Search

Introducao: O acometimento renal em gestantes portadoras de hipertensao arterial cronica (HAC) nao e amplamente conhecido. Objetivos: 1- Descrever o perfil epidemiologico de pacientes com HAC; 2- Avaliar a ocorrencia de alteracoes urinarias e de funcao renal (por meio de determinacao serica de creatinina, cistatina C e ritmo de filtracao glomerular estimada - RFGe); 3- Avaliar o desfecho das gestacoes em HAC. Metodos: Foram submetidas a avaliacoes clinicas e laboratoriais 103 gestantes com HAC (pressao arterial acima de 140/90 mmHg, identificada previamente a gestacao ou ate a 20a semana). Resultados: As gestantes tinham 21-45 (media: 34) anos; 12,6% eram primigestas, 64,1% tiveram multiplas gestacoes. A relacao proteinuria/creatininuria em amostra isolada estava alterada em 5,2% casos (0-6,44 g/g), creatinina serica estava elevada em 19,6% e cistatina C em 14,7%. Na avaliacao das caracteristicas da gestacao em pacientes com HAC e seus recem-nascidos (RN) (vs. frequencias nos casos com CKD-EPI cistatina C < 60 ml/min/1,73 m2), observou-se: 20,5% (33,3%) de nascidos pre-termo < 37 sem, 17,5% (22,2%) de RN com peso < 2500 g e 17,5% (22,2%) de RN pequeno para a idade gestacional (PIG); sobreposicao de DHEG ocorreu em 24,7% (22,2%) dos casos. Conclusao: Alteracoes renais foram identificadas por proteinuria, creatinina e cistatina C sericas em 5,2%, 19,6 e 14,7% das gestantes. Os resultados sugerem que as formulas do CKD-EPI e MDRD tambem podem ter aplicabilidade nessa avaliacao em gestantes. Detectou-se alta frequencia de RN pre-termo ou com menos de 2500 g ao nascer ou PIG, assim como de sobreposicao de DHEG (24,7%) em gestantes com HAC.

Introduction Preeclampsia (PE) and cardiovascular disease (CVD) have similar pathophysiological mechanisms and they also share some risk factors. The relationship between hypertensive disorders in pregnancy and CVD has not been totally elucidated; perhaps the metabolic stress and vascular injury may contribute to increase this future risk in such women. Objectives Investigate correlation between hypertensive disorders in pregnancy and incidence of postpartum CVD and metabolic syndrome. Methods Case-control study with a total of 65 women (45 normal pregnancy and 20 gestational hypertension). These volunteer patients were submitted to clinical, laboratorial and nutritional evaluation (bioimpedance BIODYNAMICS 310e, USA). The risk scores were estimated by using Findrisc Diabetes Risk Calculator (FDRC) and Framingham Risk Score ATP III (FRS-ATPIII); diagnosis of metabolic syndrome was based on the International Diabetes Federation (IDF) worldwide definition. Results Mean age of control group (CG) was 47.5 years and of gestational hypertension group (HG) was 43.8 years. The mean period postpartum that those patients were evaluated was 12.4 years in HG and 18.0 years in CG. Half of the HG had preeclampsia. Chronic hypertension (CH) was observed in 70% of HG and 24% of CG (p ⩽ 0.05). FDRC indicated high risk of diabetes over 10 years in 45% of HG and 21% of CG. Metabolic syndrome was present in 75% of HG and 26.6% in CG (p ⩽ 0.05). The mean body mass index (BMI) was 31.5 kg/m2 (obese) in HG and 26.5 kg/m2 (overweight) in CG. The body fat percentage detected by bioimpedance was similar, 38.5% in HG and 35.8% in CG. The FRS-ATPIII indicated low risk of CVD over 10 years in both groups. Conclusions The incidence of CH and metabolic syndrome appears to be increased in women who had hypertensive disorders in pregnancy, especially PE. A higher risk of developing diabetes over 10 years was also found in HG. The investigation of the history of hypertension during pregnancy may help preventing and early diagnosing those comorbidities. Fapesp n° 2014/00213-7

Introduction Assessment of proteinuria is essential to diagnose preeclampsia; it can be detected in spot urine sample or 24-hour urine collection. It has been shown that urine protein to creatinine (P/C) ratio seems to be highly predictive for detection of proteinuria in preeclampsia (PE). Objectives Evaluation of P/C ratio in normal pregnancy, and pregnant women with chronic hypertension (CH) and with PE. Methods P/C ratio was measured in 24 normal pregnant women, 14 with PE and 97 with CH. Proteinuria was detected by automated pyrogallol method and creatininuria by alkaline picrate method. Results Mean age of control group was 26 years, of PE group, 26 years and of CH group 34 years. P/C ratio was undetected in the control group, it was elevated in 5.2% of the CH group and in 100% of the PE group, also confirmed with 24-hour urine collection. Serum creatinine was elevated in 19.6% of the CH group and 42.8% of the PE group. Conclusions P/C ratio may be a good predictor of PE and it could be used as an alternative test to detect proteinuria in pregnant women, because it is faster and it is not influenced by serum creatinine concentration. Proteinuria should be evaluated during the prenatal care of CH women allowing early detection of incipient nephropathy. Fapesp n° 2014/00213-7. Renal evaluation in preeclampsia group. Download : Download high-res image (159KB) Download : Download full-size image

Introduction Glomerular filtration rate (GFR) increases during pregnancy and some incipient nephropathies may appear after this period, especially when gestational hypertension (GH) is present. Objectives Renal evaluation in women over 10 years after pregnancy. Methods Total of 30 volunteer patients whose last childbirth was 10–20years ago. Renal parameters assessed were: urinary excretion of retinol-binding protein (RBP), urine protein/creatinine ratio (PCR), Urine albumin/creatinine ratio (ACR), serum creatinine, serum C cystatin, vitamin D (25OHD), serum uric acid, vascular endothelial growth factor (VEGF), estimated GFR (eGFR) based on Modification of Diet in Renal Disease (MDRD) Study and the Chronic Kidney Disease Epidemiology Collaboration equation – CKD-EPI Creatinine, 2009 (CKD-EPI crea), CKD-EPI Cystatin C, 2012 (CKD-EPI cys) and CKD-EPI Creatinine-Cystatin C, 2012 (CKD-EPI crea-cys) equations. Results The average age was 45.5years old, 56.6% were afro descendant, and mean time after last labor was 13.7years. Approximately 6.6% had type 2 diabetes and 30.3% had chronic hypertension (CH) after pregnancy (among them 90% had GH). Mean body mass index (BMI) was 29.1kg/m 2 (overweight), although all patients with CAH were obese. Mean value of cystatin C was 1.45mg/L (elevated in 20%), RBP 0.30mg/L (high level in only one case), PCR 0.02g/g, ACR 6.91mg/g creatinine (high level in only one case), 25OHD 24.34ng/mL (deficiency in 33.3%), serum uric acid 4.50mg/dL (high level in only one case), serum creatinine 0.73mg/dL (normal level in all cases), VEGF 312.04pg/mL (high level in two cases). Mean clearance of creatinine using MDRD was 93.5mL/min/1.73m 2 , CKD-EPI crea 101.7mL/min/1.73m 2 , CKD-EPI cys 49.0mL/min/1.73m 2 and CKD-EPI crea-cys 68.3mL/min/1.73m 2 (about 30% less when compared with the equations without cystatin C, then 26.6% had eGFR 2 ). None of the patients had ever been assisted by a nephrologist. Conclusions Obesity, CH, 25OHD deficiency, high levels of serum cystatin C and low eGFR may appear years after pregnancy, especially if GH was present. Women who had GH should have long-term follow up with nephrologist to have a more complete and regular renal evaluation. The eGFR by combined creatinine-cystatin C equation seems to be better than other formulas and it could be useful to detect early chronic kidney disease. Fapesp n° 2014/00213-7

A presente pesquisa busca investigar, pelo método da análise de conteúdo, as 37 crônicas reunidas em O ato e o fato, de autoria do escritor e jornalista carioca Carlos Heitor Cony. Publicado em 1964, ano de eclosão do golpe militar que levaria o Brasil a vinte e um anos de regime ditatorial, o livro concentra os textos escritos pelo autor, de 2 de abril a 9 de junho daquele ano, para o jornal Correio da Manhã. O estudo centra-se na interpretação das estratégias narrativas do cronista, cujo objetivo seria a ampliação da capacidade (estética) da crônica em promover a resistência ao movimento autoritário. Além das referidas narrativas - e com vistas à construção do perfil profissional, literário e intelectual de Cony - também foram realizadas leituras críticas de cerca de 450 crônicas do autor, muitas das quais encontradas nas coletâneas Da arte de falar mal (1963), Posto Seis (1965), Os anos mais antigos do passado (1998), O harém das bananeiras (1999), O suor e a lágrima (2002), O tudo e o nada (2004) e Eu, aos pedaços: memórias (2010). Com o mesmo propósito, recorreu-se, ainda, à leitura e investigação do ensaio memorialístico A revolução dos caranguejos, publicado em 2004. A busca pelo esclarecimento das estratégias narrativas do escritor traduz-se, por sua vez, na oportunidade para reflexão - mesmo que paralela - acerca das relações entre os acontecimentos sociopolíticos e a literatura brasileira pós-1964.

Objectives Evaluation of outpatients with glomerupathies who had pregnancy complicated by arterial hypertension. Methods Retrospective study with 52 women who started monitoring of glomerulonephritis during the period of 1989–2014 at outpatient clinics of UNIFESP, Sao Paulo/Brazil and who had pregnancy complicated by arterial hypertension. Results Women ranged from age 15 to 52 years old ± 7.83 (mean 30.67). A total of 88.5% (46/52) had a pregnancy with a hypertensive syndrome, 11.5% (6/52) eclampsia, 1.9% (1/52) HELLP syndrome, 75.0% (39/52) preeclampsia or pregnancy-induced hypertension. The other 11.5% (6/52) had previous kidney disease that had an acute exacerbation or was only manifested during pregnancy. The majority 86.5% (45/52) developed hypertension with proteinuria and/or hematuria after pregnancy; 7.7% (4/52) had clinical and laboratory remission after delivery, but later had progression to glomerulonephritis. About 7.7% (4/52) had late abortions, 30.8% (16/52) preterm birth, 7.7% (4/52) fetal death, and 3.8% (2/52) neonatal death. Renal biopsy was performed in 71.1% (37/52), renal transplant in 5.8% (3/52) and hemodialysis in 7.7% (4/52). The diagnoses were focal segmental glomerulonephritis in 13.5% (7/52), mild lesion 5.6% (3/52), membranoproliferative glomerulonephritis 13.5% (7/52), IgA nephropathy 5.6% (3/52), lupus nephritis 13.5% (7/52), other nephropathies 48.0% (25/52). Outpatient dropout was 43.4% (21/52). ambulatory discharge 3.8% (2/52) and 55.8% (29/52) kept follow up. Only 12.9% (4/31) of patients who kept follow up had worsening of renal function. Conclusions Women who had a pregnancy complicated with arterial hypertension, specially preeclampsia, may have a worse maternal and fetal/neonatal outcome and they may develop glomerulopathies in the long run. Monitoring by a nephrologist allows early diagnosis, preventing depletion of renal function. Table 1. Diagnoses during pregnancy in women under outpatient follow up for glomerulonephritis (%). % (n) of outpatients under monitoring for glomerulonephritis (n = 52) Eclampsia 11.5% (6) HELLP syndrome 1.9% (1) Preeclampsia/pregnancy-induced hypertensive 75% (39) Previous kidney disease 11.5% (6) Disclosures T.A. Facca: None. A.R. Sabino: None. J. Sato: None. E.A. Fama: None. G.S. Junior: None. G. Mastroianni-Kirsztajn: None. N. Sass: None.