Resumo Introdução: Disfunção erétil (DE) é um problema sexual comum entre homens com doença renal crônica (DRC). A gravidade da disfunção sexual tende a piorar com a lesão renal. Este estudo tem como objetivo avaliar função erétil e qualidade de vida sexual de pacientes homens adultos com DRC em hemodiálise (HD) em um hospital na Amazônia brasileira. Métodos: Realizou-se estudo quantitativo transversal no Setor de HD da Unidade de Nefrologia, incluindo homens com DRC ≥ 18 anos, submetidos a ≥ 3 sessões semanais de HD por ≥ 3 meses e sexualmente ativos por ≥ 6 meses. Utilizamos o Quociente Sexual Masculino (QSM) para medir satisfação sexual e o Índice Internacional de Função Erétil (IIEF5) para estabelecer função erétil. A análise estatística foi realizada com o SPSS 21.0 usando testes apropriados, como Mann-Whitney e Kruskal-Wallis (P < 0,05). Resultados: Avaliamos 98 pacientes (51,68 ± 15,28 anos). Eles eram predominantemente casados/ou vivendo com um(a) parceiro(a) (60,20%), com tempo de HD entre 1 e 5 anos (55,10%) e KTV médio de 1,17. A prevalência de DE foi 66,30% e foi associada a maior faixa etária (p = 0,01), menor renda familiar (p = 0,02), diabetes (p = 0,01), menor hemoglobina corpuscular média (p = 0,04), maior cálcio total (p = 0,04) e menor albumina (p = 0,03). Aproximadamente 75% classificaram sua vida sexual como regular a excelente. Conclusão: Apesar da elevada prevalência de DE, a maioria dos homens com DRC em HD relatou vida sexual regular a excelente. O estudo ressalta a importância de estabelecer triagem eficaz e realizar avaliações de rotina sobre questões sexuais nesses homens. Introdução (DE DRC. . (DRC) (HD brasileira Métodos Realizouse Realizou se Nefrologia QSM (QSM IIEF5 IIEF (IIEF5 210 21 0 21. apropriados MannWhitney Mann Whitney KruskalWallis Kruskal Wallis P 0,05. 005 0,05 05 0,05) Resultados 9 51,68 5168 51 68 (51,6 1528 15 28 15,2 anos. anos) casadosou casados ou uma um(a parceiroa parceiro parceiro(a 60,20%, 6020 60,20% , 60 20 (60,20%) 55,10% 5510 55 10 (55,10% 117 17 1,17 6630 66 30 66,30 p 0,01, 001 0,01 01 0,01) 0,02, 002 0,02 02 0,02) 0,04, 004 0,04 04 0,03. 003 0,03 03 0,03) 75 excelente Conclusão (DRC (IIEF 2 00 0,0 51,6 516 (51, 152 15, 602 60,20 (60,20% 55,10 551 (55,10 11 1,1 663 66,3 7 0, 51, (51 60,2 (60,20 55,1 (55,1 1, 66, (5 60, (60,2 55, (55, ( (60, (55 (60 (6

Abstract Introduction: Erectile dysfunction (ED) is a common sexual problem among men with chronic kidney disease (CKD). The severity of sexual dysfunction tends to worsen with kidney damage. This study aims to evaluate the erectile function and sexual quality of life of adult male CKD patients undergoing hemodialysis (HD) in a hospital located in the Brazilian Amazon. Methods: A cross-sectional quantitative study was performed within the HD Sector of the Nephrology Unit including men with CKD aged ≥ 18 years, undergoing ≥ 3 weekly HD sessions for ≥ 3 months who had been sexually active for ≥ 6 months. We used the Male Sexual Quotient (MSQ) to measure sexual satisfaction and the International Index of Erectile Function (IIEF5) to establish erectile function. Statistical analysis was performed with SPSS 21.0 using appropriate tests, such as Mann-Whitney and Kruskal-Wallis (P < 0.05). Results: Ninety-eight patients (51.68 ± 15.28 years) were evaluated. They were primarily married/or living with a partner (60.20%), with HD time between 1 to 5 years (55.10%), and an average KTV of 1.17. ED prevalence was 66.30%, and it was associated with a higher age group (p = 0.01), lower family income (p = 0.02), diabetes (p = 0.01), lower mean corpuscular hemoglobin (p = 0.04), higher total calcium (p = 0.04), and lower albumin (p = 0.03). Around 75% classified their sex life as regular to excellent. Conclusion: Despite the high ED prevalence, most men with CKD in HD reported experiencing regular to excellent sex life. The study underscores the importance of establishing effective screening and conducting routine evaluations regarding sexual issues in these men. Introduction (ED CKD. . (CKD) damage (HD Amazon Methods crosssectional cross sectional MSQ (MSQ IIEF5 IIEF (IIEF5 210 21 0 21. tests MannWhitney Mann Whitney KruskalWallis Kruskal Wallis P 0.05. 005 0.05 05 0.05) Results Ninetyeight Ninety eight 51.68 5168 51 68 (51.6 1528 15 28 15.2 evaluated marriedor married or 60.20%, 6020 60.20% , 60 20 (60.20%) 55.10%, 5510 55.10% 55 10 (55.10%) 117 17 1.17 6630 66 30 66.30% p 0.01, 001 0.01 01 0.01) 0.02, 002 0.02 02 0.02) 0.04, 004 0.04 04 0.04) 0.03. 003 0.03 03 0.03) 75 Conclusion (CKD (IIEF 2 00 0.0 51.6 516 (51. 152 15. 602 60.20 (60.20% 551 55.10 (55.10% 11 1.1 663 66.30 7 0. 51. (51 60.2 (60.20 55.1 (55.10 1. 66.3 (5 60. (60.2 55. (55.1 66. ( (60. (55. (60 (55 (6

RESUMO A doença renal crônica (DRC) representa um dos principais problemas de saúde pública da atualidade. A dosagem da creatinina sérica e a estimativa da taxa de filtração glomerular (TFG) são as principais ferramentas para avaliação da função renal. Para a estimativa da TFG, existem diversas equações, sendo a mais recomendada a CKD-EPI (Chronic Kidney Disease – Epidemiology). Existem ainda algumas controvérsias com relação à dosagem da creatinina sérica e da estimativa da TFG, uma vez que vários fatores podem interferir nesse processo. Uma importante mudança recente foi a retirada da correção por raça das equações para estimativa da TFG, que superestimavam a função renal, e consequentemente retardavam a implementação de tratamentos como diálise e transplante renal. Neste documento de consenso da Sociedade Brasileira de Nefrologia e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial são revisados os principais conceitos relacionados à avaliação da função renal, possíveis controvérsias existentes e recomendações para a estimativa da TFG na prática clínica. DRC (DRC atualidade (TFG CKDEPI CKD EPI Chronic Epidemiology. Epidemiology . Epidemiology) processo clínica

ABSTRACT Chronic kidney disease (CKD) represents one of today’s main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease – Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice. CKD (CKD todays today s problems (GFR CKDEPI EPI Epidemiology process transplantation Medicine reviewed practice

Abstract Background Chagas disease (CD) is a serious public health problem in Latin America. Benznidazole (BNZ) is used for the treatment of CD and, despite its wide use, little information is available about its toxicity and mechanisms of adverse drug reactions (ADR). Objectives To identify and classify clinical and laboratory adverse reactions caused by BNZ in terms of causality and severity. Methods Prospective cohort study from January 2018 to December 2021. Treatment follow-up included visits and biochemical tests (complete blood count, liver and kidney function tests) before, during and after treatment. ADR were classified according to causality and severity. In the statistical analysis, the significance level was set at p<0.05. Results Forty patients with chronic CD were included. A high prevalence of ADR was observed 161 ADR in 30 patients [90%]; of these, 104 (64.6%) were classified as possible and 57 (35.4%) as probable. The ADR were classified as moderate and mild. Of the 40 patients, nine (22.5%) discontinued treatment. ADR associated with treatment discontinuation and interventions were those that affected the dermatological system, central and peripheral nervous system and sense organs such as ageusia. Mild hematological and biochemical changes such as lymphopenia were observed after 30 days of treatment. Conclusion Many patients were able to complete the treatment even with ADR, which can be attributed to the successful follow-up strategy with symptomatic treatment and counseling, leading to patient’s awareness of symptoms and treatment adherence. (CD America (BNZ use ADR. . (ADR) severity 201 2021 followup follow up count before analysis p005 p 0 05 p<0.05 16 3 90% 90 [90%] these 10 64.6% 646 64 6 (64.6% 5 35.4% 354 35 4 (35.4% probable mild 22.5% 225 22 (22.5% ageusia counseling patient s adherence (ADR 20 202 p00 p<0.0 1 9 [90% 64.6 (64.6 35.4 (35.4 22.5 2 (22.5 p0 p<0. [90 64. (64. 35. (35. 22. (22. p<0 [9 (64 (35 (22 p< [ (6 (3 (2 (

Resumo Fundamento A Doença de Chagas (DC) representa um grave problema de saúde pública na América Latina. O Benznidazol (BNZ) é utilizado para o tratamento DC e, apesar do seu amplo uso, poucas informações estão disponíveis sobre sua toxicidade e mecanismos das Reações Adversas ao Medicamento (RAM). Objetivos Identificar e classificar as reações adversas clínicas e laboratoriais ocasionadas pelo uso do BNZ quanto à sua causalidade e gravidade. Métodos Estudo de coorte prospectivo realizado no período de janeiro de 2018 a dezembro de 2021. O acompanhamento do tratamento incluiu consultas e análises laboratoriais antes, 30 e 60 dias após o início do tratamento. As RAM foram classificadas quanto à causalidade e gravidade. Na análise estatística o nível de significância adotado foi p<0,05. Resultados Participaram do estudo 40 pacientes com DC crônica, observou-se alta prevalência de RAM com um total de 161 em 30 (90%) pacientes. Destas, 104 (64,6%) foram classificadas como possíveis e 57 (35,4%) como prováveis. As reações foram classificadas em moderadas e leves. Dos 40 pacientes, nove (22,5%) suspenderam o tratamento. As RAM associadas à interrupção e intervenções foram as que afetaram o sistema dermatológico, sistema nervoso central e periférico ou que culminaram em ageusia. Após 30 dias de tratamento, alterações hematológicas e bioquímicas leves foram observadas como linfopenia. Conclusão Apesar do elevado percentual de RAM, muitos pacientes foram capazes de completar o tratamento, o que se atribui ao êxito da estratégia de acompanhamento com intervenções de tratamento sintomático juntamente ao aconselhamento, levando à compreensão da sintomatologia e manutenção do tratamento. (DC Latina (BNZ RAM. . (RAM) gravidade 201 2021 antes 3 6 p005 p 0 05 p<0,05 4 crônica observouse observou 16 90% 90 (90% Destas 10 64,6% 646 64 (64,6% 5 35,4% 354 35 (35,4% prováveis 22,5% 225 22 (22,5% dermatológico ageusia linfopenia aconselhamento (RAM 20 202 p00 p<0,0 1 9 (90 64,6 (64,6 35,4 (35,4 22,5 2 (22,5 p0 p<0, (9 64, (64, 35, (35, 22, (22, p<0 ( (64 (35 (22 p< (6 (3 (2

Abstract Introduction: Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria. Objective: To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population. Method: Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed. Results: A total of 1138 subjects were interviewed, with a median age of 36 years old (27–52); 55.1% were female. Regarding the “creatinine” biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were “I don’t know” (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into “knows” and “does not know” the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16–8.43, p < 0.001). Conclusion: There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine. Introduction asymptomatic tests proteinuria Objective Method Crosssectional Cross sectional SP, SP (SP Brazil, Brazil , Brazil) interviewed Results 113 3 27–52 2752 27 52 (27–52) 551 55 1 55.1 “creatinine 406 40 6 40.6 exam 196 19 19.6 I dont don t know 71.6%, 716 71.6% 71 (71.6%) 0.9% 09 0 9 (0.9% 7.8%. 78 7.8% . 7 8 (7.8%) 294 29 4 29.4 knows “knows does 0.05 005 05 education sex studentworker student worker student/worker analysis OR 5.16 516 5 16 95 316843 43 3.16–8.43 0.001. 0001 0.001 001 0.001) Conclusion checkups 11 27–5 275 2 (27–52 55. 40. 19. 71.6 (71.6% 0.9 (0.9 7.8 (7.8% 29. 0.0 00 5.1 51 31684 3.16–8.4 000 0.00 27– (27–5 71. (71.6 0. (0. 7. (7.8 5. 3168 3.16–8. (27– (71. (0 (7. 316 3.16–8 (27 (71 ( (7 31 3.16– (2 3.16 3.1 3.

Resumo Introdução: A doença renal crônica costuma ser assintomática e seu diagnóstico depende da realização de exames laboratoriais, com destaque para a creatinina sérica e pesquisa de proteinúria. Objetivo: Avaliar em uma amostra da população brasileira o conhecimento sobre o papel da creatinina sérica como marcador de função renal. Método: Estudo observacional transversal realizado na cidade de São Paulo (SP, Brasil), em que foi entrevistada uma população adulta aleatória. Resultados: Foram entrevistados 1138 indivíduos, com idade mediana de 36 anos (27–52); 55,1% do sexo feminino. Com relação ao marcador “creatinina”, 40,6% afirmaram que nunca realizaram tal dosagem. Quando questionados quanto ao conhecimento sobre a utilidade desse exame, somente 19,6% sabiam a sua função. As outras respostas foram “não sei” (71,6%), avaliar o funcionamento do coração (0,9%) e fígado (7,8%). Dos que afirmaram já terem realizado o exame de creatinina, somente 29,4% acertaram a função da creatinina. Ao dividir os grupos em “sabe” e “não sabe” a função da creatinina, percebeu-se diferença estatisticamente significante (p < 0,05) em relação ao grau de escolaridade, sexo feminino, ser aluno/trabalhador da saúde, ter dosado creatinina alguma vez, conhecer alguém com doença renal e maior idade. Na análise multivariada, a principal variável relacionada com conhecer a função da creatinina foi ter realizado o exame anteriormente (OR 5,16; IC 95% 3,16–8,43, p < 0,001). Conclusão: Há grande desconhecimento sobre a creatinina e seu uso em check-ups. Os resultados indicam que é necessário maior esforço por parte dos profissionais de saúde para divulgar o papel da creatinina sérica. Introdução laboratoriais proteinúria Objetivo Método SP, SP (SP Brasil, Brasil , Brasil) aleatória Resultados 113 indivíduos 3 27–52 2752 27 52 (27–52) 551 55 1 55,1 feminino “creatinina” 406 40 6 40,6 dosagem 196 19 19,6 não sei 71,6%, 716 71,6% 71 (71,6%) 0,9% 09 0 9 (0,9% 7,8%. 78 7,8% . 7 8 (7,8%) 294 29 4 29,4 sabe “sabe percebeuse percebeu se 0,05 005 05 escolaridade alunotrabalhador aluno trabalhador vez multivariada OR 5,16 516 5 16 95 316843 43 3,16–8,43 0,001. 0001 0,001 001 0,001) Conclusão checkups. checkups check ups. ups check-ups 11 27–5 275 2 (27–52 55, “creatinina 40, 19, 71,6 (71,6% 0,9 (0,9 7,8 (7,8% 29, 0,0 00 5,1 51 31684 3,16–8,4 000 0,00 27– (27–5 71, (71,6 0, (0, 7, (7,8 5, 3168 3,16–8, (27– (71, (0 (7, 316 3,16–8 (27 (71 ( (7 31 3,16– (2 3,16 3,1 3,

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children’s variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children’s current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs. Introduction conditions characteristics measurements infants Methods Crosssectional Cross sectional 250 followup. followup follow up. up follow-up hypertension diabetes pregnancy childrens s sex score medications evaluation height dosages equation 6 mLmin173 mLmin mL min 1 73 mL/min/1.7 m variable Results 15 evaluated 3442 34 42 34.42 3 56.6%, 566 56.6% , 56 (56.6%) 14397 1439 7 1439. 469 46 9 46. 93 9. Discussion 25 mLmin17 mL/min/1. 344 4 34.4 56.6 5 (56.6% 143 2 mLmin1 mL/min/1 34. 56. (56.6 14 mL/min/ (56. mL/min (56 (5 (

RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos. Introdução condições nascimento Métodos 250 ambulatorial prénatal pré natal hipertensão gravidez sexo Apgar avaliação C Zapittelli Utilizouse Utilizou se associados 6 mLmin173 mLmin mL min 1 73 mL/min/1,7 m dependente Resultados 15 avaliadas 3442 34 42 34,42 3 56,6%, 566 56,6% , 56 (56,6%) 14397 1439 7 1439, 469 46 9 46, 93 9, Discussão proteção 25 mLmin17 mL/min/1, 344 4 34,4 56,6 5 (56,6% 143 2 mLmin1 mL/min/1 34, 56, (56,6 14 mL/min/ (56, mL/min (56 (5 (

Resumo A avaliação da função renal é feita por meio da taxa de filtração glomerular (TFG), que pode ser determinada pelo clearance de creatinina (CrCl) e é dependente da coleta urinária de 24 horas (h), o que dificulta o seu uso na atenção primária. As equações que estimam a TFG a partir da creatinina sérica tornam o exame mais acessível, contudo, os seus ajustes por raça/cor têm sido questionados em populações miscigenadas. Para verificar a concordância entre o ClCr e a TFG estimada por fórmulas (Modification of Diet in Renal Disease [MDRD-4] e Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), com ou sem ajuste por raça/cor, foram utilizados dados de subestudo da Pesquisa Nacional de Saúde (PNS) com inclusão de 272 adultos de Vitória, Espírito Santo, que fizeram coleta urinária de 24h. Adotou-se análise de variância (ANOVA) e método de Bland-Altman. Houve concordância adequada entre o ClCr e as equações, mas o ajuste por raça/cor diminui a acurácia destas últimas. No fator raça/cor, houve semelhança entre grupos para o ClCr (p=0,21) sugerindo não haver diferença no metabolismo da creatinina em função da cor da pele. Conclui-se que MDRD-4 e CKD-EPI apresentam desempenho satisfatório na avaliação da função renal, não sendo recomendado o uso de correções para raça/cor.

Abstract The assessment of renal function is performed using the glomerular filtration rate (GFR) whose measurement by creatinine clearance (ClCr) and is dependent on a 24-hour urine sample, hindering it use in primary healthcare. The equations that estimate GFR from serum creatinine make the test more accessible, however, their adjustments by race/color have been questioned in mixed populations. To test the agreement between CrCl and GFR estimated by formulas (Modification of Diet in Renal Disease [MDRD-4] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), with or without adjusting for race/color, data were used from a sub-study of the National Health Survey (NHS) including 272 adults from Vitória/Espírito Santo who underwent a 24-hour urinary sampling. Analysis of variance (ANOVA) and the Bland-Altman method were adopted. There was adequate agreement between ClCr and equations, but the adjustment by race/color decreases the accuracy of both equations. In the race/color factor, there was similarity between groups for CrCl (p=0.21), suggesting that there is no difference in creatinine metabolism induced by skin color. It is concluded that MDRD and CKD-EPI equations perform satisfactorily in the evaluation of renal function, and the use of corrections for race/color is not recommended.

Abstract The assessment of renal function is performed using the glomerular filtration rate (GFR) whose measurement by creatinine clearance (ClCr) and is dependent on a 24-hour urine sample, hindering it use in primary healthcare. The equations that estimate GFR from serum creatinine make the test more accessible, however, their adjustments by race/color have been questioned in mixed populations. To test the agreement between CrCl and GFR estimated by formulas (Modification of Diet in Renal Disease [MDRD-4] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), with or without adjusting for race/color, data were used from a sub-study of the National Health Survey (NHS) including 272 adults from Vitória/Espírito Santo who underwent a 24-hour urinary sampling. Analysis of variance (ANOVA) and the Bland-Altman method were adopted. There was adequate agreement between ClCr and equations, but the adjustment by race/color decreases the accuracy of both equations. In the race/color factor, there was similarity between groups for CrCl (p=0.21), suggesting that there is no difference in creatinine metabolism induced by skin color. It is concluded that MDRD and CKD-EPI equations perform satisfactorily in the evaluation of renal function, and the use of corrections for race/color is not recommended.

Resumo A avaliação da função renal é feita por meio da taxa de filtração glomerular (TFG), que pode ser determinada pelo clearance de creatinina (CrCl) e é dependente da coleta urinária de 24 horas (h), o que dificulta o seu uso na atenção primária. As equações que estimam a TFG a partir da creatinina sérica tornam o exame mais acessível, contudo, os seus ajustes por raça/cor têm sido questionados em populações miscigenadas. Para verificar a concordância entre o ClCr e a TFG estimada por fórmulas (Modification of Diet in Renal Disease [MDRD-4] e Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), com ou sem ajuste por raça/cor, foram utilizados dados de subestudo da Pesquisa Nacional de Saúde (PNS) com inclusão de 272 adultos de Vitória, Espírito Santo, que fizeram coleta urinária de 24h. Adotou-se análise de variância (ANOVA) e método de Bland-Altman. Houve concordância adequada entre o ClCr e as equações, mas o ajuste por raça/cor diminui a acurácia destas últimas. No fator raça/cor, houve semelhança entre grupos para o ClCr (p=0,21) sugerindo não haver diferença no metabolismo da creatinina em função da cor da pele. Conclui-se que MDRD-4 e CKD-EPI apresentam desempenho satisfatório na avaliação da função renal, não sendo recomendado o uso de correções para raça/cor.

Abstract The assessment of renal function is performed using the glomerular filtration rate (GFR) whose measurement by creatinine clearance (ClCr) and is dependent on a 24-hour urine sample, hindering it use in primary healthcare. The equations that estimate GFR from serum creatinine make the test more accessible, however, their adjustments by race/color have been questioned in mixed populations. To test the agreement between CrCl and GFR estimated by formulas (Modification of Diet in Renal Disease [MDRD-4] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), with or without adjusting for race/color, data were used from a sub-study of the National Health Survey (NHS) including 272 adults from Vitória/Espírito Santo who underwent a 24-hour urinary sampling. Analysis of variance (ANOVA) and the Bland-Altman method were adopted. There was adequate agreement between ClCr and equations, but the adjustment by race/color decreases the accuracy of both equations. In the race/color factor, there was similarity between groups for CrCl (p=0.21), suggesting that there is no difference in creatinine metabolism induced by skin color. It is concluded that MDRD and CKD-EPI equations perform satisfactorily in the evaluation of renal function, and the use of corrections for race/color is not recommended. (GFR (ClCr 24hour hour 24 sample healthcare accessible however racecolor race color populations Modification MDRD4 4 [MDRD-4 CKDEPI, CKDEPI CKD EPI , [CKD-EPI]) substudy sub study NHS (NHS 27 VitóriaEspírito Vitória Espírito sampling ANOVA (ANOVA BlandAltman Bland Altman adopted factor p=0.21, p021 p p=0.21 0 21 (p=0.21) recommended 2 [MDRD- [CKD-EPI] p02 p=0.2 (p=0.21 [MDRD [CKD-EPI p0 p=0. (p=0.2 p=0 (p=0. p= (p=0 (p= (p

Resumo A avaliação da função renal é feita por meio da taxa de filtração glomerular (TFG), que pode ser determinada pelo clearance de creatinina (CrCl) e é dependente da coleta urinária de 24 horas (h), o que dificulta o seu uso na atenção primária. As equações que estimam a TFG a partir da creatinina sérica tornam o exame mais acessível, contudo, os seus ajustes por raça/cor têm sido questionados em populações miscigenadas. Para verificar a concordância entre o ClCr e a TFG estimada por fórmulas (Modification of Diet in Renal Disease [MDRD-4] e Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), com ou sem ajuste por raça/cor, foram utilizados dados de subestudo da Pesquisa Nacional de Saúde (PNS) com inclusão de 272 adultos de Vitória, Espírito Santo, que fizeram coleta urinária de 24h. Adotou-se análise de variância (ANOVA) e método de Bland-Altman. Houve concordância adequada entre o ClCr e as equações, mas o ajuste por raça/cor diminui a acurácia destas últimas. No fator raça/cor, houve semelhança entre grupos para o ClCr (p=0,21) sugerindo não haver diferença no metabolismo da creatinina em função da cor da pele. Conclui-se que MDRD-4 e CKD-EPI apresentam desempenho satisfatório na avaliação da função renal, não sendo recomendado o uso de correções para raça/cor. TFG, , (TFG) CrCl (CrCl 2 h, h (h) primária acessível contudo raçacor raça miscigenadas Modification MDRD4 MDRD 4 [MDRD-4 CKDEPI, CKDEPI CKD EPI [CKD-EPI]) PNS (PNS 27 Vitória Santo 24h Adotouse Adotou se ANOVA (ANOVA BlandAltman. BlandAltman Bland Altman. Altman Bland-Altman últimas p=0,21 p021 p 0 21 (p=0,21 pele Concluise Conclui MDRD- (TFG (h [MDRD- [CKD-EPI] p=0,2 p02 (p=0,2 [MDRD [CKD-EPI p=0, p0 (p=0, p=0 (p=0 p= (p= (p

Abstract The assessment of renal function is performed using the glomerular filtration rate (GFR) whose measurement by creatinine clearance (ClCr) and is dependent on a 24-hour urine sample, hindering it use in primary healthcare. The equations that estimate GFR from serum creatinine make the test more accessible, however, their adjustments by race/color have been questioned in mixed populations. To test the agreement between CrCl and GFR estimated by formulas (Modification of Diet in Renal Disease [MDRD-4] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), with or without adjusting for race/color, data were used from a sub-study of the National Health Survey (NHS) including 272 adults from Vitória/Espírito Santo who underwent a 24-hour urinary sampling. Analysis of variance (ANOVA) and the Bland-Altman method were adopted. There was adequate agreement between ClCr and equations, but the adjustment by race/color decreases the accuracy of both equations. In the race/color factor, there was similarity between groups for CrCl (p=0.21), suggesting that there is no difference in creatinine metabolism induced by skin color. It is concluded that MDRD and CKD-EPI equations perform satisfactorily in the evaluation of renal function, and the use of corrections for race/color is not recommended.

Resumo A avaliação da função renal é feita por meio da taxa de filtração glomerular (TFG), que pode ser determinada pelo clearance de creatinina (CrCl) e é dependente da coleta urinária de 24 horas (h), o que dificulta o seu uso na atenção primária. As equações que estimam a TFG a partir da creatinina sérica tornam o exame mais acessível, contudo, os seus ajustes por raça/cor têm sido questionados em populações miscigenadas. Para verificar a concordância entre o ClCr e a TFG estimada por fórmulas (Modification of Diet in Renal Disease [MDRD-4] e Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), com ou sem ajuste por raça/cor, foram utilizados dados de subestudo da Pesquisa Nacional de Saúde (PNS) com inclusão de 272 adultos de Vitória, Espírito Santo, que fizeram coleta urinária de 24h. Adotou-se análise de variância (ANOVA) e método de Bland-Altman. Houve concordância adequada entre o ClCr e as equações, mas o ajuste por raça/cor diminui a acurácia destas últimas. No fator raça/cor, houve semelhança entre grupos para o ClCr (p=0,21) sugerindo não haver diferença no metabolismo da creatinina em função da cor da pele. Conclui-se que MDRD-4 e CKD-EPI apresentam desempenho satisfatório na avaliação da função renal, não sendo recomendado o uso de correções para raça/cor.

Abstract Objective To develop the second evidence-based Brazilian Society of Rheumatology consensus for diagnosis and treatment of lupus nephritis (LN). Methods Two methodologists and 20 rheumatologists from Lupus Comittee of Brazilian Society of Rheumatology participate in the development of this guideline. Fourteen PICO questions were defined and a systematic review was performed. Eligible randomized controlled trials were analyzed regarding complete renal remission, partial renal remission, serum creatinine, proteinuria, serum creatinine doubling, progression to end-stage renal disease, renal relapse, and severe adverse events (infections and mortality). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to develop these recommendations. Recommendations required ≥82% of agreement among the voting members and were classified as strongly in favor, weakly in favor, conditional, weakly against or strongly against a particular intervention. Other aspects of LN management (diagnosis, general principles of treatment, treatment of comorbidities and refractory cases) were evaluated through literature review and expert opinion. Results All SLE patients should undergo creatinine and urinalysis tests to assess renal involvement. Kidney biopsy is considered the gold standard for diagnosing LN but, if it is not available or there is a contraindication to the procedure, therapeutic decisions should be based on clinical and laboratory parameters. Fourteen recommendations were developed. Target Renal response (TRR) was defined as improvement or maintenance of renal function (±10% at baseline of treatment) combined with a decrease in 24-h proteinuria or 24-h UPCR of 25% at 3 months, a decrease of 50% at 6 months, and proteinuria < 0.8 g/24 h at 12 months. Hydroxychloroquine should be prescribed to all SLE patients, except in cases of contraindication. Glucocorticoids should be used at the lowest dose and for the minimal necessary period. In class III or IV (±V), mycophenolate (MMF), cyclophosphamide, MMF plus tacrolimus (TAC), MMF plus belimumab or TAC can be used as induction therapy. For maintenance therapy, MMF or azathioprine (AZA) are the first choice and TAC or cyclosporin or leflunomide can be used in patients who cannot use MMF or AZA. Rituximab can be prescribed in cases of refractory disease. In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy. Conclusion This consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil. evidencebased evidence LN. . (LN) 2 guideline performed remission doubling endstage end stage disease relapse infections mortality. mortality mortality) Assessment GRADE (GRADE 82 ≥82 favor conditional intervention diagnosis, (diagnosis opinion involvement but procedure parameters developed TRR (TRR ±10% 10 (±10 24h 24 25 months 50 08 0 8 0. g24 g g/2 1 period ±V, V ±V , (±V) MMF, (MMF) cyclophosphamide TAC, (TAC) therapy AZA (AZA adherence dosage biopsyrebiopsy rebiopsy biopsy/rebiopsy Brazil (LN ≥8 ±10 (±1 5 g2 g/ (±V (MMF (TAC ≥ ±1 (± ± (

ABSTRACT Introduction: Kidney transplantation is the most commonly performed type of transplant in Brazil. Tacrolimus is one of the primary drugs used in post-transplant immunosuppressive therapy, and one of its main adverse effects is nephrotoxicity. Laboratory tests to assess renal function are of great importance in monitoring post-kidney transplant patients, helping to diagnose events indicative of graft dysfunction. Objective: The present study aimed to evaluate the association between laboratory changes in renal function and blood levels of tacrolimus in post-kidney transplant patients. Methods: Observational, analytical and cross-sectional study. The results of blood levels of tacrolimus and measurements of urea, creatinine and estimated Glomerular Filtration Rate (eGFR) were analyzed, as well as the sociodemographic data of kidney transplant recipients followed at a university hospital who underwent laboratory tests between months from January 2021 to July 2022 in a period close to 1 year after the transplant. The variables analyzed in the research were collected from the patient's medical records and subsequently analyzed; the statistical analyses considered p < 0.05. The project was approved by the Ethics Committee of the Walter Cantídio University Hospital under opinion number 5,436,434 and CAAE number 57396622.1.0000.5045. Results: The sample was mainly composed of males, mixed race, with an average age of 51.5 years (SD ± 12.5) and from cities in the interior of Ceará. Regarding the percentage of patients with laboratory changes, 50.62% (n = 45) showed changes in tacrolimus blood levels. 56.79% (n = 46) had changes in serum creatinine levels, 49.38% (n = 40) had changes in serum urea levels, and 59.26% (n = 48) had altered eGFR. The correlation analyses suggested a low significance between variations of the variables studied. Conclusion: The results indicate no relationship between variations in tacrolimus blood concentrations and the appearance of changes in the results of classic renal biomarkers at the end of the first year post-transplant. However, it is necessary to carry out new studies to understand better the impact of changes in blood levels of tacrolimus on the renal function of renal allograft recipients. Introduction Brazil posttransplant post therapy nephrotoxicity postkidney dysfunction Objective Methods Observational crosssectional cross sectional eGFR (eGFR 202 patient s 005 0 05 0.05 5436434 5 436 434 5,436,43 57396622100005045 57396622 0000 5045 57396622.1.0000.5045 Results males race 515 51 51. SD 12.5 125 12 Ceará 5062 50 62 50.62 n 45 5679 56 79 56.79 46 4938 49 38 49.38 40 5926 59 26 59.26 48 studied Conclusion posttransplant. However 20 00 0.0 543643 43 5,436,4 5739662210000504 5739662 000 504 57396622.1.0000.504 12. 506 6 50.6 4 567 7 56.7 493 3 49.3 592 2 59.2 0. 54364 5,436, 573966221000050 573966 57396622.1.0000.50 50. 56. 49. 59. 5436 5,436 57396622100005 57396 57396622.1.0000.5 543 5,43 5739662210000 5739 57396622.1.0000. 54 5,4 573966221000 573 57396622.1.0000 5, 57396622100 57 57396622.1.000 5739662210 57396622.1.00 573966221 57396622.1.0 57396622.1. 57396622.1 57396622.

RESUMO Introdução: O transplante renal constitui o tipo de transplante mais realizado no Brasil. O tacrolimo é um dos principais fármacos utilizados na terapia imunossupressora pós-transplante e possui como um de seus principais efeitos adversos a nefrotoxicidade. Os exames laboratoriais de avaliação da função renal possuem grande importância no acompanhamento de pacientes pós-transplante renal, auxiliando no diagnóstico de eventos indicativos de disfunção do enxerto. Objetivo: O presente estudo objetivou avaliar a associação entre alterações laboratoriais de função renal e os níveis sanguíneos de tacrolimo em pacientes pós-transplante renal. Métodos: Estudo observacional, analítico e transversal. Foram analisados os resultados dos níveis sanguíneos de tacrolimo e das dosagens de ureia, creatinina e estimativa da Taxa de Filtração Glomerular (eTFG), bem como os dados sociodemográficos de receptores de transplante renal acompanhados em um hospital universitário, que realizaram exames laboratoriais entre os meses de janeiro de 2021 e julho de 2022 no período próximo a 1 ano após a realização do transplante. As variáveis analisadas na pesquisa foram colhidas a partir dos registros dos prontuários dos pacientes e posteriormente analisadas, as análises estatísticas consideraram p < 0,05. O projeto foi aprovado pelo Comitê de Ética do Hospital Universitário Walter Cantídio sob o parecer número 5.436.434 e CAAE número 57396622.1.0000.5045. Resultados: A amostra foi composta, majoritariamente, pelo sexo masculino, cor parda, idade média de 51,5 anos (DP ± 12,5) e de cidades do interior do Ceará. Quanto ao percentual de pacientes com alterações laboratoriais, 50,62% (n = 45) deles apresentaram alterações dos níveis sanguíneos de tacrolimo; ainda, 56,79% (n = 46) apresentaram alterações na dosagem de creatinina sérica, 49,38% (n = 40) apresentaram alterações na dosagem de ureia sérica e 59,26% (n = 48) apresentaram uma eTFG alterada. As análises de correlação realizadas sugeriram uma baixa significância entre variações das variáveis estudadas. Conclusão: Os resultados obtidos sugerem não existir relação entre variações das concentrações sanguíneas de tacrolimo e o surgimento de alterações nos resultados de biomarcadores renais clássicos ao final do primeiro ano pós-transplante. Entretanto, faz-se necessária a realização de novos estudos para uma maior compreensão do impacto causado por alterações dos níveis sanguíneos de tacrolimo na função renal de receptores de aloenxerto renal. Introdução Brasil póstransplante pós nefrotoxicidade enxerto Objetivo Métodos observacional transversal eTFG, , (eTFG) universitário 202 005 0 05 0,05 5436434 5 436 434 5.436.43 57396622100005045 57396622 0000 5045 57396622.1.0000.5045 Resultados composta majoritariamente masculino parda 515 51 51, DP 12,5 125 12 Ceará 5062 50 62 50,62 n 45 ainda 5679 56 79 56,79 46 4938 49 38 49,38 40 5926 59 26 59,26 48 alterada estudadas Conclusão póstransplante. Entretanto fazse faz se (eTFG 20 00 0,0 543643 43 5.436.4 5739662210000504 5739662 000 504 57396622.1.0000.504 12, 506 6 50,6 4 567 7 56,7 493 3 49,3 592 2 59,2 0, 54364 5.436. 573966221000050 573966 57396622.1.0000.50 50, 56, 49, 59, 5436 5.436 57396622100005 57396 57396622.1.0000.5 543 5.43 5739662210000 5739 57396622.1.0000. 54 5.4 573966221000 573 57396622.1.0000 5. 57396622100 57 57396622.1.000 5739662210 57396622.1.00 573966221 57396622.1.0 57396622.1. 57396622.1 57396622.

ABSTRACT Purpose: To assess the effect of Amorphophallus campanulatus tuber (Ac) extract in the protection of diabetic nephropathy in streptozotocin (STZ) induced diabetic nephropathy (DN) rat model. Methods: Diabetes was induced with STZ (60 mg/kg, i.p.), and DN was confirmed after six weeks of STZ administration with the estimation of kidney function test. Further rats were treated with Ac 250 and 500 mg/kg p.o. for next four week. Oxidative stress and level of inflammatory cytokines were estimated in the kidney tissue of DN rats. Histopathology of kidney tissue was performed using hematoxylin and eosin staining. Results: There was improvement in the body weight of Ac treated groups than DN group of rats. Blood glucose level was observed to be reduced in Ac treated groups than DN group on 42nd and 70th day of protocol. Treatment with Ac ameliorated the altered level of kidney function tests (creatinine and BUN), enzymes of liver function (aspartate aminotransferase and alanine aminotransferase), and lipid profile in the serum of DN rats. Oxidative stress parameters (malondialdehyde and reactive oxygen species enhances and reduction in the level of glutathione and superoxide dismutase) and inflammatory cytokines such as interleukin-6, tumour necrosis factor-α, and monocyte chemoattractant protein-1 reduces in the tissue of Ac treated group than DN group. Treatment with Ac also attenuates the altered histopathological changes in the kidney tissue of DN rats. Conclusions: The report suggests that Ac protects renal injury in DN rats by regulating inflammatory cytokines and oxidative stress. Purpose (Ac (STZ (DN model Methods 60 (6 mgkg mg kg i.p., ip i.p. , i p i.p.) test 25 50 po o p.o week staining Results nd th protocol creatinine BUN, BUN BUN) aspartate aminotransferase, aminotransferase) malondialdehyde dismutase interleukin6, interleukin6 interleukin 6, 6 interleukin-6 factorα, factorα factor α, α factor-α protein1 protein 1 protein- Conclusions ( i.p 2 5 interleukin-

Abstract Background There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF). Objectives This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes. Methods In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%. Results The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups. Conclusion HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients. (HSS . (ADHF) (LD levels outcomes casecontrol case control 17 93 (9 females78 females 78 females/7 males 1 2022 31 HSSLD WRF. WRF (WRF) allcause all cause followup. followup follow up. up follow-up 5% characteristicsA characteristics A st 3975 (397 30005150 3000 5150 [3000-5150 258 20003250, 20003250 2000 3250 , [2000-3250] p0001 p 0 001 nd 116.00 11600 116 00 (116.0 82.75126.00 827512600 82.75 126.00 82 75 126 [82.75-126.00 6850 68 50 68.5 54.0089.75, 54008975 54.00 89.75 54 89 [54.00-89.75] LDWhen When Na 137.00 13700 137 (137.0 131.75140.00 1317514000 131.75 131 140 [131.75-140.00 14000 140.0 136.00142.25, 1360014225 136.00 142.25 136 142 25 [136.00-142.25] p=0.00 13900 139 139.0 137.00141.00 1370014100 141.00 141 [137.00-141.00 136.00140.00, 1360014000 [136.00-140.00] p0470 0470 p=.047 LD) 99.00 9900 99 (99.0 94.00103.25 940010325 94.00 103.25 94 103 [94.00-103.25 99.0096.00103.00, 9900960010300 96.00 103.00 96 99.00[96.00-103.00] p=0.295, p0295 p=0.295 295 p=0.295) 48.50 4850 48 (48.5 29.7572.50 29757250 29.75 72.50 29 72 [29.75-72.5 5000 50.0 35.5063.50, 35506350 35.50 63.50, 35 63 [35.50-63.50 p=0.616, p0616 p=0.616 616 p=0.616) 120 20 (1.2 0.901.70 090170 0.90 1.70 90 70 [0.90-1.70 1.2 1.001.50, 100150 1.00 1.50 [1.00-1.50] p=0.218 p0218 218 Cl (Cl- 10200 102 102.0 99.00106.00 990010600 106.00 106 [99.00-106.00 9800 98 98.0 95.00103.00, 950010300 95.00 95 [95.00-103.00] eGFR 5600 56 56.0 41.0071.00 41007100 41.00 71.00 41 71 [41.00-71.00 5500 55 55.0 35.0071.00, 35007100 35.00 [35.00-71.00] p0050 050 p=0.050 creatinine1.10 creatinine110 1.10 10 creatinine:1.1 0.901.40 090140 1.40 40 [0.90-1.40 0.901.70, p=0.009. p0009 p=0.009 009 p=0.009) 16.1% 161 16 (16.1 355 35.5% p=0.007, p0007 p=0.007 007 p=0.007) 4 ( 37 3 7 [3-7 47, 47 [4-7] p=0.004 p0004 004 Inhospital therapy Therefore (ADHF 9 females7 females/ 202 (WRF 397 (39 3000515 300 515 [3000-515 2000325 200 325 [2000-3250 p000 116.0 1160 11 (116. 75126 82.75126.0 82751260 8275 82.7 12600 126.0 8 12 [82.75-126.0 685 68. 0089 54.0089.75 5400897 5400 54.0 8975 89.7 [54.00-89.75 137.0 1370 13 (137. 75140 131.75140.0 131751400 13175 131.7 14 [131.75-140.0 1400 140. 00142 136.00142.25 136001422 13600 136.0 14225 142.2 2 [136.00-142.25 p=0.0 1390 139. 00141 137.00141.0 137001410 14100 141.0 [137.00-141.0 00140 136.00140.00 136001400 [136.00-140.00 p047 047 p=.04 99.0 990 (99. 00103 94.00103.2 94001032 9400 94.0 10325 103.2 [94.00-103.2 0096 99.0096.00103.00 990096001030 9600 96.0 10300 103.0 99.00[96.00-103.00 p029 p=0.29 48.5 485 (48. 7572 29.7572.5 2975725 2975 29.7 7250 72.5 [29.75-72. 500 50. 5063 35.5063.50 3550635 3550 35.5 6350 63.50 [35.50-63.5 p061 p=0.61 61 (1. 901 0.901.7 09017 090 0.9 170 1.7 [0.90-1.7 1. 1.001.50 10015 100 1.0 150 1.5 [1.00-1.50 p=0.21 p021 21 (Cl 1020 102. 00106 99.00106.0 99001060 10600 106.0 [99.00-106.0 980 98. 95.00103.00 95001030 9500 95.0 [95.00-103.00 560 56. 0071 41.0071.0 4100710 4100 41.0 7100 71.0 [41.00-71.0 550 55. 35.0071.00 3500710 3500 35.0 [35.00-71.00 p005 05 p=0.05 creatinine1 creatinine1.1 creatinine11 110 1.1 creatinine:1. 0.901.4 09014 1.4 [0.90-1.4 16.1 (16. [3- [4-7 39 (3 300051 30 51 [3000-51 200032 32 [2000-325 p00 116. (116 7512 82.75126. 8275126 827 82. 1260 126. [82.75-126. 008 54.0089.7 540089 540 54. 897 89. [54.00-89.7 137. (137 7514 131.75140. 13175140 1317 131. [131.75-140. 0014 136.00142.2 13600142 1360 136. 1422 142. [136.00-142.2 p=0. 137.00141. 13700141 1410 141. [137.00-141. 136.00140.0 13600140 [136.00-140.0 p04 04 p=.0 99. (99 0010 94.00103. 9400103 940 94. 1032 103. [94.00-103. 99.0096.00103.0 99009600103 960 96. 1030 99.00[96.00-103.0 p02 p=0.2 48. (48 757 29.7572. 297572 297 29. 725 72. [29.75-72 506 35.5063.5 355063 35. 635 63.5 [35.50-63. p06 p=0.6 (1 0.901. 0901 09 0. [0.90-1. 1.001.5 1001 15 [1.00-1.5 99.00106. 9900106 1060 106. [99.00-106. 95.00103.0 9500103 950 95. [95.00-103.0 41.0071. 410071 410 41. 710 71. [41.00-71. 35.0071.0 350071 350 [35.00-71.0 creatinine1. creatinine:1 16. (16 [3 [4- 30005 [3000-5 20003 [2000-32 p0 (11 751 82.75126 827512 [82.75-126 54.0089. 54008 [54.00-89. (13 131.75140 1317514 [131.75-140 136.00142. 1360014 [136.00-142. p=0 137.00141 1370014 [137.00-141 136.00140. [136.00-140. p=. 94.00103 940010 [94.00-103 99.0096.00103. 9900960010 99.00[96.00-103. 29.7572 29757 [29.75-7 35.5063. 35506 63. [35.50-63 0.901 [0.90-1 1.001. [1.00-1. 99.00106 990010 [99.00-106 95.00103. 950010 [95.00-103. 41.0071 41007 [41.00-71 35.0071. 35007 [35.00-71. creatinine: [ [4 [3000- [2000-3 82.7512 82751 [82.75-12 54.0089 [54.00-89 131.7514 131751 [131.75-14 136.00142 136001 [136.00-142 p= 137.0014 137001 [137.00-14 136.00140 [136.00-140 94.0010 94001 [94.00-10 99.0096.00103 990096001 99.00[96.00-103 29.757 [29.75- 35.5063 [35.50-6 [0.90- 1.001 [1.00-1 99.0010 99001 [99.00-10 95.00103 95001 [95.00-103 41.007 [41.00-7 35.0071 [35.00-71 [3000 [2000- 82.751 [82.75-1 54.008 [54.00-8 131.751 [131.75-1 136.0014 [136.00-14 137.001 [137.00-1 94.001 [94.00-1 99.0096.0010 99009600 99.00[96.00-10 [29.75 35.506 [35.50- [0.90 [1.00- 99.001 [99.00-1 95.0010 [95.00-10 [41.00- 35.007 [35.00-7 [300 [2000 [82.75- [54.00- [131.75- 136.001 [136.00-1 [137.00- [94.00- 99.0096.001 9900960 99.00[96.00-1 [29.7 [35.50 [0.9 [1.00 [99.00- 95.001 [95.00-1 [41.00 [35.00- [30 [200 [82.75 [54.00 [131.75 [136.00- [137.00 [94.00 99.0096.00 990096 99.00[96.00- [29. [35.5 [0. [1.0 [99.00 [95.00- [41.0 [35.00 [20 [82.7 [54.0 [131.7 [136.00 [137.0 [94.0 99.0096.0 99009 99.00[96.00 [29 [35. [0 [1. [99.0 [95.00 [41. [35.0 [2 [82. [54. [131. [136.0 [137. [94. 99.0096. 99.00[96.0 [35 [1 [99. [95.0 [41 [82 [54 [131 [136. [137 [94 99.0096 99.00[96. [99 [95. [8 [5 [13 [136 [9 99.009 99.00[96 [95 99.00[9 99.00[

Resumo Fundamento Não houve evidência científica sobre o tratamento inicial com solução salina hipertônica (SSH) na insuficiência cardíaca agudamente descompensada (ICAD). Objetivos Este estudo avaliou o impacto do uso de SSH junto com um diurético de alça (DA) como o primeiro tratamento diurético para ICAD, com foco na função renal, níveis de eletrólitos e resultados clínicos. Métodos Neste estudo retrospectivo de caso-controle, 171 pacientes adultos (93 mulheres/78 homens) com ICAD foram incluídos entre 1º de janeiro de 2022 e 31 de dezembro de 2022. Os pacientes foram alocados em dois grupos: combinação inicial de SSH+DA e DA padronizada. O desfecho primário foi piora da função renal (PFR). A hospitalização por IC e a mortalidade por todas as causas foram avaliadas durante 6 meses de acompanhamento. O nível de significância adotado na análise estatística foi de 5%. Resultados Os grupos exibiram semelhanças nas características basais. Diurese significativamente maior no 1º dia (3975 [3000-5150] vs. 2583 [2000-3250], p=0,001) e natriurese na 2ª hora (116,00 [82,75-126,00] vs. 131,75-140,00] vs. 94,00-103,25] vs. 99,00 [96,00-103,00], p=0,295), TFG (48,50 [29,75-72,50 vs. 50,00[35,50-63,50, p=0,616) e creatinina (1,20 [0,90-1,70] vs. 1,20 [1,00-1,50], p=0,218) permaneceu estável no grupo SSH combinado inicial quando comparado ao grupo DA padronizado (Cl-: 102,00[99,00-106,00] vs. 98,00[95,00-103,00], p=0,001, TFGe: 56,00 [41,00-71,00] vs. 55,00[35,00-71,00], p=0,050, creatinina: 1,10[0,90-1,40] vs. 1,20 [0,90-1,70], p=0,009). A piora da função renal (16,1% vs. 35,5%, p = 0,007) e o tempo de internação hospitalar (4 dias [3-7] vs. 5 dias [4-7], p = 0,004) foram menores na combinação inicial SSH+DA em comparação com o DA padronizado. A mortalidade hospitalar, a hospitalização por IC e a mortalidade por todas as causas foram semelhantes entre os dois grupos. Conclusão SSH como terapia inicial, quando combinada com DA, pode proporcionar uma diurese segura e eficaz sem prejudicar a função renal na ICAD. Portanto, a SSH pode levar a um menor tempo de internação hospitalar para esses pacientes. (SSH . (ICAD) (DA clínicos casocontrole, casocontrole caso controle, controle caso-controle 17 93 (9 mulheres78 mulheres 78 mulheres/7 homens º 202 3 SSHDA padronizada PFR. PFR (PFR) acompanhamento 5% basais 3975 (397 30005150 3000 5150 [3000-5150 vs 258 20003250, 20003250 2000 3250 , [2000-3250] p=0,001 p0001 0 001 ª 116,00 11600 116 00 (116,0 82,75126,00 827512600 82,75 126,00 82 75 126 [82,75-126,00 131,75140,00 1317514000 131,75 140,00 131 140 131,75-140,00 94,00103,25 940010325 94,00 103,25 94 103 25 94,00-103,25 9900 99 99,0 96,00103,00, 960010300 96,00 103,00 96 [96,00-103,00] p=0,295, p0295 p=0,295 295 p=0,295) 48,50 4850 48 50 (48,5 29,7572,50 29757250 29,75 72,50 29 72 [29,75-72,5 50,0035,5063,50, 500035506350 50,00 35,50 63,50, 35 63 50,00[35,50-63,50 p=0,616 p0616 616 120 1 20 (1,2 0,901,70 090170 0,90 1,70 90 70 [0,90-1,70 1,2 1,001,50, 100150 1,00 1,50 [1,00-1,50] p=0,218 p0218 218 Cl (Cl- 102,0099,00106,00 10200990010600 102,00 106,00 102 106 102,00[99,00-106,00 98,0095,00103,00, 9800950010300 98,00 95,00 98 95 98,00[95,00-103,00] TFGe 5600 56 56,0 41,0071,00 41007100 41,00 71,00 41 71 [41,00-71,00 55,0035,0071,00, 550035007100 55,00 35,00 55 55,00[35,00-71,00] p0050 050 p=0,050 1,100,901,40 110090140 1,10 1,40 10 40 1,10[0,90-1,40 0,901,70, p=0,009. p0009 p=0,009 009 p=0,009) 16,1% 161 16 (16,1 355 35,5% 0,007 0007 007 4 ( 37 7 [3-7 47, 47 [4-7] 0,004 0004 004 Portanto (ICAD 9 mulheres7 mulheres/ (PFR 397 (39 3000515 300 515 [3000-515 2000325 200 325 [2000-3250 p=0,00 p000 116,0 1160 11 (116, 75126 82,75126,0 82751260 8275 82,7 12600 126,0 8 12 [82,75-126,0 75140 131,75140,0 131751400 13175 131,7 14000 140,0 13 14 131,75-140,0 00103 94,00103,2 94001032 9400 94,0 10325 103,2 2 94,00-103,2 990 99, 96,00103,00 96001030 9600 96,0 10300 103,0 [96,00-103,00 p029 p=0,29 48,5 485 (48, 7572 29,7572,5 2975725 2975 29,7 7250 72,5 [29,75-72, 0035 5063 50,0035,5063,50 50003550635 5000 50,0 3550 35,5 6350 63,50 50,00[35,50-63,5 p=0,61 p061 61 (1, 901 0,901,7 09017 090 0,9 170 1,7 [0,90-1,7 1, 1,001,50 10015 100 1,0 150 1,5 [1,00-1,50 p=0,21 p021 21 (Cl 0099 00106 102,0099,00106,0 1020099001060 10200 102,0 10600 106,0 102,00[99,00-106,0 0095 98,0095,00103,00 980095001030 9800 98,0 9500 95,0 98,00[95,00-103,00 560 56, 0071 41,0071,0 4100710 4100 41,0 7100 71,0 [41,00-71,0 55,0035,0071,00 55003500710 5500 55,0 3500 35,0 55,00[35,00-71,00 p005 05 p=0,05 1,100,901,4 11009014 110 1,1 1,4 1,10[0,90-1,4 16,1 (16, 0,00 000 [3- [4-7 39 (3 300051 30 51 [3000-51 200032 32 [2000-325 p=0,0 p00 116, (116 7512 82,75126, 8275126 827 82, 1260 126, [82,75-126, 7514 131,75140, 13175140 1317 131, 1400 140, 131,75-140, 0010 94,00103, 9400103 940 94, 1032 103, 94,00-103, 96,00103,0 9600103 960 96, 1030 [96,00-103,0 p02 p=0,2 48, (48 757 29,7572, 297572 297 29, 725 72, [29,75-72 003 506 50,0035,5063,5 5000355063 500 50, 35, 635 63,5 50,00[35,50-63, p=0,6 p06 (1 0,901, 0901 09 0, [0,90-1, 1,001,5 1001 15 [1,00-1,5 102,0099,00106, 102009900106 1020 102, 1060 106, 102,00[99,00-106, 98,0095,00103,0 98009500103 980 98, 950 95, 98,00[95,00-103,0 41,0071, 410071 410 41, 710 71, [41,00-71, 55,0035,0071,0 5500350071 550 55, 350 55,00[35,00-71,0 1,100,901, 1100901 1,10[0,90-1, 16, (16 0,0 [3 [4- 30005 [3000-5 20003 [2000-32 p=0, p0 (11 751 82,75126 827512 [82,75-126 131,75140 1317514 131,75-140 94,00103 940010 94,00-103 96,00103, 960010 [96,00-103, 29,7572 29757 [29,75-7 50,0035,5063, 500035506 63, 50,00[35,50-63 0,901 [0,90-1 1,001, [1,00-1, 102,0099,00106 10200990010 102,00[99,00-106 98,0095,00103, 9800950010 98,00[95,00-103, 41,0071 41007 [41,00-71 55,0035,0071, 550035007 55,00[35,00-71, 1,100,901 110090 1,10[0,90-1 [ [4 [3000- [2000-3 p=0 82,7512 82751 [82,75-12 131,7514 131751 131,75-14 94,0010 94001 94,00-10 96,00103 96001 [96,00-103 29,757 [29,75- 50,0035,5063 50003550 50,00[35,50-6 [0,90- 1,001 [1,00-1 102,0099,0010 1020099001 102,00[99,00-10 98,0095,00103 980095001 98,00[95,00-103 41,007 [41,00-7 55,0035,0071 55003500 55,00[35,00-71 1,100,90 11009 1,10[0,90- [3000 [2000- p= 82,751 [82,75-1 131,751 131,75-1 94,001 94,00-1 96,0010 [96,00-10 [29,75 50,0035,506 5000355 50,00[35,50- [0,90 [1,00- 102,0099,001 102009900 102,00[99,00-1 98,0095,0010 98009500 98,00[95,00-10 [41,00- 55,0035,007 5500350 55,00[35,00-7 1,100,9 1100 1,10[0,90 [300 [2000 [82,75- 131,75- 94,00- 96,001 [96,00-1 [29,7 50,0035,50 500035 50,00[35,50 [0,9 [1,00 102,0099,00 10200990 102,00[99,00- 98,0095,001 9800950 98,00[95,00-1 [41,00 55,0035,00 550035 55,00[35,00- 1,100, 1,10[0,9 [30 [200 [82,75 [96,00- [29, 50,0035,5 50003 50,00[35,5 [0, [1,0 102,0099,0 1020099 102,00[99,00 98,0095,00 980095 98,00[95,00- [41,0 55,0035,0 55003 55,00[35,00 1,100 1,10[0, [20 [82,7 [96,00 [29 50,0035, 50,00[35, [0 [1, 102,0099, 102009 102,00[99,0 98,0095,0 98009 98,00[95,00 [41, 55,0035, 55,00[35,0 1,10[0 [2 [82, [96,0 50,0035 50,00[35 [1 102,0099 102,00[99, 98,0095, 98,00[95,0 [41 55,0035 55,00[35, 1,10[ [82 [96, 50,003 50,00[3 102,009 102,00[99 98,0095 98,00[95, 55,003 55,00[35 [8 [96 50,00[ 102,00[9 98,009 98,00[95 55,00[3 [9 102,00[ 98,00[9 55,00[ 98,00[

The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.

RESUMEN La evaluación de la función renal se realiza habitualmente a través de la estimación de la tasa de filtración glomerular y el análisis de la orina. La evaluación morfológica renal a través de una imagen permite complementar esta información. Sin embargo, muchas de las aplicaciones de las técnicas actuales de imágenes son desconocidas por los médicos clínicos. Además, la comunicación entre médicos clínicos y especialistas en imágenes es menos usual de lo deseable. En esta revisión describiremos los métodos de imagen más frecuentemente utilizados para la evaluación de la función renal y otras situaciones clínicas nefrológicas, además de analizar los avances más significativos, particularmente en ultrasonografía y resonancia magnética, para la pesquisa precoz y seguimiento del daño renal.

ABSTRACT Renal hypouricemia (RHUC) is an autosomal recessive disease caused by the dysfunction of uric acid (UA) transporters in the proximal tubule causing increased fractional excretion of uric acid (FEUA). It is associated with mutations of SLC22A12 that codifies for URAT1, involved in RHUC type 1, or SLC2A9 which codifies for GLUT9 and is involved in RHUC type 2. We present the case of a man diagnosed with RHUC type 2 following hospitalization for acute kidney injury (AKI). A 43-year-old was hospitalized due to AKI after a 20 km walk at an outdoor temperature of 30°C. On the objective examination, he was dehydrated. Blood tests presented severe azotemia (creatininemia 16.43 mg/dL, uremia 254 mg/dL), UA 3.6 mg/dL, fosfatemia 6 mg/dL, Na 138 mEq/L, K 4.2 mEq/L, Cl 102 mEq/l, arterial gasometry with pH 7.35, pCO2 36 mmHg, HCO3 20 mmol/L, lactates 1.4 mmol/L. Urine test with proteinuria and unremarkable sediment. His kidneys had foci of microlithiasis. He started vigorous fluid therapy and sustained improvement in renal function was seen, with no need for renal function replacement therapy. The subsequent evaluation showed hypouricemia <1.5 mg/dL and FEUA of 32.5% (normal range 5.5%-8.5%). The molecular study identified the variant c.1221del p.(His407Glnfs*8) in the SLC2A9 gene in homozygosis, which established the diagnosis of RHUC type 2. This case highlights the importance of recognizing hereditary RHUC to prevent its manifestations, including exercise-induced AKI, nephrolithiasis, nephrocalcinosis, and more rarely, progression to stage 5 CKD. Its diagnosis should be considered in individuals with serum UA <2 mg/dL and elevated FEUA. Additionally, it should be confirmed by the identification of mutations in homozygous or compound heterozygous in SLC22A12 or SCL2A9. Treatment includes xanthine oxidoreductase inhibitors and adequacy of physical activity. The use of uricosuric antihypertensive drugs whose mechanism of action involves blocking the URAT1 transporter should be avoided.