Instituto de Urologia e Nefrologia

Introduction: Psoriasis is a chronic inflammatory dermatological condition that affects approximately 60 million individuals worldwide, with recurrence rates between 0.1% and 1.5% after conventional treatments. Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease associated with genetic and environmental factors, characterized primarily by an allergic immune response to environmental antigens with increased levels of immunoglobulin E (IgE). The gut microbiota is essential for immune system activation and the treatment of these diseases. Objective: To investigate the gut microbiota-skin axis in the treatment of atopic dermatitis and psoriasis through the promotion of gut health. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to August 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. Study quality was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 131 articles were found, and 28 articles were evaluated in full, and 17 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 24 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=77.6 %>50%. It was concluded that the gut microbiota has enormous metabolic capacity along the gut-skin axis. Dietary or microbiota metabolites are accessible to the skin. Therefore, after defining key open questions about the nature of these metabolites, their detection, and the skin changes they can induce, understanding these pathways will lead to new therapeutic strategies that target one organ to improve the health of another. Probiotics and prebiotics are microbiota management tools for treating psoriasis and atopic dermatitis.

The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.

ABSTRACTObjective: To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager’s versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence.Methods: Two urologists performed the translation of both QUALAS versions. A commission produced a consensus version (Version 2), which was applied as a pilot study to define Version 3. It was then backtranslated into English and compared with the original version for equivalence of concepts. Internal consistency with Cronbach’s alpha and the intraclass correlation coefficient (ICC) reproducibility was analyzed after two assessments with an interval from two to four weeks. Convergent and divergent validities between the QUALAS and a generic health-related quality of life questionnaire, the KIDSCREEN-27, were studied through Pearson’s correlation.Results: The reliability analysis showed good internal consistency for QUALAS-C (α=0.73) and QUALAS-T (α=0.79) and good reproducibility in both questionnaires (QUALAS-C - ICC=0.86; QUALAS-T - ICC=0.92). For QUALAS-C convergent validity, there was a low correlation between its items (r=0.35). In addition, a low correlation was also found in the divergent validity analysis, when compared to the KIDSCREEN-27 (r≤0.33). Convergent and divergent validities of the QUALAS-T questionnaire had similar results: r=0.46 and r≤0.49, respectively.Conclusions: After the adaptation and validation process, QUALAS-C and QUALAS-T questionnaires showed to be reliable and valid instruments for measuring the health-related quality of life of children and teenagers with spina bifida aged 8 years or older.

Dengue infection (DI) is the most important arboviral infection in the world. The majority of immunocompetent patients will have asymptomatic or mild infections, but the degree of dengue severity in kidney transplant recipients (KTx) is unknown. In this study, we report the clinical profile and outcomes of 39 dengue cases in KTx. From a total of 1,186 KTx outpatients in follow-up we reviewed clinical and laboratory records of 60 (5%) patients admitted with suspected DI initially screened by NS-1, IgM, and when possible, multiplex nested PCR. The prevalence of DI in KTx was 3% (39/1,118), with symptoms leading to hospital admission being fever, myalgia, malaise, and headache. Laboratory tests showed leucopenia, thrombocytopenia, and liver enzyme elevation. DI was confirmed by positivity of NS-1 (33%), IgM (69%), and/or RT-PCR (59%). Twenty-three patients (59%) had dengue with warning signs, and 15% had severe dengue, 2 of them with a fatal course. Acute graft dysfunction occurred in 59% (mean nadir serum creatinine: 2.9 ± 2.6mg/dL), 4 of them requiring dialysis. CMV coinfection diagnosed in 19% of the cases and patients was associated with worse clinical presentation. Our results suggest that KTx with DI presented initial physical and laboratorial profile similar to the general population. However, DI in KTx seems to have a higher risk for graft dysfunction, severe dengue, and death. Because CMV coinfection aggravates the DI clinical presentation and recovery, it must be evaluated in all cases.

ABSTRACTIntroduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

BackgroundDonors after brain death develop a systemic proinflammatory state that may predispose the kidneys to injury after transplantation. Because it is not known whether this inflammatory environment similarly affects the kidneys from expanded criteria donor (ECD) and standard criteria donors (SCD), we sought to evaluate differences in the gene expression of inflammatory cytokines in preimplantation biopsies (PIBx) from ECD and SCD kidneys.MethodsCytokines gene expression was measured in 80 PIBx (SCD, 52; ECD, 28) and associated with donor variables.ResultsNormal histology and chronic histological lesions were not different between both types of kidneys. ECD kidneys showed significant increase in the transcripts of MCP-1, RANTES, TGF-β1, and IL-10 when compared with SCD. Kidneys presenting normal histology had similar inflammatory profile except by a higher expression of RANTES observed in ECD (P = 0.04). Interstitial fibrosis and tubular atrophy (interstitial fibrosis and tubular atrophy ≥ 1) were associated with higher expression of TGF-β1, RANTES, and IL-10 in ECD compared with SCD kidneys. Cold ischemia time of 24 hours or longer was significantly associated with upregulation of FOXP3, MCP-1, RANTES, and IL10, whereas longer duration of donor hospitalization significantly increased gene expression of all markers. High FOXP3 expression was also associated with lower level of serum creatinine at 1 year. Donor age was not associated with any of the transcripts studied.ConclusionsPIBx of ECD exhibit a higher gene expression of inflammatory cytokines when compared with SCD kidneys. This molecular profile may be a specific ECD kidney response to brain death and may help to predict the posttransplant outcomes of ECD recipients.

OBJETIVO: Demonstrar a reducao e previsibilidade da ametropia esferica com melhora da acuidade visual promovida pelo transplante penetrante (TP) de cornea por ceratocone e o efeito da relacao diâmetro doador-receptor neste resultado. METODOS: Estudo retrospectivo revisando aleatoriamente os prontuarios de 60 pacientes submetidos ao TP por ceratocone, realizados pelo mesmo cirurgiao, com a mesma tecnica cirurgica, entre 2005 e 2008. Foram avaliados estatisticamente: ceratometria, equivalente esferico e acuidade visual no pre, pos-operatorio de 1, 3 e 6 meses. Os grupos foram entao divididos conforme a diferenca de trepanacao entre diâmetro do doador e receptor, sendo o grupo 1 composto por pacientes com diferenca de zero ou 0,25mm (8,0/8,0 e 8,25/8,0mm) e o grupo 2 por pacientes com diferenca de 0,5mm (8,0/8,5mm). RESULTADOS: Observou-se reducao significativa da ceratometria media e equivalente esferico e melhora da acuidade visual dos pacientes com ceratocone submetidos ao TP. No sexto mes a reducao do equivalente esferico foi de 79% em relacao ao pre-operatorio. Cada dia de pos-operatorio esta associado a hipermetropizacao de 0,68D (p=0,005). Entretanto, a diferenca entre os grupos nao foi significativa. Em relacao a ceratometria, cada dia de pos-operatorio associou-se a um declinio de 1,87D (p<0,0001) que variou entre os grupos significativamente (p=0,007). O grupo 1 apresentou reducao de 8,93D na ceratometria media, comparado a reducao de 6,81D no grupo 2 (p=0,035). CONCLUSAO : O planejamento da trepanacao pode proporcionar reducao significativa da elevada ametropia que comumente acompanha o pos-operatorio do TP por ceratocone, permitindo assim correcao otica satisfatoria.