Long-term results of autologous scaffold-free tissue-engineered vascular graft for hemodialysis access.

BACKGROUND: The growing size of the end stage renal disease (ESRD) population highlights the need for effective dialysis access. Exhausted native vascular access options have led to increased use of catheters and prosthetic shunts, which are both associated with high risks of access failure and infection. Emerging alternatives include tissue-engineered vascular grafts (TEVG). Here we present the endpoint results for 10 ESRD patients with the scaffold-free tissue-engineered vascular access produced from sheets of extracellular matrix produced in vitro by human cells in culture. METHODS: Grafts were implanted as arteriovenous shunts in 10 ESRD patients with a complex history of access failure. Follow-up included ultrasound control of graft morphology and function, dialysis efficiency, access failure, intervention rate, as well as immunohistochemical analysis of graft structure. RESULTS: One patient died of unrelated causes and three shunts failed to become useable access grafts during the 3-month maturation phase. The 12-month primary and secondary patency for the other six shunts was 86%. Survival of six shunts functioning as the vascular access was 22 ± 12 months with longest primary patency of 38.6 months. The dialysis event rate of 3.34 per patient-year decreased significantly with the use of this TEVG to 0.67. CONCLUSIONS: This living autologous tissue-engineered vascular graft seems to be an alternative to synthetic vascular access options, exhibiting advantages of native arteriovenous fistula.

Rol de la hematuria dismórfica en las enfermedades gomerulares / Role of urinary dysmorphic red blood cells in glomerular disease

INTRODUCCIÓN: El sedimento de orina es una herramienta en la práctica clínica empleada desde hace muchos años para la evaluación de enfermedades renales. La detección de hematuria dismórfica es útil en el diagnóstico de enfermedades glomerulares. OBJETIVOS: Agrupar las hematurias dismórficas en los casos con presencia de acantocitos y los que no los presentan, y correlacionar estos dos grupos con los hallazgos histológicos de las biopsias renales. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y analítico. Se incluyeron los sedimentos de orina de 276 pacientes. Se analizaron dos grupos de hematuria dismórfica: D1 (presencia de acantocitos) y D2 (sin acantocitos), y se correlacionó con los hallazgos histológicos de la biopsia renal (glomerulopatías proliferativas y no proliferativas). Se analizaron los diferentes elementos formes de la orina (cilindros hemáticos, leucocitarios, céreos, granulosos, grasos), la creatinina plasmática y la proteinuria de 24 hs en los dos grupos de glomerulopatías. Posteriormente se realizó una regresión logística para evaluar las variables independientes entre los hallazgos del sedimento de orina, con los correspondientes odds ratio (OR) e intervalos de confianza (IC 95%). RESULTADOS: Se contó con 172 muestras provenientes de mujeres (62.3%) y 104 de hombres (37,7%). La presencia de acantocitos (D1) en las enfermedades glomerulares proliferativas (GP) fue 17 veces más frecuente comparada con las no proliferativas (GNP) OR 17.7 IC 95% (9.6-32.5) p 0.001. La presencia de cilindros hemáticos es ocho veces más frecuente en las GP OR 8 IC 95% (3.1-20.9). Los pacientes con hematuria no acantocitica (D2) es 5 veces más frecuente en una GNP OR 5.2 IC (2.4-11.3) p 0,001. La presencia de cilindros grasos fue más frecuente en los pacientes con GNP a diferencia de los cilindros leucocitarios, cuya frecuencia fue mayor en la GP. CONCLUSIONES: La presencia de hematuria dismórfica no acantocitica (D2) se correlacionó en la histología renal con la presencia de glomerulopatías no proliferativas (GNP) en forma significativa, a diferencia de la hematuria acantocitica y cilindros hemáticos que se observaron en glomerulopatías proliferativas, por lo tanto se considera una herramienta útil para poder diferenciar clínicamente estos dos grupos, sin remplazar la biopsia renal para el diagnóstico preciso y el pronóstico

INTRODUCTION: The analysis of urine sediment is a tool that has been used for many years in clinical practice to evaluate kidney diseases. Detecting dysmorphic red blood cells (RBC's) in urine is useful for the diagnosis of glomerular diseases. OBJECTIVES: To divide the cases of glomerular hematuria into two groups, depending on the presence or absence of acanthocytes, and to compare this factor with the histological findings of renal biopsies. METHODS: In this observational, retrospective, analytical study, urine sediments of 276 patients were included. Two groups of subjects with glomerular hematuria were analyzed: D1 (presence of acanthocytes) and D2 (absence of acanthocytes). The results were compared with the renal biopsy histological findings, i.e. proliferative glomerulonephritis and non-proliferative glomerulonephritis, considered separately. The formed elements of the urine (red blood cell, white blood cell, waxy, granular and fatty casts), plasma creatinine concentration and 24-hour urinary protein were tested in the two groups. A logistic regression analysis was later performed to assess the independent variables among urine sediment findings, with the corresponding odds ratio (OR) and confidence intervals (CI 95%). RESULTS: The samples were collected from 172 women (62.3 %) and 104 men (37.7 %). The presence of acanthocytes (D1) was 17 times more frequent in proliferative glomerulonephritis (PGN) than in non-proliferative glomerulonephritis (NPGN) [OR 17.7, CI 95% (9.6-32.5), p 0.001]. The presence of red blood cell casts was 8 times more frequent in PGN [OR 8, CI 95% (3.1-20.9)]. Cases of hematuria with no acanthocytes (D2) were 5 times more frequent in NPGN [OR 5.2, CI (2.4-11.3), p 0.001]. Fatty casts appeared more frequently in patients with NPGN, whereas white blood cell casts were more common in PGN cases. CONCLUSIONS: Renal histological findings revealed a significant correlation between glomerular hematuria without acanthocytes (D2) and non-proliferative glomerulonephritis (NPGN), while the presence of acanthocytes and red blood cell casts was associated with proliferative glomerulonephritis (PGN). The existence of acanthocytes in urine constitutes a useful tool to make a clinical distinction between these two conditions, but it does not replace renal biopsy to establish an accurate diagnosis and prognosis

Evolución al año de la nefritis lúpica con proliferación extra capilar focal / Progression of focal lupus nephritis with extracapillary proliferation after one year

INTRODUCCIÓN: La nefritis lúpica proliferativa (NPL) con proliferación extra capilar focal (PECF) es una entidad frecuente en las biopsias renales, pero poco se conoce acerca de su evolución. Este estudio se realizó para investigar la correlación clínica, histológica y de laboratorio en la evolución de estos pacientes. OBJETIVO: Analizar las biopsias de nefritis lúpicas proliferativas focales o difusas (clases III y IV de la OMS), y su evolución de acuerdo al grado de proliferación extracapilar en un período de 10 años, en el Hospital de Clínicas "José de San Martín". MATERIAL Y MÉTODOS: Estudio observacional retrospectivo, se incluyeron 147 pacientes con GN clase III o IV, estudiados en un período de 10 años. Se subdividieron en base al compromiso extracapilar en: grupo 1 (5- <25% de semilunas, n=33), grupo 2 (25- 50% semilunas, n=34) y grupo 3 (>50% semilunas, n= 20) o proliferación extracapilar difusa (PECD). Los pacientes con nefritis lúpica III y IV, sin compromiso extra capilar, se denominó grupo control (n=60); las características clínicas, laboratorios y evolución en cuanto alcanzar remisión completa al año fueron comparadas entre los subgrupos y el grupo de control. Remisión completa se definió según normas KDIGO 2012. Se realizó un análisis univariado y posteriormente un multivariado, ambos con regresión logística. RESULTADOS: Hubo 124 mujeres (84,35%) y 23 hombres (15,65%) con una edad media de 35±10 años. Edad media en el grupo control, 32±10 años. El univariado mostro mayor remisión completa en el grupo control con odds ratio 0.05 (0.02.-0.12) p=0.001, y menor remisión completa en los 3 subgrupos con proliferación extra capilar, inclusive el grupo I con un odds ratio 7.61 (2,42-23.9) y valor de p=0.001 en dicho grupo. El análisis multivariado evidenció que la persistencia de la proteinuria a los 6 meses tenía significación estadística para no alcanzar la remisión completa, con un odd ratio 2.81 (1.58-5.0), valor de p=0.001. CONCLUSIÓN: La presencia de distintos grados de semilunas en la histología de las NL proliferativas (NPL), clase III y IV, y la persistencia de la proteinuria a los 6 meses, son marcadores independiente para no alcanzar la remisión completa al año

IINTRODUCTION: Although focal lupus nephritis (FLN) with extracapillary proliferation (ECP) is usually found in renal biopsies, little is known about its course. This study was carried out to investigate the correlation of clinical, histological and laboratory findings in these patients' progress. OBJECTIVE: To analyze focal or diffuse proliferative lupus nephritis biopsies (class III and IV, according to WHO) and their development regarding the level of extracapillary proliferation throughout a period of 10 years at Hospital de Clínicas 'José de San Martín'. METHODS: In this retrospective observational study, 147 patients with class III or IV GN were observed for 10 years. According to the degree of extracapillary proliferation, they were divided into the following groups: group 1 (5% <25% of crescents, n=33), group 2 (25% 50% of crescents, n=34) and group 3 [>50% of crescents, i.e. diffuse proliferative nephritis (DPN), n=20]. Patients suffering from class III and IV lupus nephritis with no extracapillary proliferation formed the control group (n=60). After one year, clinical and laboratory findings as well as the development of the condition among the four groups were compared to assess their level of remission. Complete remission was considered as defined in KDIGO 2012 Guideline. A univariate logistic regression analysis and a subsequent multivariate one were performed. RESULTS: There were 124 women (84.35%) and 23 men (15.65%) with an average age of 35±10. The average age in the control group was 32±10. The univariate analysis showed a greater number of patients who achieved complete remission in the control group with an odds ratio of 0.05 (0.02 0.12) p=0.001, whereas in the 3 groups with extracapillary proliferation fewer patients reached this state, even in group 1, which had an odds ratio of 7.61 (2.42 23.9) and p=0.001. The multivariate analysis revealed that the persistent protein in the urine after 6 months was statistically significant for not achieving complete remission, the odds ratio being 2.81 (1.58 5.0) and p=0.001. CONCLUSION: The presence of various degrees of crescent formation in class III and IV proliferative lupus nephritis (PLN) shown in the histological findings and the persistent protein in the urine at 6 months constitute independent factors for not achieving complete remission after one year

Biopsia renal en el adulto mayor / Renal biopsy in the elderly

INTRODUCCIÓN: La enfermedad renal es muy frecuente en los adultos mayores. Esta población está creciendo rápidamente y en las últimas décadas ha aumentado el número de biopsias renales efectuadas a pacientes de edad avanzada. OBJETIVO: El objetivo de este estudio fue examinar la frecuencia y la correlación clínico-patológica de las enfermedades renales en pacientes adultos mayores en los que se realizó una biopsia renal. MATERIAL Y MÉTODOS: Se analizaron retrospectivamente las formas de presentación clínica de la enfermedad renal y los hallazgos histológicos predominantes en pacientes mayores de 65 años sometidos a biopsia renal (n 109) durante un período de 12 años. RESULTADOS: De un total de 871 biopsias renales efectuadas en este período, 109 (12,5%) correspondieron a pacientes mayores de 65 años. Las indicaciones más frecuentes de la biopsia renal fueron el síndrome nefrótico (37,6%) y la insuficiencia renal (34,9%). La hematuria microscópica estuvo presente en el 59,6% y la hipertensión arterial en el 62,4% de los pacientes. La glomerulopatía membranosa fue el diagnóstico histológico más común (21,1%), seguido de la glomerulopatía extracapilar (20,2%). Cuando se correlacionaron los síndromes clínicos con los hallazgos histológicos, se encontró que el síndrome nefrótico fue la manifestación principal en la nefropatía membranosa (78,3%), en la esclerosis focal y segmentaria (55,6%) y en la nefropatía por diabetes (66,7%). La insuficiencia renal estuvo presente en el 90% de la glomerulopatía extracapilar (95,5% pauciinmune tipo 3). La hematuria microscópica fue la principal manifestación en la glomerulopatía mesangial (83,3%). CONCLUSIONES: El síndrome nefrótico y la insuficiencia renal (principalmente la insuficiencia renal rápidamente progresiva) fueron las principales indicaciones de la biopsia renal en este grupo de pacientes, en estrecha relación con los hallazgos histológicos. La glomerulopatía membranosa y la extracapilar pauiciinmune resultaron ser las más frecuentes. La biopsia renal proporciona información útil para el diagnóstico, pronóstico y tratamiento de las enfermedades renales en la población de edad avanzada

INTRODUCTION: Kidney disease is very common among the elderly. Over the last decades, the number of renal biopsies performed on these patients has increased. OBJECTIVE: This study was carried out to examine the frequency and the clinical-pathological correlation of kidney disease in elderly patients who have had a renal biopsy done. METHODS: The clinical presentation of kidney disease and the main histological findings were retrospectively analyzed in patients over 65 who had undergone renal biopsy (n=109) for a period of 12 years. RESULTS: The total number of renal biopsies performed during this period was 871, out of which 109 (12.5%) corresponded to patients over 65. The main indications for renal biopsies were nephrotic syndrome (37.6%) and kidney failure (34.9%). Microscopic hematuria was found in 59.6% of the patients and high blood pressure in 62.4% of them. The most frequent histological diagnosis was membranous glomerulonephritis (21.1%), followed by extracapillary glomerulonephritis (20.2%). When clinical syndromes and histological findings were compared, the nephrotic syndrome was found to be the main feature of membranous nephropathy (78.3%), of focal segmental glomerulosclerosis (55.6%) and of diabetic nephropathy (66.7%). Kidney failure was present in 90% of the cases of extracapillary glomerulonephritis (95.5% pauci immune or type 3). Microscopic hematuria was the main sign of mesangial prolifeative glomerulonephritis (83.3%). CONCLUSIONS: Nephrotic syndrome and kidney failure (especially rapidly progressive renal failure) were the main renal biopsy results in this group of patients, bearing close relation to histological findings. The most common types of glomerulonephritis were membranous GN and pauci immune extracapillary GN. Renal biopsy provides useful information for the diagnosis, prognosis and treatment of kidney disease in the elderly

Analysis of 65 Renal Biopsies From Patients With Rheumatoid Arthritis (1976-2015): Change in Treatment Strategies Decreased Frequency and Modified Histopathological Findings.

INTRODUCTION: No inherent renal lesions are known in rheumatoid arthritis (RA), but urinary abnormalities and renal dysfunction have been described. OBJECTIVE: First, we describe the histopathological findings of renal biopsies (RBs) in patients with RA and associated clinical manifestations. Second, we evaluated time evolution of RA and the relationship between drugs and renal disease. Last, we investigate whether changes in the management of RA from 1976 to 2015 influenced RBs indication, frequency, and type of histopathological findings. PATIENTS AND METHODS: This is a retrospective and observational study conducted at a university hospital from Argentina. Patients with a diagnosis of RA (ACR, 1987) and RBs between 1976 and 2015 were included. Sixty-five patients met the inclusion criteria. The histopathological findings and associated clinical manifestations were evaluated. Time evolution of RA and the relationship between drugs and renal disease were also determined. To clarify these issues, we characterized 3 groups according to changes in the management of RA: 1976-1989, 1990-2002, and 2003-2015. RESULTS: The most common histopathological finding was renal amyloidosis in 31% (n = 20), followed by mesangial glomerulonephritis in 18% (n = 12), membranous nephropathy in 17% (n = 11), extracapillary proliferative glomerulonephritis in 15% (n = 10), focal segmental glomerular sclerosis in 9% (n = 6), minimal change nephropathy in 5% (n = 3), and tubulointerstitial nephritis in 5% (n = 3). Time evolution of renal amyloidosis was significantly higher than other RBs (15 ± 12 vs 7 ± 6.5 years). Nephrotic syndrome was the most common clinical manifestation (60%) followed by hematuria (46%) with or without proteinuria. Membranous nephropathy was related to the use of gold salts in 45% of cases, and its frequency decreased since 1990. Before 2003, renal amyloidosis was the leading cause of kidney disease, but mesangial glomerulonephritis reached the same frequency between 2003 and 2015. We found that RBs decreased 20% in the second period (1990-2002) and 40% in the last period (2003-2015). Nephrotic syndrome remained the main RB indication during the entire study period. CONCLUSION: This is the first report on RBs findings in patients with RA from Latin America. We found a significant reduction in RBs frequency and modified histological patterns throughout the study period, although RB indication was not modified. Changes in the management of RA might have influenced these findings.

Weekly high-dose ergocalciferol to correct vitamin D deficiency/insufficiency in hemodialysis patients: a pilot trial.

Controversy exists on which vitamin D (D2 or D3) and which dosage scheme is the best to obtain and maintain adequate 25 OH D levels in dialysis patients safely. We tried to determine whether high-dose vitamin D2 supplementation could obtain optimal vitamin D status without inducing hypercalcemia. We studied 82 patients on dialysis not taking active vitamin D therapy and supplemented them with oral vitamin D2 72,000 IU/week for 12 weeks followed by 24,000 IU/week as maintenance therapy during 36 weeks. By week 12, serum 25(OH)D increased from 15.2 ± 5.4 to 42.5 ± 13.2 ng/mL (P < 0.01) at week 12 and remained optimal (34.7 ± 12.0); 84.8% of the patients reached values ≥30 ng/mL. iPTH and alkaline phosphatase did not change at 48 weeks compared with baseline, but bone alkaline phosphatase decreased significantly (54.3 ± 46.0 to 44.3 ± 25.0; P = 0.02). Uncorrected serum Ca increased significantly at the end of follow-up (9.03 ± 0.42 to 9.14 ± 0.62; P = 0.04); hypercalcemia was presented in two patients in the first control visit (week 12), in one patient in the second control (week 30), and in one patient in the third control (week 48). In 222 serum calcium determinations during follow-up, hypercalcemia was observed in only 1.8% of cases. This vitamin D2 oral regimen with initial high doses was safe and sufficient to obtain and maintain optimal serum 25(OH)D concentrations and prevent vitamin D insufficiency in chronic kidney disease patients on dialysis.

Detección de factores de riesgo e indicadores tempranos de enfermedad renal crónica en población adulta en una campaña de salud renal / Detection of risk factors and early indicators of chronic kidney disease in an adult population during a kidney health campaign

Introducción: La Enfermedad Renal Crónica (ERC) en el adulto es una afección frecuente y constituye un importante problema de Salud Pública a nivel mundial. Se la ha relacionado con un riesgo elevado de insuficiencia renal crónica terminal, enfermedad cardiovascular y muerte. Dada la creciente incidencia de ERC y la disponibilidad de medidas terapéuticas efectivas, es de vital importancia realizar la detección precoz de factores de riesgo (FR), con el fin de retrasar o prevenir su progresión. Con el objetivo de detectar precozmente indicadores de ERC y FR asociados, realizamos una campaña de salud renal en una población adulta. Metodos: Participaron 608 personas >18 años, evaluándose PA, IMC, glucemia, creatinina y en orina matinal se calculó el cociente albuminuria/creatininuria. La ERC se estadificó según albuminuria y/o filtrado glomerular estimado (IFG) por MDRD4, CKD-EPI y C.G. Resultados: La media de edad,fue 54.8±15.4 años, con predominio de mujeres (72%). El 61.5% presentaban uno o más FR: edad >55 años 52.8 %, HTA 39.3%, obesidad 36.8%, alteraciones del metabolismo hidrocarbonado (AMHC) 21.2%, diabetes: 14.1% (DBT), tabaquismo 12.3% y albuminuria 11%. Detectamos ERC en el 14%, 40% varones, con albuminuria 78.8% e IFG<60 ml/m 37.6%. El 95.2% asociaba FR. Las siguientes variables estuvieron asociadas a ERC (p<0.05): sexo masculino, edad > 55, HTA, DBT, obesidad, tabaquismo y nivel de educación. En el análisis multivariado mantuvieron significación: edad >55, obesidad, HTA, DBT y nivel de educación. El 21.8% de los hipertensos, el 37.3% con AMHC y el 100% con albuminuria lo desconocían. Conclusión: En esta población ser varón, tener >55 años, HTA, obesidad y/o DBT incrementa el riesgo de desarrollar ERC. Identificamos un alto porcentaje (61.5%) de individuos con FR y ERC. La detección precoz de FR y su tratamiento reducirían significativamente la incidencia y progresión de la ERC. Encontramos una frecuencia de ERC y albuminuria similar a otros reportes, lo cual contribuye al conocimiento de esta enfermedad y su prevalencia en Argentina

Introduction: Chronic kidney disease (CKD) in adults is a common condition and a major public health issue worldwide. There has been related to a high risk of End Stage Renal Disease (ESRD), cardiovascular disease and death. Given the increasing incidence of CKD and the availability of effective therapeutic measures, is of vital importance perform early detection of risk factors (RF), in order to delay or prevent progression to ESRD. The optimal cost-effective strategy seems to be an investigation aimed at patients with one or more risk factors for CKD. In order to detect early indicators of CKD and associated risk factors, we conducted a study in an adult population. Methods: In a cross-sectional study was evaluated BP, BMI, blood glucose, serum creatinine and albumin/creatinine ratio in urine sample in 608 people> 18 years. Participants were classified for stages of CKD according to the presence of albuminuria and / or estimated glomerular filtration rate (MDRD4, CKD-EPI and CG). For statistical analysis (Stata 11.0) we used Fisher’s exact test, Ttest and Cox regression to explore the association between variables. Effect measure RR and 95% CI, was considered significant when P <0.05. Results: Mean age 54.8 ± 15.4 years, 72% were females. 61.5% had one or more CKD RF.Presence of CKD RF : age> 55 years 52.8%, hypertension 39.3% obesity 36.8%, carbohydrate metabolism disorders (CHMD)21.2%, diabetes: 14.1% (DBT), smoking 12.31%, albuminuria 11%. CKD was found in 14% of participants, 40% were male, albuminuria in 78.8% and GFR <60 ml/m in 37.6%. The 95.2% of participants with CKD had RF. The following variables were associated with ERC (p <0.05): male gender, age> 55, hypertension, diabetes, obesity, smoking and educational level. In multivariate analysis remained significant: age> 55, obesity, hypertension, diabetes and educational level. The 21.8% of hypertensive patients, 37.3% of those with CHMD and 100% with albuminuria did not know that condition. Conclusion: In this population to be a male, to have> 55 years, hypertension, obesity and diabetes it increases the risk of developing CKD. We identified a high percentage (61.5%) of individuals with RF and ERC. The implementation of campaigns for early detection of RF and treatment would reduce the incidence and progression of CKD. We found a frequency of CKD and albuminuria similar to others international reports contributing to the understanding of this disease and its prevalence in Argentina.

Detección de factores de riesgo e indicadores tempranos de enfermedad renal crónica en población adulta en una campaña de salud renal / Detection of risk factors and early indicators of chronic kidney disease in an adult population during a kidney health campaign

Introducción: La Enfermedad Renal Crónica (ERC) en el adulto es una afección frecuente y constituye un importante problema de Salud Pública a nivel mundial. Se la ha relacionado con un riesgo elevado de insuficiencia renal crónica terminal, enfermedad cardiovascular y muerte. Dada la creciente incidencia de ERC y la disponibilidad de medidas terapéuticas efectivas, es de vital importancia realizar la detección precoz de factores de riesgo (FR), con el fin de retrasar o prevenir su progresión. Con el objetivo de detectar precozmente indicadores de ERC y FR asociados, realizamos una campaña de salud renal en una población adulta. Metodos: Participaron 608 personas >18 años, evaluándose PA, IMC, glucemia, creatinina y en orina matinal se calculó el cociente albuminuria/creatininuria. La ERC se estadificó según albuminuria y/o filtrado glomerular estimado (IFG) por MDRD4, CKD-EPI y C.G. Resultados: La media de edad,fue 54.8±15.4 años, con predominio de mujeres (72%). El 61.5% presentaban uno o más FR: edad >55 años 52.8 %, HTA 39.3%, obesidad 36.8%, alteraciones del metabolismo hidrocarbonado (AMHC) 21.2%, diabetes: 14.1% (DBT), tabaquismo 12.3% y albuminuria 11%. Detectamos ERC en el 14%, 40% varones, con albuminuria 78.8% e IFG<60 ml/m 37.6%. El 95.2% asociaba FR. Las siguientes variables estuvieron asociadas a ERC (p<0.05): sexo masculino, edad > 55, HTA, DBT, obesidad, tabaquismo y nivel de educación. En el análisis multivariado mantuvieron significación: edad >55, obesidad, HTA, DBT y nivel de educación. El 21.8% de los hipertensos, el 37.3% con AMHC y el 100% con albuminuria lo desconocían. Conclusión: En esta población ser varón, tener >55 años, HTA, obesidad y/o DBT incrementa el riesgo de desarrollar ERC. Identificamos un alto porcentaje (61.5%) de individuos con FR y ERC. La detección precoz de FR y su tratamiento reducirían significativamente la incidencia y progresión de la ERC. Encontramos una frecuencia de ERC y albuminuria similar a otros reportes, lo cual contribuye al conocimiento de esta enfermedad y su prevalencia en Argentina(AU)

Introduction: Chronic kidney disease (CKD) in adults is a common condition and a major public health issue worldwide. There has been related to a high risk of End Stage Renal Disease (ESRD), cardiovascular disease and death. Given the increasing incidence of CKD and the availability of effective therapeutic measures, is of vital importance perform early detection of risk factors (RF), in order to delay or prevent progression to ESRD. The optimal cost-effective strategy seems to be an investigation aimed at patients with one or more risk factors for CKD. In order to detect early indicators of CKD and associated risk factors, we conducted a study in an adult population. Methods: In a cross-sectional study was evaluated BP, BMI, blood glucose, serum creatinine and albumin/creatinine ratio in urine sample in 608 people> 18 years. Participants were classified for stages of CKD according to the presence of albuminuria and / or estimated glomerular filtration rate (MDRD4, CKD-EPI and CG). For statistical analysis (Stata 11.0) we used FisherÆs exact test, Ttest and Cox regression to explore the association between variables. Effect measure RR and 95% CI, was considered significant when P <0.05. Results: Mean age 54.8 ± 15.4 years, 72% were females. 61.5% had one or more CKD RF.Presence of CKD RF : age> 55 years 52.8%, hypertension 39.3% obesity 36.8%, carbohydrate metabolism disorders (CHMD)21.2%, diabetes: 14.1% (DBT), smoking 12.31%, albuminuria 11%. CKD was found in 14% of participants, 40% were male, albuminuria in 78.8% and GFR <60 ml/m in 37.6%. The 95.2% of participants with CKD had RF. The following variables were associated with ERC (p <0.05): male gender, age> 55, hypertension, diabetes, obesity, smoking and educational level. In multivariate analysis remained significant: age> 55, obesity, hypertension, diabetes and educational level. The 21.8% of hypertensive patients, 37.3% of those with CHMD and 100% with albuminuria did not know that condition. Conclusion: In this population to be a male, to have> 55 years, hypertension, obesity and diabetes it increases the risk of developing CKD. We identified a high percentage (61.5%) of individuals with RF and ERC. The implementation of campaigns for early detection of RF and treatment would reduce the incidence and progression of CKD. We found a frequency of CKD and albuminuria similar to others international reports contributing to the understanding of this disease and its prevalence in Argentina.(AU)