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.

Magnetic nanoparticles: new players in antimicrobial peptide therapeutics.

Antimicrobial peptides are distributed in all forms of life presenting activity against bacteria, fungi, viruses, parasites and cancer. In spite of the tremendous potential of these molecules, very few of them have been successfully developed into therapeutics. The major problems associated with this new class of antimicrobials are molecule stability, toxicity in host cells and production cost. A novel strategy to overcome these obstacles is conjugation to nanomaterials. Magnetic nanoparticles have been widely studied in biomedicine due to their physicochemical properties. The conjugation of antimicrobial peptides to magnetic nanoparticles could combine the best properties of both, generating an improved antimicrobial nanoparticle. Here we provide an overview and discuss the potential application of magnetic nanoparticles conjugated to antimicrobial peptides in overcoming diseases.

Enfermedad renal crónica avanzada / No disponible

La Enfermedad Renal Crónica (ERC) representa, al igual que otras enfermedades crónicas, un importante problema de salud pública, tanto por su elevada incidencia y prevalencia, como por su importante morbi-mortalidad y coste socioeconómico. La Enfermedad Renal Crónica Avanzada (ERCA) incluye los estadios 4 y 5 de la clasificación de la ERC. Se define por tanto como la enfermedad renal crónica que cursa con descenso grave del filtrado glomerular (FG < 30ml/min) Los objetivos terapéuticos están dirigidos a disminuir y tratar las complicaciones asociadas a la insuficiencia renal, y preparar de forma adecuada y con suficiente antelación el tratamiento sustitutivo de la función renal. La prevalencia de la ERCA es del 0,2-0,6% de la población adulta. Esta prevalencia aumenta con la edad, siendo en (..) (AU)

Chronic kidney disease (CKD), like other chronic diseases, is a serious public health problem because of both its high incidence and prevalence and its significant morbidity and mortality and socioeconomic cost. Advanced chronic kidney disease (ACKD)includes stages 4 and 5 of the CKD classification. It is defined as chronic kidney disease in which there is a severe reduction inglomerular filtration rate (GFR < 30 ml/min). The treatment goals are to reduce and treat the complications associated with chronickidney failure and to prepare the patient adequately and sufficiently in advance for kidney replacement therapy. The prevalence of ACKD is 0.2-0.6% of the adult population. This prevalence increases with age and in Spain is 1.6% in persons (..) (AU)

Impacto socio sanitario de la enfermedad renal crónica avanzada / No disponible

La prevalencia de ERC en España es del 11%, con una tasa elevada de factores de riesgo vascular asociados y el progresivo incremento del número de pacientes subsidiarios de depuración extrarrenal, estimado en un 5-8% anual, ha convertido a esta enfermedad en un problema sanitario, social y económico de primer orden para todos los sistemas sanitarios de los países desarrollados. La terapia renal sustitutiva, aunque es adecuada, no es óptima para (..) (AU)

The prevalence of CKD in Spain is 11%, with a high rate of associated vascular risk factors and a progressive increase in the number of patients requiring kidney replacement therapy, estimated at 5-8% annually. This has made CKD one of the leading health, social and economic problems for the health care systems of all developed countries. Kidney replacement therapy, although adequate, is not optimal for solving this clinical (..) (AU)

[Social and health impact of advanced chronic kidney disease]. / Impacto socio sanitario de la enfermedad renal cronica avanzada.

The prevalence of CKD in Spain is 11%, with a high rate of associated vascular risk factors and a progressive increase in the number of patients requiring kidney replacement therapy, estimated at 5-8% annually. This has made CKD one of the leading health, social and economic problems for the health care systems of all developed countries. Kidney replacement therapy, although adequate, is not optimal for solving this clinical problem. The key aspects of the problem are: The increase in the number of patients with CKD due to: Early vascular injury as a result of the inflammatory process associated with CKD. Aging of the population, although CKD may be more dependent on comorbidities than age "per se", and prevalence may therefore not have the expected increase. The epidemic of type 2 diabetes mellitus. CKD is the major vascular risk factor both in the general and hypertensive population or patients with established vascular injury. The estimated cost of care of stage 1-4 CKD per year can be 1.6-2.4 times more than kidney replacement therapy. The approach to this serious social and health problem is based on: Early detection and diagnosis of CKD by estimation of glomerular filtration rate and assessment of associated risk factors. Establishment of treatment goals for control of cardiovascular risk factors (blood pressure, dyslipidemia, diabetes mellitus,) and albuminuria to reduce the rate of progression of kidney disease. Joint approach to problem by primary care physicians and other specialists caring for patients at high cardiovascular risk. Establishment of criteria for referral to nephrology departments.

[Advanced chronic kidney disease]. / Enfermedad renal cronica avanzada.

Chronic kidney disease (CKD), like other chronic diseases, is a serious public health problem because of both its high incidence and prevalence and its significant morbidity and mortality and socioeconomic cost. Advanced chronic kidney disease (ACKD) includes stages 4 and 5 of the CKD classification. It is defined as chronic kidney disease in which there is a severe reduction in glomerular filtration rate (GFR < 30 ml/min). The treatment goals are to reduce and treat the complications associated with chronic kidney failure and to prepare the patient adequately and sufficiently in advance for kidney replacement therapy. The prevalence of ACKD is 0.2-0.6% of the adult population. This prevalence increases with age and in Spain is 1.6% in persons older than 64 years. - CKD is easily detected in clinical practice with simple tests (GFR estimated by equations based on serum creatinine, albuminuria and urine sediment) (Strength of Recommendation B). - It is recommended to detect the presence of CKD in all persons older than 60 years or with hypertension, diabetes or cardiovascular disease (Strength of Recommendation B). - Early detection and appropriate referral to the nephrology of patients with ACKD improves long-term morbidity and reduces costs for both the patient and the health care system (Strength of Recommendation B). Adequate communication and coordination between the primary care and nephrology is essential for this early detection: - Referral to nephrology should be made based on the stage of CKD, age of the patient, rate of progression of kidney failure, degree of albuminuria and presence or appearance of early warning signs.All patients with CKD stages 4-5 should be referred to nephrology (Strength of Recommendation C). - A protocol should be established in each health area for joint follow-up between primary care and nephrology (Strength of Recommendation C). - The creation of multidisciplinary ACKD units including a nephrologist, nephrology nurse, dietitian and social worker allows an integrated approach to the different aspects of management of patients with ACKD and is cost-effective (Strength of Recommendation B).

Enfermedad renal crónica, fórmulas de estimación de la función renal, hipertensión y envejecimiento / Chronic kidney isease, formulae to estimate kidney function, hypertension and aging

No disponible

Nefrotoxicidad por xenobióticos y agentes biológicos / Nephrotoxixity due to xenobiotics and biological agents

No disponible

Material recomendado para tratamiento de aguas en unidades pequeñas / Recommended material for water management in small units

La calidad del agua exigible para unidades pequeñas o individuales, debe ser similar a la exigida para las unidades generales. Actualmente, para técnicas de diálisis de alto flujo e incluso para técnicas de hemodiálisis convencional, se recomienda la utilización de agua altamente purificada o ultra-pura. Tanto el diseño, como el control y mantenimiento de los sistemas de tratamiento de aguas para las unidades pequeñas, deberá ser del mismo nivel que para las unidades de hemodiálisis generales. Es muy recomendable que la producción del agua ultra-pura se realice in situ y que no se almacene. Si se produce fuera de la unidad, el circuito será lo más corto posible. Todo tratamiento de aguas, individual o general, deberá contar básicamente con un pretratamiento y un tratamiento de ósmosis inversa

The quality of the indispensable water for small or individual units must be similar to the demanded one for the general units. At the moment, for techniques of dialysis of high flow and even for techniques of conventional hemodyalisis, the water use highly purified or ultra pure is recommended. As much the design, as the control and maintenance of the systems of water treatment for the small units, will have to be of he himself level that stops the units of general hemodyalisis. He is very recommendable that the production of the ultra pure water is made “in situ” and that is not stored. If one takes place outside the unit, the circuit will be but short the possible thing. All individual or general water treatment will have to basically count on a pre-treatment and a treatment of inverse osmosis

Logística e implantación de programas de TCDE / Logistics and implementation of CTED schedules

La práctica clínica parece estar de acuerdo en que existe un incremento en la supervivencia de los pacientes con FRA debido al uso de técnicas continuas frente a la HD convencional. Los criterios de eficacia clínica indica que se debe de implantar un modelo abierto y colaborativo entre los servicios de nefrología y las unidades de cuidados intensivos tanto a nivel médico como de enfermería. Indicadores de la TCDE en los pacientes críticos: A. TCDE como tratamiento sustitutivo de la función renal 1. Corrección de las alteraciones hidroelectrolíticas • Acidosis metabólica • Hipercaliemia severa • Alteraciones del Na 2. Descenso del filtrado glomerular 3. Fallo renal agudo B. TCDE como tratamiento renal sustitutivo (con y sin FRA) 1. Síndrome de distres respiratorio del adulto (ARDS) 3. Síndrome de respuesta inflamatoria sistémica (SIRS) 4. Hipertermia o hipotermia incontrolable con medidas física 5. Venenos (litio, etilenglicol,biguanidas, etanol,metanol)

In the clinical praxis seems to exist a wide consensus regarding the increase of patients’ survival with FRA due to the using of continue techniques against conventional HDI. The clinical efficiency criteria prescribe that the implantation model might be “open” and collaborative between Nephrology and Acute Patients Unities both at the medical and nursing levels. The indications of TCDE are: INDICATIONS OF TCDE IN THE CRITICAL PATIENT A. TCDE as a substituted treatment of the renal function 1. Hydro-electrolytic alterations correction • Severe metabolic acidosis • Severe hyperkalemia • Sodium alterations 2. Glomerular filtration decrease (retention of nitrogen products) 3. Acute Renal Failure B. TCDE as a renal support (with or without FRA) 1. ARDS 3. SIRS 4. Hyperthermia or hypothermia non controlled by physical measures 5. Poisoning (litio, etilenglicol,biguanidas, etanol,metanol) ARDS (Adult respiratory distress syndrome) ; SIRS (Systemic inflamatory response syndrome)

Acción hipouricemiante de Losartan® en el trasplante renal

No disponible

[Focal and segmentary necrotizing glomerulonephritis in rheumatoid arthritis. Description of 2 cases]. / Glomerulonefritis necrotizante focal y segmentaria en la artritis reumatoide. Descripción de dos casos.

Two patients diagnosed of seropositive Rheumatoid Arthritis, developed severe renal failure associated in one case to alveolar hemorrhage. The renal histological study showed in both patients Focal and Segmentary Necrotizing Glomerulonephritis, with extracapillary proliferation. There were no evidences of concomitant diseases or nephrotoxic pharmacological therapy in the two patients. The first patient had a positive response to the corticosteroid and immunosuppressive therapy, whereas the second patient developed an irreversible renal failure. We think that this complication, although extremely rare, must be taken into account in all patients with Rheumatoid Arthritis presenting a quick and sudden impairment of his renal function.