Orientador: Luciana Patrícia Fernandes Abbade / Resumo: O prurido urêmico é uma complicação frequente em pacientes renais crônicos, com impacto na qualidade de vida. Sua etiopatogênese é multifatorial e as evidências para o tratamento com emolientes, anti-histamínicos orais e drogas de ação no sistema nervoso central, como a gabapentina, são limitadas. Objetivos: 1- verificar a prevalência de prurido urêmico e seus fatores associados; 2- avaliar a eficácia na redução do prurido urêmico com a terapia tópica com cold cream após 15 dias e 3-comparar a eficácia e segurança da gabapentina versus dexclorfeniramina na redução do prurido urêmico em um período de 21 dias. Métodos: A pesquisa foi realizada entre abril de 2014 a fevereiro de 2016. Inicialmente para atender ao objetivo 1, foi realizado estudo transversal e prospectivo com pacientes em hemodiálise (etapa 1). Os dados foram obtidos por meio de prontuário eletrônico e pela aplicação de questionário estruturado. Os pacientes que relataram prurido foram convidados a participar da etapa 2 para atender ao objetivo 2, sendo este uma série de casos com seguimento longitudinal não-comparativo, no qual os pacientes receberam cold cream para uso por 15 dias. Foram avaliados a intensidade do prurido através da Escala Visual Analógica (EVA), qualidade de vida (DLQI), número de topografias corporais afetadas, período do prurido e relatório de efeitos adversos. Ao final desta fase, para atingir o objetivo 3, os pacientes (60) que ainda se queixavam de prurido de qualquer intensidade iniciara... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Uremic pruritus is a frequent complication in chronic renal patients, with an impact on quality of life. Its etiopathogenesis is multifactorial and as evidence for treatment with emollients, oral antihistamines and drugs with central nervous system action such as gabapentin are limited. Objectives: 1- to verify the prevalence of UP and its associated factors; 2- evaluate the effectiveness in reduction of uremic pruritus with topical therapy with cold cream after 15 days and 3- evaluate the efficacy and safety of gabapentin vs. dexchlorpheniramine in reducing the uremic pruritus after 21 days. Methods: The study was carried out between April 2014 and February 2016. Initially to reach objective 1, a cross-sectional and prospective study was performed with patients undergoing hemodialysis (stage 1). The data were obtained by electronic medical record and by the application of a structured questionnaire. Patients who reported pruritus were invited to participate in stage 2 to reach objective 2, a series of cases with non-comparative longitudinal follow-up, in which the patients received cold cream for apply for 15 days. The intensity of pruritus was evaluated by the Visual Analogue Scale (VAS), and also the quality of life questionnaire (DLQI), number of affected topographies, pruritus period and adverse effects were assessed. At the end of this phase, to reach the objective 3, patients (60) with any intensity of pruritus were included in stage 3, where they were randomized to re... (Complete abstract click electronic access below) / Doutor

Uremic pruritus (UP) arises in end-stage renal disease (ESRD) and is not relieved by proper dialysis. While the pathogenesis of UP is not well understood, UP responds poorly to anti-histamines. We performed a case-control study to test if cutaneous protease-mediated, non-histamine itch is augmented in UP, and if UP is associated with altered epidermal and/or papillary dermal innervation. We recruited 12 hemodialysis subjects with ESRD-specific itch (cases) (Visual Analogue Scale (VAS)-average itch in the preceding week, 78/100), and 13 age- and sex-matched hemodialysis subjects without pruritus (controls) (VAS- average itch in the preceding week, 0/100; p<0.0001 cases vs. controls). Cowhage spicule-induced itch was induced in the back where all subjects exhibited itch, and the entire duration of itch was measured with the general Labeled Magnitude Scale. Subsequently, a punch biopsy was taken from this sensory-tested skin and multi-label immunohistochemistry was performed to measure epidermal and papillary dermal innervation. In cases vs. controls, cowhage-induced area under the curve (AUC) for itch was significantly larger (median, 25%–75%: 175.4, 101.0–252.2 vs. 42.4, 24.0–160; p=0.04) as was perceived peak itch intensity (53.6, 53.3–78.9 vs. 34.2, 20.9–55.6; p=0.02). Cases showed a significant reduction in papillary dermal nerve length (PDNL)/mm epidermis (2295, 1659–2970 vs. 2909, 2228–3523; p=0.003), resulting from the loss of papillary dermal (PD)-calcitonin gene related peptide (CGRP) (+) nerves (p<0.0001), with preservation of %PD-substance P (+) nerves (p=0.1) and intraepidermal nerve fiber density (p=0.1). VAS-average itch in the preceding week negatively correlated with PDNL/mm epidermis (correlation coefficient (CC)=-0.53, p=0.003) and %PD-CGRP (+) nerves (CC=-0.37, p=0.03). Cowhage-induced AUC-itch negatively correlated with %PD-CGRP nerves only in cases (CC=-0.40, p=0.02). Our data suggest augmented protease-dependent signaling contributes to UP and indicate a mechanism for how PD-CGRP (+) nerve loss contributes to UP and augmented cowhage-itch: loss of an afferent skin-derived itch-inhibition signal to the spinal cord dorsal horn. / 2016-10-02T00:00:00Z

Bakgrund: Kronisk njursvikt innebär att njurens funktioner gradvis minskar och blir nedsatta över tid, vilket kräver dialysbehandling i flera omgångar. Några av symtomen som kan uppstå i samband med kronisk njursvikt är bland annat klåda. Uremisk klåda kan besväras av både fysiskt och psykiskt då det bidrar till sår, ökad trötthet, försämrad livskvalitet. Lidande och obehag som orsakade av uremisk klåda kan ytterligare leda till depression och ångest. Det är därför viktigt att sjuksköterskor kan bemöta och hjälpa patienter som lider av uremisk klåda att lindra symtomen. Syfte: Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder för att lindra uremisk klåda vid kronisk njursvikt Metod: Litteraturöversikten med tolv vetenskapliga artiklar. Databaserna PubMed och CINALH complete användes. Artiklarna analyserades med hjälp av Fribergs analysmodell. Resultat: I resultatet framkom fem teman; (1) Aromaterapi, (2) Termisk terapi, (3) Akupressur, (4) Krämer och (5) Övriga metoder. Dessa fem teman har visat vara effektiva för att lindra uremisk klåda. Slutsats: Sammanfattningsvis har aromaterapi, termisk terapi, akupressur, krämer och övriga omvårdnadsåtgärder visat sig verkande lindrande på uremisk klåda. Genom att tillämpa dessa omvårdnadsåtgärder kan det ytterligare bidra till bättre sömnkvalitet samt livskvalitet för patienterna som lider av uremisk klåda. Dessutom är omvårdnadsåtgärder kostnadseffektiva alternativ gentemot medicinska behandlingen. / Background: Chronic kidney failure means that the kidney's functions gradually decrease and become impaired over time, which requires dialysis treatment several rounds. Some of the symptoms that can occur in connection with chronic kidney failure is itching. Uremic itching can be troublesome both physically and psychologically as it contributes to ulcers, increased fatigue and reduced quality of life. Pain and discomfort caused by uremic pruritus can further lead to depression and anxiety. Therefore, it is necessary that nurses can address and help patients that are suffering from uremic pruritus to relieve the symptoms. Aim: The aim was to describe nurses care measure to treat pruritus in patients with chronic kidney failure. Method: The litterature review based on twelve scientific articles. The databases Pubmed and CINALH complete were used. The scientific articles were analyzed using Friberg´s model. Results: The results showed five themes; (1) Aromatherapy, (2) Thermal therapy, (3) Acupressure, (4) Creams and (5) Other methods. These five themes have been shown to be effective in relieving uremic pruritus. Conclusion: In conclusion, aromatherapy, thermal therapy, acupressure, creams and other methods have been shown to be working in treating uremic pruritus. By applying these nursing interventions can it further contribute to better quality of sleep and quality of life for patients that are suffering from uremic pruritus. Furthermore, are nursing interventions cost-effective alternatives to medical treatment.