RESUMO A lesão renal aguda é uma complicação comum da cirrose, acometendo até 20% dos pacientes hospitalizados. Este tema está em rápida evolução devido aos importantes avanços em novas classificações, biomarcadores e tratamentos que ocorreram nos últimos anos. Em nome da Sociedade Brasileira de Hepatologia, um painel de especialistas em Hepatologia e Nefrologia revisou as evidência publicadas na literatura, integrando os diferentes resultados de estudos, para desenvolver a presente recomendação.

ABSTRACT Acute kidney injury is a common complication of cirrhosis, occurring in up to 20% of patients hospitalized with cirrhosis. This field is rapidly changing, with significant advances in classification, biomarkers and therapy over the last few years. On the behalf of the Brazilian Society of Hepatology, a panel of experts in Hepatology and Nephrology reviewed published evidence to integrate findings and develop the recommendations presented in this manuscript.

PURPOSE: To evaluate alanine aminotransferase levels before and after a hemodialysis session and to correlate these values with the hematocrit rate and weight loss during hemodialysis. PATIENTS AND METHODS: The serum alanine aminotransferase levels, hematocrit rate and body weight were measured and correlated before and after a single hemodialysis session for 146 patients with chronic renal failure. An receiver operating characteristic (ROC) curve for the serum alanine aminotransferase levels collected before and after hemodialysis was plotted to identify hepatitis C virus-infected patients. RESULTS: The mean weight loss of the 146 patients during hemodialysis was 5.3% (p < 0.001). The mean alanine aminotransferase levels before and after hemodialysis were 18.8 and 23.9 IU/, respectively, denoting a significant 28.1% increase. An equally significant increase of 16.4% in the hematocrit rate also occurred after hemodialysis. The weight loss was inversely correlated with the rise in both the alanine aminotransferase level (r = 0.3; p < 0.001) and hematocrit rate (r = 0.5; p < 0.001). A direct correlation was found between the rise in alanine aminotransferase levels and the hematocrit during the hemodialysis session (r = 0.4; p < 0.001). Based on the ROC curve, the upper limit of the normal alanine aminotransferase level should be reduced by 40% relative to the upper limit of normal if the blood samples are collected before the hemodialysis session or by 60% if blood samples are collected after the session. CONCLUSION: In the present study, significant elevations in the serum alanine aminotransferase levels and hematocrit rates occurred in parallel to a reduction in body weight after the hemodialysis session. These findings suggest that one of the factors for low alanine aminotransferase levels prior to hemodialysis could be hemodilution in patients with chronic renal failure.

O trabalho teve como foco a discussão das políticas educacionais em educação ambiental e as visões de mundo com a finalidade de explicitar as implicações dessas em processos educativos. As visões de mundo são concebidas como macroestruturas epistemológicas, que compreendem um conjunto de valores, crenças, conceitos e formas de conhecimento que fundamentam as concepções e ações educativas. O trabalho apresenta, também, os componentes das visões de mundo e a maneira como esses se articulam em processos educativos. Esse aspecto é importante para se poder identificar as concepções de mundo subjacentes às práticas pedagógicas desenvolvidas pelas escolas. Na visão integrada de mundo, a problemática ambiental é entendida como decorrente do modelo de desenvolvimento social e das relações que os seres humanos estabelecem entre si e com o ambiente não humano. Considera-se, ainda, que a perspectiva relacional pode contribuir para uma mudança na atual abordagem da Educação Ambiental.

This paper focuses on the discussion of educational policies in environmental education and on world views, for the purpose of clarifying their implications in educative process. The world views are conceived as epistemological macro-structures which consist of a set of values, beliefs, concepts and forms of knowledge which are the base for conceptions and educative actions. The paper also presents the components of the world views and the ways in which these components are articulated in educative processes. This aspect is important in order that the world conceptions underlying pedagogical practices developed by the schools may be identified. In an integrated world view, an environmental issue is conceived as a relational issue resulting from the model of social development and the relationship which the human beings establish among themselves and with the non-human environment. It is considered that the relational perspective may contribute to a change in the current approach of the environmental education.