Camila Lima

Introduction: The aim of this study was to investigate the impact of canagliflozin on AKI caused by ischemia-reperfusion injury (IRI) in non-diabetic rats. Methods: Male Wistar rats weighing 250-300g were randomized into four groups: SHAM (rats subjected to sham renal ischemia-reperfusion surgery); CANA (canagliflozin by gavage, 200mg/kg, once, daily, 5 days); I/R: rats subjected to I/R- AKI (bilateral renal hilum clamping, 30 minutes); CANA+I/R: I/R rats that received canagliflozin 5 days prior to I/R. Evaluated parameters: renal function (serum creatinine [CrS], inulin clearance [inCl]; renal hemodynamics (mean arterial pressure [MAP], renal blood flow [RBF], renal vascular resistance [RVR]); redox profile (urinary peroxides, lipid peroxidation, urinary nitrate, renal tissue thiols and nuclear factor erythroid 2-related factor 2 [Nrf2] protein expression), western blot for identification of SGLT2 in the kidneys and renal histology. Results: Western blot essays confirmed the presence of SGLT2 in the kidneys. Regarding renal function in the animals subjected to IRI, an increase in CrS and a reduction in inCl were observed, while the group treated with CANA showed a reduction in CrS and an increase in inCl, demonstrating improved renal function after CANA treatment. Besides, canagliflozin pretreatment induced an improvement in renal hemodynamics and redox profile. Renal histology showed an increase in the tubular injury score in the IRI group, while canagliflozin was able to reduce tubular injury and inflammation in treated animals. Conclusion: Canagliflozin treatment prevented IRI-AKI, considering the methods employed in this study.

Introduction: Acute kidney injury (AKI) is a common complication in the intensive care unit. Urine-1 (U-1) is a frequently overlooked tool for assessing AKI; moreover, there is no evidence-based consensus on its use. This study aimed to investigate the role of U-1 and urinary microscopy (UM) in diagnosing severe AKI and the need for renal replacement therapy (RRT) in patients undergoing liver transplantation (LT). Method: Our hypothesis was to determine whether the urinary parameters available in U-1 and UM are associated with the diagnosis of severe AKI and the need for RRT. We evaluated U-1 and UM 6 hours after LTx. The criterion for diagnosing AKI was based on Kidney Disease Improving Global Outcomes (KDIGO) guidelines, relying solely on serum creatinine levels within one week. Results: Eighty-seven patients developed AKI in the first week after LT. The diagnosis of severe AKI (KDIGO 2 and 3) was found in 59 patients. Six hours after LT, the variables in U-1 were predictors of severe AKI, with the area under the curve (AUC) of 0.65 for proteins, 0.68 for leukocytes, and 0.63 for erythrocytes. In determining RRT, these variables performed better with AUC: 0.72 for proteins, 0.69 for leukocytes, and 0.68 for erythrocytes. The non-AKI and AKI groups showed a similar distribution in UM. Conclusion: Simple and commonly used parameters in clinical practice, such as proteinuria, erythrocyturia, and leukocyturia, can be valuable tools for diagnosing severe AKI and the need for RRT.

Introdução: A injúria renal aguda (IRA) é uma complicação comum na unidade de terapia intensiva. A urina-1 (U-1) é uma ferramenta frequentemente esquecida para avaliar IRA e, além disso, não existe um consenso baseado em evidências sobre seu uso. O objetivo do estudo foi investigar o papel da U-1 e da microscopia urinária (MU) no diagnóstico da IRA grave e a necessidade de terapia de substituição renal (TSR) em pacientes submetidos ao transplante hepático (TH). Métodos: Nossa hipótese foi determinar se os parâmetros urinários disponíveis, U-1 e MU, estão associados ao diagnóstico da IRA grave e à necessidade de TSR. Avaliamos U-1 e MU em 6 horas após o TH. O critério utilizado para o diagnóstico da IRA foi o Kidney Disease Improving Global Outcomes (KDIGO), baseado apenas na creatinina sérica em 1 semana. Resultados: Oitenta e sete pacientes desenvolveram IRA na 1ª semana após o TH. O diagnóstico de IRA grave (KDIGO 2 e 3) foi encontrado em 59 pacientes. Seis horas após o TH, as variáveis na U-1 foram preditoras de IRA grave, com área sob a curva [area under the curve (AUC)]: 0,65 para proteínas, 0,68 para leucócitos e 0,63 para eritrócitos. Na determinação de TSR, essas variáveis tiveram melhor desempenho com AUC: 0,72 para proteínas, 0,69 para leucócitos e 0,68 para eritrócitos. Os grupos não IRA e IRA apresentaram distribuição semelhante na MU. Conclusão: Parâmetros simples e usuais na prática clínica, como proteinúria, eritrocitúria e leucocitúria, podem ser ferramentas valiosas para o diagnóstico da IRA grave e da necessidade de TSR.

Introdução: A equipe de enfermagem desempenha um papel crucial na liderança dos procedimentos como a Terapia de Suporte Renal Contínuo (TSRC) em pacientes com injúria renal aguda (IRA), tornando essencial a aplicação do Processo de Enfermagem (PE) nesse contexto. Objetivo: Identificar, no PE, os principais diagnósticos de enfermagem (DE) conforme a taxonomia da North American Nursing Diagnosis Association - International (NANDA-I), os resultados de enfermagem (RE) de acordo com a Nursing Outcomes Classification (NOC) e as intervenções de enfermagem (IE) de acordo com the Nursing Interventions Classification (NIC). Métodos: Pesquisa prospectiva, transversal, realizada na UTI adulto de um hospital de São Paulo. Foram incluídos pacientes com idade maior ou igual a 18 anos, em uso de TSRC, internados na UTI de agosto a novembro 2022. Foram realizados exame físico e coleta de dados a partir do prontuário eletrônico e realizado o PE. A pesquisa foi aprovada pelo Comitê de Ética (CAAE: 55695322.4.0000.0071). Resultados: A amostra foi composta por 42 pacientes, sendo 27 (64,3%) do sexo masculino com idade média de 65,24 anos (DP 19,58). Em relação aos DE NANDA foram: risco de perfusão tissular periférica ineficaz, perfusão tissular renal ineficaz, risco de volume de líquidos desequilibrado, volume de líquidos excessivo, risco de desequilíbrio hidroeletrolítico, risco de infecção, risco de sangramento e síndrome do idoso frágil. Os RE NOC foram: Função renal; Eliminação urinária; Gravidade da sobrecarga hídrica, Equilíbrio hídrico; Equilíbrio eletrolítico e ácido-base; Acesso para hemodiálise; Coagulação sanguínea e Ambiente de cuidado à saúde seguro. As IE NIC foram: Controle hídrico, Controle acidobásico, Controle de eletrólitos, Terapia por hemodiálise, Controle de hipervolemia, Controle hídrico, Monitorização hídrica, Controle acidobásico, Controle de eletrólitos, Promoção contra infecção, Controle de infecção, Manutenção de acesso para diálise, Prevenção do choque, Precauções contra sangramento, Assistência no Autocuidado: atividades essenciais da vida diária, Controle do Ambiente: conforto, Controle do delírio, Controle da nutrição e Posicionamento. Conclusão: A análise dos diagnósticos, resultados e intervenções de enfermagem contribui significativamente para a melhoria da qualidade da assistência prestada, visando a segurança, o conforto e a recuperação dos pacientes em situações clínicas desafiadoras como a injúria renal aguda.

Introdução: A disfunção renal é comum após transplante de fígado (LT). No entanto, o diagnóstico diferencial pode ser desafiador, especialmente na identificação de pacientes com síndrome hepatorrenal e doença renal crônica para alocação de transplante duplo de fígado e rim. Objetivo: Avaliar a combinação de BM tradicionais com novos BM podem ajudar a predição da doença renal crônica (DRC). Métodos: Amostras de plasma (P) e urina (U) foram coletadas no pré-operatório e no pós-operatório (PO) para analisar BM tradicionais com BM novos (pro-encefalina - PENK, cistatina C - CYS-C, interleucina-18 - IL-18, molécula-1 de lesão renal - KIM-1, lipocalina associada à gelatinase de neutrófilos - NGAL, alfa 1 microglobulina - a-1M, proteína de ligação a ácidos graxos tipo fígado - L-FABP, glutationa S-transferases - GST-p, proteína-1 quimiotática de monócitos - MCP-1, inibidor de metaloproteinase-1 de tecido - TIMP-1, uromodulina – UMOD). O diagnóstico de DRC foi baseado nos níveis de Scr e a TFGe calculada pela fórmula CKD-EPI. Resultados: Dos 100 pacientes inscritos, dezessete apresentaram DRC no pré-LT, sendo 14 - KDIGO3, 2 - KDIGO 4 e 1 - KDIGO -5, 34 foram dializados e 21 faleceram dentro de 60 dias após o LT. No pré-operatório, os BM U-NGAL mediana 33 (P 25-75: 19 - 190) vs 265 (74 - 911) em DRC 0,74 (0,60 - 0,89) - p 0,006 e BUN mostrou preditor de DRC, AUC 0,74 (IC 0,58 - 0,90) - p 0,013; e BUN média 20,96 (DP 14,58) sem DRC vs 32,64 (19,76) com DRC - AUC 0,75 (IC 0,60 - 0,89) - p 0,04. No PO, BUN demonstrou ser um preditor de DRC: BUN 18,84 (10,49) sem DRC versus 30,59 (18,92) - AUC 0,70 (IC 0,53 - 0,86) - p 0,007, diurese no primeiro dia pós-LT média 532,11 (DP 439) vs 208,12 DP (231) em DRC 0,75 (IC 0,63 - 0,88) - p -0,001 e U NGAL 48 horas mediana 222 (P 25-75: 78 - 1584) vs 1175 (P 25-75: 275 - 3908) em DRC 0,66 (0,52 - 0,81) - p 0,032. Na regressão logística, as variáveis BUN e diurese foram preditores independentes de DRC com OR de 1,00 (CI 1,00 - 1,00) p < 0,05. Conclusão: A avaliação dos BM tradicionais, como BUN e diurese, é importante na previsão da doença renal crônica em pacientes submetidos a transplante de fígado, combinados com novos BM como U-NGAL, eles podem desempenhar um papel crucial na identificação precoce e na previsão da progressão da doença renal em pacientes transplantados de fígado.

Liver disease and cirrhosis are classified as the eleventh leading cause of death worldwide, representing a global challenge in the management of these pathologies [1]. In this context, liver trans...

Objective: To compare the outcomes of patients undergoing conventional gastrointestinal surgeries who developed COVID-19 to those who were not infected. Method: Descriptive comparative study. Data were collected from 142 medical records, during the period from March 2020 (beginning of the pandemic in Brazil) to December 2021. Study approved by the Research Ethics Committee (CAAE: 29473520.2.0000.5392). Results: The profile of the patients was mostly classified as ASA 2 and 3. There was the presence of at least one chronic disease in all patients with COVID-19 and in most patients without COVID-19. The mean BMI for patients with COVID-19 was type I obesity and overweight for the rest of the sample (p=0.043). There was a predominance of females among patients affected by COVID-19. Complications were longer postoperative hospital stay (p=0.015) and need for surgical approach (p=0.034). Conclusions: The profile of surgical patients with COVID-19 was linked to the presence of comorbidities, longer duration of the surgical procedure and high BMI. Complications associated with the presence of COVID-19 were longer postoperative hospital stays and surgical reoperation.

Sepsis and acute kidney injury (AKI) are two major public health concerns that contribute significantly to illness and death worldwide. Early diagnosis and prompt treatment are essential for achieving the best possible outcomes. To date, there are no specific clinical, imaging, or biochemical indicators available to diagnose sepsis, and diagnosis of AKI based on the KDIGO criterion has limitations. To improve the diagnostic process for sepsis and AKI, it is essential to continually evolve our understanding of these conditions. Delays in diagnosis and appropriate treatment can have serious consequences. Sepsis and AKI often occur together, and patients with kidney dysfunction are more prone to developing sepsis. Therefore, identifying potential biomarkers for both conditions is crucial. In this review, we talk about the main biomarkers that evolve the diagnostic of sepsis and AKI, namely neutrophil gelatinase-associated lipocalin (NGAL), proenkephalin (PENK), and cell-free DNA.

Sepsis is a disease with high mortality and morbidity despite advances in diagnostic procedures and therapeutic strategies. The aim of this study was to evaluate the profile and outcomes of community-onset sepsis. This retrospective, multicenter study included five 24-h health care units and was conducted from January 2018 to December 2021. Patients were diagnosed with sepsis or septic shock according to the Sepsis 3.0 criterion. A total of 2630 patients diagnosed as having sepsis (68.4%, 1800) or septic shock (31.6%, 830) in the 24-h health care unit were included; 43.76% of the patients were admitted to the intensive care unit, 12.2% died, 4.1% had sepsis and 30% had septic shock. The comorbidities that were independent predictors of septic shock were chronic kidney disease on dialysis (CKD-d), bone marrow transplantation and neoplasia. CKD and neoplasia were also independent predictors of mortality, with ORs of 2.00 (CI 1.10–3.68) p = 0.023 and 1.74 (CI 1.319–2.298) p = < 0.0001, respectively. Mortality according to the focus of primary infection was as follows: pulmonary 40.1%; COVID-19 35.7%; abdominal 8.1% and urinary 6.2%. Mortality due to the COVID-19 outbreak had an OR of 4.94 (CI 3.08–8.13) p ≤ 0.0001. Even though community-onset sepsis can be potentially fatal, this study revealed that some comorbidities lead to an increased risk of septic shock (d-CKD and neoplasia) and mortality. COVID-19 infection as the primary focus was an independent predictor of mortality in patients with sepsis when compared to other foci.

Introduction Sepsis is a disease with high mortality and morbidity. Despite advances in diagnosis and therapeutic packages, many gaps remain. This study aimed to evaluate the profile and outcomes of out-of-hospital sepsis. Methods This was a retrospective study, multicenter study including five basic health Unit. The study period was from January 2018 to December 2021.Patients diagnosed with sepsis or septic shock according to the Sepsis 3.0 criterion. Results A total 2630 patients were included with a diagnosis of sepsis 68.4% (1800) or septic shock 31.6% (830) in the emergency care units. The comorbidities that were independent predictors of septic shock were chronic kidney disease on dialysis (CKD-d), bone marrow transplantation and neoplasia; CKD and neoplasia were also independent predictors of mortality, with ORs of 2.00 (CI 1.10–3.68) p = 0.023 and 1.74 (CI 1.319–2.298) p = < 0.0001, respectively. Mortality according to the focus of primary infection was as follows: pulmonary 40.1%; COVID-19 35.7%; abdominal 8.1% and urinary 6.2%. Mortality due to the COVID-19 outbreak had an OR of 4.94 (CI 3.08–8.13) p ≤ 0.0001. Conclusions The following are risk factors associated with mortality in nonhospitalized sepsis: comorbidities (d-CKD and neoplasia) and the primary focus of COVID-19 infection.