INTRODUCCIÓN Y OBJETIVO: La vía de suplementación óptima (intravenosa vs. oral) de hierro en pacientes con enfermedad renal crónica (ERC) no en diálisis es controvertida. Recientemente se ha desarrollado una preparación oral (hierro liposomal, FeSu) con elevada biodisponibilidad y baja incidencia de efectos secundarios. El objetivo fue evaluar la eficacia del FeSu en pacientes con ERC estadio 3 y limitación digestiva a la ferroterapia oral convencional. MATERIAL Y MÉTODOS: Estudio observacional prospectivo con pacientes con ERC estadio 3 estable e intolerancia digestiva a la ferroterapia oral convencional. Se administró una dosis de FeSu de 30 mg/día oral durante 12 meses. El objetivo primario fue el aumento de la hemoglobina a los 6 y 12 meses. También se evaluó la adherencia terapéutica y efectos adversos. RESULTADOS: Se incluyeron 37 pacientes de 72,6 ± 14,7 años y un filtrado glomerular estimado de 42 ± 10 mL/min/1,73 m2. Treinta y dos pacientes habían recibido tratamiento previo con formulaciones orales convencionales, manifestando el 73% intolerancia digestiva con una adherencia del 9,4%. Tras 6 meses con FeSu se objetivó un incremento de las cifras de hemoglobina respecto a la basal, manteniéndose a los 12 meses (0,49 ± 0,19 y 0,36 ± 0,19 g/dL, respectivamente, p < 0,05), y pese a un descenso significativo del filtrado glomerular estimado de 3,16 ± 1,16 y 4,20 ± 1,28 mL/min/1,72 m2 a los 6 y 12 meses, respectivamente. Ningún paciente presentó reacciones adversas que obligaran a suspender el tratamiento. La adherencia fue del 100% en ambos momentos analizados. CONCLUSIONES: El FeSu es eficaz en una cohorte de pacientes con ERC estadio 3 de características extrapolables a la población general de pacientes con ERC moderada, con una baja tasa de reacciones adversas y excelente tolerabilidad
INTRODUCTION AND OBJECTIVE: The optimal iron supplementation route of administration (intravenous vs oral) in patients with chronic kidney disease (CKD) not on dialysis is a hot topic of debate. An oral preparation (liposomal iron, FeSu) has recently been developed with high bioavailability and low incidence of side effects. The objective was to evaluate the efficacy of FeSu in patients with stage 3 CKD and gastrointestinal intolerance to conventional oral iron therapy. MATERIAL AND METHODS: Prospective observational study of patients with stable stage 3 CKD and gastrointestinal intolerance to conventional oral iron therapy. An oral 30mg/day dose of FeSu was administered for 12 months. The primary outcome measure was haemoglobin increase at 6 and 12 months. Treatment adherence and adverse effects were also evaluated. RESULTS: 37 patients aged 72.6 ± 14.7 years and with an estimated glomerular filtration rate (eGFR) of 42 ± 10 ml/min/1.73 m2 were included. 32 patients had received previous treatment with conventional oral formulations, 73% of which exhibited gastrointestinal intolerance with treatment adherence of 9.4%. After 6 months with FeSu, an increase in haemoglobin was observed versus baseline, which was sustained at 12 months (0.49 ± 0.19 and 0.36 ± 0.19 g/dl, respectively, P < .05), despite a significant eGFR decrease of 3.16 ± 1.16 and 4.20 ± 1.28 ml/min/1.73 m2 at 6 and 12 months, respectively. None of the patients experienced adverse reactions that required the treatment to be suspended. Adherence was 100% at both 6 and 12 months. CONCLUSIONS: FeSu is effective in a cohort of patients with stage 3 CKD with similar characteristics to the general population of moderate CKD patients, with a low rate of adverse reactions and excellent tolerability
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Renal Insufficiency, Chronic/blood , Dietary Supplements , Iron, Dietary/administration & dosage , Liposomes , Hemoglobins/analysis , Hemoglobins/drug effects , Severity of Illness Index , Treatment Outcome , Follow-Up Studies , Prospective Studies
INTRODUCTION AND OBJECTIVE: The optimal iron supplementation route of administration (intravenous vs oral) in patients with chronic kidney disease (CKD) not on dialysis is a hot topic of debate. An oral preparation (liposomal iron, FeSu) has recently been developed with high bioavailability and low incidence of side effects. The objective was to evaluate the efficacy of FeSu in patients with stage 3 CKD and gastrointestinal intolerance to conventional oral iron therapy. MATERIAL AND METHODS: Prospective observational study of patients with stable stage 3 CKD and gastrointestinal intolerance to conventional oral iron therapy. An oral 30mg/day dose of FeSu was administered for 12 months. The primary outcome measure was haemoglobin increase at 6 and 12 months. Treatment adherence and adverse effects were also evaluated. RESULTS: 37 patients aged 72.6±14.7 years and with an estimated glomerular filtration rate (eGFR) of 42±10ml/min/1.73m2 were included. 32 patients had received previous treatment with conventional oral formulations, 73% of which exhibited gastrointestinal intolerance with treatment adherence of 9.4%. After 6 months with FeSu, an increase in haemoglobin was observed versus baseline, which was sustained at 12 months (0.49±0.19 and 0.36±0.19g/dl, respectively, P<.05), despite a significant eGFR decrease of 3.16±1.16 and 4.20±1.28ml/min/1.73 m2 at 6 and 12 months, respectively. None of the patients experienced adverse reactions that required the treatment to be suspended. Adherence was 100% at both 6 and 12 months. CONCLUSIONS: FeSu is effective in a cohort of patients with stage 3 CKD with similar characteristics to the general population of moderate CKD patients, with a low rate of adverse reactions and excellent tolerability.
Anemia, Iron-Deficiency/drug therapy , Anemia, Iron-Deficiency/etiology , Iron Compounds/administration & dosage , Renal Insufficiency, Chronic/complications , Aged , Aged, 80 and over , Female , Humans , Liposomes , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Treatment Outcome
La coordinación entre nefrología y atención primaria se recoge bien en documentos sobre el manejo de la enfermedad renal crónica (ERC), pero se conoce menos el impacto real. Objetivo: Evaluar la eficiencia de un programa de nefrología extrahospitalaria (PNE) implantado progresivamente en 10 años respecto la demanda de atención a la ERC en el Área Integral de Salud Barcelona Esquerra, 524.395 habitantes, más de un tercio de la población barcelonesa. Material y métodos: Se ha recogido el n.° y la edad de las 1.as visitas en nefrología entre 2004 y 2014 y establecido un índice de derivación (ID) entre el n. de 1.as visitas y la ERC estimada en población atendida según la implantación del PNE. Resultados: La población adulta descendió entre 2006 y 2014, pero el n.° de habitantes ≥ 65 años aumentó de 107.025 a 113.461, así la ERC estimada. Insuficiencia renal fue el motivo de > 70% de las 1.as visitas de nefrología. La media de edad fue 74 años en 2004-2009 y 70 años en 2010-2014. El ID mostró dos tendencias en el periodo analizado según el PNE incluyera consultoría presencial o no. Conclusiones: El descenso del ID sugiere mejor resolución de la atención primaria. La mejora mayor en las Áreas Básicas de Salud de referencia (con ID reducido hasta > 44%) coincide con la implantación del PNE. Precocidad y contención del PNE superan la brecha entre la atención primaria y la hospitalaria a fin de dar respuesta a la cronicidad, el envejecimiento y la dependencia
The coordination between nephrology and primary care is well documented in the management of chronic kidney disease (CKD), but the real impact is uncertain Objective: To evaluate the efficiency of an outpatient nephrology program (ONP) implanted progressively over the course of 10 years regarding the demand for CKD care in the Integral Health Area of Barcelona Esquerra, accounting for 524,395 inhabitants, which is more than a third of the population of Barcelona. Material and methods: The number and age of the new referrals to nephrology between 2004 and 2014 were identified and a referral index (RI) was established between the number of new referrals and the estimated prevalence of CKD in the population treated, based on the implementation of the ONP. Results: The adult population decreased between 2006 and 2014, but the number of inhabitants aged 65 years or above increased from 107,025 to 113,461 and so did the estimated CKD. Renal insufficiency was the reason for more than 70% of the referrals made to nephrology. The average age was 74 years old between 2004-2009 and 70 between 2010-2014. The RI showed two trends in the analysed period, depending on whether or not the ONP included the face-to-face consultancy. Conclusions: The decrease in RI suggests a better resolution at primary care. The major improvement in the Basic Health Areas of reference (with RI reduced by more than 44%) coincides with the implementation of the ONP. The implantation of ONP overcome the gap between primary and hospital care in order to respond to chronicity, aging and dependence
Humans , Aged , Nephrology/organization & administration , Comprehensive Health Care/organization & administration , Primary Health Care , Ambulatory Care/statistics & numerical data , Office Visits/trends , Health Services Needs and Demand/organization & administration , Office Visits/statistics & numerical data
The coordination between nephrology and primary care is well documented in the management of chronic kidney disease (CKD), but the real impact is uncertain. OBJECTIVE: To evaluate the efficiency of an outpatient nephrology program (ONP) implanted progressively over the course of 10 years regarding the demand for CKD care in the Integral Health Area of Barcelona Esquerra, accounting for 524,395 inhabitants, which is more than a third of the population of Barcelona. MATERIAL AND METHODS: The number and age of the new referrals to nephrology between 2004 and 2014 were identified and a referral index (RI) was established between the number of new referrals and the estimated prevalence of CKD in the population treated, based on the implementation of the ONP. RESULTS: The adult population decreased between 2006 and 2014, but the number of inhabitants aged 65 years or above increased from 107,025 to 113,461 and so did the estimated CKD. Renal insufficiency was the reason for more than 70% of the referrals made to nephrology. The average age was 74 years old between 2004-2009 and 70 between 2010-2014. The RI showed two trends in the analysed period, depending on whether or not the ONP included the face-to-face consultancy. CONCLUSIONS: The decrease in RI suggests a better resolution at primary care. The major improvement in the Basic Health Areas of reference (with RI reduced by more than 44%) coincides with the implementation of the ONP. The implantation of ONP overcome the gap between primary and hospital care in order to respond to chronicity, aging and dependence.
Ambulatory Care/statistics & numerical data , Health Services Needs and Demand/statistics & numerical data , Nephrology/statistics & numerical data , Referral and Consultation/statistics & numerical data , Renal Insufficiency, Chronic/epidemiology , Aged , Ambulatory Care/organization & administration , Efficiency, Organizational , Health Services Needs and Demand/trends , Humans , Nephrology/organization & administration , Program Development/statistics & numerical data , Program Evaluation , Spain/epidemiology
OBJECTIVE: To examine the demographic and clinical differences between men and women admitted to a Physicians' Health Programme (PHP). METHOD: Retrospective chart review of 778 medical records of physicians admitted to the Barcelona PHP from February 1, 1998 until December 31, 2015. RESULTS: Women admitted to the Barcelona PHP were younger than men, were more likely to be self-referred and to be admitted for a non-addictive mental disorder. Prevalence of unipolar affective disorders (60.1 vs. 37.6%), adjustment disorders (62.4 vs. 37.6%), and obsessive-compulsive disorder (61.1 vs. 38.9%) was significantly higher among women, whereas prevalence of alcohol use disorders was lower (32.7 vs. 67.3%). Nevertheless, both groups were similar with regard to medical specialty, working status, length of their first treatment episode, and presence of hospitalization during that episode. After multivariate analysis, age, type of referral, and main diagnosis (addictive disorders vs. other mental disorders) discriminated the differences between groups. CONCLUSION: Women physicians seem to be more prone to voluntarily ask for help from PHPs and are more likely to suffer from mood and anxiety disorders compared to men. However, mental disorders' severity may be similar in both groups. More studies are needed to clarify the gender factors related to this behavior.
BACKGROUND: How one responds to treatment of lupus nephritis (LN) is based on clinical features, but the activity in renal biopsy (RB) is uncertain. We have described the therapeutic decisions after performing a repeated RB on the assessment of response to intravenous cyclophosphamide (IC) and the possible prognostic role of this repeated RB. METHODS: Clinical, laboratory and histological features at the initial RB and repeated RB were analyzed in 35 patients. RESULTS: Data in the initial versus the repeated RB were serum creatinine 1.23 ± 1.08 and 0.96 ± 0.45 mg/dl (p < 0.05), glomerular filtration rate <60 ml/min in 12 and 5% patients and proteinuria 4.1 ± 2.8 vs. 0.6 1.1 g/day (p < 0.05). Significant differences were detected in hematuria, nephrotic syndrome and serological immune features. Complete renal remission was reached in 60% (n = 21) at the time of the repeated RB, partial remission in 31.4% (n = 11), and no response IC in 8.6% (n = 3). Nine patients showed proliferative forms in the repeated RB, 3 of them had proteinuria <1 g/day. Just after the repeated RB, 34.3% increased or started a new immunosuppressive therapy, 17.1% remained with the same complementary IST, and 14.3% decreased or stopped it. In the follow-up post repeated RB, 34.5% without active lesions showed a renal flare versus 77.8% with active lesions (p = 0.04). The mean time was 120 and 45 months, respectively. CONCLUSION: A repeated biopsy in LN distinguishes patients in true remission from those in apparent remission. By doing this, we can identify patients who could benefit from intensified treatment and for whom unnecessary treatment methods can be modified or eliminated.
Kidney/pathology , Lupus Nephritis/diagnosis , Adult , Biopsy , Cyclophosphamide/therapeutic use , Female , Humans , Immunosuppressive Agents/therapeutic use , Lupus Nephritis/drug therapy , Lupus Nephritis/pathology , Male , Reoperation , Retrospective Studies , Young Adult
BACKGROUND: Variability in the management of glomerulonephritis may negatively impact efficacy and safety. However, there are little/no data on actual variability in the treatment of minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) in adults. We assessed Spanish practice patterns for the management of adult nephrotic syndrome due to MCD or FSGS. The absence of reasonably good evidence on treatment for a disease often increases the variability substantially. Identification of evidence-practice gaps is the first necessary step in the knowledge-to-action cyclical process. We aim to analyse the real clinical practice in adults in hospitals in Spain and compare this with the recently released Kidney Disease: Improving Global Outcomes clinical practice guideline for glomerulonephritis. METHODS: Participating centres were required to include all adult patients (age >18 years) with a biopsy-proven diagnosis of MCD or FSGS from 2007 to 2011. Exclusion criteria included the diagnosis of secondary nephropathy. RESULTS: We studied 119 Caucasian patients with biopsy-proven MCD (n = 71) or FSGS (n = 48) from 13 Spanish hospitals. Of these patients, 102 received immunosuppressive treatment and 17 conservative treatment. The initial treatment was steroids, except in one patient in which mycophenolate mofetil was used. In all patients, the steroids were given as a single daily dose. The mean duration of steroid treatment at initial high doses was 8.7 ± 13.2 weeks and the mean global duration was 38 ± 32 weeks. The duration of initial high-dose steroids was <4 weeks in 41% of patients and >16 weeks in 10.5% of patients. We did find a weak and negative correlation between the duration of whole steroid treatment in the first episode and the number of the later relapses (r = -0.24, P = 0.023). There were 98 relapses and they were more frequent in MCD than in FSGs patients (2.10 ± 1.6 versus 1.56 ± 1.2; P = 0.09). The chosen treatment was mainly steroids (95%). Only seven relapses were treated with another drug as a first-line treatment: two relapses were treated with mycophenolate and five relapses were treated with anticalcineurinics. A second-line treatment was needed in 29 patients (24.4%), and the most frequent drugs were the calcineurin inhibitors (55%), followed by mycophenolate mofetil (31%). Although cyclophosphamide is the recommended treatment, it was used in only 14% of the patients. CONCLUSIONS: We found variation from the guidelines in the duration of initial and tapered steroid therapy, in the medical criteria for classifying a steroid-resistant condition and in the chosen treatment for the second-line treatment. All nephrologists started with a daily dose of steroids as the first-line treatment. The most frequently used steroid-sparing drug was calcineurin inhibitors. Cyclophosphamide use was much lower than expected.
BACKGROUND: The feminization of medicine has risen dramatically over the past decades. The aim of this article was to compare the advance of women with that of men and determine the differences between hierarchical status and professional recognition achieved by women in medicine. METHODS: A retrospective study was carried out in the Hospital Clinic Barcelona, Spain, of the period from 1996 to 2008. Data relating to temporary and permanent positions, hierarchy and career promotion achieved, specialty, age and the sex of the participants were analysed with the ANOVA test and logistic regression using the generalized estimated equation. RESULTS: After completion of specialist training, fewer women than men doctors obtained permanent positions. The ratios between the proportions of women and men remained 1.2 for permanent non-hierarchal medical positions and below 0.2 for higher hierarchal levels. Fewer women than men with hierarchy and fewer women than men achieved the rank of consultant. Promotion to consultant and senior consultant was lower than that to senior specialist, being higher in specialties with gender parity and in masculinised specialties. On comparing the two genders using a statistical model, the probability of continuous promotion decreased with the year of the application and the age of the applicant, except in women. CONCLUSIONS: Despite the number of women training as specialists having increased to 50%, women remained in temporary positions twofold longer than men. Compared to women, men showed significant representation in hierarchal medical positions, and women showed a lower adjusted probability of internal professional promotion throughout the study period.
Career Mobility , Employment , Hospitals, University , Physicians, Women/trends , Women's Rights , Female , Gender Identity , Hospitals, University/trends , Humans , Male , Referral and Consultation , Retrospective Studies , Spain , Specialization , Workforce
Introducción: El proceso de Bolonia ha provocado cambios en la estructura universitaria dando protagonismo a los conceptos de competencia y calidad. Esta situación planteó el reto de querer mostrar la contribución de la Universitat de Barcelona (UB) en la formación de médicos para la sociedad catalana y la distribución de estos titulados en relación a todo el colectivo de profesionales colegiados en la provincia de Barcelona. Sujetos y métodos: Estudio longitudinal de cuatro promociones de alumnos de la Facultad de Medicina de la UB, que ingresaron entre 1994 y 2001. Para cada cohorte se calcularon estadísticas de rendimiento académico, de formación especializada y de colegiación después de consultar diferentes bases de datos y utilizando el programa informático R. Resultados: El 85-96% de los alumnos que ingresaron en la Facultad de Medicina obtuvieron el título de licenciado en un plazo inferior a siete años. Del total de licenciados, un 83% constaba registrado en el colegio oficial de médicos de la provincia (COMB). Comparadas con la población colegiada de profesionales, estas promociones destacan por una tasa de feminización mayor (tres de cada cuatro) y tasas de extranjería prácticamente nulas. Conclusiones: Los titulados en medicina por la UB demostraron un alto rendimiento de estudio y se insertaron a la profesión en su entorno geográfico
Introduction: The Bologna process has brought about changes in the structure of the Spanish University giving prominence to the concepts of competence and quality. This posed the challenge of showing the contribution of the University of Barcelona (UB) in the training of doctors to Catalan society, and the distribution of these graduates in relation to the entire group of professional associations in the province of Barcelona. Subjects and methods: Longitudinal study of four classes of freshman students of the Faculty of Medicine, UB, who were admitted between 1994 and 2001. For each cohort academic performance, specialized training and licensing statistics were obtained after looking up different databases and using the R software. Results: Between 85% and 96% of students who entered medical school obtained a degree in Medicine in a period shorter than seven years. Of all graduates comprised 83% recorded in medical professional association of the province (COMB). In comparison with the total professional members, these classes highlighted by a greater proportion of women (3 out of 4) and virtually no immigration rates. Conclusions: Graduates in Medicine from the UB demonstrated high performance of their studies and inserted into the profession in its geographical area
Humans , Education, Medical , Professional Competence , Self Efficacy , Achievement , Educational Measurement , Longitudinal Studies
Humans , Male , Female , Malpractice/legislation & jurisprudence , Malpractice/statistics & numerical data , Ethics, Professional , Gender Identity , Gender and Health , Physician-Patient Relations , Hospital-Physician Relations , Medical Errors/ethics , Medical Errors/statistics & numerical data , Hospitalists/ethics , Professional Misconduct/ethics , Professional Misconduct/trends
Aim. To analyze women's advancement compared with that of men and to determine whether advancement in hierarchical status differs from advancement in the professional recognition achieved by women from 1996 to 2008. Methods. A retrospective study was carried in Hospital Clínic in Barcelona. We analyzed data on temporary and permanent positions, hierarchy, promotions, specialty, age, and sex among the participants. Results. The female-to male ratio among trainee medical specialists was higher than 1 throughout the study period. After completion of specialist training, the proportion of women with temporary contracts more than doubled that of men. Less than 50% of women achieved permanent positions compared with 70% of men. For permanent non-hierarchical and hierarchical positions, the female-to-male ratio gradually decreased from 0.5 to below 0.2. Although more than 50% of trainee specialists were women, the number of female consultants remained 25% lower than that of men. In 2008, the final year of the study, the percentage of women who had achieved the grade of senior consultant was one-third that of men (29.5% of men vs 10.9% of women; p < 0.0001). Conclusions. The significant differences in medical positions held by men and women illustrate the leaky pipeline phenomenon, consisting of a disproportionately low number of women achieving leading medical positions. The full potential of the increasing number of women physicians will not be reached without continuing efforts to improve the hospital medicine environment (AU)
Objetivo. Analizar el avance de las mujeres en comparación con los hombres en la medicina y analizar si el avance jerárquico difiere del avance en su reconocimiento profesional en el periodo 1996-2008. Métodos. Estudio retrospectivo en el Hospital Clínic de Barcelona mediante el análisis de datos relativos a posición temporal y permanente, jerarquía, carrera profesional, especialidad, edad y sexo de los médicos. Resultados. La proporción de mujeres y hombres entre residentes fue superior a 1 durante el período de estudio. Finalizada la residencia, la proporción de mujeres dobla la proporción de hombres entre posiciones médicas temporales. Menos del 50% de las mujeres en comparación con el 70% de los hombres logra posiciones médicas permanentes. La proporción de mujeres y hombres entre posiciones permanentes no jerarquizadas y jerarquizadas desciende gradualmente desde 0.5 hasta llegar a menos de 0.2. A pesar de que más del 50% de residentes son mujeres, ellas alcanzan el grado de consultor 25% menos que sus colegas masculinos. En 2008, el último año del estudio, un tercio de las mujeres (10,9%) en comparación con los hombres (29,5%) alcanzó el grado de consultor senior (p < 0.0001). Conclusiones. Diferencias significativas en posiciones médicas entre hombres y mujeres configuran el fenómeno conocido como "tuberías con fugas", que consiste en un número desproporcionado de mujeres que llegan a posiciones médicas principales. El potencial de la feminización médica no se alcanzará sin esfuerzos de mejora ambiental continua en la medicina hospitalaria (AU)
Humans , Male , Female , Physicians/legislation & jurisprudence , Physicians/organization & administration , Physicians, Family , Gender Identity , 50334/methods , Health Equity , Gender and Health , Professional Practice/ethics , Professional Practice/legislation & jurisprudence , Retrospective Studies , Longitudinal Studies/methods , Longitudinal Studies/trends
AIM: To analyze women's advancement compared with that of men and to determine whether advancement in hierarchical status differs from advancement in the professional recognition achieved by women from 1996 to 2008. METHODS: A retrospective study was carried in Hospital Clínic in Barcelona. We analyzed data on temporary and permanent positions, hierarchy, promotions, specialty, age, and sex among the participants. RESULTS: The female-to male ratio among trainee medical specialists was higher than 1 throughout the study period. After completion of specialist training, the proportion of women with temporary contracts more than doubled that of men. Less than 50% of women achieved permanent positions compared with 70% of men. For permanent non-hierarchical and hierarchical positions, the female-to-male ratio gradually decreased from 0.5 to below 0.2. Although more than 50% of trainee specialists were women, the number of female consultants remained 25% lower than that of men. In 2008, the final year of the study, the percentage of women who had achieved the grade of senior consultant was one-third that of men (29.5% of men vs 10.9% of women; p<0.0001). CONCLUSIONS: The significant differences in medical positions held by men and women illustrate the 'leaky pipeline phenomenon', consisting of a disproportionately low number of women achieving leading medical positions. The full potential of the increasing number of women physicians will not be reached without continuing efforts to improve the hospital medicine environment.
Physicians, Women/statistics & numerical data , Female , Humans , Male , Retrospective Studies , Sex Distribution , Sex Factors , Socioeconomic Factors , Time Factors
Biomedical Research , Physicians, Women , Biomedical Research/statistics & numerical data , Committee Membership , Education, Medical/statistics & numerical data , Ethics Committees, Research/statistics & numerical data , Female , Gender Identity , Humans , Periodicals as Topic/statistics & numerical data , Physicians, Women/supply & distribution , Sex Factors , Spain , Women's Rights
Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 +/- 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission.
Glomerulonephritis, Membranous/complications , Nephrotic Syndrome/etiology , Cohort Studies , Female , Humans , Male , Middle Aged , Nephrotic Syndrome/therapy , Proteinuria/etiology , Remission, Spontaneous , Retrospective Studies
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Humans , Female , Physician's Role , Physicians, Women/supply & distribution , Physicians, Women/trends , Education, Medical/trends
