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ABSTRACT Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

RESUMO A doença renal crônica (DRC) representa um dos principais problemas de saúde pública da atualidade. A dosagem da creatinina sérica e a estimativa da taxa de filtração glomerular (TFG) são as principais ferramentas para avaliação da função renal. Para a estimativa da TFG, existem diversas equações, sendo a mais recomendada a CKD-EPI (Chronic Kidney Disease - Epidemiology). Existem ainda algumas controvérsias com relação à dosagem da creatinina sérica e da estimativa da TFG, uma vez que vários fatores podem interferir nesse processo. Uma importante mudança recente foi a retirada da correção por raça das equações para estimativa da TFG, que superestimavam a função renal, e consequentemente retardavam a implementação de tratamentos como diálise e transplante renal. Neste documento de consenso da Sociedade Brasileira de Nefrologia e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial são revisados os principais conceitos relacionados à avaliação da função renal, possíveis controvérsias existentes e recomendações para a estimativa da TFG na prática clínica.

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Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given.

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INTRODUCTION: Chronic kidney disease is a worldwide public health problem, with a high prevalence of patients on dialysis. mHealth technologies can greatly support the treatment and monitoring of these patients. Thus, this study aimed to evaluate the spontaneous use of the application (app) Renal Health, a previously available technology, for patients on hemodialysis and validate content to support patients undergoing peritoneal dialysis. METHODS: The first stage consisted of evaluating the spontaneous use of the app, and the second stage consisted of methodological research for the development, evaluation, and improvement of a technological instrument for use in clinical practice as a support for patients undergoing peritoneal dialysis (PD). The association between categorical variables was performed using the chi-square test, adopting a significance level of 5%. RESULTS: The app was accessed by 753 users and of these, 34 % accessed the hemodialysis section. Most accesses were in the state of São Paulo/Brazil and performed by women. The records of biochemical tests did not vary according to gender and age group (p > 0.05). The developed and validated PD section enables section control, allowing the user to manage their sessions. The analysis of the technology by the specialists showed good results for the global content validity index (CVI) regarding objectives (CVI = 0.95), structure (CVI = 0.97), and relevance (CVI = 1.0). CONCLUSION: It is concluded that the hemodialysis section of the Renal Health app aroused the interest of the population and that the developed peritoneal dialysis section was validated by specialists.

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OBJECTIVE: The objective was to analyze the implementation and use of the electronic patient record in the health services of the Brazilian Air Force. METHODS: This is a cross-sectional study carried out with 234 physicians, between March and May 2021. The data collection instrument was sent by email. The electronic patient record was implemented in the Air Force approximately 3 years ago (64.5%), and about 81% of the physicians received training to operate it. RESULTS: The most common records involve data related to consultations (90.1%) and interviews with physical examination (67.1%). Physicians cited that information storage (75.6%), agility, and feasibility of recording (55.1%) were the main advantages of the electronic patient record. As disadvantages, problems in electronic equipment (69.7%) and system errors (65%) were reported. Most participants considered that the implementation had a positive impact on work dynamics (75.6%) and productivity (66.7%), mainly regarding the components "Work processes" (57.3%) and "Amount of carried out activities" (21.4%). Keeping records was significantly associated with the job position (p<0.001), type of unit (p=0.008), time of implementation (p<0.001), and participation in training (p=0.028). CONCLUSION: The implementation of the electronic patient record in the Air Force was recently done, and just over half of the physicians were trained prior to the implementation. The tool is considered compatible with work processes and has a positive effect on productivity.

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Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

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Background: hypercalcemia mediated by a silicone-induced granulomatous reaction is a condition that, despite being rare, must be remembered since there is an increasing demand for aesthetic procedures among the general population. It is necessary to rule out other causes of hypercalcemia, such as hyperparathyroidism, hypercalcemia of malignancy, infectious and non-infectious granulomatous diseases, as well as the use of drugs. Case presentation: We present a patient with a history of large amounts of silicone implants who was admitted to a hospital presenting hypercalcemia and chronic kidney disease. A skin biopsy revealed a granulomatous foreign body reaction associated with exogenous siliconomatous material. Treatment with corticosteroids was initiated, with partial renal function improvement, with no renal replacement therapy needed. Conclusion: Patients with silicone implants should be carefully monitored for renal function and may be informed to avoid nephrotoxic agents as there is sufficient evidence that this type of aesthetic procedure can trigger hypercalcemia and CKD.

Introdução: a hipercalcemia mediada por uma reação granulomatosa induzida por silicone é uma condição que, apesar de rara, deve ser lembrada, pois há uma demanda crescente por procedimentos estéticos na população em geral. É necessário descartar outras causas de hipercalcemia, como hiperparatireoidismo, hipercalcemia da malignidade, doenças granulomatosas infecciosas e não infecciosas, bem como o uso de medicamentos. Relato de caso: apresentamos um paciente com histórico implante de grandes quantidades de silicone, que foi admitido em um hospital apresentando hipercalcemia e doença renal crônica (DRC). A biópsia de pele revelou reação granulomatosa tipo corpo estranho associada a material siliconomatoso exógeno. Foi iniciado tratamento com corticosteroides, com melhora parcial da função renal, sem necessidade de terapia renal substitutiva. Conclusão: os pacientes com implantes de silicone devem ser cuidadosamente monitorados quanto à função renal e devem ser informados para evitar agentes nefrotóxicos, pois há evidências suficientes de que esse tipo de procedimento estético pode desencadear hipercalcemia e DRC.

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OBJECTIVE: To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS: This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS: ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS: The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.

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INTRODUCTION: The aim of this was to evaluate the function of vascular biomarkers to predict the need for hemodialysis in critically ill patients with COVID-19. METHODS: This is a prospective study with 58 critically ill patients due to COVID-19 infection. Laboratory tests in general and vascular biomarkers, such as VCAM-1, syndecan-1, angiopoietin-1, and angiopoietin-2, were quantified on intensive care unit (ICU) admission. RESULTS: There was a 40% death rate. VCAM and Ang-2/Ang-1 ratio on ICU admission were associated with the need for hemodialysis. Vascular biomarkers (VCAM-1, syndecan-1, angiopoietin-2/angiopoietin-1 ratio) were predictors of death and their cutoff values were useful to stratify patients with a worse prognosis. In the multivariate cox regression analysis with adjusted models, VCAM-1 (OR 1.13 [CI 95%: 1.01-1.27]; p = 0.034) and Ang-2/Ang-1 ratio (OR 4.87 [CI 95%: 1.732-13.719]; p = 0.003) were associated with the need for dialysis. CONCLUSION: Vascular biomarkers, mostly VCAM-1 and Ang-2/Ang-1 ratio, showed better efficiency to predict the need for hemodialysis in critically ill COVID-19 patients.

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BACKGROUND: The clinical picture of coronavirus disease 2019 (COVID-19)-associated sepsis is similar to that of sepsis of other aetiologies. The present study aims to analyse the role of syndecan-1 (SDC-1) as a potential predictor of septic shock in critically ill patients with COVID-19. METHODS: This is a prospective study of 86 critically ill patients due to COVID-19 infection. Patients were followed until day 28 of hospitalization. Vascular biomarkers, such as vascular cell adhesion protein-1, SDC-1, angiopoietin-1 and angiopoietin-2, were quantified upon admission and associated with the need for vasopressors in the first 7 d of hospitalization. RESULTS: A total of 86 patients with COVID-19 (mean age 60±16 y; 51 men [59%]) were evaluated. Thirty-six (42%) patients died during hospitalization and 50 (58%) survived. The group receiving vasopressors had higher levels of D-dimer (2.46 ng/ml [interquartile range {IQR} 0.6-6.1] vs 1.01 ng/ml [IQR 0.62-2.6], p=0.019) and lactate dehydrogenase (929±382 U/l vs 766±312 U/l, p=0.048). The frequency of deaths during hospitalization was higher in the group that received vasoactive amines in the first 24 h in the intensive care unit (70% vs 30%, p=0.002). SDC-1 levels were independently associated with the need for vasoactive amines, and admission values >269 ng/ml (95% CI 0.524 to 0.758, p=0.024) were able to predict the need for vasopressors during the 7 d following admission. CONCLUSIONS: Syndecan-1 levels predict septic shock in critically ill patients with COVID-19.

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ABSTRACT Objective: To understand the perceptions of mobile health technology use in adherence to the treatment of patients with chronic kidney disease under hemodialysis. Method: This is a descriptive study, with a qualitative approach, carried out in a reference hemodialysis clinic in the city of Juazeiro, Bahia, Brazil. Patients with chronic kidney disease under hemodialysis who used the Renal Health application between February and October 2022 were included in the study. The data was analyzed using the content analysis method. Results: A total of 12 patients were interviewed, the majority of whom were male, with an average age of 35.3 (±9.7) years and an average of 2.7 (±1.5) years of hemodialysis. After analyzing the content, two thematic categories emerged: "Support from mHealth technology in treatment management" and "Suggestions for improving the application", in which patients describe how the application is practical, favors the storage of information related to treatment, such as weight, water intake and medication taking times. In addition to generating graphs of the exams carried out monthly, it provides strategies that can promote disease self-management and consequently better adherence to treatment. Conclusion: The Renal Health application proved to be a useful tool capable of enhancing knowledge about chronic kidney disease and helping patients better manage their diet, fluid control and taking prescribed medications.

RESUMEN Objetivo: comprender las percepciones sobre el uso de la tecnología móvil de salud en la adherencia al tratamiento de pacientes con enfermedad renal crónica en hemodiálisis. Método: estudio descriptivo, con enfoque cualitativo, realizado en una clínica de referencia en hemodiálisis de la ciudad de Juazeiro, Bahia, Brazil. Se incluyeron en el estudio pacientes en hemodiálisis renal crónica que utilizaron la aplicación Renal Health entre los meses de febrero y octubre de 2022. Los datos se analizaron mediante el método de análisis de contenido. Resultados: se entrevistaron 12 pacientes, la mayoría del sexo masculino, con una edad promedio de 35,3 (±9,7) años y un promedio de 2,7 (±1,5) años de hemodiálisis. Tras el análisis del contenido surgieron dos categorías temáticas: "Apoyo de la tecnología mHealth en la gestión del tratamiento" y "Sugerencias para mejorar la aplicación", en el que los pacientes describen cómo la aplicación es práctica, favorece el almacenamiento de información relacionada con el tratamiento, como peso, ingesta de agua y tiempos de toma de medicamentos. Además de generar gráficos de los exámenes realizados mensualmente, brinda estrategias que pueden promover el autocontrol de la enfermedad y en consecuencia una mejor adherencia al tratamiento. Conclusión: la aplicación Renal Health demostró ser una herramienta útil capaz de mejorar el conocimiento sobre la enfermedad renal crónica y ayudar a los pacientes a gestionar mejor su dieta, control de líquidos y toma de medicamentos prescritos.

RESUMO Objetivo: compreender as percepções do uso de uma tecnologia mobile health na adesão ao tratamento do paciente renal crônico em hemodiálise Método: estudo descritivo, com abordagem qualitativa, realizado em uma clínica de referência em hemodiálise no município de Juazeiro, Bahia, Brasil. Foram incluídos no estudo pacientes renais crônicos hemodialíticos que utilizaram o aplicativo Renal Health entre os meses de fevereiro a outubro de 2022. Os dados foram analisados através do método análise de conteúdo Resultados: foram entrevistados 12 pacientes, a maioria do sexo masculino, idade média de 35,3 (±9,7) anos e média de 2,7 (±1,5) anos de hemodiálise. Após análise do conteúdo surgiram duas categorias temáticas: "Apoio da tecnologia mHealth no gerenciamento do tratamento" e "Sugestões para aperfeiçoamento do aplicativo", nas quais os pacientes descrevem como o aplicativo é prático, favorece o armazenamento de informações relacionadas ao tratamento, como peso, ingestão hídrica e horário da tomada de medicamentos. Além de gerar gráficos dos exames realizados mensalmente, proporcionando estratégias que podem favorecer o autogerenciamento da doença e consequentemente uma melhor adesão ao tratamento. Conclusão: o aplicativo Renal Health, demonstrou ser uma ferramenta útil, capaz de potencializar o conhecimento sobre a doença renal crônica e auxiliar os pacientes a gerenciarem melhor a dieta, o controle de líquidos e a tomada das medicações prescritas.

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SUMMARY OBJECTIVE: The objective was to analyze the implementation and use of the electronic patient record in the health services of the Brazilian Air Force. METHODS: This is a cross-sectional study carried out with 234 physicians, between March and May 2021. The data collection instrument was sent by email. The electronic patient record was implemented in the Air Force approximately 3 years ago (64.5%), and about 81% of the physicians received training to operate it. RESULTS: The most common records involve data related to consultations (90.1%) and interviews with physical examination (67.1%). Physicians cited that information storage (75.6%), agility, and feasibility of recording (55.1%) were the main advantages of the electronic patient record. As disadvantages, problems in electronic equipment (69.7%) and system errors (65%) were reported. Most participants considered that the implementation had a positive impact on work dynamics (75.6%) and productivity (66.7%), mainly regarding the components "Work processes" (57.3%) and "Amount of carried out activities" (21.4%). Keeping records was significantly associated with the job position (p<0.001), type of unit (p=0.008), time of implementation (p<0.001), and participation in training (p=0.028). CONCLUSION: The implementation of the electronic patient record in the Air Force was recently done, and just over half of the physicians were trained prior to the implementation. The tool is considered compatible with work processes and has a positive effect on productivity.

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Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Resumo Objetivo: avaliar o uso do aplicativo Renal Health por transplantados renais. Método: estudo observacional retrospectivo com amostra composta por usuários que realizaram cadastro na seção para transplantados renais do aplicativo de julho de 2018 a abril de 2021. Foram coletadas as seguintes variáveis: dados demográficos, inserção de dados, tempo de uso, registros de peso, pressão arterial, glicemia, creatinina, horários das medicações, consultas e exames. Realizou-se análise descritiva dos dados. Resultados: houve 1.823 downloads do aplicativo e 12,3% cadastraram-se na seção para transplantados renais, a maioria do Sudeste do Brasil (44,9%), com 36±11 anos e do sexo feminino (59,1%). Da amostra, 35,1% inseriram informações como creatinina (62%), peso (58,2%) e pressão arterial (51,8%). A maioria utilizou o aplicativo por um dia (63,3%) e 13,9% por mais de cem dias. Os que utilizaram por mais de um dia (36,7%), inseriram peso (69%), agendaram consultas (69%), medicações (65,5%) e creatinina (62%). Conclusão: a seção para transplantados renais do aplicativo Renal Health despertou interesse na população jovem, mas apresentou baixa adesão ao longo dos meses avaliados. Esses resultados oferecem perspectiva relevante na implementação de tecnologias mHealth no transplante renal.

Resumen Objetivo: evaluar el uso de la aplicación Renal Health por parte de los receptores de trasplante renal. Método: estudio observacional retrospectivo con una muestra compuesta por usuarios que se registraron en la sección de trasplantados renales dentro de la aplicación desde julio de 2018 hasta abril de 2021. Se recolectaron las siguientes variables: datos demográficos, ingreso de datos, tiempo de uso, registros de peso, presión arterial, glucosa en sangre, creatinina, esquemas de medicación, consultas y exámenes. Se realizó un análisis descriptivo de los datos. Resultados: Ocurrieron 1.823 descargas de la aplicación y 12,3% se registró en la sección de trasplantados, la mayoría del sudeste de Brasil (44,9%), con edad de 36±11 años y del sexo femenino (59,1%). De la muestra, 35,1% ingresó información como: creatinina (62%), peso (58,2%) y presión arterial (51,8%). La mayoría utilizó la aplicación durante un día (63,3%) y el 13,9% más de cien días. Quienes lo usaron por más de un día (36,7%), agregaron peso (69%), programación de consultas (69%), medicación (65,5%) y creatinina (62%). Conclusión: la sección para trasplantados renales de la aplicación Renal Health despertó interés en la población joven, pero mostró baja adherencia en los meses evaluados. Estos resultados ofrecen una perspectiva relevante en la implementación de tecnologías mHealth en el trasplante renal.

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ABSTRACT Introduction: Chronic kidney disease (CKD) has been increasing significantly. There is evidence that a large part of the population does not have enough knowledge on the subject. Objective: To investigate the level of knowledge about CKD in the general population, its risk factors and means of prevention. Methods: We ran a cross-sectional study in the population of Fortaleza, Ceará - Brazil, between 2017 and 2020, with the application of a questionnaire on CKD, risk factors and prevention. Results: we interviewed 735 volunteers, with a mean age of 38 years, of which 55% were female. Only 17.2% correctly responded to the concept of CKD, and 5.8% knew the concept of creatinine. Low water intake was the most cited risk factor by respondents (79.3%). The main risk factors and direct causes of CKD (diabetes and hypertension) were mentioned less frequently (13.2% and 15.1%, respectively). Men were more correct regarding risk factors and ways to prevent CKD. Older respondents answered more correctly the questions about the definition of CKD (n = 22; 28.6%) and creatinine (n = 7; 9.0%). With regards to education there was a statistically significant correlation in all the questions (p < 0.05). Conclusion: There is little knowledge about CKD in the general population. Higher level of education is associated with better knowledge. More health education actions are needed so that the population becomes better acquainted with CKD and, consequently, can adopt more adequate prevention and control measures.

Resumo Introdução: A doença renal crônica (DRC) vem aumentando de forma significativa. Há evidências de que grande parte da população não tem conhecimento suficiente sobre o assunto. Objetivo: Investigar na população geral o nível de conhecimento sobre a DRC, seus fatores de risco e meios de prevenção. Métodos: Foi realizado estudo transversal na população de Fortaleza, Ceará, Brasil, entre 2017 e 2020, com aplicação de um questionário sobre DRC, fatores de risco e prevenção. Resultados: Foram entrevistados 735 voluntários, com média de idade de 38 anos, dos quais 55% eram do sexo feminino. Apenas 17,2% responderam corretamente ao conceito de DRC, e 5,8% sabiam o conceito de creatinina. A baixa ingestão hídrica foi o fator de risco mais citado pelos entrevistados (79,3%). Os principais fatores de risco e as causas diretas de DRC (diabetes e hipertensão) foram mencionados com menor frequência (13,2% e 15,1%, respectivamente). Os homens tiveram maior acerto com relação aos fatores de risco e às formas de prevenção da DRC. Os entrevistados com idade mais avançada responderam mais corretamente às perguntas sobre a definição de DRC (n = 22; 28,6%) e creatinina (n = 7; 9,0%). No que diz respeito à escolaridade, em todas as perguntas houve correlação estatisticamente significativa (p < 0,05). Conclusão: Há um baixo nível de conhecimento sobre a DRC na população geral. Maior nível de escolaridade associa-se a um melhor conhecimento. São necessárias mais ações de educação em saúde para que a população conheça melhor a DRC e consequentemente possa adotar medidas de prevenção e controle mais adequadas.

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ABSTRACT Introduction: Supplementation with probiotics for patients with chronic kidney disease (CKD) may be associated with decreased systemic inflammation. Objective: To assess the impact of oral supplementation with probiotics for patients with CKD on hemodialysis. Method: This double-blind randomized clinical trial included 70 patients on hemodialysis; 32 were given oral supplementation with probiotics and 38 were in the placebo group. Blood samples were collected at the start of the study and patients were given oral supplementation with probiotics or placebo for three months. The probiotic supplement comprised four strains of encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium longum A101. Patients were given one capsule per day for 3 months. Blood samples were taken throughout the study to check for inflammatory biomarkers. Non-traditional biomarkers Syndecan-1, IFN-y, NGAL, and cystatin C were measured using an ELISA kit, along with biochemical parameters CRP, calcium, phosphorus, potassium, PTH, GPT, hematocrit, hemoglobin, glucose, and urea. Results: Patients given supplementation with probiotics had significant decreases in serum levels of syndecan-1 (239 ± 113 to 184 ± 106 ng/mL, p = 0.005); blood glucose levels also decreased significantly (162 ± 112 to 146 ± 74 mg/dL, p = 0.02). Conclusion: Administration of probiotics to patients with advanced CKD was associated with decreases in syndecan-1 and blood glucose levels, indicating potential improvements in metabolism and decreased systemic inflammation.

Resumo Introdução: A suplementação com probióticos na doença renal crônica (DRC) pode estar associada à redução do processo inflamatório sistêmico. Objetivo: Avaliar a suplementação oral com probióticos em pacientes com DRC em hemodiálise. Método: Ensaio clínico, duplo cego, randomizado com 70 pacientes em hemodiálise, sendo 32 do grupo que recebeu o suplemento de probióticos e 38 do grupo placebo. Inicialmente ocorreu a coleta de sangue e suplementação oral com probióticos ou placebo durante três meses. O suplemento probiótico foi composto pela combinação de 4 cepas de bactérias Gram-positivas encapsuladas: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 e Bifidobacterium longum A101, sendo 1 cápsula do suplemento ao dia, durante 3 meses. Após esse período foram feitas novas coletas de sangue para dosagem dos biomarcadores inflamatórios. Foram analisados os biomarcadores não tradicionais: Syndecan-1, IFN-y, NGAL e cistatina C pelo método ELISA, e os seguintes parâmetros bioquímicos: PCR, cálcio, fósforo, potássio, PTH, TGP, hematócrito, hemoglobina, glicose e ureia. Resultados: Os pacientes que receberam suplemento tiveram diminuição significativa dos níveis séricos de syndecan-1 (de 239 ± 113 para 184 ± 106 ng/mL, p = 0,005). Outro parâmetro que diminuiu significativamente nos pacientes que receberam suplemento foi a glicemia (de 162 ± 112 para 146 ± 74 mg/dL, p = 0,02). Conclusão: O uso de probióticos na DRC avançada esteve associado à redução dos níveis de syndecan-1 e glicemia, sinalizando possível melhora no metabolismo e redução do processo inflamatório sistêmico.

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This study aimed to investigate the association between novel biomarkers and renal injury in people with HIV (PWH). A cohort study was carried out with PWH under chronic use of antiretroviral therapy (ART), followed at a public outpatient service. Clinical and laboratory parameters of the patients were evaluated year by year, from 2015 [at baseline (year 1, Y1)] to 2019 [year 5 (Y5)]. At baseline, biomarkers of renal damage (e.g., neutrophil gelatinase-associated lipocalin-NGAL, monocyte chemoattractant protein-1-MCP-1, and kidney injury molecule-1-KIM-1) and endothelial activation or glycocalyx damage [e.g., intercellular adhesion molecule 1 (ICAM-1), E-selectin, and syndecan-1] were quantified using enzyme-linked immunosorbent assays and their levels were used to classify patients into different groups. However, only syndecan-1 showed a significant correlation with serum creatinine (p < .001) and glomerular filtration rate (GFR) (p = .003) over the years. Moreover, both serum creatinine and GFR in almost 5 years were significantly associated with serum levels of syndecan-1 at baseline. The multivariate linear regression with confounders showed a significant and independent association between GFR and levels of syndecan-1 and CD4 cell count in the beginning of the study, as well as age in Y5. The data reinforce the screening for kidney diseases with novel biomarkers, especially syndecan-1, as an important strategy for a timely diagnostic and therapeutic approach.

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Predicting risk factors for death in leptospirosis is challenging, and identifying high-risk patients is crucial as it might expedite the start of life-saving supportive care. Admission data of 295 leptospirosis patients were enrolled, and a machine-learning approach was used to fit models in a derivation cohort. The comparison of accuracy metrics was performed with two previous models-SPIRO score and quick SOFA score. A Lasso regression analysis was the selected model, demonstrating the best accuracy to predict mortality in leptospirosis [area under the curve (AUC-ROC) = 0.776]. A score-based prediction was carried out with the coefficients of this model and named LeptoScore. Then, to simplify the predictive tool, a new score was built by attributing points to the predictors with importance values higher than 1. The simplified score, named QuickLepto, has five variables (age > 40 years; lethargy; pulmonary symptom; mean arterial pressure < 80 mmHg and hematocrit < 30%) and good predictive accuracy (AUC-ROC = 0.788). LeptoScore and QuickLepto had better accuracy to predict mortality in patients with leptospirosis when compared to SPIRO score (AUC-ROC = 0.500) and quick SOFA score (AUC-ROC = 0.782). The main result is a new scoring system, the QuickLepto, that is a simple and useful tool to predict death in leptospirosis patients at hospital admission.

Assuntos

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OBJECTIVE: to evaluate the use of a renal health application by kidney transplant recipients. METHOD: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. RESULTS: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). CONCLUSION: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Assuntos

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Caregivers of persons with special needs (PSN) experience a variety of burdens and elevated levels of stress and anxiety throughout their lives, leading to a physical, psychological, emotional, social, and financial overload. This analytical study with a cross-sectional design and a quantitative approach aimed to appraise quality of life (QoL), reflecting the daily workload of informal family caregivers of PSN. METHODS: Four structured, validated questionnaires were utilised: sociodemographic, WHOQOL-bref, Zarit Burden Interview, and Functional Independence Measure Scale in 60 anonymous volunteered respondents. RESULTS: The informal caregivers were middle-aged mothers (81.7%), married (55%), stay-at-home spouses (60%) with high school degrees (51.6%), providing a care for their relatives with special needs for more than 20 years (41.8%). Most of the PSN were diagnosed with autistic spectrum disorder (ASD, 61.8%), had a wide spectrum of intellectual deficits, and required constant support for their basic needs. They were mainly adolescent males without physical limitations (83.4%) on disorder-specific medications (90%). The study revealed that those caregivers had a median perception of QoL considering four essential domains, with a highest score recorded for the physical domain (64.3 +/- 16.1 SD). A moderate burden level prevailed, revealing neither a correlation between the workload expressed by caregivers and the patient's functional capacity, nor in the performance of daily self-care tasks (Spearman correlation test p > 0.05), apart from the environmental domain (mild correlation = 0.335, p < 0.05). CONCLUSIONS: The reported average level of overload associated with QoL of informal caregivers exists, affecting a vast proportion of the respondents. The absence of a direct association between workload and the functional capacity/daily self-care tasks can be related to the significant personal dedication of family caregivers, regardless of their socioeconomic status.

Assuntos

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Background: In Brazil, a relevant portion and children suffer without receiving adequate control of their symptoms. Failures in pediatrician training may contribute to this problem. Objective: The goal was to characterize the educational failures perceived by pediatric residents for pediatric palliative care throughout their training. Methods: A cross-sectional study was carried out, with the application of the Pediatric Palliative Care Questionnaire (QCPP) to residents of three pediatrics and specialties of public limits at the Escola de Saúde Pública do Estado do Ceará (ESP-CE), Brazil. Results: The response rate was 68 out of 123 residents (55%). It was reported that they did not consider the specialty as patient care or death. He also feels comfortable explaining the physiological process of dying to his family. The time devoted to CPP teaching, as well as medical residency, was considered reduced. For those who attended a subspecialty, the number they signaled was "0 hours" at 82.40%. Conclusion: It can be said that the main flaws in the teaching-learning process of pediatric residents were the number of hours of training in teaching, communication skills training (through participation in conferences) and guidance on the practice of teaching suspension of invasive measures. It was observed that less time reserved for this learning is related to lesser knowledge and greater barriers to the use of palliative care. Those who declared themselves able to take care of children with life-organizing conditions received some teaching in CPP.

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