ABSTRACT BACKGROUND: The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES: To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING: This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS: Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants’ medical records. RESULTS: Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0–56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0–71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS: This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine. BACKGROUND (CKD decades transplantation RTR. . (RTR) OBJECTIVES treatment SETTING crosssectional cross sectional 201 2020 METHODS Quantitative descriptive used sampling records RESULTS Overall 30 included 20 66.9%, 669 66 9 (66.9% age 4 years [IQR 380560 38 0 56 38.0–56.0 636 63 6 63.6 men 10 33.1%, 331 33 1 (33.1% 610 61 61. 500712 50 71 2 50.0–71.2 men. 39.3% 393 39 3 (39.3 vs 216 21 21.6 0.002 0002 002 4.4% 44 (4.4% 1.0% (1.0% 21. 1. 2:1 CONCLUSIONS cancers azathioprine (RTR 202 66.9% (66.9 38056 5 38.0–56. 63. 33.1% (33.1 50071 7 50.0–71. 39.3 (39. 0.00 000 00 4.4 (4.4 1.0 (1.0 2: 66.9 (66. 3805 38.0–56 33.1 (33. 5007 50.0–71 39. (39 0.0 4. (4. (1. 66. (66 380 38.0–5 33. (33 500 50.0–7 (3 0. (4 (1 (6 38.0– 50.0– ( 38.0 50.0 38. 50.

RESUMO Objetivo: Estimar a prevalência da infecção latente por Mycobacterium tuberculosis (ILTB) em transplantados renais e avaliar as associações sociodemográficas, comportamentais e clínicas com a prova tuberculínica (PT) positiva. Métodos: Estudo transversal, com pacientes com idade ≥ 18 anos, transplantados renais no Centro de Transplante Renal do Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte (MG). Foram incluídos os pacientes submetidos a transplante renal que realizaram a PT no período entre janeiro de 2011 e julho de 2013. Quando o resultado da primeira PT foi negativo, uma segunda PT foi realizada. As análises bivariada e multivariada, por meio de regressão logística, foram utilizadas para determinar os fatores associados com PT positiva. Resultados: A amostra incluiu 216 pacientes. A taxa de prevalência para ILTB foi de 18.5%. Na análise multivariada, história de contato com caso de tuberculose e função do enxerto preservada (taxa de filtração glomerular estimada ≥ 60 ml/min/1,73 m2) foram associadas com PT positiva. O incremento da primeira PT para a segunda PT foi de 5,8%, considerado significante (p = 0,012). Conclusões: A prevalência da ILTB foi baixa nessa amostra de pacientes transplantados renais. A PT deve ser efetuada quando a função do enxerto renal estiver preservada. Uma segunda PT deve ser realizada quando a primeira PT for negativa.

ABSTRACT Objective: To estimate the prevalence of latent Mycobacterium tuberculosis infection (LTBI) in renal transplant recipients and to assess sociodemographic, behavioral, and clinical associations with positive tuberculin skin test (TST) results. Methods: This was a cross-sectional study of patients aged ≥ 18 years who underwent renal transplantation at the Renal Transplant Center of the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. We included renal transplant recipients who underwent the TST between January 2011 and July 2013. If the result of the first TST was negative, a second TST was administered. Bivariate and multivariate analyses using logistic regression were used to determine factors associated with positive TST results. Results: The sample included 216 patients. The prevalence of LTBI was 18.5%. In the multivariate analysis, history of contact with a tuberculosis case and preserved graft function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2) were associated with positive TST results. TST induration increased by 5.8% from the first to the second test, which was considered significant (p = 0.012). Conclusions: The prevalence of LTBI was low in this sample of renal transplant recipients. The TST should be administered if renal graft function is preserved. A second TST should be administered if the first TST is negative.

O Brasil é um país onde a hanseníase ainda é um problema de saúde pública, apresentando mais de 30.000 novos casos por ano nos últimos anos. Apesar do crescente número de transplante de órgãos sólidos realizados no país, sobretudo o transplante renal, não são frequentes os relatos dessa micobacteriose em pacientes imunossuprimidos pelas medicações póstransplante. Os autores relatam um caso de hanseníase multibacilar manifestada 12 anos depois do transplante renal, acompanhado desde o diagnóstico, durante a poliquimioterapia, tratamento e seguimento do eritema nodoso hansênico.

Leprosy is still a public health concern in Brazil, where more than 30,000 new cases are detected every year. There are few reports of this mycobacteriosis in imunossupressed pacients, despite the increasing number of solid organ transplantation and the use of post-transplant drugs in this country. The autors describe a case of multibacillary leprosy in a renal transplant recipient, detected 12 years after the procedure, and discuss the therapy, adverse effects and management of leprosy reactions in pacients imunosupressed by drugs.

OBJETIVO Analisar se o gênero influencia os resultados da sobrevida do enxerto e do paciente no transplante renal.MÉTODOS Revisão sistemática com metanálise de estudos de coorte disponíveis nas bases de dados Medline (PubMed), Lilacs, Central e Embase, incluindo busca manual e na literatura cinzenta. A seleção dos estudos e a coleta dos dados foram realizadas em duplicata por revisores independentes e as discordâncias foram resolvidas por um terceiro revisor. A sobrevida do enxerto e do paciente foram avaliadas como medidas de efetividade. A metanálise foi conduzida no softwareReview Manager® 5.2, aplicando o modelo de efeitos aleatórios. Foram avaliadas as comparações entre gênero de receptor, doador e doador-receptor.RESULTADOS Foram incluídos 29 estudos envolvendo 765.753 pacientes. Em relação à sobrevida do enxerto, aqueles provenientes de doadores masculinos apresentaram maior sobrevida quando comparado com aqueles de doadores femininos, somente no tempo de acompanhamento de 10 anos. A comparação entre gênero de receptor não apresentou diferença significativa em nenhum tempo de acompanhamento avaliado. Na avaliação entre gênero de doador-receptor houve favorecimento estatisticamente significante para doador masculino-receptor masculino. Não houve diferença, estatisticamente significante, na sobrevida do paciente para as comparações entre gênero em todos os períodos de acompanhamento avaliados.CONCLUSÕES A análise quantitativa dos estudos sugere que o gênero do doador ou do receptor, avaliado isoladamente, não influencia na sobrevida do enxerto e paciente. Contudo, a combinação entre gênero de doador-receptor pode ser fator determinante para a sobrevida do enxerto.

OBJECTIVE To analyze whether gender influence survival results of kidney transplant grafts and patients.METHODS Systematic review with meta-analysis of cohort studies available on Medline (PubMed), LILACS, CENTRAL, and Embase databases, including manual searching and in the grey literature. The selection of studies and the collection of data were conducted twice by independent reviewers, and disagreements were settled by a third reviewer. Graft and patient survival rates were evaluated as effectiveness measurements. Meta-analysis was conducted with the Review Manager® 5.2 software, through the application of a random effects model. Recipient, donor, and donor-recipient gender comparisons were evaluated.RESULTS : Twenty-nine studies involving 765,753 patients were included. Regarding graft survival, those from male donors were observed to have longer survival rates as compared to the ones from female donors, only regarding a 10-year follow-up period. Comparison between recipient genders was not found to have significant differences on any evaluated follow-up periods. In the evaluation between donor-recipient genders, male donor-male recipient transplants were favored in a statistically significant way. No statistically significant differences were observed in regards to patient survival for gender comparisons in all follow-up periods evaluated.CONCLUSIONS The quantitative analysis of the studies suggests that donor or recipient genders, when evaluated isolatedly, do not influence patient or graft survival rates. However, the combination between donor-recipient genders may be a determining factor for graft survival.

OBJETIVO Analisar se o gênero influencia os resultados da sobrevida do enxerto e do paciente no transplante renal.MÉTODOS Revisão sistemática com metanálise de estudos de coorte disponíveis nas bases de dados Medline (PubMed), Lilacs, Central e Embase, incluindo busca manual e na literatura cinzenta. A seleção dos estudos e a coleta dos dados foram realizadas em duplicata por revisores independentes e as discordâncias foram resolvidas por um terceiro revisor. A sobrevida do enxerto e do paciente foram avaliadas como medidas de efetividade. A metanálise foi conduzida no softwareReview Manager® 5.2, aplicando o modelo de efeitos aleatórios. Foram avaliadas as comparações entre gênero de receptor, doador e doador-receptor.RESULTADOS Foram incluídos 29 estudos envolvendo 765.753 pacientes. Em relação à sobrevida do enxerto, aqueles provenientes de doadores masculinos apresentaram maior sobrevida quando comparado com aqueles de doadores femininos, somente no tempo de acompanhamento de 10 anos. A comparação entre gênero de receptor não apresentou diferença significativa em nenhum tempo de acompanhamento avaliado. Na avaliação entre gênero de doador-receptor houve favorecimento estatisticamente significante para doador masculino-receptor masculino. Não houve diferença, estatisticamente significante, na sobrevida do paciente para as comparações entre gênero em todos os períodos de acompanhamento avaliados.CONCLUSÕES A análise quantitativa dos estudos sugere que o gênero do doador ou do receptor, avaliado isoladamente, não influencia na sobrevida do enxerto e paciente. Contudo, a combinação entre gênero de doador-receptor pode ser fator determinante para a sobrevida do enxerto.

OBJECTIVE To analyze whether gender influence survival results of kidney transplant grafts and patients.METHODS Systematic review with meta-analysis of cohort studies available on Medline (PubMed), LILACS, CENTRAL, and Embase databases, including manual searching and in the grey literature. The selection of studies and the collection of data were conducted twice by independent reviewers, and disagreements were settled by a third reviewer. Graft and patient survival rates were evaluated as effectiveness measurements. Meta-analysis was conducted with the Review Manager® 5.2 software, through the application of a random effects model. Recipient, donor, and donor-recipient gender comparisons were evaluated.RESULTS : Twenty-nine studies involving 765,753 patients were included. Regarding graft survival, those from male donors were observed to have longer survival rates as compared to the ones from female donors, only regarding a 10-year follow-up period. Comparison between recipient genders was not found to have significant differences on any evaluated follow-up periods. In the evaluation between donor-recipient genders, male donor-male recipient transplants were favored in a statistically significant way. No statistically significant differences were observed in regards to patient survival for gender comparisons in all follow-up periods evaluated.CONCLUSIONS The quantitative analysis of the studies suggests that donor or recipient genders, when evaluated isolatedly, do not influence patient or graft survival rates. However, the combination between donor-recipient genders may be a determining factor for graft survival.

OBJETIVO: Determinar a prevalência da infecção latente por Mycobacterium tuberculosis (ILMT) e o risco de infecção em pacientes com insuficiência renal crônica em um centro de hemodiálise. MÉTODOS: Foram incluídos no estudo 307 pacientes com insuficiência renal crônica em tratamento hemodialítico no Instituto Mineiro de Nefrologia, na cidade de Belo Horizonte (MG). Todos os pacientes foram submetidos a testes tuberculínicos (TTs). O efeito booster e a viragem tuberculínica foram avaliados. Se o primeiro TT (TT1) era negativo, um segundo (TT2) era realizado 1-3 semanas após o TT1 para investigar o efeito booster. Se o TT2 também era negativo, um terceiro (TT3) era realizado um ano após o TT2 para identificar a viragem tuberculínica. RESULTADOS: A prevalência da ILMT, quando considerado o ponto de corte de 5 mm de enduração, foi de 22,2% no TT1, com incremento de 11,2% no TT2. A prevalência da ILMT, quando considerado o ponto de corte de enduração de 10 mm, foi de 28,5% no TT1, com incremento de 9,4% no TT2. Um aumento significativo da prevalência da ILMT foi observado entre TT1 e TT2 (efeito booster) e entre TT2 e TT3 (p < 0,01 para ambos). Na nossa amostra, o risco médio anual de infecção foi de 1,19%. CONCLUSÕES: Na população estudada, a prevalência da ILMT foi alta, e o risco de infecção foi semelhante ao da população geral no Brasil, o que sugere infecção recente.

OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center. METHODS: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion. RESULTS: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%. CONCLUSIONS: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

BACKGROUND: This study evaluated the role of HA as a marker of liver fibrosis in patients with hepatitis C on haemodialysis. METHODS: This is a cross-sectional study in which 52 patients were divided into two groups: Group 1: patients with hepatitis C and end-stage renal disease (ESRD) undergoing haemodialysis (n = 23); and Group 2: patients with hepatitis C without ESRD (n = 29). Plasma levels of HA were associated with histological data of the samples obtained by liver biopsy and classified by METAVIR group scoring system. RESULTS: Higher plasma levels were significantly correlated to significant liver fibrosis (METAVIR > F2). In Group 1, the HA cutoff to discriminate significant fibrosis was 984.8 ng/mL, with accuracy, sensitivity and specificity of 80.8%, 83.0%, and 70.0%, respectively. In Group 2, the HA cutoff was 222.3 ng/mL, with accuracy, sensitivity and specificity of 74.5%, 70.0%, and 94.0%, respectively. CONCLUSION: HA was an accurate noninvasive marker in predicting significant fibrosis in patients with hepatitis C on haemodialysis.