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BACKGROUND: Acute kidney injury (AKI) is a life-threatening condition, especially in extreme age groups and when kidney replacement therapy (KRT) is necessary. Studies worldwide report mortality rates of 10-63% in pediatric patients undergoing KRT. METHODS: Over 13 years, this multicenter study analyzed data from 693 patients with AKI, all receiving KRT, across 74 hospitals and medical facilities in Rio de Janeiro, Brazil. RESULTS: The majority were male (59.5%), under one year old (55.6%), and treated in private hospitals (76.5%). Sixty-six percent had comorbidities. Pneumonia and congenital heart disease were the most common admission diagnoses (21.5% and 20.2%, respectively). The mortality rate was 65.2%, with lower rates in patients over 12 years (50%). Older age was protective (HR: 2.35, IQR [1.52-3.62] for neonates), and primary kidney disease had a three-fold lower mortality rate. ICU team experience (HR: 0.74, IQR [0.60-0.91]) correlated with lower mortality, particularly in hospitals treating 20 or more patients. Among the deceased, 40% died within 48 h of KRT initiation, suggesting possible late referral or treatment futility. CONCLUSIONS: This study confirms the high mortality in pediatric dialytic AKI in middle-income countries, underlining early mortality and offering critical insights for improving outcomes.
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Lesión Renal Aguda , Diálisis Renal , Humanos , Masculino , Lesión Renal Aguda/terapia , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Niño , Femenino , Preescolar , Lactante , Brasil/epidemiología , Diálisis Renal/estadística & datos numéricos , Adolescente , Recién Nacido , Estudios Retrospectivos , Comorbilidad , Factores de RiesgoRESUMEN
Introduction: Although research suggests that socioeconomic deprivation is linked to a higher incidence of acute kidney injury (AKI) and worse outcomes in high-income countries, there is limited knowledge about these epidemiologic factors in developing countries. In addition, the impact of medical institution administration (private versus public) on AKI outcomes remains to be determined. Methods: We studied 15,186 pediatric and adult patients with dialysis-requiring AKI (AKI-D) admitted to private and public hospitals in Rio de Janeiro, Brazil. According to Brazil's demographic census, socioeconomic indicators were derived from patient zip codes. Propensity score matching analysis and a mixed-effect Cox regression were used to assess the impact of socioeconomic indicators and hospital governance on patient survival. Results: Crude mortality rates were higher in private hospitals than in public hospitals (71.8% vs. 59.5%, P < 0.001) and were associated with significant differences in age (75 years, interquartile range [IQR]: 61-83 vs. 53 years, IQR: 31-66), baseline renal function (prevalence of chronic kidney disease [CKD]: 33.2% vs. 23%, P < 0.001), comorbidities (Charlson score: 2.03 ± 0.87 vs. 1.72 ± 0.75, P < 0.001), and severity of presentation (mechanical ventilation: 76.5% vs. 58% and vasopressors: 72.8% vs. 50.5%, P < 0.001). After adjustments and propensity score matching, we found no effect of different hospital administrations or socioeconomic factors on mortality. Baseline characteristics and the severity of presentation primarily influenced AKI-D prognosis. Conclusions: Despite significant racial and socioeconomic differences in hospital governance, these indicators had no independent influence on mortality. Future epidemiologic studies should investigate these relevant assumptions to allow healthcare systems to manage this severe syndrome promptly.
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BACKGROUND: Current information about acute kidney injury (AKI) epidemiology in developing nations derives mainly from isolated centers, with few quality multicentric epidemiological studies. Our objective was to describe a large cohort of patients with dialysis-requiring AKI derived from ordinary clinical practice within a large metropolitan area of an emerging country, assessing the impact of age and several clinical predictors on patient survival across the spectrum of human life. METHODS: We analyzed registries drawn from 170 hospitals and medical facilities in Rio de Janeiro, Brazil, in an eleven-year period (2002-2012). The study cohort was comprised of 17,158 pediatric and adult patients. Data were analyzed through hierarchical logistic regression models and mixed-effects Cox regression for survival comparison across age strata. RESULTS: Severe AKI was mainly hospital-acquired (72.6%), occurred predominantly in the intensive care unit (ICU) (84.9%), and was associated with multiple organ failure (median SOFA score, 11; IQR, 6-13). The median age was 75 years (IQR, 59-83; range, 0-106 years). Community-acquired pneumonia was the most frequent admission diagnosis (23.8%), and sepsis was the overwhelming precipitating cause (72.1%). Mortality was 71.6% and was higher at the age extremes. Poor outcomes were driven by age, mechanical ventilation, vasopressor support, liver dysfunction, type 1 cardiorenal syndrome, the number of failing organs, sepsis at admission, later sepsis, the Charlson score, and ICU admission. Community-acquired AKI, male gender, and pre-existing chronic kidney disease were associated with better outcomes. CONCLUSIONS: Our study adds robust information about the real-world epidemiology of dialysis-requiring AKI with considerable clinical detail. AKI is a heterogeneous syndrome with variable clinical presentations and outcomes, including differences in the age of presentation, comorbidities, frailty state, precipitation causes, and associated diseases. In the cohort studied, AKI characteristics bore more similarities to upper-income countries as opposed to the pattern traditionally associated with resource-limited economies.
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Lesión Renal Aguda , Sepsis , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/terapia , Adulto , Anciano , Brasil/epidemiología , Niño , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Masculino , Estudios Prospectivos , Diálisis Renal , Factores de Riesgo , Sepsis/complicacionesRESUMEN
BACKGROUND: Previous study showed that purinergic P2X7 receptors (P2X7R) reach the highest expression in the first week after unilateral ureteral obstruction (UUO) in mice, and are involved in the process of inflammation, apoptosis and fibrosis of renal tissue. We, herein, document the role of purinergic P2X7 receptors activation on the third day of UUO, as assessed by means of BBG as its selective inhibitor. METHODS: We investigated the effects of brilliant blue G (BBG), a P2X7R antagonist, in the third day of kidney tissue response to UUO in rats. For this purpose, male Wistar rats submitted to UUO or sham operated, received BBG or vehicle (V), comprising four groups: UUO-BBG, UUO-V, sham-BBG and sham-V. The kidneys were harvested on day 3 UUO and prepared for histology, immunohistochemistry (P2X7R, PCNA, CD-68, α-sma, TGF-ß1, Heat-shock protein-47, TUNEL assay), quantitative real-time PCR (IL-1ß, procollagens type I, III, and IV) for mRNA quantification. RESULTS: The group UUO-V presented an enhancement in tubular cell P2X7-R expression, increase influx of macrophages and myofibroblasts, HSP-47 and TGF- ß1 expression. Also, upregulation of procollagen types I, III, and IV, and IL-1ß mRNAs were seen. On the other hand, group UUO-BBG showed lower expression of procollagens and IL-1ß mRNAs, as well as less immunoreactivity of HSP-47, TGF-ß, macrophages, myofibroblasts, and tubular apoptosis. This group also presented increased epithelial cell proliferation. CONCLUSION: BBG, a known highly selective inhibitor of P2X7R, attenuated renal inflammation, collagen synthesis, renal cell apoptosis, and enhanced renal cell proliferation in the early phase of rat model of UUO.
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Proliferación Celular/efectos de los fármacos , Riñón/patología , Nefritis/tratamiento farmacológico , Antagonistas del Receptor Purinérgico P2X/uso terapéutico , Colorantes de Rosanilina/uso terapéutico , Obstrucción Ureteral/complicaciones , Actinas/metabolismo , Animales , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Apoptosis/efectos de los fármacos , Movimiento Celular , Colágeno Tipo I/genética , Colágeno Tipo III/genética , Colágeno Tipo IV/genética , Fibrosis , Proteínas del Choque Térmico HSP47/metabolismo , Interleucina-1beta/genética , Riñón/metabolismo , Túbulos Renales/patología , Macrófagos/fisiología , Masculino , Miofibroblastos/fisiología , Nefritis/etiología , Antagonistas del Receptor Purinérgico P2X/farmacología , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Colorantes de Rosanilina/farmacología , Factores de Tiempo , Factor de Crecimiento Transformador beta1/metabolismo , Regulación hacia ArribaRESUMEN
Abstract We performed a search in the MEDLINE database using the MeSH term: "Acute Kidney Injury", selecting the subtopic "Epidemiology", and applying age and year of publication filters. We also searched for the terms: "acute renal failure" and "epidemiology" "acute tubular necrosis" and "epidemiology" in the title and summary fields with the same filters. In a second search, we searched in the LILACS database, with the terms: "acute renal injury", or "acute renal failure" or "acute kidney injury" and the age filter. All abstracts were evaluated by the authors and the articles considered most relevant, were examined in their entirety. Acute Kidney Injury (AKI) -related mortality ranged from 3-63% in the studies included in this review. AKI etiology has marked regional differences, with sepsis being the main cause in developed countries. In developing countries, primary renal diseases and hypovolemia are still a common cause of AKI.
Resumo Foi realizada busca na base de dados MEDLINE utilizando o termo MeSH "Acute Kidney Injury", selecionando o subtópico "Epidemiology", e aplicados os filtros de idade e ano de publicação. Também foram realizadas buscas pelos termos "acute renal failure" e "epidemiology" "acute tubular necrosis" e "epidemiology" nos campos título e resumo com os mesmos filtros. Na segunda busca, foram pesquisadas palavras na base de dados LILACS, com os termos "lesão renal aguda", "insuficiência renal aguda" ou "injuria renal aguda" e o filtro de idade. Todos os resumos foram avaliados pelos autores e os artigos considerados mais relevantes, examinados na íntegra. A mortalidade relacionada à Lesão Renal Aguda (LRA) variou entre 3-63% nos estudos incluídos nesta revisão. A etiologia da LRA tem marcantes diferenças regionais, sendo sepse a principal causa em países desenvolvidos. Em países em desenvolvimento, as doenças renais primárias e a hipovolemia ainda configuram causas frequentes de LRA.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adulto Joven , Lesión Renal Aguda/terapia , Lesión Renal Aguda/epidemiología , Brasil/epidemiología , Biomarcadores , Incidencia , Diálisis Renal , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Terminología como AsuntoRESUMEN
We performed a search in the MEDLINE database using the MeSH term: "Acute Kidney Injury", selecting the subtopic "Epidemiology", and applying age and year of publication filters. We also searched for the terms: "acute renal failure" and "epidemiology" "acute tubular necrosis" and "epidemiology" in the title and summary fields with the same filters. In a second search, we searched in the LILACS database, with the terms: "acute renal injury", or "acute renal failure" or "acute kidney injury" and the age filter. All abstracts were evaluated by the authors and the articles considered most relevant, were examined in their entirety. Acute Kidney Injury (AKI) -related mortality ranged from 3-63% in the studies included in this review. AKI etiology has marked regional differences, with sepsis being the main cause in developed countries. In developing countries, primary renal diseases and hypovolemia are still a common cause of AKI.
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Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/terapia , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Adolescente , Biomarcadores , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Diálisis Renal , Terminología como Asunto , Adulto JovenRESUMEN
BACKGROUND: Heparanase-1 activation, albuminuria, and a decrease in glomerular heparan sulfate (HS) have been described in diabetic nephropathy (DN). Glycosaminoglycan (GAG)-based drugs have been shown to have renoprotective effects in this setting, although recent trials have questioned their clinical effectiveness. Here, we describe the effects of fucosylated chondroitin sulfate (FCS), a novel GAG extracted from a marine echinoderm, in experimentally induced DN compared to a widely used GAG, enoxaparin (ENX). METHODS: Diabetes mellitus (DM) was induced by streptozotocin in male Wistar rats divided into three groups: DM (without treatment), FCS (8 mg/kg), and ENX (4 mg/kg), administered subcutaneously. After 12 weeks, we measured blood glucose, blood pressure, albuminuria, and renal function. The kidneys were evaluated for mesangial expansion and collagen content. Immunohistochemical quantifications of macrophages, TGF-ß, nestin and immunofluorescence analysis of heparanase-1 and glomerular basement membrane (GBM) HS content was also performed. Gene expression of proteoglycan core proteins and enzymes involved in GAG assembly/degradation were analyzed by TaqMan real-time PCR. RESULTS: Treatment with GAGs prevented albuminuria and did not affect the glucose level or other functional aspects. The DM group exhibited increased mesangial matrix deposition and tubulointerstitial expansion, and prevention was observed in both GAG groups. TGF-ß expression and macrophage infiltration were prevented by the GAG treatments, and podocyte damage was halted. The diabetic milieu resulted in the down-regulation of agrin, perlecan and collagen XVIII mRNAs, along with the expression of enzymes involved in GAG biosynthesis. Treatment with FCS and ENX positively modulated such changes. Heparanase-1 expression was significantly reduced after GAG treatment without affecting the GBM HS content, which was uniformly reduced in all of the diabetic animals. CONCLUSIONS: Our results demonstrate that the administration of FCS prevented several pathological features of ND in rats. This finding should stimulate further research on GAG treatment for this complication of diabetes.
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Sulfatos de Condroitina/farmacología , Sulfatos de Condroitina/uso terapéutico , Citoprotección/efectos de los fármacos , Diabetes Mellitus Experimental/tratamiento farmacológico , Nefropatías Diabéticas/prevención & control , Riñón/efectos de los fármacos , Albuminuria/metabolismo , Animales , Colágeno/metabolismo , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/patología , Nefropatías Diabéticas/genética , Nefropatías Diabéticas/metabolismo , Nefropatías Diabéticas/patología , Glicosaminoglicanos/farmacología , Glicosaminoglicanos/uso terapéutico , Riñón/patología , Glomérulos Renales/metabolismo , Glomérulos Renales/patología , Masculino , Ratas , Ratas Wistar , EstreptozocinaRESUMEN
O condiloma acuminado gigante, ou tumor de Buschke-Lowerstein, é uma forma rara de apresentação da infecção pelo papiplomavírus humano (HPV), caracterizado por um crescimento exuberante da lesão verrucosa típica do HPV, diferenciando do condiloma simples por seu caráter invasivo, embora benigno do ponto de vista metastático, sendo, pro isso considerado por muitos como uma patologia intermediária entre o condiloma simples e o carcinoma verrucoso. Os autores apresentam uma forma rara de apresentação do tumor de Buschken-Lowerstein, de localização anorretal, confirmando através de técnica de imunoistoquimica os tipos 11 e 16 do vírus HPV. Discutem ainda os principais aspectos clínicos, histopatológicos e terapêuticos, com ampla revisão da literatura mundial.
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Humanos , Masculino , Condiloma Acuminado , Neoplasias del Ano/etiología , Neoplasias del Ano/patología , PapillomaviridaeRESUMEN
A síndrome de Ramsay-Hunt tem sido descrita com mais ênfase, provavelmente, pela melhoria das possibilidade diagnósticas e principalmente da resposta terapêutica quando iniciada precocemente. Caracteriza-se pela paralisia facial periférica, otalgia e presença de vesícula em pavilhäo auditivo externo e face. Descrevemos um quadro clássico da síndrome em paciente previamente hígido, que com a demora do diagnóstico acarretou lentidäo na recuperaçäo. O relato do caso pelos autores tem como principal objetivo demonstrar que a síndrome de Ramsay-Hunt, quando descoberta precocemente,permite-nos o tratamento com menor número de seqüelas, principalmente a paralisia facial (au)