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27. Operating costs and expenses (Details) - BRL (R$)
R$ in Thousands
 12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services R$ (8,778,963) R$ (9,013,120) R$ (8,260,763)
Selling expenses (768,693) (730,047) (598,125)
Administrative income (expenses) (1,098,990) (934,896) 44,958
Total (10,646,646) (10,678,063) (8,813,930)
Salaries, payroll charges and benefits      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (1,841,571) (1,718,199) (1,503,383)
Selling expenses (305,440) (271,690) (237,848)
Administrative income (expenses) (229,752) (194,357) (182,215)
Total (2,376,763) (2,184,246) (1,923,446)
Pension obligations      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (48,381) 131,469 (75,247)
Selling expenses (7,296) 17,941 (9,761)
Administrative income (expenses) (171,830) (136,358) (185,206)
Total (227,507) 13,052 (270,214)
GESP Reimbursement – benefits paid      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Administrative income (expenses)     696,283
Total     696,283
Construction costs      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (3,080,542) (3,651,364) (3,263,808)
Total (3,080,542) (3,651,364) (3,263,808)
General supplies      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (163,712) (173,224) (172,561)
Selling expenses (4,451) (3,585) (3,692)
Administrative income (expenses) (5,675) (2,585) (2,340)
Total (173,838) (179,394) (178,593)
Treatment supplies      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (287,592) (279,150) (269,294)
Total (287,592) (279,150) (269,294)
Outside services      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (857,063) (845,334) (791,156)
Selling expenses (258,287) (278,565) (247,687)
Administrative income (expenses) (183,746) (154,926) (123,802)
Total (1,299,096) (1,278,825) (1,162,645)
Electricity      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (794,352) (932,435) (815,164)
Selling expenses (762) (751) (770)
Administrative income (expenses) (965) (1,848) (1,596)
Total (796,079) (935,034) (817,530)
General expenses      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (531,985) (471,965) (369,213)
Selling expenses (94,112) (93,180) (86,064)
Administrative income (expenses) (302,113) (289,862) (11,467)
Total (928,210) (855,007) (466,744)
Depreciation and amortization      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (1,173,765) (1,072,918) (1,000,937)
Selling expenses (15,664) (9,729) (9,883)
Administrative income (expenses) (112,468) (63,979) (63,212)
Total (1,301,897) (1,146,626) (1,074,032)
Tax expenses      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Administrative income (expenses) (92,441) (90,981) (81,487)
Total (92,441) (90,981) (81,487)
Bad debt expense, net of recoveries      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Selling expenses (82,681) (90,488) (2,420)
Total R$ (82,681) R$ (90,488) R$ (2,420)