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 Objective: Fasting insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) index are relatively simple and reliable noninvasive markers of insulin resistance (IR). Given the relevance of correctly diagnosing IR, we emphasize the importance of establishing reliable reference intervals (RIs) for these markers. This study aimed to determine the RIs of fasting insulin and HOMA-IR index in adults living in Rio de Janeiro and, secondarily, to verify potential RI differences between sexes. Subjects and methods: Serum insulin levels of 146,497 individuals (ages 20-60 years) who underwent blood sampling in the state of Rio de Janeiro were obtained retrospectively through access to an extensive laboratory database. Insulin was measured using the electrochemiluminescence immunoassay method. After applying exclusion criteria, 21,684 individuals (18,576 [86%] women) were included. The RIs were estimated using a computational mining approach that integrates a selection of R packages. Results: The 95% RIs in women and men and in the overall population were, respectively, 2.54-13.30 μU/mL (15.3-80.12 pmol/L), 2.43-11.89 μU/mL (14.6-71.7 pmol/L), and 2.52-13.14 μU/mL (15.2-79.2 pmol/L) for fasting insulin levels and 0.39-2.86, 0.38-2.81, and 0.39-2.86 for HOMA-IR values. Despite significant differences in insulin levels and HOMA-IR index between men and women, the use of sex-specific RIs was not justified. Conclusion: The RIs of fasting insulin levels and HOMA-IR values found in the overall population can be applied to both sexes. Thus, for our population, we suggest the RIs of 2.52-13.14 μU/mL (15.1-78.8 pmol/L) for fasting insulin and 0.39-2.86 for the HOMA-IR index. Objective HOMAIR HOMA IR (HOMA-IR IR. . (IR) (RIs secondarily sexes methods 146497 146 497 146,49 ages 2060 20 60 20-6 years database method criteria 21684 21 684 21,68 18,576 18576 18 576 (18,57 86% 86 [86% included packages Results 95 respectively 2.5413.30 2541330 2.54 13.30 2 54 13 30 2.54-13.3 μUmL μU mL 15.380.12 1538012 15.3 80.12 15 3 80 12 (15.3-80.1 pmol/L, pmolL pmol/L , pmol L 2.4311.89 2431189 2.43 11.89 43 11 89 2.43-11.8 14.671.7 146717 14.6 71.7 14 6 71 7 (14.6-71. 2.5213.14 2521314 2.52 13.14 52 2.52-13.1 15.279.2 152792 15.2 79.2 79 (15.2-79. 0.392.86, 039286 0.39 2.86, 0 39 0.382.81, 038281 0.38 2.81, 38 81 0.38-2.81 0.392.86 2.86 0.39-2.8 sexspecific sex specific justified Conclusion Thus 15.178.8 151788 15.1 78.8 1 78 8 (15.1-78. (IR 14649 49 146,4 206 20- 2168 68 21,6 18,57 1857 57 (18,5 [86 9 5413 2.5413.3 254133 254 2.5 1330 13.3 5 2.54-13. 380 15.380.1 153801 153 15. 8012 80.1 (15.3-80. 4311 2.4311.8 243118 243 2.4 1189 11.8 4 2.43-11. 671 14.671. 14671 14. 717 71. (14.6-71 5213 2.5213.1 252131 252 1314 13.1 2.52-13. 279 15.279. 15279 152 792 79. (15.2-79 392 03928 039 0.3 286 382 0.382.81 03828 038 281 2.81 0.38-2.8 0.392.8 2.8 0.39-2. 178 15.178. 15178 151 788 78. (15.1-78 1464 146, 216 21, 18,5 185 (18, [8 541 2.5413. 25413 25 2. 133 13. 2.54-13 15.380. 15380 801 80. (15.3-80 431 2.4311. 24311 24 118 11. 2.43-11 67 14.671 1467 (14.6-7 521 2.5213. 25213 131 2.52-13 27 15.279 1527 (15.2-7 0392 03 0. 28 0.382.8 0382 0.38-2. 0.392. 0.39-2 17 15.178 1517 (15.1-7 18, (18 [ 2.5413 2541 2.54-1 15.380 1538 (15.3-8 2.4311 2431 2.43-1 14.67 (14.6- 2.5213 2521 2.52-1 15.27 (15.2- 0.382. 0.38-2 0.392 0.39- 15.17 (15.1- (1 2.541 2.54- 15.38 (15.3- 2.431 2.43- (14.6 2.521 2.52- (15.2 0.382 0.38- (15.1 ( (15.3 (14. (15. (14 (15

ABSTRACT COVID-19 (coronavirus disease 2019) is an infectious disease caused by the new coronavirus associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Coronaviridae comprises a large family, of which at least seven members are known to cause respiratory diseases in humans. Coronaviruses have the ability to infect virtually all major groups of animals and, eventually, can infect humans. SARS-CoV-2 is the third coronavirus to cross the species barrier and infect humans. This virus was identified in an outbreak of pneumonia cases in Wuhan city, Hubei province, China, in December 2019. Its entire genome is inscribed on a single strand of ribonucleic acid. Some proteins present on the surface of the virus act as facilitators for its entry into host cells, while others, apparently, are related to its pathogenesis. Coronaviruses are responsible for respiratory infections in humans and some animals. The infection is often mild to moderate in intensity, but some coronaviruses may cause serious illnesses, such as severe acute respiratory syndrome (SARS), which occurred in 2002, and the Middle East respiratory syndrome (MERS). Coronaviruses can activate an excessive and unregulated immune response, which may promote SARS development. Although the lungs are one of the target organs, the hypoxia mechanism is systemic and other organs begin to suffer both through lack of oxygen and through deregulation of inflammation control mechanisms.

COVID-19 (coronavirus disease 2019) is an infectious disease caused by the new coronavirus associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Coronaviridae comprises a large family and at least seven members are known to cause respiratory diseases in humans. Coronaviruses have the ability to infect virtually all major groups of animals and, eventually, can infect humans. SARS-CoV-2 is the third coronavirus to cross the species barrier and infect humans. This virus was identified in an outbreak of pneumonia in the city of Wuhan, Hubei province, China, in December 2019. Its entire genome is inscribed on a single ribbon of ribonucleic acid. Some proteins present on the surface of the virus act as facilitators of its entry into host cells, others, apparently, are related to its pathogenesis. Coronaviruses are responsible for respiratory infections in humans and some animals. The infection is often mild to moderate in intensity, but some coronaviruses can cause serious illnesses, such as Severe Acute Respiratory Syndrome (SARS) (SARS), which occurred in 2002 and the Middle East respiratory syndrome. (MERS, from Middle East respiratory syndrome). Coronaviruses can activate an excessive and unregulated immune response, which can promote SRAG development. Although the lung is one of the target organs, the hypoxia mechanism is systemic and other organs suffer both the lack of oxygen and the disruption of inflammation control mechanisms.

COVID-19 (do inglês coronavirus disease 2019) é uma doença infecciosa causada pelo novo coronavírus associado à síndrome respiratória aguda grave 2 (SARS-CoV-2). Coronaviridae compreende uma grande família e, pelo menos, sete membros são conhecidos por causarem doenças respiratórias em humanos. Os coronavírus têm a capacidade de infectar praticamente todos os principais grupos de animais e, eventualmente, podem passar a contaminar humanos. O SARS-CoV-2 é o terceiro coronavírus a transpor a barreira entre espécies e infectar humanos. Esse vírus foi identificado em um surto de casos de pneumonia na cidade de Wuhan, província de Hubei, China, em dezembro de 2019. Todo o seu genoma está inscrito em uma fita única de ácido ribonucleico. Algumas proteínas presentes na superfície do vírus atuam como facilitadores do seu ingresso nas células hospedeiras, outras, aparentemente, estão relacionadas com a sua patogenia. Os coronavírus são responsáveis por infecções respiratórias em seres humanos e em alguns animais. Frequentemente, a infecção é de intensidade leve a moderada, mas alguns coronavírus podem causar doenças graves, como a Síndrome Respiratória Aguda Grave (SRAG) (SARS, do inglês Severe Acute Respiratory Syndrome), que ocorreu em 2002 e a síndrome respiratória do Oriente Médio (MERS, do inglês Middle East respiratory syndrome). Os coronavírus podem ativar uma resposta imune excessiva e desregulada, a qual pode propiciar o desenvolvimento SRAG. Ainda que o pulmão seja um dos órgãos alvo, o mecanismo de hipóxia é sistêmico e outros órgão passam a sofrer tanto a falta de oxigênio quando a desregulação dos mecanismos de controle da inflamação.