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Background. Sympathetic outflow may be capable of selectively increasing or decreasing glomerular capillary pressure and hence glomerular filtration rate (GFR) by differentially activating separate populations of renal nerves. Sympathetic outflow to the kidney is regulated by major cortical, brainstem and medullary areas. The purpose of this study is to find out the relationship between GFR and HRV/EEG parameters as markers of the neural regulation of the kidney. Materials and Methods. The object of observations were 10 men aged 37-69 years without clinical diagnosis tested twice with 7-days interval. The rate of glomerular filtration was calculated according to endogenous creatinine clearance and the Cockcroft & Gault formula. The state of the autonomic nervous system was assessed by the HRV method. Simultaneosly qEEG recorded. Results. For the sample as a whole, a weak (r=0.396; p>0.05) correlation was found between HRV-marker of sympathetic tone and GFR. However, two clusters of individuals can be distinguished: with a strong correlation (r=0.852; n=12) and its complete absence (n=8). The qEEG method revealed neural structures generating delta and theta rhythms that upregulate GFR, and generating beta rhythm that downregulate GFR. The regression model, which includes 16 EEG parameters, allows estimating GFR with a standard error of 3,4 mL/min. Conclusion. Glomerular filtration rate is subject to the modulatory regulatory influence of the nervous system and can be estimated with high accuracy by EEG parameters.

This study examined 37 patients with hepatitis and cirrhosis of the liver and 30 healthy individuals, assessing liver function indicators and renal function under conditions of daily diuresis and after a load of drinking water and a 0.5% sodium chloride solution, at 0.5% of body weight. The study showed that hepatitis and cirrhosis of the liver lead to signs of hepatorenal syndrome development, particularly in patients with cirrhosis, primarily manifested by a reduction in glomerular filtration rate (GFR). The extent of reduction correlated with the severity of liver damage. Simultaneously, it was independent of blood pressure, plasma protein, and renal sodium exchange mechanisms. The primary dysfunction in hepatorenal syndrome was determined to be a reduction in GFR, evidenced by the rise in creatinine concentration, although urea increased only in cirrhosis, requiring further explanation. The results showed that liver diseases, especially cirrhosis, can lead to kidney problems, mainly by reducing the kidney's ability to filter blood, which was shown by higher creatinine levels in the blood.

Background. Existing methods for assessing glomerular filtration rate (GF) are invasive. Therefore, we set ourselves the goal of evaluating the rate of glomerular filtration by a non-invasive method. Materials and Methods. The object of observations were 10 men aged 37-69 years without clinical diagnosis tested twice with 7-days interval. The rate of glomerular filtration was calculated according to endogenous creatinine clearance and the Cockcroft & Gault formula. Systolic and diastolic blood pressure was measured three times in a row. The state of the autonomic nervous system was assessed by the HRV method. Results. We confirmed the significant correlation of GF with age and weight. The screening revealed a significant correlation of GF with a number of blood pressure and HRV parameters. If in the classic formula we replace creatinineemia with systolic blood pressure and HRV-markers of sympathetic tone, we get a formula for estimating the GF with a standard error of 10,9 mL/min vs 2,7 mL/min, but without blood sampling. The regression model, which includes HRV and blood pressure parameters, as well as urinary creatinine concentration, allows estimating GF with a standard error of 12 mL/min. Conclusion. The balneotherapy has a significant effect not only on blood creatinine level, but also on HRV and blood pressure parameters, and even more pronounced. Therefore, the estimation of GF based only on the Cockcroft & Gault formula is at least not much more accurate than the one proposed by us, besides, our method is completely non-invasive.

Resumen: Antecedentes: La búsqueda de biomarcadores tempranos de enfermedad renal diabética (ERD) en pacientes con diabetes mellitus tipo 2 (DMT2), como los marcadores genéticos para identificar pacientes vulnerables de la enfermedad, incluso antes de la presencia de una disminución de la estimación de tasa de filtrado glomerular (TFGe) o presencia de microalbuminuria ha cobrado importancia en los últimos años.El polimorfismo rs5186 (A1166C) presente en el gen receptor tipo 1 de la angiotensina II (AGTR1) ha sido asociado a distintos efectos del riesgo de daño renal que suelen estar presentes en pacientes con diabetes mellitus (DM). Se ha descrito que el rs5186 podría influir en la estabilidad de las proteínas que conforman al receptor de la angiotensina II tipo 1 (AT1) alterando su actividad, por lo que podría ser considerado como un factor de riesgo a enfermedad renal crónica (ERC) caracterizada por una disminución progresiva de la TFG. Sin embargo, la asociación del polimorfismo rs5186 del gen AGTR1 con ERD en pacientes con DMT2 ha sido controversial, no concluyente, incluso nula. Las controversias podrían ser por los estudios de asociación y estimación del riesgo del rs5186 previamente reportados incluyen distintos fenotipos clínicos considerados como inductores y potenciadores de ERC, además, los tamaños de las muestras analizadas en pacientes con DMT2 eran pequeñas y no tenían un control estricto en su inclusión, careciendo incluso de marcadores bioquímicos o estadificación KDOQI que han dificultado su análisis. Objetivo: Determinar la asociación del rs5186 del gen AGTR1 con la disminución de TFGe considerada como riesgo al desarrollo de ERD en pacientes con DMT2. Material y métodos: Se analizaron 297 pacientes con DMT2 no emparentados, divididos en 221 controles (KDOQI 1) y 76 casos (KDOQI 2). Se determinaron parámetros de presión arterial, antropometría y bioquímicos. El genotipado del rs5186 del gen AGTR1 se realizó por PCR en tiempo real con uso de sondas TaqMan. Se determinaron frecuencias alélicas, genotípicas y equilibrio de Hardy-Weinberg. El análisis del comportamiento de los datos se determinó con Shapiro-Wilk, la comparación de las variables por t de Student para variables continuas, y X2 para variables categóricas, se usó prueba ANOVA para comparación de medias de más de dos grupos. El efecto del rs5186 a disminución de TFGe se realizó por distintos modelos de herencia ajustados por variables de riesgo a ERD. Se consideró un valor de p < 0,05 como estadísticamente significativo. Se utilizó el software Statistical Package STATA v11. Resultados: Los modelos dominante y sobredominante mostraron un riesgo a la disminución de la TFGe de 1,89 (1,05-3,39, p = 0,031) y 2,01 (1,08-3,73, p = 0,023) en pacientes con DMT2. El riesgo aumentó a 2,54 (1,10-5,89) en el modelo sobredominante en mujeres. Conclusión: En la práctica clínica, la mayoría de las nefropatías progresan lentamente hacia la pérdida definitiva de la función renal, cursando incluso asintomáticas. El presente estudio es el primero en reportar una contribución del rs5186 del gen AGTR1 con una disminución de la TFGe y podría ser considerado como un riesgo a ERD en pacientes con DMT2. Abstract: Background: Early biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years.The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination. Objective: The aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. Methods: We analyzed 297 not related patients with T2DM, divided into 221 controls (KDOQI 1) and 76 cases (KDOQI 2). Arterial pressure, anthropometric and biochemical parameters were measured. rs5186 of AGTR1 genotyping was performed by TaqMan assay real-time PCR method. Allele and genotype frequencies, and Hardy-Weinberg equilibrium were measured. Normality test for data distribution was analyzed by Shapiro-Wilk test, variable comparison by Student's t-test for continuous variables, and Chi-squared test for categorical variables; ANOVA test was used for mean comparison of more than two groups. Effect of rs5186 to DKD was estimated by multiple heritability adjustment models for risk variables of DKD. Statistical significance was indicated by p < 0.05. Data was analyzed using Statistical Package STATA v11 software. Results: Dominant and Over-dominant models showed a likelihood ratio to GFR depletion of 1.89 (1.05-3.39, p = 0.031) and 2.01 (1.08-3.73, p = 0.023) in patients with T2DM. Risk factor increased to 2.54 (1.10-5.89) in women in Over-dominant model. Conclusión: In clinical practice, most of nephropathies progress at a slow pace into a total breakdown of renal function, even asymptomatic. This is the first study, reporting that rs5186 polymorphism of AGTR1 gene contribution to GFR depletion, and this could be evaluated as a predisposing factor for DKD in patients with T2DM.

Objectives. To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods. This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results. The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36–4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16–9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60–90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions. Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

Background: Chronic Kidney Disease (CKD) is a global public health problem with increasing prevalence and a substantial burden on healthcare systems. The characteristics of rapid progressors and factors that may predict accelerated CKD progression require further exploration, especially since there are no published studies about this topic in Colombia. Purpose: To identify the clinical and sociodemographic factors associated with the rapid progression of CKD in a large cohort of Colombian patients. Methods: This retrospective observational study included two cohorts of G1 to G4 stage CKD patients without dialysis from the Colombian North Coast. Follow-up was conducted for 18 months (n=14,420) and 24 months (n=10,042). Patients were divided into rapid progressors and stable progressors based on the glomerular filtration rate (GFR) slope 5 mL/min/1.73m2/year or ?-5 mL/min/1.73 m2/year, respectively. Results: 37.68% of the cohort was classified as rapid progressors at 24 months and 28.41% at 18 months. An R2=0.77 was found in both cohorts for GFR measurements, indicating a linear trend toward loss. Furthermore, accelerated progression was observed in younger patients and those with higher diastolic blood pressure values. Conclusion: In two large cohorts of renal patients, approximately 4 out of 10 patients were classified as rapid progressors at 24 months of follow-up and 3 out of 10 at 18 months of follow-up. It is important to identify patients at higher risk of accelerated CKD progression in the short term to provide them with personalized and effective care.

Resumen: La enfermedad renal crónica (ERC) es un importante problema de salud pública a nivel mundial afectando a más del 10% de la población española. Se asocia a elevada comorbilidad, mal pronóstico, así como a un gran consumo de recursos en el sistema sanitario. Desde la publicación del último documento de consenso sobre ERC publicado hace siete años, han sido escasas las evidencias y los ensayos clínicos que hayan mostrado nuevas estrategias en el diagnóstico y tratamiento de la ERC, con excepción de los nuevos ensayos en la enfermedad renal diabética. Esta situación ha condicionado que no se hayan actualizado las guías internacionales específicas de ERC. Esta rigidez y actitud conservadora de las guías no debe impedir la publicación de actualizaciones en el conocimiento en algunos aspectos, que pueden ser clave en la detección y manejo del paciente con ERC. En este documento, elaborado en conjunto por diez sociedades científicas, se muestra una actualización sobre conceptos, aclaraciones, criterios diagnósticos, estrategias de remisión y nuevas opciones terapéuticas.Se han revisado las evidencias y los principales estudios publicados en estos aspectos de la ERC, considerándose más bien un documento de información sobre esta patología. El documento incluye una actualización sobre la detección de la ERC, factores de riesgo, cribado, definición de progresión renal, actualización en los criterios de remisión con nuevas sugerencias en la población anciana, monitorización y estrategias de prevención de la ERC, manejo de comorbilidades asociadas, especialmente en diabetes mellitus, funciones del médico de Atención Primaria en el manejo de la ERC y qué no hacer en Nefrología.El objetivo del documento es que sirva de ayuda en el manejo multidisciplinar del paciente con ERC basado en las recomendaciones y conocimientos actuales. Abstract: Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific societies, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.

Objective: To analyze the prevalence of hyperparathyroidism in patients treated with zoledronic acid (ZA) or denosumab, its relationship with other parameters and how it affects on bone mineral density (BMD) evolution., Methods: Retrospective observational study in patients with osteoporosis or osteopenia and high risk of fracture, who have received denosumab or ZA for at least two years. Patients diagnosed with hyperparathyroidism or glomerular filtration rate <30ml/min at baseline visit were excluded from the study., Results: Ninety patients (ZA: 54.44%) were included. 18.36% of ZA-treated patients had elevated PTH levels at some time compared to 36.58% denosumab-treated patients (p>0.05). Patients with persistently elevated PTH were 6.13% in the AZ group and 19.51% in the denosumab group (p<0.04). We found a statistically significant inverse association between elevated PTH levels, glomerular filtration rate (p=0.007), and albumin-corrected calcium (p <0.001). We did not find an association between hyperparathyroidism and BMD evolution., Conclusions: A high incidence of hyperparathyroidism was observed in patients treated with AZ and especially denosumab. Hyperparathyroidism correlated inversely with glomerular filtration rate and albumin-corrected calcium. Elevated PTH does not appear to affect short-term bone mineral density evolution., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: We are assisting to an increase in survival rates among individuals with cystic fibrosis (CF). Until now, renal involvement was a minority issue, but with the rise in life expectancy, we will likely see an increase in its prevalence. Our main objective was to assess renal function in CF and study risk factors associated with its deterioration., Methods: A cross-sectional, retrospective study was conducted, including adults with CF. Clinical, respiratory function, microbiological, blood and urine analysis, and major chronic treatments received were collected., Results: Eighty nine patients with a mean age of 35±12 years were analyzed. Mean serum creatinine levels were 0.8±0.2mg/dL. 10.6% had a glomerular filtration rate less than 90mL/min/1.73m 2 . No patient showed albuminuria. In multivariate model, only age was an independent risk factor for reduced glomerular filtration (OR: 0.344; 95%CI: 0.004-0.017; P=.002)., Conclusions: 11% of CF adults show decreased glomerular filtration, with age being the sole independent risk factor. Vigilance for this uncommon condition is crucial., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: Among all patients with hypertension, those with resistant hypertension (RH) have the highest rates of subclinical organ damage (SOD). The prevalence of obstructive sleep apnea (OSA) is high in RH patients, and it could contribute to SOD. We aimed to investigate how OSA and its treatment are related to SOD in a large cohort of RH patients., Methods: This is an ancillary analysis to the SARAH study, a multicentre observational cohort aiming to evaluate the impact of OSA on RH. Individuals with RH who were undergoing a sleep study and have information on at least one of the SOD variables (vascular, cardiac or renal damage) were selected. Patients were followed-up for three years., Results: In total, 503 subjects were included. The participants were predominantly male, obese, and the median (IQR) apnea-hypopnea index (AHI) was 15.5 (7.90-31.5)events/h. No differences in the presence of vascular or cardiac damage were observed between OSA and non-OSA patients. A lower estimated glomerular filtration rate (eGFR) was observed in participants with OSA than in those without OSA, with an adjusted effect of -8.69mL/min/1.73m 2 (-13.59, -3.79; p value<0.001). Kidney damage was also greater in subjects with OSA, with an adjusted OR (95% CI) of 1.77 (1.09, 2.87; p value=0.02). The eGFR showed a linear dose-response relationship with OSA severity. Among patients treated with CPAP, lower eGFR values were observed in noncompliant subjects., Conclusions: OSA could contribute to worsening renal function in patients with RH. No compliance with CPAP was associated with lower values of eGFR., (Copyright © 2024 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Resumen: Introducción: Las consecuencias a largo plazo asociadas con la donación renal resultan controvertidas. La tasa de filtración glomerular (TFG) pre y posdonación resulta determinante en la ponderación del riesgo renal y cardiovascular. En Latinoamérica, existe escasa experiencia sobre la evaluación de la función renal por técnicas de medición del filtrado glomerular en donantes renales. Las ecuaciones MDRD y la CKD-EPI son consideradas alternativas razonables. El objetivo del trabajo fue evaluar el rendimiento de las ecuaciones MDRD y CKD-EPI en la dinámica del filtrado glomerular posnefrectomía en donantes renales. Materiales y métodos: Estudio prospectivo de cohorte con medición (mTFG) y estimación de la tasa de filtrado glomerular (eTFG) en 189 donantes renales con nefrectomía entre 2007 y 2016 en el Hospital Privado Universitario de Córdoba, Argentina. Las TFG se evaluaron, previo y posterior a la nefrectomía, mediante el aclaramiento de iotalamato determinado por cromatografía líquida de alta eficacia y por las ecuaciones para estimación de TFG: MDRD y CKD-EPI. Se constituyeron 2 grupos de estudio: grupo 1 (n = 107) con un tiempo de evaluación posterior a la estabilización de la TFG posdonación (3 meses) hasta los 5 años y grupo 2 (n = 82) con un tiempo entre 5 y 10 años posdonación. Resultados: El valor de compensación renal fue del 61,9% (52,0-71,1%) y 75,6% (64,9-84,4%) para los grupos 1 (n = 107) y 2 (n = 82), respectivamente. La ecuación MDRD subestimó la TFG en el 3,2% (90 ml/min/1,73 m2) y el 38,6% (60 ml/min/1,73 m2) respecto a la mTFG y la CKD-EPI subestimó en un 2,6% (90 ml/min/1,73 m2) y un 13,8% (60 ml/min/1,73 m2). Se evaluó el rendimiento diagnóstico con curva ROC (mTFG

Introduction. At present, it is obvious that the prognosis for the life of patients with essential hypertension, according to the cardiovascular continuum, is clearly determined primarily by the involvement in the pathological process of target organs and the severity of their structural and functional changes.The aim of the study is to identify the clinical-diagnostic and prognostic value of B2-MGU as a marker of kidney damage in essential hypertension.Materials and methods. To achieve this goal, 46 patients with essential hypertension (45.65% women and 54.35% men) aged from 28 to 71 years (mean age was 51.88 ± 2.17 years), I-II stage of the disease with level of hypertension I-III degree, varying degrees of risk, who did not receive systematic adequate antihypertensive therapy and in which as a result of comprehensive clinical, laboratory and instrumental studies there were no evidence of clinically significant chronic kidney disease. The control group consisted of 17 healthy individuals.Results. In patients with essential hypertension is forming hypertensive nephropathy, which is characterized by statistically significant excessive excretion of beta-2-microglobulin in the urine compared with almost healthy individuals. In patients with increased excretion of beta-2-microglobulin violations of intrarenal hemodynamics were registered significantly more often, violations of functional renal reserve, violations of vascular resistance of renal vessels, in a significantly higher percentage there were pathological changes in circadian rhythm of blood pressure and renal filtration function, the prevalence of concentric and eccentric hypertrophy, proteinuria, which indicates an important clinical, diagnostic and prognostic value of hyper-beta-2-microglobulinuria.Conclusions. The indicator beta-2-microglobulinuria can be used as an adequate marker of hypertensive nephropathy, as having high sensitivity, specificity, positive and negative prognosis.

Resumen: Introducción: En la práctica diaria es necesario disponer de métodos rápidos, sencillos y accesibles para valorar adecuadamente la función renal. Los objetivos fueron: 1) Cuantificar la relación y concordancia de la tasa de filtración glomerular (FG) calculada mediante el aclaramiento de creatinina en orina de 24 h (CCr) y la fórmula de Schwartz (FS) original y la FS modificada. 2) Relacionar la eliminación urinaria de sustancias que dependen del volumen de orina expulsada en una unidad de tiempo con otros parámetros que se calculan midiendo la concentración de estas sustancias en sangre y en orina. Material y métodos: El estudio incluyó 401 niños sanos de 3-14 años (187 hombres y 214 mujeres). El análisis entre las variables se realizó mediante el coeficiente de correlación de Pearson y el coeficiente de concordancia intraclase (CCI) tipo consistencia. Resultados: La correlación entre los valores de CCr y FS original (medición de creatinina no estandarizada) fue r = 0,58 (p

Introduction: The approach to the renal condition of the elderly requires diagnostic tools for this age group, which allow discerning its renal condition between chronicity and senescence. The objective of this research was to analyze whether the HUGE scale is a companion tool to determine the existence of chronic kidney disease in older adult patients seen in outpatient clinics. Methods: This observational, analytical and cross-sectional study was carried out in the nephrology outpatient clinic of the Specialty Hospital of the Armed Forces No. 1 in 2015-2018. Results: We included 285 patients. The prevalence of chronic kidney disease was higher in people older than 75 years (60.7%). With the HUGE formula, a lower proportion of chronic kidney disease was established in 37% of men and 60% of women (P = 0.002) than in the CKD-EPI formula (83% and 89%, respectively). The specificity achieved by the HUGE formula was higher than the CKD-EPI and MDRD formulas (97% vs. 80% vs. 79%, respectively), having the highest discriminative capacity (NPV 70%). Hyperuricemia and diabetes mellitus are associated with the development of chronic kidney disease. Conclusions: In this research, it was shown that the HUGE formula helps discern those older adults with decreased glomerular filtration due to senescent aging in those with kidney disease In addition, The use of the HUGE formula is recommended as a complementary tool in the approach to chronic kidney disease in older adults.

Objectives: Cystatin C is increasingly used as a marker of renal function as a complement to serum creatinine and glomerular filtration rate (GFR). We have assessed its efficacy as a predictor of mortality in a group of patients with increased cystatin C but GFR> 60mL/min., Design and Methods: We included 608 patients, 65.9% male, 34.6% had diabetes mellitus. The mean age was 58.5±14.5 years and a mean GFR of 64.1±33.5mL/min. Patients were divided into 3 groups: CONTROL (normal cystatin C and GFR> 60mL/min, age 53.3±12.8years, GFR 96.6±22.4mL/min,n=193), INCREASED CYSTATIN (cystatin C>1.03mg/l and GFR>60mL/min, age 58.9±13,1years, GFR 72.2±10.4mL/min, n=40) and CKD (chronic kidney disease, increased cystatin C and GFR <60mL/min, age 61.4±14.8years, GFR 36.0±12.7mL/min, n=160). The relationship with overall mortality was analyzed using the Kaplan-Meier method., Results: Mean cystatin C was 0.75±0.13 versus 1.79±0.54 in CKD group and 1.14±0.14mg/l, p <0.001). In CONTROL group survival was 93.9% at 5y, compared to 78.8% in the ERC group and 82.3% in the INCREASED CYSTATIN group (p <0.001) Five-year survival before renal replacement therapy was also different for the ERC group (73%, p <0.001 Log Rank) but not between the other two groups (CONTROL 99.0%, INCREASED CYSTATIN 94.3% p=0.08)., Conclusions: Increased plasmatic levels of cystatin C in patients with GFR> 60mL/min was a predictor of increased mortality but not of progression to end-stage renal failure. These results confirm the interest of routinely measuring cystatin C., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance., Material and Methods: Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m 2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m 2 ., Results: Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415)., Conclusion: Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment., (Copyright © 2024 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: to analyze the factors associated to chronic kidney disease in people living with HIV (PLHIV). Method: a paired case-control study (4 controls for each case) carried out in a specialized care service in the Southeastern of Brazil, by analyzing PLHIV medical records. The sample consisted of 85 participants, corresponding to 17 cases and 68 controls. Pearson’s chi-square test (Χ2) and Fisher’s exact test, logistic regression, Odds Ratio (OR), 95% Confidence Interval (CI) and p

Introduction: Low estimated Glomerular filtration rate (eGFR) is associated with functional decline. Little is known on that association in hospitalized elderly. Objective: Determine if low eGFR is associated with functional decline. Methods: Prospective cohort study that included 1826 patients 60 years and older hospitalized in a Geriatric Acute Unit, admitted between January 2012 and August 2015. The outcome was functional status assessed four times by the Barthel Index (BI). Kidney function was estimated by MDRD-4 IDMS and was grouped into four categories according to eGFR (normal ≥90, mild 60-89, moderate 59-30, severe

Introduction and Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF)., Methods: This is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO 2 trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms., Results: A total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m 2 and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides., Conclusions: In patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Chronic kidney disease (CKD) is a global health problem and affects approximately 15.1% of the general population in Spain (IBERICAN and ENRCA studies), although most of the literature agrees that there is an underdiagnosis that would further increase this prevalence. This article from the CKD monograph aims to summarize the main consensus guidelines for the management of CKD, highlighting the most important and novel aspects, as well as recently updated terminology and concepts. Sections addressing specific populations and prevention strategies are also included. As the family doctor (MAP) plays a fundamental role in the detection of CKD, recommendations on the multidisciplinary approach to CKD are collected., (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objetivo: conocer como afecta la circulación extracorpórea la función renal tomando como marcador la alteración del filtrado glomerular. Material y método: se realizó un estudio prospectivo, analítico y observacional en 63 pacientes pediátricos sometidos a cirugía cardiaca electiva con circulación extracorpórea en el Cardiocentro Pediátrico «William Soler» entre octubre de 2009 y abril de 2010. Se calcularon las variaciones del filtrado glomerular durante la circulación extracorpórea por el método de Schwartz y se extrajeron muestras de sangre antes y después de la circulación extracorpórea para determinar las cifras de creatinina en el plasma. Los datos se procesaron con el paquete estadístico SPSS versión 11.5.1. Los resultados se expresaron en forma de media, desviación estándar y por cientos. Se consideró que existió diferencia o asociación significativa si la probabilidad asociada al test aplicado era menor que 0,05 (pObjective: know how extracorporeal circulation affects renal function taking as marker the impairment of the glomerular filtration rate. Material and Method: we performed a prospective analytical observational study in 63 pediatric patients that underwent elective cardiac surgery with extracorporeal circulation in the Pediatric Cardiac Center ¨William Soler¨ between october 2009 and april 2010. Variations of glomerular filtration rate during extracorporeal circulation were calculated by the Schwartz method and blood samples were taken to determine plasma creatinine values before and after extracorporeal circulation. Data were processed with the SPSS statistical package version 11.5.1. Results were expressed as mean, standard deviation and percentage. We considered that difference or significant association existed if the probability associated to the applied test was less than 0,05 (p

Introduction: Congenital nephrourological abnormalities (CAKUT) are a particularly relevant group of diseases due to their high prevalence and the fact they are the main cause of chronic renal disease (CRD) in the pediatric population. Our objective was to determine the characteristics and prevalence of CAKUT in our setting, while identifying the factors associated with the occurrence of renal damage., Materials and Methods: A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric Nephrology Department of a third-level hospital from January 1 to December 31, 2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRD were searched for., Results: The study involved 685 patients with 827 kidney units affected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% were male, and the mean follow-up period after diagnosis was 9.95 ± 5.09 years. 58.8% were non-obstructive dilations, followed by renal dysplasia, obstructive dilations, and number and position abnormalities. The most frequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses were prenatal. 172 patients underwent surgery. The initially chosen treatment for VUR was endourological. Overall re-intervention rate was 20%. Of the total number of patients, glomerular filtration rate was analyzed in 383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilaterality, and proteinuria were risk factors associated with CRD., Conclusions: Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated with CRD helps to individualize the clinical follow-up of these patients, thus customizing diagnostic tests and healthcare resources.

Drug dosing according to renal function is a globally accepted practice whose main purpose is to avoid drug associated toxicity when renal clearance is decreased. Renal function is usually estimated based on creatinine clearance or an estimated glomerular filtration rate (GFR) obtained from one of the available equations based on serum biomarkers. In this review we will analyze the different available methods to adjust the dose of drugs based on GFR, with emphasis on their comparative performance for this objective. Based on this, we will provide some recommendations for drug dosing in chronic and acute renal dysfunction.

Background: There is no a unified opinion in the treatment of IgA nephropathy. This prospective cohort study was to explore the effectiveness and safety of tacrolimus for treatment of IgA (Immunoglobulin A) nephropathy patients., Methods: In this study, we assigned 50 patients with biopsy-proven IgA nephropathy in a 1:1.5 ratio to receive oral tacrolimus or full-dose glucocorticoid for 6 months. All the patients had 24-h urine protein excretion≥2.0g/24h and estimated glomerular filtration rate≥50mL/min/1.73m 2 . Primary endpoint was rate of complete remission., Results: After 6 months of treatment, seven participants achieved complete remission in the tacrolimus group and twelve participants in the glucocorticoid group, the complete remission rate was 35% and 40%, respectively. There were not significantly differences between two groups (P=0.7). However, the serum creatinine level from baseline was an increase of 13±13.5μmol/L in the tacrolimus group and a decrease of 8.2±20μmol/L in the glucocorticoid group. When patients stopped taking tacrolimus for 3 months, creatinine level can almost fall to normal level. Thus, patients with renal insufficiency have a high incidence in the tacrolimus group., Conclusions: Tacrolimus was noninferior to full-dose glucocorticoid in inducing proteinuria remission at 6 months. This suggested that those IgA nephropathy patients who are unwilling to full-dose glucocorticoid could consider tacrolimus, but need to pay attention to the impact on renal function., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Background: Parathormone (PTH) is a component of the Mineral Metabolism (MM) system that has been shown recently to add prognostic value in pts. with stable coronary artery disease (SCAD) and average renal function. However, the influence of renal function on the prognostic role of PTH in pts. with SCAD has not been shown yet., Purpose: To assess the influence of estimated glomerular filtration rate (eGFR) on the prognostic role of PTH and other MM markers in pts. with SCAD., Methods: We analyzed the prognostic value of MM markers (PTH, klotho, phosphate, calcidiol [25-hydroxyvitamin D], and fibroblast growth factor-23 [FGF23]) in 964 pts. with SCAD and eGFR<60ml/min/1.73 m 2 (LGFR) vs pts. with eGFR≥60ml/min/1.73 m 2 (HGFR) included in five hospitals of Madrid. The main outcome was the combination of death with ischemic events (any acute coronary syndrome, ischemic stroke or transient ischemic attack). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI)., Results: Age was 60.0 (52.0-72.0) years, 76.2% of patients were men, and eGFR was 80.4 (65.3-93.1) ml/min/1,73 m 2 . Median follow-up was 5.39 (2.81-6.92) years. There were 790 pts. with HGFR and 174 with LGFR. In HGFR pts., predictors of ischemic events or death were plasma levels of calcidiol [HR=0.023 (0.94-0.99) p=0.023], FGF23 [HR=1.00 (1.00-1.003) p=0.036], non-HDL cholesterol [HR=1.01 (1.00-1.01) p=0.026] and high sensitivity troponin I [HR=5.12 (1.67-15.59) p=0.004], along with age [HR=1.03 (1.01-1.05) p=0.01], treatment with statins [HR=0.36 (0.19-0.68) p=0.002], nitrates [HR=1.13 (1.07-2.79) p=0.027], dihydropyridines [HR=1.71 (1.05-2.77) p=0.032], verapamil [HR=5.71 (1.35-24.1) p=0.018], and proton-pump inhibitors [HR=2.23 (1.36-3.68) p= 0.002]. In the LGFR subgroup, predictors of death or ischemic events were PTH plasma levels, [HR=1.01 (1.00-1.01) p=0.005], eGFR [HR=0.96 (0.94-0.99) p=0.004], age [HR=1.06 (1.02-1.10) p=0.003], caucasian race [HR=0.04 (0.004-0.380) p=0.005], and treatment with insulin [HR=2.6 (1.20-5.63) p=0.015]., Conclusions: In pts. with SCAD, PTH is an independent predictor of poor outcomes only in those with eGFR<60ml/min/1.73 m 2 , while in pts. with eGFR≥60ml/min/1.73 m 2 calcidiol and FGF23 become the only components of MM that may predict prognosis. Then, renal function influences the predictive power of MM markers in pts. with SCAD., (Copyright © 2021 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aims: To evaluate the relationship between chronic kidney disease and the patient's cardiovascular risk measured through the incidence of major adverse cardiovascular events in a sample of Spanish population., Design and Methods: The sample consisted of 2,668 subjects. Mean age was 50.6±14.5 years and 54.6% were female. In all, 3.5% of subjects had a glomerular filtration rate (GFR) below 60ml/min and 4.3% a urinary albumin excretion (UAE) above 30mg/g. GFR was estimated from serum creatinine using the CKD-EPI equation. UAE was measured in first morning urine sample as mg/g of creatinine. We examined the multivariable association between the estimated GFR and the risks of cardiovascular events and death. The median follow-up was 81 (75-89) months., Results: In CKD patients the hazard ratio (HR) was 1.36 (95% CI 0.97-1.91) (P=.079) for cardiovascular events and 1.62 (95% CI 0.53-4.91) (P=.396) for cardiovascular mortality. Increased UAE was also associated with higher cardiovascular risk (HR 2.38; 95% CI 1.51-3.74; P<.001) as well as increased cardiovascular mortality (HR 4.78; 95% CI 2.50-9.11; P<.001). For patients with UAE between 30 and 300mg/g HR for cardiovascular events was 2.09 (95% CI 1.34-3.50; P=.005) and 3.80 (95% CI 1.81-7.96; P<.001) for cardiovascular mortality., Conclusions: An independent association was found between reduced GFR and cardiovascular event incidence and mortality. Increased UAE showed a higher prognostic value than decreased GFR. Our findings highlight the clinical and public health importance of routinely measuring UAE., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)