RESUMO
Introdução: Uma das funções da terapia renal substitutiva é a remoção da uréia acumulada nos pacientes portadores de insuficiência renal dialítica. Parte desta uréia encontra-se no compartimento muscular, reduzindo a capacidade dialítica de remoção deste soluto. A atividade física pode ser um fator importante que possa contribuir para melhora do fluxo sanguíneo muscular e conseqüente otimização da depuração deste soluto.Este trabalho teve como objetivo analisar, utilizando-se o índice de depuração da uréia por sessão dehemodálise (Kt/V) como parâmetro de eficácia dialítica, os resultados de um programa de exercícios isotônicos pré-dialíticos na qualidade de diálise. Metodologia: Foram analisados dados de quinze pacientes com insuficiência renal crônica (IRC) de ambos os sexos, submetidos à hemodiálise três vezes por semana. Um protocolo de exercícios isotônicos de baixa intensidade precedidos por alongamentos foi aplicado por um mês, imediatamente antes da sessão de hemodiálise. Após a hemodiálise, a concentração plasmática de uréia foi mensurada, o Kt/V determinado e comparado com o do mês anterior obtido com as mesmas condições de hemodiálise quanto à duração, filtro e acesso vascular, sem a aplicação do programa de exercícios. Teste t de Student, com significância de 5%, foi utilizado para análise dos dados. Resultados: Comparando o Kt/V do mês sem exercício (1,4 ± 0,33) com os obtidos após a aplicação do programa de exercícios (1,3 ± 0.3), os valores não foram estatisticamente significativos (p > 0,05). Conclusões: Os resultados sugerem que, na amostra analisada, o programa de exercícios na intensidade, duração e freqüência executados, não resultou na melhora da eficiência dialítica.
Introduction: One of the functions of the substitutive renal therapy is to remove accumulated urea inindividuals with dialytic renal failure. Part of this urea is found in the muscular compartment reducing the dialytic capacity to remove this solute. Physical activity can be an important contributing factor to improvethe muscle blood flow and consequently the optimization of this solute depuration . The aim of this studywas to analyze the results of a program of a pre-dialytic isotonic exercise, using the standard procedure of measure (Kt/V), as a parameter of the dialysis efficacy. Methodology: Data from fifteen (15) patients from both sexes with chronic renal failure (CRF) who had undergone hemodialysis three times a week were analyzed. A protocol of low intensity isotonic exercises preceded by stretching was applied during a month, immediately before hemodialysis sessions. After hemodialysis, a urea plasmatic concentration was measured; std Kt/Vwas determined and compared with the previous month obtained through the same conditions of hemodialysis according to the length, filter and vascular access, without the exercise program. Student´s t test with 5% of significance was used for data analysis. Results: Comparing the std Kt/V during the month without exercise(1.4 ± 0.33) with the Kt/V obtained after the exercise program (1.3 ± 0.3), the values were not statistically significant (p > 0.05). Conclusions: The results of this analyzed sample have suggested that this program ofexercise carried out in the intensity, length and frequency has not resulted improvement of the dialysis efficacy
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diálise Renal/métodos , Falência Renal Crônica/terapia , Terapia por Exercício/métodosRESUMO
BACKGROUND: The Paulista Registry of Glomerulopathies was created in May 1999 and comprises several centres of São Paulo, the most populous Brazilian State, that concentrates people from all regions of the country who look for health care. METHODS: This report includes data from 2086 patients from Brazil submitted to renal biopsy due to the presumed diagnosis of glomerular diseases, registered prospectively since May 1999 until January 2005. Data were collected by the integrants of the 11 centres involved, utilizing a standardized questionnaire. RESULTS: The mean age of the patients was 34.5+/-14.6 years. Primary glomerular diseases were more frequent in males (55.1%) than in females; on the other hand, secondary glomerular diseases were more frequent in females (71.8%). The most common clinical presentation was nephrotic syndrome and the frequency of hypertension, at this time, was 55.5%. There was a predominance of indication of biopsies in the third, fourth and fifth decades of life. The most common primary glomerular diseases were focal and segmental glomerulosclerosis (29.7%), followed by membranous nephropathy (20.7%), IgA nephropathy (17.8%), minimal change disease (9.1%), membranoproliferative glomerulonephritis (7%), crescentic glomerulonephritis (4.1%), advanced chronic glomerulopathy (4%), non-IgA mesangial glomerulonephritis (3.8%), diffuse proliferative glomerulonephritis (2.5%), focal segmental proliferative glomerulonephritis (1%) and others (0.3%). The most frequent secondary glomerular disease was lupus nephritis, corresponding to 66.2% of the cases, followed by post-infectious glomerulonephritis (12.5%), diabetic nephropathy (6.2%), diseases associated to paraproteinaemia (4.9%), hereditary diseases (4.6%), vasculitis (3.2%), malignancies (0.9.%), secondary focal segmental glomerulosclerosis (0.6%) and others (0.9%). CONCLUSION: Focal segmental glomerulosclerosis was the most frequent primary glomerular disease, followed by membranous nephropathy and IgA nephropathy. Lupus nephritis predominated over all the other secondary glomerular diseases.