Nephrology nursing requires a specific set of clinical skills and knowledge. When a professional nurse with no previous dialysis experience enters the field of nephrology nursing he or she has no nephrology related paradigms from past experiences to use as a point of reference. As a result of the rapid growth of the private dialysis company experienced over the past 10 years, many management and support service positions became available. Internal promotions resulted in the movement of experienced professional nurses from the clinical field into management and support services positions, resulting in a sudden loss of skilled individuals from the clinical field. To mitigate this effect, a training intervention was started. The newly appointed managers were all required to work in the clinical field for sixteen hours per month to expose the less experienced professional nurses to the more experienced professional nurses in order to assist them with skill acquisition thus enabling the advanced beginner and competent nurse to become a proficient nurse and/or an expert in the field of nephrology nursing. Experiential learning is not a spontaneous process but depends on many factors that could either hinder or facilitate skill acquisition. This study aimed to explore and describe the aspects that facilitate or hinder skill acquisition during the training intervention that was implemented in private chronic haemodialysis units and to write guidelines to optimize skill acquisition during the training intervention. The study followed a quantitative, descriptive, exploratory, contextual, survey design. Data was collected using a tool based on the theory of nursing accompaniment by Kotze, Kolbs theory on experiential nursing, a framework of strategies that facilitate skill acquisition by King and a generalized tool, the Learning Transfer Skills Inventory (LTSI) that was developed by Holton and Bates to measure learning transfer and factors that contribute and hinder training interventions. Data was analysed with the support of a statistician. The findings were reported and discussed in relation to the current literature. Measures were put in place to ensure validity and reliability, and ethical principles were adhered to throughout the study. Guidelines to optimize skill acquisition were developed. The limitations of the study were the sample size and the response rate. There was a paucity in existing research regarding skill acquisition in Nephrology nursing and limited statistical variance amongst the aspects that facilitate or hinder skill acquisition. It is recommended that the guidelines be implemented to measure the impact they have in the organization.

Background: Renal involvement is common in systemic lupus erythematosus (SLE) and can lead to chronic kidney disease (CKD). Diagnosis of lupus nephritis (LN) is dependent on renal biopsy. Due to its invasiveness, repeat renal biopsy for monitoring disease activity is not recommended, thus creating a need for noninvasive and accurate biomarkers. Monocyte chemoattractant protein-1 (MCP-1) and tumour necrosis factor-like weak inducer of apoptosis (TWEAK) have been implicated in the pathogenesis of LN and are thus potential biomarkers for disease activity monitoring. Methods: In this study urinary MCP-1 (uMCP-1) and TWEAK (uTWEAK), together with standard markers of disease activity, were analysed in a cohort of 50 biopsy-proven LN patients at baseline, after sixmonths of induction therapy, and at one-year. Results: Throughout the study there was correlation between uMCP-1 and uTWEAK (r=0.52, p< 0.001). Both biomarkers also correlated with standard of care tests and clinical scores. The median [interquartile range] of uMCP-1 and uTWEAK were significantly increased in the active group when compared to the quiescent group (1440 [683–2729] vs 256 [175–477] pg/mL, p< 0.0001, and 209 [117–312] vs 74 [11– 173] pg/mL, p=0.0008, respectively). After completion of induction therapy in the active group, there was no significant difference in biomarker results between the groups. The sensitivity and specificity for indicating disease activity was 95% and 73% for uMCP-1 (area under curve [AUC]=0.875), and 60% and 90% for uTWEAK (AUC=0.783), respectively. Conclusion: uMCP-1 and uTWEAK reflect LN disease activity, and correlate with standard of care biomarkers in a South African cohort. Further studies are needed to assess additional clinical benefit.

<p>2022-03-23</p>

The proximal tubule of the renal cortical nephron is highly susceptible to intoxication by chemical agents. An in vitro system was developed to study directly the effects of nephrotoxic chemicals on this renal sub-organ fraction without the complication of extrarenal factors. Segments of proximal tubules were isolated by a mechanical method from the kidneys of young rabbits. Tubules obtained by this method retained biochemical, functional, and morphological features comparable to those existing in vivo. Preliminary acute susceptibility studies demonstrated that the isolated proximal tubule segments were sensitive to a variety of known nephrotoxic agents that target the proximal tubule. These agents include halogenated hydrocarbons, heavy metals, and a halogenated vinyl cysteine conjugate. Incubation conditions were optimized to maintain the viability of proximal tubule suspensions for up to four hours. Longer incubation times made it possible to establish a chronology of early tubule responses to chemical intoxication. Long term incubation of proximal tubule suspensions with two model nephrotoxins, cadmium chloride and S-(trans-1,2-dichlorovinyl)-L-cysteine, produced in vitro tubule response patterns similar to those reported in vivo for these agents. While not entirely representative of in vivo exposure conditions, suspensions of isolated proximal tubules are an easily obtained system that proved equally applicable as a screening technique for nephrotoxic compounds or as an in vitro system for delineating proximal tubule response to chemical insult.

Introduction: In Peru there are different hospitals and university programs for training of specialists in nephrology. Objective: To assess the perception of physicians who attend such programs. Methods: We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Results: Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. Conclusion: The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O elevado consumo de sÃdio na dieta tem aumentado consideravelmente nas Ãltimas dÃcadas, promovendo o desenvolvimento de diversas doenÃas crÃnicas, como hipertensÃo arterial, acidente vascular cerebral e doenÃas coronarianas. PeptÃdeos como a urodilatina (UD) e uroguanilina (UGN) tÃm sido implicados na regulaÃÃo da homeostase de sal e Ãgua. PorÃm, os mecanismos de regulaÃÃo ainda nÃo foram bem esclarecidos, assim como suas interaÃÃes na funÃÃo renal. O objetivo desse trabalho à estudar os principais efeitos dos peptÃdeos UD e UGN em rins de ratos submetidos a alta ingestÃo de NaCl. Os efeitos foram examinados usando ratos Wistar mantidos por 10 dias em gaiolas metabÃlicas. O grupo controle recebeu somente Ãgua destilada, enquanto que o grupo tratado recebeu 2% de soluÃÃo de NaCl. A funÃÃo renal foi avaliada atravÃs da perfusÃo de rim isolado de ratos. Os dados foram comparados atravÃs de teste t de Student e ANOVA, com significÃncia de 5%. A UD promoveu reduÃÃo da pressÃo de perfusÃo, resistÃncia vascular renal e fluxo urinÃrio, foi observado tambÃm aumento da excreÃÃo de sÃdio e cloreto, sendo as alteraÃÃes mais proeminentes ao nÃvel distal. Contudo, apÃs tratamento com sal os efeitos da UD nÃo foram vistos, observou-se um aumento transporte de sÃdio e cloreto mais pronunciado ao nÃvel proximal. Os efeitos da UGN tambÃm foram avaliados na presenÃa do sal, onde foram observados a elevaÃÃo da pressÃo de perfusÃo, fluxo urinÃrio e ritmo de filtraÃÃo glomerular; seguido de aumento na excreÃÃo de sÃdio e cloreto, principalmente ao nÃvel de tÃbulo proximal. Os resultados tambÃm demonstraram a expressÃo aumentada de mRNA do receptor GC-C e uma discreta reduÃÃo na expressÃo de GC-A em ratos tratados com sal. ApÃs uma ingestÃo aumentada de sal, sÃo ativadas vias fisiolÃgicas muito bem reguladas no objetivo de eliminar o excesso de sÃdio. A UGN parece ser o hormÃnio primordial envolvido nessa via, contudo a UD apresentam tambÃm participaÃÃes nesse processo. O receptor GC-C està diretamente envolvido na regulaÃÃo desses processos fisiolÃgicos

Hemodialysis induces various symptoms in many patients. However, the type of dialysis symptoms induced and how they contribute to recovery time remains unclear. This study aims to understand patient experiences reporting dialysis recovery time and associated symptoms using three separate novel instruments developed for this study. We conducted a 13-week prospective cohort study in prevalent in-center hemodialysis patients and measured their recovery time using three instruments. Instrument A inquired how long it took to recover from the last dialysis treatment. Instrument B inquired recovery time from last treatment for each of 10 specified symptoms and Instrument C included symptom severity to Instrument B. Each instrument was used for each dialysis treatment for one week. We compared patient response and distribution of recovery time found with each instrument using mixed-effects logistic regression models. 118 participants were recruited from two centres of which 914 (86%) of 1062 expected responses were completed. Recovery time using instrument A resulted in more participants identifying some recovery time from dialysis (83 to 86%) as compared with Instrument B (66 to 80%, p = 0.001) and Instrument C (69 to 73%, p <0.001). The third visit of the week was associated with fewer patients reporting recovery time (p = 0.036). However, Instrument B (p = 0.016) and Instrument C (p < 0.001) showed a longer recovery time compared to the distribution of recovery time of Instrument A. Lack of energy was the most common symptom following dialysis (69 to 77% of all patients). Recovery time with Instrument A was a significant predictor of kidney-specific component scores and mental component score as measured by the Kidney Disease Quality of Life-36 instrument. Recovery time is complex, and includes different symptoms that vary in duration. Attempts to reduce recovery time may impact specific symptoms differentially. / Thesis / Master of Science (MSc)

Diabetic nephropathy (DN) is a complication associated with diabetes and is characterized by proteinuria and a progressive loss of kidney function. The disease morphologically manifests as an increase in the extracellular matrix (ECM) produced by kidney cells including specialized mesangial cells found in the kidney glomeruli. The mesangial cells undergo increased proliferation and hypertrophy, produce ECM components at an elevated rate and in turn the ECM itself is broken down at a reduced rate. This leads to fibrosis, or the scarring of the glomeruli. The process of fibrosis is known to be promoted by pro-fibrotic factors such as transforming growth factor beta-1 (TGF-β1), which is activated by various proteins including thrombospondin-1 (TSP-1). Both of these proteins are known to have an increased rate of expression and activation in a high glucose environment and in the kidneys of diabetic patients. Glucose-regulate protein 78 (GRP78) is another protein altered by high glucose, as it is translocated to cell surface in DN (cell surface GRP78, csGRP78). In this study, we investigate the role csGRP78 has in the regulation of TSP-1 and downstream signaling by high glucose, using primary rat mesangial cell cultures. Our results confirm that TSP-1 protein levels are increased in the cell lysate and in the ECM of cells treated with high glucose. We further show that inhibitors of csGRP78 and downstream PI3K/Akt reduce the high glucose-induced increase in TSP1 at both protein and transcript levels, and attenuate TGF-β1 signaling. / Thesis / Master of Science (MSc) / Diabetic nephropathy is a condition that is associated with a gradual loss of kidney function as well as the presence of protein in the urine. As the name implies, diabetic nephropathy occurs as a result of diabetes mellitus. The disease causes the mesangial cells in the kidney to produce excess extracellular matrix leading to scarring in the kidney, a process called fibrosis. One of the key fibrotic proteins is called transforming growth factor beta-1 (TGF-β1), stored in a latent form. A major activator of TGF-β1 is thrombospondin-1 (TSP-1). Our results demonstrate that the cell surface localization of glucose regulated protein 78 (GRP78) is required for the upregulation of TSP-1 in a high glucose environment, leading to activation of profibrotic pathways that are well known to perpetuate the fibrotic phenotype seen in diabetic nephropathy.

Orientador: Maria Lúcia Gomes Lourenço / Resumo: A doença renal crônica (DRC) é uma alteração com elevada casuística na clínica de pequenos animais, caracterizada por lesão irreversível dos néfrons. Muitos avanços foram realizados na conduta terapêutica do paciente nefropata na clínica de cães e gatos, dentre estes, a instituição da hemodiálise intermitente (HDI), representando um tratamento suporte importante. Em medicina, muitos indicadores relacionados ao risco de mortalidade têm sido explorados, dentre eles a variabilidade da frequência cardíaca (VFC), a dispersão da onda P, bem como a dispersão do intervalo QT já muito estudados, inclusive em pacientes submetidos à hemodiálise. O objetivo do presente estudo consistiu em avaliar a VFC, bem como descrever o perfil arritmogênico de cães portadores de DRC IV submetidos à HDI e compará-los a cães portadores de DRC IV submetidos apenas ao tratamento clínico e a cães saudáveis. Foram utilizados 30 cães, de ambos os sexos, de variadas idades e raças, pesando entre 15 a 30 kg. Os animais foram divididos em três grupos, sendo o grupo I (controle) –com 10 cães saudáveis, grupo II (tratamento clínico) –com 10 cães com DRC em estádio IV, submetidos ao tratamento clínico, duas vezes por semana e grupo III (HDI) –com 10 cães com DRC IV, submetidos, ao tratamento clínico e dialítico, duas vezes por semana. As análises clínicas, laboratoriais, índices de VFC e parâmetros eletrocardiográficos, bem como as dispersões do intervalo QT e onda P foram realizadas nos dois grupos de DRC IV, an... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Chronic kidney disease (CKD) is an alteration with high casuistry in the small animal clinic, characterized by irreversible damage of the nephrons. Many advances have been made in the therapeutic management of the nephropathic patient in the clinic of dogs and cats, among them, the institution of intermittent hemodialysis (IHD), representing an important support treatment. In medicine, many indicators related to mortality risk have been explored, including heart rate variability (HRV), P-wave dispersion, as well as the dispersion of the QT interval already widely studied, including in patients undergoing hemodialysis. The objective of the present study was to evaluate the HRV, as well as to characterize the arrhythmogenic profile of dogs with CKD stage IV undergoing IHD and to compare them to dogs with CKD stage IV submitted only to clinical treatment and to healthy dogs. Thirty dogs of both sexes, of varying ages and races, weighing between 15 and 30 kg were used. The animals were divided into three groups, group I (control) - 10 healthy dogs, group II (clinical treatment) - 10 dogs with CKD IV, submitted to clinical treatment twice a week and group III (IHD) - 10 dogs with CKD IV, submitted, in addition to clinical treatment, to dialysis treatment, with intermittent hemodialysis, twice a week. Clinical, laboratory, HRV indexes and electrocardiographic parameters as well as QT and P-wave dispersions were performed in both CKD groups, prior to and after the end of each clinic... (Complete abstract click electronic access below) / Doutor

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