RESUMO
Chronic kidney disease (CKD) is a growing global public health challenge worldwide. In Mexico, CKD prevalence is alarmingly high and remains a leading cause of morbidity and mortality. Diabetic kidney disease (DKD), a severe complication of diabetes, is a leading determinant of CKD. The escalating diabetes prevalence and the complex regional landscape in Mexico underscore the pressing need for tailored strategies to reduce the burden of CKD. This narrative review, endorsed by the Mexican College of Nephrologists, aims to provide a brief overview and specific strategies for healthcare providers regarding preventing, screening, and treating CKD in patients living with diabetes in all care settings. The key topics covered in this review include the main cardiometabolic contributors of DKD (overweight/obesity, hyperglycemia, arterial hypertension, and dyslipidemia), the identification of kidney-related damage markers, and the benefit of novel pharmacological approaches based on Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA). We also address the potential use of novel therapies based on Mineralocorticoid Receptor Antagonists (MRAs) and their future implications. Emphasizing the importance of multidisciplinary treatment, this narrative review aims to promote strategies that may be useful to alleviate the burden of DKD and its associated complications. It underscores the critical role of healthcare providers and advocates for collaborative efforts to enhance the quality of life for millions of patients affected by DKD.
RESUMO
This essay shows that the development of nephrology in recent years has been basically in dialysis and kidney transplantation, but access to the entire population that requires it is insufficient and limited, which is a universal phenomenon. In addition, the fragmentation of the specialty into other subspecialities has been generated. Among other reasons that prevent decision makers from deciding to expand tertiary nephrology care to a larger population, 12 intrinsic factors and four extrinsic factors are identified, together with limited resources dedicated to research; therefore, national societies of nephrology are encouraged to act and try to modify those factors that are obstacles to the development of the specialty and the expansion of nephrological care.
En este ensayo se muestra que el desarrollo de la nefrología en los últimos lustros ha sido básicamente en la diálisis y el trasplante renal, pero es insuficiente y limitado el acceso a toda la población que los requieren, lo cual es un fenómeno universal. Además, se ha generado la fragmentación de la especialidad en otras subespecialidades. Entre otros motivos que impiden que los tomadores de decisiones se decidan por ampliar la atención nefrológica terciaria a mayor población se identifican 12 factores intrínsecos y cuatro extrínsecos, aunado a limitados recursos destinados a la investigación, por lo que se invita a que las sociedades nacionales de nefrología actúen y traten de modificar esos factores que son obstáculos para el desarrollo de la especialidad y la ampliación de la atención nefrológica.
Assuntos
Transplante de Rim , Nefrologia , Humanos , Diálise Renal , ConfusãoRESUMO
Resumen En este ensayo se muestra que el desarrollo de la nefrología en los últimos lustros ha sido básicamente en la diálisis y el trasplante renal, pero es insuficiente y limitado el acceso a toda la población que los requieren, lo cual es un fenómeno universal. Además, se ha generado la fragmentación de la especialidad en otras subespecialidades. Entre otros motivos que impiden que los tomadores de decisiones se decidan por ampliar la atención nefrológica terciaria a mayor población se identifican 12 factores intrínsecos y cuatro extrínsecos, aunado a limitados recursos destinados a la investigación, por lo que se invita a que las sociedades nacionales de nefrología actúen y traten de modificar esos factores que son obstáculos para el desarrollo de la especialidad y la ampliación de la atención nefrológica.
Abstract This essay shows that the development of nephrology in recent years has been basically in dialysis and kidney transplantation, but access to the entire population that requires it is insufficient and limited, which is a universal phenomenon. In addition, the fragmentation of the specialty into other subspecialities has been generated. Among other reasons that prevent decision makers from deciding to expand tertiary nephrology care to a larger population, 12 intrinsic factors and four extrinsic factors are identified, together with limited resources dedicated to research; therefore, national societies of nephrology are encouraged to act and try to modify those factors that are obstacles to the development of the specialty and the expansion of nephrological care.
RESUMO
Acute kidney injury (AKI), defined as an abrupt increase in serum creatinine, a reduced urinary output, or both, is experiencing considerable evolution in terms of our understanding of the pathophysiological mechanisms and its impact on other organs. Oxidative stress and reactive oxygen species (ROS) are main contributors to organ dysfunction in AKI, but they are not alone. The precise mechanisms behind multi-organ dysfunction are not yet fully accounted for. The building up of uremic toxins specific to AKI might be a plausible explanation for these disturbances. However, controversies have arisen around their effects in organs other than the kidney, because animal models usually depict AKI as a kidney-specific injury. Meanwhile, humans present AKI frequently in association with multi-organ failure (MOF). Until now, medium-molecular-weight molecules, such as inflammatory cytokines, have been proven to play a role in endothelial and epithelial injury, leading to increased permeability and capillary leakage, mainly in pulmonary and intestinal tissues.
Assuntos
Injúria Renal Aguda/metabolismo , Insuficiência de Múltiplos Órgãos/metabolismo , Toxinas Urêmicas/metabolismo , Animais , Humanos , Ligação ProteicaRESUMO
Resumen En este simposio se describen las principales características de seis revistas científicas mexicanas reconocidas por el Journal Citation Reports: Archives of Medical Research, Revista de Investigación Clínica-Clinical and Translational Investigation, Gaceta Médica de México, Salud Pública de México, Cirugía y Cirujanos y Salud Mental. Se hace énfasis en sus aspectos históricos y organizacionales, así como en sus logros principales ante la comunidad científica nacional e internacional.
Abstract This symposium describes the main characteristics of six Mexican scientific journals indexed in the Journal Citation Reports: Archives of Medical Research, Revista de Investigación Clínica-Clinical and Translational Investigation, Gaceta Médica de México, Salud Pública de México, Cirugía y Cirujanos and Salud Mental. Particular emphasis is given to their historical and organizational aspects, as on well as their main achievements recognized by the national and international scientific community.
Assuntos
Humanos , História do Século XIX , História do Século XX , História do Século XXI , Publicações Periódicas como Assunto/classificação , Publicações Periódicas como Assunto/história , Pesquisa , MéxicoRESUMO
This symposium describes the main characteristics of six Mexican scientific journals indexed in Journal Citation Reports: Archives of Medical Research, Revista de Investigación Clínica-Clinical and Translational Investigation, Gaceta Médica de México, Salud Pública de México, Cirugía y Cirujanos and Salud Mental. Particular emphasis is given to their historical and organizational aspects, as well as to their main achievements recognized by the national and international scientific community.En este simposio se describen las principales características de seis revistas científicas mexicanas reconocidas por el. Journal Citation Reports: Archives of Medical Research, Revista de Investigación Clínica-Clinical and Translational Investigation, Gaceta Médica de México, Salud Pública de México, Cirugía y Cirujanos y Salud Mental. Se hace énfasis en sus aspectos históricos y organizacionales, así como en sus logros principales ante la comunidad científica nacional e internacional.