Evaluación de la función renal más allá del laboratorio: rol y desarrollo actual de la imagenología renal / Evaluation of kidney function beyond the laboratory: role and current state of kidney imaging

La evaluación de la función renal se realiza habitualmente a través de la estimación de la tasa de filtración glomerular y el análisis de la orina. La evaluación morfológica renal a través de una imagen permite complementar esta información. Sin embargo, muchas de las aplicaciones de las técnicas actuales de imágenes son desconocidas por los médicos clínicos. Además, la comunicación entre médicos clínicos y especialistas en imágenes es menos usual de lo deseable. En esta revisión describiremos los métodos de imagen más frecuentemente utilizados para la evaluación de la función renal y otras situaciones clínicas nefrológicas, además de analizar los avances más significativos, particularmente en ultrasonografía y resonancia magnética, para la pesquisa precoz y seguimiento del daño renal.

The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.

Prevalencia de Complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato y su impacto a corto plazo en la función renal / Prevalence of clinical and surgical complications in immediate post-renal transplantation and their short-term impact on renal function

INTRODUCCIÓN. La enfermedad renal crónica es definida como la pérdida progresiva, permanente e irreversible de la función renal, uno de los tratamientos es el trasplante renal el mismo que aumenta la calidad de vida de los pacientes que presentan esta patología, sin embargo, a pesar de ser uno de las mejores terapias no está exento de complicaciones especialmente las que se presentan posterior al acto quirúrgico ya que afectan al buen funcionamiento del injerto y afecta la supervivencia del mismo. OBJETIVO. Determinar la prevalencia de complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato con el fin de identificar las principales complicaciones que ocasionan mayor deterioro en la función renal a corto plazo. MATERIAL Y MÉTODOS. Estudio Observacional descriptivo transversal, de pacientes trasplantados que se encuentran en seguimiento desde enero del 2015 hasta diciembre del 2018 en el servicio de Trasplante renal del Hospital de Especialidades Carlos Andrade Marín. La muestra será los 211 pacientes trasplantados de donante cadavérico. Los análisis se realizaron con el paquete estadístico IBM SPSS versión 25, para lo cual se empleó estadísticas descriptivas, utilizando tablas y representando los valores absolutos y relativos de las variables cualitativas, así como medidas de tendencia central y de variabilidad para las variables cuantitativas. RESULTADOS. Se estudiaron 193 pacientes trasplantados de los cuales el 49.66% tuvieron complicaciones, de los mismos el 33.16% fueron complicaciones clínicas y 16,5% complicaciones quirúrgicas; de las clínicas la infección de tracto urinario fueron las más prevalentes con 15%, seguida por el rechazo agudo 6,7%, las infecciones por virus poliomavirus BK fueron un porcentaje de 6,2%, la necrosis tubular aguda el 3,16% terminando con el rechazo hiperagudo en el 1,5% y la toxicidad por calcineurínicos 1,04%. Mientras tanto las complicaciones quirúrgicas las urológicas son las más prevalentes 8,8% seguida por las colecciones liquidas con el 6,74% finalmente la trombosis vascular con el 1,04%. CONCLUSIONES. Las complicaciones más prevalentes son las clínicas vs las quirúrgicas, afectando de igual forma la función renal al año sin diferencia estadísticamente significativa.

INTRODUCTION. Chronic kidney disease is defined as the progressive, permanent and irreversible loss of renal function, one of the treatments is renal transplantation, which increases the quality of life of patients with this pathology, however, despite being one of the best therapies, it is not free of complications, especially those that occur after surgery, since they affect the proper functioning of the graft and affect its survival. OBJECTIVE. To determine the prevalence of clinical and surgical complications in immediate post-renal transplantation in order to identify the main complications that cause greater deterioration in short-term renal function. MATERIAL AND METHODS. Cross-sectional descriptive observational study, of transplanted patients under follow-up from January 2015 to December 2018 in the Renal Transplant service of the Hospital de Especialidades Carlos Andrade Marín. The sample will be the 211 cadaveric donor transplanted patients. The analyses were performed with the IBM SPSS version 25 statistical package, for which descriptive statistics were used, using tables and representing the absolute and relative values of qualitative variables, as well as measures of central tendency and variability for quantitative variables. RESULTS. We studied 193 transplanted patients of whom 49.66% had complications, of which 33. Of the clinical complications, urinary tract infection was the most prevalent with 15%, followed by acute rejection 6.7%, polyomavirus BK infections were 6.2%, acute tubular necrosis 3.16%, ending with hyperacute rejection in 1.5% and calcineurin toxicity 1.04%. Meanwhile, urological surgical complications are the most prevalent 8.8% followed by liquid collections with 6.74% and finally vascular thrombosis with 1.04%. CONCLUSIONS. The most prevalent complications are clinical vs. surgical, affecting renal function at one year with no statistically significant difference.

Evaluación de la función renal en el recién nacido prematuro / Evaluation of kidney function in the premature newborn

Antecedentes: La Lesión Renal Aguda (LRA) es una de las lesiones más comunes asociadas al proceso inflamatorio sistémico en el prematuro, se encuentra relacionada a disfunción de otros órganos y se considera como marcador predictor de morbilidad y mortalidad. Objetivo general: Describir métodos clínicos y biomarcadores de evaluación de la función renal del recién nacido prematuro expuesto a condiciones de gravedad como ventilación mecánica, nefrotoxicidad y alteraciones metabólicas, el análisis de estos factores nos permi-tirá detectar tempranamente LRQy presevar la nefrogénesis. Metodología: Es una investigación teórico-descriptiva de tipo documental, que implica la búsque-da, análisis y selección de documen-tos electrónicos en base de datos publicados en Pubmed, Scielo, Cochrane, artículos de revisiones sistemáticas y bibliográficas completas, metaanálisis, consensos y guías de práctica clínica en idioma español e inglés. Resultados esperados: El médico involucrado en la atención del recién nacido prematuro tenga el conocimiento sobre la importancia de la evaluación y preservación de la función renal para la toma de decisiones eficaces, optimas en el manejo integral, en pacientes con patología compleja en etapas tem-pranas de la vida.

Background: Acute kidney injury is one of the most common injuries associated with the systemic inflammatory process in premature infants; it is related to the dysfunction of other organs and is considered a predictive marker of morbidity and mortality. General objective: Describe clinical methods and biomarkers for evaluating renal function in premature newborns exposed to severe conditions such as mechanical ventilation, nephrotoxicity, and metabolic alterations. Analyzing these factors will allow us to detect AKI early and preserve nephrogenesis. Methodology: This is a theoretical-descriptive study of documentary type that involves the search, analysis, and selection of electronic documents in databases published in PubMed, Scielo, and Cochrane, articles from systematic reviews, and complete biblio-graphical reviews, meta-analyses, consensus, and clinical practice guides in Spanish and English. Expected results: The doctor involved in the care of the premature newborn knows the importance of the evaluation and preservation of renal function for effective decision-making, which is optimal in the integral management of patients with complex pathology in the early stages of life.

Síndrome urémico hemolítico del adulto / Adult hemolytic uremic syndrome

El síndrome urémico hemolítico (SUH), descripto en 1955, se caracteriza por la tríada de anemia hemolítica no inmunomediada, trombocitopenia y lesión renal aguda. En su patogenia interviene la toxina Shiga, producida con mayor frecuencia por E. coli O157:H. Puede manifestarse a cualquier edad, aunque es infrecuente en adultos, y se desarrolla en forma esporádica o en brote. Se presenta con un cuadro de dolor abdominal, diarrea, fiebre y vómitos. Puede afectar el sistema nervioso central, pulmones, páncreas y corazón. En adultos, el síndrome evoluciona tras un período de incubación de 1 semana posterior a la diarrea y tiene alta morbimortalidad, a diferencia de los casos pediátricos. Presentamos el caso de una paciente adulta, que cursó internación por síndrome urémico hemolítico. (AU)

Hemolytic uremic syndrome (HUS), described in 1955, is characterized by the triad of non-immune mediated hemolytic anemia, thrombocytopenia, and acute kidney injury. Shiga toxin, produced most frequently by E coli O157:H, is involved in its pathogenesis. Hus can manifest at any age, although it is rare in adults and develops sporadically or in outbreaks. HUS presents with a picture of abdominal pain, diarrhea, fever and vomiting. It can affect the central nervous system, lungs, pancreas, and heart.In adults, the syndrome evolves after an incubation period of 1 week after diarrhea, with high morbidity and mortality, unlike pediatric cases.We present the case of an adult patient who was hospitalized for hemolytic uremic syndrome. (AU)

Creatinina plasmática medida por método enzimático y estimulación del filtrado glomerular con la fórmula Full-Age-Spectrum, en una población pediátrica ambulatoria de la Argentina / Plasma creatinine measured by enzymatic method and estimation of glomerular filtration rate using the Full-Age-Spectrum equation in a pediatric outpatient population in Argentina

Introducción: el método recomendado para la medición de creatinina plasmática (Cr) es el enzimático, que permite obtener la tasa de filtrado glomerular estimado (TFGe) con la fórmula Full-Age-Spectrum (FAS) para todas las edades, al normalizar la TFGe con valores poblacionales de Cr. Objetivos: obtener valores poblacionales de Cr medida con un método enzimático y evaluar la fórmula FAS, en una población pediátrica ambulatoria de la Argentina, puesto que no existen publicaciones al respecto en nuestro país. Material y métodos: estudio descriptivo, retrospectivo, transversal, por muestreo consecutivo. Se consideró la población pediátrica ambulatoria de 2 a 17 años que concurrió una sola vez, entre 07/2018 y 11/2021 al laboratorio del Hospital Municipal (Bahía Blanca, Argentina) con petición médica de Cr. Se evaluó la distribución poblacional de Cr. Se comparó FAS original (FAS-Belga) con FAS normalizada con valores locales de Cr (FAS-Local). Resultados: se estudiaron 2793 individuos. Los varones tuvieron un valor de Cr superior al de las mujeres a los 16 y 17 años. La TFGe fue menor con FAS-Local que con FAS-Belga [mediana (RI) mL/min/1,73 m2 : 107,3 (22,9) vs. 117,0 (26,5); p=0,0001; rbis=0,87 (tamaño del efecto grande)]. Del análisis del gráfico de Bland-Altman y el índice de concordancia Kappa se obtuvo que FAS-Local no fue comparable con FAS-Belga. Conclusiones: los valores poblacionales de Cr, medida con un método enzimático, son los primeros en obtenerse en una población pediátrica ambulatoria argentina. Dichos valores son necesarios para aplicar FAS en la Argentina (AU)

Introduction: the recommended test for the measurement of plasma creatinine (Cr) is the enzymatic method, which allows calculating the estimated glomerular filtration rate (eGFR) with the Full-Age-Spectrum (FAS) equation for all ages, by normalizing the eGFR with population Cr values. Objectives: to obtain population Cr values measured with an enzymatic method and to evaluate the FAS equation in an pediatric outpatient population in Argentina, since there are no reports on this subject in our country. Material and methods: A descriptive, retrospective, cross-sectional, consecutive sampling study. The pediatric outpatient population aged 2 to 17 years who attended only once to the laboratory of the Municipal Hospital (Bahía Blanca, Argentina) between 07/2018 and 11/2021 with medical request for Cr measurement. The population distribution of Cr was evaluated. The original FAS (FAS-Belgian) was compared to FAS normalized with local Cr values (FAS-Local). Results: 2793 individuals were studied. Males had a higher Cr value than females at 16 and 17 years of age. The eGFR was lower with FAS-Local than with FAS-Belgian [median (IQR) mL/min/1.73 m2: 107.3 (22.9) vs. 117.0 (26.5); p=0.0001; rbis=0.87 (large effect size)]. Analysis of the Bland-Altman plot and the Kappa concordance index showed that FAS-Local was not comparable to FAS-Belgian. Conclusions: population Cr values, measured with an enzymatic method, are the first to be obtained in an Argentine pediatric outpatient population. These values are necessary to apply the FAS in Argentina (AU)

Estimación de la función renal para la dosificación de drogas / Estimation of kidney function to adjust drug dosing

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.

Green coffee bean extract attenuates gentamicin induced acute nephrotoxicity in rats / El extracto de grano de café verde atenúa la nefrotoxicidad aguda inducida por gentamicina en ratas

Gentamicin induced acute nephrotoxicity (GIAN) is considered as one of the important causes of acute renal failure. In recent years' great effort has been focused on the introduction of herbal medicine as a novel therapeutic agent for prevention of GIAN. Hence, the current study was designed to investigate the effect of green coffee bean extract (GCBE) on GIAN in rats. Results of the present study showed that rat groups that received oral GCBE for 7 days after induction of GIAN(by a daily intraperitoneal injection of gentamicin for 7days), reported a significant improvement in renal functions tests when compared to the GIAN model groups. Moreover, there was significant amelioration in renal oxidative stress markers (renal malondialdehyde, renal superoxide dismutase) and renal histopathological changes in the GCBE-treated groups when compared to GIAN model group. These results indicate that GCBE has a potential role in ameliorating renal damage involved in GIAN.

La nefrotoxicidad aguda inducida por gentamicina (GIAN) se considera una de las causas importantes de insuficiencia renal aguda. En los últimos años, el gran esfuerzo se ha centrado en la introducción de la medicina herbal como un nuevo agente terapéutico para la prevención de GIAN. Por lo tanto, el estudio actual fue diseñado para investigar el efecto del extracto de grano de café verde (GCBE) sobre la GIAN en ratas. Los resultados del presente estudio mostraron que los grupos de ratas que recibieron GCBE oral durante 7 días después de la inducción de GIAN (mediante una inyección intraperitoneal diaria de gentamicina durante 7 días), informaron una mejora significativa en las pruebas de función renal en comparación con los grupos del modelo GIAN. Además, hubo una mejora significativa en los marcadores de estrés oxidativo renal (malondialdehído renal, superóxido dismutasa renal) y cambios histopatológicos renales en los grupos tratados con GCBE en comparación con el grupo del modelo GIAN. Estos resultados indican que GCBE tiene un papel potencial en la mejora del daño renal involucrado en GIAN.

Evaluación de la función renal para la detección y seguimiento de la enfermedad renal crónica. Documento multidisciplinario de consenso 2021. Especial atención sobre situaciones clínicas específicas / Evaluation of renal function for the detection and follow-up of chronic kidney disease. Multidisciplinaryconsensus document 2021. Special attention to specific clinical situations

Resumen El filtrado glomerular (FG) se considera el mejor índice para evaluar la función renal en la práctica clínica. Recientemente, ha ganado popularidad la utilización de ecuaciones que estiman el FG, en distintas poblaciones, a partir de los niveles séricos de algunos biomarcadores. Sin embargo, no todas las fórmulas han sido validadas en los diversos escenarios clínicos probables. Las sociedades participantes: Sociedad Argentina de Nefrología, Asociación Bioquímica Argentina, Fundación Bioquímica Argentina y Confederación Unificada Bioquímica de la República Argentina, integradas por nefrólogos y bioquímicos, realizaron un consenso actualizado sobre la utilización del FG como herramienta de detección de la enfermedad renal crónica (ERC) en la Argentina. Se analizó la bibliografía existente y, teniendo en cuenta aspectos de nuestra realidad sanitaria, se establecieron sugerencias para su utilización. Se actualizaron las indicaciones del uso del FG medido. En sucesivos capítulos se puso foco en distintos estados del FG en diversas poblaciones y situaciones. En los estados de reducción del FG, se mencionaron tanto los fisiológicos propios del envejecimiento, como los determinados por situaciones patológicas, por ejemplo, el observado en la ERC avanzada o el determinado en aquellos pacientes que recibieron un trasplante renal. Se revisaron, por otro lado, las situaciones de incremento del FG, como las observadas en el embarazo o en la obesidad. Se refirieron, asimismo, las limitaciones de la estimación del FG, se reconoció su valor en situaciones de la práctica clínica habitual, o en contextos epidemiológicos definidos y se sugirieron las ecuaciones más adecuadas para su utilización en cada caso.

Abstract The glomerular filtration rate (GFR) is considered the best index to assess the renal function in clinical practice. Recently, the use of equations to estimate GFR in different populations, based on the serum levels of some biomarkers, has gained popularity. However, not all the equations have been validated in the various likely clinical scenarios. Thus, the participating societies, i.e. the Argentine Society of Nephrology, the Argentine Association of Biochemistry, the Argentine Foundation of Biochemistry, and the Unified Confederation of Biochemistry of Argentina, composed of nephrologists and biochemists, have established an updated consensus on the use of the GFR as a tool for the detection of chronic kidney disease (CKD) in Argentina. The consensus was established on the basis of the analysis of the existing literature and taking into account aspects of the health situation in Argentina. Suggestions for the use of the GFR were made, and the indications for its use were updated. The successive chapters of the consensus consider different values of the GFR in different populations and situations. The different situations considered and reviewed include cases of a decrease in the GFR, such as the physiological one related to aging and that related to pathological situations, as observed in advanced CKD or in patients who have received a kidney transplant, as well as cases of an increase in the GRF, such as that observed in pregnancy or obesity. The consensus also mentions the advantages and limitations of the estimation of the GFR in situations of usual clinical practice or in specific epidemiological contexts, and the most appropriate equations for its use in each case is suggested.

Resumo A filtração glomerular (FG) é considerada o melhor índice para avaliar a função renal na prática clínica. Recentemente, a utilização de equações que calculam a FG, em diferentes populações, ganhou popularidade a partir dos níveis séricos de alguns biomarcadores. Entretanto, nem todas as fórmulas têm sido validadas nos diversos cenários clínicos prováveis. As sociedades participantes: Sociedade Argentina de Nefrologia, Associação Bioquímica Argentina, Fundação Bioquímica Argentina e Confederação Unificada Bioquímica da República Argentina, integradas por nefrologistas e bioquímicos, realizaram um consenso atualizado sobre a utilização da FG, como ferramenta de detecção da doença renal crônica (DRC) na Argentina. Foi analisada a bibliografia existente e, considerando aspectos da nossa realidade sanitária, foram estabelecidas sugestões para sua utilização. Foram atualizadas as indicações do uso da FG medida. Em sucessivos capítulos se colocou o foco em diferentes estados da FG em populações e situações diversas. Nos estados de redução da FG, foram mencionados tanto os fisiológicos próprios do envelhecimento, quanto os determinados por situações patológicas, por exemplo, aquele observado na DRC avançada ou o determinado naqueles pacientes que receberam um transplante renal. Por outra parte, foram revistas as situações de aumento da FG como as observadas na gravidez ou na obesidade. Foram referidas, também, as limitações da estimativa da FG, foi reconhecido o seu valor em situações da prática clínica habitual, ou em contextos epidemiológicos definidos e se sugeriram equações mais adequadas para sua utilização em cada caso.

Benefits of water intake on kidney function in older adults: protocol for a randomized controlled trial / Benefícios da ingestão de água na função renal de idosos: protocolo para um estudo clínico randomizado controlado

Objective: The goal of this study is to evaluate the benefits of an increase in water intake guided by a mathematical formula (per kg of body weight) on kidney function in older adults. Methods: Older adults (≥ 65 years old) cared for at the Internal Medicine Unit of a tertiary hospital will be randomized to receive or not guidance on water intake (30 mL/kg per day) after initial assessment of kidney function. After 14 days, participants will be reevaluated through clinical and laboratory examinations. Patients with uncompensated disease will be excluded. The main outcomes will be glomerular filtration rate and laboratory measures such as serum and urinary osmolality, sodium, urea, 24-h urine volume and serum creatinine, uric acid, and copeptin. The Mini Nutritional Assessment (MNA) questionnaire will be applied to participants at each visit. Categorical variables will be described as numbers of cases (%) and compared using the χ2 test whereas continuous variables will be analyzed with Student's t-test in relation to baseline measures. The Generalized Estimating Equations (GEE) method will be performed to assess differences over time and between groups. This study was approved by the Institution's Research Ethics Committee (grant number 16-0153) and is in accordance with the Declaration of Helsinki. Expected Results:By increasing water intake (ml/Kg) we expect to provide an improvement in kidney function in older population assessed by serum creatinine and cystatin-c applied to eGFR formulas. Relevance:Many conditions, both organic and behavioral, can contribute to chronic dehydration states in older adults. To mention, decreased ability to concentrate urine, reduced kidney mass, blood flow, and glomerular filtration rate (GFR) along with changes in sensitivity to hormones such as renin, vasopressin and natriuretic peptide can generate water imbalance, leading to dehydration. For being simple and inexpensive, this strategy may be broadly used and bring several health benefits to older adults.

Objetivo: O objetivo deste estudo é avaliar os benefícios de um aumento da ingestão de água guiado por uma fórmula matemática (por kg de massa corporal) na função renal de idosos. Metodologia:Idosos (≥ 65 anos) atendidos pelo Serviço de Clínica Médica de um hospital terciário foram randomizados para receber ou não orientação sobre o consumo de água (30 mL/kg por dia) após uma avaliação inicial da função renal. Após 14 dias, os participantes serão reavaliados através de exames clínicos e laboratoriais. Pacientes com doença descompensada serão excluídos. Os desfechos principais são a taxa de filtração glomerular e medidas laboratoriais como osmolaridade, sódio e ureia séricos e urinários, volume de urina de 24 horas e creatinina, ácido úrico e copeptina séricos. A Mini Avaliação Nutricional (MNA) será aplicada aos participantes a cada consulta. Variáveis categóricas serão descritas como números de casos (%) e comparadas usando o teste χ2 , enquanto variáveis contínuas serão analisadas com o teste t de Student em relação às medidas iniciais. O método de Equações de Estimativas Generalizadas (GEE) será usado para avaliar diferenças ao longo do tempo e entre grupos. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da nossa Instituição (processo número 16-0153) e está de acordo com a Declaração de Helsinki. Resultados esperados:Ao aumentar a ingestão de água (ml/Kg) esperamos proporcionar uma melhora na função renal na população idosa avaliada pela creatinina sérica e cistatina-c aplicada às fórmulas de eGFR. Relevância:Muitas condições, tanto orgânicas quanto comportamentais, podem contribuir para estados de desidratação crônica em idosos. Vale mencionar que a diminuição da capacidade de concentração da urina, redução da massa renal, fluxo sanguíneo e taxa de filtração glomerular (TFG) juntamente com alterações na sensibilidade a hormônios como renina, vasopressina e peptídeo natriurético podem gerar desequilíbrio hídrico, levando à desidratação. Por ser simples e de baixo custo, essa estratégia pode ser amplamente utilizada e trazer diversos benefícios à saúde dos idosos.

Correlación entre las ecuaciones para la estimación del filtrado glomerular (MDRD, CKD-EPI,) y la depuración de creatinina en orina de 24 horas en pacientes oncológicos / Correlation between the equations for the estimation of the filtering glomerular (MDRD, CKD-EPI,) and creatinine clearance in 24-hour urine in cancer patients

Demostrar la correlación entre las ecuaciones MDRD, CKD-EPI con la depuración de creatinina de 24 horas en pacientes oncológicos. Estudio transversal realizado en el Instituto Oncológico Nacional Dr Juan Tanca Marengo durante el periodo de tiempo comprendido entre el mes de agosto 2019 a agosto de 2020. Al evaluar las distintas variable MDRD obtuvo un valor promedio de 44,81 ml/min/m2 con un intervalo de 41,07 ­ 48,55 ml/min/m2 , la variable CKD-EPI el valor promedio fue 43,59 + 18,09 ml/min/m2 con un intervalo de 40,01 ­ 47,18 ml/min/m2 , para el estándar de referencia depuración de creatinina de 24 horas el promedio fue de 54ml/min/m2 Al evaluar la relación entre los dos estimadores de TFG se encontró que ambos presentan una fiabilidad regular presentando una correlación intraclase de 0,43 (p<0,05) entre los estimadores CKD-EPI y MDRD en relación con la TFG de creatinina de 24horas. Cuando se evaluó pacientes con tumores sólidos y hematológicos, se encontró una mayor correlación intraclase con la escala MDRD-4 0,60 (0,25 ­ 0,82) < 0,05 en tumores hematológicos en comparación con CKD-EPI. En la población general, CKD-EPI es la fórmula recomendada, y se está recomendado con mayor frecuencia en pacientes oncológicos. Nuestro estudio demostró que la ecuación MDRD es la fórmula que mejor se correlaciona con la depuración de creatinina de 24 horas, siendo mejor en el grupo de tumores hematológicos, pero no existe diferencia estadísticamente significativa entre las dos ecuaciones.

To demonstrate the correlation between the MDRD, CKD-EPI equations with the 24-hour creatinine clearance in cancer patients. Cross-sectional study carried out at the National Oncological Institute Dr Juan Tanca Marengo during the period of time between the month of August 2019 to August 2020. When evaluating the different MDRD variables, an average value of 44.81 ml / min / m2 was obtained with an interval of 41.07 ­ 48.55 ml / min / m2, the CKD-EPI variable the average value was 43.59 + 18 , 09 ml / min / m2 with an interval of 40.01 ­ 47.18 ml / min / m2, for the reference standard creatinine clearance of 24 hours the average was 54 ml / min / m2 When evaluating the relationship between the two estimators of GFR, it was found that both present a regular reliability, presenting an intraclass correlation of 0.43 (p <0.05) between the CKD-EPI and MDRD estimators in relation to the 24-hour creatinine GFR. When patients with solid and hematological tumors were evaluated, a higher intraclass correlation was found with the MDRD-4 scale 0.60 (0.25 ­ 0.82) <0.05 in hematological tumors compared to CKD-EPI. In the general population, CKD-EPI is the recommended formulation, and it is more frequently recommended in cancer patients. Our study showed that the MDRD equation is the formula that best correlates with 24-hour creatinine clearance, being better in the group of hematological tumors, but there is no statistically significant difference between the two equations.

Síndrome de Reacción a drogas con Eosinofilia y Síntomas Sistémicos (DRESS) asociados a Nefritis Túbulo Intersticial Aguda en un adolescente / DRESS síndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) associated with Tubulo Interstitial Nephritis in a adolescent

Resumen El síndrome de DRESS (Reacción a drogas con eosinofilia y síntomas sistémicos) es una patología poco frecuente en Pediatría, descrita por primera vez en 1996, por Bocquet. Puede presentarse en un tiempo variable luego de exposición a algunos medicamentos, se caracteriza por fiebre, compromiso cutáneo y de órganos internos. En este caso, se presenta a un paciente de 13 años, con antecedente de uso de Trimetroprim sulfa desde hace 2 meses, con cuadro de 3 días consistente en fiebre y rash cutáneo, sin compromiso de mucosas, con respuesta no favorable al manejo con esteroide, requiriendo Inmunoglobulina IV. Semanas después del inicio de los síntomas y evolución estable presenta insuficiencia renal aguda que requirió terapia de reemplazo renal. Se descartaron otras patologías subyacentes de índole autoinmune. Hubo recuperación de azoados y normalización de los demás paraclínicos el día 40 de la enfermedad. El paciente continúa asintomático, 4 meses después, con tratamiento con esteroide oral, en descenso lento y gradual. Se debe considerar la evaluación permanente de las pruebas de función renal en los pacientes que presenten Síndrome de DRESS, por su asociación con Nefritis intersticial aguda y complicaciones relacionadas.

Abstract DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a rare pathology in Pediatrics, first described in 1996 by Bocquet. It can appear in a variable period of time after exposure to some medications, it is characterized by fever, skin involvement and internal organs. A 13-year-old patient is presented, with a history of use of Trimethoprim sulfa for two months, with a disease of three days of evolution, consisting of fever and skin rash, without mucosal involvement, with an unfavorable response to steroid management, requiring Intravenous inmunoglobulin. Weeks after the onset of symptoms and stable evolution, he presented acute renal failure that required renal replacement therapy. Other underlying autoimmune pathologies were ruled out. There was recovery of renal function test and normalization of the other paraclinical on day 40 of the disease. Patient remains asymptomatic four months later, with oral steroid treatment, in slow and gradual decline. Permanent evaluation of renal function tests should be considered in patients with DRESS syndrome, due to its association with acute tubulointerstitial nephritis and related complications.

Evaluación del proceso de atención urológica de pacientes pediátricos con mielomeningocele / Evaluation of the urological care process of pediatric patients with myelomeningocele

Introducción: El mielomeningocele (MMC) es una de las malformaciones congénitas más severas compatible con la vida. El 90% de los pacientes presenta vejiga neurogénica que debe ser evaluada y tratada precozmente. Objetivos: Describir la evaluación y tratamiento nefrourológico recibido por pacientes con MMC hasta el momento de la primera consulta en el Hospital Garrahan (periodo pre-ingreso). Describir la evaluación realizada y el tratamiento urológico implementado a partir del ingreso al hospital Garrahan (periodo post-ingreso). Evaluar la prevalencia de Enfermedad Renal Crónica (ERC). Población y Métodos: Se realizó un estudio con diseño clínico analítico, retrospectivo, longitudinal sobre pacientes con MMC de 1 mes a 18 años derivados al Hospital Garrahan para atención ambulatoria en los años 2011 y 2012. Resultados: Se incluyeron115 pacientes. Al momento de la derivación al hospital ("pre-ingreso") 7% de los pacientes habían logrado completar evaluación nefrourológica, (ecografía vesicorenal, urodinamia, Cistouretrografía, Centellograma renal y Creatininemia). Tratamiento: 33% vaciaban vejiga por CIL o vesicostomía y 21% recibían Oxibutinina. A partir del ingreso al seguimiento en el Garrahan 83% lograron completar la evaluación, y en función del resultado de la misma se indicó CIL en 87% y Oxibutinina en el 66% de los pacientes. La prevalencia de ERC al ingreso fue de 43%; la mayoría en estadio I. Conclusiones: La mayoría de los pacientes con MMC fueron derivados al hospital de tercer nivel con evaluaciones urológicas incompletas y sin el tratamiento adecuado de la vejiga neurogénica. El inicio del seguimiento interdisciplinario en un hospital de alta complejidad facilitó la realización de las evaluaciones necesarias y la implementación del tratamiento adecuado (AU)

Introduction: Myelomeningocele (MMC) is one of the most severe congenital malformations compatible with life. Of all the patients, 90% presents with a neurogenic bladder requiring early evaluation and treatment. Objectives: To describe the uronephrological evaluation and treatment received by patients with MMC up to the first consultation at Garrahan Hospital (pre-follow-up period). To describe the urological evaluation and treatment implemented from referral to Garrahan Hospital (follow-up period). To evaluate the prevalence of chronic kidney disease (CKD). Population and Methods: A retrospective, longitudinal study with a clinical, analytical design was conducted in patients with MMC between 1 months and 18 years of age referred to Garrahan Hospital for outpatient care in 2011 and 2012. Results: 115 patients were included. At the time of referral to the hospital ("pre-follow-up") 7% of the patients had undergone complete uronephrological evaluation (kidney-bladder ultrasonography, urodynamic studies, cystourethrography, renal scintigraphy, and creatininemia levels). Treatment: 33% emptied their bladder by CIC or vesicostomy and 21% received oxybutynin. From follow-up initiation at Garrahan Hospital, 83% underwent complete evaluation, and based on the results CIC was indicated in 87% and oxybutynin in 66% of the patients. On admission, prevalence of CKD was 43%; with stage I in the majority of the patients. Conclusions: The majority of the patients with MMC were referred to a third-level hospital with incomplete urological studies and without adequate treatment of the neurogenic bladder. Initiation of interdisciplinary follow-up at a tertiary hospital allowed for the necessary studies and implementation of adequate treatment (AU)

Biomarkers of acute kidney injury in patients with nephrotic syndrome / Biomarcadores de lesão renal aguda em pacientes com síndrome nefrótica

ABSTRACT Introduction: Emergence of acute kidney injury (AKI) in patients with nephrotic syndrome (NS) requires prompt diagnosis and differentiation between acute tubular necrosis (ATN) and proliferative glomerulonephritis. We studied the potential use of commercial urinary biomarkers' tests in the diagnosis of AKI in patients with NS. Methods: A cross sectional estimate of urinary concentrations of KIM-1 and NGAL was performed in 40 patients with NS: 9 with proliferative glomerulopathy, being 4 with AKI and 31 without proliferative glomerulopathy, being 15 with AKI. AKI was defined using the KDIGO criteria. Results: The mean age was 35 ± 16 years. The main diagnoses were focal and segmental glomerulosclerosis (10, 25%), membranous glomerulopathy (10, 25%), minimal change disease (7, 18%), lupus nephritis (6, 15%), and proliferative glomerulonephritis (3, 8%). Patients with ATN had higher levels of urinary KIM-1 (P = 0.0157) and NGAL (P = 0.023) than patients without ATN. The urinary concentrations of KIM-1 (P= 0.009) and NGAL (P= 0.002) were higher in patients with AKI than in patients without AKI. Urinary NGAL and KIM-1 levels were significantly higher in patients with ATN without proliferative glomerulonephritis than in patients with proliferative glomerulonephritis (P = 0.003 and P=0.024, respectively). Conclusions: Neutrophil gelatinase associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) estimates correlated with histological signs of ATN and were able to discriminate patients with AKI even in conditions of NS. Furthermore, urinary levels of NGAL and KIM-1 may be useful in the differential diagnosis of acute tubular necrosis and exudative glomerulonephritis in patients with nephrotic syndrome.

RESUMO Introdução: O surgimento de lesão renal aguda (LRA) em pacientes com síndrome nefrótica (SN) requer diagnóstico imediato e diferenciação entre necrose tubular aguda (NTA) e glomerulonefrite proliferativa. Avaliamos o uso potencial de testes de biomarcadores urinários comerciais no diagnóstico de LRA em pacientes com SN. Métodos: Uma estimativa transversal das concentrações urinárias de KIM-1 e NGAL foi realizada em 40 pacientes com SN: 9 com glomerulopatia proliferativa, sendo 4 com LRA e 31 sem glomerulopatia proliferativa, sendo 15 com LRA. A LRA foi definida usando os critérios da KDIGO. Resultados: A média de idade foi de 35 ± 16 anos. Os principais diagnósticos foram glomeruloesclerose segmentar e focal (10, 25%), glomerulopatia membranosa (10, 25%), doença por lesão mínima (7, 18%), nefrite lúpica (6, 15%) e glomerulonefrite proliferativa (3, 8 %). Os pacientes com NTA apresentaram níveis mais elevados de KIM-1 urinário (P = 0,0157) e NGAL (P = 0,023) do que pacientes sem NTA. As concentrações urinárias de KIM-1 (P = 0,009) e NGAL (P = 0,002) foram maiores em pacientes com LRA do que em pacientes sem LRA. Os níveis urinários de NGAL e KIM-1 foram significativamente maiores em pacientes com NTA sem glomerulonefrite proliferativa do que em pacientes com glomerulonefrite proliferativa (P = 0,003 e P = 0,024, respectivamente). Conclusões: As estimativas de lipocalina associada a gelatinase de neutrófilos (NGAL) e molécula de lesão renal 1 (KIM-1) se correlacionaram com sinais histológicos de NTA, e foram capazes de discriminar pacientes com LRA mesmo em condições de SN. Além disso, os níveis urinários de NGAL e KIM-1 podem ser úteis no diagnóstico diferencial de necrose tubular aguda e glomerulonefrite exsudativa em pacientes com síndrome nefrótica.

Ação do estanozolol sobre a histologia renal e hepática em ratos treinados com natação / [Stanozolol action on renal and hepatic histology in swimming trained rats]

No presente estudo, foram analisados os efeitos do estanozolol, associado ou não à atividade física, sobre o hemograma, o peso ponderal, a ingestão líquida e sólida, a urinálise, a expressão do VEGF-A renal e o glicogênio hepático, além da histopatologia hepática e renal em ratos Wistar. Foram utilizados 32 ratos Wistar, machos, jovens, separados em quatro grupos: GC (grupo controle); GCE (grupo controle-exercício); GT (grupo tratamento-esteroide); GTE (grupo tratamento-esteroide-exercício). Os animais dos grupos GT e GTE (n=16) foram submetidos a injeções subcutâneas, cinco dias/semana, durante 30 dias, na concentração de 5mg/kg de estanozolol diluído em 1mL de óleo de gergelim, utilizado como veículo. A natação foi definida como exercício físico. Houve aumento no peso dos animais submetidos ao estanozolol e ao exercício a partir da terceira semana de uso e aumento da excreção urinária a partir da quinta semana; os demais parâmetros da urinálise foram semelhantes entre os grupos. O uso de estanozolol associado ou não à atividade física promoveu redução da expressão do VEGF-A nos rins e do glicogênio hepático, além de alterações histopatológicas nesses órgãos. Quanto à hematologia, houve uma diminuição dos leucócitos no GTE em relação aos grupos GT e GCE. Quanto aos linfócitos, houve um aumento no GT e uma diminuição no GTE, e, em relação ao número de plaquetas, houve diminuição no GTE quando comparado ao GT e ao GCE Assim, conclui-se que estanozolol na dose de 5,0mg/kg causa alterações renais e hepáticas em ratos Wistar, podendo levar à falência dos rins e do fígado.(AU)

The goal of this study was to determine the effect of stanozolol (ST) on kidney and liver of Wistar rats. Thirty-two male animals were divided into the following four groups: control group (CG); Control group-exercise (GCE); Group-steroid treatment (GT); Group treatment-steroid-exercise (GTE). Swimming was defined as exercise. The animals GT and GTE was submitted to subcutaneous injections, five days/week for 30 days, at a concentration of 5mg/kg ST diluted in 1mL/kg of sesame oil. The results showed an increase in weight gain in all animals submitted to ST and exercise from the 3rd week of use and increase in urinary excretion from the 5th week and the other urinalysis parameters were similar. The ST associated or not with physical activity reduced VEGF-A expression in the kidneys and hepatic glycogen, as well as histopathological changes in these organs. Regarding hematology, there was a decrease in leukocytes in the GTE. As for lymphocytes there was an increase in GT and a decrease in GTE, and in relation to the number of platelets, there was a decrease in GTE. In conclusion, the administration of stanozolol at 5.0mg/kg caused a structural change of kidney and liver in treated animals.(AU)

Usefulness of Kidney Donor Profile Index (KDPI) to predict graft survival in a South Brazilian Cohort / Utilidade do Índice de Perfil de Doadores de Rins (KDPI) para prever a sobrevida do enxerto em uma coorte do Sul do Brasil

Abstract Introduction: Kidney Donor Profile Index (KDPI) has been incorporated in the United States to improve the kidney transplant allocation system. Objectives: To evaluate deceased kidney donors' profile using KDPI and compare to the previous United Network for Organ Sharing (UNOS) definition of expanded criteria donors (ECD) and assess the KDPI applicability to predict five-year graft survival and renal function in our sample. Methods: Retrospective cohort of 589 kidney transplants from deceased donors performed from January 2009 to May 2013 with follow-up until May 2018. Results: In 589 kidney transplants, 36.6% of donors were classified as ECD and 28.8% had KDPI ≥ 85%. Mean KDPI was 63.1 (95%CI: 60.8-65.3). There was an overlap of standard and ECD in KDPI between 60 and 95 and a significantly lower death-censored graft survival in KDPI ≥ 85% (78.6%); KDPI 0-20: 89.8%, KDPI 21-59: 91.6%, and KDPI 60-84: 83.0%; p = 0.006. The AUC-ROC was 0.577 (95%CI: 0.514-0.641; p = 0.027). Renal function at 5 years was significantly lower according to the incremental KDPI (p < 0.002). KDPI (HR 1.011; 95%CI 1.001-1.020; p = 0.008), donor-specific antibodies (HR 2.77; 95%CI 1.69-4.54; p < 0.001), acute rejection episode (HR 1.73; 95%CI 1.04-2.86; p = 0.034) were independent and significant risk factors for death-censored graft loss at 5 years. Conclusion: In our study, 36.6% were classified as ECD and 28.8% had KDPI ≥ 85%. KDPI score showed a moderate power to predict graft survival at 5 years. Renal function was significantly lower in patients with higher KDPI.

Resumo Introdução: O Índice de Perfil de Doadores de Rins (KDPI) foi adotado nos Estados Unidos para melhorar o sistema de alocação de transplantes renais. Objetivos: avaliar o perfil dos doadores de rim falecidos usando o KDPI e comparar com a definição anterior do United Network for Organ Sharing (UNOS) de doadores de critérios expandidos (DCE) e avaliar a aplicabilidade do KDPI para prever a sobrevida do enxerto em cinco anos e a função renal em nossa amostra. Métodos: Coorte retrospectiva de 589 transplantes renais de doadores falecidos, realizada de janeiro de 2009 a maio de 2013, com acompanhamento até maio de 2018. Resultados: Em 589 transplantes renais, 36,6% dos doadores foram classificados como DCE e 28,8% apresentaram KDPI ≥ 85%. O KDPI médio foi de 63,1 (IC 95%: 60,8-65,3). Houve uma sobreposição de padrão e DCE no KDPI entre 60 e 95 e uma sobrevida do enxerto censurada por óbito significativamente menor no KDPI ≥ 85% (78,6%); KDPI 0-20: 89,8%, KDPI 21-59: 91,6% e KDPI 60-84: 83,0%; p = 0,006. A ASC-ROC foi de 0,577 (IC 95%: 0,514-0,641; p = 0,027). A função renal aos 5 anos foi significativamente menor de acordo com o aumento do KDPI (p <0,002). KDPI (HR 1.011; 95% CI 1.001-1.020; p = 0.008), anticorpos específicos contra doadores (HR 2,77; 95% CI 1,69-4,54; p <0,001), episódio de rejeição aguda (HR 1,73; 95% CI 1,04-2,86; p = 0,034) foram fatores de risco independentes e significativos para perda do enxerto censurada por óbito em 5 anos. Conclusão: Em nosso estudo, 36,6% foram classificados como DCE e 28,8% apresentaram KDPI ≥ 85%. O escore KDPI mostrou potencial moderado para prever a sobrevida do enxerto em 5 anos. A função renal foi significativamente menor nos pacientes com maior KDPI.

Avaliação da Cistatina C como marcador de Lesão Glomerular em mulheres portadoras de pré-eclâmpsia / Evaluation of Cystatin C as a marker of Glomerular Injury in women with pre-eclampsia

A função renal alterada é um componente essencial do processo fisiopatológico que está relacionado ao pior prognóstico materno-fetal. Os rins estão entre os órgãos centrais afetados na pré-eclâmpsia, e desempenham um papel significativo na síntese e degradação das substâncias de baixo peso molecular, como creatinina, ureia e cistatina C. A cistatina C vem sendo apontada como uma substância promissora para avaliar a função renal, e alterações da filtração glomerular precocemente. O presente trabalho foi realizado para investigar a cistatina C sérica e urinária como marcador de lesão glomerular em grávidas portadoras de PE, e correlacionar com a dosagem de creatinina e uréia. Trata-se de um estudo transversal com 44 gestantes com diagnóstico da pré-eclâmpsia e 24 normotensas. Os níveis de cistatina C plasmáticos e urinárias apresentam-se elevados e estatisticamente significativos (respectivamente, p=0,001, p=0,012) nas mulheres portadoras de PE quando comparadas com as normotensas. Comparando-se com outros marcadores, a cistatina C sérica demonstrou melhor capacidade de identificar a função renal, com valor percentual de área da curva ROC de 91,7%. Nesse estudo, a cistatina C mostra-se um bom marcador de lesão glomerular em gestantes portadoras de pré eclâmpsia, comparável aos marcadores tradicionais uréia e creatinina. Sua vantagem sobre estes marcadores refere-se a sua menor influência de diversos aspectos biológicos não relacionados a doença gestacional propriamente dita.

Renal function is an essential component of the pathophysiological process that is related to the worst maternal-fetal prognosis. The kidneys are among the major levels of affection in PE, and play a significant role in the turnover of most low molecular weight substances such as creatinine, urea and cystatin C. Cystatin C has been shown to be a promising substance for assessing renal function and glomerular filtration changes earlier. The present study was carried out to investigate serum and urinary cystatin C as marker of glomerular lesion in pregnant women with PE, and correlate with creatinine and urea. It is a cross-sectional study with 44 pregnant women diagnosed with preeclampsia and 24 normotensive women. Plasma and urinary cystatin C levels were elevated and statistically significant (p = 0.001, p = 0.012) in women with PE compared to normotensive women, respectively. Compared with other markers, serum cystatin C demonstrated a better ability to identify renal function, with a percentage of area of the ROC curve of 91.7%. Cystatin C is a good marker of glomerular lesion in pregnant women with preeclampsia, comparable to traditional urea and creatinine markers. Their advantage over these markers is their lower influence of several biological aspects unrelated to gestational disease itself.

Metabolic and volume status evaluation of hemodialysis patients with and without residual renal function in the long interdialytic interval / Avaliação metabólica e volêmica no maior intervalo interdialítico de pacientes em hemodiálise com e sem função renal residual

Abstract Introduction: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. Objective: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). Methodology: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. Results: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. Conclusion: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.

Resumo Introdução: Não se sabe ao certo se a função renal residual (FRR) de pacientes dialíticos pode atenuar o impacto metabólico do maior intervalo interdialítico (MII) de 68 horas, no qual ocorre acúmulo de volume, ácidos e eletrólitos. Objetivo: Avaliar os níveis séricos de eletrólitos, balanço hídrico e status ácido-básico de pacientes dialíticos com e sem FRR ao longo do MII. Metodologia: Tratou-se de estudo unicêntrico, transversal e analítico, que comparou pacientes com e sem FRR, definida como diurese acima de 200 mL em 24 horas. Para tal, os pacientes foram pesados e submetidos à coleta de amostras séricas para análise bioquímica e gasométrica no início e fim do MII. Resultados: Foram avaliados 27 e 24 pacientes com e sem FRR, respectivamente. Pacientes sem FRR apresentaram maior aumento de potássio sérico durante o MII (2,67 x 1,14 mEq/L, p < 0,001) atingindo valores mais elevados no fim (6,8 x 5,72 mEq/L, p < 0,001); menor valor de pH no início do intervalo (7,40 x 7,43, p = 0,018), maior proporção de pacientes com bicarbonato sérico < 18 mEq/L (50 x 14,8 %, p = 0,007) e distúrbio ácido-básico misto (70,8 x 42,3 %, p = 0,042), além de maior ganho de peso interdialítico (14,67 x 8,87 mL/kg/h, p < 0,001) e menor natremia (137 x 139 mEq/L, p = 0,02) no fim do intervalo. A calcemia e fosfatemia não foram diferentes entre os grupos. Conclusão: Pacientes com FRR apresentaram melhor controle dos níveis séricos de potássio, sódio, status ácido-básico e da volemia ao longo do MII.

Estimación de la tasa de filtración glomerular en adultos mayores mediante las ecuaciones CKD-EPI / Estimate of the glomerular filtration rate in aged adults through the CKD-EPI equations

Introducción: La tasa de filtración glomerular se considera el mejor índice para evaluar la función renal, ya que su reducción aparece mucho antes que cualquier manifestación clínica derivada de la disfunción renal. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 92 pacientes sin enfermedad renal y con esta, atendidos en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de febrero a noviembre de 2017, a fin de evaluar las ecuaciones insuficiencia renal crónica-colaboración epidemiológica (CKD-EPI) para estimar el filtrado glomerular en adultos mayores. Resultados: Se halló menor promedio de filtrado con orina de 24 horas en el grupo sin nefropatía (64,8 mL/min) y mayor en el grupo de nefrópatas (25,8 mL/min) respecto a dichas ecuaciones. Aunque no hubo diferencias significativas en el filtrado según edad, sexo y peso corporal, en ambos grupos al emplear CKD-EPI, los valores mayores se obtuvieron con CKD-EPI cistatina C. Conclusiones: En los ancianos sin marcadores de daño renal la utilización de las fórmulas CKD-EPI con cistatina permite una mejor estimación de la función renal.

Introduction: The glomerular filtration rate is considered the best index to evaluate the renal function, since its reduction is evidenced much time before any clinical manifestation which derives from the renal failure. Methods: A descriptive, cross-sectional and observational study of 92 patients without and with renal disease, assisted in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from February to November, 2017, was carried out in order to estimate glomerular filtrate in older adults by means of the CKD-EPI equations. Results: Lower average filtrate with 24 hours urine was found in the group without nefropathy (64.8 mL/min) and it was higher in the kidney disease group (25.8 mL/min) regarding these equations. Although in both groups there were no significant differences in the filtrate according to age, sex and corporal weight, when using the equations CKD-EPI, the higher values were obtained with CKD-EPI cystatine C. Conclusions: The use of the formulas CKD-EPI with cystatine allows a better estimate of the renal function in aged patients without markers of renal damage.