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Objective: The aim of this study was to evaluate breast arterial calcification (BAC) detected on routine mammography, analyzing its association with chronic degenerative disease. Materials and Methods: This was a cross-sectional study involving women treated at a specialized outpatient clinic for high-risk hypertension, diabetes, or chronic kidney disease, as well as volunteers who participated in a study to validate a method of screening for occult renal disease. A total of 312 patients between 40 and 69 years of age, with no history of breast cancer, all of whom had undergone routine mammography in the last two years, were included. The mammograms were analyzed by researchers who were unaware of the risk factors for BAC in each case. Results: The mean age was 55.9 ± 7.4 years, and 64.3% of the patients were white. The mean glomerular filtration rate was 41.87 ± 6.23 mL/min/1.73 m2. Seventy-one patients (22.8%) had BAC. We found that BAC was associated with advanced age, hypertension, diabetes, chronic kidney disease, and low glomerular filtration rate. In the multivariate analysis, advanced age and diabetes continued to be associated with BAC. The odds ratio for BAC was higher for all chronic diseases. Conclusion: The association of BAC with advanced age, hypertension, diabetes, chronic kidney disease, and low glomerular filtration rate should call the attention of radiologists. Therefore, the presence of BAC should be reported, and patients with BAC should be screened for those diseases. Resumo Objetivo: O objetivo deste estudo foi avaliar calcificações arteriais mamárias (CAMs) detectadas em mamografia de rotina e analisar sua associação com doenças crônicas degenerativas. Materiais e Métodos: Estudo transversal com mulheres atendidas em um ambulatório especializado para tratamento de hipertensão de alto risco, diabetes ou doença renal crônica, bem como as voluntárias que participaram de um estudo para validar um escore para triagem de doença renal crônica oculta. Trezentas e doze pacientes entre 40 e 69 anos de idade, sem histórico de câncer de mama, com mamografia realizada nos últimos dois anos foram incluídas. Os pesquisadores, que desconheciam os fatores de risco para CAMs, analisaram as mamografias de rotina. Resultados: A média de idade foi 55,9 ± 7,4 anos, 64,3% brancas. A média da taxa de filtração glomerular foi 41,87 ± 6,23 mL/min/ 1,73 m2. Setenta e uma participantes (22,8%) apresentavam CAMs. Houve associação entre CAMs e idade, hipertensão, diabetes, doença renal crônica e taxa de filtração glomerular. Na análise multivariada, idade e diabetes persistiram associadas a CAMs. O odds ratio entre CAMs versus doenças crônicas foi elevado. Conclusão: Houve associação entre CAMs com a idade, hipertensão, diabetes, doença renal crônica e taxa de filtração glomerular. Esta associação chama a atenção do radiologista/clínico, para que a presença dessas alterações deva ser relatada, e essas doenças devam ser triadas nestes pacientes.

After the second decade of life, the glomerular filtration rate (GFR) decreases progressively. There is still considerable debate about the importance of this "physiological decrease" in GFR with age in many situations attributed to the effects of concomitant hypertension, atherosclerosis, cardiovascular diseases (among others) observed in the elderly. The GFR is considered the best indicator of renal function and its estimate has been suggested in the guidelines of chronic kidney disease (CKD). However, in the most commonly equations used, the elderly subjects were not included or were underrepresented. The purpose of this is to describe a nomogram based on an equation to estimate GFR based on serum creatinine, age and sex that was developed for the study Berlin Initiative Study (only individuals older than 70 years were included). The performance of the equation, called BIS1 was compared with Hioxal (gold standard), three equations based on serum creatinine (CG, MDRD and CKD-EPI) and three equations based on cystatin C (proposed by the CKD-EPI) and the second showed less bias among that another equations and compared the CG, MDRD and CKD-EPI equations, had the lowest rate of misclassification of CKD in participants with less than 60 mL/min/1.73 m2.

Senhor Editor, Com a nova definicao proposta pelo The National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQITM) em 2002,1 o diagnostico da doenca renal cronica (DRC) tornou-se mais facil, permitindo a sua identificacao em todos os estagios, particularmente nos iniciais, quando, frequentemente, cursa na ausencia de sinais e sintomas. Esta nova definicao e composta de um componente de lesao do parenquima renal, por exemplo, a documentacao de perda urinaria anormal de proteina e/ou hematuria de origem glomerular e [...]

INTRODUCAO: Identificar a Doenca Renal Cronica (DRC) em seus estagios iniciais permite intervencoes com potencial de alterar a evolucao natural da doenca e de diminuir a mortalidade precoce. O Screening For Occult Renal Disease (SCORED) e um questionario de nove questoes com pesos diferentes e preve uma chance de 20% para DRC em caso de pontuacao > 4 pontos. OBJETIVO: Traduzir, adaptar transculturalmente e validar o questionario SCORED para o portugues brasileiro. METODOS: Etapas do processo: 1. Traducao do ingles para o portugues brasileiro; 2. Retrotraducao para o ingles; 3. Avaliacao das versoes por comite de especialistas, gerando uma versao consensual; 4. Validacao da versao final para a cultura brasileira. O questionario foi aplicado em 306 individuos avaliados para DRC segundo os criterios do NKF KDOQI™. RESULTADOS: A idade media dos participantes foi de 49 ± 13 anos, 61% eram mulheres, 69% eram brancos, 68% apresentavam escolaridade ate o ensino medio, 38,5% tinham hipertensao arterial e 12,3% Diabetes Mellitus. A versao final do questionario SCORED em portugues brasileiro nao apresentou dificuldades de compreensao. A DRC foi diagnosticada em 20 (6,4%) participantes. A versao brasileira do questionario SCORED apresentou sensibilidade de 80%, especificidade de 65%, valor preditivo positivo de 14%, valor preditivo negativo de 97% e acuracia de 66%. CONCLUSAO: As etapas cumpridas no processo de adaptacao transcultural permitiram desenvolver a versao brasileira do questionario SCORED, ferramenta que, por ser de facil compreensao, boa aceitacao e de baixissimo custo, podera constituir importante instrumento de rastreio de pessoas com chance de apresentar DRC.

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4%). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4%) at the baseline period of the study than after 1 year of the study (26.8%). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22%) was lower than the percentage of non-adherent patients who became adherent (50%). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.