Unlike other adverse drug reactions, visceral organ involvement is a prominent feature of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and correlates with mortality. The aim of this study was to systematically review cases published in PubMed-indexed, peer-reviewed journals in which patients had renal injury during the episode of DRESS syndrome (DS). We found 71 cases, of which 67 were adults and 56% were males. Female sex was associated with higher mortality. Chronic kidney disease (CKD) was present in 14% of patients who developed acute kidney injury (AKI) during DS. In 21% of cases, the kidneys were the only visceral organ involved, while 54% of patients had both liver and kidney involvement. Eosinophilia was absent in 24% of patients. The most common classes of medication associated with renal injury in DS were antibiotics in 34%, xanthine oxidase inhibitors in 15%, and anticonvulsants in 11%. Among antibiotics, vancomycin was the most common culprit in 68% of patients. AKI was the most common renal manifestation reported in 96% of cases, while isolated proteinuria or hematuria was present in only 4% of cases. In cases with AKI, 88% had isolated increase in creatinine and decrease in glomerular filtration (GFR), 27% had AKI concomitantly with proteinuria, 18% had oliguria, and 13% had concomitant AKI with hematuria. Anuria was the rarest manifestation, occurring in only 4% of patients with DS. Temporary renal replacement therapy was needed in 30% of cases, and all but one patient fully recovered renal function. Mortality of DS in this cohort was 13%, which is higher than previously reported. Medication class, latency period, or pre-existing CKD were not found to be associated with higher mortality. More research, particularly prospective studies, is needed to better recognize the risks associated with renal injury in patients with DS. The development of disease-specific biomarkers would also be useful so DS with renal involvement can be easier distinguished from other eosinophilic diseases that might affect the kidney.

Destacam-se casos novos de hanseníase com grau de incapacidade física 2 (GIF 2) que demonstram a ineficiente detecção oportuna. O artigo é um relato de casos e propõe analisar o diagnóstico tardio sob a perspectiva do itinerário terapêutico (IT), com base em um estudo qualitativo. O cenário foram dois municípios da Região Metropolitana da Baixada Santista: Praia Grande e São Vicente. Realizou-se análise documental e entrevista em profundidade com quatro participantes. O material foi submetido à análise de conteúdo e definiram-se as categorias temáticas: cuidado em saúde; corpo na hanseníase; incapacidades na hanseníase; e diagnóstico tardio. Revelaram-se intrincados itinerários terapêuticos, marcados pela fragilidade do cuidado com erro e atraso no diagnóstico, que potencializaram os riscos individuais e coletivos e impactaram negativamente o cotidiano dos sujeitos.

Introduction: The objective of this study was to present the use of the Problem, Objectives, Alternatives, Consequences, Trade-offs, Uncertainty, Risk, and Linked decisions (PrOACT-URL) and multi-criteria decision analysis (MCDA) frameworks as a methodological innovation with the potential to support decision-making in the process of incorporating and monitoring technologies in the Brazilian Unified Health System (SUS). Methods: The present is a case study that used these frameworks as a basis for the benefit-risk assessment (BRA) of chemotherapy treatment options for multiple myeloma (MM) in the context of a Brazilian public hospital. Results: The application of the PrOACT-URL was not sufficient to guide stakeholders in making decisions about the best treatment alternative for MM, making it necessary to complement the qualitative analysis with the MCDA. In general, comparing the average scores for the five treatment options, the overall survival result was higher in four of the five treatments available for MM. The results that presented the lowest score were the risk of thrombosis and the risk of neuropathy. The sensitivity analysis showed that, for most stakeholder groups (managers, academia and clinicians), the treatment with the highest total value in the ranking was treatment with cyclophosphamide, thalidomide and dexamethasone (CTD). Conclusions: The present case study showed that cyclophosphamide, thalidomide and dexamethasone presented the best benefit-risk balance for the treatment of MM and highlights the importance of the complementarity of these two structured approaches for more transparent decision-making, with an expansion of the deliberative process and the incorporation of preferences from different stakeholders.