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29. Operating costs and expenses (Details) - BRL (R$)
R$ in Thousands
 12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services R$ (9,086,456) R$ (8,778,963) R$ (9,013,120)
Selling expenses (693,480) (686,012) (639,559)
Bad debt expense, net of recoveries (166,727) (82,681) (90,488)
Administrative expenses (996,877) (1,098,990) (934,896)
Total (10,943,540) (10,646,646) (10,678,063)
Salaries, payroll charges and benefits      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (1,959,539) (1,841,571) (1,718,199)
Selling expenses (289,378) (305,440) (271,690)
Administrative expenses (254,284) (229,752) (194,357)
Total (2,503,201) (2,376,763) (2,184,246)
Pension obligations      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (25,066) (48,381) 131,469
Selling expenses (3,602) (7,296) 17,941
Administrative expenses (141,758) (171,830) (136,358)
Total (170,426) (227,507) 13,052
Construction costs      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (2,739,657) (3,080,542) (3,651,364)
Total (2,739,657) (3,080,542) (3,651,364)
General supplies      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (238,034) (163,712) (173,224)
Selling expenses (6,391) (4,451) (3,585)
Administrative expenses (4,881) (5,675) (2,585)
Total (249,306) (173,838) (179,394)
Treatment supplies      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (265,146) (287,592) (279,150)
Total (265,146) (287,592) (279,150)
Outsourced services      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (996,477) (857,063) (845,334)
Selling expenses (273,470) (258,287) (278,565)
Administrative expenses (204,728) (183,746) (154,926)
Total (1,474,675) (1,299,096) (1,278,825)
Electricity      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (956,840) (794,352) (932,435)
Selling expenses (1,154) (762) (751)
Administrative expenses (1,363) (965) (1,848)
Total (959,357) (796,079) (935,034)
General expenses      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (629,253) (531,985) (471,965)
Selling expenses (102,213) (94,112) (93,180)
Administrative expenses (232,288) (302,113) (289,862)
Total (963,754) (928,210) (855,007)
Depreciation and amortization      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Cost of services (1,276,444) (1,173,765) (1,072,918)
Selling expenses (17,272) (15,664) (9,729)
Administrative expenses (98,825) (112,468) (63,979)
Total (1,392,541) (1,301,897) (1,146,626)
Tax expenses      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Administrative expenses (58,750) (92,441) (90,981)
Total (58,750) (92,441) (90,981)
Bad debt expense, net of recoveries      
SummaryOfOperatingCostsAndExpensesLineItems [Line Items]      
Selling expenses (166,727) (82,681) (90,488)
Total R$ (166,727) R$ (82,681) R$ (90,488)