RESUMO
BACKGROUND: Currently, following the new advances in cancer treatments and the increasing prevalence of kidney disease in the population, more kidney biopsies are being performed. The aim of our study is to analyze clinical and histological characteristics of patients with active solid organ malignancy who underwent kidney biopsy. This is a multi-center collaborative retrospective study supported by groups GLOSEN/Onconephrology from the Spanish Society of Nephrology. Clinical, demographical and histological data were collected. RESULTS: A total of 148 patients with cancer who underwent a kidney biopsy from 12 hospitals were included. 64.3% men and mean age of 66.9 years old. The indications for biopsy were acute renal injury (67.1%), proteinuria (17.1%), exacerbated chronic kidney disease (8.2%), and chronic kidney disease (7.5%). Most frequent malignances were lung (29.1%) and abdominal (25%), with 49.7% metastatic cancer. As oncospecific treatment, 28% received chemotherapy, 29.3% immunotherapy, 19.3% specific therapies, and 2.1% conservative treatment. At the time of kidney biopsy, median creatinine was of 2.58 mg/dL [1.81-4.1 (IQ 25-75)], median urine protein-to-creatinine ratio of 700 mg/g [256-2463 (IQ 25-75)] and 53.1% presented hematuria. The most frequent renal biopsy diagnoses were: acute interstitial nephritis (39.9%), acute tubular necrosis (8.8%), IgA nephropathy (7.4%) and membranous nephropathy (6.1%). Median follow-up was 15.2 months [5.7-31.4 (IQ 25-75)]. CONCLUSIONS: There is a new trend in kidney disease and cancer patients in terms of diagnosis and treatment. Acute interstitial nephritis has established itself as the most common kidney injury in patients with cancer who underwent a kidney biopsy. Renal biopsy is a valuable tool for diagnosis, treatment, and prognosis of solid organ cancer patients with kidney damage.
RESUMO
El contexto organizativo para la prestación de cuidados incluye los factoresorganizativos y estructurales que facilitan la práctica profesionalenfermera y tienen un impacto significativo en los resultados de los pacientesy de los centros.Objetivo: analizar el contexto organizativo para la prestación de cuidadosen los hospitales del sistema público de salud.Método: los datos se recogieron en los talleres organizados por laCoordinación de Enfermería del Institut Català de la Salut, empleandoun cuestionario que contenía los elementos del Nursing Work Index-Revised.La estrategia de análisis es eminentemente descriptiva, incluyendotambién la exploración de la correlación entre las subescalas delinstrumento.Resultados: se analizaron 405 cuestionarios. El resultado principal delestudio indica un bajo grado de desarrollo del contexto organizativo enlos hospitales estudiados. Los factores organizativos más desarrolladosson la Autonomía y el Control sobre la práctica enfermera. Losfactores organizativos menos desarrollados incluyen el Reconocimientoprofesional y la Formación. Ninguno de los factores evaluados obtuvouna puntuación sobresaliente.Conclusiones: el Nursing Work Index-Revised es una buena herramientapara efectuar una estimación aproximada del contexto organizativopara la prestación de cuidados. Los gestores deberían hacer unaprofunda reflexión sobre el coste de no considerar los aspectos que facilitanla práctica enfermera en los hospitales
The organisational context for the delivery of care includes organisationaland structural factors that facilitate the professional practice of nursingand have a significant impact on the results for patients and centres.Objective: analyse the organisational context for the delivery of healthcarein public hospitals belonging to the national health system.Method: data were gathered at the workshops organised by the NursingCoordination division of the Catalan Health Institute, utilising aquestionnaire that contained the items from the Nursing Work Index-Revised. The analysis strategy is eminently descriptive, including the explorationof the correlation between the elements subscales.Results: 405 questionnaires were analysed. The main result of thisstudy shows a low degree of development in the organisational contextin the studied hospitals. The most developed organisational factorsare Autonomy and Control on the Nursing Practice. The least developedorganisational factors include Professional Recognition andTraining. None of the studied factors obtained an excellent score.Conclusions: the Nursing Work Index-Revised is a good tool to makea close estimation of the organisational context for the delivery ofhealthcare. Managers should give some serious thought to cost whenother aspects that facilitate nursing practice in hospitals are not considered (AU)
