Chronic Kidney Disease

SUMMARY Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this pathology remain asymptomatic most of the time, presenting the complications typical of renal dysfunction only in more advanced stages. Its treatment can be conservative (patients without indication for dialysis, usually those with glomerular filtration rate above 15 ml/minute) or replacement therapy (hemodialysis, peritoneal dialysis, and kidney transplantation). The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.

The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China

OBJECTIVE: This study investigated the correlation between the albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and whether the ratio can predict chronic kidney disease progression even more reliably than 24-hour proteinuria can, particularly in primary IgA nephropathy. METHODS: A total of 182 patients with primary IgA nephropathy were evaluated. Their mean urine albumin-to-creatinine ratio and 24-hour proteinuria were determined during hospitalization. Blood samples were also analyzed. Follow-up data were recorded for 44 patients. A cross-sectional study was then conducted to test the correlation between these parameters and their associations with chronic kidney disease complications. Subsequently, a canonical correlation analysis was employed to assess the correlation between baseline proteinuria and parameters of the Oxford classification. Finally, a prospective observational study was performed to evaluate the association between proteinuria and clinical outcomes. Our study is registered in the Chinese Clinical Trial Registry, and the registration number is ChiCTR-OCH-14005137. RESULTS: A strong correlation (r=0.81, p<0.001) was found between the ratio and 24-hour proteinuria except in chronic kidney disease stage 5. First-morning urine albumin-to-creatinine ratios of ≥125.15, 154.44 and 760.31 mg/g reliably predicted equivalent 24-hour proteinuria ‘thresholds’ of ≥0.15, 0.3 and 1.0 g/24 h, respectively. In continuous analyses, the albumin-to-creatinine ratio was significantly associated with anemia, acidosis, hypoalbuminemia, hyperphosphatemia, hyperkalemia, hypercholesterolemia and higher serum cystatin C. However, higher 24-hour proteinuria was only associated with hypoalbuminemia and hypercholesterolemia. Higher tubular atrophy and interstitial fibrosis scores were also associated with a greater albumin-to-creatinine ratio, as observed in the canonical correlation analysis. Finally, the albumin-to-creatinine ratio and 24-hour proteinuria were associated with renal outcomes in univariate analyses. CONCLUSION: This study supports the recommendation of using the albumin-to-creatinine ratio, rather than 24-hour proteinuria, to monitor proteinuria and prognosis in primary IgA nephropathy.

Enfermedad cardiovascular (ECV) en la enfermedad renal crónica (ERC) / The cardiovascular disease in chronic kidney disease (CKD)

Desde la primera descripción de la asociación entre enfermedad renal crónica y enfermedad cardiaca, los estudios epidemiológicos han confirmado y extendido el conocimiento acerca de esta relación. El riesgo de enfermedad cardiovascular se incrementa al progresar la falla renal, probablemente por la suma de los factores de riesgo no tradicionales propios de la insuficiencia renal. No solamente es la patología cardiovascular más frecuente en esta población, sino que además es sub diagnosticada y sub tratada. Los pacientes y los miembros del equipo médico deben ser educados acerca de este mayor riesgo cardiovascular y de las implicancias que esto tiene en el cuidado.

Since the first description of the association between chronic kidney disease and heart disease, epidemiological studies have confirmed and extended the knowledge about this association. The risk of cardiovascular disease increases with progression of renal failure, probably by the sum of nontraditional risk factors own of renal failure. Not only cardiovascular disease is more common in this population, it is also underdiagnosed and undertreated. Patients and medical staff members should be educated about the increased cardiovascular risk and the implications for the care that entails.

Prevalencia y clasificación de enfermedad renal crónica en pacientes con diabetes mellitus tipo 2 en el centro comunitario de salud familiar Pantanosa, Frutillar / Frequency of chronic kidney disease among ambulatory patients with type 2 diabetes

Background: Type 2 diabetes mellitus is the main cause of chronic kidney disease in developed countries. Aim: To study the prevalence of chronic kidney disease among adults with diabetes mellitus attended at a public primary health care clinic in southern Chile. Material and Methods: One hundred patients with type 2 diabetes mellitus, aged more than 15 years participated in this cross sectional study. Chronic kidney disease was defined as the presence of a urine albumin/creatinine ratio over 30 mg/g or an estimated glomerular filtration rate of less than 60 mL/min/1,73 m², detected in at least two opportunities, separated at least by three months. Results: Thirty four percent of participants had chronic kidney disease (17% stage 1 or 2 and 17% stage 3). Thirty percent of participants had an abnormal urinary albumin/creatinine ratio. Halfof the patients with an estimated glomerular filtration rate below 60 mL/min/1,73 m², had a normal urinary albumin/creatinine ratio. Conclusions: The rates of chronic kidney disease in this group of diabetic patients are very similar to those reported elsewhere.

Doença renal crônica no paciente idoso / Chronic kidney disease in the elderly

A doença renal crônica (DRC) é hoje considerada um grande problema de saúde pública em todo o mundo. O grande número de complicações decorrentes da doença e a ocorrência frequente de comorbidades determinam desfechos devastadores, tais como as complicações cardiovasculares e mortalidade precoce. Contudo, está cada vez mais claro que o diagnóstico precoce da DRC possibilita retardar e, eventualmente, prevenir algumas das suas complicações, permitindo, assim, alterar o curso clínico da doença. Por conseguinte, não é estranho observar que várias organizações públicas de saúde, particularmente nos países desenvolvidos, tenham dirigido especial atenção ao estudo da epidemiologia da DRC, concentrando esforços no diagnóstico precoce e na instituição de intervenções imediatas, objetivando alterar o curso da doença. Com a nova definição de DRC proposta no início da década passada, ficou evidente que a doença é uma das mais prevalentes nos pacientes idosos. Na presente revisão, os autores discutem os principais pontos do diagnóstico, classificação e tratamento da DRC e finalizam propondo o atendimento interdisciplinar multidimensional como a abordagem mais adequada no manejo do paciente idoso com DRC.

Chronic kidney disease (CKD) is now considered a major public health problem worldwide. The large number of disease complications and the frequent occurrence of comorbidities can lead to devastating outcomes, such as cardiovascular complications and early mortality. However, it has become increasingly clear that early diagnosis of CKD may delay and possibly prevent some CKD-related complications, with the potential to change the clinical course of the disease. Therefore, several public health organizations, particularly in developed countries, have drawn special attention to the epidemiological study of CKD, focusing on early diagnosis and prompt treatment in order to change the course of the disease. Based on the new definition of CKD proposed at the beginning of the last decade, CKD is now recognized as one of the most prevalent diseases in the elderly population. In this review, key issues involving diagnosis, classification and treatment of CKD were discussed and a multidimensional and interdisciplinary approach was proposed as the most appropriate strategy in the management of elderly patients with CKD.

Terapia antihipertensiva en enfermedad renal crónica / Treatment of hypertension in chronic kidney disease

La enfermedad renal crónica (ERC) constituye una de las causas más frecuentes de hipertensión arterial (HTA) secundaria. Existe una nueva clasificación de la ERC basada en la presencia de un daño estructural con o sin un deterioro de la velocidad de filtración glomerular (VFG). La prevalencia de la HTA varía principalmente según la magnitud de la VFG y la etiología de la enfermedad del parénquima renal. Los mecanismos hipertensógenos primordiales son: la retención de sodio e hipervolemia, y la activación del eje renina angiotensina aldosterona. La HTA es también un factor de progresión de la ERC. La terapia se basa en la restricción de sodio, diuréticos y bloqueadores del eje renina angiotensina. Consideraciones farmacológicas y clínicas son fundamentales para un efectivo uso de esta terapia. Los objetivos son la prevención cardiovascular y renal, a través de la obtención de determinados niveles de presión arterial (PA).

Chronic kidney disease (CKD) is one of the most common causes of secondary hypertension (HTN). Currently, there is a new classification of CKD based on the presence of structural damage with or without glomerular filtration rate(GFR) deterioration. The prevalence of HTN in CKD varies mainly depending on the magnitude of the GFR and the etiology of renal parenchymal disease. Main hipertensive mechanisms are: salt retention with fluid overload, and reninangiotensin aldosterona axis activation. HTN is also a factor for CKD progression. The current therapy is based on sodium restriction, diuretics and renin angiotensin system blockers. Pharmacological and clinical precautions are essential foran effective use of this therapy. Objectives are to prevent cardiovascular and renal events, through obtaining certain blood pressure (BP) levels.

Aneurisma de artéria renal em rim transplantado: reparo ex vivo e reimplante do enxerto / Renal artery aneurysm in a transplanted kidney: ex vivo graft repair and reimplantation

Aneurisma verdadeiro de artéria renal em rim transplantado é ocorrência rara. As possibilidades de tratamento dependem do tamanho, da localização do aneurisma e da clínica apresentada pelo paciente. Descreve-se um caso de aneurisma gigante de artéria renal em rim transplantado que recebeu tratamento ex vivo e reimplante na fossa ilíaca direita. Detalhes do procedimento cirúrgico são descritos.

True aneurysm of a renal artery in a transplanted kidney is a rare occurrence. Treatment options depend on size and location of the aneurysm and the patient's clinical condition. We report a case of a giant aneurysm of the renal artery in a transplanted kidney that was treated ex vivo and reimplanted in the right iliac fossa. Details of the surgical procedure are described.

Prevalencia de insuficiencia renal crónica en el servicio de nefrología y de consulta externa del Hospital Escuela Antonio Lenin Fonseca Martínez en el periodo del 01 de junio del 2006 al 31 de mayo del 2007 / Prevalence of chronic renal failure in the service of nephrology and outpatient Antonio College Hospital Lenin Fonseca Martinez in the period from 01 June 2006 to May 31, 2007

El objetivo del presente estudio es conocer la prevalencia de la Insuficiencia Renal Crónica en la consulta externa y sala de nefrología del Hospital Escuela Antonio Lenin Fonseca Martínez durante el periodo de 01 de junio del 2006 al 31 de mayo del 2007. La información se obtuvo a través de una ficha de recolección. Los principales resultados del estudio fueron que la prevalencia de la Insuficiencia Renal Crónica es del 70 por ciento. El 72.3 por ciento de la población en estudio pertenecen a la región del Pacífico y el departamento con mayor procedencia es Managua con un 31.3 por ciento. El 57.3 por ciento de los pacientes con IRC son del sexo masculino, el 28.7 por ciento se encuentran en edades comprendidas entre los 38-48 años y el 52.7 por ciento tienen estudios primarios. El 29 por ciento de los pacientes con IRC tienen antecedentes personales de Hipertensión, 25 por ciento de Diabetes Mellitus y el 9.5 por ciento en Uropatías y enfermedades autoinmunes. El 33.5 por ciento de los pacientes con diagnostico de IRC su etiología es desconocida, el 25.4 por ciento...

Alterações morfológicas e funcionais dos rins de cães com insuficiência renal crônica / Morphologic and functional alterations of the kidneys of dogs with chronic renal failure

Alterações morfológicas de 11 casos de cães com insuficiência renal foram caracterizadas e classificadas de acordo com os padrões estabelecidos pela Organização Mundial de Saúde para seres humanos. Glomerulonefrite esclerosante difusa foi diagnosticada em 82,0 por cento dos animais e nefrite intersticial crônica nos 18,0 por cento restantes. Os tipos e freqüência das lesões identificadas foram similares às encontradas na literatura para a insuficiência renal crônica.

Morphologic alterations of 11 cases of dogs with renal failure were characterized and classified according to the patterns established by the World Health Organization for human beings. Diffuse sclerosing glomerulonephritis was diagnosed in 82.0 percent of the animals and chronic interstitial nephritis in the remaining 18.0 percent. The types and frequencies of lesions were similar to the those noticed in the literature for chronic renal failure.

Nefropatia diabética / Diabetic nephropathies

Nefropatia diabética é uma das principais complicações do diabetes mellttus, sendo a maior causa de doença renal em pacientes com insuficiência renal crônica terminal. É caracterizada por microalbuminúria, progredindo com proteinúria, perda de função renal e hipertensão arterial. Mau controle metabólico, hipertensão arterial e predisposição genética são importantes fatores de risco. O manejo adequado e precoce do paciente diabético é importante para prevenir e retardar a progressão da doença renal nestes indivíduos

Factores de riesgo que influyen en la ocurrencia de insuficiencia renal crónica en pacientes ingresados en el Servicio de Medicina Interna del Hospital Escuela Oscar Danilo Rosales Argüello de León, enero-diciembre 2000 / Risk factors that incluenced the occurrence of chronic renal insufficency in patients admitted in the Internal Medicine Service of the Hospital Escuela Oscar Danilo Rosales de León, january-december 2000

Se realizón un estudio de tipo analítico, estudio de casocontrol, en el Hospital Escuela Oscar Danilo Rosales Argüello de León, a los pacientes que ingresaron al servicios de Nefrología del Departamente de Medicina Interna, en el período comprendido de enero a diciembre del año 2000. En el estudio se observó que la mayoría de pacientes con insuficiencia renal crónica, eran del sexo masculino. En relación a los factores de riesgos presentes, los hombres con exposición a plaguicidas, el uso de aminoglucósidos y antiinflamatorios no esteroides, tienen más riesgo de desarrollar insuficiencia renal crónica que los expuestos

Prevención del progreso y las complicaciones de la enfermedad renal

El médico general tiene cada vez más la responsabilidad de enfrentar adecuadamente problemas como el de la enfermedad renal que, hasta no hace mucho, eran remitidos directamente a especialistas. Debe saber cuándo y con qué criterios hacer tal remisión, pero debe instaurar sin demora las medidas necesarias para prevenir el rápido progreso y las complicaciones inherentes a la falla renal