Estimated glomerular filtration rate (eGFR), 25(OH) D3, chronic kidney disease (CKD), the MYH9 (myosin heavy chain 9) gene in old and very elderly people.

It is known that the common physiological denominator of the ageing process is an attenuation of functional performance with respect to the situation of young people and adults. However, since the first cohort-based longitudinal studies, it has not been possible to establish a "linear" relationship between age and glomerular filtration in all cases. This does not mean that there is no physiological ageing process at all; in addition to those already elucidated, its mechanisms include cell senescence, podocyte dysfunction, a vitamin D deficiency, and homozygotic forms of the MYH9 gene. The aim of the present work was to analyse the prevalence of chronic kidney disease (CKD) and, where possible, the correlation between CKD, defined by an eGFR < 60 ml/min/1.73 m(2), plasma 25(OH)D3 levels and the MYH9 gene in a population of elderly and very elderly persons. These parameters have not been evaluated previously in populations of elderly and very elderly patients. It is concluded that a moderate decrease in the eGFR occurs with age. This does not imply the presence of CKD in elderly people, since in most individuals the reduced eGFR is not accompanied by anaemia, and no individuals show hypocalcaemia, hyperphosphataemia or a high Alb/Cr ratio. Here we observed a lower Hb level and an elevated Alb/Cr ratio in subjects heterozygotic for the MYH9 gene. This could be interpreted in the sense that the gene could exert some protective effect on renal function, whereas the heterozygotic form (allele A) of the MYH9 gene could be considered a very early marker, a new risk factor for the appearance of CKD, or a sign of renal frailty in elderly people.

¿Son modificables las actitudes hacia laspersonas mayores en estudiantes de medicina?Experiencia en la Universidad de Salamanca / Are the medical students’ attitudes towards older people modifiable? The University of Salamanca’s experience

Introducción. Los médicos y los estudiantes de medicina tienden a tener actitudes negativas hacia las personas mayores. En la Unión Europea, sólo el 50% de los estudiantes de medicina reciben formación en medicina geriátrica. Sujetos y métodos. Se evaluaron las actitudes hacia las personas mayores en la cohorte de estudiantes de medicina de 5.º del curso 2006-07 inscritos en la asignatura de geriatría, al comienzo y al fin de la misma. Se utilizó un cuestionario basado en la escala diferencial semántica de Rosencranz et al, donde las puntuaciones bajas indican actitudes más positivas. Resultados. Se obtuvieron datos de 93 estudiantes, 74% fueron mujeres y 26% varones. El promedio de edad fue 22,4 años. Se apreció una mejoría en la mayoría de las variables evaluadas, con diferencias significativas en 21 de las 32 variables analizadas. Sólo el15% declaró haber recibido un entrenamiento previo en el área del envejecimiento. Conclusiones. La exposición a conocimientos y prácticas basadas en la atención y cuidado de las personas mayores modificarían positivamente las actitudes de los estudiantes de medicina (AU)

Introduction. Both physicians and medical students show negative attitudes towards older people. In the European Union, only about 50% of the medical students receive geriatric medicine training. Subjects and methods. Attitudes towards elder people were evaluated in medical students in the fifth year of their studies during 2006-07 academical year, before and after receiving specific training in geriatric medicine. To measure attitudes we used the instrument developed by Rosencranz et al, which incorporates the Aged Semantic Differential; low scores show positives attitudes. Results. 93questionnaires were filled in correctly; 74% of the participants were women and 26% men. Average age was 22.4 years. Our results shows lower values in the majority of the 32 variables studied, with statistically significant differences in 21 of them. Only 15% of the participants declared to have received geriatric medicine training before our study. Conclusions. Medical students’ exposure to knowledge and practice in elderly care could positively modify their attitudes (AU)

Identificación de mayores con trastornos mentales y su relación con autopercepción de salud en medio comunitario rural. Estudio de corte transversal / Identification of elderly subjects with mental illness and its relationship with self-perception of health in a rural community setting. A cross-sectional study

INTRODUCCIÓN. El incremento de la carga de los trastornos mentales en la población de mayores y los pocos datos de prevalencia en medio rural comunitario son la razón de esta comunicación. Nuestro objetivo fue identificar adultos mayores con trastornos neuropsiquiátricos (ansiedad, depresión, distimia) en medio comunitario rural y su relación con la autopercepción del estado de salud. MATERIAL Y MÉTODOS. Estudiamos una cohorte de mayores de 65 años (n = 165) de Garcibuey (C1) y Villanueva del Conde (C2), dos pueblos de la provincia de Salamanca. Utilizamos un cuestionario realizado en base al de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) para el estudio SABE que revela aspectos en 4 dominios diferentes: datos demográficos, estado de salud, estado nutricional y aspectos sociales de los adultos mayores. Los datos se obtuvieron entre noviembre de 2006 y febrero de 2007 por entrevista directa y revisión sistemática de historias clínicas. Utilizamos para el tratamiento estadístico el paquete SPSS 12.0. RESULTADOS Y CONCLUSIONES. Cuarenta y una (25,2%) de las personas han sufrido o sufren un trastorno neuropsiquiátrico, 121 (74,2%) no. Nueve están bajo tratamiento médico farmacológico. El 63,4% vive solo o con su pareja; 22 (53,6%) perciben su estado de salud como malo o regular. El 65,8% consume psicofármacos. Las mujeres (28 [68,2%]) fueron las más afectadas (AU)

INTRODUCTION. This paper aims to deal with the increaseof the burden of mental disorders in the elderly populationand scarce prevalence data in the rural communitysetting and the poor evidence in rural settings. Our aim wasto identify elderly adults with neuropsychiatric morbidity(anxiety, depression and dysthymia) in rural communityarea, and their relationship to self-perception of one’s healthcondition.MATERIAL AND METHODS. A cohort made up of subjectsover 65 years (n = 165) from Garcibuey (C1) and Villanuevadel Conde (C2), Salamanca, was studied. We used aquestionnaire based on the SABE study from Pan-AmericanHealth Organization/World Health Organization (PAHO/WHO) to evaluate personal data, health and nutritionalstatus and social issues in elderly subjects. Data was collectedbetween November 06 - February 07 by direct personalinterview and systematic review of medical record.RESULTS AND CONCLUSIONS. Forty-one (25.2%) ofthe cohort have suffered or are suffering a neuropsychiatricdisorder, 9 of whom are currently under medical treatment.A total of 63.4% live alone or with a partner; 22 (53.6%) perceivetheir health status as fair or bad. A total of 65.8% consumepsychodrugs. Neuropsychiatric disorders are more frequentin women (28 [68.2%]) (AU)

Estudio de farmacovigilancia para evaluar la seguridad y la efectividad del tratamiento con losartán: efectos a largo plazo de losartán solo o en combinación sobre la uricemia / Pharmacovigilance study of the safety and effectiveness of losartan therapy: long-term effects of losartan alone or in combination on uricemia

Introducción: se evalúa la acción del tratamiento con losartán sobre la uricemia, en pacientes hipertensos en el medio comunitario. Material y método: estudio de farmacovigilancia, observacional, prospectivo, multicéntrico, no aleatorizado, abierto, de 1 año de seguimiento. Centros de atención primaria de Ávila, Burgos, León, Palencia, Salamanca, Valladolid y Zamora. Se incluyó a 275 pacientes de 67,5 años, con hipertensión arterial, no diabéticos y diabéticos (n = 19), a los que se trató con losartán, 50 mg/día. A las 8 semanas se aumentaba a 100 mg/día si era preciso. Si a las 24 semanas la presión arterial (PA) persistía elevada, se añadía hidroclorotiazida, 25 mg. Se procedió a la toma de sangre para uricemia, creatinina, electrolitos, glucemia, colesterol y triglicéridos al comienzo y a las 48 semanas de tratamiento. Resultados: la uricemia disminuyó significativamente en el grupo de pacientes tratados con losartán y losartán + tiazidas. El 30% de los pacientes recibió 50 mg de losartán, el 14%, 100 mg y el 56%, losartán + tiazida. La PA media ± desviación estándar varió desde 166 ± 29 mmHg de sistólica y 96 ± 19 mmHg, al comienzo del estudio, a 145 ± 23 mmHg de sistólica y 83 ± 18 mmHg de diastólica al finalizarlo. La creatinina, el sodio, el potasio, la glucemia, el colesterol y los triglicéridos no sufrieron deterioro durante el año de seguimiento. Conclusiones: el losartán es un fármaco seguro, con pocos efectos secundarios y que, tras 1 año de seguimiento, disminuye la uricemia sin deterioro del perfil lipídico, hidrocarbonato ni renal. Se postula como fármaco de primera elección en hipertensos mayores con hiperuricemia

Objectives: to evaluate the effect of losartan therapy on uricemia in patients with hypertension in the community setting. Design: observational, prospective, multicenter, nonrandomized, open-label pharmacovigilance study with a 1-year follow-up. Setting: primary care centers in Avila, Burgos, Leon, Palencia, Salamanca, Valladolid, and Zamora (Spain). Patients and method: two hundred seventy-five men and women (mean age 67.5 years), without diabetes (n = 256) and with diabetes (n = 19), treated with 50 mg/day of losartan were included. If high blood pressure (BP) (> 140/90 mmHg) was uncontrolled at 8 weeks, the dose was increased to 100 mg/day. If BP continued to be high at 24 weeks, hydrochlorothiazide (25 mg) was added. BP was measured after the patient had been sitting for 7 minutes with a mercury manometer and phase V Korotkoff's sound as the reference point. Blood samples were drawn for analysis of uricemia, creatinine, electrolytes, glycemia, cholesterol, and triglycerides at the beginning of the study and after 48 weeks' treatment. Results: uricemia significantly decreased in the group of patients treated with losartan and losartan + thiazides. Thirty percent of the patients received 50 mg of losartan, 14% received 100 mg and 56% received losartan + thiazide. Systolic BP was reduced from 166 (SD 29) mmHg at the beginning of the study to 145 (SD 23) at the end of the study. Diastolic BP was reduced from 96 (SD 19) mmHg to 83 (SD 18) mmHg. No negative effects on creatinine, sodium, potassium, glycemia, cholesterol or triglyceride values were found during the 1-year follow-up. Conclusions: losartan is a safe drug with few adverse effects. After a 1-year follow-up, it reduces uricemia without producing negative effects on lipid, carbohydrate or renal profiles. Therefore, it could be used as a first-line drug in elderly patients with hypertension and hyperuricemia

Manejo de agua y sodio por el riñón senescente. Interpretación de una técnica de aclaramiento para su estudio funcional / Handling of water and sodium by the senescent kidney. Interpretation of a clearance technique for functional study

Los trastornos hidroelectrolíticos, particularmente las hiponatremias, son frecuentes en personas ancianas y, en general, achacadas a un síndrome de secreción inapropiada de hormona antidiurética. Si bien esto es lo más frecuente en adultos jóvenes, no es el caso en los ancianos, cuya causa más frecuente es una depleción real del sodio motivada por cierto grado de incompetencia de la parte gruesa de la rama ascendente del asa de Henle. La localización se hizo mediante una sobrecarga hiposalina y un estudio de aclaramientos utilizando la técnica de Chaimowitz, que describimos y comentamos en este trabajo

Hydroelectrolytic disorders, especially hyponatremias, are frequent in the elderly and are generally due to a syndrome of inappropriate antidiuretic hormone secretion. Although this is the most common cause in young adults, the most frequent cause in the elderly is Na depletion due to impaired competence of the thick ascending limb of Henle's loop. Localization was performed through hyposaline loading and clearance study using Chaimowitz's technique, which we describe and discuss in the present article

Effect of ham protein substitution on oxidative stress in older adults.

Mediterranean diet has been related to a low risk of coronary hearth disease. In the present study, we have evaluated the effect of substituting 120 g of meat by 120 g of acorn-fed Iberian ham (one of the meat components of the Mediterranean diet) on body weight, blood pressure (MAP), plasma lipids and oxidant-antioxidant equilibrium in 13 males and 8 females with an average age of 71. Study was performed in three periods: basal diet evaluations (BD1), ham diet for 6 weeks (HD), and basal diet again for 6 weeks (BD2). MAP significantly diminished from 96 mmHg in BD1 to 89 mmHg after HD. After BD2, MAP remained in the same value. Plasma total antioxidant substances increased from 0.791 mmol/L in BD1, to 1.525 in HD, and to 1.213 in BD2. Glutathione reductase significantly increased from 49.5 U/L in BD1 to 57 in HD and decreased to 49.2 in BD2. Glutathione peroxidase rose from 33 U/gHb in BD1 to 72 in HD and decreased to 52 in BD2. Superoxide dismutase increased from 401 U/gHb in BD1 to 723 in HD and decreased to 433 in BD2. Plasma thiobarbituric acid reacting substances (TBARS) fall from 1.65 mmol/l in BD1 to 1.38 in HD and to 1.47 in BD2. TBARS in erythrocyte membranes also diminished but only in BD2. It can be concluded that including acorn-fed Iberian ham in the diet increased the antioxidant substances and decrease lipid peroxidation, with its subsequent beneficial effects on the atherogenic risk factors.

Acute renal failure in the aged.

Acute renal failure (ARF) is frequent in aged individuals. In this article, we review the literature and relate our own experience in this field. It is concluded that there are no technical reasons to deny treatment for ARF using any of the available techniques based on age. Attempts to prevent the onset of ARF are important. Prophylaxis may be focused on diligent and adequate diagnosis and treatment of reversible renal hypoperfusion, by far the most common cause of pre-renal ARF in the elderly. Administration of potentially nephrotoxic drugs should be avoided, but when necessary creatinine clearance (as the marker of glomerular filtration) rather than blood creatinine levels should be used to establish the appropriate dose. In the elderly, azotemia or other consequences of ARF may induce acute behavioral changes that are almost always reversible; treatment should not be stopped on the false assumption that the patient's mental status is irreversible.

Effect of felodipine on systemic hemodynamics of spontaneous mild-hypertensive aged rats.

The aim of the present study was to examine the effects of felodipine, a dihydropyridinic calcium ions channels blocker, on mean arterial blood pressure (MAP), cardiac output (CO), peripheral resistances (TPR) and blood flow distribution in spontaneously mildly hypertensive female Wistar 30-34 months old rats. Under pentobarbital anesthesia, CO and regional organ blood flow were measured by the radioactive microspheres method, before and 30 min after administration of felodipine 0.5 mumol/kg b. w. by gastric gavage. They were compared to the corresponding values in normotensive rats of the same strain and age. Fifteen (from twenty five) rats were hypertensive with a MAP averaging 139 +/- 2 mm Hg. CO and TPR were slightly higher in these hypertensive rats. Cerebral blood flow (CBF) was lower, though the difference did not reach significant values. MAP significantly decreased after felodipine with no significant changes in CO and TPR in hypertensive as well as in normotensive animals. Renal blood flow (RBF) was similar before and after felodipine which significantly decreased renal vascular resistance in both groups. Felodipine administration did not induce significant changes in CBF but a significant increase in portal venous inflow (PVI) in hypertensive rats only. In conclusion, in old female rats with mild spontaneously hypertension, acute felodipine oral administration reduced arterial blood pressure without diminishing CBF.

Is renal protection with calcium antagonists possible?

Organ protection is the main goal in the treatment of high blood pressure. Consequently, this protective capacity should be one of the main characteristics of any drug used in the treatment of hypertension. A renal protective agent should protect the kidney from intrinsic renal vasoconstrictors and exogenous agents, and should also protect, or at least delay, the decline in renal function in the presence of renal insufficiency, by mechanisms other than increasing glomerular filtration pressure. Verapamil protects mesangial cells from the reduction in surface area induced by endothelin in vitro. In human subjects, it minimises the renal impairment provoked by the administration of cisplatin, and in mice it protects superficial cortical blood flow from the vasoconstriction elicited by cyclosporin. Finally, verapamil may protect from glomerulosclerosis as a result of its capacity to inhibit mesangial cell replication.

Improved survival in intestinal ischemia by allopurinol not related to xanthine-oxidase inhibition.

Allopurinol, a xanthine-oxidase (XO) inhibitor, has been used to improve the resistance to ischemia with disappointing results that have been attributed to administration regimen of the drug. Our aim was to investigate the effect of different administration schedules of allopurinol on the survival in rats undergoing intestinal ischemia testing the blockade of XO. Intestinal ischemia was achieved by 90 min of clamping the superior mesenteric artery (SMA) close to its origin from the aorta. Three groups of animals were evaluated: A-group: only the allopurinol solvent was given; B-group: the full dose of allopurinol (100 mg/k b.w.) was given iv and C-group: the 75% dose was administered orally 24 hr before and the remaining 25% was administered 30 min before. Survival was evaluated at 48 hr and the blockade of XO was assayed by High Efficacy Liquid Chromatography (HELC) in homogenate of intestinal wall. Survival was only improved in the C-group (P = 0.02). Levels of hypoxanthine were significantly increased both in B-group and C-group (P = 0.003) when compared with the A-group. Levels of uric acid in B-group (P = 0.0003) and C-group (P = 0.0009) were significantly decreased with respect to A-group. That means that an effective blockade of XO is achieved whichever the regimen of administration. Allopurinol and oxypurinol levels were significantly increased (P = 0.05 and P = 0.008) in C-group when compared with B-group. We conclude that the protective effect of allopurinol on survival in intestinal ischemia in rats is not related to the blockade of XO but rather to the allopurinol and oxypurinol levels in intestinal wall.

[Effect of xanthine oxidase inhibitors on the prognosis of acute intestinal ischemia]. / Efecto de los inhibidores de la xantino-oxidasa sobre el pronóstico de la isquemia intestinal aguda.

During the last few years, the scientific field has focused its attention on the pathogenic role of free radicals in the process of ischemia-revascularization. It is a well-known fact that xanthine oxidase is an important source of tissular free radicals. Bearing this in mind, we designed an experimental protocol to analyse the effect of allopurinol (a xanthine oxidase inhibitor) in the survival of rats after the occlusion of the superior mesenteric artery during a period of 90 minutes and its action on the superoxide radical liberation. The concentration of oxipurinol and allopurinol in the ischemic area (intestine), liver and blood were measured. We concluded that the administration of allopurinol increased the survival rate, which is correlated to higher concentrations of allopurinol and oxipurinol in the inner part of the intestinal cells. A correlation between the survival rate and superoxide radicals was not found.

Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure.

Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

Effect of allopurinol on the renovascular responses to adenosine.

It is known that renal ischemia enhances the production of adenosine, which is further metabolized by xanthine oxidase, and that the inhibition of this metabolizing enzyme by allopurinol ameliorates the consequences of renal ischemia. This study was undertaken to define the effect of allopurinol on the renal responses to adenosine. It was found that 5 minutes of intrarenal infusion of adenosine in control dogs produced a typical biphasic response characterized by an initial vasoconstriction, decreasing renal blood flow by 46.3% +/- 6.0%, followed by vasodilation, increasing renal blood flow by 8.5% +/- 3.6% above the control levels. Adenosine infusion was also accompanied by a significant reduction of plasma renin activity, from 8.4 +/- 0.6 ng/ml/hour to 3.8 +/- 0.4 ng/ml/hour. The administration of an intravenous infusion of 50 mg allopurinol did not alter the vasoconstrictor phase of adenosine--the average decrease was 41.1% +/- 3.3%; however, it prevented much of the vasodilation because renal blood flow over the 5 minutes remained 17.9% +/- 5.0% less than the levels recorded before adenosine infusion. Allopurinol also prevented the decrease of plasma renin activity, for which the average values recorded before and after adenosine were 9.6 +/- 0.6 ng/ml/hour and 8.2 +/- 0.6 ng/ml/hour, respectively. The results of this study indicate that allopurinol exerts specific effects on the vasodilatory component of adenosine and prevents the adenosine-suppressive effect on the renin-angiotensin system.

Influence of plasma renin content, intrarenal angiotensin II, captopril, and calcium channel blockers on the vasoconstriction and renin release promoted by adenosine in the kidney.

Our study was undertaken to assess whether the effect of intrarenal infusion of adenosine on renal blood flow and renin release in dogs is modified by the degree of stimulation of the intrarenal renin-angiotensin system. This system was modified by sodium deprivation, extracellular volume expansion, beta-adrenergic blockade and stimulation, angiotensin II infusion, and inhibition of converting enzyme by captopril. In addition, the effect of blocking slow calcium channels with verapamil on the vasoconstrictor effect of adenosine was also studied. Results demonstrate that the vasoconstrictor effect of adenosine was not modified by the status of stimulation or inhibition of the renin-angiotensin system or by the status of expansion of the extracellular volume. In all cases adenosine inhibited the renal secretion of renin. Verapamil abolished the vascular actions of adenosine, but it had no effect on the inhibition of renin release. We conclude that plasma renin or angiotensin II levels are not a necessary determinant of the renal vasoconstriction induced by adenosine. This effect seems to be mediated by the entry of calcium into the cell.

[Erythrocyte levels of ALA-dehydrase and uro-synthetase in chronic renal insufficiency (author's transl)]. / Estudio de los niveles eritrocitarios de ala-dehidrasa y uro-sintetasa en la insuficiencia renal crónica.

Erythrocyte levels of ala-dehydrase and uro-synthetase as well as hematocrit, hemoglobin, iron levels and serum iron binding capacity were studied in a group of 28 patients with chronic renal failure in hemodialysis and compared to those of a control group. As is usual, hematocrit, hemoglobin an iron levels were significantly decreased, as were ala-dehydrase levels, while uro-synthetase levels were within normal levels. These results are interpreted as a blockade of the biosynthetic pathway of the protoporphyrins, which lends support to the hypothesis of an existing defect in hemoglobin synthesis in patients with chronic renal failure.

[Threshold for bicarbonate in epileptic children in treatment with anticonvulsant drugs (author's transl)]. / Descenso del umbral renal para el bicarbonato en niños tratados con anticonvulsivantes.

The study comprised 31 ambulatory epileptic children aged 1,5-14 years (mean: 7.37), receiving treatment with anticonvulsant drugs. Authors found that renal threshold for bicarbonate was inferior when compared to control group (mean = 21.3 mEq/l., SD = 1.75; mean = 25.34 mEq/l., SD = 1.29; p less than 0.0001), low calcemia (mean = 9.12 mg./dl., SD = 0.51; mean = 9.43, SD = 0.45; p less than 0.01) and elevated alkaline phosphatase (mean = 212.6 mU/ml., SD = 75.9; mean = 127.4, SD = 50.2; p less than 0.01). No significant difference in urinary excretion of cyclic AMP, phosphate or calcium was observed. Nineteen patients who had subnormal threshold (inferior to -2 SD in the control group) when compared with control group, had: low calcemia (p less than 0.01), high alkaline phosphatase (p less than 0.0001) and a similar urinary cyclic AMP, calciuria and phosphaturia. A negative correlation between renal threshold to bicarbonate and serum phosphate (r = -0.49, p less than 0.01) and a negative correlation between the urinary cyclic AMP and the duration of treatment (r = -0.42, p less than 0.05) was found. It is commented that although in deficiency rickets, proximal tubular acidosis is due to secondary hyperparathyroidism, in their patients despite they had biochemical characteristics of rickets, low calcemia and elevated alkaline phosphatase, the descent of renal threshold to bicarbonate is a nonparathoromone mediated phenomenon.