Search

Resumen: Antecedentes y objetivo: Valorar la presión generada por una pinza ajustable en fístulas arteriovenosas (FAV) durante el proceso de hemostasia y compararla con la generada por la compresión manual. Evaluar las variaciones de la compresión manual durante el proceso de hemostasia. Métodos: Se analizaron los datos de 51 sesiones de hemodiálisis de 15 pacientes. Se utilizó la presión intraacceso como indicador indirecto de la presión generada por ambos métodos sobre la FAV. La misma se registró antes de retirar la aguja venosa (PBasal), tras retirar la aguja y colocar la pinza (P1), tras ajustar la pinza (P2), al comenzar el paciente a ejercer compresión manual (M0), a los 3 min del inicio de la presión manual (M3) y a los 6 min del inicio de la presión manual (M6). Resultados: La presión intraacceso fue menor al aplicar la pinza y ajustarla (P2) que al aplicar presión manual (M0), con una diferencia media de −9,43 mmHg (variación −18,57%, IC 95%: −14,09 a −4,77 mmHg, p

Chronic kidney disease is common in people >65years of age. The development and improvement of dialysis techniques has allowed its generalisation to the entire population, when there is a situation of terminal nephropathy, without limit of use due to chronological age. Decision making in elderly patients with advanced chronic kidney disease is complex: in addition to renal parameters, both comorbidity and the presence of geriatric syndromes must be considered. This review addresses the management of information, the decision making of different treatment modalities that can be offered to these patients, and the time of initiation and/or withdrawal of dialysis.

Resumen La enfermedad renal cronica es frecuente en personas > 65 anos. El desarrollo y el perfeccionamiento de tecnicas de dialisis ha permitido su generalizacion a toda la poblacion cuando se llega a una situacion de nefropatia terminal, sin existir limite de uso por la edad cronologica. La toma de decisiones en ancianos con enfermedad renal cronica avanzada es compleja: ademas de parametros renales se debe considerar la comorbilidad, asi como la presencia de sindromes geriatricos. En esta revision se aborda la gestion de la informacion, la toma de decision de diferentes modalidades de tratamiento que se pueden ofertar a estos pacientes y el momento de inicio y/o retirada de dialisis.

Background and Aims Percutaneous renal biopsy (PRB) guided by ultrasound is the gold standard for the diagnosis of nephropathies and glomerulopathies. Sometimes, comorbidity and relative contraindications for PRB could condition us to consider clinical diagnosis as sufficient to treat renal pathology. This is a continuous challenge for the nephrologist due to the prognostic and therapeutic diversity of the different types of nephropathies. Therefore, we wonder if in most cases it is still necessary to perform PRB, or clinical diagnosis would be enough in a significant number of them. We decided to assess our PRB series over 15 years, comparing clinical and biopsy diagnosis, and learning about the complications associated with the technique. Method Cross-sectional analysis of the 262 PRB conducted between January 2003 and December 2018. In our department, before performing the PRB, doctors always make a clinical report with different diagnostic possibilities that facilitates the pathologist's work. For this study the first diagnostic option, being the most clinically compatible with the patient, was always taken. We also collected socio-demographic data, clinical data (hypertension and diabetes mellitus), pre and post-biopsy diagnosis, and complications associated with the technique. For the statistical analysis, the SPSS 15 program was used to calculate frequencies, and the Kappa coefficient for diagnostic concordance. Results 262 PRB were performed, of which 149 (56.9%) were performed in men and 113 (43.1%) in women. Average age: 58.6 ± 19.2 years. 173 patients were hypertensive (66%) and 50 had DM (19.1%). Renal pathologies by age are similar to the data reported by Spanish Society. The table shows the concordance measured by the kappa coefficient in the pre and post-PRB diagnosis of the most frequent nephropathies. There were 15 PRB with complications (5.8%): 12 minors (4.6%, haematuria and hematoma); and 3 major: 2 haemorrhages (0.8%) and 1 nephrectomy (0.4%). 33 PRB (12.6%) were inconclusive due to insufficient material. Conclusion From the data obtained, a high mismatch was observed in very common nephropathies in our environment, such as IgA nephropath and pauci-immune focal and segmental necrotizing glomerulonephritis. In contrast, PRB showed more cases of diabetic nephropathy and tubulointerstitial nephropathy. In the case of the pathologies due to nephrotic syndrome (table) we find a high discordance. This may be due to the fact that in all of those cases there was an initial nephrotic syndrome, and our clinical diagnosis was partly based on the frequency of glomerulopathies in the adult. In conclusion, the different concordances between pre and post-biopsy diagnoses show us that clinical diagnosis is not enough to obtain a final diagnosis. In most cases PRB is necessary for the definitive diagnosis. In addition, after the introduction of the ultrasound, complications have decreased, especially when the biopsy is performed by the nephrologist.

espanolEl rinon del anciano experimenta cambios estructurales y funcionales, que lo convierte en mas vulnerable para la enfermedad renal. La mayoria de ancianos con enfermedad renal cronica fallece antes de desarrollar progresion renal. Sin embargo, el principal grupo de pacientes incidentes de nefropatia terminal es el de personas mayores de 65 anos, representando la diabetes mellitus y las causas vasculares sus principales etiologias. En esta revision se analizan elementos renales (filtrado glomerular, proteinuria/albuminuria, potasio, fracaso renal agudo y diureticos) y factores geriatricos (estado funcional, cognitivo y fragilidad) como predictores de progresion de enfermedad renal. La identificacion de estos factores contribuira a establecer estrategias de prevencion renal y al pronostico de la enfermedad en la toma decisiones. EnglishThe kidney in elderly people suffers structural and functional changes, which makes it more vulnerable to kidney disease. The majority of the elderly with chronic kidney disease die before developing renal progression. However, the main group of patients that develop terminal nephropathy is that of people older than 65 years, representing diabetes mellitus and vascular causes the main etiologies. In this review, renal elements (glomerular filtration, proteinuria/ albuminuria, potassium, acute renal failure and diuretics) and geriatric factors (functional, cognitive and frail state) are analyzed as predictors of renal disease progression. The identification of these factors will help to establish strategies for renal prevention and the prognosis of the disease in decision making.

Los tumores pueden acompanarse de diversas manifestaciones paraneoplasicas, entre ellas el sindrome nefrotico. Presentamos el caso de un varon con un deterioro del estado general, lesiones cutaneas y un sindrome nefrotico. Tras realizar biopsia cutanea y renal se llego al juicio diagnostico de que las manifestaciones que presentaba el paciente eran paraneoplasicas, debidas a un cancer de colon que se confirmo posteriormente mediante colo-noscopia.

ResumenDescribimos el caso de una mujer joven, que fue diagnosticada de insuficiencia renal avanzada, con un hallazgo casual de una nefrocalcinosis sin una etiología clara, al haberse encontrado asintomática a lo largo de su vida. El estudio genético por paneles de genes conocidos asociados a enfermedad tubulointersticial permitió descubrir una acidosis tubular renal distal autosómica dominante, asociada a una mutación de novo en el exón 14 del gen SLC4A1, que hubiera sido imposible diagnosticar clínicamente por lo avanzado de la enfermedad renal cuando fue descubierta.AbstractWe describe the case of a young woman who was diagnosed with advanced kidney disease, with an incidental finding of nephrocalcinosis of unknown aetiology, having been found asymptomatic throughout her life. The genetic study by panels of known genes associated with tubulointerstitial disease allowed us to discover autosomal dominant distal renal tubular acidosis associated with a de novo mutation in exon 14 of the SLC4A1 gene, which would have been impossible to diagnose clinically due to the advanced nature of the kidney disease when it was discovered.