Referência e contrarreferência de pacientes com doença renal crônica

Texto que compõe o módulo 11 "Controle, avaliação e regulação" do curso de especialização em Nefrologia Multidisciplinar, produzido pela UNA-SUS/UFMA. Apresenta um breve relato sobre a hierarquização, integralidade e a regulação no SUS, destacando pontos estabelecidos por portarias ministeriais e avaliando criticamente as lacunas ainda presentes no contexto brasileiro. Aborda, ainda, a organização da Rede SUS para a atenção ao portador de Doença Renal Crônica (DRC), especificando a estruturação do sistema, detalhando os pontos de atenção dos componentes da Rede de Atenção à Saúde das Pessoas com Doenças Crônicas e suas respectivas atribuições dentro da linha de cuidado. Além disso, descreve as tipologias e atribuições das unidades de atenção.Ministério da Saúd

Prevalence of chronic kidney disease and comorbidities in isolated African descent communities (PREVRENAL): methodological design of a cohort study

Background: Chronic kidney disease (CKD) is considered a serious public health problem, both in Brazil and worldwide, with an increasing number of cases observed inrecent years. Especially, CKD has been reported to be highly prevalent in those of African descent. However, Brazil lacks data from early-stage CKD population studies, and the prevalence of CKD is unknown for both the overall and African descent populations. Hence, the present study aims to estimate the prevalence of early-stage CKD and its associated risk factors in African-Brazilians from isolated African-descent communities. Herein, the detailed methodology design of the study is described. Methods: This population-based, prospective, longitudinal, cohort study (PREVRENAL) is performed in three stages: first, clinical, nutritional, and anthropometric evaluationsmeasurements of serum and urinary markersand examinations of comorbidities were performed. Second, repeated examinations of individuals with CKD, systemic arterial hypertension, and/or diabetes mellitusimage screeningand cardiac risk assessment were performed. Third, long-term monitoring of all selected individuals will be conducted (ongoing). Using probability sampling, 1539 individuals from 32 communities were selected. CKD was defined asaglomerular filtration rate (GFR) 30 mg/day. Discussion: This study proposes to identify and monitor individuals with and without reduced GFR and high albuminuria in isolated populations of African descendants in Brazil. As there are currently no specific recommendations for detecting CKD in African descendants, four equations for estimating the GFR based on serum creatinine and cystatin C were used and will be retrospectively compared. The present report describes the characteristics of the target population, selection of individuals, and detection of a population at risk, along with the imaging, clinical, and laboratory methodologies used. The first and second stages have been concluded and the results will be published in the near future. The subsequent (third) stage is the long-term, continuous monitoring of individuals diagnosed with renal abnormalities or with CKD risk factors. The entire study population will be re-evaluated five years after the study initiation. The expectation is to obtain information about CKD evolution among this population, including the progression rate, complication development, and cardiovascular events.Research Support Foundation of Maranhao (Fundacao de Amparo a Pesquisa do Maranhao - FAPEMA)Univ Fed Maranhao, Kidney Dis Prevent Ctr, Sao Luis, MA, BrazilUniv Fed Maranhao, Dept Med 1, Sao Luis, MA, BrazilUniv Fed Maranhao, Dept Publ Hlth, Sao Luis, MA, BrazilUniv Fed Maranhao, Kidney Dis Prevent Ctr, Sao Luis, MA, BrazilUniv Fed Maranhao, Dept Physiol Sci, Sao Luis, MA, BrazilUniv Sao Paulo, Ribeirao Preto Sch Med, Dept Pathol & Radiol, Ribeirao Preto, SP, BrazilUniv Estado Rio De Janeiro, Dept Internal Med, Rio De Janeiro, RJ, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Discipline Nephrol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Discipline Nephrol, Sao Paulo, SP, BrazilWeb of Scienc

GERONTOLOGIA E A ARTE DO CUIDAR EM ENFERMAGEM: REVISÃO INTEGRATIVA DA LITERATURA / GERONTOLOGY AND THE ART OF NURSING CARE: INTEGRATIVE LITERATURE REVIEW

Introdução: Estima-se que em 2020, o Brasil terá a sexta maior população idosa do mundo com cerca de 32 milhões de pessoas. É consenso que nenhum profissional da área da saúde é capaz de atender isoladamente às diferentes necessidades de um idoso. A Enfermagem Gerontológica desenvolve sua atuação em diferentes campos, como na educação, na assistência, na assessoria e/ou consultoria, no planejamento e coordenação de serviços de enfermagem. Objetivo: Realizar uma revisão acerca da atuação do enfermeiro no processo de cuidar em gerontologia. Métodos: Estudo descritivo, do tipo revisão integrativa, norteado por esta questão: “qual a atuação do enfermeiro e sua contribuição no contexto da interdisciplinaridade na saúde do idoso”? O levantamento bibliográfico foi realizado nas base de dados Medline, SciELO, PubMed, LILACS, utilizando os seguintes descritores: gerontologia, idoso, enfermagem e envelhecimento. Resultados: Dentre os dezoito artigos investigados os campos de atuação destacados foram: os assistenciais (consulta de enfermagem ao idoso, os diagnósticos de enfermagem, a atuação no manejo de incontinências, a estimulação cognitiva, o cuidado em terapia renal), atuação em instituições de longa permanência (com atividades de promoção de envelhecimento saudável) e docência voltada ao ensino sobre gerontologia em cursos de graduação e pós-graduação. Conclusão: O campo de atuação para enfermeiro em gerontologia possibilita o exercício profissional em vários cenários, com desenvolvimento de ações voltadas para o cuidado junto ao idoso nas áreas da educação, cuidado e gerenciamento de serviços.Palavras- chave: Gerontologia. Idoso. Interdisciplinaridade. Envelhecimento.AbstractIntroduction: It is estimated that Brazil will have the sixth largest elderly population in the world by 2020 with about 32 million people. It is a consensus that no health professional is able separately to meet the different needs of an elderly person. The Gerontological Nursing develops its activities in different fields such as education, assistance and/or consulting, in the planning and coordination of nursing services. Objective: To perform a review of the nurse's field of work in the care process in gerontology. Methods: a descriptive study of integrative review guided by this question: "What is the nurse's field of work and contribution in the context of interdisciplinary in the health of the elderly"? The literature review was performed in Medline, SciELO, PubMed and LILACS database using the following descriptors: gerontology, elderly, nursing and aging. Results: Among the eighteen articles selected for analysis, the fields of work used were the assistance (nursing consultation for the elderly, nursing diagnoses, the performance in the management of incontinence, cognitive stimulation, elderly care in renal therapy), participation in long-stay institutions (educational activities to promote healthy aging) and teaching focused on gerontology education in undergraduate and graduate courses. Conclusion: The field of work for nurses in gerontology enables the development of professional practice in many scenarios, with the development of actions towards the care of the elderly in the fields of education, care and services management.Keywords: Gerontology. Elderly. Interdisciplinary. Aging

Correlation between serum cystatin C and markers of subclinical atherosclerosis in hypertensive patients

BACKGROUND: Serum cystatin C (s-CC), an endogenous marker of kidney function, has also been proposed as a cardiovascular risk marker. However, it is unknown whether it is a direct marker of atherosclerosis, independently of kidney function. OBJECTIVE: The aim of this study was to correlate s-CC with two surrogate markers of subclinical atherosclerosis. METHODS: This is a cross-sectional study involving 103 middle-aged (57.49 ± 11.7 years) hypertensive outpatients, being 60 female (58.25%), most with preserved kidney function. S-CC was correlated with carotid intima media thickness (IMT) and flow-mediated dilation of brachial artery (FMD), both assessed by ultrasound, as well as with measured creatinine clearance and established cardiovascular risk factors. RESULTS: S-CC was neither significantly correlated with IMT (r = -0.024; p = 0.84) nor with FMD (r = -0.050 and p = 0.687) and no significant association was observed with conventional risk factors and inflammatory markers. In univariate analysis, s-CC was correlated with measured creatinine clearance (r = -0,498; p < 0,001), age (r = 0,408; p < 0,001), microalbuminuria (r = 0,291; p = 0,014), uric acid (r = 0,391; p < 0,001), ratio E/e' (r = 0,242; p = 0,049) and Framingham score (r = 0,359; p = 0,001). However, after multiple regression analysis, only the association with measured creatinine clearance remained significant (r = -0,491; p < 0,001). CONCLUSION: In middle-aged hypertensive outpatients, s-CC correlated with measured creatinine clearance, as expected, but no association was observed with markers of atherosclerosis neither with established cardiovascular risk factors.FUNDAMENTO: A cistatina C sérica (s-CC), um marcador endógeno da função renal, tem sido proposta também como um marcador de risco cardiovascular. No entanto, ainda não está estabelecido se se trata de um marcador direto de aterosclerose, independentemente da função renal. OBJETIVO: O objetivo deste estudo foi correlacionar a s-CC com dois marcadores substitutos de aterosclerose subclínica. MÉTODOS: Trata-se de um estudo transversal envolvendo 103 pacientes hipertensos ambulatoriais, de meia idade (57,49 ± 11,7 anos), sendo 60 do sexo feminino (58,25%) e a maioria com função renal preservada. A s-CC foi correlacionada com a espessura mediointimal carotídea (EMIc) e a dilatação mediada por fluxo de artéria braquial (DMF), ambas avaliadas por ultrassonografia, bem como com o clearance de creatinina medido e fatores de risco cardiovascular estabelecidos. RESULTADOS: A s-CC não se correlacionou significativamente nem com a EMIc (r = -0,024, p = 0,84) nem com a DMF (r = -0,050 e p = 0,687), e não foi observada também associação significativa com fatores de risco convencionais nem marcadores inflamatórios. Na análise univariada, a s-CC se correlacionou com o clearance de creatinina medido (r = - 0,498, p < 0,001), idade (r = 0,408, p < 0,001), microalbuminúria (r = 0,291, p = 0,014), ácido úrico (r = 0,391, p < 0,001), relação E/e' (r = 0,242, p = 0,049) e escore de Framingham (r = 0,359, p = 0,001). No entanto, após análise de regressão múltipla, apenas a associação com o clearance de creatinina medido permaneceu significativa (r = -0,491, p <0,001). CONCLUSÃO: Em pacientes hipertensos ambulatoriais de meia idade, a s-CC se correlacionou com o clearance de creatinina medido,como esperado, mas não foi observada associação com marcadores de aterosclerose nem com fatores de risco cardiovascular estabelecidos.Universidade Federal de São Paulo (UNIFESP)Universidade Federal do MaranhãoUNIFESPSciEL

Brazilian consortium for the study on renal diseases associated with COVID-19 : a multicentric effort to understand SARS-CoV-2-related nephropathy

Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2

Controle e avaliação da doença renal crônica no sistema único de saúde

Texto que compõe o módulo 11 "Controle, avaliação e regulação" do curso de especialização em Nefrologia Multidisciplinar, produzido pela UNA-SUS/UFMA. Trata dos aspectos relacionados à importância do controle e da avaliação no âmbito do SUS e de instituições que tratam pacientes com Doença Renal Crônica (DRC). Enfatiza, ainda, os Sistemas de Informação em Saúde (SIS) utilizados para caracterização clínico-epidemiológico dos pacientes com DRC e dos grupos de riscos.Ministério da Saúd

Níveis de complexidade da assistência aos pacientes com doença renal crônica

Texto que compõe o módulo 11 "Controle, avaliação e regulação" do curso de especialização em Nefrologia Multidisciplinar, produzido pela UNA-SUS/UFMA. Apresenta as formas de atendimento à pessoa com doença renal crônica nos três níveis de atenção à saúde (atenção básica, assistência de média e alta complexidade), considerando os princípios da integralidade, a hierarquia e a regionalização do SUS.Ministério da Saúd

Association between estimated glomerular filtration rate and sodium excretion in urine of African descendants in Brazil: a population-based study

ABSTRACT Introduction: Excessive salt intake is a risk factor for the development of chronic kidney disease (CKD). Objective: To evaluate the association between estimated glomerular filtration rate (eGFR) and sodium excretion in urine samples of Brazilians of African ancestry. Methods: Cross-sectional, population-based study of 1,211 Brazilians of African ancestry living in Alcântara City, Maranhão, Brazil. Demographic, nutritional, clinical, and laboratory data were analyzed. The urinary excretion of sodium was estimated using the Kawasaki equation. Calculations of eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation. Multivariate linear-regression model was used to identify the relationship between sodium excretion and eGFR. Results: Mean age was 37.5±11.7 years and 52.8% were women. Mean urinary excretion of sodium was 204.6±15.3 mmol/day and eGFR was 111.8±15.3 mL/min/1.73m2. According to multivariate linear regression, GFR was independently correlated with sodium excretion (&#946;=0.11; p<0.001), age (&#946;=-0.67; p<0.001), female sex (&#946;=-0.20; p<0.001), and body mass index (BMI; &#946;=-0.09; p<0.001). Conclusions: The present study showed that age, female sex, BMI, and correlated negatively with eGFR. Sodium excretion was the only variable that showed a positive correlation with eGFR, indicating that high levels of urinary sodium excretion may contribute to hyperfiltration with potentially harmful consequences

Variability in Hemoglobin Levels and the Factors Associated with Mortality in Hemodialysis Patients: A 78-Month Follow-Up Study

Some studies have described that when the hemoglobin levels of chronic kidney disease (CKD) patients change, especially in those taking erythropoiesis-stimulating agents (ESA), they are associated with unfavorable outcomes such as increased morbidity and mortality, mainly due to cardiovascular events. This prospective cohort study included patients with end-stage renal disease currently undergoing hemodialysis. The initial 6-month clinical evaluation provided data of the variability in hemoglobin, associated blood parameters, and the use of erythropoietin. Subsequently, the patients were followed up for 78 months to evaluate mortality-associated factors. In total, 133 patients completed the 6-month follow-up with a mean age of 47.1 (±13.2) years. The majority were women (51.9%). Six-month hemoglobin levels were as follows: always low (18.0%), intermediate/target (1.5%), always high (0.8%), low-amplitude fluctuation/Hb low (n = 37; 27.8%), low-amplitude fluctuation/Hb high (13.53%), and high-amplitude fluctuation (38.6%), among end-stage renal disease patients. At the end of 78 months, 50 (37.6%) patients died; 70% of deaths were attributed to cardiovascular etiologies. A high variability was observed in hemoglobin levels, which was not associated with mortality. Among all the variables evaluated, age, erythropoietin dose, and transferrin saturation were associated with a higher mortality. Thus, this study suggests that greater attention to erythropoietin doses and transferrin saturation levels may improve the survival of dialysis patients