Documento de consenso para la detección y manejo de la enfermedad renal crónica

Abstract

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations.

Cribado y diagnóstico de la enfermedad renal crónica en personas con diabetes mellitus

“…Sin embargo numerosos estudios han demostrado una excelente correlación entre la EUA en 24 horas y el cociente albúmina-creatina en orina matinal puntual recogida después el descanso nocturno [17][18] . La variabilidad de la EUA a lo largo de día es muy elevada y puede ser superior durante el horario diurno (25 %) respecto al horario nocturno 19 , motivo por el cual se ha estandarizado la recogida de orina al levantarse el paciente por la mañana 20 .…”

“…La EUA también puede fluctuar día a día hasta un 40 % 20 , sobre todo en las fases iniciales, por lo que no es infrecuente observar que un paciente con EUA elevada en una determinación se normaliza posteriormente. Por ello, y para realizar un diagnóstico correcto, es necesario disponer de dos determinaciones de EUA patológicas en un intervalo de como mínimo tres meses.…”

Hyponatremia and SARS-CoV-2 infection: A narrative review

“…Although it had appeared that the kidney has no share in hyponatremia development in SARS-CoV-2 infection previously, and most of the main mechanism of hyponatremia was SIADH. [25,26] Recently, it was reported that the kidneys are involved in SARS-CoV-2 -associated hyponatremia. Generally, it seems that there are 3 possible mechanisms that may lead to hyponatremia: excess ADH secretion either due to hypothalamic-pituitary-adrenal axis abnormality and/or ectopic ADH production due to SARS-CoV-2 pneumonia, and fluid plus sodium loss.…”

Approaches by Rhodotorula mucilaginosa from a chronic kidney disease patient for elucidating the pathogenicity profile by this emergent species

“…Nevertheless, despite their importance, invasive Rhodotorula infections are not well explained yet, few is known about the virulence potential of this yeast, and whether the dissemination process depends more of pathogenic merit of the fungus or the patient debility. In fact, CKD has become a serious public health problem, affecting 8 to 16% of the world’s population, it is responsible for high morbidity and mortality and represents a heavy financial burden for public health systems in developing and developed countries [16]. CKD implies in structural and functional renal deficiencies, which result in complex disorders.…”