ABSTRACT
Propósito de la revisión Una extensa literatura describe la cistatina C como un marcador sensible de la morbimortalidad cardiovascular. En esta revisión analizamos las recientes evidencias del papel de la cistatina C como biomarcador para mejorar la estratificación del riesgo de insuficiencia renal incidente y de morbimortalidad cardiovascular, más allá de su papel como medida del filtrado glomerular. Evidencias recientes No existen evidencias consistentes de la superioridad de la cistatina C sobre la creatinina en la estimación del filtrado glomerular. Estudios recientes muestran que la combinación de la cistatina C, la albuminuria y la creatinina mejora la detección y la estratificación del riesgo de muerte, insuficiencia cardiaca, eventos cardiovasculares e insuficiencia renal crónica comparada con el uso único de la creatinina. Resumen La combinación de múltiples marcadores mejora la detección y estratificación del riesgo cardiovascular y renal en pacientes con enfermedad renal crónica. Los estudios presentados en esta revisión representan un cambio hacia la utilización de un «panel renal» en el que la cistatina C desempeña un papel relevante (AU)
Purpose of review There is extensive literature that has described cystatin C as a sensitive marker of cardiovascular morbidity and mortality. In this review, we have analyzed the recent evidence on the role of cystatin C as a biomarker to improve risk stratification of incident renal failure and cardiovascular morbidity-mortality, going beyond its role as a measure of glomerular filtration rate. Recent findings No consistent evidence has been found on the superiority of cystatin C over creatinine in assessing glomerular filtration rate. Recent studies have shown that the combination of cystatin C, creatinine and albuminuria improves detection and risk stratification for death, heart failure, cardiovascular events and chronic kidney disease compared with creatinine alone. Summary The combination of multiple biomarkers improves cardiovascular detection and risk stratification in patients with chronic renal disease. The studies presented in this review represent a shift towards the use of a «renal panel» in which cystatin C plays an important role (AU)
Subject(s)
Humans , Cystatin C/analysis , Glomerular Filtration Rate/physiology , Renal Insufficiency/diagnosis , Cardiovascular Diseases/diagnosis , Biomarkers/analysis , Albuminuria/diagnosis , Creatinine/analysisABSTRACT
AIMS: To study the features of acute renal failure (ARF) in our hospital and to determine prognosis and mortality associated factors. METHODS: Retrospective study of ARF episodes during a two years period (2005-2007). ARF was considered when a sudden rise in serum creatinine concentration was more than 0,5 mg/dl in patients with normal renal function and more than 1 mg/dl in patients with previous mild to moderate chronic renal failure. We analyzed epidemiologic, clinical, laboratories results, therapeutics and prognosis factors. RESULTS: Two hundred and one patients were evaluated (62,7% males; Age= 67,35 16,38 years (63,68%>65 years); Comorbility Index of Charlson 3,49 2,43). 115 episodes presented in patients with previous renal failure. ARF was pre-renal in 52,7%, renal in 34,8% and post-renal in 8,5%. 35,8% of ARF patients had oliguria or anuria. The mean duration of ARF/hospitalization was 22,47 days (22,47 21,83). The percentage of resolved ARF was 70,1%. Mortality was 30,8%. The univariated analysis showed comorbility Index of Charlson, oliguria, low serum albumin and cholesterol, and anemia were significantly associated with mortality (p<0,05). The lineal regression analysis found three factors associated to the mortality rate: Comorbility Index of Charlson, oliguria and low serum cholesterol. Mortality predictive model was carried out. CONCLUSION: Highest basal comorbility of patients, oliguria and malnutrition-inflammation dates are princess prognosis and mortality factors in ARF today A new approach is needed in ARF because this new type/class of population.
Subject(s)
Acute Kidney Injury , Acute Kidney Injury/complications , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , Aged , Female , Humans , Male , Middle Aged , Nephrology , Prognosis , Retrospective StudiesABSTRACT
Objetivo: analizar las características del fracaso renal agudo(FRA) en nuestro centro y determinar su influencia en el pronóstico del mismo y en la mortalidad. Material y métodos: estudio retrospectivo de los episodios de FRA valorados por nuestro Servicio durante un período de dos años (2005-2007). Los criterios de inclusión fueron: elevación de la creatinina sérica0,5 mg/dl en pacientes con función renal previa normal y de 1 mg/dl en aquéllos con insuficiencia renal crónica previa. Se registraron factores epidemiológicos, clínicos, analíticos, terapéuticos y pronósticos. Resultados: valoramos 201 episodios de FRA. El 62,7% 16,38 (63,68% ±) eran varones. La edad media fue de 67,35 >65 años). El índice de comorbilidad de Charlson (ICCH) mostraba unos valores de 3,49 ± 2,43. Ciento quince pacientes tenían IRC previa al ingreso. El 52,7% fueron prerrenales, el 34,8% parenquimatosos y el 8,5% obstructivos. El 35,8%cursaron con oligoanuria. El tiempo medio de ingreso fue de22,47 ± 21,3 días. El 70,1% de los pacientes recuperaron función renal al alta. La mortalidad fue del 30,8%. En el estudio univariante se asociaron significativamente con la mortalidad(p <0,05): ICCH, oliguria, hipoalbuminemia, niveles bajos de colesterol y anemia. En el análisis de regresión lineal múltiple, los factores que mejor la explicaban fueron: ICCH, oliguria y niveles bajos de colesterol. Realizamos un modelo predictivo de mortalidad con estos factores. Conclusión: la mayor complejidad clínica basal de los pacientes, el desarrollo de oliguria y la presencia de datos de malnutrición-inflamación aparecen como los principales factores pronósticos y de mortalidad en el FRA que valoramos los nefrólogos en el momento actual (AU)
Aims: To study the features of acute renal failure (ARF) in our hospital and to determine prognosis and mortality associated factors. Methods: This is a retrospective study analyzing the ARF episodes observed in our center during a two years period (2005-2007). ARF was considered when a sudden rise in serum creatinine concentration was more than0, 5 mg/dl in patients with normal renal function and more than 1 mg/dl in patients with previous mild to moderate chronic renal failure. We analyzed epidemiologic, clinical, laboratories results, therapeutics and prognosis factors. Results: Two hundred and one patients were evaluated (62,7% males; Age= 67,35 ± 16,38 years (63,68% >65 años); Comorbility Index of Charlson was 3,49 ± 2,43). 115 ARF episodes occurred in patients with previous renal failure. ARF was pre-renal in 52, 7%, renal in 34,8% and post-renal in8,5%. 35,8% of ARF patients had oliguria or anuria. The mean duration of ARF/hospitalization was 22,47 days (22,47± 21,83). The percentage of resolved ARF was 70, 1%.Mortality was 30, 8%. The univariate analysis showed that comorbility Index of Charlson, oliguria, low serum albumin, low cholesterol and anemia were significantly associated with mortality (p <0,05). However, only Charlson Index,oliguria and low serum cholesterol were independent predictors of mortality in multivariate analysis. Mortality predictive model was carried out. Conclusion: Highest basal comorbility of patients, oliguria and malnutrition inflamation dates are independent predictors of mortality in patients with acute renal failure (AU)
