RESUMO Introdução: O surgimento de lesão renal aguda (LRA) em pacientes com síndrome nefrótica (SN) requer diagnóstico imediato e diferenciação entre necrose tubular aguda (NTA) e glomerulonefrite proliferativa. Avaliamos o uso potencial de testes de biomarcadores urinários comerciais no diagnóstico de LRA em pacientes com SN. Métodos: Uma estimativa transversal das concentrações urinárias de KIM-1 e NGAL foi realizada em 40 pacientes com SN: 9 com glomerulopatia proliferativa, sendo 4 com LRA e 31 sem glomerulopatia proliferativa, sendo 15 com LRA. A LRA foi definida usando os critérios da KDIGO. Resultados: A média de idade foi de 35 ± 16 anos. Os principais diagnósticos foram glomeruloesclerose segmentar e focal (10, 25%), glomerulopatia membranosa (10, 25%), doença por lesão mínima (7, 18%), nefrite lúpica (6, 15%) e glomerulonefrite proliferativa (3, 8 %). Os pacientes com NTA apresentaram níveis mais elevados de KIM-1 urinário (P = 0,0157) e NGAL (P = 0,023) do que pacientes sem NTA. As concentrações urinárias de KIM-1 (P = 0,009) e NGAL (P = 0,002) foram maiores em pacientes com LRA do que em pacientes sem LRA. Os níveis urinários de NGAL e KIM-1 foram significativamente maiores em pacientes com NTA sem glomerulonefrite proliferativa do que em pacientes com glomerulonefrite proliferativa (P = 0,003 e P = 0,024, respectivamente). Conclusões: As estimativas de lipocalina associada a gelatinase de neutrófilos (NGAL) e molécula de lesão renal 1 (KIM-1) se correlacionaram com sinais histológicos de NTA, e foram capazes de discriminar pacientes com LRA mesmo em condições de SN. Além disso, os níveis urinários de NGAL e KIM-1 podem ser úteis no diagnóstico diferencial de necrose tubular aguda e glomerulonefrite exsudativa em pacientes com síndrome nefrótica.

ABSTRACT Introduction: Emergence of acute kidney injury (AKI) in patients with nephrotic syndrome (NS) requires prompt diagnosis and differentiation between acute tubular necrosis (ATN) and proliferative glomerulonephritis. We studied the potential use of commercial urinary biomarkers' tests in the diagnosis of AKI in patients with NS. Methods: A cross sectional estimate of urinary concentrations of KIM-1 and NGAL was performed in 40 patients with NS: 9 with proliferative glomerulopathy, being 4 with AKI and 31 without proliferative glomerulopathy, being 15 with AKI. AKI was defined using the KDIGO criteria. Results: The mean age was 35 ± 16 years. The main diagnoses were focal and segmental glomerulosclerosis (10, 25%), membranous glomerulopathy (10, 25%), minimal change disease (7, 18%), lupus nephritis (6, 15%), and proliferative glomerulonephritis (3, 8%). Patients with ATN had higher levels of urinary KIM-1 (P = 0.0157) and NGAL (P = 0.023) than patients without ATN. The urinary concentrations of KIM-1 (P= 0.009) and NGAL (P= 0.002) were higher in patients with AKI than in patients without AKI. Urinary NGAL and KIM-1 levels were significantly higher in patients with ATN without proliferative glomerulonephritis than in patients with proliferative glomerulonephritis (P = 0.003 and P=0.024, respectively). Conclusions: Neutrophil gelatinase associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) estimates correlated with histological signs of ATN and were able to discriminate patients with AKI even in conditions of NS. Furthermore, urinary levels of NGAL and KIM-1 may be useful in the differential diagnosis of acute tubular necrosis and exudative glomerulonephritis in patients with nephrotic syndrome.

Although urinary tract infections (UTI) represent the most common infection caused by enterococci, some aspects remain to be fully clarified. The aim of this study was to determine the clinical characteristics present in UTI caused by Enterococcus spp. in patients followed up at the Prof. Edgard Santos Teaching Hospital of the Federal University of Bahia. All patients consecutively examined between 1997 and 2005, who received a diagnosis of UTI caused by Enterococcus spp. were included in the study. UTI was defined as the presence of 10(5) colony-forming units per mL of urine. Standard microbiological techniques were used. During the study period, 6.2% of the urine cultures were positive for Enterococcus spp. The mean age of the patients was 48.9 years and 57% were male. At initial evaluation, 13% of the patients had complaints suggestive of UTI. Nineteen patients had a history consistent with obstructive uropathy and 26 with neurogenic bladder. At final evaluation, UTI was the diagnosis in 48 patients. In 36 patients (29%), the primary diagnosis was related to urogenital diseases, consisting of obstructive uropathy in 23 of these cases, while in 32 patients (25.8%) primary diagnosis was related to neurologic diseases, frequently neurogenic bladder. UTI caused by Enterococcus spp. is not infrequent, is usually associated with few or no symptoms and occurs in sick patients who have anatomical or functional obstructive uropathy associated or not with urinary tract catheterization or instrumentation. The diagnosis of enterococcal UTI may indicate a urinary tract abnormality yet to be diagnosed.

OBJECTIVE: The present study aims at assessing the occurrence of pyelonephritis and long-term complications in rats submitted to surgical reduction of bladder capacity. MATERIALS AND METHODS: Sprague-Dawley rats were submitted to supratrigonal cystectomy (29 animals) or sham operation (15 animals) and sacrificed 2, 4 and 6 months after the surgical procedure. The arterial blood pressure and serum creatinine levels were assessed before the surgery and at the time of the sacrifice. After the sacrifice a careful inspection of the urinary apparatus was performed to the characterization of the hydronephrosis and for the detection of the presence of calculi. With sterile technique, the urine was aspirated from the bladder and the kidneys removed and sent to a microbiologic study. RESULTS: Pyelonephritis was frequent in animals submitted to supratrigonal cystectomy. The most frequent and isolated microorganisms were Staphylococcus sp. and E. coli. The presence of urinary calculi was correlated significantly to the presence of urinary tract infection (p < 0.003). Arterial hypertension was frequent amongst animals submitted to supratrigonal cystectomy. Serum creatinine was high in 72.4% of the animals in the group submitted to supratrigonal cystectomy. The presence of calculi and pyelonephritis were frequent in rats presenting renal insufficiency and in hypertensive rats. CONCLUSIONS: The long-term course of urinary infection in rats submitted to supratrigonal cystectomy was characterized by a high incidence of renal insufficiency and arterial hypertension that seem to be related to dysfunction and bladder obstruction induced by an extensive surgical procedure and the presence of urolithiasis and pyelonephritis.

OBJETIVO: O ensaio de enzyme-linked immunosorbent assay (ELISA) para a pesquisa de anticorpos anticardiolipina (aCL) é o mais importante teste para o diagnóstico da síndrome antifosfolipídica (SAF). Entretanto esse teste também pode ser positivo em algumas doenças infecciosas. Tem sido sugerido que a detecção de anticorpos para uma mistura de fosfolípides ou para beta2-glicoproteína I (beta2-GP I) teria uma maior especificidade para a SAF que o teste de ELISA-padrão para aCL. O objetivo do presente estudo é comparar a especificidade de três testes para anticorpos antifosfolípides (aFL) em pacientes com doenças infecciosas. MÉTODOS: Anticorpos antifosfolípides foram pesquisados por três técnicas de ELISA, ou seja, o teste-padrão para aCL, o kit de ELISA APhL® e o teste para anti-beta2-GP I em pacientes com doenças infecciosas, tais como sífilis (69), leptospirose (33) e Calazar (30). RESULTADOS: A freqüência de positividade de aFL da classe IgG em pacientes com sífilis, leptospirose e Calazar foi de 13/69 (19%), 9/33 (27%) e 2/30 (6%), respectivamente, com o ELISA-padrão para aCL versus 1/69 (1,4%), 0/33 (0%) e 0/30 (0%) com o kit de ELISA APhL®. A positividade do isotipo IgM foi de 10/69 (14%), 4/33 (12%) e 1/30 (3%), respectivamente, com o ELISA-padrão para aCL, e 1/69 (1,4%), 0/33 (0%) e 0/30 (0%) com o kit de ELISA APhL®. Anticorpos da classe IgG contra beta2GPI foram detectados em 14/69 casos de sífilis (20%), 6/33 casos de leptospirose (18%) e 16/30 casos de Calazar (53%). Assim, o kit de ELISA APhL® apresentou uma maior especificidade: 97% (95% CI: 92%-99%) comparado com 81% (95% CI: 74%-87%) para o teste de aCL-padrão e 72% (95% CI: 64%-79%) para o teste de anticorpos anti-beta2 GPI. CONCLUSÕES: O kit de ELISA APhL® parece ser mais específico para a SAF que o ELISA-padrão para aCL, assim como o teste para anti-beta2GPI. Esse kit pode ser usado para ajudar no diagnóstico e na confirmação da SAF.

OBJECTIVE: The standard enzyme-linked immunosorbent assay (ELISA) for anticardiolipin (aCL) antibodies is the most important test for the diagnosis of antiphospholipid syndrome (APS). However, the test is also positive in some infectious diseases and other non-related syndromes. It has been suggested that the detection of antibodies to a mixture of phospholipids or to beta2-glycoprotein I (beta2-GP I) has higher specificity for APS than the standard aCL ELISA. The aim of the present work is to compare the diagnostic specificity of three different antiphospholipid (aPL) assays in patients with infectious diseases. METHODS: Antiphospholipid antibodies were searched by three ELISA techniques, namely standard aCL, APhL® ELISA kit and anti-beta2-GP I, in sera of patients with infectious diseases, including syphilis (69), leptospirosis (33) and visceral leishmaniasis (30). RESULTS: The frequency of positivity of IgG aPL in patients with syphilis, leptospirosis and Kala-azar was 13/69 (19%), 9/33 (27%) and 2/30 (6%), respectively, using standard ELISA, versus only 1/69 (1.4%), 0/33 (0%) and 0/30 (0%) positivity by the APhL® ELISA kit. The positivity of the isotype IgM aPL was 10/69 (14%), 4/33 (12%) and 1/30 (3%), respectively, by the standard ELISA, and 1/69 (1.4%), 0/33 (0%) and 0/30 (0%) by the APhL® ELISA kit. The presence of significant levels of IgG anti-beta2GPI was observed in 14/69 cases of syphilis (20%), 6/33 cases of leptospirosis (18%) and 16/30 cases of Kala-azar (53%). The APhL® ELISA kit had superior performance showing the highest specificity: 97% (95% CI: 92%-99%) for IgG compared to 81% (95% CI: 74%-87%) for standard ELISA and 72% (95% CI: 64%-79%) for anti-beta2 GPI assay. CONCLUSIONS: The APhL® ELISA kit proved to be significantly more specific than the aCL standard ELISA and the anti-beta2GPI ELISA, and it should be used to help in the diagnosis and confirmation of APS.

OBJETIVO: Identificar a incidência, fatores de risco e mortalidade de insuficiência renal aguda (IRA), em pacientes submetidos à cirurgia para revascularização miocárdica com circulação extracorpórea. MÉTODOS: Estudados prospectivamente todos os pacientes submetidos a cirurgia de revascularização miocárdica e as variáveis clínicas e laboratoriais analisadas através de métodos uni e multivariado (regressão logística). RESULTADOS: Insuficiência renal aguda ocorreu em 16,1% dos 223 pacientes estudados, diálise foi necessária em 4,9% dos pacientes. Os fatores de risco associados à IRA na análise univariada foram: idade > 63 anos OR 3,6 (95% IC=1,6 a 8,3), creatinina sérica pré-operatória > 1,2 mg/dl OR 5,9 (95% IC=2,4 a 14,6), duração da circulação extracorpórea > 90 min OR 2,1 (95% IC=1,0 a 4,4), uso de balão intra-aórtico OR 2,6 (95% IC=1,2 a 5,5); necessidade de drogas inotrópicas OR 4,4 (95% IC=1,9 a 10,2) e, na análise multivariada, foram fatores independentes associados à IRA idade > 63 anos OR 3,0 (95% IC=1,3 a 7,2), creatinina sérica pré-operatória > 1,2 mg/dl OR 4,3 (95% IC=1,6 a 11,4), necessidade de drogas inotrópicas OR 3,2 (95% IC=1,3 a 8,0). A mortalidade nos pacientes com IRA foi de 25,0 % em comparação com 1,1% entre os sem IRA e 63,6% entre os que necessitaram de diálise. CONCLUSÃO: Insuficiência renal aguda em cirurgia de revascularização miocárdica é uma complicação freqüente e está associada à alta mortalidade. Sendo fatores de risco independentes: idade, insuficiência renal prévia e necessidade de drogas inotrópicas.

OBJECTIVE: To identify the incidence, risk factors, and mortality of acute renal failure (ARF) in patients undergoing myocardial coronary artery bypass surgery with extracorporeal circulation. METHODS: All patients undergoing myocardial coronary artery bypass surgery were prospectively studied, and their clinical and laboratory variables were assessed using uni- and multivariate analysis (logistic regression). RESULTS: Acute renal failure occurred in 16.1% of the 223 patients studied; 4.9% of patients required dialysis. Risk factors associated with ARF in the univariate analysis were age > 63 years, OR 3.6 (95% CI=1.6 to 8.3); preoperative serum creatinine > 1.2 mg/dL, OR 5.9 (95% CI=2.4 to 14.6); duration of extracorporeal circulation > 90 min, OR 2.1 (95% CI=1.0 to 4.4); use of intraaortic balloon, OR 2.6 (95% CI=1.2 to 5.5); need for inotropic drugs, OR 4.4 (95% CI=1.9 to 10.2). In the multivariate analysis, independent factors associated with ARF were: age > 63 years, OR 3.0 (95% CI=1.3 to 7.2); preoperative serum creatinine > 1.2 mg/dL, OR 4.3 (95% CI=1.6 to 11.4); need for inotropic drugs, OR 3.2 (95% CI=1.3 to 8.0). Mortality in the patients with ARF was 25.0% compared with 1.1% in those without ARF and 63.6% in those who required dialysis. CONCLUSION: Acute renal failure after myocardial coronary artery bypass surgery is a frequent complication associated with a high mortality rate. The independent risk factors are age, previous renal failure, and the need for inotropic drugs.

OBJETIVO: Avaliar se a hipertensão arterial (HA) diagnosticada durante os primeiros dois meses de acompanhamento associa-se com a incidência de doença renal terminal (DRT) em negros e mulatos com glomerulonefrite, levando em consideração a idade, o sexo e o diagnóstico histológico. MÉTODOS: Estudo de coorte retrospectivo baseado em uma amostra de 120 pacientes negros e mulatos: 26 com glomerulonefrite membranoproliferativa (GNMP), 58 com glomeruloesclerose segmentar e focal (GSF) e 36 com outros tipos de glomerulonefrites (OTGN). HA foi considerada presente em pacientes usando anti-hipertensivos, em adultos apresentando média de três medidas de pressão arterial (PA) sistólica igual ou superior a 140 ou média das correspondentes medidas da PA diastólica igual ou superior a 90 mmHg. Para a faixa etária igual ou inferior a 18 anos foram utilizados os critérios da "Task Force on Blood Pressure in Children". RESULTADOS: HA no início do acompanhamento foi diagnosticada em 48 dos 120 pacientes (41,6%). A incidência de DRT foi aproximadamente 2,6 vezes maior em pacientes hipertensos (risco relativo (RR) = 2,62; intervalo de confiança (IC) 95% =1,01-7,03; p=0,031). A associação entre HA e aumento da incidência de DRT foi similar entre o grupo com idade menor ou igual a 18 anos e o grupo com idade superior a 18 anos. Mesmo após o ajuste para idade, sexo e tipo histológico, a incidência de DRT permaneceu maior (e marginalmente significante) em hipertensos que em normotensos (RR ajustado =2,15; IC 95%=0,86-5,39; p=0,07). CONCLUSÕES: De acordo com os resultados, detecção precoce de HA em negros e mulatos com glomerulonefrite ajuda a identificar pacientes com maior risco de DRT, independente da idade, do sexo e do tipo histológico. Outros trabalhos são necessários para determinar em que extensão a severidade e grau de controle da HA contribuem para o desenvolvimento de DRT em negros e mulatos com glomerulonefrite.

OJECTIVE: To assess whether hypertension diagnosed during the first two months of follow-up is associated with the incidence of end-stage renal disease (ESRD) in negroes and mulattoes with glomerulonephritis after taking into account age, gender and the histological diagnosis.METHODS: A retrospective cohort study based on a sample of' 120 negro and mulatto patients with glomerulonephritis, 26 with membranoproliferative glomerulonephritis (MPGN), 58 with focal segmental glomerulosclerosis (FSG) and 36 with other types of glomerulonephritis (OTGN). Hypertension was considered present if antihypertensive treatment was used, in adults (age >18 years) with a mean of the three first systolic blood pressures of 140 mmHg or a mean of the corresponding diastolic blood pressure of 90 mm Hg or greater. For ages equal to or below 18 years the criteria recommended by the "Task Force on Blood Pressure in Children" were used.RESULTS: Hypertension was diagnosed in 48 of the 120 patients (41.6%). The incidence of ESRD was approximately 2.6 times higher in hypertensive patients (relative risk(RR)=2.62; 95 % confidence interval (CI) =1.01-7.03, p=0.031). This association between hypertension and higher risk of ESRD was similar between the group younger than 19 and the group older than 18 years. Even after adjusting for age, gender and histologic type, the incidence of ESRD remained higher (and marginally significant) in the hypertensive than in the normotensive group (adjusted RR=2.15; IC 95%=0.86-5.39, p=0.07).CONCLUSIONS: According to the findings, early detection of hypertension in negroes and mulattoes with glomerulonephritis helps to identify patients with higher risk of ESRD, independently of age, gender and histologic type. Further research is needed to determine to what extent the severity of hypertension and the degree of blood pressure control contribute to the development of ESRD in negroes and mulattoes with glomerulonephritis.

As formas severas de esquistossomose mansônica, particularmente a hépato-esplênica, se acompanham de glomerulopatia geralmente manifesta por síndrome nefrótica. Nos últimos 10 anos reduziu-se muito o número de casos observados desta glomerulopatia no Hospital Universitário Prof. Edgard Santos, um hospital geral num estado onde esta parasitose é endêmica. O objetivo deste estudo foi verificar se estava havendo, de fato, desaparecimento desta patologia ou se este número decrescente refletia apenas diminuição marcante de casos graves de esquistossomose mansônica acompanhados neste Hospital. Para isso foram comparadas as prevalências de glomerulopatia em hepatosplênicos esquistossomóticos autopsiados no Hospital Universitário Prof. Edgard Santos em duas décadas: de 1960-70, antes da intervenção terapêutica nas áreas endêmicas de esquistossomose com oxamniquine, e de 1980-1990, após a adoção desta intervenção. Houve grande redução no número de doentes com hepatosplenomegalia esquistossomótica autopsiados no Hospital Universitário Prof. Edgard Santos quando comparadas a década antes (140 autópsias) e depois (31 autópsias) do tratamento com oxamniquine. A prevalência de glomerulopatia, entretanto, persistiu a mesma (11,4% comparada com 12,9%, respectivamente). A conclusão é que a redução do achado de glomerulopatia esquistossomótica em nossos dias reflete apenas a redução das formas graves da parasitose após a intervenção terapêutica nas áreas endêmicas.

Hepatosplenic form of S. mansoni infection may be accompanied by a glomerulopathy in 12-15% of cases, manifested in the majority by a nephrotic. This type of renal involvement is becoming a rare occurrence in our University Hospital (Hospital Universitário Prof. Edgard Santos) a typical general hospital in an endemic state for this parasitic disease. To investigate this fact, autopsied cases with patients with hepatosplenic form of schistosomiasis mansoni during two decades in our Hospital - 1960-70, (before a therapeutic intervention in endemic areas with oxamniquine) and 1980-1990 (after the intervention) were compared in reference to number of cases and the finding of glomerulonephritis by histological examination. Even though there was a strinking decrease in number of patients with advanced forms of this disease (140 as compared to 31 autopsies in these two decades), the prevalence of glomerulonephritis diagnosed was 11.4 (16 cases) in the first and 12.9 (4 cases) in the second. As there was no change in pattern of attendance in this Hospital, the drastic decrease in number of severe forms of this parasitic infection following massive therapy of the endemic population with oxamniquine in the most likely explanation not only for the decrease in number of hepatosplenic cases but, also, and as a consequence, the scarcity of cases of the schistosomal glomerulopathy observed.

Leptospirose é uma importante causa de insuficiência renal aguda, em nosso ambiente. Embora vários sejam os mecanismos implicados, o papel da rabdomiólise na patogênese da insuficiência renal aguda na leptospirose ainda não foi analisado. Com esse objetivo, 16 pacientes com o diagnóstico da forma icterohemorrágica da leptospirose consecutivamente admitidos no Hospital Couto Maia, Salvador, Bahia, foram prospectivamente estudados. A doença foi caracterizada por início súbito e, à admissão, ictericia, sufusões hemorrágicas conjuntivais e mialgias. Proteinúria de intensidade média a moderada com sedimento urinário inexpressivo foi observada em 37,5% dos pacientes e níveis séricos elevados de uréia e creatinina em 78,5% e 74,0%, respectivamente. Níveis aumentados de aminotransferase foram documentados em todos os 12 e de CPK em todos os 10 pacientes avaliados para essas enzimas. Níveis séricos maiores que 120µg/l foram observados em 56,2% dos pacientes. Não foram encontradas correlações, entretanto, entre mioglobinemia e insuficiência renal em gravidade da leptospirose.

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120µg/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Com o objetivo de estudar a freqüência de insuficiêncai renal aguda e o papel da rabdomiólise na sua patogênese, 18 pacientes adultos com o diagnóstico de tétano, consecutivamente admitidos no hospital de doenças infecciosas (Hospital Couto Maia, Salvador, BA)foramprospectivamente avaliados. Destes, 14 eram do sexo masculino e 4 do feminino, com idade média de 31,8± 2,0 anos. Exceto porproteinúria leve a moderada (< 100mg/dl) em 9pacientes, os sumários de urina foram considerados normais. Creatininas séricas superiores a l,4mg/dl foram observadas em 39% dos pacientes, níveis elevados de CPK em 87,5% e mioglobina sérica maior que 120µg/dl em 39%. Oligúria foi documentada em apenas um paciente; nenhum paciente requereu tratamento dialítico. Não foram observadas correlações entre insuficiência renal aguda e níveis séricos de mioglobina e/ou CPK. A insuficiência renal aguda no tétano não foi infreqüente; geralmente é não-oligúrica, de pequena gravidade, transitória e não relacionada à severidade da doença ou aos níveis séricos de mioglobina e/ou CPK.

To study the frequency and examine the role of rhabdomyolysis in the acute renalfailure in tetanus 18 patients with the diagnosis of generalized tetanus consecutively admitted to the infectious disease hospital were evaluated. Ofthese 14 were male and 4female with mean age of 31.8± 2.0 years. Except for mild proteinuria recorded in 9 patients, the urinalysis were unremarkable. Serum creatinine higher than 1.4mg/dl was recorded in 39% of the patients, abnormal levels of CPK in 87,5% and serum myoglobin greater than 120µg/l in 39% of the patients. Oliguria was documented in one patient and none required diafysis therapy. No correlation wasfound between renal failure and myoglobin and/or CPK serum levels. Acute renalfailure in tetanus was not infrequent; usualfy it was non-oliguric, mild and transient and not related to the severity of the disease or to serum levels of myoglobin and/or CPK.

Envolvimento renal tern sido documentado em pacientes com o diagnóstico de salmonelose septicêmica prolongada (SSP). Entretanto, ainda é controversa a existência de uma glomerulopatia especificamente relacionada a SSP ou se a infecção bacteriana prolongada agrava a glomerulopatia esquistossomótica pré-existente. Com o objetivo de analisar as manifestações clínicas e histológicas do envolvimento renal, 8 pacientes com o diagnostico de SSP foram estudados e comparados com 8 pacientes portadores de glomerulopatia esquistossomótica, pareados por sexo e doença glomerular. A idade media dos pacientes com SSP foi de 17,7 anos; a manifestação clinica do envolvimento renal foi de hematúria, em todos, estando associada a proteinúria não nefrótica em 4 deles. Entre os pacientes com glomerulopatia esquistossomótica, a idade media foi de 23,0 anos e síndrome nefrótica foi a manifestação clínica da nefropatia em 7 dos 8 pacientes. Relacionada a cura de infecção pela salmonela, houve remissão completa com o diagnóstico de glomerulopatia esquistossomótica tiveram um curso caracterizado por síndrome nefrótica persistente, corticosteróide-resistente. Exceto pela hipercelularidade glomerular e o infiltrado intersticial por células mononucleares, mais pronunciada entre os pacientes com SSP, nao foram observadas diferenças na histologia renal entre os dois grupos de pacientes. Os dados fortemente sugerem que a SSP exacerba a glomerulopatia esquistossomótica, clinicamente não manifesta, pela adição de lesões ativas, relacionadas a septicemia prolongada

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia

Anormalidades das funções renais têm sido demonstradas em pacientes portadores de leishmaniose visceral; embora haja tendência à normalização logo após o tratamento antiparasitário, algumas dessas anormalidades persistem. Com o propósito de estudar o curso clínico a longo prazo do envolvimento renal na leishmaniose visceral, 32 pacientes foram estudados na área endêmica, pelo menos 6 meses após a cura clínica da doença, e comparado a um grupo-controle de 28 indivíduos. Em nenhum paciente se documentou história ou dados clínicos sugestivos de doença renal. A avaliação laboratorial foi normal em todos os pacientes, exceto 3 com sumários de urina anormais em um, proteinúria leve e hematúria microscópica num único sumário de urina (três outros foram normais) e leucocitúria em dois outros pacientes. Concluiu-se que na leishmaniose visceral o envolvimento renal é discreto e transitório, havendo desaparecimento das alterações sugestivas de disfunção após a cura da doença parasitária.

Abnormalities of renal function have been demonstrated inpatients with visceral leishmaniasis; although there was a trend toward normalization following antiparasitic therapy, some abnormalities persisted. With thepurpose of studying the long- term clinical course of renal involvement in visceral leishmaniasis, 32 patients with a diagnosis of this parasitic disease were evaluated in the endemic area and at least 6 months after the clinical cure of the disease and compared with a control group of 28 individuals. No patient had a history or clinical findings suggestive of renal disease and all were normotensive. Laboratory evaluation was normal in all except 3 patients with abnormal urinalysis. Mild proteinuria and microscopic hematuria were seen in a single urinalysis in one patient (although three other urinalysis were normal), and leucocyturia in two female patients. It was concluded that the renal involvement in visceral leishmaniasis is mild and transient, with normal renal function observed on long-term follow-up after cure of the parasitic infection.