 361 ARF cases prospectively studied during a two-year period (January 1995 to December 1996), 130 (36%) occurred in patients over 70 years of age. Etiology, clinical course and prognosis were analyzed. The average age was 76.0 ± 4.7 years, varying from 70 to 94 years; 84 patients (65%) were male, and surgical causes accounted for 51% of geriatric ARF. RESULTS: The most frequent causes were: ischemic (volume depletion, arterial hypotension, and/or low cardiac output) in 48 patients (38%), sepsis in 40 (312%), nephrotoxic drugs in 46 (35%) and obstructive abnormalities in 10 (7.7%); in other 14 (11%) they were diagnosed more than a causal agent. Oliguria was present in 37.2% (81 patients), and dialysis was needed in 50 patients (39%). The mortality in the population with age below 70 years was 43% and in the elderly patients was 53.8%; total mortality was similar in both groups of patients (p=0.085). Oliguria, need for dialysis, presence of surgical causes of ARF, and ARF acquired within the intensive care unit were associated with poor prognosis in elderly group. CONCLUSION: We concluded that the percentile of elderly patients with ARF is elevated; they presented mortality about of 50%, and this is not superior to the observed in the youngest population; oliguria, dialysis need, ICU cares and surgery are factors of unfavorable prognostic in these patients.

A nefropatia esquistossomótica está classicamente vinculada à fornia hepatoesplênica da esquistossomose. Ao longo dos últimos anos 24 casos de pacientes esquistossomóticos hepato-intestinais e portadores de síndrome nefrótica foram estudados. Com o objetivo de verificar a possível participação etiológica da esquistossomose na gênese da nefropatia, analisamos este grupo comparativamente ao grupo de 37 doentes portadores de síndrome nefrótica idiopática. Ambos os grupos apresentaram distribuição distinta dos tipos histológicos de glomerulopatia. No grupo de esquistossomóticos houve predomínio estatisticamente significante de glomerulonefrite proliferativa mesangial (33.3%), enquanto no grupo controle houve predomínio da glomerulonefrite membranosa (32.4%). A positividade para IgM à imunofluorescência foi de 94.4% nos doentes esquistossomóticos versus 55.0% no grupo controle (p<0.01). No grupo de esquistossomóticos 8 pacientes evidenciaram glomerulonefrite proliferativa mesangial e 5, glomerulonefrite membranoproliferativa. Em ambos os tipos histológicos a imunofluorescência mostrou depósitos granulares de IgM e C3 nos glomérulos. Os dados do presente estudo sugerem que as glomerulonefrites proliferativa mesangial e membranoproliferativa, com depósitos glomerulares de IgM e C3 representam as lesões renais específicas da nefropatia esquistossomótica.

Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (p<0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membra-noproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy.