RESUMEN
BACKGROUND AND AIMS: Amyloidosis is a rare complication of inflammatory bowel disease [IBD]; its low prevalence has hindered both descriptive and therapeutic studies. The aim of this study was to estimate the prevalence of amyloidosis in IBD and the risk factors associated with this complication. METHODS: This paper presents an observational study, followed by a systematic review of the epidemiological and clinical characteristics of the disease and a review of the diagnostic and therapeutic options. RESULTS: The prevalence of amyloidosis among IBD patients is 0.53% (95% confidence interval [CI]: 0.32-0.75), although epidemiological data suggest that it may be under-diagnosed. The phenotype most frequently associated with amyloidosis is males with aggressive and extensive Crohn's disease, fistulising behaviour, perianal disease, and extra-intestinal complications, with the development of proteinuria and renal failure. CONCLUSIONS: Identifying risk factors of amyloidosis in IBD patients and screening for proteinuric renal dysfunction are useful to improve diagnostic accuracy. Referral of biopsies to a tertiary centre should also be considered, to improve diagnostic accuracy. Although there is no reliable evidence on the effectiveness of treatment, it seems reasonable to treat the underlying disease with potent immunosuppression to minimise inflammatory activity, thereby switching off amyloidogenesis.
Asunto(s)
Amiloidosis/etiología , Enfermedades Inflamatorias del Intestino/complicaciones , Amiloidosis/diagnóstico , Amiloidosis/epidemiología , Amiloidosis/terapia , Humanos , Fenotipo , Prevalencia , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Bencimidazoles/efectos adversos , Hemorragia Gastrointestinal/inducido químicamente , Insuficiencia Renal Crónica/complicaciones , Trombofilia/tratamiento farmacológico , beta-Alanina/análogos & derivados , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Bencimidazoles/administración & dosificación , Bencimidazoles/farmacocinética , Bencimidazoles/uso terapéutico , Dabigatrán , Diabetes Mellitus Tipo 2/complicaciones , Transfusión de Eritrocitos , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Tasa de Filtración Glomerular , Humanos , Hipertensión/complicaciones , Tasa de Depuración Metabólica , Diálisis Renal , Insuficiencia Renal Crónica/metabolismo , Insuficiencia Renal Crónica/terapia , Trombofilia/etiología , Infecciones Urinarias/complicaciones , beta-Alanina/administración & dosificación , beta-Alanina/efectos adversos , beta-Alanina/farmacocinética , beta-Alanina/uso terapéuticoRESUMEN
BACKGROUND: Currently, chronic kidney disease (CKD) is understood as global important public health problem, a situation that requires a new approach. OBJECTIVES: To show the results obtained after implementing a quick resolution consultation for CKD management. METHODS: Results were analysed during 6 month time period. RESULTS: A total of 9.61% of received proposals were referred to primary care without in-person visits. In addition, 28.05% of patients were initially evaluated through high resolution clinics and 62.33% were directly referred to other clinics. From the initial 28.05% mentioned, once evaluated, treatment adjusted and informed about the disease, 70% were referred over to primary care for monitoring and the remaining 30% were given specialist appointments. As a consequence, 70.65% of patients were selected for monitoring by nephrology from all proposals received, and 29.35% for primary care monitoring. We observed a significant decrease in the delay until the first medical appointment. CONCLUSIONS: Quick resolution consultations demonstrated to be an efficient tool for CKD management. Its implementation allowed both low consumption of health care resources, selected patients with high risk of progressive cardiovascular disease for long term monitoring, and offered not only an initial evaluation and adjustment of treatment with information provided to those who would be monitored by primary care, but also diminished primary care delays significantly.
Asunto(s)
Derivación y Consulta , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Anciano , Anciano de 80 o más Años , Humanos , Comunicación Interdisciplinaria , Nefrología , Atención Primaria de Salud , Estudios Retrospectivos , Factores de TiempoRESUMEN
Antecedentes: La enfermedad renal crónica (ERC) se entiende actualmente como un importante problema de salud pública global, que requiere una nueva aproximación. Objetivos: Mostrar los resultados de la implantación de una consulta de rápida resolución para el manejo de la ERC. Métodos: Se han analizado de manera retrospectiva los resultados obtenidos durante un período de seis meses, entre septiembre de 2011 y febrero de 2012. Las variables estudiadas han sido la edad de los pacientes, el origen de las propuestas, la causa de las remisiones, el destino inicial dado a estas y el destino final de los pacientes. Resultados: Un 9,61 % de las propuestas recibidas se ha remitido a Atención Primaria sin consulta presencial. Un 28,05 % de los pacientes han sido evaluados inicialmente en la consulta de alta resolución y un 62,33 % se ha citado directamente para el resto de las consultas. Del 28,05 % inicial, tras el proceso de evaluación, ajuste e información acerca de la enfermedad un 70 % ha sido remitido nuevamente a Primaria para seguimiento, y el otro 30 % se ha citado para su seguimiento en consultas. Por tanto, del total de propuestas se ha seleccionado un 70,65 % de pacientes para seguimiento por Nefrología y un 29,35 % para seguimiento por Atención Primaria. Por otro lado, se ha disminuido la demora para primeras visitas a menos de la mitad. Conclusiones: La consulta de alta resolución se ha mostrado como un instrumento eficiente en el manejo de la ERC. Su implantación ha permitido, consumiendo un mínimo de los recursos asistenciales, seleccionar para seguimiento a largo plazo a aquellos pacientes de mayor riesgo de progresión y cardiovascular pero ofreciendo también una evaluación inicial, ajuste de tratamiento e información a los que serán seguidos por Atención Primaria, y disminuir la demora en primeras visitas de manera significativa (AU)
Background: Currently, chronic kidney disease (CKD) is understood as global important public health problem, a situation which requires a new approach. Objectives: To show the results obtained after implementing a quick resolution consultation for CKD management. Methods: Results were analysed during 6 month time period. Results: A total of 9.61% of received proposals were referred to primary care without in-person visits. In addition, 28.05% of patients were initially evaluated through high resolution consults and 62.33% were directly referred to other consults. From the initial 28.05% mentioned, once evaluated, treatment adjusted and informed about the disease, 70% were referred over to primary care for monitoring and the remaining 30% were given specialist appointments. As a consequence, 70.65% of patients were selected for monitoring by nephrology from all proposals received, and 29.35% for primary care monitoring. We observed a significant decrease in the delay until the first medical appointment. Conclusions: Quick resolution consultations demonstrated to be an efficient tool for CKD management. Its implementation allowed both low consumption of health care resources, selected patients with high risk of progression cardiovascular disease for long term monitoring, and offered not only an initial evaluation and adjustment of treatment with information provided to those who would be monitored by primary care, but also diminished primary care delays significantly (AU)
