Abstract Background: Despite well-documented risks, injectable supplements containing high doses of vitamins are commonly used. Objectives: To describe acute kidney injury (AKI) as a complication of vitamin intoxication. Methods: Our series consisted of 16 patients with kidney complications resulting from the use of veterinary intramuscular injection supplements of vitamin A, D and E. The patients were admitted to two referral hospitals in Fortaleza (Brazil) between January 2010 and January 2015. Results: Patients’ mean age was 28.3 ± 8.9 years (19-53 years), and 11 (68.7%) were male. Main signs and symptoms upon admission were nausea (68.7%), vomiting (62.5%), weight loss (43.7%), epigastric pain (31.2%) and headache (31.2%). At hospital admission the mean laboratory values were: hemoglobin 10 ± 2.0 g/dL (6.1-14.2), leukocytes 10,542 ± 4871/mm3 (4100-15,100), creatinine 3.9 ± 5.2 mg/dL (0.7-22) and urea 91 ± 88 mg/dL (22-306), respectively. Serum calcium was 12 ± 2.2 mg/dL (8.8-15.5), 24-h urine calcium was 575 ± 329 mg (10.7-1058), serum PTH was 55 ± 141 pg/mL (2-406), and serum vitamin D concentration was 135 ± 75 ng/mL (22-265). Using KDIGO criteria, AKI was diagnosed in 13 patients (81.2%), classified as stage 1 (n = 3), stage 2 (n = 3) or stage 3 (n = 7). No deaths occurred in the study period. Conclusions: Excessive use of veterinary vitamin supplements containing high doses of vitamin A, D and E was associated with AKI. Hypercalcaemia, which was a common finding, appears to be a contributing factor to the development of this type of AKI.

Resumen Antecedentes: Suplementos inyectables que contienen altas dosis de vitaminas son utilizados con frecuencia, a pesar de los riesgos bien documentados. Objetivo: Describir la ocurrencia de daño renal agudo (IRA) como complicación de intoxicación por suplementos vitamínicos. Métodos: Esta es una serie de 16 pacientes con complicaciones renales resultantes de la utilización de inyección intramuscular de suplementos veterinarios con vitaminas A, D y E. Los pacientes fueron ingresados en 2 hospitales de referencia en Fortaleza (Brasil), entre enero de 2010 y enero de 2015. Resultados: La edad media de los pacientes fue de 28,3 ± 8,9 años (19-53 años) y 11 (68,7%) eran varones. Signos y síntomas principales al ingreso fueron náuseas (68,7%), vómitos (62,5%), pérdida de peso (43,7%), dolor epigástrico (31,2%) y cefalea (31,2%). Al ingreso en el hospital los valores medios de laboratorio fueron: hemoglobina 10 ± 2,0 g/dL (6,1-14,2), leucocitos 10.542 ± 4.871/mm3 (4.100-15.100), creatinina 3,9 ± 5,2 mg/dL (0,7-22) y urea 91 ± 88 mg/dL (22-306), respectivamente. El nivel de calcio sérico fue de 12 ± 2,2 mg/dL (8,8-15,5), el de calcio en orina de 24 h fue de 575 ± 329 mg (10,7-1.058), el de PTH sérico fue de 55 ± 141 pg/mL (2-406) y el nivel de vitamina D sérica fue de 135 ± 75 ng/mL (22-265). Utilizando criterios KDIGO, se diagnosticó IRA en 13 pacientes (81,2%); fueron clasificadas como clase 1 (n = 3), clase 2 (n = 3) y clase 3 (n = 7). No hubo muertes en el período de estudio. Conclusiones: El uso excesivo de suplementos vitamínicos veterinarios que contienen altas dosis de vitamina A, D y E se asoció con IRA. La hipercalcemia, un hallazgo común, parece ser un factor que contribuye al desarrollo de este tipo de IRA.

RESUMO Nos últimos anos, o olhar sobre a formação dos profissionais de saúde tem se intensificado, particularmente sobre aquela que possa impactar a resolução dos problemas de saúde da população. Um dos aspectos para o alcance desta demanda refere-se a uma formação que incorpore metodologias ativas no processo ensino-aprendizagem de estudantes da saúde. Neste entendimento, tomando como referência metodologias de aprendizagem baseada em problemas, as quais utilizam certos passos para a resolução de problemas, e diante dos desafios de trabalhar com grandes grupos, desenvolveu-se a estratégia educacional denominada Ciclo de Discussão de Problemas (CDP). Este artigo tem por objetivo descrever o CDP como uma estratégia educacional utilizada em grandes grupos no ensino da graduação em saúde. Esta estratégia ancora-se nos princípios de metodologia ativa, pois utiliza problemas com temáticas comuns aos cursos da área da saúde, para desenvolver nos alunos o aprendizado autodirigido, a habilidade de solucionar problemas, o pensamento crítico e o estudo colaborativo, além da visão integrada das ciências básicas. Esta estratégia envolve dois momentos em sala de aula para cada problema: análise e resolução, englobando 12 passos.

ABSTRACT In recent years, the training of health professionals has become an area of increasing scrutiny and focus, particularly regarding what can be done to solve public health problems. One aspect that can respond to such demands is training that incorporates active methodologies in health students’ learning processes. By this understanding, taking problem-based learning methodologies as a reference, which follow certain steps to solve problems, and in light of the challenges in working with large groups, we developed an educational strategy called Cycle of Problem Discussion (CDP). This article aims to describe CPD as a pedagogical strategy used in large groups in undergraduate health courses. This strategy is anchored in principles of active methodology because it applies problems with common themes to healthcare courses in order to develop students’ self-directed learning, problem-solving abilities, critical thinking and collaborative study, in addition to an integrated view of basic sciences. The strategy involves two moments for each problem in the classroom: analysis and resolution, encompassing twelve steps.

Objective: To determine the rates of red blood cell and leukocyte alloimmunization in patients with chronic kidney disease awaiting kidney transplantation. Methods: In this cross-sectional and prospective study, the serum of 393 chronic kidney disease patients on a transplant waiting list in Ceará, Northeastern Brazil were tested for red cell and leukocyte antibodies. In addition, demographic, clinical and laboratory data were collected. Results: The average age in the sample of 393 patients was 34.1 ± 14 years. Slightly more than half (208; 52.9%) were male. The average numbers of transfusions and gestations were 3.1 ± 3.3 and 1.6 ± 6, respectively. One third (33.6%) were alloimmunized: 78% with leukocyte antibodies, 9.1% with red cell antibodies and 12.9% with both. Red cell antibodies were detected in 29 cases (7.4%), 17 of whom were women, who had received more transfusions than the males (p-value < 0.0001). The most frequently detected red cell antibodies belonged to the Rh (24.1%) and Kell (13.8%) blood group systems. Leukocyte antibodies were detected in 30.5% of cases, 83 of whom were women, who had received more transfusions than the males (p-value < 0.0001) and were more reactive to panel reactive antibodies (p-value < 0.0001). The mean alloreactivity to panel reactive antibodies was 47.7 ± 31.2%. Conclusion: Chronic kidney disease patients on the transplant waiting list in Ceará, Brazil, display high rates of red cell (7.4%) and leukocyte (30.5%) alloimmunization. In this sample, alloimmunization was significantly associated with the number of transfusions and gender.