[Association between membranous glomerulonephritis and Crohn's disease]. / Asociación de glomerulonefritis membranosa y enfermedad de Crohn.

We report the case of a 37 year old man who suffered from Crohn's Disease (CD), and was receiving treatment with mesalazine (5-ASA). Nine years after the diagnosis, because of detecting a slight proteinuria, a renal biopsy is made, being the anatomo-pathologic result compatible with membranous glomerulonephritis (MGN). Checking previous literature we have only found two cases reported of MGN in coincidence with Inflammatory Bowel Disease (IBD), one in association with Ulcerative Colitis and the other with Crohn's Disease in a 12 years old boy. This is, therefore, the second case presenting MGN associated with CD and the first in an adult patient.

Osteal complications as first manifestation in a patient with primary Sjögren's Syndrome and with associated distal tubular acidosis (type 1) and chronic renal insufficiency.

Renal affection is among the complications associated with the Sjögren's Syndrome. Tubulo-interstitial nephritis constitutes the most frequent renal lesion and distal tubular acidosis (Type 1) is the most important clinical manifestation of this tubular dysfunction, although the occurrence of chronic renal insufficiency is not an uncommon finding in the presence of distal renal tubular acidosis. Osteomalacia is a clinical consequence of tubular acidosis caused by buffering of H+ in the bone. We present the case of a woman with osteal complication a year before being diagnosed with primary Sjögren's Syndrome and with distal tubular acidosis and renal insufficiency associated at diagnosis.

[Study of the derivations to an external consultation of Internal Medicine: can be managed the waiting list?]. / Estudio de las derivaciones a una consulta externa de Medicina Interna: se puede gestionar la lista de espera?

BACKGROUND: The lack of coordination and organization between primary and specialized attention, generates inefficiency bags in the area of external consultations. MATERIAL AND METHOD: The characteristics of the attention of 120 patients derived consecutively to an external Internal Medicine consultation of a local hospital are analyzed. RESULTS: Of the 120 mentioned patients 19 did not appear (16.23%). 70.3% of the taken care of patients came from primary attention and 29.7% did it of specialized attention. Of the patients derived by primary attention: 63.3% went without data adapted in the derivation leaf, 59.2% did not contribute complementary diagnostic tests and 40.8% were registered in the first consultation. Of the patients derived from specialized attention: 100% contribute clinical information to the consultation, 90% contribute complementary studies and 56.65% are registered in the first consultation. CONCLUSIONS: The discontinuity in the attention between primary and specialized attention generates an inefficient use of the resources, that in the area of external consultations influences in the appearance of waiting lists.