Background Residual Renal Function (RRF) preservation is related to survival in Peritoneal Dialysis (PD) patients. The effect of different PD modalities on RRF is unclear. Objectives: To analyse the evolution of RRF function in patients in PD, maintained with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD), and study other possible factors related to RRF decline. Methods: A single-centre retrospective study with 104 incident PD patients (48 CAPD and 56 APD). Patients with no RRF function at PD beginning were excluded. The mean age was 52.1±16 years, 70% were male and 16% diabetics. Thirteen patients used low glucose degradation product (GDP) solutions and 57 patients were using icodextrin. The use of diuretics, angiotensinconverting enzyme inhibitors and angiotensin II receptor blockers was also analysed. RRF and diuresis were analysed every 3 months and peritoneal transport every 6 months, forl a total of 48 months. The mean follow-up was 29.3±19 months. Results: CAPD patients were older, had higher prevalence of diabetes, used less icodextrin and more low GDP solutions and were followed for a longer time. No significant differences in RRF were observed in either modality in basal or during the follow-up: RRF at 24 months with 3.67±3.5ml/min in CAPD patients and 3.82±2.5ml/min in APD patients; or in diuresis: 883±807ml/day and 1333±905ml/day respectively. Neither group showed significant differences in peritoneal transport parameters over time. The use of icodextrin was related to a higher diuresis preservation at 24 months: 1519±1035ml/day in patients using icodextrin and 767±633ml/day in patients without icodextrin (p=0.01). No differences were found in RRF evolution in either group. Conclusions: We conclude that DP modality does not influence either the RRF function or diuresis outcomes or peritoneal transport parameters. The initial use of icodextrin was related to better diuresis preservation without changes in RRF

Resumo Introdução: Após o transplante renal, as mulheres recuperam a fertilidade em pouco tempo. Entretanto, a viabilidade da gestação e as complicações maternas da gravidez ainda são objeto de estudo. Objetivo: Descrever a evolução da gestação após o transplante renal, com foco principal nas complicações maternas. Métodos: Estudo retrospectivo de casos de gravidez ocorridos entre 2004 e 2014 em pacientes transplantadas renais, com seguimento de 12 meses após o parto. Cada gravidez foi considerada um evento. Resultados: Houve 53 gestações em 36 pacientes. A média de idade foi de 28 ± 5 anos. Gravidez ocorreu 4,4 ± 3 anos após o transplante. A imunossupressão preconcepção era composta de tacrolimo, azatioprina e prednisona em 74% dos casos. Houve 15% de aborto no 1º trimestre e 8% no segundo trimestre. Em 41% dos casos, foi necessário induzir o parto. De todos os nascimentos, 22% foram prematuros e 17% muito prematuros. Houve 5% de natimortos e de mortes neonatais. Proteinúria de novo ocorreu em 60%, infecção do trato urinário em 23%, pré-eclâmpsia em 11%, rejeição aguda em 6% e perda do enxerto em 2% dos casos. Foi observada elevação significante da creatinina quando comparados período preconcepção, 3º trimestre e pós-12 meses de seguimento (média de 1,17 vs. 1,46 vs. 1,59 mg/dl; p < 0,001). Conclusão: Os resultados demonstram taxa de aborto maior que na população em geral, com altas taxas de complicações maternas. Aumento sustentado da creatinina sugere aumento do risco de perda do enxerto em longo prazo.

Abstract Introduction: Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. Objective: To describe the outcomes of pregnancies in kidney transplanted patients, focusing on maternal complications. Methods: Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. Results: There were 53 pregnancies in 36 patients. Mean age was 28 ± 5years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p < 0.001). Conclusion: Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

Background: A glomeruloesclerose segmentar e focal é uma causa comum de síndrome nefrótica. Em casos de resistência à corticoterapia e à ciclosporina várias alternativas têm sido sugeridas, com base em estudos limitados e com resultados discordantes. Vários estudos em transplante de órgãos têm demonstrado que a associação de ciclosporina e micofenolato de mofetil têm um efeito imunossupressor sinérgico. Casos clínicos: Apresentam -se dois casos de síndrome nefrótica devida a glomeruloesclerose segmentar e focal idiopática, com resistência à corticoterapia, a ciclosporina associada a baixa dose de corticoides e ao micofenolato de mofetil em monoterapia em um dos casos e onde a remissão completa foi alcançada com a associação de ciclosporina e micofenolato de mofetil. Ambos os casos não apresentaram complicações significativas durante o seguimento. Conclusão: A associação terapêutica de ciclosporina e micofenolato de mofetil parece ser eficaz e segura no tratamento de glomerulosclerose segmentar e focal idiopática resistente a corticoterapia e a ciclosporina

Background: Focal and segmental glomerulosclerosis is a common cause of nephrotic syndrome. In cases of steroid and cyclosporine resistance several alternatives have been suggested, based on limited studies with conflicting results. Several studies in organ transplantation have shown that the association of cyclosporine and mycophenolate mofetil has a synergic immunosuppressive effect. Clinical cases: We present two cases of nephrotic syndrome due to idiopathic focal segmental glomerulosclerosis with resistance to steroids, cyclosporine plus low -dose steroids and to mycophenolate mofetil in monotherapy in one of them, where complete remission was achieved with the association of cyclosporine and mycophenolate mofetil. There were no significant complications or renal failure during follow-up in both cases. Conclusion: Combined therapy with cyclosporine and mycophenolate mofetil appears to be effective and safe in the treatment of steroid and cyclosporine resistant idiopathic focal segmental glomerulosclerosis