Prednisone is the initial treatment of primary focal segmental glomerulosclerosis. However, when immunosuppressive agents in combination with steroids are used in the treatment of prednisone-dependent and prednisone-resistant patients the remission rate is variable. We report a long-term trial using cyclophosphamide (2.0 to 3.0 mg/kg body weight for 12 weeks) in combination with prednisone (1.0 to 2.0 mg/kg body weight), as compared with prednisone alone for the treatment of prednisone-resistant and frequently relapsing nephrotic syndrome and focal segmental glomerulosclerosis. Fifty-four patients (34 males and 20 females) with a diagnosis of idiopathic nephrotic syndrome and focal segmental glomerulosclerosis, followed-up for an average of 86.1 ± 82.4 months, were evaluated. Complete remission occurred in 20.4% and partial remission in 14.8% of the patients treated with steroids and in 26.7 and 20.0% of the patients treated with cyclophosphamide + prednisone, respectively. Of the 24 prednisone-resistant patients treated with steroids in combination with cyclophosphamide, 33.3% obtained a complete/partial response. At the time of final evaluation, 25% of the patients treated with prednisone and 10.0% of those treated with prednisone in combination with cyclophosphamide had reached end-stage renal disease. Persistent nephrotic syndrome and progressive renal insufficiency were more frequently observed among the patients treated with prednisone alone (50.0 vs 33.3% and 33.3 vs 16.7%, respectively). The treatments were well tolerated and no patient experienced adverse reactions requiring discontinuation of medications. Although open-label and non-randomized, the present trial showed that cyclophosphamide is a reasonable choice for the treatment of primary focal segmental glomerulosclerosis and prednisone-resistant nephrotic syndrome.

OBJETIVO: Avaliar a relação entre raça e tipo histológico de glomerulonefrite, levando em consideração idade, sexo e presença da forma hepatoesplênica da esquistossomose mansônica. MATERIAL E MÉTODOS: Pacientes do Serviço de Nefrologia da Universidade Federal da Bahia, 80 com esclerose glomerular focal (EGF) e 50 com glomerulonefrite membranoproliferativa (GNMP) foram comparados quanto à distribuição dos tipos raciais (negro, mulato, branco). Pacientes com lupus eritematoso sistêmico ou qualquer outro tipo de doença auto-imune não foram incluídos na presente análise. Comparações ajustadas foram feitas através do método de Mantel-Haenszel e de um modelo de regressão logística múltipla. RESULTADOS: Raça foi significantemente associada com o tipo histológico; a relação entre o número de negros ou mulatos e o número de brancos foi aproximadamente 2,4 vezes maior (odds ratio=2,43; IC 95%=1,09-5,45) em pacientes com EGF do que em pacientes com GNMP. Esta associação entre raça e tipo histológico foi independente da idade, do sexo e da presença da forma hepatoesplênica da esquistossomose. No modelo de regressão logística múltipla, raça foi significativamente (p=0,037) associada com o tipo histológico (odds ratio=2,54; IC 95%=1,06-6,06). CONCLUSÃO: A maior freqüência de negros e mulatos no grupo EGF nesta amostra de pacientes da Bahia é consistente com os achados de estudos realizados nos Estados Unidos. Os dados apoiam a possibilidade de uma relação entre descendência africana e susceptibilidade aumentada para EGF, independente da idade, do sexo e do diagnóstico de esquistossomose. A identificação dos mecanismos que determinam esta diferença racial representa uma importante questão para futuras investigações.

OBJECTIVE: To assess the association between race and type of glomerulonephritis, taking into account age, gender and the presence of hepatosplenic schistosomiasis mansoni. METHODS: Patients from the Renal Service of the Federal University of Bahia, Brazil, 80 with focal segmental glomerulosclerosis (FSG) and 50 with membranoproliferative glomerulonephritis (MPGN) were compared regarding the distribution of the racial types (black, mulatto, white). Patients with systemic lupus erythematosus or any kind of autoimmune disease were not included in the present analysis. Adjusted comparisons were performed using the Mantel-Haenszel method and a multivariate logistic regression model. RESULTS: Race was significantly associated with histologic type; the odds of being classified as black or mulatto were approximately 2.4 times higher (odds ratio=2.43; IC 95%=1.09-5.45) in patients with FSG than in those with MPGN. The association between race and histologic type was not influenced by the potential effects of age, gender and hepatosplenic schistosomiasis. In the multivariate logistic regression model, race was significantly associated (p=0.037) with type of glomerulonephritis (odds ratio=2.54; IC 95%=1.06-6.06). CONCLUSION: A higher frequency of negroes and mulattoes in the FSG group (compared with MPGN) in this sample from the State of Bahia is consistent with findings of previous studies from the United States. The data support the possibility of a greater susceptibility to FSG among negroes and mulattoes, independently of age, gender and schistosomiasis. The identification of the mechanisms that determine this racial difference represents an important question for future investigations.

OBJETIVO: Avaliar mudanças, ao longo dos anos, na freqüência de resistência à norfloxacina e ciprofloxacina em bactérias isoladas de uroculturas. MÉTODOS: Resultados de todas as uroculturas com crescimento bacteriano de pelo menos 10(5) unidades formadoras de colônias por mL de urina (UFC/mL), realizadas no Serviço de Nefrologia da Universidade Federal da Bahia durante o período 1983-1994, foram analisadas. As bactérias incluídas na análise foram aquelas mais freqüentemente isolados: Escherichia coli (n=668), Klebsiella spp. (n=286), Staphylococcus spp. (n=186), Proteus spp. (n=135) e Enterobacter spp. (n=129). RESULTADOS: A freqüência de bactérias resistentes à norfloxacina foi de 3,2%, no período 1983-1986; 5,9%, no período 1987-1990; e 9,1%, no período 1991-1994 (p<0,05). Klebsiella spp. e Enterobacter spp. foram as bactérias que apresentaram maiores aumentos na freqüência de resistência à norfloxacina. Para a ciprofloxacina, constatou-se resistência em 7,4% das bactérias isoladas, no período 1985-1989, e 16,5%, no período 1990-1994 (p<0,05). Esse aumento na freqüência de bactérias resistentes à ciprofloxacina foi mais marcante para Enterobacter spp. e Staphylococcus spp. CONCLUSÕES: Os resultados do presente estudo mostram um aumento gradual na freqüência de resistência à norfloxacina e ciprofloxacina entre as bactérias mais comumente isoladas em uroculturas. A influência do uso prévio de quinolonas e de peculiaridades da bactéria infectante, nesses achados, representa importante questão a ser investigada.

OBJECTIVE: To assess time trends in the frequency of norfloxacin and ciprofloxacin resistance of bacteria isolated from urine culture. METHODS: Results of all urine cultures with a bacterial growth of at least 10(5) colony-forming units per milliter, performed at the Renal Service of the Federal University of Bahia, Brazil, from 1983 to 1994 were analyzed. The bacteria considered for this analysis were those most often isolated: Escherichia coli (n=668), Klebsiella spp. (n=286), Staphylococcus spp. (n=186), Proteus spp. (n=135) and Enterobacter spp. (n=129). RESULTS: The frequencies of norfloxacin resistance for the periods 1983-1986, 1987-1990 and 1991-1994 were 3.2%, 5.9% and 9.1%, respectively (p-value<0.05). The most pronounced increases in the frequencies of norfloxacin-resistance were observed for Klebsiella spp. and Enterobacter spp. The frequency of ciprofloxacin resistance was 7.4% in the period 1985-1989 and 16.5% in the period 1990-1994 (p-value<0.05). This time trend in ciprofloxacin resistance was more striking for Enterobacter spp. and Staphylococcus spp. CONCLUSION: The results show a gradual increase in the frequency of norfloxacin and ciprofloxacin resistance of the bacteria most commonly isolated from urine cultures. The influence of previous treatment with quinolones and characteristics of the infecting bacteria on these findings are important questions to to be addressed in future investigations.