Bakgrund: Kronisk njursjukdom (CKD) är en dödlig världsomfattande och växande sjukdom som oftast inte visar symtom förrän i ett sent stadie. Därför är förebyggandet av dess utveckling högst relevant.   Syfte: Att kartlägga studier där effekter av växtbaserade kostmönster och intag av vegetabiliskt protein på njurhälsa har studerats.  Metodbeskrivning: En kartläggande översiktstudie genomfördes med litteratursökning i databasen PubMed. Granskade orginalstudier (tvärsnittsstudier, kohortstudier, och RCT) från hela världen med fokus på växtbaserad kost och/eller vegetabiliskt protein och njurhälsa, publicerade på engelska 2018–2023, avseende vuxna över 18 år, män och kvinnor, med eller utan nedsatt njurfunktion (ej dialys/ transplantation), inkluderades. Utfallsmått var estimerad glomerulär filtrationshastighet (eGFR), proteinuri, uremiska toxiner samt fosforeliminering. Kvalitativ utvärdering, tabulering och sammanfattning av studieresultaten gjordes.  Resultat: De 12 inkluderade studierna visar positiva resultat på något eller flera utfallsmått vid högre följsamhet till växtbaserade kostmönster eller vid högre intag av vegetabiliskt protein med avseende på risk för CKD och/eller nedsättning av njurfunktion. En av tvärsnittsstudierna som jämförde intagsnivåer av vegetabiliskt protein fann en 56 % lägre prevalens av CKD i den högsta intagsnivån. Två kohortstudier redovisar 71 % respektive 18 % lägre risk för CKD för de högsta intagsnivåerna av vegetabiliskt protein. Resultaten i en interventionsstudie rapporterade 36 % minskning av 24-timmars utsöndringen av fosfor.   Slutsats: Kartläggningen visar att ett växtbaserat kostmönster med hög andel hälsosamma vegetabilier och större andel vegetabiliskt protein jämfört med animaliskt kan ge lägre risk för CKD eller långsammare progression. Vidare forskning inom området behövs men det kan finnas skäl för dietister att förespråka växtbaserade kostmönster.

Bakgrund: Inom yrket som röntgensjuksköterska används dagligen kontrastmedel i samband med undersökningar. För att räkna ut hur mycket kontrastmedel som patienter ska erhålla för att förebygga kontrastinducerade njurskador används ekvationsformler för att räkna ut njurfunktionens glomerulära filtrationshastighet. Två formler som jämfördes var CKD-EPI och MDRD. Syfte: I denna litteraturstudie var syftet att jämföra vilken av de två mest förekommande ekvationsformler är mest optimal att använda för att räkna ut estimerat GFR. Metod: Denna studie genomfördes i form av en litteraturstudie där 11 artiklar kvalitetsgranskades och sammanställdes. Resultat: CKD-EPI-formeln uppvisade generellt bättre prestationsförmåga för noggrannhet, precision och avvikelse än MDRD-formeln för estimering av GFR. Dock hade båda ekvationerna svagheter och är inte universella då MDRD och CKD-EPI-formlerna inte är lämpliga att använda på alla individer. Slutsats: I dagsläget är CKD-EPI-formeln den som ter sig vara mest användbar, dock behövs det mer forskning för att kunna utveckla ekvationsformler som passar för alla typer av patienter. / Background: In the profession as radiology nurse contrast media is used daily in radiologic examinations. In order to determine the volume of contrast media that patients should be administered and to prevent contrast-induced nephropathy equation formulas are applied to calculate the kidney function glomerular filtration rate. Two formulas were compared the CKD-EPI and MDRD. Aim: In this literature study the aim was to compare which of the two most commonly used equation formulas is the most optimal for calculating estimated GFR. Methods: This study was conducted as a literature study, where 11 articles were quality assessed and compiled. Results: The CKD-EPI formula generally showed better performance for estimating GFR in accuracy, precision and bias than the MDRD formula. However, both equation formulas present inadequacies and are not universal as they are not applicable to all individuals. Conclusions: At the moment the CKD-EPI formula appears to be the most applicable, although more research is required in order to develop equation formulas which cater to all types of patients.

No description available.

Made available in DSpace on 2016-06-02T19:52:10Z (GMT). No. of bitstreams: 1 6705.pdf: 2359566 bytes, checksum: 240ad1a74c5f1d0c475d067396513040 (MD5) Previous issue date: 2015-02-27 / Financiadora de Estudos e Projetos / In order to overcome the barriers to break into foreign markets and expand the presence of their business, some companies take hold of strategic partnerships. One of these production strategies is the Completely Knocked Down (CKD), which aims to attend nationalization requirements in recipient countries. Although they facilitate internationalization, supply chains CKD face constraints caused by the large distance between supplier and customer, making logistics operations less consistent and less flexible. The problem that motivated this thesis came from a logistics project demanded by a national CKD automaker experiencing problems with the lack of an efficient logic of occupation of its warehouses and the high level of handling of parts in the supplying process. The aim of this work is to present and discuss the operational logistics of CKD production system in the automotive industry from a case study, trying to understand what conditions a CKD chain of supplies produce on the production operations of an assembly plant and how to operationalize the CKD system before the implications of their conditions impose the production system. The research method used was the single case study, using research from several sources of evidence. The transactions of materials and information between the supplier and CKD national carmaker were investigated, and internal logistics processes the automaker until the release of vehicles for distribution in dealerships. The case study revealed that there are different logics that influence the internal logistics operations to the assembler. The issuer's logic, that is, the CKD supplier, influences the receiving processes and blocking parts of the automaker; recipient's logic, or rather the automaker itself, influences the supply of assembly lines; and distribution of logic, led by the market and holding company that operates the automaker, influences the production and distribution of the vehicles produced. Solutions have been proposed to mitigate the effect of these constraints in order to make the logistic process of the company more efficient and effective by redefining the supply of parts approach and the redefinition of the shipping configuration of CKD materials. / Para superar as barreiras de entrada em mercados estrangeiros e ampliar a presença de seus negócios, algumas companhias lançam mão das parcerias estratégicas. Uma dessas estratégias de produção é o Completely Knocked Down (CKD), que tem o intuito de atender requisitos de nacionalização nos países destinatários. Embora facilite a internacionalização, cadeias de suprimentos CKD enfrentam constrangimentos causados pela larga distância entre fornecedor e cliente, tornando as operações logísticas menos consistentes e menos flexíveis. O problema dessa dissertação surgiu de um projeto logístico demandado por uma montadora nacional de veículos CKD que vivenciava problemas com a falta de uma lógica eficiente de ocupação de seus armazéns e pelo alto nível de manuseio das peças no processo do abastecimento. O objetivo desta dissertação é apresentar e discutir a operacionalização logística do sistema de produção CKD na indústria automobilística a partir de um estudo de caso, buscando entender quais os condicionantes que uma cadeia de suprimentos CKD produz sobre as operações produtivas de uma montadora e como operacionalizar o sistema CKD perante as implicações que suas condicionantes impõem ao sistema produtivo. O método de pesquisa utilizado foi o estudo de caso único, utilizando a investigação de diversas fontes de evidências. Foram investigadas as transações de materiais e informações entre o fornecedor CKD e a montadora nacional, e os processos logísticos internos à montadora até a liberação dos veículos para a distribuição nas concessionárias. O estudo de caso revelou que existem diferentes lógicas que condicionam as operações logísticas internas à montadora. A lógica do emitente, ou seja, do fornecedor CKD, influencia os processos de recebimento e blocagem das peças na montadora; a lógica do destinatário, ou melhor, da própria montadora, influencia o abastecimento das linhas de montagem; e a lógica de distribuição, comandada pelo mercado e pela holding que opera a montadora, influencia a produção e a distribuição dos veículos produzidos. Foram propostas soluções para atenuar o efeito desses condicionantes, de forma a tornar mais eficaz e eficiente o processo logístico da empresa, através da redefinição da abordagem de abastecimento das peças e da redefinição da configuração de envio dos materiais CKD.

Background: Chronic kidney disease (CKD) affects approximately 26 million individuals in the United States and is a top priority in the objectives for Healthy People 2020. Despite efforts to improve awareness, discussion of CKD is often minimal or ineffective in the primary care setting. This leads to a lack of patient awareness and knowledge of self-care skills to prevent or slow progression of the disease. A lack of communication of has been attributed to the provider's lack of confidence and knowledge to discuss CKD and to avoid unnecessary stress. Purpose: The purpose of the DNP project is to provide a systematic review of patient-provider communication processes used to influence self-management or behavioral change in primary care and propose a tool to enhance communication and slow progression of CKD. Methods: A systematic review was conducted following the method guidelines of the Cochrane Collaboration. Six electronic databases were searched. Inclusion criteria were adult humans, primary research studies, systematic and literature reviews, focus on communication of self-management or behavioral change strategies, primary outcomes of improving self-management and/or patient outcomes and availability of full-text online or by request. Outcomes: Of the 5765 articles initially identified, 28 studies met inclusion criteria. The studies revealed a lack of evidence directed towards CKD and communication was not directly addressed in a majority of the studies. Interventions most successful in improving patient outcomes were individualized, elicited collaboration or interaction with the patient and provider, were motivational or encouraging and aided in barrier identification and problem solving. A communication tool was developed from the evidence in order to stimulate more meaningful conversation between the patient and provider.

Purpose – To provide a framework for the improvement of the supply chain of Completely Knocked Down Products with a focus on waste reduction and cost-efficiency. Method– A case study at a company dealing with CKD assembly, based on observations and interviews. Triangulation of several sources from scholarly articles, examples from the automotive industries and researches. This investigation has been designed to provide logic and coherent structure backing the purpose following the red-thread of answering the research questions. The objective of the study is achieved combining literature review and a case study mainly based on observations and interviews. Results – CKD production can be beneficial depending on the specific content and market conditions. This thesis focuses on value creation throughout each stage of the production of CKD, from design to final assembly. The study found some guidelines that should be followed in managing the supply chain of CKD products. It fills a vacuum of knowledge on the topic. Implications – The frameworks resulting from the research, highlight the actions to be taken to implement CKD efficiently, with minimum waste and cost, leading to an overall improvement of the entire supply chain. Limitations – There have been found limited resources on the topic. Developing a framework without thorough examples from different industries contexts was a limitation due to the absence of available information. Observations and interviews limited to one company that locally assembles globally sourced parts.

A doença renal crônica (DRC) é uma afecção frequente em cães idosos, de alta morbidade e mortalidade, sendo definida como uma injúria renal morfo-funcional irreversível, de um ou ambos os rins, que está intrinsecamente associada à degeneração celular. Seu tratamento é paliativo, sendo que nos estágios mais avançados, o animal pode necessitar de hemodiálise ou transplante renal, prática dificultada e muitas vezes inviável na medicina veterinária. As células-tronco mesenquimais derivadas do tecido amniótico caracterizam-se por ser uma população de células de alta plasticidade e de grande potencial imunomodulador, sendo capazes de se diferenciar e produzir diferentes tipos celulares necessários num processo de reparação. Os avanços nos estudos das células-tronco podem tornar a terapia celular uma forma viável de tratamento alternativo ou adjuvante dessa doença, uma vez que estas poderiam restaurar a funcionalidade e manter a integridade do rim. O objetivo deste estudo foi avaliar se o tratamento experimental com células-tronco mesenquimais derivadas do âmnio (CTMAs) canino podem reduzir ou estabilizar a taxa de progressão e o quadro clínico da DRC em cães. Para tanto, células-tronco provenientes da membrana amniótica foram cultivadas até a segunda passagem (P2) e criopreservadas para posterior aplicação. Onze cães domésticos, machos e/ou fêmeas, acometidos pela DRC adquirida em graus II ou III segundo classificação da IRIS e sem outra afecção adjacente receberam duas aplicações de CTMAs nos dias D0 e D30, por via endovenosa. Para avaliar a progressão ou estabilização do quadro clínico foram colhidas amostras de sangue total, soro sanguíneo e urina para exames de hemograma, bioquímica sérica e urinaria e urinálise em quatro momentos: D0, D7, D30 e D60. A análise estatística foi realizada através da aplicação do teste ANOVA, para comparação de médias nas diferentes fases de tratamento, seguida pelo teste de Tukey, para comparação das médias entre os grupos. Do ponto de vista clínico, dois animais apresentaram melhora e se mantiveram estáveis durante todo o período de acompanhamento, dois animais apresentaram melhora nos primeiros 30 dias, apresentando novamente sintomatologia da doença após esse período e os demais apresentaram melhora nos primeiros sete dias de tratamento, havendo uma piora geral do quadro após esse período. Contudo, os exames laboratoriais em todos os casos não revelaram uma melhora significativa com o tratamento. Aparentemente, a utilização de células-tronco de origem amniótica não influencia de forma relevante na melhora da doença devido à extensa lesão renal que cães apresentam. / Chronic kidney disease (CKD) is a common condition in older dogs with high morbidity and mortality and is defined as an irreversible morpho-functional renal injury of one or both kidneys, which is intrinsically associated with cell degeneration. Its treatment is palliative, and in the more advanced stages, the animal may need dialysis or kidney transplantation, a practice that is difficult and often not feasible in veterinary medicine. The mesenchymal stem cells derived from amniotic tissue characterized by being a population of high plasticity and high cell immunomodulatory potential, being able to differentiate and produce different cell types required in a repair process. Advances in stem cell studies may make cell therapy a viable alternative or adjunctive treatment for this disease, since it could restore functionality and maintain kidney integrity. The objective of this study was to evaluate if the experimental treatment with the canine amnio- derived mesenchymal stem cells (AMSCs) can reduce or stabilize the rate of progression, and clinical condition of CKD in dogs. For this purpose, stem cells from the amniotic membrane were grown until the second pass (P2) and cryopreserved for later use. Eleven domestic male and / or female dogs, affected by the CKD acquired in grades II or III according to IRIS classification and without another adjacent disease, received two applications on days D0 and D30 intravenously. To evaluate the progression or stabilization of the clinical condition, whole blood, blood serum and urine samples were collected for hemogram, serum and urinary biochemistry and urinalysis at four moments: D0, D7, D30 and D60. Statistical analysis was performed using the ANOVA test, to compare means in the different treatment phases, followed by the Tukey test, to compare the means between the groups. From a clinical point of view, two animals showed improvement and remained stable throughout the follow-up period, two animals showed improvement in the first 30 days, showing again symptoms of the disease after this period and the other showed improvement in the first seven days of treatment, with a general worsening of the condition after this period. However, laboratory tests in all cases showed no significant improvement with treatment. Apparently, the use of stem cells of amniotic origin does not influence in a relevant way the improvement of the pathology due the extensive kidney lesion presented by dogs.

A doença renal crônica é uma doença de alta incidência na espécie felina, sendo responsável por altas taxas de mortalidade e morbidade. O tratamento clínico é paliativo. Atualmente as células-tronco têm sido estudadas para várias doenças degenerativas e crônicas, entre elas a doença renal. O presente estudo testou a utilização uma nova linhagem de células, progenitoras do tecido renal na terapia de gatos domésticos acometidos naturalmente com doença renal crônica, nos estágios 1, 2 e 3 da doença (creatinina <1,6 a 5,0 mg/dl), por meio de avaliações clínicas e laboratoriais. Os animais foram divididos em dois grupos, experimental e controle. No grupo experimental foi aplicado pela via intraperitoneal 2x106 células progenitoras renais e os animais do grupo controle receberam a aplicação de PBS. Os animais foram avaliados nos dias 0, 7 e 14 e monitorados clinicamente e por meio de exames laboratoriais, incluindo hemograma, creatinina, urinálise e o SDMA. A análise estatística foi realizada pelo teste Scheirer Ray Hare para dados não paramétricos (p=0,05). A aplicação intraperitoneal ocorreu sem intercorrências e aparenta ser segura para utilização em gatos. Dos 4 animais do grupo experimental 3 apresentaram melhora clínica, melhora do apetite e ganho de peso, o quarto animal apresentou perda de peso inicial, mas retornou ao peso do início do estudo 14 dias após a aplicação das células. Não houve diferenças estatísticas nos parâmetros de creatinina, ureia, fósforo e densidade urinária. Os leucócitos do grupo experimental apresentaram uma redução significativa em relação ao grupo controle. O SDMA apresentou redução em 3 animal do grupo experimental e aumento nos animais do grupo controle, mas a análise não apresentou diferença estatística devido ao aumento dos valores no em um dos animais. A aplicação de células progenitoras renais no tratamento da DRC em gatos é promissora e pode ser realizada pela via intraperitoneal, sem que ocorra intercorrências. / Chronic kidney disease is a high incidence disease in the feline species, responsible for high rates of mortality and morbidity. The clinical treatment is palliative. Currently, stem cells have been studied for various degenerative and chronic diseases, including kidney disease. The present study tested the use of a new lineage of renal tissue progenitor cells in the therapy of naturally occurring chronic kidney disease in cats at stages 1, 2 and 3 of the disease (creatinine <1.6 to 5.0 mg/dl), through clinical and laboratory evaluations. The animals were divided into two groups, experimental and control. In the experimental group 2x106 renal progenitor cells were administered intraperitoneally and the animals in the control group received PBS application. The animals were evaluated on days 0, 7 and 14 and monitored clinically and through laboratory tests, including complete blood count, creatinine, urinalysis and SDMA assay. Statistical analysis was performed by the Scheirer Ray Hare test for non-parametric data (p = 0.05). The intraperitoneal application occurred uneventfully and appeared to be safe for use in cats. Of the 4 animals in the experimental group 3 showed clinical improvement, food intake and weight gain, the fourth animal presented initial weight loss, but returned to the weight of the study beginning 14 days after the application of the cells. There were no statistical differences in the parameters of creatinine, urea, phosphorus and urinary density. Leukocytes in the experimental group showed a significant reduction in relation to the control group. The SDMA showed reduction in 3 animals from the experimental group and increase in the animals from the control group, but the analysis did not show statistical difference due to the increase values in one of the animals. The application of renal progenitor cells in the treatment of CKD in cats is promising and can be performed intraperitoneally, without causing intercurrences.

A doença renal crônica é uma doença de alta incidência na espécie felina, sendo responsável por altas taxas de mortalidade e morbidade. O tratamento clínico é paliativo. Atualmente as células-tronco têm sido estudadas para várias doenças degenerativas e crônicas, entre elas a doença renal. O presente estudo testou a utilização uma nova linhagem de células, progenitoras do tecido renal na terapia de gatos domésticos acometidos naturalmente com doença renal crônica, nos estágios 1, 2 e 3 da doença (creatinina <1,6 a 5,0 mg/dl), por meio de avaliações clínicas e laboratoriais. Os animais foram divididos em dois grupos, experimental e controle. No grupo experimental foi aplicado pela via intraperitoneal 2x106 células progenitoras renais e os animais do grupo controle receberam a aplicação de PBS. Os animais foram avaliados nos dias 0, 7 e 14 e monitorados clinicamente e por meio de exames laboratoriais, incluindo hemograma, creatinina, urinálise e o SDMA. A análise estatística foi realizada pelo teste Scheirer Ray Hare para dados não paramétricos (p=0,05). A aplicação intraperitoneal ocorreu sem intercorrências e aparenta ser segura para utilização em gatos. Dos 4 animais do grupo experimental 3 apresentaram melhora clínica, melhora do apetite e ganho de peso, o quarto animal apresentou perda de peso inicial, mas retornou ao peso do início do estudo 14 dias após a aplicação das células. Não houve diferenças estatísticas nos parâmetros de creatinina, ureia, fósforo e densidade urinária. Os leucócitos do grupo experimental apresentaram uma redução significativa em relação ao grupo controle. O SDMA apresentou redução em 3 animal do grupo experimental e aumento nos animais do grupo controle, mas a análise não apresentou diferença estatística devido ao aumento dos valores no em um dos animais. A aplicação de células progenitoras renais no tratamento da DRC em gatos é promissora e pode ser realizada pela via intraperitoneal, sem que ocorra intercorrências. / Chronic kidney disease is a high incidence disease in the feline species, responsible for high rates of mortality and morbidity. The clinical treatment is palliative. Currently, stem cells have been studied for various degenerative and chronic diseases, including kidney disease. The present study tested the use of a new lineage of renal tissue progenitor cells in the therapy of naturally occurring chronic kidney disease in cats at stages 1, 2 and 3 of the disease (creatinine <1.6 to 5.0 mg/dl), through clinical and laboratory evaluations. The animals were divided into two groups, experimental and control. In the experimental group 2x106 renal progenitor cells were administered intraperitoneally and the animals in the control group received PBS application. The animals were evaluated on days 0, 7 and 14 and monitored clinically and through laboratory tests, including complete blood count, creatinine, urinalysis and SDMA assay. Statistical analysis was performed by the Scheirer Ray Hare test for non-parametric data (p = 0.05). The intraperitoneal application occurred uneventfully and appeared to be safe for use in cats. Of the 4 animals in the experimental group 3 showed clinical improvement, food intake and weight gain, the fourth animal presented initial weight loss, but returned to the weight of the study beginning 14 days after the application of the cells. There were no statistical differences in the parameters of creatinine, urea, phosphorus and urinary density. Leukocytes in the experimental group showed a significant reduction in relation to the control group. The SDMA showed reduction in 3 animals from the experimental group and increase in the animals from the control group, but the analysis did not show statistical difference due to the increase values in one of the animals. The application of renal progenitor cells in the treatment of CKD in cats is promising and can be performed intraperitoneally, without causing intercurrences.

Chronic kidney disease (CKD) is growing global public health problem affecting 1 in 10 adults in developed countries and recognised as an important risk factor for cardiovascular disease (CVD) development. CVD is the main cause of death among CKD patients. Endothelial injury and dysfunction are critical steps in atherosclerosis, a major CVD. Oxidative stress (increased level of reactive oxygen species, ROS) has been associated with CVD development. Intravenous (IV) iron preparations are widely used in the management of CKD mediated anaemia, and have been associated with increased oxidative stress and cellular dysfunction. This study examined the effect of pharmacologically-relevant concentrations of IV Venofer (iron sucrose) or IV Ferinject (Ferric carboxymaltose, FCM) on primary human umbilical vein endothelial cell (HUVEC) activation/damage and on intracellular ROS generation as well as studying the potential mechanisms responsible. Data from TUNEL assay and Annexin V-FITC/PI staining showed that, IV FCM had no effect, but IV iron sucrose increased HUVEC apoptosis at 24hr. IV iron sucrose inhibited cell proliferation and reduced cell viability. Both compounds induced EC activation through sustained activation of p38 MAPK and up-regulation of ICAM-1 and VCAM-1. Additionally, the compounds induced significant increase in total ROS and superoxide anion production, which was attenuated by the anti-oxidant N-acetylcysteine (NAC). P38 MAPK showed up-regulation of pro-apoptotic protein Bax and down-regulation of antiapoptotic Bcl-2 protein in HUVEC treated with IV iron sucrose and p38 inhibition reversed these effects. In summary, these results suggest that IV iron sucrose causes more severe EC injury than IV FCM. However, both IV iron preparations induced intracellular ROS and superoxide anion generation in HUVEC leading to EC activation/dysfunction, providing a potential explanation for vascular damage in CKD patients.