Archives of renal diseases and management, Dec 16, 2022
Introduction: The kidneys are fundamental organs for survival and the progressive loss of their f... more Introduction: The kidneys are fundamental organs for survival and the progressive loss of their functions causes the loss of regulatory, excretory and endocrine functions, essentially affecting the entire balance of the organism. Chronic Kidney Disease (CKD) is considered a complex disease and a worldwide public health problem with the number of patients continuously increasing, even in the pediatric population. CKD often progresses to end-stage requiring Renal Replacement Therapy (RRT). Kidney transplantation is the treatment of choice to maximize the survival, growth, and development of pediatric patients, however, if dialysis is necessary, Peritoneal Dialysis (PD) is a high-quality and low-cost RRT modality preferred therapy for children and adolescents with End-Stage Kidney Disease (ESKD). In this scope, this study aimed to carry out an integrative review of the survival and the epidemiological, clinical, social and economic profile of children and adolescents with PD. Methods: It is an integrative review whose data collection was carried out between January 2019 and January 2021 following the methodology suggested by the literature, using a validated data collection instrument. The following health science descriptors (DECs) from the VHL portal (virtual health library) were used: children, adolescents, chronic peritoneal dialysis, survival and epidemiology. Results: Thirty-five studies were selected and evaluated using the Critical Appraisal Skills Program (CASP). The level of evidence of the articles was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Survival and epidemiological, social, economic and clinical aspects of pediatric PD in Brazil and worldwide have been described and reviewed. Conclusions: The complexity and costs involved in the care of pediatric patients in RRT impact their survival. Mortality and morbidity are higher than in healthy children and life expectancy is considerably lower. ESKD is more severe in the pediatric population and interferes with general development, weight and height gain, regulation of mineral metabolism and causes definitive cardiovascular calcifications. Kidney transplantation is the treatment of choice to maximize the survival, growth and development of pediatric patients. However, if dialysis is necessary PD is the first-choice modality in this population. Unfortunately, data are scarce in the literature on its survival and its epidemiological, social, economic and clinical aspects.
The covid-19 vaccine confers direct protection and reduces transmission rates of the virus and ne... more The covid-19 vaccine confers direct protection and reduces transmission rates of the virus and new variants. Vaccines from Pfizer/BioNTech and CoronaVac have been cleared for children in Brazil. They are safe, effective, and immunogenic. There are no known complications associated with the use of steroids or vaccines in pediatric patients with covid-19 and nephrotic syndrome. With or without immunosuppression, these patients are not at increased risk of severe covid-19, and steroids are safe for them. A milder form of covid-19 occurs in patients with chronic kidney disease without the need for hospitalization. The vaccine response may be reduced and/or the duration of antibodies after vaccination may be shorter than in the general population. However, considering risk of exposure, vaccination against covid-19 is recommended. It is believed that patients with hemolytic-uremic syndrome are at higher risk of severe covid-19. Vaccination is recommended, although specific data on the saf...
Rare disease or an orphan disease is a disease that affects a small percentage of the population.... more Rare disease or an orphan disease is a disease that affects a small percentage of the population. Most of these diseases are present throughout the patients life, even if the symptoms do not appear immediately. They are often fatal or chronically debilitating and the impact on the quality of life of patients and their families is significant. Patients with rare diseases often experience delays in diagnosis, which can negatively impact management and delay treatment. Familial genetic testing or cascade genotyping of all newly diagnosed individuals can speed up the diagnosis of these diseases and allow more patients to be identified at a younger age. Care for patients with chronic and rare diseases is complex, mainly due to lack of knowledge about the disease, which makes accurate and early diagnosis difficult, in addition to the need to perform specific tests, which are sometimes highly complex and costly. Added to these factors are difficulties in obtaining adequate treatment when available, raising awareness of the patient and family about the disease and adherence to treatment. Residência Pediátrica; 2023: Ahead of Print. DOI: 10.25060/residpediatr-2023-1062 Nota aos leitores: pode haver informações pendentes, por se tratar de um artigo em “visualização pré-publicação”. A multidisciplinary approach is very important: care provided by a doctor, nurse, psychologist, nutritionist and social worker. These professionals, in addition to medical care, address the particularities of the disease and treatment, the impact on the life of the patient and his family, the approach to psychological and social issues, and guidance regarding medications and diets.
OBJECTIVE To describe the dietary patterns and occurrence of metabolic disorders in children and ... more OBJECTIVE To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. METHODS Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. RESULTS 40 individuals were analyzed. Mean age at diagnosis was 7.2±4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. CONCLUSION Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications.
Archives of renal diseases and management, Dec 16, 2022
Introduction: The kidneys are fundamental organs for survival and the progressive loss of their f... more Introduction: The kidneys are fundamental organs for survival and the progressive loss of their functions causes the loss of regulatory, excretory and endocrine functions, essentially affecting the entire balance of the organism. Chronic Kidney Disease (CKD) is considered a complex disease and a worldwide public health problem with the number of patients continuously increasing, even in the pediatric population. CKD often progresses to end-stage requiring Renal Replacement Therapy (RRT). Kidney transplantation is the treatment of choice to maximize the survival, growth, and development of pediatric patients, however, if dialysis is necessary, Peritoneal Dialysis (PD) is a high-quality and low-cost RRT modality preferred therapy for children and adolescents with End-Stage Kidney Disease (ESKD). In this scope, this study aimed to carry out an integrative review of the survival and the epidemiological, clinical, social and economic profile of children and adolescents with PD. Methods: It is an integrative review whose data collection was carried out between January 2019 and January 2021 following the methodology suggested by the literature, using a validated data collection instrument. The following health science descriptors (DECs) from the VHL portal (virtual health library) were used: children, adolescents, chronic peritoneal dialysis, survival and epidemiology. Results: Thirty-five studies were selected and evaluated using the Critical Appraisal Skills Program (CASP). The level of evidence of the articles was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Survival and epidemiological, social, economic and clinical aspects of pediatric PD in Brazil and worldwide have been described and reviewed. Conclusions: The complexity and costs involved in the care of pediatric patients in RRT impact their survival. Mortality and morbidity are higher than in healthy children and life expectancy is considerably lower. ESKD is more severe in the pediatric population and interferes with general development, weight and height gain, regulation of mineral metabolism and causes definitive cardiovascular calcifications. Kidney transplantation is the treatment of choice to maximize the survival, growth and development of pediatric patients. However, if dialysis is necessary PD is the first-choice modality in this population. Unfortunately, data are scarce in the literature on its survival and its epidemiological, social, economic and clinical aspects.
The covid-19 vaccine confers direct protection and reduces transmission rates of the virus and ne... more The covid-19 vaccine confers direct protection and reduces transmission rates of the virus and new variants. Vaccines from Pfizer/BioNTech and CoronaVac have been cleared for children in Brazil. They are safe, effective, and immunogenic. There are no known complications associated with the use of steroids or vaccines in pediatric patients with covid-19 and nephrotic syndrome. With or without immunosuppression, these patients are not at increased risk of severe covid-19, and steroids are safe for them. A milder form of covid-19 occurs in patients with chronic kidney disease without the need for hospitalization. The vaccine response may be reduced and/or the duration of antibodies after vaccination may be shorter than in the general population. However, considering risk of exposure, vaccination against covid-19 is recommended. It is believed that patients with hemolytic-uremic syndrome are at higher risk of severe covid-19. Vaccination is recommended, although specific data on the saf...
Rare disease or an orphan disease is a disease that affects a small percentage of the population.... more Rare disease or an orphan disease is a disease that affects a small percentage of the population. Most of these diseases are present throughout the patients life, even if the symptoms do not appear immediately. They are often fatal or chronically debilitating and the impact on the quality of life of patients and their families is significant. Patients with rare diseases often experience delays in diagnosis, which can negatively impact management and delay treatment. Familial genetic testing or cascade genotyping of all newly diagnosed individuals can speed up the diagnosis of these diseases and allow more patients to be identified at a younger age. Care for patients with chronic and rare diseases is complex, mainly due to lack of knowledge about the disease, which makes accurate and early diagnosis difficult, in addition to the need to perform specific tests, which are sometimes highly complex and costly. Added to these factors are difficulties in obtaining adequate treatment when available, raising awareness of the patient and family about the disease and adherence to treatment. Residência Pediátrica; 2023: Ahead of Print. DOI: 10.25060/residpediatr-2023-1062 Nota aos leitores: pode haver informações pendentes, por se tratar de um artigo em “visualização pré-publicação”. A multidisciplinary approach is very important: care provided by a doctor, nurse, psychologist, nutritionist and social worker. These professionals, in addition to medical care, address the particularities of the disease and treatment, the impact on the life of the patient and his family, the approach to psychological and social issues, and guidance regarding medications and diets.
OBJECTIVE To describe the dietary patterns and occurrence of metabolic disorders in children and ... more OBJECTIVE To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. METHODS Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. RESULTS 40 individuals were analyzed. Mean age at diagnosis was 7.2±4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. CONCLUSION Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications.
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Papers by Maria Goretti M G Penido