RESUMO A insuficiência renal crônica (IRA) é um processo fisiopatológico multifatorial e irreversível que frequentemente conduz a um estado terminal no qual o paciente passa a necessitar de tratamento por transplante renal. A maioria dos casos de IRA são devidos a doenças crônicas degenerativas; a disfunção endotelial é um dos fatores contribuintes na fisiopatologia. Um dos mecanismos mais importantes para o funcionamento adequado do endotélio é a regulação da síntese de óxido nítrico. Este composto é sintetizado por meio da enzima sintase do óxido nítrico, que tem três isoformas. Os polimorfismos no gene NOS3 tem sido implicados como fatores que alteram a homeostase desse mecanismo. Os polimorfismos Glu298Asp 4 b/a e -786T>C do gene NOS3 têm sido associados a uma deterioração mais rápida da função renal nos pacientes com IRA. Estes polimorfismos têm sido avaliados em pacientes com IRA de causas determinadas ou não-determinadas e relacionados a uma perda mais rápida da função renal.

ABSTRACT Chronic kidney disease (CKD) is a multifactorial pathophysiologic irreversible process that often leads to a terminal state in which the patient requires renal replacement therapy. Most cases of CKD are due to chronic-degenerative diseases and endothelial dysfunction is one of the factors that contribute to its pathophysiology. One of the most important mechanisms for proper functioning of the endothelium is the regulation of the synthesis of nitric oxide. This compound is synthesized by the enzyme nitric oxide synthase, which has 3 isoforms. Polymorphisms in the NOS3 gene have been implicated as factors that alter the homeostasis of this mechanism. The Glu298Asp polymorphisms 4 b/a and -786T>C of the NOS3 gene have been associated with a more rapid deterioration of kidney function in patients with CKD. These polymorphisms have been evaluated in patients with CKD of determined and undetermined etiology and related to a more rapid deterioration of kidney function.

Introduction: nowadays, exclusive breastfeeding is recommended during the first 6 months and may continue for up two years, complemented with adequate complementary feeding. If it is required, fruits, vegetables as well as gluten free cereals may be introduced between 4-6 months of age. It has been observed that an inadequate introduction causes alterations in development and favors food intolerances. The purpose of the present study is to assess the introduction of complementary feeding in children under 24 months of age in an urban health area with significant cultural diversity. Material and methods: descriptive observational study through interviews for 9 months (August 2014 to April 2015). Sociodemographic and economic variables, type of delivery, gestational age, care of the newborn by other members of the environment, vaccination and the first day of visit to the health center were evaluated. Related to feeding, the type of lactation, the age of initiation of formula feeding, and the time of introduction of complementary feeding were assessed. Results: 51 children were evaluated. 94% of them started complementary feeding before 6 months (fruits and free gluten cereals). These data are greater if there is care by another family member (grandmother). There were no statistically significant differences in any of the variables analyzed, except for pneumococcal vaccination (p<0.001) Conclusions: in our environment, a correct introduction of complementary feeding is carried out. Applying community interventions can improve adherence to current recommendations.

Introducción: el consumo exclusivo de lactancia materna se recomienda hasta los seis meses de edad, manteniéndola hasta los dos años con una alimentación complementaria adecuada. De requerirse, frutas, verduras y cereales sin gluten pueden introducirse entre los 4-6 meses. Se ha observado que una introducción inadecuada produce alteraciones en el desarrollo y favorece las intolerancias alimentarias. El propósito del presente trabajo es valorar la introducción de la alimentación complementaria en los niños menores de 24 meses de edad en un área de salud urbana con una importante diversidad cultural. Material y métodos: estudio observacional descriptivo mediante entrevistas durante nueve meses (de agosto de 2014 a abril de 2015). Se evaluaron variables sociodemográficas y económicas, tipo de parto, edad gestacional, cuidado o no del recién nacido por otros miembros del entorno, vacunación y el primer día de visita al centro de salud. En relación con la alimentación, se valoró el tipo de lactancia, la edad de inicio de lactancia diferente a la materna y el momento de introducción de la alimentación complementaria. Resultados: 51 niños fueron evaluados. Un 94% de los niños inicia la alimentación complementaria antes de los seis meses (frutas y cereales sin gluten). Estos datos son mayores si hay cuidado por otro miembro de la familia (abuela). No se apreciaron diferencias estadísticamente significativas en ninguna de las variables analizadas, excepto en la vacunación del neumococo (p <0,001). Conclusiones: en nuestro medio se realiza una correcta introducción de la alimentación complementaria. La aplicación de intervenciones en la comunidad puede mejorar la adherencia a las recomendaciones actuales.