Incidencia de enfermedad renal crónica en pacientes diabéticos en el Policlínico Vedado en el año 2016 / Incidence of the chronic renal disease in diabetic patients in the Policlinic "Vedado" in 2016

Introducción: enfermedad renal crónica no es más que la pérdida lenta de la función de los riñones con el tiempo. El principal trabajo de estos órganos es eliminar los desechos y el exceso de agua del cuerpo. La pérdida de la función puede ser tan lento que usted no presentará síntomas hasta que los riñones casi hayan dejado de trabajar. Objetivo: identificar la incidencia de enfermedad renal crónica en pacientes con diabetes mellitus atendidos en el Consultorio Médico de la Familia No. 19 del Policlínico Vedado, municipio Plaza de la Revolución, año 2016. Materiales y métodos: se realizó un estudio descriptivo, transversal para identificar la incidencia de enfermedad renal crónica en pacientes diabéticos del consultorio médico de la familia No. 19 del Policlínico Vedado, municipio Plaza de la Revolución, en el año 2016. El universo estuvo compuesto por 51 pacientes diabéticos y las variables empleadas fueron: edad, sexo, color de la piel, valores de la microalbuminuria, tiempo de evolución de la diabetes, antecedentes patológicos personales y familiares, hábitos tóxicos, exámenes complementarios como creatinina para calcular el filtrado glomerular. Resultados: las pacientes femeninas menores de 65 años ocupan un estadio II y III, y las pacientes femeninas mayores de 65 años ocupan un estadio III y IV según filtrado glomerular, mientras que los pacientes masculinos menores y mayores de 65 años se encontraban en estadio II y III, según filtrado glomerular. Conclusiones: la enfermedad renal crónica en pacientes diabéticos es una condición mediana prevalencia en la población del consultorio #19 del policlínico Vedado, donde incide de manera considerable la edad, sexo, color de la piel y el antecedente patológico personal hipertensión (AU).

Introduction: the chronic renal disease is the slow loss of the kidneys function in the time. The main work of these organs is eliminating then wastes and water excess of the body. The loss of the function may be so slow that the symptoms do not show almost until the kidneys had stopped working. Objective: to identify the incidence of the chronic renal disease in patients with diabetes mellitus attended in the medical consultation Nr. 19 belonging to "Vedado" policlinic, municipality of Plaza de la Revolución, in 2016. Materials and methods: a descriptive, cross-sectional study was carried out to identify the incidence of the chronic renal disease in diabetic patients from the medical consultation Nr. 19, "Vedado" policlinic, municipality of Plaza de la Revolución, in 2016. The universe was formed by 51 diabetic patients and the used variables were: age, sex, skin color, micro albuminuria values, diabetes evolution time, personal and familiar pathological antecedents, toxic habits, complementary tests like creatinine test to calculate glomerular filtration. Results: female patients aged less than 65 years are in stages II and III, and female patients elder than 65 years old are in III and IV stages cording to the glomerular filtration. Conclusions: the chronic renal disease in diabetic patients is a medium prevalence condition in the population of the Nr. 19 consultation of the "Vedado" Policlinic, with a significant incidence of age, sex, skin color and personal pathological antecedents of hypertension (AU).

Biomodelo de insuficiencia renal crónica con el uso del tisuacryl en ratas / Chronic renal failure model with the use of tisuacryl in rats

Introducción: con el propósito de mejorar la atención a la Insuficiencia Renal Crónica (IRC) como problema de salud, se han desarrollado numerosas investigaciones experimentales en biomodelos. Perfeccionar los biomodelos de IRC, es uno de los retos actuales. Los biomodelos de IRC quirúrgicos son los más utilizados y entre sus variantes se deben favorecer la precisión en la instauración y evolución con respecto al tiempo de la insuficiencia. Objetivo: evaluar un modelo experimental de Insuficiencia Renal Crónica en ratas con el uso del Tisuacryl. Método: para ello se utilizaron 90 ratas Wistar distribuidas en series (de 7, 28, 42, y 60 días) y grupos de trabajo (controles y experimentales) para cada serie. Se diseñó un modelo de IRC por ablación de 5/6 de la masa renal y se utilizó el adhesivo tisular Tisuacryl de producción nacional como sellante de las superficies de corte. Se evaluaron la proteinuria de 24 horas, creatinina plasmática, flujo plasmático renal efectivo (FPRE), intensidad de filtración glomerular (IFG) y la fracción de filtración. Resultados: se apreció un aumento de la Proteinuria y la Creatinina y una caída del flujo plasmático renal efectivo y la intensidad de filtración glomerular. Todas las variables caracterizaron la instauración de una insuficiencia renal crónica en el modelo con un grado de moderado a ligero con estabilidad. Conclusiones: se evaluó un modelo de Insuficiencia Renal Crónica en ratas con el uso del Tisuacryl, lo que ha permitido comprobar cómo este modelo ha llegado a replicar las condiciones en humanos. Se determinan como variables fundamentales para indicar la evaluación del grado de Insuficiencia la proteinuria, la creatinina plasmática, el FPRE y IFG, justificando el grado de insuficiencia, los cuales transitan para este modelo por moderado y ligero.

Introduction: to provide better health care to renal failure patients is a national health goal in our country; thus, different studies have been carried out using biomodels for renal failure. To improve the reliability of these biomodels still remains as a major challenge. Particularly, models for chronic renal failure (CRF) have been widely used, pursuing a better accuracy in instauration and evolution time, especially in defining the failure's duration. Objective: to validate an experimental model for CRF in rats using Tisuacryl developed in our laboratory. Methods: ninety Wistar rats were distributed into series (of 7, 28, 42, and 60 days) and working groups (controls and experimental) for each series. CRF model for ablation of 5/6 of the renal mass was designed, using the tissue adhesive Tisuacryl (of national production) as sealant of the cut surfaces. The following parameters were evaluated: protein excretion during 24 hours, plasmatic creatinine, renal effective plasmatic flow (REPF), glomerular filtration rate (GFR), and filtration fraction. Results: an increase in protein excretion and creatinine was observed, as well as a drop in, REPF, and GFR. All variables changed to levels compatible with a scenario of CRF of moderate to slight stability level. Conclusions: the Tisuacryl rat model for CRF was evaluated. As result, this model reproduces the conditions of the disease in humans. The best variables for describing the CRF were: protein excretion, plasma creatinine, REPF and GFR, since these allow assessing the failure's degree. In this model the failure degree transits from slight to moderate.

Sintomas depressivos e suas características em pacientes submetidos a hemodiálise / Depressive symptoms and their characteristics in patients undergoing hemodialysis

A depressão é uma condição presente em 20% dos portadores de doenças crônicas, estando associada à incapacitação funcional e comprometimento da saúde física. A doença renal crônica faz parte desse escopo, com prevalência de 405 pacientes por milhão de habitantes submetidos a hemodiálise no Brasil. Objetiva-se avaliar prevalência de sintomatologia depressiva e suas características em pacientes sob tratamento dialítico. Métodos: Estudo transversal, realizado entre junho e agosto de 2010, incluindo os pacientes submetidos a hemodiálise no Hospital Geral de Caxias do Sul, que preencheram os critérios de inclusão. Procedeu-se a aplicação de instrumentos de coleta de dados. O ponto de corte para depressão foi de 16 pontos no Inventário de Depressão de Beck. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: A amostra foi constituída por 64 pacientes. A média de idade foi de 53,66 ± 15,82 anos; 51,7% eram do sexo feminino. A prevalência de depressão foi de 44,8%. Os pacientes com IDB < 16 apresentaram escore médio de 7,23 ± 3,5; já aqueles com IDB > 16 apresentaram média de 26,43 ± 9,35 (p < 0,001). Os pacientes que necessitavam cuidador apresentaram maiores índices de depressão (p< 0,001). Nos pacientes com IDB > 16 os fatores mais influentes foram sono, cansaço e incapacidade de tomar decisões. Conclusão: A prevalência de depressão nos pacientes em hemodiálise é alta. Os pacientes que necessitam de cuidadores apresentam maior escore no IDB. Alterações do sono, cansaço e incapacidade de tomar decisões são os principais fatores para o humor depressivo.

Depression is a condition present in 20% of patients with chronic diseases and is associated with functional disability and impaired physical health. Chronic kidney disease is part of this scope, with an estimated prevalence of 405 patients per million undergoing hemodialysis in Brazil. The objective of this study was to evaluate the prevalence of depressive symptoms and their characteristics in patients on dialysis. Methods: A cross-sectional study conducted between June and August 2010, including patients undergoing hemodialysis at the General Hospital of Caxias do Sul, who met the inclusion criteria. The data collection instruments (questionnaire, Mini Mental State Examination and the Beck Depression Inventory–BDI) were administered individually during a hemodialysis session. The cut-off point for depression was 16 points in the BDI. Results: We studied 64 patients. The mean age was 53.66 ± 15.82 years, 51.7% were females. The prevalence of depression was 44.8. Patients with BDI<16 had a mean score of 7.23 ± 3.5, whereas those with BDI>16 had an average of 26.43 ± 9.35 (p <0.001). Patients who needed caregivers had higher levels of depression (p <0.001). In patients with BDI>16, the most influent factors were sleep, fatigue and inability to make decisions. Conclusion: The prevalence of depression in hemodialysis patients is high. Patients who need caregivers had higher scores on the BDI. Sleep disorders, fatigue and inability to make decisions are the main factors for depressed mood.

Calciflaxis y enfermedad renal crónica / Calciphylaxis and chronic renal disease

Es una vasculopatía caracterizada por calcificación de la capa media de los vasos y proliferación de la íntima de los mismos, asociado a fibrosis y trombosis luminal, llevando a necrosis de los tejidos circundantes, en especial de los tejidos blandos. La fisiopatología de la calciflaxis está relacionada con múltiples factores, siendo una condición que lleva a la calcificación vascular acelerada y que se ha asociado a una serie de factores de riesgo como la enfermedad renal crónica en terapia de reemplazo y en trasplante renal. Se han relacionado otros factores no urémicos como son anormalidades en el metabolismo del calcio, hiperparatiroidismo primario, estados de hipercoagulabilidad como malignidad, déficit de proteína C y S, hepatopatía alcohólica, terapia con warfarina, hipoalbuminemia, terapias con calcio y vitamina D, obesidad y producto calcio/fósforo superior a 70. A continuación se reporta el caso de una paciente a quien se le documenta un cuadro clínico de calciflaxis, describiendo la presentación clínica de esta patología, los factores de riesgo identificados y las complicaciones presentadas durante su atención (Acta Med Colomb 2011; 36: 149-152).

Calciphylaxis is a vasculopathy characterized by calcification of the tunica media and proliferation of the tunica intima of blood vessels, in association with fibrosis and thrombosis of the lumen, which lead to necrosis of surrounding (especially soft) tissues. The pathophysiology of calciphylaxis is related with multiple factors. This condition leads to accelerated vascular calcification and has been associated with a number of risk factors, such as chronic renal disease, kidney replacement therapy, and renal transplantation. It has also been related with other, non-uremic, factors, such as calcium deregulation, primary hyperparathyroidism, hypercoagulability states (such as malignancy and deficiency of proteins C and S), alcoholic hepatopathy, warfarin therapy, hypoalbuminemia, therapy with calcium and vitamin D, obesity, and a Calcium/Phosphorus product above 70. We report the case of a patient with calciphylaxis by describing the clinical presentation, the associated risk factors, and the complications seen during the care of the patient (Acta Med Colomb 2011; 36: 149-152).

Nível de atividade física e risco cardiovascular de pacientes comdoença renal crônica / Physical activity levels and cardiovascular risk in patients withchronic kidney disease

Objetivo: Comparar o nível de atividade física e o Risco Cardiovascular (RCV) dos pacientes com Doença Renal Crônica (DRC) em estágio 3, 4 e 5 napré-diálise. Métodos: A amostra compôs-se de 83 pacientes com DRC, estágio 3, 4 e 5 na pré-diálise, que, através do Questionário Internacional deAtividade Física (IPAQ), foram divididos em Grupo Ativo (A) e Grupo Sedentário (S). Analizaram-se as características demográficas e o RCV através doprotocolo da American Heart Association (2001) e, após as análises, foi comparado o RCV entre os grupos A e S. Resultados: Os grupos A e S nãoobtiveram diferenças significativas quanto às variáveis do RCV. Porém, quando calculou-se a pontuação do RCV referentes aos dois grupos, observou-sediferença significativa (A= 17,1 ± 7,28 e S= 23,3 ± 9,21). Observou-se também que, quanto maior o estágio da DRC, menor o nível de atividade física emaior o RCV. Conclusão: Os fatores de RCV analisados separadamente são independentes dos níveis de atividade física em pacientes com DRC emestágio 3, 4 e 5 na pré-diálise. Na avaliação da pontuação referente ao RCV, observou-se que o grupo A teve menos risco que o grupo S. Assim, acreditaseque a prática de atividade física seja suficiente para melhorar o RCV dessa população. Porém, talvez seja necessário um programa de atividade físicasistematizado e controlado para observar melhoras nas variáveis referentes ao RCV.

Objective: To compare the physical activity levels and cardiovascular risk in patients with chronic renal disease, stages 3, 4 and 5, not yet on dialysis.Methods: The study sample consisted of 83 patients in stages 3, 4 and 5 of chronic renal disease, and not yet on dialysis. Using the Physical ActivityInternational Questionnaire they were divided into Active and Sedentary Groups. Demographic characteristics and cardiovascular risk were evaluated usingthe American Heart Association protocol (2001) and after these evaluations the cardiovascular risk was compared among active and sedentary groups.Results: The active and sedentary groups did not show significant differences in cardiovascular risk variables. However, when the score for cardiovascularrisk was calculated for the two groups, there was a significant statistical difference (A= 17.1 ± 7.28 and S= 23.3 ± 9.21). We also observed that there wasa correlation between CKD stages and physical activity levels and cardiovascular risk. Conclusions: The cardiovascular risks analyzed separately areindependent from the physical activity levels in pre-dialysis chronic renal disease patients, stages 3, 4 and 5. When the risk cardiovascular scores wereavailable, we observed lower numbers in the active group than the sedentary group. Thus, we believe that physical activity is sufficient to improve thecardiovascular risk in these patients. However, a controlled physical activity program would be recommended in order to improve the cardiovascular risk in this population.