Regina Abdulkader - Academia.edu (original) (raw)

Papers by Regina Abdulkader

Leptospirosis is a worldwide zoonosis. Typically, patients are young men, although children can b... more Leptospirosis is a worldwide zoonosis. Typically, patients are young men, although children can be affected. In children, this disease causes mainly alterations of sensorium. Acute renal failure and jaundice (Weil's syndrome) are less common in children than in adults. The main renal histological findings are acute interstitial nephritis and acute tubular necrosis. Acute renal failure is characterized by hypokalemia and nonoliguria. Many factors are involved in its physiopathology: hypotension, hypovolemia, rhabdomyolysis, hyperbilirubinemia, and, primarily, the direct action of leptospiral proteins. Antibiotic administration (especially early administration) reduces length of hospitalization and leptospiruria. For children, even late antibiotic treatment has been shown to reduce the extent of acute renal failure and thrombocytopenia. Although the best method of dialysis is not yet established, early and intensive dialysis can decrease mortality. Mortality in patients with acute renal failure is ∼15-20% in association with the presence of oliguria, higher levels of creatinine, and older age. Functional recovery is fast and complete; however, abnormal urinary concentration can persist.

J Bras Nefrol, Jun 1, 1996

... Marcelino de Souza Durão Júnior, Ana Flávia Ramires dos Santos, Mirian Aparecida Boim, Oscar ... more ... Marcelino de Souza Durão Júnior, Ana Flávia Ramires dos Santos, Mirian Aparecida Boim, Oscar Fernando Pavão dos Santos renal e de como ocorre a sua regeneração após um insulto agudo. ... Cellular basis of ischemic acute renal failure. In Lazarus JM, Brenner BM eds. ...

J Bras Nefrol, Dec 1, 2000

J Bras Nefrol, Mar 1, 1997

International Journal of Nephrology and Renovascular Disease, 2016

Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to t... more Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis. To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008) and B (from 2013 to 2015). Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P⩽0.0001). Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092). Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan-Meier model (log-rank = 0.188). TCC removal for low blood flow occurred in 8.9% of procedures. Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic.

J Bras Nefrol, Mar 1, 1992

Clinical nephrology

A case of a patient developing anuric acute renal failure and a hemorrhagic syndrome resembling d... more A case of a patient developing anuric acute renal failure and a hemorrhagic syndrome resembling disseminated intravascular coagulation after contact with Lonomia caterpillars is reported. Renal histology showed only mild changes consistent with renal ischemia, although the patient never was hypotensive. The mechanisms of renal injury were obscure and might be related to transient glomerular ischemia due to microcirculation fibrin deposition or to direct venom nephrotoxicity.

Journal of Nephrology, 2015

Single-pass batch dialysis (SBD) is a well-established system for treatment of end-stage renal di... more Single-pass batch dialysis (SBD) is a well-established system for treatment of end-stage renal disease. However, little evidence is available on sustained low-efficiency extended dialysis (SLED) performed with SBD in patients with acute kidney injury (AKI) in the intensive care unit (ICU). All SLED-SBD sessions conducted on AKI patients in nine ICUs between March and June 2010 were retrospectively analyzed regarding the achieved metabolic and fluid control. Logistic regression was performed to identify the risk factors associated with hypotension and clotting during the sessions. Data from 106 patients and 421 sessions were analyzed. Patients were 54.2 ± 17.0 years old, 51 % males, and the main AKI cause was sepsis (68 %); 80 % of patients needed mechanical ventilation and 55 % vasoactive drugs. Hospital mortality was 62 %. The median session time was 360 min [interquartile range (IQR) 300-360] and prescribed ultrafiltration was 1500 ml (IQR 800-2000). In 272 sessions (65 %) no complications were recorded. No heparin was used in 269/421 procedures (64 %) and system clotting occurred in 63 sessions (15 %). Risk factors for clotting were sepsis [odds ratio (OR) 2.32 (1.31-4.11), p = 0.004], no anticoagulation [OR 2.94 (1.47-5.91), p = 0.002] and the prescribed time (hours) [OR 1.14 (1.05-1.24), p = 0.001]. Hypotension occurred in 25 % of procedures and no independent risk factors were identified by logistic regression. Adequate metabolic and fluid balance was achieved during SLED sessions. Median blood urea decreased from 107 to 63 mg/dl (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), potassium from 4.1 to 3.9 mEq/l (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and increased bicarbonate (from 21.4 to 23.5 mEq/l, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Median fluid balance during session days ranged from +1300 to -20 ml/24 h (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). SLED-SBD was associated with a low incidence of clotting despite frequent use of saline flush, and achieved a satisfactory hemodynamic stability and reasonable metabolic and fluid control in critically-ill AKI patients.

The American journal of tropical medicine and hygiene, 1997

To assess the mechanisms related to tetanus-induced acute renal failure (ARF), 30 patients with t... more To assess the mechanisms related to tetanus-induced acute renal failure (ARF), 30 patients with tetanus had their renal function prospectively studied and factors possibly related to renal changes were evaluated during four weeks of hospitalization. Fifty percent of these patients had a glomerular filtration rate (GFR) < or = 50 ml/min in the first or second week of hospitalization (Group I) and 50% had a GFR > 50 ml/min throughout the entire hospitalization period (Group II). Age, gender, tetanus incubation time and tetanus onset time, hospitalization time, use of nephrotoxic drugs, need for mechanical ventilation with intermittent positive pressure, and presence of systemic infection were similar in both groups. None of the patients presented with oliguria. Autonomic nervous system (ANS) overactivity, characterized by intense variations in systolic and diastolic blood pressure, by increased heart rate and elevated urinary metanephrine excretion, was higher in Group I compare...

The American journal of tropical medicine and hygiene, 1996

Hypokalemia in leptospirosis acute renal failure (ARF) was studied in nine patients with severe l... more Hypokalemia in leptospirosis acute renal failure (ARF) was studied in nine patients with severe leptospirosis ARF and five patients with moderate leptospirosis ARF and compared with five patients with severe acute tubular necrosis (ATN) and eight healthy individuals. Urinary volumes of both the severe and moderate leptospirosis groups were higher than those of the severe ATN group. Leptospirosis groups had serum potassium levels lower than those found in the healthy and severe ATN groups. Serum sodium levels were lower in the severe leptospirosis group than in the moderate leptospirosis, the severe ATN, and the healthy groups. There was a positive correlation between the fractional excretion of sodium and potassium in the severe leptospirosis group as well as between serum creatinine and potassium levels in the pooled leptospirosis groups. Urinary pH in the severe and moderate leptospirosis groups was lower than in the severe ATN group. Aldosterone levels were higher in the severe l...

Revista da Associação Médica Brasileira, 2004

Revista da Associação Médica Brasileira, 2002

A re-estenose, processo que ocorre em uma porcentagem significativa dos pacientes submetidos à an... more A re-estenose, processo que ocorre em uma porcentagem significativa dos pacientes submetidos à angioplastia coronária, representa uma limitação importante do procedimento. Diversas opções farmacológicas anteriores não demonstraram eficácia na prevenção da re-estenose. Schnyder e colaboradores, entretanto, demonstraram que a redução dos níveis séricos de homocisteína com o uso de ácido fólico, vitamina B12 e piridoxina associou-se a uma redução da taxa de re-estenose de 48%. Quando encontrada em valores elevados no plasma, a homocisteína é um importante preditor de risco cardiovascular, além de se correlacionar com a gravidade da ateros-clerose coronariana. Alguns autores observaram que a homocisteína em níveis elevados poderia promover o crescimento das células musculares lisas dos vasos além de prejudicar a resposta vasodilatadora dependente do endotélio. Uma redução da ordem de 25% a 30% nos valores de homocisteína no plasma pode ser obtida de forma significativa com a utilização da ácido fólico, vitamina B12 e piridoxina. Schnyder e colaboradores realizaram um estudo duplo-cego com 205 pacientes submetidos à angioplastia coronariana com sucesso. Os pacientes foram aleatorizados para receber uma combinação de ácido fólico (1 mg), vitamina B12 (400 mcg) e piridoxina (10 mg) ou placebo por 6 meses. A taxa de utilização de stents neste estudo foi de 49%. Os autores observaram uma redução média dos níveis plasmáticos de homocisteína de 35% neste período. Após a realização de cinecoronariografia, ao final dos 6 meses, que o diâmetro luminal mínimo era significativamente maior e o grau de estenose menos importante (39,9% contra 48,2%) no grupo que recebeu o tratamento com ácido fólico, vitamina B12 e piridoxina. A taxa de re-estenose também foi menor no grupo tratado (19,6% contra 37,6%, p=0,01), assim como a necessidade de revascularização do vaso tratado (10,8% contra 22,3%, p=0,04).

Revista da Associação Médica Brasileira, 2001

Quando as causas de morte no mundo são estudadas, as chamadas "causas externas" ocupam a quarta p... more Quando as causas de morte no mundo são estudadas, as chamadas "causas externas" ocupam a quarta posição (cerca de 11%). São precedidas pelas doenças cardiovasculares (cerca de 31%), pelas doenças infecciosas e parasitárias (cerca de 18%) e pelas neoplasias (cerca de 13%). De acordo com a Organização Mundial de Saúde (OMS), as causas externas são responsáveis por taxas de mortalidade mais elevadas na população jovem, do sexo masculino e que vive em países pobres. Aliás, a análise das diferentes regiões do mundo revela um panorama ilustrativo. Na África, as causas externas representam a segunda causa de morte e as causas etiológicas mais freqüentes são as guerras e os homicídios. Na Europa, nas Américas, nos países do Leste do Mediterrâneo e nos do Sudeste da Ásia, as causas externas constituem-se na terceira causa de morte. Entretanto, o perfil etiológico modifica-se substancialmente de região para região. Na Europa e nas Américas predominam os assim denominados "acidentes" por veículos automotores, em sua maioria colisões e atropelamentos. Nos países do Leste do Mediterrâneo as guerras são o agente etiológico que mais se destaca, com mais de 35% do total. No Sudeste da Ásia, as diferentes causas etiológicas, intencionais e não-intencionais, distribuem-se de maneira mais uniforme. Nos países do Pacífico, as causas externas são a quarta causa de morte e, curiosamente, a maioria destacada das mortes (mais de 30% do total) deve-se a suicídio. Esta heterogeneidade torna-se ainda mais explícita se focalizarmos, especificamente, os países das Américas. Na América do Norte e nos países do Cone Sul (exceção feita ao Paraguai), os óbitos por causas externas situam-se na faixa de 6 a 7%, e o coeficiente de mortalidade por 100 mil habitantes é da ordem de 55 a 60. As mortes resultam, em proporção consistente, de colisões e atropelamentos, suicídios e quedas. México e Brasil guardam uma razoável semelhança: óbitos por causas externas na faixa de 12 a 13%, coeficiente de mortalidade por 100 mil habitantes de 65 a 70 e causa etiológica mais comum, o homicídio. O Caribe Inglês parece-se com a América do Norte e o Caribe Latino assemelha-se ao México e ao Brasil. A área Andina é uma catástrofe. As taxas praticamente duplicam-se, e cerca de 50% das mortes estão relacionadas a homicídios. Os dados disponíveis não permitem evidenciar qualquer correlação significativa entre taxas de mortalidade por causas externas e PIB anual per capita, gasto total em saúde ou número de médicos por 10.000 habitantes. Comentário Estas informações permitem supor que, sob a denominação genérica -causas externas -incluem-se, em realidade, várias doenças que refletem o perfil cultural, social e econômico da população. Faz-nos entrever, outrossim, que estratégias visando à prevenção não podem ser padronizadas, mas devem considerar as peculiaridades locais. Se voltarmos nossa atenção para o Brasil, encontraremos nas diferentes regiões, diferenças marcantes que ilustram claramente os impactos da cultura, do nível de urbanização, das condições sociais e econômicas. Seria interessante correlacionar as taxas de morbidade e mortalidade por causas externas com os investimentos feitos em educação. Talvez esta informação fosse importante e nos permitisse entrever soluções.

PloS one, 2012

The causes of death on long-term mortality after acute kidney injury (AKI) have not been well stu... more The causes of death on long-term mortality after acute kidney injury (AKI) have not been well studied. The purpose of the study was to evaluate the role of comorbidities and the causes of death on the long-term mortality after AKI. We retrospectively studied 507 patients who experienced AKI in 2005-2006 and were discharged free from dialysis. In June 2008 (median: 21 months after AKI), we found that 193 (38%) patients had died. This mortality is much higher than the mortality of the population of São Paulo City, even after adjustment for age. A multiple survival analysis was performed using Cox proportional hazards regression model and showed that death was associated with Khan's index indicating high risk [adjusted hazard ratio 2.54 (1.38-4.66)], chronic liver disease [1.93 (1.15-3.22)], admission to non-surgical ward [1.85 (1.30-2.61)] and a second AKI episode during the same hospitalization [1.74 (1.12-2.71)]. The AKI severity evaluated either by the worst stage reached durin...

Renal Failure, 2007

The effects of hemodialysis (HD) on pulmonary function are still controversial. The objective of ... more The effects of hemodialysis (HD) on pulmonary function are still controversial. The objective of this study was to evaluate the effect of intermittent hemodialysis (IHD) and sustained low-efficiency dialysis (SLED) on the respiratory mechanics of ICU patients under invasive mechanical ventilation. We prospectively studied 31 patients. Laboratory and respiratory evaluation (static and dynamic compliance and resistance) was performed pre- and post-HD. Forty HD sessions were studied and grouped in: SLED (n = 17; Qa = 200-250 mL/min, Qd = 300 mL/min) and IHD (n = 23; Qa = 250-300 mL/min, Qd = 500 mL/min). There was no difference between the groups according to age, gender, comorbidities, APACHE II, and cause of mechanical ventilation, but pre-HD, patients in the IHD group had higher levels of plasma creatinine (5.4 +/- 2.0 vs. 4.2 +/- 1.3 mg/dL, p = 0.048) and platelets (286 +/- 186 vs. 174 +/- 95 10(3)/mm(2), p = 0.032) and lower arterial pH (7.37 +/- 0.07 vs. 7.42 +/- 0.05, p = 0.02). The efficiency of the treatment was similar (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) with both types of HD regarding fluid removal, urea reduction rate, and decrease in plasma creatinine. Pre-HD, the ventilatory conditions of both groups were similar (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) except for pressure support ventilation and airflow resistance. There were no changes (pre- versus post-HD p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) induced either by IHD or SLED in the ratio PaO(2)/FiO(2) or in any measured ventilatory parameter. In conclusion, neither IHD nor SLED modifies the pulmonary function of patients under mechanical ventilation.

Revista da Associação Médica Brasileira, 2003

Os índices prognósticos têm sido cada vez mais utilizados em pacientes em unidades de terapia int... more Os índices prognósticos têm sido cada vez mais utilizados em pacientes em unidades de terapia intensiva (UTI) para avaliação da qualidade de uma determinada UTI, para comparação entre UTIs, para a randomização de pacientes em protocolos de estudo, etc. A prática de se usar índices para prever o prognóstico de um paciente individualmente deve ser vista com extrema cautela. Ridley AS, em artigo recente, revisa de uma maneira muito simples as bases matemáticas em que os índices se apoiam e quais seus possíveis pontos de erro e suas limitações. Inicialmente, devese ter em mente que os índices fornecem uma probabilidade e não uma predição absoluta de que um determinado evento ocorra (no caso óbito ou sobrevida). No desenvolvimento dos índices, o grupo inicial de pacientes é formado segundo critérios bem definidos de inclusão e de exclusão, portanto a aplicação de um determinado índice para um grupo de pacientes, ou para um paciente individualmente, com características diferentes do grupo inicial não é recomendável. Outros eventos igualmente importantes, como é a qualidade de vida, não são preditos. Os parâmetros que entraram no desenvolvimento do índice e a maneira como foram coletados, manual ou automaticamente, devem ser os mesmos a serem utilizados para um paciente individual. Por exemplo: a presença de sedação pode impedir uma avaliação adequada do estado de consciência de um paciente e conseqüentemente diminuir a acurácia do cálculo do seu risco de morte. Ridley também analisa os problemas que podem surgir dos métodos utilizados na validação dos índices e o seu poder de discriminação. Um bom índice deve apresentar uma boa discriminação e uma boa calibração, duas qualidades que em geral não são concomitantes nos índices de caráter genérico. A utilização de índices para se determinar a futilidade de um tratamento para um paciente individual deve ser feita com cautela e não deve, de maneira nenhuma, substituir o julgamento clínico.