Resumo Introdução: A doença renal crônica (DRC) é um grande problema de saúde, determina redução na expectativa de vida e aumento dos riscos de doenças cardiovasculares. Método: Estudo observacional, de coorte, retrospectivo, baseado em dados de prontuários de pacientes com DRC em hemodiálise, diálise peritoneal e transplante renal na cidade de Curitiba, no período de janeiro a junho de 2014, avaliando o impacto financeiro no Sistema Único de Saúde (SUS) e na saúde suplementar. Resultados: O menor custo de um transplante renal no primeiro ano foi de R$ 40.743,03, quando utilizada a ciclosporina, e o maior de R$ 48.388,17, com a utilização do tacrolimo. Já no segundo ano pós-transplante, a hemodiálise e a diálise peritoneal têm valor superior ao transplante renal. Transplante com doador falecido, com tacrolimo: R$ 67.023,39; hemodiálise R$ 71.717,51 e diálise peritoneal automática R$ 69.527,03. Conclusões: Após os dois primeiros anos da terapia renal substitutiva, o transplante demonstra menores custos ao sistema, quando comparado às outras modalidades avaliadas. Baseado nisso, esta terapia justifica melhorias nas políticas governamentais nesse setor.

Abstract Introduction: Chronic kidney disease (CKD) is a major health problem, determining the reduction in life expectancy and an increased risk of cardiovascular disease. Method: An observational, cohort, retrospective, based on patient's medical records data with CKD under hemodialysis, peritoneal dialysis and kidney transplantation in the city of Curitiba, in the period from January to June 2014, evacuativo the financial impact on the Unified Health System (SUS) and the supplementary health. Results: The lowest cost of a kidney transplant in the first year was R$ 40,743.03 when cyclosporine was used and the highest was R$ 48,388.17 with the use of tacrolimus. In the second year post-transplant, hemodialysis and peritoneal dialysis have a higher cost compared to kidney transplant. Transplantation with deceased donor, treated with tacrolimus: R$ 67,023.39; Hemodialysis R$ 71,717.51 and automated peritoneal dialysis automatic R$ 69,527.03. Conclusions: After the first two years of renal replacement therapy, transplantation demonstrates lower costs to the system when compared to other modalities evaluated. Based on that, this therapy justifies improvements in government policies in this sector.

OBJECTIVE: Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation. METHODS: Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1) the control group, recipients of open donor nephrectomy (n = 29), and 2) the study group, recipients of laparoscopic donor nephrectomy (n = 26). Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor. RESULTS: The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047) and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01). CONCLUSION: The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure laparoscopic donor nephrectomy utilization in renal transplantation.

PURPOSE: We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery. MATERIALS AND METHODS: From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83%) with a single renal artery and 22 (17%) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. RESULTS: The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6% vs 4.5%, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23% vs 12%, respectively, p = 0.18). Five patients in the single artery group (4.6%) and one patient in the multiple arteries group (4.5%) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9% vs 18.1%, respectively, p = 0.51). CONCLUSION: Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.

OBJETIVO: Analisar os efeitos morfológicos e funcionais do pneumoperitônio sobre o rim remanescente em ratos submetidos a nefrectomia unilateral. MÉTODOS: Foram utilizados 48 ratos da linhagem Wistar, adultos, machos, pesando entre 240 e 350 g, distribuídos em três grupos. Os ratos do Grupo 1 foram subdivididos em dois subgrupos, Controle 1A e Controle 1B. Os Grupos 2 e 3 e os subgrupos contaram com 12 animais cada. Todos os animais foram anestesiados e submetidos a punção abdominal com agulha. Os Grupos 2 e 3 foram submetidos a insuflação abdominal com CO2 por 2 e 4 horas respectivamente, com uma pressão intra-abdominal (PIA) constante de 15 mmHg. Os ratos do Controle 1A e 1B foram mantidos puncionados por 2 e 4 horas respectivamente, porém sem insuflação de gás. Ao final desse período foi realizada nefrectomia esquerda em todos os animais. Quatro semanas após, novo pneumoperitônio foi instalado com o mesmo tempo de duração, conforme os grupos. Após 8 semanas os animais sofreram eutanásia para remoção do rim remanescente. Foram coletadas amostras de sangue durante todo o experimento para análise da função renal por meio da creatinina sérica. O rim remanescente foi submetido a análise microscópica para avaliação do grau de hipertrofia glomerular, contagem do número de células mesangiais e observação da presença ou não de esclerose glomerular. Os diversos grupos foram submetidos a observação temporal e a análise estatística por meio de estudo comparativo longitudinal e transversal. RESULTADOS: A avaliação da função renal residual não evidenciou alteração de significância clinica em ratos submetidos a 2 e 4 horas de pneumoperitônio após um período de 8 semanas. A análise morfológica do rim remanescente não revelou alteração histológica sugestiva de dano renal nos grupos em estudo. CONCLUSÃO: A função e a morfologia renal de ratos submetidos a nefrectomia unilateral, não são significativamente influenciadas por prolongados e sucessivos pneumoperitônios, conforme demonstram os achados bioquímicos e histológicos neste estudo.

PURPOSE: The aim of this experimental study is to analyze the morphologic and functional effects of the pneumoperitoneum on the remnant kidney in rats submitted to a unilateral nephrectomy. METHODS: Forty-eight male adults Wistar rats , with an average weight between 240 to 350 g, were distributed in three groups. The rats in Group 1 were subdivided into two other subgroups: Control Group 1A and 1B. Groups 2 and 3 and respective subgroups included 12 rats each. All animals were anesthetized and submitted to a puncture. Animals in Groups 2 and 3 were submitted to abdominal insufflation with CO2, during 2 and 4 hours respectively, with a constant IAP of 15 mmHg. Rats of the Control Group 1A and 1B were maintained punctured during 2 and 4 hours respectively, however, without insufflation. In the end of this period, a left nephrectomy was performed in all animals. After 4 weeks, a new pneumoperitoneum with the same duration was installed, according to the groups. After 8 weeks, the animals were submitted to euthanasia to remove the remnant kidney. Samples of blood were collected during the whole experiment to evaluated the renal function by dosing serum creatinine. The remnant kidney was analyzed microscopically to evaluate its level of glomerular hypertrophy, the number of mesangial cells, and to observe the presence of glomerular sclerosis. All groups were kept under observation and the results were submitted to statistical analysis by a longitudinal and transversal comparative study. RESULTS: At the evaluation of residual renal function no significant clinical alteration was seen in rats submitted to pneumoperitoneum during 2 and 4 hours after a period of 8 weeks. The morphologic analysis of the remnant kidney showed no histological renal injury in the groups. CONCLUSION: The function and renal morphology of rats submitted to a unilateral nephrectomy were not significantly influenced by prolonged and successive pneumoperitoneum, according to this study's biochemical and histological findings.