RESUMO
BACKGROUND AND OBJECTIVES: With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest. RESULTS: Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P<0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P<0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P<0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P<0.001). CONCLUSIONS: In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.
Assuntos
Rim/diagnóstico por imagem , Ultrassonografia Pré-Natal , Sistema Urinário/diagnóstico por imagem , Anormalidades Urogenitais/diagnóstico por imagem , Adolescente , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/embriologia , Hipertensão/etiologia , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Rim/anormalidades , Rim/cirurgia , Nefropatias/etiologia , Masculino , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Sistema Urinário/anormalidades , Sistema Urinário/cirurgia , Infecções Urinárias/etiologia , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/embriologia , Anormalidades Urogenitais/mortalidade , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urológicos , Adulto JovemRESUMO
Recent years has seen an increasing interest in the quality of life (QOL) of children with chronic kidney disease (CKD). The objective of this cross-sectional study was to investigate the prevalence of behavioral disorders and to assess the health-related QOL (HRQOL) in 136 patients with CKD. To estimate the prevalence of behavior disorders and analyze HRQOL, we used the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Inventory of Quality of Life (PedsQL) Core Scales as assessment tools for both the patients and caregivers. When compared to healthy controls, the CKD group had significantly lower scores in almost all PedsQL domains. After adjustment, only absence of religion/other religions remained significantly associated with a lower global HRQOL score [odds ratio (OR) 6.2, P=0.009]. Among the parents, two factors remained significantly associated with a lower global HRQOL score: patients' age >10 years (OR 5.4, P=0.033) and absence of religion/other religions (OR 3.2, P=0.038). The CKD group demonstrated a higher proportion of behavioral and emotional disorders in all SDQ domains. There was a negative correlation between the presence of behavior and emotional disorders and HRQOL score (r= -0.552, P<0.001). Our findings suggest the importance of evaluating behavioral and social repercussions of CKD in order to improve the life quality of this pediatric population.
Assuntos
Transtornos do Comportamento Infantil/psicologia , Falência Renal Crônica/psicologia , Transtornos Mentais/psicologia , Qualidade de Vida/psicologia , Adolescente , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/complicações , Modelos Logísticos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Fatores Socioeconômicos , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Knowledge of risk of urinary tract infection (UTI) recurrence in vesicoureteral reflux (VUR) can help clinicians make therapeutic decisions. The aim of this retrospective cohort study was to identify risk factors associated with recurrent urinary tract infection in children with VUR. In addition, a risk score that might predict the chance of UTI recurrence was also proposed. METHODS: Between 1970 and 2007, 740 patients were diagnosed with VUR and were systematically followed up at a single tertiary Renal Unit. Recurrent UTI was defined as more than 1 episode during follow-up. A binary logistic regression model was applied to identify variables independently associated with recurrent UTIs. RESULTS: During follow-up, information was obtained on 58,856 person-months. Recurrent UTIs occurred in 120 (16.2%) patients. The overall incidence rate of UTI was 8.4 episodes per 1000 person-months (95% CI, 7.7, 9.2). After adjustment by multivariable analysis, 5 variables were independent predictors of recurrent UTI: UTI as clinical presentation, age < 6 months, female gender, dysfunctional elimination syndrome, and severe grade of reflux. The risk for recurrent UTI was classified as low in 24% of children, medium in 42%, and high in 34%. UTI incidence rates per 1000 person-months were 4.3 (95% CI, 3.2, 5.6), 7.9 (95% CI, 6.7, 9.1), and 11.3 (95% CI, 9.9, 12.8) for low-, medium-, and high-risk groups, respectively. CONCLUSION: The prediction model of recurrent UTI allows an early recognition of patients at risk for long-term morbidity and might contribute to the formulation of therapeutic strategies.
Assuntos
Infecções Urinárias/epidemiologia , Refluxo Vesicoureteral/complicações , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Masculino , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIM: The aim of this study was to investigate risk factors associated with different extents of renal parenchyma involvement in a paediatric series of primary vesicoureteral reflux (VUR). METHODS: A total of 549 patients with VUR were analyzed. The variable of interest was renal scar, assessed by technetium-99m dimercaptosuccinic acid scan, and classified into three subtypes: focal scar, multiple cortical scarring and diffuse scars with a contracted renal unit. The multinomial regression model was applied to identify independent variables associated with each subtype of renal damage. RESULTS: After adjustment, four variables remained independently associated with a contracted renal unit: reflux grades III-V (odds ratio (OR)=9.7; 95% confidence interval (CI) = 4.1-21.0), age at diagnosis (OR=3; 95% CI=1.6-5.1), unilateral reflux (OR=2.1; 95% CI=1.2-3.8), and male sex (OR=2; 95% CI=1.1-3.8). Two variables were associated with multiple scars: reflux grades III-V (OR=13.8; 95% CI=7.4-26.0) and age at diagnosis (OR=1.9; 95% CI=1.2-3.0). Two variables were associated with a focal scar: reflux grades III-V (OR=7.9, 95% CI CI=3.8-16.4) and male sex as a protective factor (OR=0.5; 95% CI=0.25-1.0). CONCLUSION: Our findings suggest that the development of a contracted renal unit is probably due to congenital malformation, more commonly observed in male infants with high-grade reflux.
Assuntos
Nefropatias/etiologia , Refluxo Vesicoureteral/complicações , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Rim/patologia , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Infecções Urinárias/complicaçõesRESUMO
BACKGROUND: The clinical course of chronic kidney disease (CKD) in children is heterogeneous and has not been fully established. The aim of this retrospective cohort study was to identify predictive factors associated with the progression of CKD among the children and adolescents admitted to a Predialysis Interdisciplinary Management Programme (PDIMP). METHODS: We analysed the following variables at admission: age, gender, race, blood pressure, primary renal disease, Z-scores for weight and height, CKD stage and degree of proteinuria. Two time-dependent covariates were considered: hypertension and proteinuria. CKD stage 5 was assigned as a dependent variable. Time-fixed and time-dependent Cox regression analyses were applied to evaluate renal survival. RESULTS: One hundred and seven patients with CKD stage 2-4 were followed up for a median time of 94 months. Fifty-seven patients (53.3%) progressed to CKD stage 5. After adjustment for time-fixed model, three baseline variables were found to be independent predictors of CKD stage 5: glomerular disease (hazard ratio, HR = 3.0, P = 0.015), CKD stage 4 (HR = 2.6, P = 0.001) and severe proteinuria (HR = 4.1, P = 0.006). After adjustment for the time-dependent model, three variables were found to be independent predictors of CKD stage 5: proteinuria as time-dependent covariate (HR = 1.9, P = 0.041), CKD stage 4 (HR = 2, P = 0.0086) and baseline serum albumin <3.5 g/dl (HR = 2.6, P = 0.0015). CONCLUSIONS: Taking into account manageable factors, further prospective controlled studies are necessary to assess intervention measures in order to possibly modify the clinical course of CKD in children.
Assuntos
Insuficiência Renal Crônica/etiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Lactente , Masculino , Equipe de Assistência ao Paciente , Modelos de Riscos Proporcionais , Proteinúria/complicações , Diálise Renal , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Adulto JovemRESUMO
The purpose of this retrospective cohort study was to describe the outcome of 107 patients with chronic kidney disease (CKD) admitted to a pre-dialysis interdisciplinary management program from 1990 to 2006. The events of interest were progression to CKD stage 5 (renal survival), patient survival, hypertension, and somatic growth. Survival was studied by the Kaplan-Meier method. Patients were classified into four groups according to their primary renal disease: congenital nephro-uropathies; glomerular diseases; cystic disease, and miscellaneous. Median follow-up time was 94 months [Interquartile (IQ) range 38-145]. The probability of reaching CKD stage 5 was estimated to be 36% by 5 years after admission. As a whole, the mean estimated glomerular filtration rate (GFR) decrease per year was 5.8 ml/min per 1.73 m(2) body surface area [standard deviation (SD) 12.4]. The glomerular diseases group showed a median rate of GFR deterioration of 10 ml/min per 1.73 m(2) per year (IQ range -24 to -5.7), whereas the median rate of GFR deterioration for the groups with cystic diseases, congenital nephro-uropathies, and miscellanea were 2.5 ml/min (IQ range -10 to +0.34), 2.2 ml/min (IQ range -5.0 to -0.52), and 0.36 ml/min (IQ range -2.5 to +2.6), respectively (P < 0.001). The results of this study support the view that children and adolescents with glomerular diseases present a faster deterioration of renal function. Therefore, patients with glomerular diseases need to be referred early to a pediatric nephrology center so that suboptimal pre-dialysis care might possibly be avoided.
Assuntos
Proteinúria/mortalidade , Proteinúria/terapia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Glomerulonefrite/mortalidade , Glomerulonefrite/terapia , Humanos , Hipertensão Renal/mortalidade , Hipertensão Renal/terapia , Estimativa de Kaplan-Meier , Masculino , Equipe de Assistência ao Paciente , Diálise Renal , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The aim of this report was to estimate the risk of hypertension in children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR at a single tertiary renal unit. Of 735 patients, 664 (90%) were systematically followed and had multiple measurements of blood pressure. Hypertension was defined as values persistently above 95th for age, sex, and height in three consecutive visits. Risk of hypertension was analyzed by the Kaplan-Meier method. Of 664 patients followed, 20 (3%) developed hypertension. The estimated probability of hypertension was 2% (95%CI, 0.5%-3%), 6% (95%CI, 2%-10%), 15% (95%CI, 11%-20%) at 10, 15, and 21 years of age, respectively. The prevalence of hypertension has increased with age: it was 1.7% for patients with 1 yr-9.9 yr, 1.8% for adolescents with 10 yr-14.9 yr, 4.7% for patients with 15-19.9 yr, and 35% for patients>20 years at the end of the follow-up (P<0.001). It was estimated by survival analysis that 50% of patients with unilateral and bilateral renal damage would have sustained hypertension at about 30 and 22 years of age, respectively. Hypertension increased with age and was strongly associated with renal damage at entry in an unselected population of primary VUR.
Assuntos
Hipertensão Renal/etiologia , Refluxo Vesicoureteral/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Rim/patologia , Masculino , Refluxo Vesicoureteral/patologiaRESUMO
The aim of the present study was to evaluate plasma renin activity (PRA) and Angiotensin (Ang) levels [Ang I, Ang II and Ang-(1-7)] to examine the circulating Renin-Angiotensin System (RAS) in renal disease among children with different forms and stages of chronic renal failure (CRF). Subjects were divided as follows: 32 normotensive healthy subjects, 23 normotensive CRF subjects, 34 hypertensive CRF subjects and 21 subjects with end-stage renal disease (ESRD). Radioimmunoassays for PRA (ngAngI/mL/h) and angiotensin (pg/mL) measurements were performed on all subjects. PRA, Ang I, Ang II and Ang-(1-7) levels were significantly higher in hypertensive CRF subjects when compared with normotensive CRF and healthy subjects (p < 0.05 for all comparisons). No differences were observed between normotensive CRF and healthy subjects. ESRD subjects exhibited a dramatic increase in Ang-(1-7) (25-fold higher than control values). In hypertensive CRF subjects, treatment with angiotensin-converting enzyme inhibitors (ACEi) increased (1.4-fold) plasma Ang-(1-7) and decreased (2.4-fold) Ang II. In ESRD, the use of ACEi produced a similar (1.5-fold) elevation of Ang-(1-7), but no changes in plasma Ang II. Our data showed different circulating RAS profiles between hypertensive and in normotensive CRF subjects. Marked changes in plasma Ang-(1-7) were associated with the presence of hypertension and progression of kidney dysfunction.
Assuntos
Angiotensinas/sangue , Falência Renal Crônica/sangue , Sistema Renina-Angiotensina/fisiologia , Renina/sangue , Adolescente , Angiotensina I/sangue , Angiotensina II/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Hipertensão/sangue , Falência Renal Crônica/fisiopatologia , Masculino , Fragmentos de Peptídeos/sangue , Peptidil Dipeptidase A/metabolismoRESUMO
OBJECTIVE: To identify independent factors predicting the resolution of primary vesico-ureteric reflux (VUR) in a cohort of medically managed children. PATIENTS AND METHODS: Between 1977 and 2003, 506 children were diagnosed with VUR and were conservatively managed and prospectively followed. All of the children were maintained on antibiotic prophylaxis. Follow-up imaging consisted of voiding cysto-urethrography (VCUG) or a direct isotope cystogram at intervals of 2-3 years. The predictive factors used are based on the patient data at the time of entry in the protocol. The dependent variable was VUR resolution. The criterion for resolution was based on a single negative VCUG or direct isotope cystogram. A survival analysis identified variables significantly associated with VUR resolution. Cox's regression model was applied to identify variables independently associated with the dependent variable. RESULTS: After adjustment, four variables remained as independent predictors of VUR resolution: nonwhite race, relative risk (95% confidence interval) of 1.5 (1.1-1.9; P = 0.009); mild grade of VUR, 3.3 (2.1-5.3; P < 0.001); absence of renal damage, 3.3 (2.4-4.5; P < 0.001); and absence of dysfunctional voiding, 2.0 (1.4-3.1; P < 0.001). For mild VUR, three variables were significantly associated: male gender, 1.7 (1.1-2.6; P = 0.012); absence of renal damage, 3.4 (1.8-6.4; P < 0.001); and unilateral VUR, 1.6 (1.1-2.3; P = 0.004). For moderate/severe VUR, three variables were significantly associated: nonwhite race, 1.7 (1.1-2.6; P = 0.01); absence of renal damage, 3.0 (2.0-4.4; P < 0.001); and absence of dysfunctional voiding, 2.8 (1.4-5.5; P = 0.004). CONCLUSION: Few factors are amenable to intervention to modify the natural history of VUR. According to our findings, there are only two possible interventions: avoiding renal scars and managing voiding dysfunction.
Assuntos
Refluxo Vesicoureteral/terapia , Antibioticoprofilaxia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Infecções Urinárias/prevenção & controle , Transtornos Urinários/etiologiaRESUMO
O estudo trata da importância da utilização da visita domiciliar na identificação de características e informações relacionadas às conseqüências da doença renal crônica na vida de pacientes e familiares atendidos pelos profissionais do Programa Interdisciplinar de Prevenção e Assistência na IRC em Crianças e Adolescentes do Hospital das Clínicas da UFMG. Foram visitados 21 doentes, sendo entrevistado um familiar. Entre as modificações ocorridas com a família, foram citadas as dificuldades de o familiar responsável pelos cuidados ter atividades fora do lar e as mudanças dos padrões alimentares de toda a família. A visita domiciliar se mostrou uma estratégia assistencial eficiente, contribuindo para a relação entre pacientes, familiares e profissionais.
This study emphasizes the importance of home visits in identifying the characteristics and information on the consequences of chronic renal disease in the life of patients and their families cared for by health workers in the Interdisciplinary Program for Prevention and Care in the Chronic Renal Failure for Children and Adolescents at the University Hospital of the Federal University of Minas Gerais. Twenty-one patients were visited and a family memeber of each one was interviewed. Modifications in the family included difficulties when the person caring for the patient had outdoor activities and the changes in eating patterns for the whole family. Home visits showed themselves to be an efficient strategy for care, contributing to the relation between patients, family members and health workers.
El estudio trata sobre la importancia de utilizar la visita domiciliaria para identificar características e informaciones relacionadas con las consecuencias de la enfermedad renal crónica en la vida de pacientes y familiares atendidos por los profesionales del Programa Interdisciplinario de Prevención y Asistencia a la IRC (insuficiencia renal crónica) en Niños y Adolescentes del Hospital de Clínicas de la UFMG (Universidad Federal de Minas Gerais). Se efectuaron visitas a 21 enfermos y entrevista a un familiar. Entre las modificaciones ocurridas en la familia se citaron las dificultades del familiar responsable de los cuidados para conciliar sus tareas fuera del hogar y los cambios en la alimentación de toda la familia. La visita domiciliaria demostró ser una estrategia asistencial eficiente que contribuye a la relación entre pacientes, familiares y profesionales.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Insuficiência Renal Crônica/prevenção & controle , Serviços Hospitalares de Assistência Domiciliar , Serviços de Assistência Domiciliar , Entrevistas como Assunto , Doença Crônica , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To evaluate the clinical/radiological features of patients with primary vesicoureteral reflux (VUR) admitted to a single institution from 1969 to 1999. METHODS: At admission, after the institution of chemoprophylaxis, patients were investigated by CUM, DMSA, and US. The children were managed with periodical clinical and laboratory evaluations. Analyses were performed with the data obtained at admission. RESULTS: A total of 483 patients were enrolled in the protocol. There was a predominance of females (70%) and caucasian race (70%). Mean age at VUR diagnosis was 26 months and 92.5% of the patients had urinary infection before admission. A total of 710 refluxing units were analyzed. The distribution of reflux grade was: grade I (49; 7%); II (254; 36%); III (190; 26%); IV (161; 23%) e V (56; 8%). Approximately one half of the units analyzed were from patients presenting renal damage at admission. The distribution of the severity of renal damage was as follows: mild (36%), moderate (34%), and severe (30%). There was a significant risk of severe renal damage for the males (OR = 1.74, 95% CI = 1.2 - 2.5, p = 0.002). CONCLUSION: There was a predominance of VUR among females and most presented a mild or moderate degree. However, there was a high percentage of renal damage at admission and a tendency to greater morbidity for the males.
Assuntos
Nefropatias/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Nefropatias/etiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Refluxo Vesicoureteral/complicaçõesRESUMO
We report the long-term clinical results of conservative management of children with unilateral multicystic dysplastic kidneys (MCDK). Between 1989 and 2002, 43 children with MCDK detected by prenatal ultrasonography were prospectively followed. At birth, ultrasonography confirmed the prenatal findings in all cases. Patients underwent a radioisotope scan and micturating cystogram in order to confirm the diagnosis and to exclude other uropathies. Follow-up ultrasound (US) examinations were performed at 6-month intervals during the first 2 years of life and yearly thereafter. The mean follow-up time was 42 months (range 12-156 months). Two children developed hypertension during follow-up. In total 257 US scans were performed. The mean number of US scans per patient was 6 (range 3-10). US scans demonstrated partial involution of the MCDK in 30 (70%) cases and complete involution in 8 (19%). The absolute MCDK length remained almost unchanged in 5 children (11%). The estimated median time of complete involution of the MCDK was 122 months [95% confidence interval (CI)=86-158 months]. A total of 33 (76.7%) contralateral kidneys underwent compensatory hypertrophy, reaching a renal length above the 95th percentile during follow-up. The estimated median time for the occurrence of compensatory hypertrophy was 30 months (95% CI=15-45 months). In conclusion, the natural history of MCDK is usually benign but patients must have long-term follow-up with US scans and blood pressure measurements.
Assuntos
Rim Displásico Multicístico/fisiopatologia , Progressão da Doença , Feminino , Humanos , Hipertensão/etiologia , Lactente , Recém-Nascido , Masculino , Rim Displásico Multicístico/complicações , Rim Displásico Multicístico/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Remissão Espontânea , Ultrassonografia Pré-NatalRESUMO
OBJETIVOS: Avaliar retrospectivamente as características clínicas/radiológicas dos pacientes admitidos com refluxo vésico-ureteral primário (RVU) entre 1969-1999. MÉTODOS: Pacientes com RVU primário foram submetidos a um protocolo de avaliação clínica, laboratorial e radiológica e acompanhados longitudinalmente. Na admissão, após controle da bacteriúria e do início da quimioprofilaxia, foram realizados avaliação laboratorial e estudo de imagens do trato urinário. Esta consistiu de uretrocistografia miccional, urografia excretora, cintilografia renal (DMSA) e ultra-sonografia. Para o presente estudo foram utilizados os dados obtidos na admissão. RESULTADOS: Foram admitidos nesse período 483 pacientes. Houve predomínio do sexo feminino (70 por cento) e da cor branca (70 por cento). A média de idade ao diagnóstico foi de 26 meses, sendo que 92,5 por cento das crianças já haviam apresentado infecção urinária. Um grupo de 710 unidades renais foi analisado. A distribuição do grau de refluxo foi a seguinte: grau I (49; 7 por cento); II (254; 36 por cento); III (190; 26 por cento); IV (161; 23 por cento) e V (56; 8 por cento). Um total de 249 unidades renais apresentaram dano renal à admissão. A distribuição quanto à intensidade da lesão foi a seguinte: leve (36 por cento), moderada (34 por cento) e grave (30 por cento). Houve um risco significativo maior de lesão renal grave no sexo masculino (OR = 1,74, IC 95 por cento = 1,2 - 2,5, p = 0,002). CONCLUSÃO: O RVU predominou no sexo feminino e em sua maioria apresentou-se em graus leves a moderados. Contudo, houve um alto percentual de dano renal à admissão e uma tendência de maior morbidade para o sexo masculino.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nefropatias/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Nefropatias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Refluxo Vesicoureteral/complicaçõesRESUMO
Objetivo :Avaliar o curso clínico da insuficiência renal crônica (IRC) em crianças e adolescentes admitidos no Programa lnterdisciplinar de Prevenção e Assistência da IRC do HC-UFMG. Métodos :A população estudada consistiu de 62 crianças e adolescentes portadores de IRC em tratamento conservador, admitidos no programa entre 1990 a 1999. Esses pacientes foram submetidos a avaliações clínico-laboratoriais com periodicidade média de dois meses. Foram avaliadas as seguintes variáveis: idade de admissão, idade de diagnóstico da IRC, causa básica da doença, sexo, data da última consulta ou data da indicação de diálise, dados iniciais e finais de pressão arterial, e dados laboratoriais incluindo uréia e creatinina. Para a realização do estudo foi construído um banco de dados no programa Epi lnfo. Foram estudados como parâmetros nutricionais o peso e a estatura, calculados o escore Z e o percentil. A sobrevida foi analisada pelo método de Kaplan-Meier. Resultados :As causas básicas mais freqüentes da IRC foram as uropatias (56 por cento) e as glomerulopatias (19 por cento). O tempo médio de acompanhamento foi de 43 meses. Na admissão, a taxa de filtração glomerular estimada variou de 7,0 ml/min a 69 ml/min, sendo a mediana de 33,2 ml/min. Um total de 21 (34 por cento) pacientes evoluiu para insuficiência renal crônica terminal (IRCT). O grupo de glomerulopatas apresentou maior risco de necessitar de terapêutica de substituição da função renal (RR=2,08). À admissão, as medianas dos escores Z de peso e estatura foram de - 1,95 e -2,60, respectivamente, e ao final do seguimento, de - 1,8 e -2,7. Conclusão :A instituição de cuidados por equipe interdisciplinar para pacientes portadores de insuficiência renal crônica antes do início da terapia da substituição da função renal oferece benefícios a estas crianças e adolescentes, possibilitando uma abordagem clínica mais abrangente e eficaz.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Equipe de Assistência ao Paciente , Promoção da Saúde/métodos , Insuficiência Renal CrônicaRESUMO
The purpose of this study was to identify clinical, nutritional, and laboratory factors associated with the rate of progression of chronic renal insufficiency among children and adolescents admitted to a pre-end-stage renal failure (ESRF) interdisciplinary program. Sixty-two children and adolescents aged 2 months to 19 years with chronic renal failure on conservative management were prospectively followed from 1990 to 1999. The following variables were analyzed: age at admission, sex, race, blood pressure, primary renal disease, Z scores for weight and height, glomerular filtration rate (GFR), urea, and presence and degree of proteinuria. Progression to ESRF was assigned as a dependent variable. The analysis was conducted in two steps. In a univariate analysis, variables associated with ESRF outcome were identified by the log-rank test. Then, the variables that were significantly associated with adverse outcome were included in a multivariate analysis. This analysis, using the Cox proportional hazards model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. Twenty-one (34%) patients evolved to ESRF during a median follow-up of 43 months. Two variables were identified as independent predictors of progression to ESRF: GFR under 30 ml/min (RR=3, 95% CI=1.7-5.3, P=0.0001) and severe proteinuria (RR=3.1, 95% CI=1.2-7.6, P=0.01). The combination of two factors-GFR lower than 30 ml/min and presence of severe proteinuria on admission-was an independent indicator of adverse outcome in children and adolescents with chronic renal insufficiency who were conservatively managed.
Assuntos
Falência Renal Crônica/patologia , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Lactente , Masculino , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Proteinúria/etiologia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: The purpose of the study was to evaluate the clinical/radiological features of patients with primary vesicoureteral reflux (VUR) admitted to a single institution from 1969 to 1999. METHODS: The patients' records were retrospectively reviewed and the following clinical data obtained at admission were analyzed: age, gender, race, date of entry, previous symptoms, weight, height, blood pressure, and serum renal function. The renal imaging tests at baseline were also retrospectively analyzed including voiding cystourethrography, excretory urography, DMSA scan, and ultrasonography. For statistical analysis, reflux was classified into two categories: (1) mild/moderate (grade I/II/III) and (2) severe (grade IV/IV). Renal damage was categorized according to the following classification: (I) mild, focal damage; (II) moderate, more extensive scars, and (III) severe, generalized damage or shrunken kidney. The odds ratio (OR) and the respective confidence interval (95%CI) were calculated to compare the difference in risk between groups. RESULTS: A total of 461 patients were enrolled in the protocol. There was a predominance of female gender (71%) and white race (73%). Mean age at VUR diagnosis was 2.8 y and 93% of the patients had urinary infection before admission. Bilateral reflux was diagnosed in 249 (54%) children, for a total of 710 renal units for study. The distribution of reflux grade was as follows: grade I (7%); II (36%); III (26%); IV (23%), and V (8%). Of the 450 children investigated, 180 (40%) presented with renal damage, for a total of 234 (26%) units with renal scars. Renal damage was associated with the following factors: Diagnosis after 2 y of age (OR = 1.5, 95%CI = 1.08-2.1, p = 0.01), severe degree of reflux (OR = 6, 95%CI = 4-9, p < 0.001). There was a significant risk of severe renal damage for male gender (OR = 1.9, IC95% = 1.3-2.1, p = 0.001). CONCLUSION: There was a predominance of renal damage in children diagnosed above 2 y and with a high degree of reflux. Severe renal damage was associated with male gender.
Assuntos
Nefropatias/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Adolescente , Distribuição por Idade , Brasil , Criança , Pré-Escolar , Feminino , Instalações de Saúde , Humanos , Lactente , Nefropatias/epidemiologia , Nefropatias/etiologia , Masculino , Estudos Retrospectivos , Distribuição por Sexo , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/epidemiologiaRESUMO
Objetivo: analisar a história clínica e evolução de crianças e adolescentes com HI, ressaltando peculiariades próprias destes pacientes. Métodos: 471 pacientes de HI têm sido acompanhados em regime ambulatorial, sendo submetidos ao protocolo: Rx de abdome, ultrassonografia de rins e vias urinárias; ionograma, gasometria e bioquímica de sangue; urina de 24 horas para dosagem de cálcio e outros eletrólitos e creatinina; urinálise, urocultura e microscopia de contraste de fase; urina de segunda micção matinal em jejum para dosagem de cálcio e creatinina. Resultados: 56 por cento masculinos e 44 por cento femininos; 56 brancos, 37 por cento não-brancos e 7 por cento sem relato de cor da pele. Ao diagnóstico 6 por cento eram lactentes, 15 por cento pré-escolares, 55 por cento escolares e 24 por cento adolescentes, 47 por cento tinha hematúria associada à dor abdominal, 31 por cento hematúria isolada, 14 por cento dor abdominal isolada, 8 por cento tinham infecção urinária, enurese noturna, dor suprapúbica ou uretral ou a síndrome miccional com frequência/urgência e incontinência urinária. A associação de hipercalciúria com litíase do trato urinário foi positiva em 56 por cento dos pacientes. Em 18,5 por cento houve associação com hiperuricosúria e em 8,5 por cento com hipocitratúria. 33 por cento dos pacientes tiveram má evolução com recorrência de nefrolitíase, persistência de hematúria e dor abdominal. Conclusões: a HI deve ser diagnosticada e tratada criteriosamente com o objetivo de reduzir suas consequências como hematúria, dor abdominal, formação de cálculos urinários e as possíveis alterações ósseas. Sinais e sintomas como urgência e incontinência urinárias, dor suprapúbica e enurese noturna podem ter como causa a hiperexcreção renal de cálcio
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , HipercalcemiaRESUMO
Avaliar a intoxicaçäo por alumínio (AI) em pacientes portadores de insuficiência renal crônica (IRC). Analisou-se os níveis séricos do metal em um grupo controle (GC) e em três gruposde pacientes: G1 (38 pacientes co IRC em tratamento conservador), G2 (7 pacientes em diálise peritoneal ambulatorial contínua (DPAC) e G3 (42 pacientes em hemodiálise crônica). Concomitantemente foi coletado sangue para hemograma e dosagem de uréia, creatinina, cálcio (CA), fósforo (P), fosfatase alcalina (FA) e paratormônio (PTH). O AI dosado pela técnica de espectrofotometria de absorçäo atômica com forno de grafite, na água do serviço de diálise do hospital das Clínicas da Universidade Federal de Minas Gerais era inferior a 5ml/l. Os níveis de AI no G3 (média de 20,2 mg/l +- 10,5 mg/l) foram significativamente superiores p<0,0005) aos níveis do GI (9,7 mg/l +- 5,4 mg/l) e do G2 (9,1 mg/l + - 1,4mg/l). A concentraçäo sérica de AI de 17 indivíduoa normais do GC (2,5mg/l + - 1,4mg/l) foi significativamente inferior à dos demais grupos. A correlaçäo da concentraçäo sérica de AI com os parâmetros bioquímico mostrou correlaçäo negativa com o PTH apenas no GI (r=0,34, p=0,04). Foi realizado o teste de desferxamina (DFO) em ito pacientes do G3 que tinham AL sérico basal>30mg/l. O teste foi positivo em quatro pacientes. Em conclisäo, säo os pacientes em hemodiálise qye apresentam maior risco de acúmulo tecidual de AI, jistificando medidas para monitorizaçäo e prevençäo desta intoxicaçäo
Assuntos
Humanos , Masculino , Feminino , Alumínio/intoxicação , Diálise Peritoneal Ambulatorial Contínua , Diálise Renal , Insuficiência Renal CrônicaRESUMO
Os neonatos suspeitos de apresentarem anomalia do trato urinário pelo ultrasom realizado na gestaçäo foram avaliados com o objetivo de identificar as uropatias prevalentes em nosso meio, estudar a evoluçäo a longo prazo e avaliar os fatores associados a mau prognóstico. Após o nascimento, iniciou-se a profilaxia com cefalosporina e foi realizada a seguinte propedêutica seriada: ultrasom, uretrocistografia miccional, cintilografia renal, bacteriologia da urina e funçäo renal. Um total de 83 pacientes foi estudado, sendo 54 (65,1 p/cento) do sexo masculino. O diagnóstico mais frequente foi a obstruçäo da junçäo ureteropélvica (26[31,3 p/cento]), seguido de rim multicístico (13[15,7 0p/cento)] e outros menos frequentes. A média de seguimento
Assuntos
Humanos , Recém-Nascido , Gravidez , Doenças Urológicas/prevenção & controle , Hidronefrose , Insuficiência Renal Crônica/prevenção & controle , Ultrassonografia Pré-Natal/estatística & dados numéricos , Estudos ProspectivosRESUMO
Objetivo: O achado de hidronefrose fetal tem sido observado cada vez com maior freqüência, e é provável que, com a melhoria dos equipamentos ecográficos, essa observaçäo seja crescente. Neste presente estudo, apresentamos uma avaliaçäo de crianças portadoras de hidronefrose fetal, com o objetivo de analisar as causas mais freqüentes de hidronefrose fetal e a evoluçäo a longo prazo. Métodos: Em um período de 13 anos, 148 crianças foram admitidas no estudo e submetidas a um protocolo previamente estabelecido: na admissäo, era iniciada a quimioprofilaxia e procedida a avaliaçäo de imagens do trato urinário, consistindo de realizaçäo de uretrocistografia miccional e ultra-som. Os estudos seqüenciais foram determinados pelos achados nessa avaliaçäo inicial...