The incidence of diabetic end-stage renal failure (ESRF) varies worldwide and risk factors have been demonstrated in several populations. The objective of the present study was to identify possible factors associated with the risk of development of ESRF in patients with diabetes mellitus (DM). Two groups of diabetic subjects were included in a case-control study: 1) one group was submitted to renal replacement therapies, attending dialysis centers in São Paulo city and 2) the same number of controls without clinical nephropathy (two negative dipstick tests for urine protein), matched for duration of DM, were obtained from an outpatient clinic. A standardized questionnaire was used by a single investigator and additional data were obtained from the medical records of the patients. A total of 290 diabetic patients from 33 dialysis centers were identified, and 266 questionnaires were considered to contain reliable information. Male/female ratios were 1.13 for ESRF and 0.49 for the control group. A higher frequency of men was observed in the ESRF group when compared with controls (53 vs 33%, P<0.00001), although logistic regression analysis did not confirm an association of gender and diabetic nephropathy (DN). Similar proportions of non-white individuals were found for both groups. Patients with insulin-dependent diabetes mellitus (IDDM) were less common than patients with non-insulindependent diabetes mellitus (NIDDM), particularly in the control group (3.4 vs 26.3%, P<0.00001, for controls and ESRF patients, respectively); this type of DM was associated with a higher risk of ESRF than NIDDM, as determined by univariate analysis or logistic regression (OR = 4.1). Hypertension by the time of the DM diagnosis conferred a 1.4-fold higher risk of ESRF (P = 0.04), but no difference was observed concerning the presence of a family history. Association between smoking and alcohol habits and increased risk was observed (OR = 4.5 and 5.9, respectively, P<0.001). A 2.4-fold higher risk of ESRF was demonstrated in patients with multiple hospitalizations due to DM decompensation, which suggested poor metabolic control. Photocoagulation and neuropathy were found to be strongly associated with ESRF but not with macrovascular disease. Data collected in our country reinforce the higher risk attributable to IDDM and the association between hypertension and the progression of DN. Indirect evidence for an association with metabolic control is also suggested. Correspondence

Flávio Mendonça PintoMédico, nefrologista, docente Faculdade de Minas -Faminas -BH RESUMO Introdução: A esofagite eosinofilica é uma doença imunológica crônica relacionada à disfunção esofágica e acúmulo de eosinófilos na mucosa esofágica. Recentemente descrita, seu diagnóstico ainda é realizado tardiamente devido à sintomatologia semelhante à doença do refluxo gastroesofágico. Objetivo: Analisar os fatores que dificultam o diagnóstico e a variação da apresentação clínica da doença em pacientes pediátricos. Metodologia: Foram utilizados 10 artigos para uma revisão de literatura a partir das bases de dados Scielo e PubMed. Foram usados os critérios inclusivos: acesso livre ao tema, títulos e abstracts associados ao tema e publicados desde 2008 a partir dos descritores escolhidos nas línguas portuguesa, inglesa e espanhola. Conclusão: A média de idade em que ocorrem os diagnósticos hoje ainda é tardia, o que possibilita a evolução da doença para complicações evitáveis. A partir dos critérios diagnósticos, deve-se atentar também à esta doença quando o paciente apresenta sintomas esofágicos e assim evitar que ocorra uma piora do quadro. Palavras-chave: Esofagite Eosinofílica, Eosinofilia, Pediatria, Refluxo gastroesofágicoABCTRACT Introduction: Eosinophilic esophagitis is a chronic immunological disease related to esophageal dysfunction and accumulation of eosinophils in the esophageal mucosa. Recently described, its diagnosis is still made late due to symptoms similar to gastroesophageal reflux disease. Objective: To analyze the factors that hinder the diagnosis and the variation of the clinical presentation of the disease in pediatric patients. Methodology: 10 articles were used for a literature review based on the Scielo and PubMed databases. Inclusive criteria were used: free access to the topic, titles and abstracts associated with the topic and published since 2008 from the descriptors chosen in Portuguese, English and Spanish. Conclusion: The average age at which diagnoses occur today is still late, which allows the disease to evolve into preventable complications. Based on the diagnostic criteria, attention should also be paid to this disease when the patient has esophageal symptoms and thus prevent the condition from worsening.

Objetivo: avaliar a associação entre Letramento Funcional em Saúde (LFS) e a capacidade de autocuidado de pacientes renais crônicos não dialíticos. Métodos: estudo transversal em ambulatório de nefrologia de município mineiro/Brasil. Incluídos adultos e idosos com Doença Renal Crônica (DRC) não dialítica. O LFS foi avaliado pelo instrumento SAHLPA-18 e o autocuidado com a escala ASAS-R, ambos validados na língua portuguesa. Resultados: dentre os 167 participantes, 53,9% tinham LFS inadequado (≤14 pontos). O autocuidado apresentou mediana de 52 pontos. A associação entre o LFS e o autocuidado foi significativa (p<0,001) e a correlação entre essas variáveis também foi significativa, positiva e direta (coeficiente= 0,722; p<0,001). No modelo final, a cada aumento de um ponto no LFS ocorreu aumento de 0,20 na capacidade do autocuidado, sendo o R2=41,9%. Conclusão: a pontuação do LFS impactou de forma significativa a capacidade de autocuidado dos pacientes com DRC não dialítica.

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