Orientador: Luis Cuadrado Martin / Coorientador: Fernando Antonio de Almeida / Resumo: Introdução: as doenças cardiovasculares representam a maior causa de mortalidade nos pacientes renais crônicos antes e após o transplante renal, dentre elas a doença coronariana apresenta destaque especial. Preditores de risco tem sido usados no seu diagnóstico que é desafiador. Poucos trabalhos validaram preditores clínicos de seleção para exames invasivos para o diagnóstico de doença arterial coronariana (DAC) antes do transplante renal.Objetivo: avaliar a frequência e poder discriminatório de preditores clínicos da presença da doença arterial coronariana em pacientes renais crônicos em programa de diálise candidatos ao transplante renal, avaliar a performance da fórmula de Gowdak e colaboradores de risco de doença arterial coronariana e verificar a associação entre doença arterial coronariana e desfechos no grupo estudado.Métodos: foram analisadas as cinecoronariografias de candidatos ao transplante renal de dois centros de transplante renal do estado de São Paulo, realizadas entre março de 2008 e abril de 2013. Foi realizado estudo transversal para verificar o poder preditivo de parâmetros clínicos para a presença de doença coronária significativa (estenose ≥70% em uma ou mais artérias epicárdicas ou ≥ 50% no tronco da coronária esquerda). Adicionalmente, verificou-se o poder discriminatório de um escore clínico de risco previamente estabelecido (que leva em conta presença de diabetes melito (DM), idade e manifestações clínicas de doença cardiovascular). Foi realizado... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cardiovascular diseases are major causes of mortality in chronic renal failure patients before and after renal transplantation. Among them, coronary disease presents a special emphasis. Predictors of risk for coronary artery disease has been used for its diagnosis. Few studies have validated clinical predictors to selection patients for invasive procedures for the diagnosis of coronary artery disease (CAD) before renal transplantation. Objective: this study evaluated the frequency and discriminatory power of clinical predictors of coronary artery disease in chronic renal failure patients undergoing dialysis who were renal transplant candidates, assessed a previously developed scoring system (Gowdak et al.) for coronary artery disease, and we also checked the association between coronary artery disease and outcomes of the study group. Methods: coronary angiographies conducted between March 2008 and April 2013 from candidates for renal transplantation from two transplant centers in São Paulo state were analyzed. Cross-sectional study was conducted to verify the predictive power of clinical parameters for the presence of significant coronary artery disease (≥70% stenosis in one or more epicardial artery or ≥ 50% in the left main coronary artery). In addition, the discriminating power of a previously established clinical risk score was assessed (which takes account of diabetes mellitus (DM), age and clinical manifestations of cardiovascular disease). It was also conducted observational longitudinal study and drew up survival curves according to the angiographic diagnosis to verify the association between the presence of coronary heart disease and outcomes. Results: we screened 128 patients, of which 23 were excluded. The prevalence of coronary atheromatosis of any grade was 60/105 (57%) and significant coronary atheromatosis was 30/105 (29%) in the... (Complete abstract click electronic access below) / Doutor

Risk adjustment models are used to predict health care costs of insurees and represent an important part of mechanisms for redistribution of funds among insurance companies. In the Czech Republic, pharmacy-based cost groups (PCGs) were introduced into the risk adjustment model in 2018, reflecting the costs of chronic diseases in addition to age and gender. The thesis reviews the model for the most expensive chronic disease - renal failure. Using the sample of General Health Insurance fund (GHI) insurees reported with typical health care consumption for kidney disease in years 2015-2018, we tested the current model and subsequently modified the classification criteria for PCG "renal failure". The classification based on the number of dialysis procedures proved to be much better indicator of costs than the currently used consumption of typical drugs. The incorporation of dialysis-based approach into the PCG model improved the explained variation from 26 % to 49 %, and the predictive power increased substantially. The study suggests improvements of the Czech risk adjustment model and proposes a fairer fund redistribution among insurance companies, while no additional data collection is needed.

Objective: Studies have shown that iodinated radiocontrast use is associated with acute renal failure especially in the presence of chronic kidney disease and multiple factors modulate this risk. The purpose of this meta-analysis is to compare the incidence of renal failure requiring hemodialysis between transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement using the Edwards valve. Methods: The PubMed database was searched from January 2000 through December 2014. A total of 10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR procedures using the Edwards valve were included. Variables of interest were baseline logistic EuroSCORE, prevalence of diabetes mellitus, hypertension, peripheral arterial disease, chronic kidney disease and amount of contrast used. The primary endpoint was incidence of renal failure requiring hemodialysis. The odds ratio and 95% CI were computed and P < 0.05 was considered as the level of significance. Results: The logistic EuroSCORE was significantly higher in TA compared to TF (P = 0.001) TAVR. The amount of contrast (mL) used was significantly higher in the TF group compared to the TA group (mean difference: 36.9, CI: 25.7-48.1, P < 0.001). The incidence of hemodialysis following the procedure was significantly higher in the TA group compared to TF group (odds ratio = 4.3, CI: 2.4-7.8, P < 0.00001). Conclusions: This meta-analysis suggests that despite the lower amount of contrast used in TA-TAVR, the incidence of renal failure requiring hemodialysis was higher with the Edwards valve. This suggests that the incidence of renal failure requiring hemodialysis after TAVR is associated with baseline comorbidities in the TA-TAVR group rather than the volume of contrast used.

NSAIDs depress prostaglandins synthesis through inhibition of COX-1 that is involved in maintaining cell integrity and COX-2 that, although presents particularly in the kidneys, is overexpressed in response to inflammation. Both the beneficial and side effects of NSAIDs are, therefore, through their inhibition of COX enzymes. Introduction of COX-2-selective inhibitors has improved the safety profile of the drugs with regard to their most common side effect which occurs at the gastrointestinal level but has not rendered them less cardio-nephrotoxic. Renal side effects of NSAIDs are rare, sometimes transient and often reversible upon drug withdrawal. The incident rate and the severity of the renal side effect, however, increase in patients with risk factors such as those with diabetes, heart failure, renal dysfunction and in the elderly. The side effects range from electrolyte retention and reduce glomerular filtration to nephritic syndrome and chronic renal failure. These effects are shared among NSAIDs with evidence of dose and exposure dependency. There is no known predictor for the nephrotoxicity. However, a relationship has been found between high plasma concentration and the renal adverse effect of NSAIDs. The usefulness of therapeutic drug monitoring in patients with risk factors needs to be explored.

Bakgrund: Kronisk njursvikt ger påverkan på både den fysiska, psykiska och sociala hälsan. Den fysiska ohälsan kräver dialysbehandling för att personen ska överleva. Hemodialys är en vanlig form av dialysbehandling och är både en tids- och energikrävande process. Intermittent dialys tar flera timmar i veckan och medför ytterligare påverkan på fysisk, psykisk och social hälsa.  Syfte: Att utforska hur personer över 18 år med kronisk njursvikt upplever sin fysiska, psykiska och sociala hälsa när de lever med intermittent hemodialys. Metod: En litteraturöversikt med deskriptiv design. Elva stycken originalartiklar med kvalitativ ansats inkluderades. Databaserna som användes var Psycinfo, Cinahl och Pubmed. Huvudresultat: Under resultatanalysen framkommer sex kategorier; symtom, positiva känslor, negativa känslor och relationer som fördelades under de tre hälsoområdena; fysisk, psykisk och social hälsa. Resultatet visade att det fanns både negativa och positiva upplevelser involverade kring den fysiska, psykiska och sociala hälsan. Den fysiska hälsan upplevdes påverkad både under, efter och mellan behandlingarna gällande bland annat svaghet, fatigue och försämrad sömnkvalitet. Gällande det psykiska upplevdes både positiva och negativa känslor samt känsla av förlust av bland annat självständighet och livslust. Den sociala hälsan blev också påverkad av behandlingen då relationer och det vardagliga livet förändrades drastiskt. Slutsats: Utifrån resultatet kunde slutsatsen dras att hemodialysbehandling till följd av kronisk njursvikt påverkar den fysiska, psykiska och sociala hälsan både positivt och negativt. Med kunskap om dessa erfarenheter kan sjuksköterskan optimera omvårdnaden för personer som genomgår hemodialysbehandling. / Background: Chronic kidney failure affects physical, mental and social health. Physical illness requires dialysis for survival. Hemodialysis is a common form of dialysis treatment and is both a time- and energy-consuming process. Intermittent dialysis takes several hours a week and entails additional impact on physical, psychological and social health. Aim: To explore how people over 18 years of age with chronic renal failure experience their mental, physical and social health when living with intermittent hemodialysis. Method: A literature review with descriptive design. Eleven original articles with a qualitative approach were included. The databases used were Psycinfo, Cinahl and Pubmed. Main findings: During the results analysis, six categories emerge; symptoms, positive emotions, negative emotions, relationships, family and friends, which were distributed under the three health domains; physical, mental and social health. The result showed that there were both negative and positive experiences involved in physical, mental and social health. The physical health was perceived to be affected both during, after and between the treatments regarding, among other things, weakness, fatigue and reduced sleep quality. Regarding the psychological, both positive and negative emotions were experienced, as well as a sense of loss of, among other things, independence and zest for life. Social health was also affected by the treatment as relationships and everyday life changed drastically. Conclusion: Based on the results, the conclusion could be drawn that hemodialysis treatment as a result of chronic kidney failure affects physical, mental and social health both positively and negatively. Such experiences will lead to increased knowledge for nurses and optimize the care given to people undergoing hemodialysis.

INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...

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Hyperacute renal failure is rarely the initial presentation of systemic lupus erythematosus (SLE). Pregnancy can predispose untreated lupus nephritis to acute renal failure. Collapsing glomerulopathy (CG) type of renal failure is not a new clinicopathological entity. There have been documented cases prior to 1979. It is thought that detection bias coupled with the predilection for HIV has caused this form of glomerulopathy to be incorrectly named or diagnosed as 'malignant focal segmental glomerulosclerosis (FSGS)'. This is a case of CG described in lupus nephritis. We present a case of untreated lupus in a female in whom pregnancy triggered the exacerbation of lupus nephritis that presented as collapsing glomerulopathy.

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