RESUMO
La ecografía es una herramienta esencial en el manejo del paciente nefrológico que permite el diagnóstico, el seguimiento y la realización de intervencionismo sobre el riñón. La utilidad de los ultrasonidos en Nefrología no se circunscribe exclusivamente al estudio ecográfico del riñón. Mediante ecografía el nefrólogo puede, además, optimizar el manejo de la fístula arteriovenosa para hemodiálisis, medir el riesgo cardiovascular (grosor íntima-media), implantar catéteres centrales para hemodiálisis ecoguiados y ayudar en la colocación de los peritoneales, así como calcular la volemia del paciente mediante ecografía cardiaca básica, ecografía de la vena cava inferior y pulmonar. Desde el Grupo de Trabajo en Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN) hemos elaborado este documento de consenso en el que se resumen las principales aplicaciones de la ecografía en Nefrología, incluyendo los requisitos técnicos básicos necesarios, el marco normativo y el nivel de capacitación de los nefrólogos en esta materia. El objetivo de este trabajo es promover la inclusión de la ecografía, tanto diagnóstica como intervencionista, en la práctica clínica habitual del nefrólogo y en la cartera de servicios de Nefrología con la finalidad de ofrecer un manejo diligente, eficiente e integral al paciente nefrológico
Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs. From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient
Assuntos
Humanos , Nefrologia/educação , Ultrassonografia/normas , Nefropatias/diagnóstico por imagem , Sociedades Médicas , Ultrassonografia/métodos , EspanhaRESUMO
Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs. From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient.
Assuntos
Consenso , Nefrologia/educação , Ultrassom/educação , Ultrassonografia de Intervenção , Comitês Consultivos , Derivação Arteriovenosa Cirúrgica/educação , Cateterismo/métodos , Competência Clínica , Ecocardiografia , Humanos , Biópsia Guiada por Imagem , Nefrologia/instrumentação , Diálise Renal/métodos , Espanha , Ultrassom/instrumentaçãoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Injúria Renal Aguda/terapia , Hipoalbuminemia/prevenção & controle , Cadeias kappa de Imunoglobulina/análise , Túbulos Renais/química , Membranas Artificiais , Mieloma Múltiplo/complicações , Proteínas do Mieloma/análise , Diálise Renal/métodos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Dexametasona/administração & dosagem , Cadeias kappa de Imunoglobulina/sangue , Rins Artificiais , Mieloma Múltiplo/sangue , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Diálise Renal/instrumentação , Albumina Sérica/análiseAssuntos
Injúria Renal Aguda/terapia , Hipoalbuminemia/prevenção & controle , Cadeias kappa de Imunoglobulina/análise , Túbulos Renais/química , Membranas Artificiais , Mieloma Múltiplo/complicações , Proteínas do Mieloma/análise , Diálise Renal/métodos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Humanos , Cadeias kappa de Imunoglobulina/sangue , Rins Artificiais , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/sangue , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Diálise Renal/instrumentação , Albumina Sérica/análiseRESUMO
BACKGROUND:: Diagnostic and Interventional Nephrology has been a rising field in recent years worldwide. Catheter insertion, renal biopsy, renal ultrasound, and peritoneal dialysis catheter or permanent dialysis catheter insertion are vital to our specialty. At present, many of these procedures are delegated to other specialties, generating long waiting lists and limiting diagnosis and treatment. METHODS:: An online survey was emailed to all Nephrology departments in Spain. One survey response was allowed per center. RESULTS:: Of 195 Nephrology departments, 70 responded (35.8%). Of them, 72.3% (52) had ultrasound equipment, 77.1% insert temporary jugular catheters, and 92.8% femoral. Up to 75.7% (53 centers) perform native renal biopsies, of which 35.8% (19) are real-time ultrasound guided by nephrologists. Transplant kidney biopsies are done in 26 centers, of which 46.1% (12) by nephrologists. Tunneled hemodialysis catheters are inserted in 27 centers (38.5%), peritoneal catheter insertion in 18 (31.6%), and only 2 centers (2.8%) perform arteriovenous fistulae angioplasty. In terms of ultrasound imaging, 20 centers (28.5%) do native renal ultrasound and 16 (22.8%) transplanted kidneys. Of all units 71.4% offer carotid ultrasound to evaluate cardiovascular risk, only in 15 centers (21%) by nephrologists. AVF ultrasound scanning is done in 55.7% (39). CONCLUSION:: Diagnostic and Interventional Nephrology is slowly spreading in Spain. It includes basic techniques to our specialty, allowing nephrologists to be more independent, efficient, and reducing waiting times and costs, overall improving patient care. Nowadays, more nephrologists aim to perform them. Therefore, appropriate training on different techniques should be warranted, implementing an official certification and teaching programs.
Assuntos
Nefrologistas/tendências , Nefrologia/tendências , Diálise Peritoneal/tendências , Padrões de Prática Médica/tendências , Ultrassonografia de Intervenção/tendências , Derivação Arteriovenosa Cirúrgica/tendências , Cateterismo Venoso Central/tendências , Pesquisas sobre Atenção à Saúde , Humanos , Biópsia Guiada por Imagem/tendências , Diálise Renal/tendências , EspanhaRESUMO
No disponible
Assuntos
Humanos , Nefropatias/diagnóstico , Nefrologia/métodos , Sociedades Médicas , EspanhaRESUMO
No disponible