ABSTRACT Introduction: Peritoneal dialysis patients are at increased risk of developing abdominal wall complications, including hernias. This study aimed to determine the incidence of hernias in peritoneal dialysis patients, identify risk factors, and evaluate their impact on technique survival. Methods: A retrospective cohort study was conducted, including prevalent peritoneal dialysis patients in a single center, from January 2010 to October 2020. Data on baseline characteristics, previous abdominal surgeries, and hernia history were collected. Patients with diagnosed hernias during peritoneal dialysis were compared to a control group. Results: Among 155 peritoneal dialysis patients, hernias occurred in 29% (n=45) of the population, with an incidence rate of 0.09 hernias/patient/year. Umbilical hernias were the most common subtype. Autosomal dominant polycystic kidney disease (OR (odds ratio) 3.925; 95% confidence interval (CI), 1.208 - 12.75) history of surgical repaired hernias (OR 5.586; 95% CI 1.540 - 20.255) and a higher number of previous abdominal surgeries (OR 1.680; 95% CI 1.025 - 2.752) were independent predictors of hernia development. Surgical treatment was performed in 59.3% of cases, with a 18.8% recurrence rate. Higher daytime infusion volumes were associated with hernia recurrence (p=0.045). Peritoneal dialysis technique survival did not differ significantly between the hernia and control groups (p=0.700). Conclusion: Hernias are frequent in peritoneal dialysis patients, with autosomal dominant polycystic kidney disease, previous abdominal surgeries, and history of surgically repaired hernias as identified risk factors. Hernias do not significantly interfere with peritoneal dialysis technique survival, but comprehensive management strategies, including early surgical repair and peritoneal dialysis prescription adaptations, can optimize outcomes.

Abstract Encapsulating peritoneal sclerosis is an uncommon but serious complication of peritoneal dialysis. In most cases, the symptoms appear after peritoneal dialysis withdrawal, which hampers its diagnosis. We present the case of a 44-years-old Caucasian male who had been on peritoneal dialysis for 6 years and 3 months and was switched to hemodialysis due to ultrafiltration failure. During his last months on peritoneal dialysis, he developed anorexia and asthenia, which were initially attributed to dialysis inadequacy. After hemodialysis induction, the patient developed abdominal pain, increased abdominal volume, obstipation alternating with diarrhea, and weight loss. Computed tomography showed de novo ascites. A diagnosis of early encapsulating peritoneal sclerosis was considered, and treatment was promptly initiated with nutritional support, oral prednisolone, and tamoxifen for one year. The patient progressed with resolution of the symptoms. One month after the end of the treatment, he underwent a successful kidney transplant and remain without any major intercurrences. A high level of clinical suspicion is crucial for the early diagnosis of encapsulating peritoneal sclerosis as the disease can be fatal in advanced stages. This case highlights that with early treatment, kidney transplantation can be successfully performed after an episode of encapsulating peritoneal sclerosis.

Resumo A esclerose peritoneal encapsulante é uma complicação incomum, mas grave, da diálise peritoneal. Na maioria dos casos, os sintomas aparecem após a suspensão da diálise peritoneal, o que dificulta seu diagnóstico. Apresentamos o caso de um homem caucasiano de 44 anos de idade que esteve em diálise peritoneal por 6 anos e 3 meses e foi transferido para hemodiálise devido a falha de ultrafiltração. Durante seus últimos meses em diálise peritoneal, ele desenvolveu anorexia e astenia, que foram inicialmente atribuídas à inadequação da diálise. Após a indução de hemodiálise, o paciente desenvolveu dor abdominal, aumento do volume abdominal, obstipação alternada com diarreia, e perda de peso. A tomografia computadorizada mostrou ascite de novo. Foi considerado um diagnóstico de esclerose peritoneal encapsulante precoce, e o tratamento foi prontamente iniciado com suporte nutricional, prednisolona oral e tamoxifeno por um ano. O paciente progrediu com resolução dos sintomas. Um mês após o término do tratamento, ele foi submetido a um transplante renal bem-sucedido e permanece sem maiores intercorrências. Um alto nível de suspeita clínica é crucial para o diagnóstico precoce da esclerose peritoneal encapsulante, uma vez que a doença pode ser fatal em estágios avançados. Este caso destaca que, com tratamento precoce, o transplante renal pode ser realizado com sucesso após um episódio de esclerose peritoneal encapsulante.

Abstract Objectives: This work aimed to evaluate and compare the surface roughness, contact angle, and C. albicans adhesion in three materials for removable denture bases: polymethylmethacrylate and the thermoplastic resins polypropylene and polyolefin. Methods: Nine samples were manufactured, three of each material (n=3): polypropylene, polyolefin, and polymethylmethacrylate (control group). The thermoplastic resins were fabricated by injection technique and the polymethylmethacrylate by compression technique. After laboratory polishing, the surface roughness (Ra and Rz) was assessed with the 3D optical roughness meter NPFLEX, and the contact angle was measured with the optical tensiometer Contact angle system OCA15. C. albicans adhesion was assessed through colony- forming unit assays (n=9). ANOVA and Kruskal-Wallis tests were done to compare groups, considering a significance level of 0.05. Results: All values obtained for the control group were lower than those obtained for the thermoplastic resins. Statistically significant differences were found: for Ra between polypropylene (0.15±0.072 μm) and polymethylmethacrylate (0.03±0.006 μm) (p=0.045); for the contact angle between the three groups (p<0.001) - polymethylmethacrylate (26.57±6.719°), polypropylene (57.57±11.098°), and polyolefin (69.06±8.955°); and for C. albicans adhesion between polymethylmethacrylate and polypropylene (p=0.007) and polymethylmethacrylate and polyolefin (p=0.013). Conclusions: In the tested conditions and for the materials assessed, polymethylmethacrylate showed the lowest roughness, contact angle, and C. albicans adhesion, thus exhibiting better properties for removable denture bases than the thermoplastic materials.

Resumo Objetivos: Este trabalho pretende avaliar e comparar os parâmetros de rugosidade de superfície, ângulo de contacto e adesão de C. albicans em três materiais de base para próteses removíveis: o polimetilmetacrilato e as resinas termoplásticas polipropileno e poliolefina. Métodos: Foram confecionados 9 espécimes, 3 de cada um dos seguintes materiais (n=3): polipropileno, poliolefina e polimetilmetacrilato (grupo controlo). As resinas termoplásticas foram produzidas por técnica de injeção, e o polimetilmetacrilato por técnica de compressão. Após o polimento laboratorial, avaliou-se a rugosidade de superfície (Ra e Rz) com o rugosímetro ótico 3D NPFLEX e o ângulo de contacto com o tensiómetro ótico Contact angle system OCA15. A adesão de C. albicans foi avaliada por quantificação das unidades formadoras de colónias (n=9). Os testes ANOVA e Kruskal-Wallis foram utilizados para comparação dos resultados entre os grupos, com um nível de significância de 0,05. Resultados: Todos os valores obtidos para o grupo de controlo foram inferiores aos das resinas termoplásticas. Verificaram-se diferenças estatisticamente significativas: na Ra, entre o polipropileno (0,15±0,072 μm) e o polimetilmetacrilato (0,03±0,006 μm) (p=0,045); no ângulo de contacto, entre os 3 grupos (p<0,001) - PMMA (26,57±6,719°), polipropileno (57,57±11,098°) e poliolefina (69,06±8,955°); e na adesão de C. albicans, entre o polimetilmetacrilato e a polipropileno (p=0,007), e entre o polimetilmetacrilato e a poliolefina (p=0,013). Conclusões: Nas condições testadas e para os materiais estudados, o polimetilmetacrilato apresentou menor rugosidade, menor ângulo de contacto e menor adesão de C. albicans, evidenciando melhores características para base de prótese removível do que os materiais termoplásticos.

ABSTRACT Cardiovascular disease continues to be the most frequent cause of death in peritoneal dialysis patients and an important obstacle for the improvement of technique survival. Heart failure diagnosis and management is particularly challenging among dialysis patients, and this condition remains underdiagnosed and undertreated in this population. The most common phenotype of heart failure among peritoneal dialysis patients is heart failure with preserved ejection fraction, diastolic disfunction and left ventricular hypertrophy. Unfortunately, unlike what happens with heart failure with reduced ejection fraction, there is lack of evidence to support a specific drug regimen to treat heart failure with preserved ejection fraction. Several conditions associated with end stage kidney disease, such as anemia, hyperphosphatemia, secondary hyperparathyroidism, inflammation, and insulin resistance seem to be involved in the pathogenesis of heart failure with preserved ejection fraction and for this reason, the term uremic cardiomyopathy has been proposed. There is a lack of evidence regarding the optimal heart failure treatment for peritoneal dialysis patients and more studies are needed to assess the efficacy and safety of the new drugs available for heart failure treatment. This review explores the spectrum of heart failure on peritoneal dialysis, its pathogenesis, risk factors and possible therapeutic and preventive measures.

ABSTRACT Chronic kidney disease is an increasingly common diagnosis in the very elderly and identifying the patients who benefit from a nephrologist’s intervention and the ones who would not might avoid wasteful or harmful interventions. The aim of this study is to identify the risk factos for progressive versus non‑progressive chronic kidney disease in a population aged over 80 years old. We performed a cohort single‑center retrospective study including 101 patients over 80 years old with chronic kidney disease diagnosed for at least five years and followed regularly by a nephrologist. Progressive disease was defined as glomerular filtration rate declines greater than 5 mL/min/1.73 m2/year. Of the 101 patients, 33.7% had progressive chronic kidney disease. The median glomerular filtration progression rate was 3.0 [2.1‑6.0] mL/min/1.73m2/year. Hypertension and diabetes mellitus prevalence was similar between groups. Nephrology follow‑up time was longer in the progressive group (5.0 vs 2.0 years, p=0.01). Regarding chronic kidney disease complications, 37.6% had anemia and half of these needed erythropoiesis‑stimulating agents. None of the patients had hyperphosphatemia. About 18.8% presented metabolic acidosis. In multivariable analysis, after adjusting for covariables such as age, hypertension, and diabetes mellitus only the presence of metabolic acidosis (OR 0.4, CI: 0.1‑0.8) was associated with the development of progressive chronic kidney disease. Progressive chronic kidney disease group presented higher mortality (log rank 4.5, p=0.03). Ischemic cardiomyopathy (OR: 0.5, CI: 0.2‑0.9) and progressive chronic kidney disease (OR: 0.6, CI:0.3‑0.8) were associated with all‑cause mortality. Our results showed that most elderly patients have non‑progressive chronic kidney disease. Patients with metabolic acidosis seem to be at an increased risk for developing progressive disease. Most elderly patients die before reaching end‑stage kidney disease, so it is importante to look at progressive kidney disease in those patients as an important marker of comorbidity and privilege cardioprotective measures.

ABSTRACT Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p<0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p<0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients.

Resumo Objetivos: Este estudo retrospetivo correlacionou o comprimento de núcleos metálicos fundidos com a qualidade do selamento endodôntico apical remanescente. Métodos: Um total de 320 radiografias periapicais foi analisado visualmente por dois examinadores independentes e calibrados. O comprimento dos retentores foi classificado em adequado, curto e longo (2/3, <2/3 e >2/3 do comprimento radicular, respetivamente). A qualidade do selamento apical remanescente foi analisada considerando três aspetos: compactação lateral, distância do ápice radicular e a quantidade de material obturador remanescente. O teste de Qui-Quadrado, com nível de significância de 5%, foi usado para análise estatística. Resultados: A distribuição dos 443 retentores intrarradiculares avaliados, com respeito ao comprimento, foi de 14,9%, 82,4% e 2,7% (adequado, curto e longo; respetivamente). Na avaliação do tratamento endodôntico, 76,1% foram inadequados em pelo menos um aspeto, enquanto aproximadamente 50% apresentaram-se como incorretos em todos os aspectos analisados (p=0,0003). Quando os aspetos protéticos e endodônticos foram considerados, 5,9% dos tratamentos foram considerados apropriados, 16,9% foram clinicamente aceitáveis e 77,2%, inadequados. Conclusões: Retentores adequados foram 2,5 vezes mais frequentes em dentes com tratamento endodôntico adequado. A baixa frequência de retentores intrarradiculares apropriados sugere tratamento endodôntico inadequado.

Abstract Objective: This study retrospectively correlated metallic cast retainers’ length with the quality of the remaining apical sealing. Methods: A total of 320 periapical radiographs were analyzed by two independent, calibrated examiners. The retainers’ length was classified as adequate, short, and long (2/3, <2/3, and >2/3 of the root length, respectively). The quality of the remaining apical sealing was assessed considering three aspects: lateral compaction, distance to the root apex, and amount of remaining filling material. A chi-square test at a 5% significance level was used for statistical analysis. Results: Of the 443 intracanal retainers assessed, 14.9% were adequate, 82.4% short, and 2.7% long. Regarding endodontic treatment aspects, 76.1% were inadequate in at least one aspect, whereas approximately 50% were incorrect in all aspects analyzed (p=0.0003). When both prosthetic and endodontic aspects were considered, 5.9% of the treatments were considered appropriate, 16.9% clinically acceptable, and 77.2% inadequate. Conclusions: Suitable retainers were 2.5 times more frequent in teeth with adequate endodontic treatment. The low frequency of appropriate intracanal retainers suggests inappropriate endodontic treatment.

Atheroembolic renal disease is a multisystem clinical entity of unknown incidence. It is often associated with severe atherosclerotic disease and its etiology can be spontaneous or iatrogenic. Its pathophysiology is based on renal dysfunction secondary to embolization of cholesterol crystals, followed by occlusive phenomena affecting the renal vasculature. The present report describes the case of a patient with several cardiovascular risk factors, with a recent introduction of rivaroxaban. The clinical course presented was suggestive of renal atheroembolic disease, and the histological evaluation corroborated this diagnosis.

Sarcoidosis is a rare multisystem disease that is characterized by the formation of inflammatory granulomatous processes. The lung is the most frequently affected organ, but kidney injury can also occur. It is a disease with a highly variable course and prognosis and non-consensual treatment. This report describes the successful case of a patient with sarcoidosis presenting with pulmonary, cutaneous and renal injury, who presented with adequate diagnostic timing and optimal therapy response.

Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis commonly involves kidney, lung, upper respiratory tract, skin, gastrointestinal and occasionally peripheral nervous system. Central nervous system is less commonly affected and is generally part of a multi-organ scenario. We present a case of a 21-year-old female with chronic kidney disease secondary to myeloperoxidase ANCA associated vasculitis, diagnosed at age 19. She then presented with pulmonary-renal syndrome with stage 5 CKD. Three months’ cyclophosphamide and prednisone were instituted, followed by azathioprine, but she remained dialysis dependent. After 2 years, while on maintenance treatment, she was admitted to the emergency department with tonic-clonic seizures. She had started oral ciprofloxacin 2 days before for acute gastroenteritis. No illicit drugs were noticed. Blood tests showed an increased myoglobin but were otherwise unremarkable. No anomalies were reported on cerebral computed tomography or cerebrospinal fluid analysis. Magnetic resonance imaging showed diffuse cortico-subcortical lesions with T2 and proton density hypersignal suggesting recent ischemia, and segmental irregularities of various cerebral and vertebral arteries, consistent with small and medium size vessel vasculitis. Intravenous methylprednisolone and oral cyclophosphamide were started. Anti-myeloperoxidase ANCA levels were increased (>200 RU/mL), reinforcing our diagnostic hypothesis of central nervous system (CNS) recurrence of ANCA vasculitis. The patient had a favorable clinical course, with no neurological sequelae. Conclusions: This is a case of ANCA associated vasculitis that presented with kidney and lung but no CNS involvement and recurred with primarily cerebral disease. Favorable outcome was seen with standard immunosuppression. Awareness of this rare but severe complication is critical for timely recognition and prompt treatment.

The aim of this work was to study the corrosion process of new aluminium alloy AA2524-T3 (Solution Heat Treated and Cold Worked), which is a promising substitute of the base line AA2024-T3 for aircrafts fabrication, by global and localised techniques in sodium chloride medium (0.05 mol L-1 NaCl). The open circuit potential results revealed a stochastic evolution of pitting events and to the resulting variations in the ratio of passive/active areas and/or cathode/anode, which may be related to the presence of different types of intermetallics. The cyclicvoltammetry showed that the corrosion potential (Ecorr) and the pit nucleation potential (E pit) values are quite similar (approximately -0.525 V). The results of EIS show that the corrosion rate is quite stable, with no tendency to increase or decrease for longer immersion periods. The results of SVET were in agreement with the results obtained by EIS technique, showing strong anodic activity on the surface with no repassivation along the whole immersion time. Besides, corrosion process led to significant surface degradation after 24h.

Background: Peritoneal protein losses (PPL) are an inevitable process in peritoneal dialysis (PD). Few studies have supported a positive correlation between PPL and infections or general morbidity and mortality. The aim of this study was to investigate whether PPL was a risk factor of peritonitis. Methods: We retrospectively studied all incident PD patients in a PD single unit during the previous 10 years. We recorded baseline PPL (bPPL) and relevant analytic and clinical data. Patients were distributed into one of 2 bPPL groups (group 1: ≤5.89g/day and group 2: >5.89g/day) to compare their peritonitis risk. Results: 104 Patients were included, with a median follow-up of 29 months. Higher bPPL patients were more likely to have peritonitis (group 1: 43%, group 2: 72%, p<0.01). After adjustment for covariates, bPPL remained an independent predictor of peritonitis (p=0.01). The time to first peritonitis was shorter in the group with higher bPPL (p=0.01) although after adjustment for other covariates no significant associations were found. In the Poisson regression, more elevated bPPL were associated with higher peritonitis rates after adjustment for other independent variables (p=0.02). Conclusion: In this retrospective study, higher bPPL were able to independently predict risk of peritonitis, reflecting its impact on the morbidity of PD patients. Patients with higher bPPL levels presented shorter peritonitis-free time to first peritonitis episode and higher probability of more peritonitis episodes over time.

Introduction: Chronic kidney disease (CKD) is strongly associated with hypertension (HTN) and each can cause or aggravate the other. Misclassification of BP control is an important problem in hypertensive patients with CKD, making ambulatory blood pressure monitoring (ABPM) an important tool. The aim of our study was to review the influence of ABPM results in antihypertensive treatment and BP control in hypertensive CKD patients. Methods: Retrospective observational study; inclusion of hypertensive CKD patients stages 1 to 5 not on dialysis who performed ABPM in our department; data collected from clinical records and ABPM reports. Results: A total of 54 hypertensive CKD patients were reviewed. Reasons appointed for requesting ABPM included suspicion of resistant hypertension (40.7%), uncontrolled hypertension (29.6%), white coat hypertension (16.7%), hypotension (9.2%) and masked hypertension (3.8%). Interestingly, pre-ABPM clinical interpretation of BP control was found inadequate in 55.6% of patients. Conclusion: Misclassification of BP was a significant problem. As a result of these findings our department incorporated ABPM more routinely as recommended best practice

Atypical haemolytic uraemic syndrome (aHUS) is a rare, life-threatening, genetic disease, due to uncontrolled alternative pathway complement activation. Although the renal microvasculature appears to be the predominantly affected target, other organ pathology compatible with local thrombotic microangiopathy has been reported. Eculizumab is a humanized antibody therapy that has been associated with significant inhibition of complement-mediated thrombotic microangiopathy events in aHUS. In this report, we describe the rare case of a patient with relapsing atypical haemolytic uraemic syndrome, cutaneous manifestations of the thrombotic microangiopathy and we discuss the treatment with plasma exchange and eculizumab