Scielo RSS http://scielo.pt/rss.php?pid=2976-052620250004&lang=pt vol. 39 num. 4 lang. pt http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S2976-05262025000400001&lng=pt&nrm=iso&tlng=pt Abstract Introduction: With aging populations and wider access to renal replacement therapy (RRT), more patients undergo dialysis, often with declining quality of life, leading to consideration of RRT withdrawal. Early integration of palliative care (PC) is essential to ensure a patient‑centered approach. This study evaluates the clinical course of patients admitted to a university hospital PC unit who had RRT withdrawn. Methods: Retrospective observational study of all patients admitted to a hospital‑based Palliative Care Unit (PCU) in Portugal with RRT suspension from September 2018 to February 2024. Patient demographics, clinical course, symptoms, complications, and management were analysed. Results: Twenty‑seven patients were included (59% male; mean age 77.4 years). Almost all had ≥1 cardiovascular risk factor; common comorbidities included heart failure (51.9%), cerebrovascular disease (48.2%), and active neoplasia (48.2%). RRT was withdrawn in 77% due to irreversible consciousness impairment or hemodynamic instability. Nephrology (100%) and PC (92.3%) were the most involved specialties. Most patients (81.5%) had ≥3 symptoms, primar-ily asthenia (85.2%), anorexia (81.5%), dyspnea (70.4%), and pain (66.7%); many presented before RRT withdrawal. Post‑withdrawal, constitutional symptoms increased. Mean PC follow‑up was 13.4 days; median survival was 12 days. All but one patient died in the hospital. Conclusion: Short PC follow‑up and limited patient involvement in RRT withdrawal decisions (22%) highlight the vulnerability of this population and late referral to palliative care. Earlier integration and proactive advance care planning are critical to optimizing patient‑centered decision‑making and symptom management. http://scielo.pt/scielo.php?script=sci_arttext&pid=S2976-05262025000400008&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Hyponatremia is the most common electrolyte disorder in hospitalized patients and requires accurate assessment of volume status to guide appropriate management. The venous excess ultrasound grading system (VExUS) is a point‑of‑care ultrasound tool used to assess venous congestion through Doppler evaluation of abdominal venous flow patterns. Its role in the context of hypoosmolar hyponatremia remains to be defined. Methods: In this proof‑of‑concept, prospective, observational study, hospitalized adult patients with hypoosmolar hyponatremia (plasma sodium ≤130 mEq/L) were included. Within 24 hours of enrolment, all patients underwent VExUS assessment evaluating the inferior vena cava diameter and Doppler waveforms in at least one venous territory (hepatic, portal, or renal veins). Treating physicians were blinded to ultrasound findings. Serum sodium was measured at baseline and at 24, 48, and 96 hours. VExUS evaluation of volume status was compared to final diagnosis and other surrogates of volume. Results: A total of 26 patients were included. VExUS identified venous congestion in 4 patients (15.4%). VExUS discrepancies between clinical and ultrasound‑based volume assessment were observed in 2 cases (7.7%). These discrepancies were not associated with significant differences in sodium level trends (0h: p=0.409; 24h: p=0.884; 48h: p=0.598; 96h: p=0.351), nor with changes in treatment. However, VExUS eliminated discrepancies between final diagnosis and presumptive diagnosis at study inclusion. Conclusion: In this study, VExUS proved useful in detecting venous congestion not evident on clinical examination, improving diagnostic accuracy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S2976-05262025000400018&lng=pt&nrm=iso&tlng=pt Abstract Introduction: IgA nephropathy (IgAN) is one of the most common primary glomerulonephritis worldwide, presenting with highly variable clinical manifestations and disease progression. The 10‑year risk of end‑stage kidney disease (ESKD) ranges from 5% to 60%, making risk stratification a major challenge. To address this, the IgAN‑Prediction Tool (IgAN‑PT) was developed and is currently recommended for risk assessment. Methods: This study aimed to evaluate the applicability of the IgAN-PT in a Portuguese cohort. We conducted a retrospective analysis of all biopsy‑confirmed IgAN cases from January 1998 to December 2018 and assessed the tool’s predictive performance. Results: In a cohort of 93 Portuguese patients, the IgAN‑PT significantly correlated with 5‑year progression to ESKD or a ≥50% reduction in eGFR (OR 1.06; 95%CI [1.02‑1.1]), demonstrating good discriminative performance (AUC 0.75; 95%CI [0.681‑0.910]). Additionally, baseline proteinuria >1.4 g/24h, eGFR <79 mL/min/1.73m², and an IgAN‑PT score >12.4% provided the best sensitivity‑specificity compromise for predicting the primary outcome. A multivariate model incorporating both IgAN‑PT and the presence of crescents showed improved predictive capacity compared with IgAN‑PT alone (AUC 0.845; 95%CI [0.754‑0.937]). Conclusion: Our findings validate the use of IgAN‑PT in a Portuguese cohort and suggest that incorporating the presence of crescents enhances its predictive accuracy. http://scielo.pt/scielo.php?script=sci_arttext&pid=S2976-05262025000400027&lng=pt&nrm=iso&tlng=pt Abstract Atypical hemolytic uremic syndrome (aHUS) is a rare, complement‑mediated thrombotic microangiopathy requiring early recognition and treatment. We present the case of a 57 year old woman with aHUS triggered by a diarrheal illness, who developed acute kidney injury and hematological abnormalities. Eculizumab was initiated within 48 hours, alongside plasma exchange. The patient achieved hematologic remission within two weeks and recovered renal function within one month. Genetic testing revealed no pathogenic variants in complement‑related genes. Based on clinical stability and genetic findings, eculizumab was discontinued after six months. At the 12 month follow‑up, the patient remained in remission with preserved renal function. This case supports the safety of eculizumab withdrawal in genetically negative aHUS under close monitoring. http://scielo.pt/scielo.php?script=sci_arttext&pid=S2976-05262025000400033&lng=pt&nrm=iso&tlng=pt Abstract Atypical hemolytic uremic syndrome (aHUS) is a rare, complement‑mediated thrombotic microangiopathy requiring early recognition and treatment. We present the case of a 57 year old woman with aHUS triggered by a diarrheal illness, who developed acute kidney injury and hematological abnormalities. Eculizumab was initiated within 48 hours, alongside plasma exchange. The patient achieved hematologic remission within two weeks and recovered renal function within one month. Genetic testing revealed no pathogenic variants in complement‑related genes. Based on clinical stability and genetic findings, eculizumab was discontinued after six months. At the 12 month follow‑up, the patient remained in remission with preserved renal function. This case supports the safety of eculizumab withdrawal in genetically negative aHUS under close monitoring. http://scielo.pt/scielo.php?script=sci_arttext&pid=S2976-05262025000400035&lng=pt&nrm=iso&tlng=pt Abstract Atypical hemolytic uremic syndrome (aHUS) is a rare, complement‑mediated thrombotic microangiopathy requiring early recognition and treatment. We present the case of a 57 year old woman with aHUS triggered by a diarrheal illness, who developed acute kidney injury and hematological abnormalities. Eculizumab was initiated within 48 hours, alongside plasma exchange. The patient achieved hematologic remission within two weeks and recovered renal function within one month. Genetic testing revealed no pathogenic variants in complement‑related genes. Based on clinical stability and genetic findings, eculizumab was discontinued after six months. At the 12 month follow‑up, the patient remained in remission with preserved renal function. This case supports the safety of eculizumab withdrawal in genetically negative aHUS under close monitoring.