Registro de biópsias renais de um hospital universitário de Porto Alegre e correlações de dados demográficos e clínicos com os achados anatomo-patológicos

Introdução: A prevalência e a distribuição das glomerulopatias varia nos diferentes países e continentes, tendo relação com a população estudada. Não existem registros de biópsias renais e suas correlações clínico-patológicas em nosso Estado. Objetivos: Determinar o perfil epidemiológico das glomerulopatias, correlacionando os achados histopatológicos com o perfil demográfico e clínico dos pacientes. Métodos: Foram revisadas 1051 biópsias renais e avaliados dados demográficos, clínicos e laboratoriais dos pacientes entre os anos de 2000 a 2018. Foram descritas as prevalências das glomerulopatias, suas distribuições, características clínicas dos pacientes e suas variações temporais em três períodos. Resultados: As glomerulopatias secundárias predominaram (52,4%), seguido pelas glomerulopatias primárias (29,6%). Nas formas primárias, a glomeruloesclerose segmentar e focal (GESF) foi predominante (37,3%), seguido da nefropatia por IgA (NIgA; 24,4%). A nefrite lúpica (NL; 41,1%) teve a maior prevalência nas formas secundárias, e na sequencia doença renal do diabetes (DRD; 17,8%). Síndrome nefrótica foi a maior indicação de biópsia renal. Na variação temporal, houve um aumento significativo nos casos de NIgA (p=0,001) e redução na GESF (p<0,001), assim como redução na NL (p=0,027) e aumento da DRD (p<0,001). Conclusão: GESF e NIgA prevaleceram nas glomerulopatias primárias, e NL e DRD nas secundárias. Síndrome nefrótica foi a maior indicação para a biópsia. A variação temporal mostrou redução da GESF e NL, e aumento da NIgA e DRD.Introduction: The prevalence and distribution of glomerulopathies varies in different countries and continents, having a relationship with the studied population. There are no records of renal biopsies and their clinical-pathological correlations in our State. Objectives: To determine the epidemiological profile of glomerulopathies, correlating histopathological findings with the demographic and clinical profile of patients. Methods: 1051 renal biopsies were reviewed and demographic, clinical and laboratory data of patients between the years 2000 to 2018 were evaluated. The prevalence of glomerulopathies, their distribution, clinical characteristics of patients and their temporal variations in three time periods were described. Results: Secondary glomerulopathies predominated (52.4%), followed by primary glomerulopathies (29.6%). In primary forms, focal segmental glomerulosclerosis (FSGS) predominated (37.3%), followed by IgA nephropathy (NIgA; 24.4%). Lupus nephritis (LN; 41.1%) had the highest prevalence in secondary forms, and in sequence diabetic kidney disease (DKD; 17.8%). Nephrotic syndrome was the major indication for renal biopsy. Considering the temporal variation, there was a significant increase in cases of NIgA (p=0.001) and a reduction in FSGS (p<0.001), as well as a reduction in LN (p=0.027) and an increase in DKD (p<0.001). Conclusion: FSGS and NIgA predominated in primary glomerulopathies, and LN and DKD in secondary forms. Nephrotic syndrome was the major indication for biopsy. The temporal variation from years 2000 to 2018 showed a decrease in FSGS and LN, and an increase in NIgA and DKD

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

Medidas de mitigação ao atropelamento de fauna em rodovias federais concedidas no Brasil

O desenvolvimento socioeconômico de diversos paí­ses está relacionado   expansão e manutenção da infraestrutura rodoviária. No Brasil, o modo rodoviário é o mais utilizado, todavia, as rodovias podem causar impactos negativos   biodiversidade, pois contribuem para a fragmentação de hábitats e a redução de fluxos biológicos. Dentre os principais impactos causados pelas rodovias, destaca-se o atropelamento da fauna, de forma que medidas de mitigação para esse impacto se tornam necessárias. Com base nos dados coletados até o ano de 2017, o presente estudo tem por objetivo apresentar informações quanto  s medidas mitigadoras ao atropelamento de fauna silvestre presentes nas rodovias federais concedidas do Brasil. Foram cadastradas 461 medidas de mitigação, mais 627 dispositivos de engenharia que podem ser utilizados como passagens, sendo que, desse total, 334 encontram-se nas proximidades de áreas legalmente protegidas. Existem 158 medidas em fase de planejamento para serem implementadas

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Transplante renal sem imunossupressão de manutenção. Pares monozigóticos e receptores de rim e medula óssea do mesmo doador

Resumo Pacientes que receberam transplantes renais sem imunossupressão de manutenção têm sido esporadicamente relatados. Os casos incluem relatos de pacientes não aderentes que suspenderam a medicação imunossupressora, transplantes entre gêmeos monozigóticos, transplante renal após um bem sucedido transplante de medula óssea do mesmo doador e transplante simultâneo de medula óssea e rim para tratamento de pacientes com mieloma múltiplo com insuficiência renal associada. Existem, atualmente, ensaios clínicos em andamento com o propósito de induzir tolerância imunológica específica ao doador utilizando a infusão de células hematopoiéticas do mesmo doador do enxerto renal. A seguir, descrevemos dois casos de transplante renal sem imunossupressão como exemplos de situações descritas acima