Scielo RSS http://scielo.pt/rss.php?pid=0872-016920200004&lang=en vol. 34 num. 4 lang. en http://scielo.pt/img/en/fbpelogp.gif http://scielo.pt http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400001&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400002&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400003&lng=en&nrm=iso&tlng=en http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400004&lng=en&nrm=iso&tlng=en Incremental dialysis is increasingly recognized as a safe and beneficial method of initiating dialysis. Different centers use distinct prescription methods. We discuss the advantages of incremental hemodialysis and the potential benefit of preserving residual renal function as we present our experience. We reviewed the data from 20 incident patients, with a mean follow-up of 9.5 months, who started dialysis with our prescription method, using hemofiltration as the preferred depurative technique. All patients tolerated treatment well; no major complications were reported. Dialysis adequacy targets were achieved. While data are clearly limited, we raise the hypothesis that convective techniques could bring additional benefit in preserving residual renal function in incident patients, and that this strategy should be studied and compared with others. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400005&lng=en&nrm=iso&tlng=en Background: The efficacy and cost-effectiveness of drug-eluting balloon (DEB) in vascular access for dialysis remain unclear. Methods: Data obtained from using DEB in highly recurrent stenosis were retrospectively analyzed. These data were obtained from procedures performed in the Vascular Access Center, responsible for attending over 3600 patients from 30 dialysis centers. Highly recurrent stenosis is defined as stenosis having three or more previous interventions and/or associated with early recurrence defined as the last procedure in less than 90 days. Patency and cost-effectiveness were evaluated. Patency was defined as the number of days free of interventions after applying DEB. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER) and an estimation of costs per day/patient/year. Results: Data from 37 consecutive procedures on 32 patients were assessed. The average patency time between interventions was 107.22 ± 104.428 days before DEB intervention. After the procedure, the average patency time intervention was 160.27 ± 96.472 days (ρ=0.001). The cost analysis revealed an ICER of 10.37€/ patency day gained. The costs estimation revealed improved patency of 14.5 days/patient/year, and an increased cost of 1028.4€/patient/year when compared to conventional balloon. Conclusions: This retrospective analysis may suggest a benefit of DEB on this highly recurrent stenosis. Although it appears to be more expensive, the increased patency at long term may be considered encouraging. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400006&lng=en&nrm=iso&tlng=en Introduction: SARS-CoV2 represents a challenge for hemodialysis (HD). By August 24 2020, the disease had affected 55720 people in Portugal. The northern Minho province has had 4428 cases. The Minho has 870 HD patients among 11 ambulatory HD centers and the Nephrology Department of Braga Hospital. Braga Hospital centralized HD treatments of COVID-19 patients. We describe our experience managing these patients. Results: We used a 2-station room and dedicated nurse with PPE but, as numbers increased, HD was performed in the main HD room. Disinfection protocols and specific routes were created. Swabs were repeated 14 days after diagnosis and then weekly until recovery. A total of 17 HD COVID-19 patients were diagnosed in the Minho, 16 of which performed HD in Braga Hospital. The first patient was diagnosed on March 16 and the last on May 5. Ten were males, mean age 60.6±13.2 years and median dialysis vintage 38.5 months (IQR 23.5-85.8). Four patients were diabetic and 10 were hypertensive. Only 1 of the 5 hospitalized patients was admitted for symptoms attributable to COVID-19. One developed severe respiratory insufficiency; 3 took hydroxychloroquine and 1 died. The 11 patients on ambulatory care had mild or no symptoms. At diagnosis, the mean hemoglobin was 10.1±1.8g/dL; mean leukocytes count 6.5±3.4x10/μL; mean platelet count 161±7x10/μL and mean LDH 241±148U/L. Median C reactive protein was 11.3mg/L (IQR 1.6-23.8). Patients’ swabs turned negative after a mean of 22±10 days. No association was found between the duration of a positive swab and gender, diabetes or hypertension. Discussion: Compared with the general population, Minho HD patients had a higher incidence of cases, possibly due to an increased risk and more testing. Incidence and mortality were lower than in other series. Centralizing infected patients may help prevent the spread of the disease and reduce the burden on HD centers. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400007&lng=en&nrm=iso&tlng=en Novel Coronavirus disease (COVID-19) is a newly discovered contagious disease that has affected many countries around the world. Although diffuse alveolar damage and acute respiratory failure are the main features, involvement of other organs is recognized and needs to be explored. Information on kidney disease in patients with COVID-19 is limited, with many studies showing that acute kidney injury is an uncommon disorder in COVID-19. Despite this low prevalence, it can lead to potentially significant morbidity and mortality in these patients. Thus the authors consider the development of acute kidney injury in patients with COVID-19 an important issue, worthy of clinical attention, and they present this point in the current review. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400008&lng=en&nrm=iso&tlng=en With an increased number of aged chronic kidney disease (CKD) patients, along with medical and technological advances, the options to approach end-stage kidney disease (ESKD) have multiplied. Nephrologists should be aware that taking care of elderly patients is different from taking care of younger ones. The spectrum of choices is as wide as the functional status of these patients. For fit ones, the main goal should be to restore function as much as possible and to rehabilitate. On the other hand, for frail patients, the expectations should be realistic in terms of survival, disease trajectory and symptomatic control, because while kidney replacement therapies can prolong life, they do not cure. The issue is complex due to its multidimensional perspective, so decisions must take into account the patient’s options, respecting his/her autonomy, dignity and quality of life. This text aims to review the particularities of geriatric CKD patients’ assessment towards options to care for ESKD, in a specific population which is growing in our practice. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400009&lng=en&nrm=iso&tlng=en Multiple Myeloma (MM) is characterized by a neoplastic proliferation of plasma cell clones producing monoclonal immunoglobulin. Manifestations of the disease are heterogenous and include dialysis-requiring acute kidney injury (AKI) caused mainly by cast nephropathy (CN). It is known that early and rapid decrease in serum free light chains (sFLC) levels is particularly important for renal recovery, which has led to a renewed interest in extracorporeal methods of removal of sFLC. In this review we will discuss the management of light chain CN focusing on extracorporeal light chains removal modalities and their indication. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400010&lng=en&nrm=iso&tlng=en Monoclonal gammopathies consist of a broad spectrum of diseases, ranging from asymptomatic monoclonal gammopathy of undetermined significance to multiple myeloma (MM). Multiple myeloma is a malignant plasma cell disorder and accounts for 10% of all hematological malignancies and 1% of all malignancies. Differential diagnosis may be challenging, considering the variety of clinical entities with similar behavior. About 15-20% of MM only secretes monoclonal light chains, called light chain MM, which is associated with poorer outcome. Two intermediate concepts were recently introduced, monoclonal gammopathy of renal significance (MGRS) and a wider concept of monoclonal gammopathy of clinical significance (MGCS). The former behaves as a clonal proliferative disorder with associated nephrotoxicity, but does not have the hematological criteria for MM, while MGCS expands this concept to other organs. A subtype of MGCS is monoclonal immunoglobulin deposition disease, a multisystemic disorder characterized by light or heavy chain deposition of monoclonal immunoglobulin in various organs and encompasses three clinical entities: Light-Chain, Light-and Heavy-Chain, and Heavy-Chain Deposition Disease (LCDD, LHCDD and HCDD, respectively). We describe an unusual case of LCDD in which MM was subsequently considered although the proposed criteria are not met. We demonstrate the variability of clinical-pathological presentation of LCDD, requiring a rapid decision-making, particularly in terms of kidney and survival outcomes. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400011&lng=en&nrm=iso&tlng=en Severe Chronic Kidney Disease is considered a powerful method of contraception per se, and pregnancy among women undergoing chronic hemodialysis is a rare event. Women on dialysis usually have amenorrhea or irregular menstrual cycles and sexual dysfunction. They are often unaware of their pregnancy, which delays the diagnosis and the beginning of adequate obstetric-nephrological care, increasing the risk of maternal and fetal complications including pre-eclampsia, fetal growth restriction, preterm delivery, and perinatal death. However, pregnancy among women on dialysis is increasing exponentially around the world. The authors present the two last pregnancies of patients on dialysis followed in their hospital, review clinical procedures, and the improvements of medical care during gestation used to contribute to a successful gestation outcome. Pregnancy is possible in women on chronic hemodialysis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400012&lng=en&nrm=iso&tlng=en Severe Chronic Kidney Disease is considered a powerful method of contraception per se, and pregnancy among women undergoing chronic hemodialysis is a rare event. Women on dialysis usually have amenorrhea or irregular menstrual cycles and sexual dysfunction. They are often unaware of their pregnancy, which delays the diagnosis and the beginning of adequate obstetric-nephrological care, increasing the risk of maternal and fetal complications including pre-eclampsia, fetal growth restriction, preterm delivery, and perinatal death. However, pregnancy among women on dialysis is increasing exponentially around the world. The authors present the two last pregnancies of patients on dialysis followed in their hospital, review clinical procedures, and the improvements of medical care during gestation used to contribute to a successful gestation outcome. Pregnancy is possible in women on chronic hemodialysis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400013&lng=en&nrm=iso&tlng=en Severe Chronic Kidney Disease is considered a powerful method of contraception per se, and pregnancy among women undergoing chronic hemodialysis is a rare event. Women on dialysis usually have amenorrhea or irregular menstrual cycles and sexual dysfunction. They are often unaware of their pregnancy, which delays the diagnosis and the beginning of adequate obstetric-nephrological care, increasing the risk of maternal and fetal complications including pre-eclampsia, fetal growth restriction, preterm delivery, and perinatal death. However, pregnancy among women on dialysis is increasing exponentially around the world. The authors present the two last pregnancies of patients on dialysis followed in their hospital, review clinical procedures, and the improvements of medical care during gestation used to contribute to a successful gestation outcome. Pregnancy is possible in women on chronic hemodialysis. http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000400014&lng=en&nrm=iso&tlng=en Severe Chronic Kidney Disease is considered a powerful method of contraception per se, and pregnancy among women undergoing chronic hemodialysis is a rare event. Women on dialysis usually have amenorrhea or irregular menstrual cycles and sexual dysfunction. They are often unaware of their pregnancy, which delays the diagnosis and the beginning of adequate obstetric-nephrological care, increasing the risk of maternal and fetal complications including pre-eclampsia, fetal growth restriction, preterm delivery, and perinatal death. However, pregnancy among women on dialysis is increasing exponentially around the world. The authors present the two last pregnancies of patients on dialysis followed in their hospital, review clinical procedures, and the improvements of medical care during gestation used to contribute to a successful gestation outcome. Pregnancy is possible in women on chronic hemodialysis.