Pea protein hydrolysate (PPH) has antihypertensive effects and prostanoids have been implicated in renal diseases. To investigate the role of PPH and prostanoids on renal and cardiovascular effects in cardio-renal disease, normal and diseased Han:SPRD-cy rats were given diets containing either 0, 0.5% or 1% PPH for 8 weeks. At termination, diseased rat kidneys displayed increased renal cyst growth, fibrosis, plasma creatinine and lower monocyte chemoattractant protein-1. Diseased rats also exhibited left ventricular (LV) hypertrophy, elevated systolic and diastolic blood pressures and LV end diastolic and systolic pressures. Four of five prostanoids were elevated in diseased rat kidneys. PPH attenuated systolic blood pressure, but not other components of the cardio-renal syndrome. PPH also increased select prostanoids in normal and diseased rats. Thus, dietary PPH attenuates hypertension in the Han:SPRD-cy rat, but does not ameliorate other components of disease, possibly due to increased prostanoid effects or an insufficient treatment length.

ABSTRACT IMPORTANCE: Age-related macular degeneration (AMD) is a leading cause of low vision in elderly population. The association of vascular and renal conditions has been reported inconsistently. Unfolding the association may provide the insight to eye care providers to take account general health management into eye care. OBJECTIVES: To investigate the prevalence of the vascular and renal comorbidities with AMD, examine the association of a single or combination of these comorbidities with AMD. DSIGN AND PARTICIPANTS: Population-base cross-sectional study involved the adults aged 40 years or older (N=4596) who participated in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), a national representative population-based survey of non-institutionalized US residents. MAIN OUTCOMES AND MEASURES: AMD was defined by the presence of drusen and presence of pigmental abnormality. Angina pectoris (AP), coronary heart disease (CHD), congestive heart failure (CHF) and myocardial infarction (MI), and stroke, assessed by self-report by the questionnaire of medical conditions, Chronic kidney disease (CKD), assessed by self-report and estimation of glomerular filtration rate (GFR) and the level of urine albumin. Heart disease (HD) was defined as having AP or CHF or CHD or MI. RESULTS: Among individuals with AMD, 6% had AP, 10% had CHD, 7% had CHF, 10% had MI, 13% had stroke, and 29% had CKD. The weighted prevalence of these conditions were significantly higher than those without AMD (All P-values CONCLUSION AND RELEVANCE: These findings from the nationally-representative sample of the US population highlight the prevalence of vascular and renal comorbidities associated with AMD, the modest evidence of relationship of each single comorbidity, and strong association of combination of stroke and CKD to AMD independent of age, gender, and other factors. Because of the cross-sectional design, the results of this study can not address a causal relationship between AMD and the examined comorbidities. It is unclear whether AMD and comorbidities arise from individual predisposition to vascular and renal diseases or whether complications from these morbidities increase the risk of AMD. However, the important caveat is that preventive and care management for the examined comorbidities may lessen the severity of symptoms or prevent AMD.

Chronic Kidney Disease (CKD) is a progressive condition that in the majority of cases leads to End Stage Renal Failure (ESRD) and the need for dialysis, with the only cure being renal transplant. CKD affects both adults and children; however the underlying causes of the disease are different. CKD in adults is most commonly secondary to diabetes and/or hypertension while CKD in children is usually caused by congenital structural abnormalities that result directly in renal dysfunction. There have been numerous reports of inflammatory and immunological disturbances in adult CKD that involve both the cellular and humoral immune systems. Consequences of these include an increased rate of cardiovascular disease (CVD), decreased response to vaccinations, as well as increased rates of infection, anaemia and malnutrition. Children with CKD display many of the clinical complications seen in adult kidney disease that are associated with inflammatory and immunological changes. In adults however, many of the primary conditions associated with CKD are inherently pro-inflammatory; therefore it is not clear whether the inflammatory changes observed in adults with CKD are due to pre-existing inflammatory conditions, renal disease per se or a combination of both. The majority of CKD in children is caused by conditions that are not inflammatory in nature. This presents a unique opportunity to study the inflammatory consequences of CKD alone, without the added complication of underlying inflammatory disorders. Despite this, there has been little investigation of the inflammatory and immunological status of children with CKD. Some very recent studies have shown that children with CKD have an increased systemic inflammatory state[1-3], however the nature of these immunological and inflammatory changes remains poorly defined. Identification of the specific inflammatory processes that occur in CKD may provide new treatment targets and the opportunity to develop urgently needed new therapies. The purpose of this thesis is to investigate the presence of immunological changes associated with inflammation in children with CKD. This is the first study to include children with very mild disease, and the significant changes that are present in the early stages of the disease are of particular note. I have shown that CKD in children is an intrinsically inflammatory condition, with increased accumulation of markers of oxidative stress and production of pro-inflammatory cytokines. The inflammatory markers identified in this study may be applied as a foundation for more sensitive diagnostic markers of disease progression as well as provide a basis for novel treatment strategies in this group of patients. Early identification of increased inflammation is a prerequisite for the application of preventive strategies. In addition, a better understanding of the level and mechanisms of systemic inflammation in children with CKD may enable a more accurate assessment of their risk of other inflammatory conditions such as CVD, anaemia, muscle wasting, and malnutrition. Future research that specifically focuses on the reasons and mechanisms for different rates of disease progression may emerge as a result of this study. Importantly, the findings of this study may have implications in the long term treatment of disease and may allow identification of new treatment strategies to achieve better patient outcomes. The outcomes of the study are: • Better definition of inflammatory profiles in paediatric CKD and correlation with disease severity and progression, which should contribute to improved management strategies. • Identification of new treatment targets to reduce the damage caused by chronic systemic inflammation. • Mechanistic understanding of the relationship of the inflammatory profile in regard to source leucocytes or other contributing cell types. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1330366 / Thesis (Ph.D.) -- University of Adelaide, School of Paediatrics and Reproductive Health, 2008

Made available in DSpace on 2014-06-11T19:23:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-11-12Bitstream added on 2014-06-13T19:29:45Z : No. of bitstreams: 1 moreira_lag_me_arafcf.pdf: 220588 bytes, checksum: cd403b75b05e1455d959138d5ab09209 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Universidade Estadual Paulista (UNESP) / Na avaliação de pacientes portadores de doença renal crônica, além da análise da alimentação ingerida é importante a análise da presença de produtos nitrogenados nos fluidos corporais como o sangue e urina, apresentando para este fim como grande potencial, a análise da saliva. Nesse sentido, uma das áreas relacionadas com a análise de alterações da composição bioquímica da saliva e que vem despertando o interesse, é a evolução clínica de pacientes portadores de doença renal, submetidos ou não a tratamento dialítico. Com base no contexto acima, a presente pesquisa teve por objetivo avaliar a saliva como meio de monitorar as variações dos compostos nitrogenados, em portadores desta patologia submetidos ao tratamento dialítico. No desenvolvimento da pesquisa foram avaliados a ingestão alimentar, a antropometria e os seguintes indicadores bioquímicos e físico-químicos: uréia, proteína total, aminoácidos, pH, e fluxo salivar. Foram encontrados nas determinações de uréia realizadas no soro, saliva não estimulada e saliva estimulada 136 mg/dl,107 mg/dl e 97 mg/dl antes da hemodiálise, respectivamente; e após a mesma, 39 mg/dl, 38,9 mg/dl e 36,0 mg/dl. As proteínas totais no soro, na saliva não estimulada e saliva estimulada apresentaram respectivamente valores de 7,0 g/dl, 0,30 g/dl; e 0,19 g/dl antes da hemodiálise e após a mesma, 9,0 g/dl, 0,22 g/dl e 0,20 g/dl. O pH salivar sofreu decréscimo após a hemodiálise. Os resultados obtidos permitem concluir que as proteínas totais na saliva e no soro não apresentaram comportamento semelhante. A hemodiálise atua sobre o pH salivar, mas não restabelece os níveis normais. A hemodiálise foi efetiva em reduzir a concentração dos compostos nitrogenados presentes na saliva / In the evaluation of patient carriers of chronic renal disease, besides the analysis of the ingested food, the analysis of the presence of nitrogenous products in the physical fluids like blood and urine and saliva are also important. In this sense, one of the areas of great scientific interest related to the analysis of biochemical composition alterations of saliva is the clinical evolution of patient carriers of renal disease, subjected or not to hemodialysis treatment. These studies can subsidize the development in the future of diagnoses methods for renal patients through the analysis of saliva. Based on the above context, this research aimed to evaluate saliva as a means of monitoring changes of nitrogen compounds in patients with renal disease undergoing dialysis. At the development of this research, food ingestion, the antropometria and the following biochemical and physical-chemical indicators were analyzed: urea, total protein, aminoacids, pH and salivary flow. The determinations of urea in the serum, of not stimulated saliva and of stimulated saliva were 136 mg/dl, 107 mg/dl and 97 mg/dl, respectively, before the hemodialysis, and after that, 39mg/dl, 38,9mg/dl and 36,0mg/dl. The total proteins in the serum, not stimulated saliva and stimulated saliva showed up 7,0 g/dl, 0,3 g/dl and 0,19 g/dl before the hemodialysis, respectively, and after that 9,0 g/dl, 0,22 g/dl and 0,20 g/dl. The saliva pH decreased after the hemodialysis. The obtained results allowed to conclude that the total proteins in the saliva and in the serum did not present similar behavior. The hemodialysis influences the salivary pH but does not restore it to normal levels. The hemodialysis was effective in the reduction of nitrogen compounds present in saliva

Submitted by CRISTIANE PARISOTO MASIERO null (cparisoto@uol.com.br) on 2018-04-03T14:43:56Z No. of bitstreams: 1 Cristiane Parisoto Masiero - Mestrado - 2018 versão final.pdf: 3444941 bytes, checksum: 319b20a2ac83b2c09f1e15a808f5a52b (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-03T16:53:25Z (GMT) No. of bitstreams: 1 masiero_cp_me_bot.pdf: 3444941 bytes, checksum: 319b20a2ac83b2c09f1e15a808f5a52b (MD5) / Made available in DSpace on 2018-04-03T16:53:25Z (GMT). No. of bitstreams: 1 masiero_cp_me_bot.pdf: 3444941 bytes, checksum: 319b20a2ac83b2c09f1e15a808f5a52b (MD5) Previous issue date: 2018-03-01 / RESUMO Introdução: A doença renal crônica é um problema de saúde pública global e vem apresentando uma tendência de crescimento. Quando a capacidade renal atinge parâmetros entre 10 e 15%, é necessária a realização de uma terapia renal substituitiva. No hospital em questão, o centro de hemodiálise se encontra com sua capacidade total instalada e a demanda por vagas continua. Os pacientes então começaram a ser internados aguardando pela vaga ambulatorial por períodos que podem chegar a 3 meses. A opção internação pela internação, que pareceu funcionar bem no início, logo criou novas interações antes inexistentes, além de consequências para os pacientes, como infecção hospitalar e depressão. Objetivo: Contribuir para a implementação de novas metodologias participativas na busca por soluções coletivas que atinjam os determinantes organizacionais nas atividades da área de saúde. Método: Foi utilizado o Laboratório de Mudanças (LM) que possui como base a teoria histórico cultural e o princípio da dupla estimulação e visa a construção coletiva de soluções. O trabalho foi dividido em duas fases: uma de coleta de dados etnográficos, com entrevistas individuais e coletivas, observação in loco e exame de documentos. Na segunda fase foram realizadas oito sessões do LM com um grupo composto em média por quinze pessoas do setor de terapia renal substitutiva e os setores que passaram a interagir após a internação dos pacientes. Resultados: A análise da atividade atual demonstrou que os pacientes com problemas renais continuam chegando ao hospital por diversas vias e que os profissionais não possuíam autonomia para negar o paciente pela falta de vaga. A equipe absorve essa demanda e sofre o impacto inicial é a que atende a insuficiência renal aguda (IRA) e equipe a de nefrologistas. Dados históricos demonstram que a equipe se manteve a mesma ao passo que o número de pacientes triplicou. Foram sendo arranjados locais para esses pacientes serem dialisados, ocupando outro setor, o do Centro de Terapia Intensiva (CTI), também com a capacidade esgotada. Essas mudanças levaram a contradições secundárias no sistema de atividade que emergiram durante as sessões do LM. As sessões proporcionaram um momento para discussão desses problemas, a mudança de alguns componentes do grupo para uma visão mais sistêmica da situação e a formação de agência de parte dos envolvidos. Após passar pelas fases de questionamento e construção histórica da atividade, houve a elaboração de proposta de novo modelo mais voltado para o método de diálise peritoneal, onde há maior autonomia do paciente, que pode realizar a diálise em sua casa. A prevenção também foi foco de discussão. Conclusão: O Laboratório de Mudanças proporcionou que os participantes ampliassem a compreensão dos problemas vivenciados pelo setor de hemodiálise de forma pessoal para sistêmica. Também possibilitou micro ciclos de aprendizagem expansiva, porém de forma diferente nos diversos atores. Houve a criação de agência manifestadas nas sessões e também fora dela. O LM demonstrou ser um importante método para a construção de mudanças organizacionais de forma coletiva. / ABSTRACT Introduction: Chronic kidney disease is a global public health problem and the tendency seems to increase. When renal capacity reaches parameters between 10 and 15%, renal replacement therapy is necessary. At the hospital in this study, the hemodialysis center has its full capacity installed and the demand for vacancies continues. The patients then began to be hospitalized waiting for the outpatient vacancy for periods that can reach 3 months. The hospitalization option, which seemed to work well in the beginning, soon created new interactions that did not exist before, as well as consequences for the patients, such as hospital infection and depression. Objective: To contribute to the implementation of new collaborative methodologies in the search for collective solutions of organizational determinants in health activities. Method: It was applied the Change Laboratory (CL) Method based on cultural historical theory and the principle of double stimulation that aims the collective construction of solutions. The study was divided in two phases: one of ethnographic data collection, with individual and collective interviews, on-site observation and documents examination. In the second phase eight CL sessions were performed with a group consisting of an average of fifteen people from the renal replacement therapy sector and the sectors that started to interact after the patients' hospitalization. Results: The analysis of the current activity demonstrated that patients with kidney problems continue arriving at the hospital through several routes and the hospital do not have the autonomy to deny the patient due to lack of space. The team absorbs this demand and suffers the initial impact is that it addresses acute renal failure (ARF) and team of nephrologists. Historical data demonstrate that the team remained the same while the number of patients tripled. Locations were set up for these patients to be dialyzed, occupying another sector, the Intensive Care Center (ICC), also with its full capacity. These changes led to secondary contradictions in the system of activity that emerged during CL sessions. The sessions provided a moment to discuss these problems and the change of some components of the group to a more systemic view of the situation and with the formation of agency on part of those involved. After the phases of questioning and historical construction of the activity, a proposal for a new model was developed that is more focused on the peritoneal dialysis method, that gives more autonomy for the patient, who can perform dialysis at home. Prevention was also on the focus of the discussion. Conclusion: The Change Laboratory Method provided the change in the understanding of the problems experienced by the hemodialysis sector in a personal to a systemic way. It also enabled micro cycles of expansive learning, but differently in different actors. There was the creation of agencies manifested in the sessions and also outside of them. CL has been shown to be an important method for building collective organizational changes.

Orientador: Ildeberto Muniz de Almeida / Resumo: RESUMO Introdução: A doença renal crônica é um problema de saúde pública global e vem apresentando uma tendência de crescimento. Quando a capacidade renal atinge parâmetros entre 10 e 15%, é necessária a realização de uma terapia renal substituitiva. No hospital em questão, o centro de hemodiálise se encontra com sua capacidade total instalada e a demanda por vagas continua. Os pacientes então começaram a ser internados aguardando pela vaga ambulatorial por períodos que podem chegar a 3 meses. A opção internação pela internação, que pareceu funcionar bem no início, logo criou novas interações antes inexistentes, além de consequências para os pacientes, como infecção hospitalar e depressão. Objetivo: Contribuir para a implementação de novas metodologias participativas na busca por soluções coletivas que atinjam os determinantes organizacionais nas atividades da área de saúde. Método: Foi utilizado o Laboratório de Mudanças (LM) que possui como base a teoria histórico cultural e o princípio da dupla estimulação e visa a construção coletiva de soluções. O trabalho foi dividido em duas fases: uma de coleta de dados etnográficos, com entrevistas individuais e coletivas, observação in loco e exame de documentos. Na segunda fase foram realizadas oito sessões do LM com um grupo composto em média por quinze pessoas do setor de terapia renal substitutiva e os setores que passaram a interagir após a internação dos pacientes. Resultados: A análise da atividade atual demonstrou que os pac... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: ABSTRACT Introduction: Chronic kidney disease is a global public health problem and the tendency seems to increase. When renal capacity reaches parameters between 10 and 15%, renal replacement therapy is necessary. At the hospital in this study, the hemodialysis center has its full capacity installed and the demand for vacancies continues. The patients then began to be hospitalized waiting for the outpatient vacancy for periods that can reach 3 months. The hospitalization option, which seemed to work well in the beginning, soon created new interactions that did not exist before, as well as consequences for the patients, such as hospital infection and depression. Objective: To contribute to the implementation of new collaborative methodologies in the search for collective solutions of organizational determinants in health activities. Method: It was applied the Change Laboratory (CL) Method based on cultural historical theory and the principle of double stimulation that aims the collective construction of solutions. The study was divided in two phases: one of ethnographic data collection, with individual and collective interviews, on-site observation and documents examination. In the second phase eight CL sessions were performed with a group consisting of an average of fifteen people from the renal replacement therapy sector and the sectors that started to interact after the patients' hospitalization. Results: The analysis of the current activity demonstrated that patients with... (Complete abstract click electronic access below) / Mestre

Orientador: Luis Cuadrado Martin / Resumo: Introdução: A Doença Renal Crônica é um importante problema de saúde em todo o mundo, com repercussões sistêmicas de evolução progressiva, ocasionada em grande parte dos casos pelos efeitos deletérios renais da hipertensão arterial. É possível destacar o declínio funcional, como o principal ponderador para elevação das taxas de morbidade e mortalidade. Que reporta a necessidade de métodos que visem prevenir, retardar ou minimizar os agravos renais e cardiovasculares. Objetivo: Analisar a associação da albuminúria com o nível de atividades físicas e capacidade funcional em indivíduos portadores de hipertensão arterial. Materiais e métodos: Foi realizado um estudo transversal, com casuística composta por pacientes hipertensos, de todas as unidades de saúde de Itaí, com idade mínima de 18 anos, com algum grau de albuminúria, avaliados através do uso de fita reagente e quantificada pelo exame de urina 24 horas, o nível de atividades físicas foi avaliado com uso do questionário internacional de atividades física IPAQ, a capacidade funcional foi avaliada através da execução do teste de caminhada de seis minutos (TC6), o índice de dispneia pela escala modificada de Borg e a rigidez arterial foi aferida através da velocidade de onda de pulso (VOP). Para análise dos dados os indivíduos foram divididos em três grupos em conformidade ao grau de albuminúria, sendo <10mg/24h, 10mg/24h a <30mg/24h e 30mg/24h ou valores superior. As variáveis categóricas foram expressas por números absoluto... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic Kidney Disease is a major health problem worldwide, with systemic and progressive repercussions, due in large part to the deleterious effects of hypertension. Among its repercussions it is possible to highlight the functional decline, as the main weight for raising morbidity and mortality rates. That reports the need for methods that aim to prevent, delay or minimize renal and cardiovascular diseases. Objective: To analyze the association of albuminuria with the level of physical activity and functional capacity in individuals with arterial hypertension. Materials and methods: A cross-sectional study was carried out with a sample of hypertensive patients from all health units of Itaí, with a minimum age of 18 years, with some degree of albuminuria, evaluated using reagent tape and quantified by the examination Of 24-hour urine, the level of physical activity was assessed using the IPAQ international physical activity questionnaire, functional capacity was assessed by performing the six-minute walk test (MWT), dyspnea index using the modified Borg scale And arterial stiffness was measured by pulse wave velocity (PWV). For data analysis, subjects were divided into three groups according to albuminuria, being <10mg / 24h, 10mg / 24h at <30mg / 24h and 30mg / 24h or higher values. Categorical variables were expressed by absolute numbers and percentage and compared by the chi-square test. The continuous and parametric distribution variables were compared by t... (Complete abstract click electronic access below) / Mestre

Orientador: Luis Cuadrado Martin / Resumo: Introdução. A doença renal crônica (DRC) representa um grave problema de saúde pública, que tem afetado milhões de pessoas em todo o mundo, gerando impacto negativo tanto na qualidade, como na quantidade de vida de seus portadores. É causada em grande parte dos casos pela nefropatia diabética. É possível destacar o declínio funcional como importante fator para elevação das taxas de morbidade e mortalidade. Desta forma, é possível ressaltar a importância da reabilitação física para saúde destas pessoas. Contudo há a necessidade de maior esclarecimento sobre as repercussões do treinamento físico em relação à proteinúria, que constitui indicador adverso de lesão renal na DRC. Objetivo. Avaliar a associação entre atividade física e capacidade funcional com albuminúria em portadores de diabetes mellitus. Materiais e métodos. Foi realizado um estudo transversal, com casuística composta por pacientes diabéticos, de todas as unidades de saúde de Itaí, com idade mínima de 18 anos, com algum grau de albuminúria, avaliados através do uso de fita reagente e quantificada pelo exame de urina 24 horas, o nível de atividades físicas foi avaliado com uso do questionário internacional de atividades física IPAQ, a capacidade funcional foi avaliada através da execução do teste de caminhada de seis minutos (TC6), o índice de dispneia pela escala modificada de Borg e a rigidez arterial foi aferida através da velocidade de onda de pulso (VOP), índice de amplificação e pressão arterial central. Para... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Chronic kidney disease (CKD) is a serious public health problem that has affected millions of people worldwide, negatively impacting both the quality and quantity of life of its patients. It is caused in large part by diabetic nephropathy. It is possible to highlight functional decline as an important factor for raising morbidity and mortality rates. In this way, it is possible to emphasize the importance of the physical rehabilitation for health of these people. However, there is a need for greater clarification about the repercussions of physical training on proteinuria, which is an adverse indicator of renal damage in CKD. Goal. To assess the association between physical activity and functional capacity with albuminuria in patients with diabetes mellitus. Materials and methods: A cross-sectional study was carried out with a sample of diabetic patients from all health units of Itaí, with a minimum age of 18 years, with some degree of albuminuria, evaluated through the use of reagent tape and quantified by the urine test 24 hours , the level of physical activity was assessed using the IPAQ international physical activity questionnaire, functional capacity was assessed by performing the six-minute walk test (6MWT), the dyspnea index using the modified Borg scale, and arterial stiffness was measured by pulse wave velocity (VOP), amplification index, and central arterial pressure. For data analysis, subjects were divided into three groups according to the degree of albuminuria,... (Complete abstract click electronic access below) / Mestre

A Doença Renal Crônica (DRC) é caracterizada pela degeneração progressiva e irreversível das estruturas componentes do sistema renal. Em estágio avançado da DRC é indicado o tratamento substitutivo renal, também conhecido como Hemodiálise (HD). Este tratamento é acompanhado por comorbidades como desnutrição e fraqueza muscular, que apresentam forte associação com a diminuição da independência funcional. Neste sentido, este trabalho apresenta como objetivos: (1) Caracterizar a morfologia muscular de pacientes com doença renal crônica (DRC) que realizam HD, comparada a um grupo controle; (2) Avaliar a característica neuromecânica muscular dos membros inferiores de pacientes com doença renal crônica (DRC) que realizam HD, comparada ao grupo controle (3) Investigar a influência das características morfológicas e neuromecânicas dos membros inferiores dos pacientes com DRC no desempenho do teste de caminhada de seis minutos (TC6’). Participaram da pesquisa 17 pacientes com DRC e 17 sujeitos controle, pareados por idade e características antropométricas. O presente estudo foi dividido em dois capítulos em que foram avaliadas as seguintes variáveis: Capítulo I: 1) perfil bioquímico dos pacientes; 2) nível de atividade física; 3) força dos extensores de joelho, flexores plantares e de preensão manual; 4) espessura muscular dos flexores e extensores do cotovelo, dos extensores de joelho, dos flexores plantares e flexores dorsais do tornozelo; 5) qualidade muscular (força/espessura muscular) do braço, dos extensores de joelho e dos flexores plantares. Os resultados do presente capítulo demonstram que os pacientes com DRC que realizam HD quando comparados ao grupo controle apresentam: 1) menor nível de atividade física; 2) maior tempo despendido sentado durante a semana e o final de semana; 3) nenhuma diferença na força de preensão manual (FPM); 4) menor capacidade de força máxima dos extensores de joelho e flexores plantares; 5) menor espessura muscular dos flexores e extensores de cotovelo, dos extensores de joelho e dos flexores plantares e dorsais; 6) menor qualidade muscular dos membros superiores, extensores de joelho e flexores plantares; Capítulo II: Neste capítulo, o perfil neuromecânico e funcional foi observado a partir das variáveis: 1) taxa de produção de força dos extensores de joelho e flexores plantares; 2) tempo de reação total dos extensores de joelho e do gastrocnêmio medial; 3) atividade elétrica muscular dos extensores de joelho e do gastrocnêmio medial; 4) eficiência neuromuscular dos extensores de joelho e do gastrocnêmio medial; 5) arquitetura muscular do vasto lateral, gastrocnêmio medial, sóleo e tibial anterior. Os resultados do capítulo II demonstram que os pacientes com DRC que realizam HD quando comparados ao grupo controle apresentam: 1) menor taxa de produção de força e eficiência neuromuscular dos extensores de joelho e flexores plantares; 2) maior tempo de reação total dos extensores de joelho e flexores plantares; 3) nenhuma diferença na magnitude da ativação dos músculos extensores de joelho e do gastrocnêmio medial durante a CVMi; 4) menores comprimentos de fascículos relativo (comprimento de fascículo/comprimento da tibia) do gastrocnêmio medial e do sóleo; 5) menor comprimento de fascículo absoluto para o sóleo; 6) menor espessura muscular do vasto lateral, sóleo e tibial anterior; 7) nenhuma diferença no ângulo de penação das musculaturas dos membros inferiores; 8) comprimento de fascículo relativo do gastrocnêmio medial pode influenciar o desempenho do TC6’ em pacientes com doença renal. Tais resultados podem auxiliar médicos, fisioterapeutas e professores de educação física na prescrição do treinamento voltado para cada uma das propriedades (morfológicas e neuromecânicas), uma vez que nosso estudo parece ser um dos primeiros a avaliar de forma sistemática e associada essa plasticidade morfológica e neuromuscular em doentes renais crônicos. / Chronic Kidney Disease (CKD) is characterized by progressive degeneration and irreversible components of the kidney’s structures system. In patients with end-stage renal disease (ESRD) is indicated renal replacement by hemodialysis (HD). This treatment is accompanied by comorbidities such as malnutrition and muscle weakness, which have strong association with decreased functional independence. Thus, this study presents the following objectives: (1) Characterize the muscle morphology in patients with CKD in HD tratment, compared to healthy subjects; (2) To evaluate neuromechanical characteristic of the lower limbs muscle of patients with CKD in HD tratment, compared to healthy subjects (3) To investigate the influence of lower limbs neuromechanics and morphological characteristics of patients with CKD in performance of the six-minute walk (6MWT). They participated in the survey 17 CKD patients and 17 healthy subjects paired for age and anthropometric characteristics. This study was divided into two chapters in which the following variables were evaluated: Chapter I: 1) biochemical profile of patients; 2) level of physical activity; 3) force of knee extensors, plantar flexors and handgrip; 4) muscle thickness of the flexors and extensors elbow, quadriceps, the plantar flexors and ankle dorsal flexosr; 5) quality muscle (force / muscle thickness) of the arm, the knee extensors and plantar flexors. The results of this chapter show that patients with CKD in HD tratment when compared to healthy subjects present: 1) lower level of physical activity; 2) increased time spent sitting during the week and the weekend; 3) no difference in the handgrip; 4) lower capacity of maximum force of the knee extensor and plantar flexors; 5) less muscle thickness of the flexors and extensors elbow, the knee extensors and plantar flexors and dorsal flexors; 6) lower quality muscle of the upper limbs, knee extensor and plantar flexors; Chapter II: In this chapter, the neuromechanics and functional profile was observed from the variables: 1) rate development force production of knee extensors and plantar flexors; 2) reaction time of the knee extensors and the medial gastrocnemius; 3) muscular electrical activity of the knee extensors and the medial gastrocnemius; 4) neuromuscular efficiency of knee extensors and the medial gastrocnemius; 5) muscle architecture of vastus lateralis, medial gastrocnemius, soleus and tibialis. The Chapter II results demonstrate that patients with CKD in HD tratment when compared to healthy subjects present: 1) less rate development force production and neuromuscular efficiency of the knee extensor and plantar flexors; 2) more reaction time of the knee extensor and plantar flexors; 3) no difference in the magnitude of the extensor muscles of the knee and the medial gastrocnemius activation of during CVMI; 4) lower relative fascicles lengths (fascicle length / tibia length) of the medial gastrocnemius and the soleus; 5) shorter length of absolute fascicle for the soleus; 6) less muscle thickness of the vastus lateralis, soleus and tibialis; 7) no difference in penation angle of the lower limbs muscle; 8) relative medial gastrocnemius fascicle length can influence of the 6MWT in performance patients with CKD. These results may help doctors, physical therapists and physical education teachers in the prescription of training focused on each of the properties (morphological and neuromechanics), since our study appears to be among the first to evaluate systematically and associated form that morphologic and neuromuscular plasticity in CKD.

Base teórica: O efeito da vitamina D e análogos sobre a redução da albuminúria na doença renal crônica tem sido demonstrado em estudos clínicos, mas os seus efeitos sobre o podócito glomerular ainda não são claros. Objetivo: Avaliar o efeito da reposição de vitamina D3 sobre a expressão das proteínas associadas ao podócito em pacientes portadores de doença renal crônica (DRC). Métodos: Foram incluídos 27 pacientes portadores de DRC e níveis séricos reduzidos de 25-hidrovitamina D [25(OH)D], com taxa de filtração glomerular estimada (TFGe) entre 15 e 89 ml/min/1,73 m2 e índice proteinúria/creatininúria (IPC) acima de 0,5. Os pacientes receberam reposição de vitamina D3 (colecalciferol) por 6 meses de acordo com o nível sérico de 25(OH)D, sendo mensurados pré e pós tratamento 25(OH)D, TFGe, IPC e outros parâmetros do metabolismo mineral e ósseo. O RNAm de nefrina, podocina, podocalixina, transient receptor potential cation channel 6 (TRPC-6) e dos fatores de crescimento vascular endotelial A (VEGF-A) e transformador beta (TGF-β1) foram quantificados em células do sedimento urinário através da reação em cadeia da polimerase em tempo real, pré e pós reposição de vitamina D3. Os RNAm dos marcadores do podócito foram correlacionados com a 25(OH)D, proteinúria e função renal no período basal e após a intervenção. Resultados: Após 6 meses de suplementação com colecalciferol, a concentração plasmática média da 25(OH)D aumentou de 19  7 ng/mL para 28  11 ng/mL (P = 0.003). A TFGe reduziu -4,71 ml/min/1,73 m2 (p=0,010 vs. basal) e não houve alteração na proteinúria após reposição de vitamina D3, bem como dos parâmetros do metabolismo mineral e ósseo. A 25(OH)D sérica correlacionou-se com a proteinúria, tanto no período basal (r=0,517, p=0,008) quanto após o tratamento (r=0,539, p=0,005). Globalmente, a variação na excreção urinária dos RNAm associados ao podócito após o tratamento não foi estatisticamente significante. Pacientes que atingiram níveis de 25(OH)D ≥20 ng/ml aos seis meses tiveram uma tendência de redução da nefrina [4,48(3,03-5,93) vs. 2,79(1,46-4,12), p=0,085] e da podocina [3,43(2,54-4,32) vs. 2,50(1,21-3,15), p=0,079]; em contrário, no grupo que permaneceu com deficiência de 25(OH)D a podocalixina aumentou significativamente [2,71(2,10- 3,42) vs. 3,63(2,64-4,52), p=0,009] e houve tendência de aumento da nefrina [3,12(2,41-3,10) vs. 4,61(2,83-6,40), p=0,072] e da podocina [3,24(2,37-4,38) vs. 3,83(2,78-4,88), p=0,091)]. Ao final de seis meses, pacientes com melhor nível de função renal (TFGe ≥30 ml/min/1,73 m2) tiveram redução do RNAm de TGF-β1 (p=0,039). Conclusão: A reposição de vitamina D3 (colecalciferol) por seis meses não reduziu a podocitúria ou a proteinúria nestes pacientes com DRC, embora tenha-se observado uma redução marginal no RNAm urinário de nefrina e podocina quando níveis suficientes de 25(OH)D foram atingidos. O uso mais precoce e mais prolongado da vitamina D3 deveria ser investigado como potencial medida de nefroproteção adicional em pacientes renais crônicos. / Background: Previous studies have demonstrated that vitamin D or analog decreases albuminuria in chronic kidney disease (CKD) patients. However, the precise mechanism underlying the potential protective effects of vitamin D on glomerular podocytes is unclear. Objective: In this study we investigated the effect of vitamin D3 supplementation on urinary podocytes protein expression. Methods: Twenty-seven CKD patients who had low baseline vitamin D [25(OH)D] levels, estimated glomerular filtration rate (eGFR) between 15 and 89 ml/min/1,73 m2, and proteinuria/creatininuria index (PCI) higher than 0,5 were studied. During 6 months, all of the patients received cholecalciferol (vitamin D3) supplementation according to 25(OH)D level. Estimated GFR, PCI, 25(OH)D levels, and bone and mineral metabolism parameters were measured at the baseline and after 6 months. In addition, messenger RNA (mRNA) of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6 (TRPC-6), vascular endothelial growth factor A (VEGF-A), and transformig growth factor β1 (TGF-β1) were quantified in urinary sediment cells using real time polymerase chain reaction before and after intervention. The podocyte markers were correlated with 25(OH)D levels, proteinuria and renal function after vitamin D3 supplementation. Results: During cholecalciferol supplementation, the mean 25(OH)D concentration increased from 19  7 ng/mL at baseline to 28  11 ng/mL at month 6 (P = 0.003). Urinary proteinuria did not change after cholecalciferol supplementation. However, eGFR decreased -4.71 ml/min/1.73 m2 (p=0.010 vs. baseline. The serum levels of 25(OH)D were correlated with proteinuria in both periods: baseline (r=0.517, p=0.008) and posttreatment (r=0.539, p=0.005). Patients who reached 25(OH)D levels ≥20 mg/ml at 6 months showed a trend of lower nephrin [4.48(3.03-5.93) vs. 2.79(1.46-4.12), p=0.085] and podocin [3.43(2.54-4.32) vs. 2,50(1.21-3.15), p=0.079]. On the other side, podocalyxin levels increased significantly [2.71(2.10-3.42) vs. 3.63(2.64-4.52), p=0.009] and both nephrin and podocin also increased but these not significant statistically [nephrin: 3.12 (2.41-3.10) vs. 4.61 (2.83-6.40), p=0,072; podocin: 3.24 (2.37-4.38) vs. 3.83 (2.78-4.88), p=0.091)]. After 6 months supplementation, patients with higher levels of renal function (eGFR ≥30 ml/min/1.73 m2) showed reduction of TGF-β1 RNAm (p=0.039). Conclusion: Vitamin D3 (cholecalciferol) supplementation during 6 months did not changed proteinuria level. However, we observed a reduction of urinary nephrin and podocin mRNA in patients who reached sufficient 25(OH)D levels. Larger studies are needed to clarify whether vitamin D3 supplementation, mainly on early stages of CKD, may have beneficial effects on lowering proteinuria and on delaying progression of CKD.