Bases clínicas y genéticas de la nefroesclerosis hipertensiva. Estudio NEFROSEN / Clinical and genetic bases of hypertensive nephrosclerosis. NEFROSEN Study

Justificación: Se conoce como nefroesclerosis la enfermedad renal crónica (ERC) que complica la hipertensión arterial (HTA) esencial. La ausencia de correlación entre el control de la HTA y la progresión a ERC terminal sugiere la existencia de una enfermedad intrínseca y primitiva. Recientemente se ha asociado con polimorfismos del gen MYH9 en individuos afroamericanos. El objetivo del trabajo que presentamos es determinar si algún polimorfismo de dicho gen se relaciona en raza caucásica con la asociación de HTA esencial y nefroesclerosis y, además, conocer los marcadores de progresión a ERC terminal. Será un estudio retrospectivo que comparará a pacientes con nefroesclerosis frente a pacientes con HTA esencial sin enfermedad renal y, además, se incluirán pacientes con nefroesclerosis y progresión de la enfermedad renal frente a los que se mantienen estables. Métodos: Entre octubre de 2009 y octubre de 2010 se incluirán 500 pacientes con ERC (estadios 3-5) atribuida a nefroesclerosis según criterios clínicos habituales, y 300 pacientes afectados de HTA esencial (FGe >60ml/min/1,73 m2; microalbuminuria <300 mg/g). Para el estudio genético también se incluirán 200 controles sanos de población general. Habrá dos cortes del estudio, la primera visita en el hospital y la visita final (en estadio 5 el inicio del tratamiento sustitutivo constituirá el final del seguimiento). Se registrarán datos clínicos y analíticos, y se recogerán muestras de sangre para el estudio genético. Discusión: Nuestro estudio, con la doble vertiente genética y clínica, tratará de determinar si en la raza caucásica existe relación entre el diagnóstico de nefroesclerosis y el gen MYH9, y estudiará, además, los posibles marcadores de progresión (AU)

Background: Hypertensive nephrosclerosis is a chronic kidney disease (CKD) associated to essential hypertension. The lack of correlation between strict control of hypertension and progression of CKD suggests an intrinsic and primary disease. New evidence suggests that MYH9 gene alterations are associated with nephrosclerosis in African Americans. The aim of this study is to investigate whether a polymorphism of MYH9 in Caucasians is linked to the association of essential hypertension and nephrosclerosis. The secondary objective is to identify the clinical risk factors of progression to end-stage renal disease (ESRD). This is a retrospective study that will compare patients with nephrosclerosis versus essential hypertensives without renal disease, and also patients with nephrosclerosis and impaired rena l function versu s those that are stable .Methods: Between October 2009 and October 2010, 500patients stages 3-5 CKD attributed to nephrosclerosis according to usual clinical criteria, and 300 essential hypertensives (eGFR > 60 mL/min/1.73m2; mi c roalbuminur ia<300 mg/g) will be recruited. 200 healthy controls from general population will also be included for the genetic study. There will be two sections of the study, first and final visit to the clinic (stage 5, the start of replacement therapy will be the end of follow-up). Clinical and laboratory data will be recorded, and blood samples will be collected. Discussion: Our study will seek to determine if there exists a relationship between the diagnosis of nephrosclerosis and MYH9 gene in the Caucasian race, and to study possible risk factors for progression to ESRD, on both clinical and genetic basis (AU)

[Clinical and genetic basis of hypertensive nephrosclerosis. NEFROSEN Study]. / Bases clínicas y genéticas de la nefroesclerosis hipertensiva. Estudio NEFROSEN.

BACKGROUND: Hypertensive nephrosclerosis is a chronic kidney disease (CKD) associated with essential hypertension. The lack of correlation between hypertension control and progression to end-stage CKD suggests an intrinsic and primitive disease. New evidence suggests that MYH9 gene alterations are associated with polymorphisms in African Americans. The aim of this study is to investigate whether a polymorphism of MYH9 in Caucasians is linked to essential hypertension and nephrosclerosis. The secondary objective is to identify the clinical risk factors of progression to end-stage CKD. This is a retrospective study that will compare patients with nephrosclerosis and essential hypertensives without renal disease, and also patients with nephrosclerosis and impaired renal function with those that are stable. METHOD: Between October 2009 and October 2010, 500 patients with stages 3-5 CKD attributed to nephrosclerosis according to usual clinical criteria, and 300 essential hypertensives (eGFR>60 mL/min/1.73 m2; microalbuminuria <300 mg/g) are to be recruited. A total of 200 healthy controls from the general population are also to be included for the genetic study. There are two study sections, being the first and final visits to the clinic (for stage 5 cases, the start of replacement therapy will be the end of follow-up). Clinical and laboratory data will be recorded, and blood samples will be collected. DISCUSSION: Our study will aim to determine if there is a relationship between the diagnosis of nephrosclerosis and the MYH9 gene in Caucasians, and to study possible risk factors for progression to end-stage CKD, on both clinical and genetic bases.

Seudooclusión intestinal por carbonato de lantano / No disponible

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[Use of MDRD equation to detect occult renal failure and reduce the risk of digitalis overdose]. / Utilidad de la ecuación MDRD para detectar insuficiencia renal oculta y disminuir el riesgo de sobredosificación digitálica.

INTRODUCTION: Digoxin overdose is closely related to Chronic Kidney Disease and creatinine dosage adjustment is usually needed. Our goal was to assess the advantages of serum creatinine and the MDRD equation to detect hidden renal insufficiency to reduce the overdose Digital risk. METHODS: We describe all digoxin samples processed and registered in our hospital laboratory database for a year. Patients under 18 years and samples below therapeutic ranges were excluded. Chi square (p<0.05), ROC curves and logistic regression analysis were conducted. SPSS software was used. RESULTS: Between 1228 digoxin samples taken to 679 patients (273 men, 77 +/- 10 years old , and 406 women 82 +/- 8 years old), 14% were over therapeutic range (28 men and 67 women). Significant differences were observed in over dosage between high creatinine group regarding to normal creatinine group (31% vs. 10% in men, 44% vs. 15% in women). ROC curves showed that the most accurate levels to predict digoxin over dosage were MDRD<56 ml/min/1.73 m(2) in men and MDRD<52 ml/min/1.73 m(2) in women. 68% of over dosage men had declines of MDRD levels, compared to 61% with high creatinine levels, 81% of over dosage women had declines of MDRD compared to 51% with elevated creatinine levels. CONCLUSIONS: Even in patients with normal creatinine levels, chronic kidney disease enhances digoxin over dose risk. Using the decline of glomerular filtration rate estimated by the MDRD equation is better than elevated creatinine levels to detect digoxin overdose, thus constituting a very useful tool to reduce the risk of overdose, especially among women.

Utilidad de la ecuación MDRD para detectar insuficiencia renal oculta y disminuir el riesgo de sobredosificación digitálica / No disponible

Introducción: la Enfermedad Renal Crónica plantea importantes problemas de sobredosificación digitálica y hace necesario el ajuste de dosis y la valoración de la función renal, que se realiza habitualmente mediante la creatinina sérica. Nuestro objetivo fue valorar las ventajas de la creatinina sérica y de la ecuación MDRD para detectar insuficiencia renal oculta y poder reducir el riesgo de sobredosificación digitálica. Material y métodos: estudio descriptivo transversal durante un año, en el que se analizaron las determinaciones de digoxina desde la base de datos del laboratorio. Se excluyeron pacientes infra dosificados y menores de 18 años. Se emplearon las pruebas chi cuadrado (p <0,05), curvas ROC, así como análisis de regresión logística, mediante el programa SPSS. Resultados: se realizaron 1.228 determinaciones de digoxina a 679 pacientes(273 varones 77 ± 10 años, y 406 mujeres 82 ± 8 años), de los que el14% estaba sobre dosificado (28 varones y 67 mujeres).Se observan diferencias significativas en sobredosificación en los que tienen creatininas elevadas respecto a creatinina normal (31 vs. 10% en varones, 44 vs. 15% en mujeres). Mediante curvas ROC, la mayor eficacia diagnóstica se obtendría envarones, con cifras de MDRD <56 ml/min/1,73 m2, y mujeres MDRD <52 ml/min/1,73 m2. El 68% de varones sobre dosificados tenían descensos de MDRD, frente al 61% con creatininas elevadas; el 81% de las mujeres sobredosificadas tenían descendido MDRD frente al 51% con elevación de creatinina. Conclusiones: cifras de creatinina normales esconden insuficiencias renales que aumentan el riesgo de sobredosificación. Utilizar el descenso de la tasa de filtrado glomerular estimado mediante la ecuación MDRD es mejor que utilizar las cifras decreatinina elevadas para detectar sobredosificación digitálica, por lo que constituye una herramienta muy útil para poder reducir el riesgo de sobredosificación, sobre todo en mujeres (AU)

Introduction: Digoxin overdose is closely related to Chronic Kidney Disease and creatinine dosage adjustment is usually needed. Our goal was to assess the advantages of serum creatinine and the MDRD equation to detect hidden renal insufficiency to reduce the overdose Digital risk. Methods: We describe all digoxin samples processed and registered in our hospital laboratory database for a year. Patients under 18 years and samples bellow therapeutic ranges were excluded. Chi square (p<0.05), ROC curves and logistic regression analysis were conducted. SPSS software was used. Results: Between 1228 digoxin samples taken to 679 patients (273 men, 77 ± 10 years old , and 406 women 82 ± 8 years old), 14% were over therapeutic range (28 men and 67 women). Significant differences were observed in over dosage between high creatinine group regarding to normal creatinine group (31% vs. 10% in men, 44% vs. 15% in women). ROC curves showed that the most accurate levels to predict digoxin over dosage were MDRD <56 ml/min/1.73m2 in men and MDRD <52 ml/min/1.73m2 in women. 68% of over dosage men had declines of MDRD levels, compared to 61% with high creatinine levels, 81% of over dosage women had declines of MDRD compared to 51% with elevated creatinine levels. Conclusions: Even in patients with normal creatinine levels, chronic kidney disease enhances digoxin over dose risk. Using the decline of glomerular filtration rate estimated by the MDRD equation is better than elevated creatinine levels to detect digoxin overdose, thus constituting a very useful tool to reduce the risk of overdose, especially among women (AU)

Oncocitoma Renal y Microcarcinoma Papilarcoexistentes sobre Enfermedad Quística Adquirida pre diálisis / Renal oncocytoma and papillary microcarcinoma coexistint with cystic disease acquired before dialysis

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