In the month in which World Kidney Day is celebrated (March 10), HC teams celebrate the hospital's presence among the 10 services in the country that performed more than 100 transplants in 2021. World Kidney Day promotes awareness about kidney diseases and the need for strategies for their prevention and control.
In Brazil, kidney transplantation represents around 70% of total organ transplants, 90% of which are fully financed by the Unified Health System (SUS). At Hospital de Clínicas, nephrology is the specialty with the highest number of transplants: since 1984, there have been more than 3200.
For professor Marilda Mazzali, coordinator of kidney transplants at Unicamp's HC, facing the pandemic brought many lessons to her nephrology sector. It was possible, for example, to investigate the use of care protocols in chronic, pre-dialysis patients and in people who had normal kidney function and entered the ICU due to Covid-19. “In these two years of the pandemic, we have reinvented ourselves, but we still have a lot to learn about post-Covid syndrome in general,” said Mazzali.
According to her, the pandemic brought a change in the service profile. Since the first wave, in 2020, the service has maintained priority for chronic and transplant patients. There was a reduction in consultations for less complex cases, mainly due to the lack of transport from city halls. “Unfortunately, there was an initial drop in the follow-up of pre-dialysis patients, but for chronic kidney disease patients on dialysis, care did not stop.”
Among the reformulations of transplant procedures during the pandemic was transplantation with a short hospital stay, with more care and redirected immunosuppression. “Most programs reduced activities, especially last year, but we kept the service running normally”, reports the teacher. In 2022, the first two months saw a historic drop in donations, with the spread of the Ômicron variant. “In January we got 28 donors, but only two were viable and for one of them there was no compatible recipient”, explains Mazzali.
Still in the nephrologist's assessment, the pandemic worsened the problem for patients with controlled kidney disease, monitored according to conservative treatment. “After contracting Covid-19, some underwent dialysis”, she explains. Patients with kidney disease, when infected by Covid-19, may have their pre-existing kidney disease worsened.
Among patients without kidney disease who were admitted to the ICU in serious condition due to Covid-19, the majority ended up developing acute kidney failure. “We had several ways of dialyzing, but the patients were very unstable. This required more specific techniques, such as continuous dialysis. When the patient recovers well from Covid, he recovers kidney function”, he explains.
Marilda highlights that global studies are underway on less invasive diagnostic methods (without biopsy). The Unicamp HC Kidney Transplant Program will be part of an international multicenter study on the topic.
Chronic kidney diseases
Chronic kidney disease generally has a multifactorial etiology and can be worsened by the absence of healthy habits. It may be associated with factors such as hypertension, diabetes, glomerulonephritis (non-infectious inflammation of the kidney glomeruli), cystic kidney disease, family history of chronic kidney disease, cardiovascular problems, obesity, smoking, urinary tract infection and recurrent kidney stones, use of medications that can compromise kidney functions and age over 50 years.
Prevention is the most viable alternative to avoiding CKD. The appearance of symptoms is an indication that the disease is advanced. They are: constant urge to urinate, with little liquid, changes in the color and smell of urine, constant pain in the lower back or flanks, swelling of the legs, feet, arms or face, itching, excessive tiredness for no apparent reason, nausea (especially in the morning) and vomiting. The diagnosis of CKD is made through a urine test with blood creatinine measurement. There is no cure, but treatments slow its progression. “Changing habits is essential at any stage of the disease, whether during conservative treatment, dialysis or even after a successful transplant”, he explains.
The forms of prevention are: regular physical exercise, care for dehydration, low consumption of salt, red meat and fats, control of body weight, blood pressure, cholesterol and glucose, not smoking and consuming alcoholic beverages in moderation. As far as possible, the use of non-steroidal anti-inflammatory drugs should be avoided. Experts reinforce the need to carry out laboratory tests once a year to assess the health of the kidneys, through blood creatinine measurement and urine analysis. Elderly patients, those with cardiovascular disease or a family history of kidney disease have a great potential for developing kidney damage and should be periodically investigated with the same tests.
CKD data in Brazil
In absolute numbers, the country ranks second worldwide in kidney transplants. Last year, 4.828 procedures of this type were registered in Brazil. Unicamp HC performed 135 transplants.
It is estimated that there are 850 million people with kidney disease in the world. In Brazil, there would be more than ten million people with the pathology. Of these, 90 are on dialysis, a process of artificially stimulating kidney function, generally when the organs are approximately 10% functional.
The unit's Integrated Nephrology Center serves patients with CKD and their families, in specialized outpatient clinics that follow the patient through all stages of chronic kidney disease. Comprehensive patient care is provided through an educational program with a multidisciplinary team.
Original article published on the Hospital de Clínicas da Unicamp website.
