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BACKGROUND/AIMS: Acute kidney injury (AKI) has been reported as a recognized condition among the elderly population; however, its clinical epidemiology is still poorly evaluated. We propose to evaluate the epidemiological profile of AKI in hospitalized elderly patients and the variables associated with renal replacement therapy (RRT) dependency at discharge after an episode of AKI. METHODS: This prospective observational study enrolled 286 elderly patients (aged ≥60 years), who had a diagnosis of AKI and were admitted to a tertiary care hospital. Clinical data were analyzed, which included RRT indication, referral time to nephrologist support, standby period in the emergency care units (ECU) before a transfer to an intensive care unit, staff criteria used to indicate palliative care, and the incidence of patients who stayed on chronic dialysis for at least 6 months after discharge. RESULTS: The overall hospital mortality was 56.3%. Acute Kidney Injury Network (AKIN) 3 at the time of admission was significantly higher in patients who underwent RRT. Intrinsic AKI (p < 0.001), AKIN 3 (p < 0.001), RRT (p < 0.001), and increased length of stay in ECUs (p = 0.01) all had a significantly higher prevalence among non-survivors. On multivariate analysis, however, only renal aetiology (intrinsic AKI) was independently associated with mortality (OR 2.88; 95% CI [1.29-6.13]). Approximately 85% of the discharged patients (n = 125) were dialysis free and 36.4% of them who had a previous diagnosis of chronic kidney disease (CKD) upon admission had a worse renal function. Age, AKIN 3, RRT, prior history of CKD, diabetes mellitus, and the number of hemodialysis sessions showed to have an impact on dialysis dependence. Furthermore, 24 of 161 patients who had a dialysis indication were placed on palliative care. CONCLUSIONS: The severity of AKI and the need for RRT were risk factors for mortality and dependence on dialysis. Antecedents of CKD seem to be associated with a poor renal outcome following an AKI episode. Starting RRT had an impact on the clinical decision to enroll these patients into palliative care.

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Acremonium infection is rare and associated with immunosuppression. A case of recurrent cutaneous Acremonium infection after short term voriconazole use is described. Surgical resection was the definitive therapy. Oral voriconazole was used in the treatment of Acremonium infection, but recurrence was associated with short therapy. Prolonged antifungal therapy and surgical resection are discussed for the treatment of localized lesions.

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Acremonium infection is rare and associated with immunosuppression. A case of recurrent cutaneous Acremonium infection after short term voriconazole use is described. Surgical resection was the definitive therapy. Oral voriconazole was used in the treatment of Acremonium infection, but recurrence was associated with short therapy. Prolonged antifungal therapy and surgical resection are discussed for the treatment of localized lesions.

Infecção por Acremonium é rara e pode estar associada com imunossupressão. Descrevemos um caso de infecção recorrente de pele por Acremonium após tratamento breve com voriconazol. Ressecção cirúrgica foi o tratamento definitivo. Terapia prolongada com antifúngicos e ressecção cirúrgica são discutidas para o tratamento de doenças fúngicas localizadas.

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The role of the Major Histocompatibility Complex (MHC) in transplantation immunology is widely known. Incompatibilities associated with Human Leukocyte Antigens (HLA) between donors and recipients are related to poorer prognosis in allograft acceptance and survival, often resulting in rejection episodes. HLA-A, HLA-B, HLA-DR and HLA-DQ compatibility are widely studied in clinical transplants but few studies investigated the influence of non-classical HLA loci, such as HLA-G, a non-classical class I HLA gene located at 6p21.31 in the MHC region, i.e. 300 kb telomeric to HLA-A. MHC region genes are characterized by extreme polymorphism as well as strong positive linkage disequilibrium (LD) between HLA loci (alleles). LD studies related to MHC region provide investigators with a tool to assess candidate genes with an at-risk HLA haplotype, with implications for allograft transplants, human reproduction and disease susceptibility. Many studies reported striking LD between HLA-G and HLAA alleles and also between HLA-G and HLA Class II alleles, but the biologicalimplications for these findings are not clear yet. DNA sequencing methodology was used to determine HLA-G (exons 2 and 3) polymorphisms from 52 patients who underwent kidney transplantation and their donors. It is the purpose of this study to investigate the influence of HLA-G polymorphism in a set of kidney transplants and the occurrence of rejection episodes. It was observed that pairs with 2 HLA-G matches presented a lower risk of rejection occurrence than those pairs with 0 or 1 match. It was also observed that subjects whose genotype presented one synonymous substitution (S) in one HLA-G allele in the HLA-G0101 group of alleles and another allele with a non-synonymous substitution (N/S) on HLA-G0103, HLA-G010401, HLA-G010403 or HLA-G0105N alleles, apparently had a greater chance of rejection episodes. Additionally, HLA-G, as well as HLA-A, -B e -DR, compatibility may also be important for allograft acceptance (rejection probability lower than 0.09%). Besides, heterozygous S/NS patients had a five times greater chance of rejection than S/S and NS/NS patients. Some haplotypes found in the present study were already described in literature: A01-G01B (010102 or 0106), A03-G0101A, A23-G010401, A26-G01B, A31-G0103, A02-G0101A, A24-G0101A, A33-G0103, A68-G01B. We have also described LD between HLA-G alleles and HLA class II DRB1 allelic groups and found significant LD between DRB104-G01B, DRB113-G010401, DRB114-G010108, DRB115-G0103, DRB103-G0101A and DRB103-G01B.

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O presente trabalho teve por objetivo estudar o comportamento da doença de Chagas em transplantados reanais. Foram revisados os prontuários da Unidade de Transplante Renal do HUEC, cujos transplantes foram realizados no período de 1980 a 2000. Dos 470 pacientes analisados, 50,4 por cento receberam transplante de doador cadavérico, 46,2 por cento de doador ao vivo-relacionado e 3,4 por cento de doador não-relacionado. Foi possível a análise de sorologia em 339. Em 271 pacientes, foi possível o acompanhamento sorológico pré e p2s transplante e verificando-se que tres pacientes eram soropositivos no pré e p2s transplante, sendo que um apresentou manifestação clínica pós-transplante para óbito. Um paciente previamento soronegativo, tornou-se soropositivo no pós-transplante, mas sem manifestação clínica até a presente data. Embora em 68 pacientes só estava disponível a sorologia pré ou pós transplante, impedindo a avaliação do curso da doença, foi observado que 5,9 por cento dos pacientes eram positivo para IgG e IgM após o transplante. A doençde de Chagas ou tripanosomose americana é um problema de saúde pública na América Latina, que alcança atualmente 16 a 18 milhões de pessoas e 90 milhões de indivíduos estão expostos ao risco de adquirí-la. A incidência de doenç de Chagas em pacientes transplantados renais não se mostrou alta. Entretanto, deve-se atentar para o seu diagnóstico e profilaxia, pois em indivíduos imunossuprimidos esta doença pode levar à alta morbimortalidade

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