RESUMO
Hypertension and blood pressure variability (BPV; SD and average real variability) in primary proteinuric glomerulopathies are not well described. Data were from 433 participants in the NEPTUNE (Nephrotic Syndrome Study Network). Hypertensive BP status was defined as previous history of hypertension or BP ≥140/90 mm Hg for adults/≥95th percentile for children at baseline. BPV was measured in participants with ≥3 visits in the first year. Two-hundred ninety-six adults (43 years [interquartile range, 32-57.8 years], 61.5% male) and 147 children (11 years [interquartile range, 5-14 years], 57.8% male) were evaluated. At baseline, 64.8% of adults and 46.9% of children were hypertensive. Histological diagnosis was associated with hypertensive status in adults (P=0.036). In adults, hypertensive status was associated with lower hazard of complete remission (hazard ratio, 0.36; 95% confidence interval, 0.19-0.68) and greater hazard of achieving the composite end point (end-stage renal disease or estimated glomerular filtration rate decline >40%; hazard ratio, 4.1; 95% confidence interval, 1.4-12). Greater systolic and diastolic SD and average real variability were also associated with greater hazard of reaching the composite end point in adults (all P<0.01). In children, greater BPV was an independent predictor of composite end point (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability; all P<0.05). Hypertensive status was common among adults and children enrolled in NEPTUNE. Differences in hypertensive status prevalence, BPV, and treatment were found by age and histological diagnosis. In addition, hypertensive status and greater BPV were associated with poorer clinical outcomes.
Assuntos
Assistência Ambulatorial , Determinação da Pressão Arterial , Hipertensão , Síndrome Nefrótica , Adolescente , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Criança , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/fisiopatologia , Hipertensão Maligna/diagnóstico , Hipertensão Maligna/epidemiologia , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/complicações , Síndrome Nefrótica/epidemiologia , Síndrome Nefrótica/fisiopatologia , Síndrome Nefrótica/urina , Variações Dependentes do Observador , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
We evaluated the feasibility of using universal serial bus (USB) drives for communicating medical information between parents of children receiving dialysis and medical personnel during clinical encounters. When surveyed, parents and pediatric resident physicians supported the use of USB drives and were willing to use the devices. The utilization rate of USB drives was 57%.
Assuntos
Comunicação , Dispositivos de Armazenamento em Computador/estatística & dados numéricos , Unidades Hospitalares de Hemodiálise , Gestão da Informação/métodos , Sistemas Computadorizados de Registros Médicos/instrumentação , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Criança , Estudos de Viabilidade , Feminino , Humanos , Gestão da Informação/instrumentação , Internato e Residência , Masculino , Erros Médicos/prevenção & controle , Pais , Pediatria , Relações Profissional-FamíliaRESUMO
A 6-year-old girl touched an agar plate containing Escherichia coli O157:H7 while visiting a hospital laboratory, and subsequently, colitis and hemolytic uremic syndrome developed. Pulsed-field gel electrophoresis patterns of the isolate cultured from her stool and that from the laboratory were identical.