RESUMO
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.
RESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adulto Jovem , Injúria Renal Aguda/terapia , Injúria Renal Aguda/epidemiologia , Brasil/epidemiologia , Biomarcadores , Incidência , Diálise Renal , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Terminologia como AssuntoRESUMO
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.
Assuntos
Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Adolescente , Biomarcadores , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Diálise Renal , Terminologia como Assunto , Adulto JovemRESUMO
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.
Assuntos
Humanos , Masculino , Condiloma Acuminado , Neoplasias do Ânus/etiologia , Neoplasias do Ânus/patologia , PapillomaviridaeRESUMO
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)