Brazilian Journal of Nephrologyhttps://www.scielo.br/feed/jbn/2020.v42n2/2024-03-12T20:21:41.078000ZVol. 42 No. 2 - 2020WerkzeugBone biopsy in chronic kidney disease: still an option?10.1590/2175-8239-JBN-2020-00352024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZDrueke, Tilman B.
<em>Drueke, Tilman B.</em>;
<br/><br/>
Effects of ambient temperature and humidity on kidney stone admissions in Brazil10.1590/2175-8239-JBN-2020-00622024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZIyer, Sitalakshmi J.Goldfarb, David S.
<em>Iyer, Sitalakshmi J.</em>;
<em>Goldfarb, David S.</em>;
<br/><br/>
Pre-formed DSA and kidney allograft outcomes10.1590/2175-8239-JBN-2020-00432024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZYeung, Melissa Y.
<em>Yeung, Melissa Y.</em>;
<br/><br/>
Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO10.1590/2175-8239-JBN-2019-00452024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZCarbonara, Cinthia Esbrile MoraesReis, Luciene Machado dosQuadros, Kélcia Rosana da SilvaRoza, Noemi Angelica VieiraSano, RafaelCarvalho, Aluizio BarbosaJorgetti, VandaOliveira, Rodrigo Bueno de
<em>Carbonara, Cinthia Esbrile Moraes</em>;
<em>Reis, Luciene Machado Dos</em>;
<em>Quadros, Kélcia Rosana Da Silva</em>;
<em>Roza, Noemi Angelica Vieira</em>;
<em>Sano, Rafael</em>;
<em>Carvalho, Aluizio Barbosa</em>;
<em>Jorgetti, Vanda</em>;
<em>Oliveira, Rodrigo Bueno De</em>;
<br/><br/>
ABSTRACT Introduction: Mineral and bone disorders (MBD) are major complications of chronic kidney disease (CKD)-related adverse outcomes. The Brazilian Registry of Bone Biopsy (REBRABO) is an electronic database that includes renal osteodystrophy (RO) data. We aimed to describe the epidemiological profile of RO in a sample of CKD-MBD Brazilian patients and understand its relationship with outcomes. Methods: Between August 2015 and March 2018, 260 CKD-MBD stage 3-5D patients who underwent bone biopsy were followed for 12 to 30 months. Clinical-demographic, laboratory, and histological data were analyzed. Bone fractures, hospitalizations, and death were considered the primary outcomes. Results: Osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, osteomalacia, osteoporosis, and aluminum (Al) accumulation were detected in 85, 43, 27, 10, 77, and 65 patients, respectively. The logistic regression showed that dialysis vintage was an independent predictor of osteoporosis (OR: 1.005; CI: 1.001-1.010; p = 0.01). The multivariate logistic regression revealed that hemodialysis treatment (OR: 11.24; CI: 1.227-100; p = 0.03), previous parathyroidectomy (OR: 4.97; CI: 1.422-17.241; p = 0.01), and female gender (OR: 2.88; CI: 1.080-7.679; p = 0.03) were independent predictors of Al accumulation; 115 patients were followed for 21 ± 5 months. There were 56 hospitalizations, 14 deaths, and 7 fractures during follow-up. The COX regression revealed that none of the variable related to the RO/turnover, mineralization and volume (TMV) classification was an independent predictor of the outcomes. Conclusion: Hospitalization or death was not influenced by the type of RO, Al accumulation, or TMV classification. An elevated prevalence of osteoporosis and Al accumulation was detected.The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors10.1590/2175-8239-JBN-2019-00802024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZLopes, Jocefábia Reika AlvesMarques, Ana Lígia de BarrosCorrea, João Antonio
<em>Lopes, Jocefábia Reika Alves</em>;
<em>Marques, Ana Lígia De Barros</em>;
<em>Correa, João Antonio</em>;
<br/><br/>
Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis10.1590/2175-8239-JBN-2019-01512024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZSugizaki, Clara Sandra de AraujoBraga, Clarice CarneiroFreitas, Ana Tereza Vaz de SouzaPeixoto, Maria do Rosário Gondim
<em>Sugizaki, Clara Sandra De Araujo</em>;
<em>Braga, Clarice Carneiro</em>;
<em>Freitas, Ana Tereza Vaz De Souza</em>;
<em>Peixoto, Maria Do Rosário Gondim</em>;
<br/><br/>
Abstract Objective: To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale’s psychometric properties for patients on hemodialysis (HD). Methods: The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach’s alpha was used to measure the scale’s internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). Results: The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale’s internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). Conclusion: Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.Validation and applicability of an alternative method for dialysis water and dialysate quality analysis10.1590/2175-8239-JBN-2019-02032024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZCarvalho, Gabriela CorrêaBugno, AdrianaAlmodovar, Adriana Aparecida BuzzoSilva, Fernando Pontes de Lima ePinto, Terezinha de Jesus Andreoli
<em>Carvalho, Gabriela Corrêa</em>;
<em>Bugno, Adriana</em>;
<em>Almodovar, Adriana Aparecida Buzzo</em>;
<em>Silva, Fernando Pontes De Lima E</em>;
<em>Pinto, Terezinha De Jesus Andreoli</em>;
<br/><br/>
ABSTRACT Introduction: In hemodialysis, patients are exposed to a large volume of water, which may lead to fatal risks if not meeting quality standards. This study aimed to validate an alternative method for monitoring microbiological quality of treated water and assess its applicability in dialysis and dialysate analysis, to allow corrective actions in real-time. Methods: Validation and applicability were analyzed by conventional and alternative methods. For validation, E. coli standard endotoxin was diluted with apyrogenic water in five concentrations. For the applicability analysis, treated water for dialysis was collected from different points in the treatment system (reverse osmosis, drainage canalization at the storage tank bottom, reuse, and loop), and dialysate was collected from four machines located in different rooms in the hemodialysis sector. Results: The validation results were in accordance with the Brazilian Pharmacopoeia acceptance criteria, except for the last two concentrations analyzed. In addition, the ruggedness criterion performed under the US Pharmacopoeia was in agreement with the results. Discussion: A limiting factor in the applicability analysis was the absence of the endotoxin maximum permitted level in dialysate by the Brazilian legislation. When comparing the analysis time, the alternative method was more time-consuming than the conventional one. This suggests that the alternative method is effective in the case of few analyses, that is, real-time analyses, favoring corrective actions promptly. On the other hand, it does not support the implementation of the alternative method in a laboratory routine due to the high demand for analyses.Influence of climate on the number of hospitalizations for nephrolithiasis in urban regions in Brazil10.1590/2175-8239-JBN-2019-01552024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZAbreu Júnior, João deFerreira Filho, Sebastião Rodrigues
<em>Abreu Júnior, João De</em>;
<em>Ferreira Filho, Sebastião Rodrigues</em>;
<br/><br/>
Abstract Introduction: Nephrolithiasis has a worldwide prevalence of approximately 5 to 15%, and its occurrence is associated with age, sex, race, dietary habits, geographic location, climatic conditions, and other factors. The objective of the present study was to determine the association between climate and the number of hospitalizations for nephrolithiasis (NH) in Brazilian cities located in different climatic regions. Methods: We analyzed data from cities with tropical and subtropical climates. The effects of the lowest (LT), mean (MT), and highest (HT) monthly temperatures and relative humidity of the air (RH) were assessed. Results: A positive association was found between the number of hospitalizations for nephrolithiasis and temperature ((LT x NH; R2=0.218; P<0.0001) (MT x NH; R2=0.284; P<0.0001) (HT x NH; R2=0.317; P<0.0001)), and a negative association was found between the number of hospitalizations for nephrolithiasis and the relative humidity (RH x NH; R2=0.234; P<0.0001). Interactions were also observed between MT and RH with respect to their effects on the NH, as described by a linear model (NH = 4.688 + 0.296 x MT - 0.088 x RH). The NH was higher in cities with tropical climates than in cities with subtropical climates (82.4 ± 10.0 vs 28.2 ± 1.6; P<0.00001). Conclusion: There is an association between the NH and variations in temperature and relative humidity.Influenza A (H1N1): outbreak management in a dialysis unit and clinical outcomes of infection in chronic hemodialysis patients10.1590/2175-8239-JBN-2019-01802024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZVentura, Carlucci GualbertoRoque, Felício LopesSousa, Itanilton Queiroz deLobo, Renata DesordiLuders, Claudio
<em>Ventura, Carlucci Gualberto</em>;
<em>Roque, Felício Lopes</em>;
<em>Sousa, Itanilton Queiroz De</em>;
<em>Lobo, Renata Desordi</em>;
<em>Luders, Claudio</em>;
<br/><br/>
ABSTRACT Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. Conclusion: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.Brazilian Dialysis Census: analysis of data from the 2009-2018 decade10.1590/2175-8239-JBN-2019-02342024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZNeves, Precil Diego Miranda de MenezesSesso, Ricardo de Castro CintraThomé, Fernando SaldanhaLugon, Jocemir RonaldoNasicmento, Marcelo Mazza
<em>Neves, Precil Diego Miranda De Menezes</em>;
<em>Sesso, Ricardo De Castro Cintra</em>;
<em>Thomé, Fernando Saldanha</em>;
<em>Lugon, Jocemir Ronaldo</em>;
<em>Nasicmento, Marcelo Mazza</em>;
<br/><br/>
Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes10.1590/2175-8239-JBN-2018-02442024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZSousa, Marcos Vinicius deZollner, Ricardo de LimaMazzali, Marilda
<em>Sousa, Marcos Vinicius De</em>;
<em>Zollner, Ricardo De Lima</em>;
<em>Mazzali, Marilda</em>;
<br/><br/>
Abstract Introduction: Renal fibrosis is the end point of a process that begins at transplant, with ischemia reperfusion and early inflammation, and progresses over time with immunological and non-immunological phenomena. Early identification of morphological markers and intervention could improve graft function and survival. Objective: to evaluate the correlation between intensity and specificity of pre-transplant anti-HLA antibodies and kidney allograft pathology in order to identify early risk factors or markers of allograft dysfunction. Methods: A retrospective cohort of kidney transplant recipients with pre-transplant anti-HLA antibodies who underwent graft biopsy within the first two years post-transplant was divided into two groups according to the specificity of anti-HLA antibodies: nonspecific (non-DSA, n = 29) and specific (DSA+, n = 16). Kidney graft pathology, renal function, and proteinuria were analyzed. Results: general characteristics were similar in both groups, except for the higher dose of thymoglobulin in DSA+ group (p < 0.05). The non-DSA group had higher scores for glomerulosclerosis, interstitial inflammation (i) and interstitial fibrosis (ci) (p < 0.05) and higher incidence of cell-mediated acute rejection. No statistical difference in incidence of antibody-mediated rejection, renal function, and proteinuria was observed during follow up. Discussion and conclusions: the difference in inflammation scores and interstitial fibrosis may be associated to the higher incidence of acute cell-mediated rejection and polyomavirus nephropathy in the Non-DSA group. We also should take into account the protective effect of higher doses of thymoglobulin, reducing ischemia reperfusion injury in the DSA+ group. The short follow-up might have been insufficient to detect long-term changes in allograft tissue, renal function, and proteinuria.Usefulness of Kidney Donor Profile Index (KDPI) to predict graft survival in a South Brazilian Cohort10.1590/2175-8239-JBN-2018-02632024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZPrado, Natália PetterSilva, Cynthia Keitel daMeinerz, GiseleKist, RogerGarcia, Valter DuroKeitel, Elizete
<em>Prado, Natália Petter</em>;
<em>Silva, Cynthia Keitel Da</em>;
<em>Meinerz, Gisele</em>;
<em>Kist, Roger</em>;
<em>Garcia, Valter Duro</em>;
<em>Keitel, Elizete</em>;
<br/><br/>
Abstract Introduction: Kidney Donor Profile Index (KDPI) has been incorporated in the United States to improve the kidney transplant allocation system. Objectives: To evaluate deceased kidney donors’ profile using KDPI and compare to the previous United Network for Organ Sharing (UNOS) definition of expanded criteria donors (ECD) and assess the KDPI applicability to predict five-year graft survival and renal function in our sample. Methods: Retrospective cohort of 589 kidney transplants from deceased donors performed from January 2009 to May 2013 with follow-up until May 2018. Results: In 589 kidney transplants, 36.6% of donors were classified as ECD and 28.8% had KDPI ≥ 85%. Mean KDPI was 63.1 (95%CI: 60.8-65.3). There was an overlap of standard and ECD in KDPI between 60 and 95 and a significantly lower death-censored graft survival in KDPI ≥ 85% (78.6%); KDPI 0-20: 89.8%, KDPI 21-59: 91.6%, and KDPI 60-84: 83.0%; p = 0.006. The AUC-ROC was 0.577 (95%CI: 0.514-0.641; p = 0.027). Renal function at 5 years was significantly lower according to the incremental KDPI (p < 0.002). KDPI (HR 1.011; 95%CI 1.001-1.020; p = 0.008), donor-specific antibodies (HR 2.77; 95%CI 1.69-4.54; p < 0.001), acute rejection episode (HR 1.73; 95%CI 1.04-2.86; p = 0.034) were independent and significant risk factors for death-censored graft loss at 5 years. Conclusion: In our study, 36.6% were classified as ECD and 28.8% had KDPI ≥ 85%. KDPI score showed a moderate power to predict graft survival at 5 years. Renal function was significantly lower in patients with higher KDPI.Rare inherited kidney diseases: an evolving field in Nephrology10.1590/2175-8239-JBN-2018-02172024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZCunha, Mariana Faucz Munhoz daSevignani, GabrielaPavanelli, Giovana MemariCarvalho, Mauricio deBarreto, Fellype Carvalho
<em>Cunha, Mariana Faucz Munhoz Da</em>;
<em>Sevignani, Gabriela</em>;
<em>Pavanelli, Giovana Memari</em>;
<em>Carvalho, Mauricio De</em>;
<em>Barreto, Fellype Carvalho</em>;
<br/><br/>
Abstract There are more than 150 different rare genetic kidney diseases. They can be classified according to diagnostic findings as (i) disorders of growth and structure, (ii) glomerular diseases, (iii) tubular, and (iv) metabolic diseases. In recent years, there has been a shift of paradigm in this field. Molecular testing has become more accessible, our understanding of the underlying pathophysiologic mechanisms of these diseases has evolved, and new therapeutic strategies have become more available. Therefore, the role of nephrologists has progressively shifted from a mere spectator to an active player, part of a multidisciplinary team in the diagnosis and treatment of these disorders. This article provides an overview of the recent advances in rare hereditary kidney disorders by discussing the genetic aspects, clinical manifestations, diagnostic, and therapeutic approaches of some of these disorders, named familial focal and segmental glomerulosclerosis, tuberous sclerosis complex, Fabry nephropathy, and MYH-9 related disorder.Early Hospital Readmission (EHR) in kidney transplantation: a review article10.1590/2175-8239-JBN-2019-00892024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZTavares, Melissa GasparTedesco-Silva Junior, HelioPestana, Jose Osmar Medina
<em>Tavares, Melissa Gaspar</em>;
<em>Tedesco-Silva Junior, Helio</em>;
<em>Pestana, Jose Osmar Medina</em>;
<br/><br/>
Abstract Early hospital readmission (EHR), defined as all readmissions within 30 days of initial hospital discharge, is a health care quality measure. It is influenced by the demographic characteristics of the population at risk, the multidisciplinary approach for hospital discharge, the access, coverage, and comprehensiveness of the health care system, and reimbursement policies. EHR is associated with higher morbidity, mortality, and increased health care costs. Monitoring EHR enables the identification of hospital and outpatient healthcare weaknesses and the implementation of corrective interventions. Among kidney transplant recipients in the USA, EHR ranges between 18 and 47%, and is associated with one-year increased mortality and graft loss. One study in Brazil showed an incidence of 19.8% of EHR. The main causes of readmission were infections and surgical and metabolic complications. Strategies to reduce early hospital readmission are therefore essential and should consider the local factors, including socio-economic conditions, epidemiology and endemic diseases, and mobility.Vitamin D Toxicity10.1590/2175-8239-JBN-2019-01922024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZLim, KennethThadhani, Ravi
<em>Lim, Kenneth</em>;
<em>Thadhani, Ravi</em>;
<br/><br/>
Abstract Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.Anca negative pauci-immune crescentic glomerulonephritis and mixed connective tissue disease: a case study10.1590/2175-8239-JBN-2019-00032024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZFernandes, SaraTeixeira, CatarinaFalcão, Luis PedroCosta, Ana CortesãoRaimundo, MárioSilva, SóniaCardoso, JoãoAlmeida, Edgar De
<em>Fernandes, Sara</em>;
<em>Teixeira, Catarina</em>;
<em>Falcão, Luis Pedro</em>;
<em>Costa, Ana Cortesão</em>;
<em>Raimundo, Mário</em>;
<em>Silva, Sónia</em>;
<em>Cardoso, João</em>;
<em>Almeida, Edgar De</em>;
<br/><br/>
Abstract One of the most common causes of rapidly progressive glomerulonephritis (RPGN) is pauci-immune crescentic glomerulonephritis (CrGN). In the majority of cases, this condition has a positive serologic marker, the anti-neutrophil cytoplasmic antibodies (ANCAs), but in approximately 10% there are no circulating ANCAs, and this subgroup has been known as the ANCA-negative pauci-immune CrGN. RPGN can be associated with systemic diseases, but there are only few case reports describing the association with mixed connective tissue disease (MCTD). The authors report a case of ANCA-negative CrGN associated with a MCTD.Severe hypokalemia secondary to abuse of β-adrenergic agonists in a pediatric patient: Case report10.1590/2175-8239-JBN-2019-00202024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZAliaga, Carolt AranaArizon, Leonor Fayos deBermúdez, Rosario MontañésCastán, Jose A. BallarínSantandreu, Anna Vila
<em>Aliaga, Carolt Arana</em>;
<em>Arizon, Leonor Fayos De</em>;
<em>Bermúdez, Rosario Montañés</em>;
<em>Castán, Jose A. Ballarín</em>;
<em>Santandreu, Anna Vila</em>;
<br/><br/>
ABSTRACT This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of β-adrenergic agonists in the context of a probable factitious disorder.A rare case of PLA2R- and THSD7A-positive idiopathic membranous nephropathy10.1590/2175-8239-JBN-2019-00772024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZWanderley, David CamposJones, Bárbara DornelasBarbosa, Fabricio Augusto MarquesAraujo, Stanley de Almeida
<em>Wanderley, David Campos</em>;
<em>Jones, Bárbara Dornelas</em>;
<em>Barbosa, Fabricio Augusto Marques</em>;
<em>Araujo, Stanley De Almeida</em>;
<br/><br/>
ABSTRACT Idiopathic membranous nephropathy (IMN) is a frequent cause of nephrotic syndrome in adults. In terms of etiology, the condition may be categorized as primary/idiopathic or secondary. Literature on the pathophysiology of IMN has indicated the presence of autoantibodies (PLA2R and THSD7A) directed against podocyte antigens. The detection of antibodies against a domain favors IMN. The presence of autoantibodies against one of the domains would in theory exclude the possibility of there being autoantibodies against the other domain. However, cases of patients with PLA2R- and THSD7A-positive disease have been recently reported, showing that antibodies against two targets may be concomitantly produced via yet unknown pathophysiological mechanisms. This study reports the case of a 46-year-old male patient with nephrotic-range proteinuria, hematuria, hypoalbuminemia, and hypercholesterolemia submitted to biopsy and histopathology examination (LM, IF, IHC, and EM) eventually diagnosed with PLA2R- and THSD7A-positive IMN associated with IgA nephropathy, stressing our experience with the use of IgG subclasses, PLA2R, and THSD7A in the workup for MN and the relevance of adopting a broad and adequate approach to elucidating and acquiring knowledge of the pathophysiology of IMN.Primary antiphospholipid syndrome in a hemodialysis patient with recurrent thrombosis of arteriovenous fistulas10.1590/2175-8239-JBN-2019-00812024-03-12T20:21:41.078000Z2020-08-09T06:48:18.290000ZGjorgjievski, NikolaDzekova-Vidimliski, Pavlina
<em>Gjorgjievski, Nikola</em>;
<em>Dzekova-Vidimliski, Pavlina</em>;
<br/><br/>
ABSTRACT Introduction: The antiphospholipid syndrome is a systemic autoimmune disease defined by recurrent vascular and/or obstetrical morbidity that occurs in patients with persistent antiphospholipid antibodies. Case presentation: A patient on hemodialysis with a primary antiphospholipid syndrome presented with recurrent vascular access thrombosis, obstetrical complications, and positive lupus anticoagulant. The patient had multiple arteriovenous fistulas that failed due to thrombosis. The obstetrical morbidity was defined by one miscarriage at the 7th week of gestation and a pregnancy complicated by pre-eclampsia with preterm delivery at the 28th week of gestation. A thorough thrombophilia screening confirmed the presence of antiphospholipid antibody. Lupus anticoagulant was present in plasma, measured on two occasions 12 weeks apart. Conclusion: Thrombophilias are inherited or acquired predispositions to vascular thrombosis and have been associated with thrombosis of the arteriovenous fistula. Patients on hemodialysis with recurrent vascular access thrombosis and presence of thrombophilia should be evaluated about the need for anticoagulant therapy with a vitamin K antagonist.