ABSTRACT Introduction: Delayed graft function (DGF), an outcome for which inflammation is critical, has been associated with worse outcomes after kidney transplantation (KT). The neutrophil to lymphocyte and platelet (NLP) ratio is a biomarker of systemic inflammation. We assessed postoperative NLP ratio applicability as an early predictor of DGF in KT patients. Methods: Retrospective cohort of adult patients submitted to KT at our unit, between 1 January 2010 and 31 December 2020. NLP was calculated at 24 hours post-KT. Primary outcome was development of DGF. Logistic regression was calculated to determine significant factos which may have contributed to DGF. Results: We included 527 patients with a mean age of 49.9 ± 12.8 years. In 47.8% of patients expanded criteria donors were used, and in 3.6% non-heart-beating donors. DGF occurred in 17.8% of patients. Mean post-KT NLP was higher in patients submitted to induction therapy with lymphocyte depleting antibodies (50.2±40.3 vs 11.9±7.4 with basiliximab, p<0.001), but it was found to be higher even before KT (5.2±1.8 vs 1.9±1.2, p=0.001). Grafts from non-heart-beating donors (OR 13.989, 95% CI 4.741, 41.274, p=0.000), longer warm ischemia time (OR 1.035, 95% CI 1.007, 1.064, p=0.014) and higher NLP ratio 24 hours after transplantation (OR 1.009, 95% CI 1.002, 1.016, p=0.015) were independently associated with DGF. Conclusion: Higher NLP ratio at 24 hours after KT was independently associated with DGF. This reflects the impact of inflammation on KT outcomes and highlights the role of the NLP ratio as a sensitive marker of systemic inflammatory response after KT.

Abstract Introduction: Spontaneous isolated visceral artery dissection is a quite rare condition and designates a dissection that originates in the visceral artery itself with no involvement of the aorta. The objective of this revision article is to summarize the current evidence on this rare pathology. Methods: A non-systematic literature search was performed using the PubMed database. Only English literature was considered. A narrative review was constructed, with the following headings: epidemiology; etiology; diagnosis; treatment; and follow-up. Results: The celiac trunk is very rarely affected by isolated dissection. Simultaneous isolated celiac and splenic artery dissection are even rarer with less than 50 cases described so far. Even if there are associated with several possible risk factors, their definitive etiology remains unknown. The clinical presentation is quite variable ad most of the patients can be handled medically. Nonetheless, careful follow-up appears to be recommended and endovascular or open surgery should be performed in case of complications. Conclusions: Spontaneous isolated celiac and splenic artery dissection are very rare and definitive etiology remains unknown. Individualized treatment and careful follow-up are recommended.

ABSTRACT Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown positive renal outcomes in diabetic patients. There is also emerging evidence in non-diabetic patients. This review was conducted to analyse the renal outcomes of SGLT2i in patients without diabetes mellitus (DM). Methods: A systematic review was performed in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant manner. We included only randomized trials that examined the effect of SGLT2i on renal outcomes in non-diabetic patients. Results: A total of ten randomized trials were included with a combined cohort of 26 298 patients. There was a tendency for lesser risk of adverse renal outcomes in heart failure (HF) patients with reduced ejection fraction (EF) (hazard ratio (HR) 0.50-0.71). Lesser effect on adverse renal outcomes was seen in HF patients with preserved EF (HR 0.95). For both preserved and reduced EF HF, there was a statistically significant reduction in the rate of decline in estimated glomerular filtration rate (eGFR) (p<0.001). On a short follow-up, there was a significant reversible reduction in GFR. In the long term, chronic kidney disease (CKD) proteinuric patients had a statistically significant lesser risk of adverse renal outcomes (p<0.001) and a significant reduction in albuminuria (p=0.0016). CKD patients, including non-proteinuric, had a significant reduction in the rate of kidney disease progression (HR = 0.71). Conclusion: Treatment with SGLT2i significantly reduces the rate of kidney disease progression in CKD non-diabetic patients with eGFR ≥ 20 mL/min/1.73 m2. Benefit seems greater in proteinuric patients. Benefit for eGFR < 20 mL/min/1.73 m2, dialysis and kidney transplant patients is yet to be defined.

Abstract Campo Grande, the capital of the state of Mato Grosso do Sul, experiences challenges to promote collective well-being in an intelligent urban environment, as proposed by the Sustainable Development Goals. Part of the challenges is related to the increase in the urban population combined with the increase in the number of vehicles. The literature points to Smart Cities that, through technological devices and Information and Communication Technologies (ICT), seek to mitigate the global impacts of urban mobility and make them more receptive cities. Thus, this theoretical essay aims to reflect on the technological tools that comprise Smart Cities, with a view to reducing traffic accidents in urban centers. This is basic and exploratory research, supported by a literature review. The results showed that Smart Cities do not only translate into the use of ICT tools but rather the use of technological tools to support decision-making by municipal public managers and in the construction of cities of the future, making them more receptive. This study is expected to promote a broader debate in the academic and collective environment, among agents that make up the municipal public power, in addition to the members and parties examined in the collective well-being of urban society.

Resumen Campo Grande, capital del estado de Mato Grosso do Sul, experimenta desafíos para promover el bienestar colectivo, en un entorno urbano inteligente, como lo proponen los Objetivos de Desarrollo Sostenible. Parte de los desafíos está relacionada con el aumento de la población urbana, combinado con el aumento del número de vehículos. La literatura apunta a Ciudades Inteligentes que, a través de dispositivos tecnológicos y Tecnologías de la Información y la Comunicación (TIC), buscan mitigar los impactos globales de la movilidad urbana y hacerlas ciudades más receptivas. Así, este ensayo teórico pretende reflexionar sobre las herramientas tecnológicas que componen las Ciudades Inteligentes, con miras a reducir los accidentes de tráfico en los centros urbanos. Se trata de una investigación básica y exploratoria, respaldada por una revisión de la literatura. Los resultados mostraron que las Ciudades Inteligentes no solo se traducen en el uso de herramientas TIC, más bien en el uso de herramientas tecnológicas para apoyar la toma de decisiones de los gestores públicos municipales y en la construcción de las ciudades del futuro, haciéndolas más receptivas. Se espera que este estudio pueda promover un debate más amplio, en el ámbito académico y colectivo, entre los agentes que integran el poder público municipal, además de los miembros y partidos interesados en el bienestar colectivo de la sociedad urbana.

Resumo Campo Grande, capital do estado de Mato Grosso do Sul (MS), vivencia desafios para promover o bem-estar coletivo, num ambiente urbano inteligente, como propõem os Objetivos do Desenvolvimento Sustentável. Parte desses desafios está relacionada ao aumento da população urbana, combinado com a elevação do número de veículos. A literatura aponta as Cidades Inteligentes que, por meio dos aparatos tecnológicos e das Tecnologias da Informação e Comunicação (TICs), buscam mitigar os impactos negativos derivados da crescente mobilidade urbana e torná-las cidades mais receptivas. Assim, este ensaio teórico objetiva refletir sobre as ferramentas tecnológicas que comportam as Cidades Inteligentes, com vistas à redução dos acidentes de trânsito, nos centros urbanos. Trata-se de uma pesquisa básica e exploratória, amparada por uma revisão bibliográfica. Os resultados apontaram que as Cidades Inteligentes não se traduzem apenas no emprego das ferramentas das TICs, mas sim no emprego de ferramentas tecnológicas de apoio às tomadas de decisões dos gestores públicos municipais e nas construções das cidades do futuro, tornando-as mais receptivas. Espera-se que este estudo possa promover um debate mais amplo, no ambiente acadêmico e coletivo, entre os agentes que integram o poder público municipal, além dos membros e das partes interessadas no bem-estar coletivo da sociedade urbana.

RESUMO Objetivo: Este estudo foi realizado para compreender as disparidades na mortalidade e sobrevivência sem as principais morbidades entre recém-nascidos muito prematuros e de muito baixo peso entre Unidades de Terapia Intensiva Neonatal (UTINs) participantes da Rede Brasileira de Pesquisas Neonatais (RBPN) e Rede de Pesquisa Neonatal do Japão (NRNJ). Métodos: Foi realizada uma análise dos dados secundários dos bancos de dados da RBPN e da NRNJ. As pesquisas foram realizadas em 2014 e 2015 e incluíram 187 UTINs. O desfecho primário foi mortalidade ou sobrevida sem qualquer morbidade importante. Utilizou-se a análise de regressão logística com ajuste para os fatores de confusão. Resultados: A população do estudo foi composta por 6.406 recém-nascidos do NRNJ e 2.319 do RBPN. Ajustando para diversos fatores de confusão, os prematuros da RBPN tiveram 9,06 vezes maiores chances de mortalidade (IC95% 7,30–11,29) e menores chances de sobrevivência sem morbidades importantes (AOR 0,36; IC95% 0,32–0,41) em comparação com os da NRNJ. Fatores associados a maiores chances de mortalidade entre as UTINs brasileiras incluíram: síndrome de escape de ar (AOR 4,73; IC95% 1,26–15,27), enterocolite necrosante (AOR 3,25; IC95% 1,38–7,26) e sepse de início tardio (AOR 4,86; IC95% 2,25–10,97). Conclusões: Os recém-nascidos muito prematuros e de muito baixo peso do Brasil apresentaram chances significativamente maiores de mortalidade e menores chances de sobrevivência sem as principais morbidades em comparação aos do Japão. Além disso, identificamos os fatores que aumentam as chances da morte neonatal no Brasil, sendo a maioria relacionada à sepse tardia.

Abstract Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26–15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

ABSTRACT This paper discusses core principles such as play, collaboration, and agency that support the online workshops offered by the Global Play Brigade (GPB), an international community of activists from different areas, who got together to fight against the global crisis that threatened the world in so many ways due to the covid-19 pandemic. To exemplify part of the theoretical and methodological approach involved in the plan and, the workshop, as well as its goals, one of the sessions will be described along with perspectives aligned to Spinoza, Vygotsky, Freire, and some other authors to promote understanding of how people can be affected towards social change. It is known that there are many facets to the current turmoil, so the GPB seeks to create spaces in which creativity and critical thinking can create possibilities for emotional support, development, hope, and action.

RESUMO Este artigo discute princípios fundamentais como brincar, colaboração e agência que são base para os workshops online oferecidos pela Global Play Brigade (GPB), uma comunidade internacional de ativistas em diferentes áreas, que se uniram para lutar contra a crise global que ameaçava o mundo de diferentes maneiras devido à pandemia da covid-19. Para exemplificar parte da abordagem teórico-metodológica envolvida no plano, o próprio workshop e seus objetivos, uma das sessões será descrita juntamente com perspectivas alinhadas a Spinoza, Vygotsky, Freire e alguns outros autores para entender como as pessoas podem ser afetadas no intuito de mudança social. É notório que a turbulência atual apresenta muitas facetas, por isso o GPB busca criar espaços nos quais a criatividade e o pensamento crítico possibilitem suporte emocional, desenvolvimento, esperança e ação.

Abstract The presence of salts in the soil solution reduces the osmotic potential, hindering water absorption by roots. However, plants have defense mechanisms against stresses, releasing signaling molecules, in which nitric oxide plays an important role in the abiotic stress. This study aimed to assess the physiological quality of seeds from Passiflora mucronata Lam. genotypes pre-conditioned with the nitric oxide donor Tadalafil kept under salt stress. Seeds from nine P. mucronata genotypes evaluated under four nitric oxide donor Tadalafil concentrations : 0.0, 1.5, 2.5, 5.0, 7.5, 10.0 and 12.5 mg L-1, applied by soaking seeds for two hours, followed by washing in running water and germination in germitest® paper moistened with NaCl at -1.2 MPa. The experiment was carried out in a completely randomized design, with four replicates of 25 seeds. The nitric oxide donor Tadalafil, at concentrations of 1.5 and 2.5 mg L-1, increased the germination speed, shoot length, and dry mass. Pre-conditioning of seeds with the nitric oxide donor Tadalafil at concentrations of 5.0, 7.5, 10.0, and 12.5 mg L-1 determined the death of seeds. Seeds from genotype G3, pre-conditioned with Tadalafil at concentrations of 1.5 and 2.5 mg L-1, presented higher germination, germination speed index, mean germination time, shoot length, root length and dry matter values. Genotypes presented distinct phenotypic responses, providing intraspecific divergence.

Resumo A presença de sais na solução do solo reduz o potencial osmótico, dificultando a absorção de água pelas raízes. No entanto, as plantas apresentam mecanismos de defesa contra estresses, liberando moléculas sinalizadoras, nas quais o óxido nítrico desempenha um papel importante no estresse abiótico. Objetivou-se com este trabalho avaliar a qualidade fisiológica de sementes de genótipos de Passiflora mucronataLam. pré-condicionados com o doador de óxido nítrico Tadalafil emantidos sob estresse salino. Sementes de nove genótipos de P. mucronata foram avaliadassob quatro concentrações do doador de óxido nítrico Tadalafil: 0,0; 1,5; 2,5; 5,0; 7,5;10,0 e 12,5 mg L-1, aplicadas por imersão das sementes por duas horas, seguidas de lavagem em água corrente e germinação em papel germitest® umedecido com NaCl a -1,2 MPa. O experimento foi conduzido em delineamento inteiramente casualizado, com quatro repetições de25 sementes.O doador de óxido nítrico Tadalafil, nas concentrações de 1,5 e 2,5 mg L-1,aumenta a velocidade de germinação, o comprimento da parte aérea e a massa seca. O pré-condicionamento das sementes com o doador de óxido nítrico Tadalafil, nas concentrações de 5,0;7,5; 10,0 e 12,5 mg L-1, determina a morte das sementes. As sementes dogenótipo G3, pré-condicionadas com Tadalafil, nas concentrações de 1,5 e 2,5 mg L-1, apresentam maiores médias de germinação, índice de velocidade de germinação, tempo médio degerminação,comprimento da parte aérea, comprimento da raiz e massa seca. Os genótipos apresentaram respostas fenotípicas distintas, proporcionando divergência intraespecífica.

Abstract Recent advances in genome editing have enormously enhanced the effort to develop biotechnology crops for more sustainable food production. CRISPR/Cas, the most versatile genome-editing tool, has shown the potential to create genome modifications that range from gene knockout and gene expression pattern modulations to allele-specific changes in order to design superior genotypes harboring multiple improved agronomic traits. However, a frequent bottleneck is the delivery of CRISPR/Cas to crops that are less amenable to transformation and regeneration. Several technologies have recently been proposed to overcome transformation recalcitrance, including HI-Edit/IMGE and ectopic/transient expression of genes encoding morphogenic regulators. These technologies allow the eroding of the barriers that make crops inaccessible for genome editing. In this review, we discuss the advances in genome editing in crops with a particular focus on the use of technologies to improve complex traits such as water use efficiency, drought stress, and yield in maize. production CRISPRCas CRISPR Cas genomeediting tool allelespecific allele specific However regeneration recalcitrance HIEdit/IMGE HIEditIMGE HI Edit/IMGE Edit IMGE ectopictransient ectopic transient regulators review efficiency stress maize HIEdit EditIMGE

ABSTRACT Urinary tract infection is an important cause of hospitalization, morbidity and mortality, being responsible for an important fraction of health expenses. The main risk factors are urine flow obstruction, urinary catheters, immunosuppression and diabetes mellitus. We present a case of pyelonephritis that culminated in nephrectomy, finally unravelling an unexpected diagnosis. A 52-year-old male presented in the emergency department with two weeks of pain in the left iliac fossa that irradiated to the lumbar region and cloudy urine. Lab work revealed severe anaemia (4.9 g/dL), inflammatory markers elevation, leucoerythrocyturia, serum creatinine of 4.33 mg/dL and metabolic acidosis. Computed tomography scan showed a swollen left kidney with a staghorn calculus and intraparenchymal hypodensities. After a failed trial of large spectrum antibiotics, he was submitted to left radical nephrectomy with significant clinical improvement. Gross examination showed a markedly dilated pyelocalicial tree, filled with several staghorn calculi and purulent secretions with associated parenchymal atrophy. Histopathologic evaluation revealed exuberant chronic pyelonephritis with an acute inflammatory infiltrate that extended into the perinephric fat and multiple Schistosoma ova, predominantly calcified. The authors describe the case of a severe pyelonephritis with exuberant clinical and imagiological features and rare microbiological findings, suggesting previous genitourinary Schistosomiasis that predisposed to nephrolithiasis and chronic pyelonephritis.

ABSTRACT Introduction: Acute kidney injury (AKI) is a major complication in critically ill septic patients and is associated with increased morbidity and mortality. A recent study suggested a risk score based on patient’s chronic comorbidities and acute events at intensive care unit (ICU) admission as a reliable tool for predicting AKI in critically ill adult population. The aim of this study was to adapt this score to septic-AKI patients and evaluate its prognostic value as predictor of the need for renal replacement therapy (RRT) at ICU admission. Methods: This is a retrospective analysis of 399 septic-AKI patients admitted to the Division of Intensive Medicine of the Centro Hospitalar Universitário Lisboa Norte between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. The Renal Replacement Therapy Risk Score was adapted from the AKI risk prediction score proposed by Malhotra et al (Nephrol Dial Transplant. 2017;32:814-22). Results: Fifty two percent of patients were KDIGO stage 3, 25.8% KDIGO stage 2 and 22.3% KDIGO stage 1. Twenty seven percent of patients required RRT. Patients requiring RRT had higher risk score than those who did not (6.6±2.5 vs 5.1 ±2.6, p<0.001). An optimal cut-off value of ≥ 6 in this score predicted the need for RRT with sensitivity 0.630 and specificity 0.391. Conclusion: The RRT risk score at ICU admission was independently associated with the requirement of RRT septic-AKI patients. The assessment of this ratio is simple and can prove useful in identifying patients at risk for need of RRT.

Resumo Joannesia princeps, popularmente conhecida como cutieira, é uma Euphorbiaceae endêmica do Brasil, cuja madeira é utilizada para diversos fins industriais. As sementes possuem aproximadamente 37% de óleo útil para fins industrias e medicinais, servem de alimento para cutias (Dasyprocta azarae), além de apresentarem destacada importância na sucessão ecológica em áreas degradas. Objetivou-se estudar a germinação, fenologia e a morfometria de frutos, sementes e plântulas de Joannesia princeps. Foram utilizados 1000 frutos de Joannesia princeps colhidos de 40 matrizes de Mata Atlântica do Entorno do Caparaó, que compõem um bosque existente no Horto Municipal da cidade de Alegre - ES, nos quais foram analisados os atributos qualitativos em relação à morfologia. Na análise biométrica, foram analisados: comprimento, diâmetro e espessura. As análises das plântulas foram conduzidas periodicamente no 6°, 7º, 14º, 21º, 28º, 35º e 42º dia após a germinação, utilizando-se quatro repetições de 15 plântulas normais e sadias para as descrições. Observou-se que as raízes mudaram o tom de sua coloração de esbranquiçada para branco-amarelada entre o 14º para o 21º dia após a germinação (DAG), enquanto o hipocótilo, nos estádios iniciais, apresentava coloração avermelhada passando para verde após o 14º DAG. Os demais órgãos não apresentaram mudanças consideráveis, contudo, biometricamente, todos os órgãos apresentaram acréscimo nas suas dimensões, conforme a evolução do desenvolvimento. Os aspectos morfológicos descritos e ilustrados demonstraram-se estáveis e, portanto, informativos para a caracterização e identificação da espécie em processo de germinação e nos primeiros estádios de desenvolvimento.

Abstract Joannesia princeps, popularly known as a cutieira, is a Euphorbiaceae endemic to Brazil and its wood is used for various industrial purposes and the seed has approximately 37% of useful oil for industrial and medicinal purposes, besides presenting outstanding importance in ecological succession in degraded areas, whose seeds serve as food for agoutis. The objective was to study germination, phenology and morphometry of fruits, seeds and seedlings of Joannesia princeps. We used 1,000 fruits of Joannesia princeps harvested from 40 matrices of Atlantic Forest surrounding Caparaó, which make up an existing forest in the Municipal Garden of the city of Alegre, in Espírito Santo state, in which qualitative attributes were analyzed in relation morphology. In the biometric analysis, the following were analyzed: length, diameter and thickness and seedling analyses were conducted periodically on the 6th, 7th, 14th, 21th, 28th, 35th and 42th days after germination (DAG), using four replicates of 15 normal and healthy seedlings for descriptions. It was observed that the roots have changed their color of whitish for yellowish-white between the 14th and 21st DAG, while the hypocotyl, in the initial presented reddish color passing to green after the 14th DAG. The other organs did not present considerable changes, however, biometrically, all organs showed an increase in their dimensions, according to the evolution of development. The morphological features described and illustrated were stable, and therefore, informative for the characterization and identification of the species in the germination process and in the first stages of development.

Resumo Introdução: A lesão renal aguda (LRA) foi descrita em pacientes com doença do Coronavírus 2019 (COVID-19) e é considerada um marcador de gravidade da doença e fator prognóstico negativo para sobrevivência. Neste estudo, os autores visaram estudar o impacto da lesão renal aguda transitória e persistente (LRAp) na mortalidade hospitalar em pacientes com COVID-19. Métodos: Estudo observacional retrospectivo de pacientes internados com COVID-19 no Departamento de Medicina do Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, entre Março-Agosto de 2020. Realizou-se análise multivariada para prever desenvolvimento de LRA e mortalidade hospitalar. Resultados: De 544 pacientes com COVID-19, 330 desenvolveram LRA: 166 LRA persistente (LRAp), 164, LRA transitória. Pacientes com LRA eram mais velhos, apresentaram mais comorbidades prévias, maior necessidade de serem medicados com inibidores do SRAA, apresentaram creatina sérica basal mais elevada (CrS) (1,60 mg/dL vs 0,87 mg/dL), maior razão NL, e acidemia mais grave na admissão hospitalar, e necessitaram mais frequentemente de internação na UTI, ventilação mecânica, e uso de vasopressores. Pacientes com LRA persistente apresentaram maior nível de CrS (1,71 mg/dL vs 1,25 mg/dL) na admissão hospitalar. A mortalidade hospitalar foi de 14,0% e foi maior em pacientes com LRA (18,5% vs 7,0%). A DRC e ferritina sérica foram preditores independentes de LRA. A LRA não previu mortalidade, mas a LRAp foi um preditor independente de mortalidade, assim como idade e nível de lactato. Conclusão: A LRAp foi associada independentemente à mortalidade hospitalar em pacientes com COVID-19, mas seu impacto no acompanhamento de longo prazo ainda precisa ser determinado.

Abstract Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

Resumo Introdução: COVID-19 é atualmente um problema de saúde global e uma causa importante de mortalidade. Doença renal crônica (DRC) é um dos fatores de risco para infecção, morbilidade e mortalidade por SARS-CoV-2. Neste estudo, objetivamos avaliar a apresentação clínica e os outcomes de doentes com DRC com COVID-19, bem como identificar preditores de mortalidade. Métodos: Estudo retrospetivo de doentes com DRC internados num hospital terciário português entre Março-Agosto/2020. As variáveis foram submetidas a análise univariada e multivariada para determinar fatores preditivos de mortalidade hospitalar. Resultados: analisámos 130 pacientes com DRC (média de idades 73,9 anos; 60,0% homens). Hipertensão (81,5%), doença cardiovascular (36,2%) e diabetes (54,6%) foram comorbilidades frequentes. Tosse, dispneia, febre e insuficiência respiratória também foram comuns. Quase 60% apresentavam anemia, 50% hipoalbuminemia e 13,8% hiperlactacidemia, 17% acidemia. A ferritina sérica média foi 1531 µg/L, PCR média 8,3 mg/dL, LDH médio 336,9 U/L. A maioria foi tratada com lopinavir/ritonavir, hidroxicloroquina ou corticosteroides e apenas 2 com remdesivir. Oitenta por cento tiveram lesão renal aguda; 16,2% necessitaram de internamento na unidade de cuidados intensivos. Os 34 pacientes que faleceram eram mais velhos e mais propensos a ter insuficiência cardíaca. Estes apresentaram razão neutrófilos/linfócitos e níveis de ferritina, lactato e LDH mais elevados. A análise multivariada identificou uma associação entre idade avançada [OR 1,1 (IC 1,01-1,24), p=0,027], níveis de ferritina [OR 1,0 (IC 1,00-1,00), p=0,009] e LDH mais elevados [OR 1,0 (IC 1,00-1,01), p=0,014] e mortalidade. Conclusão: Na nossa coorte de doentes com DRC com COVID-19, a idade avançada e níveis mais elevados de ferritina e LDH foram fatores de risco independentes para mortalidade.

Abstract Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.