[Kt calculation as a quality indicator of haemodialysis adequacy]. / Cálculo del Kt como indicador de calidad en el área de adecuación en hemodiálisis.

The haemodialysis dose is a good marker of dialysis adequacy, and we usually monitor it with Kt/V measure. The dialysis dose monitored with Kt allows a better discrimination, detecting a percentage of the patients that perhaps do not get an adequate dose for their gender or body surface area after treatment with a minimum recommended dose of Kt/V. The objective of this study was to evaluate Kt as a clinical indicator referred to dialysis adequacy in the haemodialysis population. The aim was that more than 85% of the patients would achieve the recommended Kt target for their gender (at least 50 litres in men and 45 litres in women), or their body surface area. In each of the patients (mean 129) the Kt mean value was determined for three consecutive dialysis sessions, one every two months, during the follow-up period (14 months). At the beginning, the Kt/V value was on target (> 1.3) in 93.2% of the patients, but only in 58% according to Kt measure for their gender. After 4 months, we observed that 85% of patients' Kt target increased for their gender, but only 68% did if we used the Kt individualised for their body surface area. From month 6 to the end of the follow-up period, more than 85% of patients obtained an adequate Kt for their body surface area (p < 0.001). A significant increase of Kt mean (5.4 litres) was observed at the end of the study (p < 0.001). The usual dialysis prescription parameters were modified increasing blood flow rate (34.14 ml/min, p < 0.001), session effective duration (8.04 minutes, p < 0.001), dialyser surface area (24.1% of patients changed from helixone 1.3 to 1.6 m2, p < 0.001) and haemodialysis modality (56.8% of patients changed from conventional haemodialysis to on-line haemodiafiltration, p < 0.001). We conclude that monitoring dialysis dose with Kt is a good clinical measure of adequacy, and using it as a quality indicator can be done in line with the more demanding quality standards.

[Infrequent manifestations of Henoch-Schonlein purpura]. / Manifestaciones infrecuentes en la púrpura de Schönlein-Henoch.

We review the cases of 148 children with Henoch-Schönlein purpura diagnosed in a period of seventeen years (from 1975 to 1992). Thirteen cases (8.7%) of unusual clinical manifestations were found: testicular affection in six cases (7.6% of the males); IgA nephropathy in four (2.7%); exudative enteropathy in two (1.3%); duodenal syndrome in two; previous abdominal manifestation which led to surgical procedures in one (0.7%) and another case with detachment of the retina. These clinical findings are analyzed and the possibility of unnecessary therapeutic acts is discussed.

[Guide for the prevention of renal diseases during and after childhood]. / Guía para la prevención de las enfermedades renales en y desde la infancia.

Kidney disease Prevention in childhood can be made from three levels. In the first level or Primary Prevention one must prevent kidney disease taking steps for "Kidney Health" promotion: environmental factors, nourishing, sanitary education and preventive pediatrics. Secondary Prevention lies in the correct diagnostic during first years in life and in a suitable treatment of the kidney diseases, especially in children to have a kidney failure risk: obstructive uropathy and vesicoureteral reflux. Tertiary Prevention deals with aggravating factors in an established Kidney chronic failure, and its prevention includes: normoproteic diet, phosphorus restriction, arterial hypertension control and nutritional and pharmacological steps to reduce the hyperlipidemia.