Bases clínicas y genéticas de la nefroesclerosis hipertensiva. Estudio NEFROSEN / Clinical and genetic bases of hypertensive nephrosclerosis. NEFROSEN Study

Justificación: Se conoce como nefroesclerosis la enfermedad renal crónica (ERC) que complica la hipertensión arterial (HTA) esencial. La ausencia de correlación entre el control de la HTA y la progresión a ERC terminal sugiere la existencia de una enfermedad intrínseca y primitiva. Recientemente se ha asociado con polimorfismos del gen MYH9 en individuos afroamericanos. El objetivo del trabajo que presentamos es determinar si algún polimorfismo de dicho gen se relaciona en raza caucásica con la asociación de HTA esencial y nefroesclerosis y, además, conocer los marcadores de progresión a ERC terminal. Será un estudio retrospectivo que comparará a pacientes con nefroesclerosis frente a pacientes con HTA esencial sin enfermedad renal y, además, se incluirán pacientes con nefroesclerosis y progresión de la enfermedad renal frente a los que se mantienen estables. Métodos: Entre octubre de 2009 y octubre de 2010 se incluirán 500 pacientes con ERC (estadios 3-5) atribuida a nefroesclerosis según criterios clínicos habituales, y 300 pacientes afectados de HTA esencial (FGe >60ml/min/1,73 m2; microalbuminuria <300 mg/g). Para el estudio genético también se incluirán 200 controles sanos de población general. Habrá dos cortes del estudio, la primera visita en el hospital y la visita final (en estadio 5 el inicio del tratamiento sustitutivo constituirá el final del seguimiento). Se registrarán datos clínicos y analíticos, y se recogerán muestras de sangre para el estudio genético. Discusión: Nuestro estudio, con la doble vertiente genética y clínica, tratará de determinar si en la raza caucásica existe relación entre el diagnóstico de nefroesclerosis y el gen MYH9, y estudiará, además, los posibles marcadores de progresión (AU)

Background: Hypertensive nephrosclerosis is a chronic kidney disease (CKD) associated to essential hypertension. The lack of correlation between strict control of hypertension and progression of CKD suggests an intrinsic and primary disease. New evidence suggests that MYH9 gene alterations are associated with nephrosclerosis in African Americans. The aim of this study is to investigate whether a polymorphism of MYH9 in Caucasians is linked to the association of essential hypertension and nephrosclerosis. The secondary objective is to identify the clinical risk factors of progression to end-stage renal disease (ESRD). This is a retrospective study that will compare patients with nephrosclerosis versus essential hypertensives without renal disease, and also patients with nephrosclerosis and impaired rena l function versu s those that are stable .Methods: Between October 2009 and October 2010, 500patients stages 3-5 CKD attributed to nephrosclerosis according to usual clinical criteria, and 300 essential hypertensives (eGFR > 60 mL/min/1.73m2; mi c roalbuminur ia<300 mg/g) will be recruited. 200 healthy controls from general population will also be included for the genetic study. There will be two sections of the study, first and final visit to the clinic (stage 5, the start of replacement therapy will be the end of follow-up). Clinical and laboratory data will be recorded, and blood samples will be collected. Discussion: Our study will seek to determine if there exists a relationship between the diagnosis of nephrosclerosis and MYH9 gene in the Caucasian race, and to study possible risk factors for progression to ESRD, on both clinical and genetic basis (AU)

[Clinical and genetic basis of hypertensive nephrosclerosis. NEFROSEN Study]. / Bases clínicas y genéticas de la nefroesclerosis hipertensiva. Estudio NEFROSEN.

BACKGROUND: Hypertensive nephrosclerosis is a chronic kidney disease (CKD) associated with essential hypertension. The lack of correlation between hypertension control and progression to end-stage CKD suggests an intrinsic and primitive disease. New evidence suggests that MYH9 gene alterations are associated with polymorphisms in African Americans. The aim of this study is to investigate whether a polymorphism of MYH9 in Caucasians is linked to essential hypertension and nephrosclerosis. The secondary objective is to identify the clinical risk factors of progression to end-stage CKD. This is a retrospective study that will compare patients with nephrosclerosis and essential hypertensives without renal disease, and also patients with nephrosclerosis and impaired renal function with those that are stable. METHOD: Between October 2009 and October 2010, 500 patients with stages 3-5 CKD attributed to nephrosclerosis according to usual clinical criteria, and 300 essential hypertensives (eGFR>60 mL/min/1.73 m2; microalbuminuria <300 mg/g) are to be recruited. A total of 200 healthy controls from the general population are also to be included for the genetic study. There are two study sections, being the first and final visits to the clinic (for stage 5 cases, the start of replacement therapy will be the end of follow-up). Clinical and laboratory data will be recorded, and blood samples will be collected. DISCUSSION: Our study will aim to determine if there is a relationship between the diagnosis of nephrosclerosis and the MYH9 gene in Caucasians, and to study possible risk factors for progression to end-stage CKD, on both clinical and genetic bases.

[Treating high blood pressure in kidney patients: evidence and implications]. / Tratamiento de la hipertensión arterial en pacientes con enfermedad renal crónica. Evidencias e implicaciones.

The main aim delaying progression of chronic kidney disease (CKD) are tight control of blood pressure to levels below 130/80 mmHg and reductioner 24-h urine protein to <0.5 g or microalbuminuria to <300 mg/g. First-line agents for renoprotection are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers at the highest tolerated dose. The combination of these types of drugs, the so-called dual blockade, further reduces an elevated urinary albumin or protein excretion but, at least in patients at high cardiovascular risk, does not delay progression of renal failure. An intensified multifactorial intervention is necessary for renal patients because 35 to 50% of cases with grade 3 or 4 CKD are prone to premature complications such as end-stage renal disease and/or cardiovascular events. New strategies to block the renin-angiotensin system could be of help in improving of outcomes in CKD patients.

Tratamiento de la hipertensión arterial en pacientes con enfermedad renal crónica. Evidencias e implicaciones / Treating high blood pressure in Kidney patients: evidence and implications

Los principales objetivos para diferir la progresión de la enfermedad renal crónica (ERC) son el control de la presión arterial a valores < 130/80 mmHg y de, modo independiente, la reducción de la proteinuria a cifras < 0,5 g/24 h (microalbuminuria < 300 mg/g). Los fármacos del primer escalón terapéutico son los inhibidores de la enzima de conversión de la angiotensina y los antagonistas de los receptores de la angiotensina II a las dosis máximas toleradas. La combinación de ambos incrementa su efecto antiproteinúrico, pero en pacientes con alto riesgo vascular no reduce la progresión de la insuficiencia renal. El control de los pacientes con ERC precisa de un tratamiento terapéutico multifactorial que debe establecerse de forma temprana e intensiva. Un 35-50% de pacientes con ERC de estadios 3-4 y proteinuria significativa progresan en un plazo medio a enfermedad renal terminal o mueren previamente por complicaciones cardiovasculares, por lo que pueden ser oportunas nuevas estrategias para bloquear el sistema renina-angiotensina (AU)

The main aim delaying progression of chronic kidney disease (CKD) are tight control of blood pressure to levels below 130/80 mmHg and reductioner 24-h urine proteine to < 0.5 g or microalbuminuria to < 300 mg/g. First-line agents for renoprotection are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers at the higherst toleratedose. The combination of these types of drugs, the so-called dual blockade, further reduces an elevated urinary albumin or protein excretion but, at least in patients at high cardiovascular risk, does not delay progression of renal failure. An intensified multifactorial intervention is necessary for renal patients because 35 to 50% of cases with grade 3 or 4 CKD are prone to premature complications such as end-stage renal disease and/or cardiovascular events. New strategies to block the renin-angiotensin system could be of help in improving of outcomes in CKD patients (AU)

Novedades en la Guía Europea de Hipertensión 2007 / No disponible

La Guía Europea de Hipertensión 2007 está promovida por las Sociedades Europeas de Hipertensión y de Cardiología de modo conjunto. Los cambios en relación a la Guía previa del año 2003 son escasos aunque algunos aspectos son relevantes. Quizá el más significativo sea la inclusión del síndrome metabólico como factor de riesgo cardiovascular, con una importancia similar a la diabetes mellitus o a la lesión de órgano diana. También es llamativo el reconocimiento de la enfermedad renal crónica como una condición de muy alto riesgo en el paciente hipertenso. Se describe por primera vez la hipertensión arterial (HTA)enmascarada que está presente en un 10-15% de casos y se asocia a un mayor riesgo cardiovascular. En la evaluación diagnóstica no se considera necesario el examen del fondo de ojo. La decisión sobre el comienzo del tratamiento se debe basar en las cifras de PA sistólica y diastólica y en el grado de riesgo cardiovascular globalmente considerado. El inicio de la terapéutica con fármacos debe ser precoz. La demora para verificar la respuesta a las medidas no farmacológicas debe ser sólo de algunas semanas y no de meses como se establecía previamente. Cualquiera de los cinco grandes grupos (diuréticos, betabloqueantes, calcio antagonistas, IECA y ARA-II) es válido para la primera etapa del tratamiento, aunque la elección debe ser individualizada en base a los posibles factores de riesgo y patología cardiovascular y renal asociada. Se hace una apuesta decidida por las combinaciones porque la mayoría de los pacientes precisará de más de un fármaco para su control (AU)

The 2007 European Guidelines on Hypertension are jointly sponsored by the European Society of Cardiology and the European Society of Hypertension. Changes with respect to the previous2003 Guidelines are few but some are significant. Perhaps the most significant change is inclusion of metabolic syndrome as a cardiovascular risk factor similar in importance to diabetes mellitus or target-organ damage. Also striking is the recognition of chronic kidney disease as a very high risk condition in hypertensive patients. Masked arterial hypertension (AHT) is included for the first time as a new entity that is present in 10-15% of cases and associated with increased cardiovascular risk. The eye fund us examination is no longer considered necessary in the diagnostic evaluation. The decision to start treatment should be based on systolic and diastolic BP values and on assessment of total cardiovascular risk. Drug therapy should be started early. The delay to check the response to non pharmacological measures should be only some weeks and not months as was previously established. Any of the five large groups (diuretics, beta-blockers, calcium antagonists, ACE inhibitors and angiotensin II blockers) is valid for the first stage of treatment, although the choice should be individualized based on the possible risk factors and associated cardiovascular and renal disease. The guidelines place strong emphasis on drug combinations because most patients will require more than one drug for their control (AU)

[Novelties in the European Hypertension Guide 2007. European Society of Cardiology. European Society of Hypertension]. / Novedades en la Guía Europea de Hipertensión 2007.

The 2007 European Guidelines on Hypertension are jointly sponsored by the European Society of Cardiology and the European Society of Hypertension. Changes with respect to the previous 2003 Guidelines are few but some are significant. Perhaps the most significant change is inclusion of metabolic syndrome as a cardiovascular risk factor similar in importance to diabetes mellitus or target-organ damage. Also striking is the recognition of chronic kidney disease as a very high risk condition in hypertensive patients. Masked arterial hypertension (AHT) is included for the first time as a new entity that is present in 10-15% of cases and associated with increased cardiovascular risk. The eye fundus examination is no longer considered necessary in the diagnostic evaluation. The decision to start treatment should be based on systolic and diastolic BP values and on assessment of total cardiovascular risk. Drug therapy should be started early. The delay to check the response to nonpharmacological measures should be only some weeks and not months as was previously established. Any of the five large groups (diuretics, beta-blockers, calcium antagonists, ACE inhibitors and angiotensin II blockers) is valid for the first stage of treatment, although the choice should be individualized based on the possible risk factors and associated cardiovascular and renal disease. The guidelines place strong emphasis on drug combinations because most patients will require more than one drug for their control.

Fiebre de origen desconocido y fracaso renal agudo / Unknown origin fever and acute renal failure

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Infarto renal / Renal infarction

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Hipertensión arterial, hipokaliemia grave e hiperaldosteronismo como forma de presentación de un carcinoma suprarrenal / Arterial hypertension, serious hypokaliemia and hyperaldosteronism as presentation form of adrenal gland carcinoma

No disponible

Trombosis carotída como primera manifestación de un síndrome nefrótico a cambios mínimos / Carotidartery thrombosis as the first manifestation of minimal changes nephrotic syndrome

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[Tesio catheters for long-term hemodialysis: our experience in a comarcal hospital]. / Catêteres de Tesio permanentes para realización de hemodiálisis crónica: nuestra experiencia en un hospital comarcal.

INTRODUCTION: Good vascular access remains the cornerstone of effective hemodialysis treatment. The Tesio catheters has been proposed to be a reliable source of vascular access for the dialysis patients. SUBJECTS AND METHODS: We examined all Tesio catheters inserted over a 3-year period in our hospital. We obtained age, sex, dialysis duration, original nephropaty, vascular access history, complications, dialysis parameters, catheter function duration, confort level for patients and nurses, and death in all our cases. RESULTS: 33 catheters were inserted in 30 patients, 14 male and 16 female. Age 73,92 +/- 9,22 years. Dialysis duration, 25,64 +/- 53,45 months. Diabetic nephropaty 26,66%, NAE 40%, others 33,33%. First vascular access in 13 patients (43,33%), one previously fistula, 5 patients (16,66%), and more of one FAV, 12 patients (40%). We observed two bleeding cases, eight parcial trombosis, one total trombosis (non-function), six tunneled infection and two systemic infection. Only 3 catheters were removal. We obteined good dialysis parameters. Confort state for patients and nurses were satisfactory. Death 12 patients. Catheter function at the moment of study 16,76 +/-12,99 months. CONCLUSIONS: We concluded that Tesio catheters can provide excellent long-term vascular access for hemodialysis patients, especially in the older people and with some previous failure fistulas, with low complication rates and acceptable dialysis parameters and tolerance. However, the arteriovenous fistula remains the gold standard for long-term hemodialysis access.

Catéteres de Tesio permanentes para realización de hemodiálisis crónica: nuestra experiencia en un hospital comarcal / Tesio catheters for long-term hemodialysis: our experience in a comarcal hospital

Introducción: La consecución y mantenimiento de un buen acceso vascular sigue siendo una de las piezas claves para la realización de un tratamiento dialítico adecuado. Los catéteres de Tesio están demostrando ser una opción válida de acceso vascular. Objetivos y métodos: Hemos examinado todos los catéteres de Tesio colocados en nuestra Unidad a lo largo de tres años. Hemos analizado la edad, sexo, tiempo en diálisis, nefropatía de base, accesos vasculares previos, complicaciones, parámetros dialíticos, tiempo de funcionamiento en el momento del estudio, nivel de confort de pacientes y enfermeras y fallecimientos en todos estos pacientes. Resultados: En este tiempo se han colocado 33 catéteres a 30 pacientes, 14 hombres y 16 mujeres. Edad media 73,92 ± 9,22 años. Tiempo en diálisis 25,64 ± 53,45 meses. Nefropatía diabética 26,66 5, nefroangioesclerosis (NAE) 40%, otras causas 33,33%. Primer acceso vascular en 13 pacientes (43,33%), una FAV previa en 5 (16,66%) y más de una FAV previa en 12 (40%). Hemos tenido dos casos de sangrado, ocho de trombosis parcial, uno de obstrucción total (no funcionamiento), seis infecciones de tunel u orificio y dos infecciones sistémicas. Sólo en tres casos se precisó retirada del catéter. Los parámetros de diálisis analizados han sido satisfactorios. El grado de confort de pacientes y personal de enfermería ha sido bueno. Han fallecido 12 pacientes. El tiempo medio de funcionamiento en el momento del análisis era de 16,76 ± 12,99 meses. Conclusiones: Los catéteres de Tesio pueden constituir un buen acceso vascular permanente para la hemodiálisis, especialmente en pacientes mayores y con accesos vasculares previos fallidos. Presentan pocas complicaciones, buenos parámetros de diálisis y tolerancia. En cualquier caso, la fístula arteriovenosa autóloga todavía constituye la opción más deseable

Introduction: Good vascular access remains the cornerstone of effective hemodialysis treatment. The Tesio catheters has been proposed to be a reliable source of vascular access for the dialysis patients. Subjects and methods: We examined all Tesio catheters inserted over a 3-year period in our hospital. We obtained age, sex, dialysis duration, original nephropaty, vascular access history, complications, dialysis parameters, catheter function duration, confort level for patients and nurses, and death in all our cases. Results: 33 catheters were inserted in 30 patients, 14 male and 16 female. Age 73,92 ± 9,22 years. Dialysis duration, 25,64 ± 53,45 months. Diabetic nephropaty 26,66%, NAE 40%, others 33,33%. First vascular access in 13 patients (43,33%), one previously fistula, 5 patients (16,66%), and more of one FAV, 12 patients (40%). We observed two bleeding cases, eight parcial trombosis, one total trombosis (non-function), six tunneled infection and two systemic infection. Only 3 catheters were removal. We obteined good dialysis parameters. Confort state for patients and nurses were satisfactory. Death 12 patients. Catheter function at the moment of study 16,76 ± 12,99 months. Conclusions: We conclued that Tesio catheters can provide excellent long-term vascular access for hemodialysis patients, especially in the older people and with some previous failure fistulas, with low complication rates and acceptable dialysis parameters and tolerance. However, the arteriovenous fistula remains the gold standard for long-term hemodialysis access

Enfermedad de Caroli en paciente portador de trasplante renal por poliquistosis / No disponible

No disponible