Artigos publicados - Dra. Germana Brito

Onco Nefrologia

Efficacy and safety of regional anticoagulation

atients with cancer admitted to critical care units are at increased risk of being affected with acute kidney injury (AKI) and mortality. Sustained low-efficiency dialysis (SLED) combines the cardiovascular stability of continuous therapy with the operational facility of conventional hemodialysis (HD). Citrate has become an alternative to heparin in anticoagulation because it favors the maintenance of filter patency and reduces bleeding. We analyzed the efficacy and safety of citrate versus heparin use in extended HD for patients with cancer and AKI. Methods: This retrospective cohort study evaluated patients with cancer and dialytic AKI who received SLED with anticoagulation using citrate versus heparin from January 2014 to June 2017.

fevereiro 2, 2022 Nenhum comentário

Onco Nefrologia

The Influence Of Acute Kidney Disease

Background and Aims
Cisplatin (CDDP) is used as the first line of treatment for some tumors, but its use may be restricted due to its nephrotoxicity. Carboplatin (CARBO) and oxaliplatin (OXA) are less nephrotoxic alternatives to CDDP. This study has the objective to determine the incidence of acute kidney disease after chemotherapy with CDDP, CARBO, or OXA.

fevereiro 2, 2022 Nenhum comentário

Onco Nefrologia

Prednisone monotherapy induced remission

The treatment of membranous lupus nephritis (MLN) is still controversial in the literature. We conducted a retrospective analysis of patients in two medical centers of São Paulo-Brazil in order to evaluate the clinical response in patients submitted to either a regimen with prednisone alone or to a double immunosuppressive regimen (prednisone plus cyclophosphamide or prednisone plus azathioprine).

fevereiro 2, 2022 Nenhum comentário

Glomerulopatia

Long-Term Outcome of Patients

Aims of our study were to describe the long-term survival in patients surviving an acute tubular necrosis (ATN) episode and determine factors associated with late mortality. We performed a prospective cohort study that evaluated the long-term outcome of 212 patients surviving an ATN episode. Mortality at the end of followup was 24.5%, and the probability of these patients being alive 5 years after discharge was 55%. During the followup, 4.7% of patients needed chronic dialysis. Univariate analysis showed that previous CKD (), cardiovascular disease (), age greater than 60 years (), and higher SCr baseline (), after 12 months () and 36 months (), were predictors of long-term mortality. In multivariate analysis, older age (HR = 6.4, CI 95% = 1.2–34.5, ) and higher SCr after 12 months (HR = 2.1, 95% CI 95% = 1.14–4.1, ) were identified as risk factors associated with late mortality. In conclusion, 55% of patients surviving an ATN episode were still alive, and less than 5% required chronic dialysis 60 months later; older age and increased Scr after 12 months were identified as risk factors associated with late death.

fevereiro 2, 2022 Nenhum comentário

Lesão renal aguda

Can Delivery Dialysis Dose?

Intensity of dialysis dose in acute kidney injury (AKI) might benefit critically ill patients. The aim of this study was to evaluate the effect of intermittent hemodialysis (IHD) dose on mortality in patients with AKI. Methods: Prospective observational study was performed on AKI patients treated with IHD. The delivered dialysis dose per session was calculated based on single-pool Kt/V urea. Patients were allocated in two groups according to the weekly delivered median Kt/V: higher intensity dialysis dose (HID: Kt/V higher than median) and lower intensity dialysis dose (LID: Kt/V lower than median). Thereafter, AKI patients were divided according to the presence or absence of sepsis and urine output. Clinical and lab characteristics and survival of AKI patients were compared. Results: A total of 121 AKI patients were evaluated. Forty-two patients did not present with sepsis and 45 did not present with oliguria. Mortality rate after 30 days was lower in the HID group without sepsis (14.3% × 47.6%; p = 0.045) and without oliguria (31.8% × 69.5%; p = 0.025). Survival curves also showed that the HID group had higher survival rate when compared with the LID group in non-septic and non-oliguric patients (p = 0.007 and p = 0.003, respectively). Conclusion: Higher dialysis doses can be associated with better survival of less seriously ill AKI patients.

fevereiro 2, 2022 Nenhum comentário

Lesão renal aguda

Sled with trisodium citrate 4%

The use of citrate as regional anticoagulation in the sustained low extended dialysis (SLED) in cancer patients with coagulation disorders tends to be much used, yet it is important to note that particularities which may be subject those patients with multiple clinical factors complicating. Aims: Check the clinical and laboratory characteristics of cancer patients using trisodium citrate in SLEDs; check the particularities of cancer dialysis patients using regional anticoagulation and assess the need for calcium replacement EV in SLED with regional citrate anticoagulation.

fevereiro 2, 2022 Nenhum comentário