Revista HCPA: uma Mensagem de Agradecimento

Após editar o último fascículo de 2012 da Revista HCPA e Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, finalizo minha função como Editor-chefe de nossa revista. No período de 2009 a 2010 como Co-editor tive um importante aprendizado com a Professora Sandra Silveiro, a quem agradeço todo o suporte e incentivo para levar adiante um periódico que já apresentava pré-requisitos exigidos para submissão à base de dados SciELO. Mérito conquistado por ela, como Editora-chefe da Revista HCPA, em conjunto com nossa Editora Executiva, bibliotecária Rosa Maidana, que desenvolveram intenso e bem-sucedido trabalho nos anos precedentes

Dia Mundial do Rim: em 2011, Proteja seus Rins e Salve seu Coração

No sexto ano consecutivo, foi comemorado no dia 10 de março de 2011 mais uma edição do Dia Mundial do Rim, organizado pela Sociedade Internacional de Nefrologia e Federação Internacional de Fundações do Rim, e no Brasil pela Sociedade Brasileira de Nefrologia. Assim como em 2010 a campanha do Dia Mundial do Rim foi dedicada à interação rim e diabetes, neste ano o tema escolhido enfatiza a estreita relação entre doença renal crônica (DRC) e doença cardiovascular (DCV), e a alarmante morbimortalidade decorrente desta associação

NLRP3 inflammasome modulation by melatonin supplementation in chronic pristane-induced lupus nephritis

Lupus nephritis (LN) is a kidney inflammatory disease caused by systemic lupus erythematosus (SLE). NLRP3 inflammasome activation is implicated in LN pathogenesis, suggesting its potential targets for LN treatment. Melatonin, an endogenous indoleamine, is considered an important multitasking molecule that has been reported to have anti-inflammatory effects by inhibiting nuclear factor-kappa B (NF-κB)-mediated inflammatory responses in vivo. This molecule has also protective effects against the activation of the inflammasomes and, in particular, the NLRP3 inflammasome. Thus, this work evaluated the effect of melatonin on morphological alteration and NLRP3 inflammasome activation in LN pristane mouse models. To evaluate the melatonin effects in these mice, we studied the renal cytoarchitecture by means of morphological analyses and immunohistochemical expression of specific markers related to oxidative stress, inflammation and inflammasome activation. Our results showed that melatonin attenuates pristane-induced LN through restoring of morphology and attenuation of oxidative stress and inflammation through a pathway that inhibited activation of NLRP3 inflammasome signaling. Our data clearly demonstrate that melatonin has protective activity on lupus nephritis in these mice that is highly associated with its effect on enhancing the Nrf2 antioxidant signaling pathway and decreasing renal NLRP3 inflammasome activation

Pathophysiology and treatment of the nephrotic syndrome : current concepts

Foram revisados aspectos da fisiopatologia e do tratamento sindrômico do estado nefrótico. São citados o conceito e as causas de síndrome nefrótica. Foram revisadas a fisiopatologia do edema, bem como as causas e o tratamento do edema refratário. É apresentado um fluxograma para o manejo clínico do edema nefrótico, considerando a complexidade do edema refratário. Foram abordadas medidas para redução de proteinúria, como o uso de inibidores da enzima de conversão da angiotensina, a dieta hipoproteica e o papel dos antiinflamatórios não esteróides neste contexto. Foram revistas as complicações da síndrome nefrótica, como dislipidemia e hipercoagulabilidade, no que concerne à sua fisiopatologia e tratamento atual.Our objective is to review the pathophysiology and treatment of the nephrotic syndrome. This article includes definitions and causes of nephrotic syndrome, and an assessment of the pathophysiology of the nephrotic edema as well as of the causes and treatment of refractory edema. An algorithm for the treatment nephrotic edema is proposed taking into account the complexity of refractory edema. We also address measures aimed at reducing proteinuria, such as the use of angiotensin-converting enzyme inhibitors, hypoprotein diet, and the roles of non-steroidal anti-inflammatory drugs in this context. We also review the complications of nephrotic syndrome such as hyperlipidemia and the hypercoagulability with regards to their pathophysiology and current treatment

The spectrum of biopsy-proven glomerular diseases in a tertiary Hospital in Southern Brazil

Background: The prevalence and distribution of glomerular diseases difer among countries, and the indication to perform a kidney biopsy varies among centres. In this study, we assessed the prevalence of primary and secondary glomerulopathies based on histological diagnoses, and the correlation between glomerulopathies and demographic and clinical data was evaluated. Methods: In this study, 1051 kidney biopsies were retrospectively reviewed between 2000 and 2018. Patient demographic, clinical and laboratory data were assessed. The prevalence of primary glomerulonephritis (PG) and secondary glomerulopathies (SG), as well as tubulointerstitial diseases (TIDs), hereditary nephropathies (HNs) and other diagnoses, were determined. The frequency of primary and secondary glomerulopathies was evaluated by age group, and the temporal variation in frequencies across three time periods (2000-2005, 2006-2011, and 2012-2018) was reported. Results: The prevalence of SG predominated (52.4%), followed by PG (29.6%), other diagnoses (10.7%), TID (6.6%) and HN (1.1%). Among the primary forms of glomerular disease, focal segmental glomerulosclerosis (FSGS) was the most common (37.3%), followed by IgA nephropathy (IgAN, 24.4%), membranous nephropathy (MN, 18.6%) and minimal change disease (MCD, 8.4%). Lupus nephritis (LN, 41.1%) was most common in patients with SG, followed by diabetic kidney disease (DKD, 17.8%), systemic vasculitis (SV, 10.2%) and secondary FSGS (2nd FSGS, 10%). Nephrotic syndrome was the most common clinical presentation in patients with PG and also in patients with DRD and 2nd FSGS, whereas in patients with IgAN and SV, nephritic syndrome was the main presentation. For the age group between 18 and 50 years, LN, FSGS and IgAN predominated; for patients aged between 51 and 65 years, the proportion of DKD and 2nd FSGS increased, and SV was more common in patients >65 years. The temporal variation in PG across the three time periods showed a statistically signifcant increase in IgAN (p =0.001) and a reduction in FSGS over time (p <0.001). In SG, there was a reduction in LN (p =0.027) and an increase in DKD (p <0.001) over time, with a tendency for 2nd FSGS to decrease over time (p =0.053). Conclusions: In the studied kidney biopsy registry, FSGS and IgAN were the most prevalent diagnoses in patients with PG, and LN and DKD were the most prevalent in patients with SG. Nephrotic syndrome was the major indication for biopsy. When comparing the temporal variation in glomerulopathies, there was a reduction in FSGS and an increase in IgAN in patients with PGs over time, and for patients with SGs, there was a reduction in LN with an increase in cases of DKD over time

Clinical utility and interpretation of screening for urinary erythrocyte dysmorphism

Introdução: O dismorfismo eritrocitário urinário foi descrito há vários anos e tem sido usado para identificar os sangramentos glomerulares e para orientar a investigação subseqüente. Este estudo avalia a variabilidade na análise do dismorfismo eritrocitário por diferentes observadores, verificando a correlação entre as observações e sua associação com o diagnóstico etiológico das hematúrias. Métodos: Foram selecionadas 18 amostras de sedimento urinário de pacientes com hematúria glomerular e não-glomerular, cujas imagens foram capturadas por um programa de análise de imagens e gravadas em meio magnético. Essas imagens foram analisadas por doze observadores treinados na análise de dismorfismo eritrocitário que atuam em laboratórios de análises clínicas de Porto Alegre. Os observadores, cegos em relação ao diagnóstico etiológico da hematúria, classificaram as amostras pela presença ou ausência de dismorfismo e estimaram a porcentagem de hemácias dismórficas em relação ao seu número total. Resultados: Utilizando o ponto de corte de 75% de hemácias dismórficas como diagnóstico de hematúria glomerular, o diagnóstico correto foi obtido em 79% das observações. A sensibilidade foi de 76%, e a especificidade de 82%, com valores preditivos positivo e negativo de 80% e 78% respectivamente. A correlação entre as observações foi calculada com o uso de coeficiente kappa, observando-se uma concordância moderada (kappa = 0,58). Conclusões: Este estudo demonstrou que, a despeito da ausência de critérios rígidos de avaliação e classificação do dismorfismo, sua realização por profissionais capacitados apresenta um nível aceitável de acurácia e concordância, justificando seu uso na avaliação de pacientes com hematúria.Introduction: Urinary erythrocyte dysmorphism was described long ago and has been used to identify glomerular bleeding and to guide subsequent investigation. The aim of this study was to analyze the variability of erythrocyte dysmorphism observation performed by several observers, evaluating the correlation between the observations and their association with etiologic diagnosis of hematuria. Methods: Eighteen urinary sediment samples from patients with glomerular and nonglomerular hematuria were studied. Their images were captured by phase-contrast microscopy and saved for later analysis. These images were analyzed by 12 observers experienced in erythrocyte dysmorphism evaluation who work in clinical laboratories in Porto Alegre, Brazil. The observers, who were blinded to the etiologic diagnosis of hematuria, classified the samples according to the presence or absence of erythrocyte dysmorphism and estimated the percentage of dysmorphic erythrocytes in relation to total number. Results: Correct diagnoses were obtained in 79% of the observations, considering 75% as the cut-off point of dysmorphic erythrocytes for the diagnosis of glomerular hematuria. Sensitivity and specificity were 76 and 82%, respectively; positive predictive value was 80% and negative predictive value was 78%. Agreement among observers was calculated using the kappa coefficient, which showed a moderate agreement (kappa = 0.58). Conclusions: Our study demonstrated that, despite the absence of strict criteria for assessing and classifying dysmorphism, the performance of urinary erythrocyte dysmorphism test by skilled professionals presents an acceptable level of accuracy and agreement, which supports its use in the evaluation of patients with hematuria