Rastreamento de doença renal em pacientes com Diabetes Mellitus na atenção primaria de saúde / Kidney disease screening in patients with Diabetes Mellitus in primary health care / Seguimiento de enfermedad renal en pacientes con Diabetes Mellitus en la atención primaria de salud

Objetivo: determinar a ocorrência de albuminúria aumentada em pacientes com Diabetes Mellitus tipo 2. Método: estudo quantitativo e transversal. A amostra de conveniência foi constituída por 46 pacientes, atendidos em um serviço de atenção primaria de saúde, no município de Macapá, Amapá, em 2012. A coleta de dados ocorreu no período de março a julho de 2012, utilizou-se formulário para registro das variáveis demográficas (sexo e idade) e clínicas (tratamento para o Diabetes Mellitus, hemoglobina glicada A1c, albuminúria de 24 horas e índice albumina-creatinina). Os dados foram analisados por meio de estatística descritiva. O projeto foi aprovado por Comitê de Ética em Pesquisa. Resultados: dos 46 participantes, 4,3% apresentaram albuminas aumentada no exame de urina de 24 horas e 19,6%, no índice albumina-creatinina. Conclusão:os resultados ratificam a importância do rastreamento anual de doença renal com vistas ao diagnóstico e tratamento precoce, no intuito de retardar a progressão da doença.

Objective: to determine the occurrence of elevated albumin in patients with type 2 Diabetes Mellitus. Method: this quantitative, cross-sectional study considered a convenience sample of 46 patients treated at a primary care health service in Macapá, Amapá, in 2012. Data were collected from March to July 2012, using a form to record demographic (sex and age) and clinical variables (treatment for DM, HbA1c, 24-hour albuminuria and albumin-creatinine ratio). Data were analyzed using descriptive statistics. The project was approved by the research ethics committee. Results: of the 46 patients with diabetes investigated, 4.3% had elevated albumin in 24-hour urinalysis and a 19,6% albumin-creatinine ratio. Conclusion: these results confirm the importance of annual screening for kidney disease with a view to early diagnosis and treatment in order to slow the progression of the disease.

Objetivo: determinar la presencia de albuminuria elevada en pacientes con Diabetes Mellitus tipo 2. Método: estudio cuantitativo y transversal. La muestra de conveniencia fue constituida por 46 pacientes, atendidos en un servicio de salud de atención primaria en la ciudad de Macapá, Amapá, en 2012. La recolección de datos tuvo lugar en el período de marzo a julio de 2012, se utilizó el formulario para el registro de las variables demográficas (sexo y edad) y clínicas (tratamiento para la Diabetes Mellitus, la Hemoglobina glicosilada A1c, la albuminuria de 24 horas y la relación albúmina-creatinina). Los datos se analizaron por medio de estadística descriptiva. El proyecto fue aprobado por Comité de Ética en Investigación. Resultados: de los 46 pacientes investigados, el 4,3% presentó aumento de albuminas en el análisis de orina de 24 horas y el 19,6% en la tasa albúmina-creatinina. Conclusión: los resultados confirman la importancia del seguimiento anual de la enfermedad renal con vistas al diagnóstico y el tratamiento precoz, con el fin de retardar la progresión de la enfermedad.

Clinical epidemiology of cardiovascular disease in chronic kidney disease.

The public health importance of chronic kidney disease (CKD) has only come to be appreciated in the last decade. While glomerular filtration rate (GFR) and urinary albumin creatinine levels are highly predictive of mortality, thresholds that may be useful for screening may be much closer to 'normal' than generally recognised. When optimising the balance between true negative and true positive mortality prediction, GFR from creatinine and GFR from cystatin C and albumin creatinine ratios all seem to perform similarly. Among the older population, mortality rates with creatinine-based GFR are lowest for those with levels between 60 and 90 ml/min/1.73 m(2), unlike with GFR from cystatin C, where mortality rates climb monotonically with declining GFR. Thus, the validity of creatinine-based GFR in older community-dwelling individuals is questionable. Nationally, representative data suggest management of modifiable cardiovascular risk factors in adults with CKD is far from optimal. This paper explores the possibility that robust associations between declining kidney function and cardiovascular outcomes could be caused by an unknown, confounding, shared-risk factors and extrapolates findings from renal transplant donor populations to support this hypothesis.

Preventing diabetic nephropathy: the role of primary care.

Diabetic nephropathy is the leading cause of end-stage renal disease in the United States and is associated with significant human and economic cost. It is recognized that care of the person with diabetes should be focused on the prevention of the many devastating long-term complications of the disease. The primary care provider is in a key position to implement good preventive care. Monitoring for microalbuminuria is the accepted method for identifying early nephropathy. Individual providers need to be aware of current guidelines for performing screening exams. Once early nephropathy is detected, prudent care with tight glycemic control, angiotension-converting enzyme therapy, control of hypertension, and lifestyle risk-factor modification are warranted. Currently, there is strong indication that the progression of renal disease can be slowed with appropriate early interventions. Positive outcomes are dependent on timely detection of microalbuminuria.