O32 Kidney biopsy — Department of internal medicine experience (1990–2002)

SlO (sodium genetic

Abstracts intake, factors,

water etc.)

content

of sodium,

/ European

physical

031 The prognostic value of cardiac troponin mortality in hemodialysis patients R. Hojs, R. Ekart, T. Hojs-Fabjan, M. Gorenjak

t

Journal

activity,

for

ratial

of Internal and

cardiovascular

(Mar&or,

SI)

Atherosclerosis is accelerated in hemodialysis patients, the prevalence of coronary artery disease is approximately 40% and cardiovascular mortality is 10 to 20 times higher than in general population. Cardiac troponin T (cTnT) has been established as a very sensitive marker of myocardial injury in general population. Less is known about the prognostic value of cTnT in hemodialysis patients. In our study 90 chronic hemodialysis patients (35 women and 55 men) were followed prospectively after determination of cTnT level (cTnT Assay, Roche), at l-months intervals. The outcome after 21 months was chosen as the end-point. Mean age of in the study included patients was 56.2~ 13.3 years. Mean duration of dialysis treatment was .58.8?48.7 months. During a follow-up 18 patients died, 13 (72%) of them from cardiovascular causes. In these patients cTnT values were significantly higher (0.12 vs. 0.06 microg/l; p=O.O06) than in those who survived. Correlation between cardiovascular mortality and cTnT was also found (r=O.294; p=O.O06). Hemodialysis patients were divided in relationship to the cTnT levels below and above two different cut-off levels: 0.1 kg/l - positive test; and 0.05 (*g/l previously suggested as a possible risk stratification value. The survival rates were analysed using Kaplan-Meier curves. The cut-off level of 0.1 kg/l resulted in survival rates of 92% and 64% for the group below and above. The cut-off level of 0.05 pg/l resulted in survival rates of 94% and 71% for the group below and above. The log rank test showed a significant difference in survival between groups for cTnT cut-off level of 0.1 *g/l (p=O.O006) and also for cut-off level of 0.05 pg/l (p=O.O04). According to our results cTnT was associated with higher cardiovascular mortality and was also predictor of cardiovascular outcome. The cut-off level of 0.1 pg/l may be usefully applied for cardiovascular mortality risk stratification in hemodialysis patients.

032 Kidney biopsy - Department of Internal 2002) N. Oliveira, J. Cotter, E. Torres, G. Alves

Medicine (Guimaraes,

experience

(1990-

P)

Objective: To prove the importance of kidney biopsy (KB) done by Internists in a Department of Internal Medicine. Methods: Retrospective Study. We review the charts of patients to whom a percutaneous KB of native kidney was done, in our Department between 01/01/1990 and 31/12/2002. The following dates were obtained: gender, age, indications for performing KB, renal function, proteinuria range, urinary sediment, hypertension, histopathological results, definitive diagnosis, complications associated with procedure and influence on therapy. Results: We analysed 95 KB in 85 patients: 46 females with mean age 32 years and 39 males with mean age of 40 years. The main motives for performing KB were nephrotic syndrome in 31 cases, assymptomatic urinary alterations in 23 cases and recurrent hematuria in 20 cases. Twenty-nine patients had acute renal failure. We diagnosed nephrotic range proteinuria (>3.5 g/day) in 37 cases and non-nephrotic range proteinuria (l-3.5 g/d) in 27 cases. There were hematuria in 72 cases and cilindruria in 35 cases. We observed hypertension in 48 patients. The most frequent histopathological diagnosis were mesangioproliferative glomerulonephritis (GN) in 16 cases, IgA nephropathy in 16 cases, membranoproliferative GN in 9 cases, diffuse proliferative GN in 8 cases, focal segmental glomerosclerosis and membranous nephropathy which

Medicine

14 (2003)

Sl-S159

one in 7 cases. The primary renal disease more diagnosed was IgA nephropathy (12 cases). Lupic nephritis was the renal disease most frequent in systemic disorders (16 cases). There were complications in 24 patients; the mean was pain in the local of biopsy (13 cases). There was only one major complication - perirenal hematoma. KB was important to guide therapy in 36 cases; 23 of these cases correspond to renal disease in systemic disorders. KB gave prognostic information in all patients. Conclusion: In our experience, KB done by Internists in a Department of Internal Medicine is essential on diagnosis, treatment and prognosis of intrinsic renal disease and kidney involvement in systemic disorders.

033 Accelerated-malignant WV P.G. Cunha, .I. Cotter, Porto, P)

hypertension Cl. Alves,

J.M.

(AM-HTA)

and

Calheiros,

E. Matos

renal

disease

(Guimaraes,

Between 1 /Ol/ 1992 and 3 l/ 12/2002, we diagnosed and treated 58 cases of AM-HTA. Twenty of these cases (in 18 patients) had concurrent RD. We defined Accelerated HTA by the coexistence of diastolic blood pressure (BP)>120 mmHg and grade III Keith-Wagener (KW) retinopathy; Malignant HTA was defined by the coexistence of diastolic BP>120 mmHg and grade IV KW retinopathy. RD was defined as existence of serum creatinine level >1.5 mg/dl in the male and >1.4 mg/dl in the female and/or Proteinuria >I g/24 h and/or urinary casts. Of all the patients with AM-HTA, we compared those who had RD with those who had none. Our analysis focused on number of cases, sex, age, knowledge of previous RD, creatinine level on admission, concurrent cardiac and/or neurological damage, BP on admission, percentage of patients with controlled BP at hospital discharge, results and evolution of renal function during follow up. Regarding the patients with RD, 12 were males with an average age of 42 years (27 to 68), and 6 were females with an average age of 34 years (21 to 48). Of those without RD, 19 were males with an average age of 49 years (22 to 65), and 16 were females with an average age of 46 years (25 to 65). Knowledge of previous RD was reported in 2 patients. Creatinine at admission was averaged in 4.55 mg/dl (1.4 to 15) in the patients with RD, and 0.89 mg/dl (0.6 to 1.3) in the patients without RD. There was concurrent cardiac damage in 7 patients with RD and 12 patients without RD. We registered concurrent neurological damage in 8 patients with RD and 14 patients without RD. BP at arrival was 2231139 mmHg (average) in the patients with RD, and 222/ 137 (average) in the patients without RD. The percentage of patients with controlled BP at hospital discharge was 20% for patients with RD and 26% for patients without RD. We addressed 5 patients to haemodialysis treatment or renal transplant. The follow up of 6 patients with RD and 17 patients without RD, for an average period of 22.7 months, did not show a significant deterioration of creatinine serum levels in both groups.

034 Lupus Nephritis - experience of an internal medicine service P.G. Cunha, J. Cotter, G. Alves, E. Lopes (Guimaraes, P)

Of 20 patients who were diagnosed with Systemic Lupus Erythematosus between l/03/ 1993 and 31/03/2003. 15 had Lupus Nephritis (LN). The diagnosis of nephritis was based on the evidence of proteinuria over 500 mg/day (IO cases) and/or changes on urinalysis by microscopic assessment (9 cases). LN was present at initial evaluation in 14 patients; it was defined 6 months after initial evaluation in 1 patient. All the patients were