Resumo Introdução: A vida das pessoas com Doença Renal Crônica (DRC) é alterada em diversos aspectos. Dentre eles, o trabalho destaca-se como um dos que sofrem profundas consequências e comprometimento na sua continuidade. Embora existam estudos sobre as limitações impostas pelo tratamento da DRC nas atividades profissionais, a percepção dos pacientes em relação a essas limitações ainda é pouco explorada na literatura. Objetivo: Conhecer as percepções dos pacientes renais crônicos, em hemodiálise e transplantados renais, sobre as limitações impostas pelo tratamento nas suas atividades profissionais. Métodos: Estudo qualitativo, realizado com 21 pacientes com DRC (13 em tratamento de hemodiálise e 8 transplantados renais). A coleta de dados se deu por meio de entrevistas, a partir de um roteiro semiestruturado, e submetidas à análise de conteúdo, na modalidade temática. Resultados: Foram identificados três temas de análise: 1. Diagnóstico e acesso ao tratamento; 2. Limitações nas atividades diárias e no trabalho e 3. Mudanças relacionadas ao trabalho e apoio familiar. Entre os pacientes com hemodiálise, a necessidade de realizar sessões frequentes foi citado como um dificultador para a retomada das atividades laborais. Mesmo entre os pacientes transplantados, as limitações físicas e os cuidados pós-cirúrgicos afetaram a produtividade e a capacidade de retorno ao trabalho da maneira habitual. Conclusões: As mudanças experimentadas pelos entrevistados após o início do tratamento da DRC afetaram sua capacidade de retornar ao trabalho, e o apoio familiar foi considerado essencial para facilitar esse processo. A pesquisa qualitativa se mostrou uma ferramenta importante no entendimento de como as mudanças na vida do paciente renal crônico após o início do tratamento afetam sua capacidade de retornar ao trabalho.

Abstract Introduction: The lives of people with Chronic Kidney Disease (CKD) are changed in several ways, among them, work stands out as one of those that suffers profound consequences and compromises its continuity. Although there are studies on the limitations imposed by the treatment of CKD in professional activities, the perception of patients in relation to these limitations is still little explored in the literature. Objective: To know the perceptions of chronic kidney patients, on hemodialysis and kidney transplant patients, about the limitations imposed by the treatment in their professional activities. Methods: Qualitative study, carried out with 21 patients with CKD (13 on hemodialysis and 8 with kidney transplant). Data collection took place through interviews, based on a semi-structured script, and submitted to content analysis, in the thematic modality. Results: Three analysis themes were identified: 1. Diagnosis and access to treatment; 2. Limitations in daily activities and work and 3. Work-related changes and family support. Among hemodialysis patients, the need for frequent sessions was cited as a barrier to resuming work activities. Even among transplant patients, physical limitations and post-surgical care affected productivity and the ability to return to work as usual. Conclusions. The changes experienced by respondents after starting CKD treatment affected their ability to return to work, and family support was considered essential to facilitate this process. Qualitative research proved to be an important tool in understanding how changes in the life of chronic renal patients after starting treatment affect their ability to return to work.

Abstract Coronaviruses are known to be responsible for infections in humans since the 1960s and have accounted for epidemics in recent human history. More recently, in 2019, a disease caused by a new coronavirus appeared in China, in the province of Wuhan, with a characteristic of greater infectivity, called COVID-19, which has caused a new world pandemic. Considering the need to contain the advance in the number of cases, based on the high rate of transmissibility, several countries have adopted extreme social distancing measures, including the so-called ‘lockdown’. Despite the socioeconomic side effects, the aforementioned measure reduced the progression of the pandemic in countries that adopted it. In Brazil, the state of Ceará was one of the first epicenters of the disease in the country and the state capital city of Fortaleza, on May 8, implemented the lockdown measure to contain the increase in the number of cases. It was then observed, in a tertiary hospital, which is a referral for COVID-19 cases, a decrease in the daily occupancy rate of beds reserved for the pandemic after the lockdown onset, evidencing that this measure leads to a sustainable reduction in bed occupation rates, thus preventing the collapse and overload in health services.

SUMMARY Background: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death.

ResumenRESUMEN: Arch Med Inter 2013 - 35(2):55-58 La rabdomiólisis es una condición clínica en la que ocurre daño al músculo esquelético, lo que lleva a la liberación de componentes celulares a la circulación, siendo una de sus complicaciones el fallo renal agudo. Describimos el caso de un paciente de 46 años, usuario de drogas por más de 20 años, que habia hecho uso de grandes cantidades de cocaína y luego realizó actividades extenuantes. Después del episodio, presentó dolor abdominal de moderada intensidad, asociado con el oscurecimiento de la orina y oliguria, refiriéndose también náuseas, vómitos y fiebre. Fue admitido con cuadro de insuficiencia respiratoria, fallo renal agudo y acidosis metabólica. Los niveles de creatinokinasa estaban significativamente elevados (47914UI/L). Se realizó hemodiálisis de emergencia. El paciente mejoró en los diez días siguientes, con recuperación de la función renal. Presentó un síndrome de abstinencia, que fue controlada con benzodiazepínicos. Este caso ilustra la ocurrencia de rabdomiólisis y fallo renal agudo causados por el uso de cocaína. Se debe tener en cuenta la posible ocurrencia de estas complicaciones en todo paciente drogadicto, para realizar un diagnóstico y tratamiento adecuado.

AbstractABSTRACT: Arch Med Ina 2013 - 35(2):55-58 Rhabdomyolysis is a clinical condition in which there is injury to the muscle, which causes the release of celular components into circulation, and one of the complications isa cute kidney injury. We describe the case of a 46 years old patient, drug user for more than 20 years, who has uses large amount of cocaine and then went to practice a strenuous exercise. After the episode he developed moderate intensity abdominal pain, associated with dark-colored urine and oliguria, along with nausea, vomiting and fever. He was admitted with respiratory insufficiency, acute kidney injury and metabolic acidosis. The levels of creatinokinasa were extremely high (47914IU/L). Urgent hemodialysis was done. The patient remained stable, with normalization of arterial pH and a syndrome compatible with abstinence, which was treated with benzodiazepines. After ten days he presented total recovery of renal function. This case illustrates the occurrence of rhabdomyolysis and acute kidney injury due to the use of cocaine. It is important to have in mind the possible occurrence of these complications in every drug user patient, in order to give adequate diagnosis and treatment.