Mejoría del control de la hipertensión en la consulta con el uso de un dispositivo oscilométrico automático de lectura diferida / Improved office blood pressure control by automatic delayed-reading oscillometric device

Introducción: La medición de la presión arterial (PA) en la consulta es un procedimiento recomendado, aunque, actualmente, se está generalizando el uso de las medidas ambulatorias. Objetivo: Conocer el grado de control de la hipertensión arterial (HTA), usando la medición en la clínica. Material y métodos: Durante noviembre del 2019, se recogieron datos demográficos, clínicos, la PA sistólica (PAS) y diastólica (PAD) en consulta con observador, usando un aparato automático con lectura diferida y datos de monitorización ambulatoria de la PA (MAPA) en caso de haberse realizado. Resultados: Se incluyeron 102 pacientes (67 varones), con edad media de 64,9 años, 30% diabéticos y 34% con complicaciones cardiovasculares. Un 70% tenían una PA clínica controlada (< 140/90 mmHg), la PAS media fue de 131 ± 16,5 mmHg y la PAD de 73 ± 9,5 mmHg. Los pacientes ancianos y diabéticos presentaban un peor control. Treinta y tres sujetos disponían de MAPA, lo que permitió clasificarlos según la PA de 24 horas en: normotensión verdadera 30%, HTA aislada en consulta 9%, HTA sostenida 15% y HTA enmascarada 45%. Conclusión: El uso de aparatos automáticos disminuye el fenómeno de bata blanca mejorando el porcentaje de pacientes con HTA controlada en la consulta. Sin embargo, este control no se confirma fuera de ella, lo que evidencia la importancia de la MAPA en la evaluación global de la HTA. La toma de la PA en la consulta es útil en la valoración inicial del paciente y aporta aspectos educativos, aunque hay que optimizar la metodología para definir su papel en la clínica. (AU)

Introduction: Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used. Objective: To know the degree of BP control by clinical measurement. Material and methods: During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected. Results: 102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension. Conclusion: The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role. (AU)

Hipertensión del anciano: qué debemos conocer / Hypertension in the elderly: What we need to know

Más de dos terceras partes de los mayores de 65 años son hipertensos. Junto a la elevada prevalencia, la hipertensión se acompaña de comorbilidad que condiciona una población heterogénea en relación con la autonomía y capacidad funcional. En esta edad, la hipertensión tiene unas características que hacen difícil su manejo, destacando la elevada prevalencia de la hipertensión sistólica aislada por la rigidez vascular típica del envejecimiento. Aunque la toma de decisiones se basa en la medida clínica de la presión, se sabe que en los ancianos la presión está sujeta a numerosas influencias tanto temporales (ausencia de descenso nocturno), como del entorno (exacerbación del fenómeno de bata blanca) y de la posición (hipotensión ortostática). Estas circunstancias hay que tenerlas en cuenta a la hora del manejo. En esta edad, hay suficiente evidencia de que el tratamiento reduce tanto la morbimortalidad cardiovascular como la mortalidad por todas las causas. (AU)

More than two thirds of people over 65 are hypertensive. Along with the high prevalence, hypertension is associated by comorbidities that originates a heterogeneous elderly population in relation to their autonomy and functional capacity. At this age, hypertension has special characteristics that make its management difficult, highlighting by isolated systolic hypertension due to the vascular stiffness typical of aging. Although decision-making is based on the clinical measurement of blood pressure, it is known that in the elderly pressure is subject to numerous influences: temporal (absence of night dipping), of the environment (exacerbation of the white coat phenomenon) and of the position (orthostatic hypotension). These circumstances must be taken into account when evaluating and deciding on therapy. At this age, there is sufficient evidence that treatment reduces both cardiovascular morbimortality and all-cause mortality. (AU)

[Improved office blood pressure control by automatic delayed-reading oscillometric device]. / Mejoría del control de la hipertensión en la consulta con el uso de un dispositivo oscilométrico automático de lectura diferida.

INTRODUCTION: Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used. OBJECTIVE: To know the degree of BP control by clinical measurement. MATERIAL AND METHODS: During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected. RESULTS: 102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension. CONCLUSION: The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role.

[Hypertension in the elderly: What we need to know]. / Hipertensión del anciano: qué debemos conocer.

More than two thirds of people over 65 are hypertensive. Along with the high prevalence, hypertension is associated by comorbidities that originates a heterogeneous elderly population in relation to their autonomy and functional capacity. At this age, hypertension has special characteristics that make its management difficult, highlighting by isolated systolic hypertension due to the vascular stiffness typical of aging. Although decision-making is based on the clinical measurement of blood pressure, it is known that in the elderly pressure is subject to numerous influences: temporal (absence of night dipping), of the environment (exacerbation of the white coat phenomenon) and of the position (orthostatic hypotension). These circumstances must be taken into account when evaluating and deciding on therapy. At this age, there is sufficient evidence that treatment reduces both cardiovascular morbimortality and all-cause mortality.

Renal Artery Dissection in a Young Woman: Diagnoses Beyond Fibromuscular Dysplasia.

A 31-year-old woman presented at the emergency room after experiencing colic pain in the right iliac fossa for 5 days. She had previously consulted another center, where deterioration of renal function had been identified and abdominal computed tomography (CT) angiography had shown a dissection of the right renal artery, with areas suggestive of infarction in the right kidney, as well as an aneurysm in the left renal artery and a smaller left kidney. The patient had no relevant family or personal history except posttraumatic carotid-cavernous fistula in 2014, which had been treated with embolization. In our hospital, the patient was hypertensive and acute renal failure was confirmed, accompanied by an increase in lactate dehydrogenase and isomorphic microhematuria. After a new CT Scan, in addition to the lesions described in the renal arteries, another aneurysm in the splenic artery and an aneurysm of the right femoral artery were identified. Antihypertensive treatment was initiated with calcium antagonists and anticoagulation. Subsequent renal arteriography confirmed the dissection of the right renal artery, which could not be repaired, and a coated stent was placed in the left renal artery to exclude the aneurysm. The splenic artery lesion was treated 2 months later. The etiological diagnosis in this young woman was challenging. The presence of visceral aneurysms suggested a differential diagnosis comprising fibromuscular dysplasia, vasculitis, and collagenopathies. Using a multidisciplinary approach and directed anamnesis, the presence of frequent sprains, joint hypermobility, and skin fragility was confirmed. Blood immunology and CT angiography including the thoracic and cervical territories were normal. Echocardiography revealed tricuspid insufficiency. All these data suggested the presence of a collagen-like Ehlers-Danlos syndrome (vascular form). The diagnosis was confirmed by the genetic study, which showed a pathogenic mutation in the COL3A1 gene. Currently, the patient is asymptomatic with recovered renal function following treatment with a beta-blocker and antiplatelet therapy.

¿Cómo influye el consumo de sal en la presión arterial? Mecanismos etiopatogénicos asociados / How does salt intake influence blood pressure? Associated aetiopathogenic mechanisms

Existen numerosas evidencias tanto epidemiológicas como experimentales que demuestran la existencia de una relación entre el consumo de sal y las cifras de presión arterial. Los individuos tienen distintos grados de susceptibilidad al efecto presor de la sal, fenómeno que se conoce como sensibilidad a la sal. El fenómeno del incremento o no modificación de las cifras de presión arterial al pasar de una dieta pobre en sal a otra rica ha llevado a acuñar los conceptos de sensibilidad o resistencia a la sal. Clásicamente se ha aceptado la teoría de Guyton del fenómeno de natriuresis por presión para explicar este efecto, así como, el papel fundamental que desempeñan las distintas proteínas transportadoras de sodio de los túbulos renales. En los últimos años, hay trabajos que cuestionan esta teoría y apuntan al posible papel del sistema inmune y de un tercer almacén de sodio en el organismo como factores etiopatogénicos

Abundant evidence from epidemiological and experimental studies has established a link between salt and blood pressure. However, there is heterogeneity in the blood pressure responses of humans to changes in sodium intake. Those individuals in whom a severe, abrupt change in salt intake causes the least change in arterial pressure and are termed salt-resistant, whereas in those in whom this leads to large changes in blood pressure, are called salt sensitive. Classically, Guyton's theory of the pressure-natriuresis phenomenon has been accepted to explain the pressor effect of salt, as well as the fundamental role played by the different protein sodium transporters of the renal tubules. In recent years, new theories have emerged pointing to the possible role of the immune system and the existence of a third sodium store in the body as aetiopathogenic factors

Perfusión de lidocaína intravenosa / Intravenous lidocaine infusion

La perfusión perioperatoria de lidocaína intravenosa tiene propiedades analgésicas, antihiperalgésicas y antiinflamatorias, disminuyendo el consumo de opioides y agentes volátiles, brindando una rápida recuperación de la función intestinal y alta hospitalaria. Esta revisión narrativa tiene como objetivo exponer su farmacología e indicaciones para su aplicación en la clínica anestésica. Recientes revisiones sistemáticas y metaanálisis confirman su empleo en cirugía abdominal videolaparoscópica y abierta, como también en otros tipos de cirugía, destacándose su uso en protocolos de pronta recuperación. Potenciales beneficios en dolor crónico posoperatorio, disfunción cognitiva posoperatoria y recurrencia de cáncer están siendo investigados. La evidencia actual avala su administración en el contexto de analgesia multimodal debido a sus propiedades inmunomoduladoras sobre el estrés quirúrgico, considerándose un fármaco necesario en la clínica perioperatoria moderna

Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery. Peri-operative lidocaine infusion may be a useful analgesic adjunct in enhanced recovery protocols. Potential benefits of intravenous lidocaine in chronic post-surgical pain, post-operative cognitive dysfunction, and cancer recurrence are under investigation. Due to its immunomodulation properties over surgical stress, current evidence suggests that intravenous lidocaine could be used in the context of multimodal analgesia

Intravenous lidocaine infusion. / Perfusión de lidocaína intravenosa.

Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery. Peri-operative lidocaine infusion may be a useful analgesic adjunct in enhanced recovery protocols. Potential benefits of intravenous lidocaine in chronic post-surgical pain, post-operative cognitive dysfunction, and cancer recurrence are under investigation. Due to its immunomodulation properties over surgical stress, current evidence suggests that intravenous lidocaine could be used in the context of multimodal analgesia.

[How does salt intake influence blood pressure? Associated aetiopathogenic mechanisms]. / ¿Cómo influye el consumo de sal en la presión arterial? Mecanismos etiopatogénicos asociados.

Abundant evidence from epidemiological and experimental studies has established a link between salt and blood pressure. However, there is heterogeneity in the blood pressure responses of humans to changes in sodium intake. Those individuals in whom a severe, abrupt change in salt intake causes the least change in arterial pressure and are termed salt-resistant, whereas in those in whom this leads to large changes in blood pressure, are called salt sensitive. Classically, Guyton's theory of the pressure-natriuresis phenomenon has been accepted to explain the pressor effect of salt, as well as the fundamental role played by the different protein sodium transporters of the renal tubules. In recent years, new theories have emerged pointing to the possible role of the immune system and the existence of a third sodium store in the body as aetiopathogenic factors.

Hiperuricemia y riesgo cardiovascular: Mito o realidad / Hyperuricemia and cardiovascular risk: myth or fact?

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El uso de nuevas técnicas para el diagnóstico de recidiva del feocromocitoma / The use of new techniques for diagnosis of relapse of pheochromocytoma

El feocromocitoma es un tumor secretor de catecolaminas que procede de las células cromafines de la médula suprarrenal y del tejido simpático y parasimpático extraadrenal. Para su diagnóstico se deben realizar pruebas hormonales complementadas con técnicas de imagen como la tomografía (TAC) y/o la resonancia magnética (RM). La confirmación de sulocalización así como la existencia de tumores múltiples requiere el uso de una prueba funcional, siendo de elección la gammagrafía con iodometilbencilguanidina (IMBG). Su sensibilidad disminuye en feocromocitomas de localización extra adrenal o malignos. Se presentan 2 casosen los que, a pesar de una alta sospecha diagnóstica de recidiva de feocromocitoma, la gammagrafría con IMBG fue negativa, siendo la tomografía por emisión de positrones (PET-CT) con18-fluorodesoxiglucosa (18F-FDG) fundamental para el diagnóstico en ambos casos. Además, se comenta la necesidad de hacer un estudio genético en algunos casos con feocromocitoma nosindrómico (AU)

Pheochromocytoma is a catecholamine-secreting tumor derived from chromaffincells of the adrenal medulla and extra-adrenal sympathetic and parasympathetic tissue. Diagnosis should be made by hormonal tests and supplemented with imaging techniques such as tomography (CT) and/or magnetic resonance imaging (MR). To confirm its location and the existence of multiple tumors, it is necessary to perform a functional test, the iodomethyl-benzylguanidine (IMBG) scintigraphy being the test of choice. Its sensitivity decreases in extra-adrenal location pheochromocytomas or malignant tumors. Two cases are reported in which, despite high clinical suspicion of recurrence of pheochromocytoma, the IMBG scintigraphy was negative. The positron emission tomography (PET-CT) using 18-fluorodeoxyglucose(18F-FDG) was essential for the diagnosis in both cases. In addition, the need for a genetic study in some cases of non-syndromic pheochromocytoma is discussed (AU)

[Relationship between renal size and blood pressure profile in patients with autosomal dominant polycystic kidney disease without renal failure]. / Relación entre el tamaño renal y el perfil de presión arterial en pacientes con poliquistosis renal autosómica dominante sin insuficiencia renal.

BACKGROUND: Enlargement of renal size plays an important role in the development of hypertension in patients with autosomic dominant polycystic kidney disease (ADPKD) and normal renal function. METHODS: A 24h blood pressure monitoring (ABPM) and a renal echography have been performed in 37 patients with ADPKD and estimated glomerular filtration rate > 60 ml/min/1.73 m(2) to study the relationship between renal size and an altered blood pressure profile in prehypertension stages. RESULTS: 13 patients had normal blood pressure, 11 were diagnosed of masked hypertension, 4 had white coat hypertension and 9 had hypertension. We have found in the normotensive group with a dipper blood pressure profile a positive and statistically significant relationship between renal size and diastolic blood pressure variability. CONCLUSIONS: ABPM helps to make an early diagnosis of hypertension and to identify those patients with masked hypertension. This study suggests a relationship between renal size and a blood pressure profile linked to a major cardiovascular risk in normotensive patients with ADPKD.

Relación entre el tamaño renal y el perfil de presión arterial en pacientes con poliquistosis renal autosómica dominante sin insuficiencia renal / Relationship between kidney size and blood pressure profile in patients with autosomal dominant polycystic kidney disease without renal failure

Antecedentes: El aumento del tamaño renal desempeña un papel importante en el desarrollo de la hipertensión arterial (HTA) en pacientes con poliquistosis renal autosómica dominante (PQRAD) con función renal normal. Material y métodos: Se han practicado a 37 pacientes con PQRAD, filtrado glomerular estimado (FGe) por MDRD>60 ml/min/1,73 m2y supuestamente normotensos, una monitorización de la presión arterial (MAPA) y una ecografía renovesical para investigar la posible relación entre el aumento del tamaño renal y un perfil patológico de presión arterial (PA) en estadios de prehipertensión. Resultados: 13 pacientes resultaron ser normotensos, 11 presentaron HTA enmascarada, cuatro tuvieron HTA de bata blanca y nueve, HTA verdadera. Se ha observado en los pacientes normotensos con patrón reductor de la PA una correlación positiva y estadísticamente significativa entre el tamaño renal y la variabilidad de la presión arterial diastólica (PAD). Conclusiones: La MAPA permite realizar un diagnóstico precoz de la HTA e identificar apacientes con hipertensión enmascarada. Este trabajo sugiere que en pacientes normotensos con PQRAD existe una posible relación entre el tamaño renal y un perfil de PA con mayor riesgo cardiovascular (AU)

Background: Enlargement of renal size plays an important role in the development of hypertension in patients with autosomal dominant polycystic kidney disease (ADPKD)and normal renal function. Methods: A 24h blood pressure monitoring (ABPM) and a renal ecography have been performed in 37 patients with ADPKD and estimated glomerular filtration rate >60 ml/min/1,73 m2to study the relationship between renal size and an altered blood pressure profile in prehypertension stages. Results: 13 patients had normal blood pressure, 11 were diagnosed of masked hypertension, 4 had white coat hypertension and 9 had hypertension. We have found in the normotensive group with a dipper blood pressure profile a positive and statistically significant relationship between renal size and diastolic blood pressure variability. Conclusions: ABPM helps to make an early diagnosis of hypertension and to identify those patients with masked hypertension. This study suggests a relationship between renal size and a blood pressure profile linked to a major cardiovasular risk in normotensive patients with ADPKD (AU)

Complicaciones de aterosclerosis de grandes vasos / Complications of large vessel atherosclerosis

La enfermedad renal ateroembólica es consecuencia del desprendimiento y migración a vasos distales de microémbolos de colesterol, procedentes de placas de ateroma de grandes arterias. Estos émbolos pueden ocluir pequeños vasos en el riñón, retina, cerebro, páncreas, músculos y piel. Se produce en pacientes con arterioesclerosis tras procesos endovasculares o bien se puede producir espontáneamente. Por ello ante un deterior de función renal inexplicable, en paciente con signos de arterioesclerosis, se debe sospechar siempre una enfermedad ateroembólica y buscar manifestaciones extrarrenales. En estos casos, puede ser necesaria la confirmación histológica para el diagnóstico definitivo. No existe tratamiento específico, debiendo tomar algunas medidas como, suspender los anticoagulantes, las manipulaciones aórticas y reducir la PA. De ello dependerá la evolución, ya que ésta puede ser muy variable siendo, desde formas leves, hasta potencialmente mortales. Por otro lado es conveniente remarcar; que a pesar del control estricto de los factores de riesgo vascular, la enfermedad aterosclerótica es una enfermedad progresiva, como se desprende del caso que presentamos y aconsejamos en pacientes de este tipo, con alto riesgo vascular, la toma periódica de la PA en ambas extremidades (AU)

Atheroembolic renal disease is a consequence of the detachment and migration of microemboli distal vessels of cholesterol from atherosclerotic plaques of large arteries. These emboli can occlude small vessels in the kidney, retina, brain, pancreas, muscles and skin. It occurs in patients with atherosclerosis after endovascular procedures or it may occur spontaneously. Therefore, before an unexplained deterioration of renal function, in patients with signs of atherosclerosis, an atherosclerotic disease should always be suspected and seek for extra renal manifestations. In these cases, histological confirmation may be required for definitive diagnosis. There is non specific treatment and certain measures should be taken such as suspending anticoagulants, aortic manipulation and reducing the blood pressure. The evolution will depend on this, as it can vary from being mild to life-threatening forms. On the other band, it is advisable to note, that in despite the strict control of vascular risk factors, atherosclerotic disease is a progressive disease, as shown in the case reported, and in such patients, with high vascular risk, we advise monitoring their BP regularly in both extremities (AU)

Aplicación práctica de la evaluación de la sensibilidad a la sal / Application of the assessment of salt sensitivity

Hay numerosas evidencias tanto epidemiológicas como experimentales que demuestranla relación entre el consumo de sal y las cifras de presión arterial (PA). Los individuostienen distintos grados de susceptibilidad al efecto presor de la sal, fenómeno que seconoce como sensibilidad a la sal. El fenómeno de que las cifras de PA se incrementen ono se modifi quen al pasar de una dieta pobre en sal a otra rica en sal ha llevado a acuñarlos conceptos de sensibilidad o resistencia a la sal. La sensibilidad a la sal aumenta conla edad, también se observa con más frecuencia en pacientes de raza negra, diabéticos ynefrópatas. Hay distintos métodos para evaluar la respuesta de la PA a los cambios en laingesta de sal. Dada la complejidad de los protocolos, la evaluación de la sensibilidad ala sal se usa con propósitos de investigación y es ocasional su uso en la práctica clínica(AU)

Abundant evidence from epidemiological and experimental studies has established a linkbetween salt and blood pressure values. Individuals have different grades of susceptibilityto the pressure effect of salt, a phenomenon known as salt sensitivity. The phenomenonof increase or no change in BP blood pressure values when changing from a low-salt dietto a high-salt diet has resulted in a concept called salt sensitivity or resistance. Saltsensitivity increases with age, black race, diabetes mellitus and renal diseases. A varietyof different techniques have been used to assess blood pressure response to changes insalt intake in humans. However, due to the complexity of the procedure they are mainlyused for research and occasionally for clinical practice(AU)

[Tables estimating glomerular filtration rate from plasma creatinine]. / Tablas para la estimación del filtrado glomerular a partir de la creatinina plasmática.

Chronic kidney disease (CKD) and its related complications have become an important health and social problem. Very expensive resources are required in end-stage renal disease, and both complications of CKD as well as the important associated cardiovascular risk demand for interventions long before renal substitution therapies are needed. Thus, early diagnosis of CKD is currently considered of paramount importance, and it is based essentially upon the estimation of the glomerular filtration rate by formulae such as the abbreviated equation of the MDRD study. Nevertheless, in spite of international published recommendations, an automatic calculation to estimate the glomerular filtration rate (GFR) from serum creatinine is not reported by most laboratories yet and the need for creatinine assay standardisation is far from being implemented. Thus, we have designed some tables to show the creatinine value corresponding to different GFR for ages between 20 and 90 y/o, at 5 years intervals and in both sexes with both the MDRD-4 and MDRD-IDMS equations (Modification of Diet in Renal Disease-Isotope Dilution Mass Spectrometry). Moreover, we have created a global table including an estimation of GFR from plasma creatinine, age and sex by the MDRD-IDMS formula, the recommended for those laboratories which measure serum creatinine with assays aligned to the reference method. These tables aim to increase the awareness of the different assays for serum creatinine and to facilitate the diagnosis of CKD converting serum creatinine into GFR. This action should allow not only the early detection but also the possibility to establish the appropriate medical actions recommended after CKD detection.

Tablas para la estimación del filtrado glomerular a partir de la creatinina plasmática / Tables for estimating glomerular filtration rate from plasma creatinine

La enfermedad renal crónica (ERC) y las complicaciones que de ella se derivan se ha convertido en un importante problema social y sanitario, tanto por los recursos que se requieren en los estadios finales de la enfermedad como por las complicaciones secundarias a la propia ERC y a su elevado riesgo cardiovascular asociado. Hoy se considera de gran valor el diagnóstico precoz, basándose la definición y la clasificación actuales fundamentalmente en la estimación del filtrado glomerular (FG) por medio de fórmulas como la ecuación abreviada del estudio MDRD. No obstante, a pesar de las recomendaciones internacionales, no en todos los laboratorios es posible el cálculo automático del FG a partir de la creatinina plasmática ni se ha enfatizado la necesidad de estandarización de los métodos de medición de la misma. Es por ello que hemos diseñado unas tablas en las que se ha calculado el valor de creatinina correspondiente a los diferentes FG con significación clínica para cada una de las edades comprendidas entre 20y 90 años y a intervalos de 5 años en ambos sexos con lasfórmulas MDRD-4 y MDRD-IDMS (Modification of Diet in Renal Disease-Isotope Dilution Mass Spectrometry). Además hemos creado una tabla que integra de forma global una estimación del FG a partir de la creatinina plasmática por el método MDRD-IDMS que es el recomendado para aquellos laboratorios que utilizan un método de medición de la creatinina con trazabilidad respecto al método de referencia de espectrometría de masas por dilución isotópica. Estas tablas pretenden, no sólo incrementar la conciencia de la existencia de distintos ensayos en la medida de la creatinina sérica que influyen sobre la estimación del FG, sino también el facilitar el diagnóstico de la ERC a partir de la conversión de la creatinina plasmática en FG, para permitirá sí el diagnóstico precoz y el establecimiento de las acciones precisas que se recomiendan tras su detección (AU)

Chronic kidney disease (CKD) and its related complications have become an important health and social problem. Very expensive resources are required in end-stage renal disease, and both complications of CKD as well as the important associated cardiovascular risk demand for interventions long before renal substitution therapies are needed. Thus, early diagnosis of CKD is currently considered of paramount importance, and it is based essentially upon the estimation of the glomerular filtration rate by formulae such as the abbreviated equation of the MDRD study. Nevertheless, in spite of international published recommendations, an automatic calculation to estimate the glomerular filtration rate (GFR) from serum creatinine is not reported by most laboratories yet and the need for creatinine as say standardisation is far from being implemented. Thus, we have designed some tables to show the creatinine value corresponding to different GFR for ages between 20 and 90 y/o, at 5years intervals and in both sexes with both the MDRD-4 and MDRD-IDMS equations (Modification of Diet in Renal Disease-Isotope Dilution Mass Spectrometry). Moreover, we have created a global table including an estimation of GFR from plasma creatinine, age and sex by the MDRD-IDMS formula, the recommended for those laboratories which measure serum creatinine with assays aligned to the reference method. These tables aim to increase the awareness of the different assays for serum creatinine and to facilitate the diagnosis of CKD converting serum creatinine into GFR. This action should allow not only the early detection but also the possibility to establish the appropriate medical actions recommended after CKD detection (AU)

Necesidad de una conexión realista con asistencia primaria / Need for a realistic connection with primary care

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