ABSTRACT Introduction: Optimal fluid balance in peritoneal dialysis requires adequate urinary and peritoneal water and sodium removal and restriction of dietary sodium intake (<2 g/day). We aim to study the relationship between sodium intake, blood pressure control and medication burden in peritoneal dialysis patients. Methods: Observational, cross-sectional study of chronic peritoneal dialysis patients followed in our hospital in March 2022. We estimated patient’s sodium intake according to the equations proposed by Kim et al. Mean ambulatory blood pressure was categorized in controlled, stage one, stage two and stage three hypertension. A qualitative evaluation of sodium intake was done by asking patients about their compliance with a low-salt diet. Results: Eighty-two patients: mostly men, with a mean age of 54.1±14.7 years and dialysis vintage of 26.2±18.7 months. Most patients were on continuous ambulatory peritoneal dialysis (63.4%) and the mean weekly Kt/V was 2.2±0.4. A percentage of 85.4% of our patients had residual diuresis, averaged at 1257±867 mL/day. Mean dietary sodium intake was 3.5±1.1 g; it was higher in men and patients with uncontrolled hypertension, regardless of age, dialysis vintage and other comorbidities. We found a strong correlation between dietary sodium intake and residual diuresis, systolic blood pressure, diastolic blood pressure and the number of anti-hypertensive drugs. Patients with a sodium intake ≥ 3.3 g had higher risk of uncontrolled BP and higher medication burden. Qualitative evaluation of this sub-population revealed that only 2.3% (n=1) admitted non-compliance with a low-sodium diet. Conclusion: We found a strong correlation between estimated dietary sodium consumption, blood pressure control and medication burden. Most importantly, there was a striking difference between patient’s perception of sodium consumption and the actual results. Our results highlight the importance of dietary salt restriction in blood pressure control and reinforce the need for a dietary consultation in peritoneal dialysis patients.

Abstract Introduction: Coronavirus disease 19 (COVID-19) has caused a direct increase in mortality but not all of it is entirely attributable to COVID-19, meaning there was a higher rate of mortality in non-COVID-19 patients due to the pandemic. The aim of this study was to compare two groups of patients: group 1, which included all of the patients admitted to the Internal Medicine ward during the month of April in the year 2019 and group 2, composed of all of the patients admitted to the same ward in April 2020 (a non-COVID ward) and to identify factors which were closely related with worse renal function in two group of patients. Methods: Retrospective observational study carried out through the analysis of digital data of all non-COVID-19 patients admitted at an Internal Medicine ward in April 2019 (group 1) and April 2020 (group 2). Results: A total of 162 patients were included. Group 1 represented 63.6% of the patients and group 2 represented 36.4%. Although there was a significant difference (p<0.001) between baseline creatinine and that presented at admission for hospitalization in both groups, the difference was markedly greater in the second group when compared to the first group. The worsening of renal function, measured by the CKD-EPI formula, was associated with higher mortality, which was higher in the 2020 group. Conclusion: There was a sense of fear imposed by the pandemic, which delayed resorting to medical care. This increased the severity of medical conditions. In the post-pandemic aftermath, it is essential that General and Family Medicine coordinate effectively with different medical specialties to jointly improve the follow-up of our patients.

Resumo Introdução: A doença de coronavírus 19 (COVID-19) causou um aumento direto na mortalidade, mas nem tudo é totalmente atribuível ao COVID-19, o que significa que houve uma taxa mais elevada de mortalidade em doentes não COVID-19 devido à pandemia. O objetivo deste estudo foi comparar dois grupos de doentes: grupo 1, incluiu todos os doentes internados na enfermaria de Medicina Interna durante o mês de abril do ano de 2019 e o grupo 2, composto pelos doentes internados na mesma enfermaria em abril de 2020 (enfermaria não COVID) e identificar o que se associou, de forma significativa, a alteração da função renal. Métodos: Estudo observacional retrospetivo realizado através da análise de dados digitais de todos os doentes não COVID-19 internados numa enfermaria de Medicina Interna em abril de 2019 (grupo 1) e abril de 2020 (grupo 2). Resultados: Foram incluídos 162 doentes; dos quais 63,6% eram do grupo 1 e 36,4% do grupo 2. Embora houvesse diferença significativa (p<0,001) entre a creatinina basal e a apresentada à admissão para internamento em ambos grupos, a diferença foi marcadamente maior no segundo grupo quando comparado ao primeiro grupo. O agravamento da função renal, medida pela fórmula CKD-EPI, associou-se a maior mortalidade que foi mais elevada no grupo de 2020. Conclusão: A pandemia COVID-19 impôs um sentimento de medo na população, que levou ao atraso no recurso aos serviços de saúde, levando a uma maior gravidade das condições médicas. No rescaldo pós-pandemia, é essencial uma coordenação eficaz entre a Medicina Geral e Familiar e as diferentes especialidades médicas para melhorar, conjuntamente, o acompanhamento dos nossos doentes, de forma a eliminar o medo imposto pela COVID-19.

ABSTRACT Introduction: Sleep disorders affect up to 70% of peritoneal dialysis (PD) patients and appear to have significant negative effects on their quality of life (QoL). We compared life and sleep quality between patients on automated PD (APD) and continuous ambulatory PD (CAPD). Material and Methods: Cross-sectional study in chronic PD patients followed in our Dialysis Unit in February 2022. We evaluated sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) and QoL with EUROHIS-QOL-8. Results: Fifty-two patients, mostly men (65.4%, n=32), with a mean age of 52.7±14.2 years and PD vintage of 24.3±17.1 months. Our sample had similar distribution between APD and CAPD; we found no difference between groups regarding demographic data, PD-related quality parameters or prevalence of previous sleep disturbances. Mean QoL index was 69.9%±9.3% and similar between APD and CAPD patients; EUROHIS-QOL-8 negatively correlated with the scores on ESS (p=0.004) and PSQI (p=0.011). Regarding sleep quality, the mean ESS was 8.8±4.2 and PSQI was 7.6±3.6. APD patients had similar scores on ESS, but higher prevalence of severe daytime sleepiness (ESS≥18) (p=0.04) and higher scores on PSQI (p=0.002). Within the PSQI, sleep’ latency (p=0.003), duration (p=0.002) and efficiency (p=0.013) were the most affected parameters. Higher PSQI scores also correlated with worse blood pressure control; a cut-off value for PSQI of 6 was found to increase the risk of uncontrolled hypertension. Conclusion: In our series, APD patients had worse global sleep quality (PSQI) when compared to ACPD patients. This difference was mainly due to worse sleep latency, duration and efficiency. The assessment of the quality of life showed no difference between groups, however there was a clear link between quality of life and sleep quality.

ABSTRACT A 43-year-old male patient followed for 27 years in a Nephrology consultation with negative autoimmune diagnostic workup and a histologically proven membranous nephropathy (MN), interpreted as a primary MN. During the follow-up he had multiple relapses, requiring continuous immunosuppression. Eventually, end-stage renal disease developed and the patient started hemodialysis (HD) in January 2018. Soon after initiating HD, he was admitted to the ward due to persistent fever of unknown origin, refractory to antipyretic and antibiotic therapy, but responsive to prednisolone (40 mg/day). Again, the diagnostic workup was negative and the patient was discharged with a corticosteroid taper over 16 weeks. In a posterior admission, after prednisolone suspension, the patient presented to the emergency room with persistente fever, involuntary weight loss, pruriginous macular rash and inflammatory joint pain. As the anti-nuclear antibody and anti-dsDNA came up positive and there was complement consumption, a diagnosis of a systemic lupus flare was established. His stay was complicated by sudden respiratory distress associated with hemoptysis and hemoglobin drop, with a confirmed diffuse alveolar hemorrhage. Daily plasma Exchange and intensive immunosuppression was necessary and the patient evolved into complete clinical remission with partial serological response. Usually, patients with systemic lupus erythematosus (SLE) develop clinical and serological remission upon initiating HD, reducing the number of flares and need for medication. This case depicts a lupus flare after starting HD, on a previously serologically negative patient, complicated with a rare type of lung parenchyma involvement, which is associated with a high mortality and required intensive immunosuppression for disease control. One can speculate whether or not the initial glomerulopathy was the first manifestation of SLE, previously controlled due to the continuous use of immunosuppression.

A Doença de Fabry é uma doença hereditária recessiva ligada ao X, que resulta da deficiência da enzima hidrolase α -galactosidade A (α -Gal A). A ausência de actividade da α -Gal A leva à acumulação de glicoesfingolípidos globotriaosilceramida (GL -3) nos lisossomas das células. É responsável por lesões cutâneas e oculares, bem como doença renal, cardíaca e cerebrovascular. Os autores apresentam uma doente de 39 anos, género feminino que foi referenciada pelo seu Oftalmologista à consulta de Nefrologia, após o diagnóstico de córnea verticillata e catarata subcapsular posterior. Este caso ilustra a importância de uma equipa multidisciplinar na detecção da doença. No homem, a maioria dos sintomas inicia -se na infância; no género feminino, o início da sintomatologia ocorre mais tarde e a sua apresentação é mais variável. A heterogeneidade das manifestações leva ao erro ou atraso diagnóstico. O diagnóstico precoce é fundamental para que a terapêutica enzimática de substituição seja iniciada antes da lesão irreversível

Fabry’s disease is a recessive X -linked disorder that results from a deficiency of the hydrolase alpha-galactosidase A (α-Gal A). The absence of α -Gal A enzyme activity leads to accumulation of glycosphingolipid globotryaosylceramide (GL -3) in the lysosomes of a variety of cell types. It can cause skin and ocular lesions, progressive renal, cardiac or cerebrovascular disorders. The authors report the case of a 39-year-old female who was referred to a nephrology appointment by her ophthalmologist, after the diagnosis of cornea verticillataand posterior subcapsular cataract. This case illustrates the importance of a multidisciplinary evaluation to an effective clinical screening. In males, most symptoms begin in childhood; in females the onset can be observed later and presentation is more variable. Various manifestations often lead to misdiagnosis or are frequently delayed for many years. Enzyme replacement therapy highlights the importance of early diagnosis so that treatment can be initiated before irreversible organ damage occurs

A trombose do seio cavernoso (TSC) é uma situação clínica rara, resultando normalmente da complicação de um processo infeccioso dos seios paranasais. Outras causas incluem alterações pró-trombóticas, anemia e trauma. Os sinais e sintomas são extremamente variados e inespecíficos, sendo o seu diagnóstico efetuado através de ressonância magnética nuclear (RMN). Os autores apresentam um caso clínico de uma doente com 75 anos de idade, que recorre ao serviço de urgência devido à dor em olho direito vermelho associado à cefaléias frontais com quatro dias de evolução. Ao exame oftalmológico observou-se defeito pupilar aferente relativo no olho direito (OD); na biomicroscopia vasos episclerais dilatados, catarata nuclear e à fundoscopia um edema discreto da papila com apagamento do rebordo nasal, hemorragias punctiformes dispersas e tortuosidade vascular em OD. A realização de angio-RMN confirmou o diagnóstico tendo a doente sido tratada com enoxaparina. Apesar do tratamento da TSC ser um tratamento etiológico, foi demonstrado que a anticoagulação está associada à diminuição da taxa de mortalidade.

Cavernous sinus thrombosis (CST) is a rare condition, usually results from a late complication of an infection of the paranasal sinuses. Other causes include prothrombotic disorders, anemia and trauma. The signs and symptoms are extremely varied and nonspecific, being the diagnosis made through magnetic resonance imaging (MRI). The authors present a 75-year-old woman, admitted in the emergency room complaining of ocular pain in the right eye (RE), red eye and frontal headache. She presented on ophthalmic examination of the RE: dilated episcleral vessels, nuclear cataract and a relative afferent pupillary defect. Fundoscopy examination of the RE revealed disc edema with nasal disc margin blurred, small dot hemorrhages and vascular tortuosity. The MRI angiography confirmed the diagnosis and the patient was treated with low molecular weight heparin. Despite treatment of CST is directed to the causal situation, being shown that anticoagulation is associated with reduction in mortality.