Microalbuminuria como marcador de daño renal en pacientes con hipertensión arterial / Microalbuminuria as a marker of kidney damage in patients with arterial hypertension

Introducción: La hipertensión arterial es un poderoso factor de riesgo de daño renal. La prevalencia es muy alta entre los pacientes con Enfermedad Renal Crónica. Objetivo: Determinar la presencia de Microalbuminuria y su valor como marcador de daño renal en pacientes con diagnóstico de Hipertensión arterial. Material y Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de 123 pacientes. Se determinó edad, sexo, cifras de colesterol, triglicéridos, creatinina y microalbuminuria y factores de riesgo vascular. Se utilizó la estadística descriptiva e inferencial. Resultados: El 40,7 Microalbuminuria as a marker of kidney damage in patients with arterial hypertension de los pacientes pertenecen al grupo de más de 70 años con predominio del sexo masculino (65 por ciento), 62,6 Microalbuminuria as a marker of kidney damage in patients with arterial hypertension presentaron microalbuminuria, 97,3 Microalbuminuria as a marker of kidney damage in patients with arterial hypertension tenían factores de riesgo asociados con prevalencia aumentada del tabaquismo, dislipidemia, obesidad y enfermedades vasculares asociadas con RP>1. Predominó el grupo mayor de 70 años, del sexo masculino, con presencia de microalbuminuria. La presencia de más de tres factores de riesgo se asoció a la microalbuminuria. La presencia de microalbuminuria aumentó con los años de evolución de la enfermedad. Predominó el estadio 3 de la Enfermedad Renal Crónica en los pacientes con hipertensión arterial y microalbuminuria y se relacionó directamente con los años de evolución de la hipertensión arterial. Conclusiones: La determinación de la microalbuminuria en los pacientes con hipertensión arterial es un marcador de riesgo importante y sencillo para determinar el daño renal subclínico y está muy relacionado con el incremento de la edad del paciente, años de hipertensión y asociación con otros factores de riesgo vasculares(AU)

Introduction: Arterial hypertension is a powerful risk factor for kidney damage. The prevalence is very high among patients with chronic kidney disease. Objective: To determine the presence of microalbuminuria as a marker of kidney damage in patients with arterial hypertension admitted between September 2016 and September 2017. Material and Methods: A descriptive, longitudinal, prospective study was conducted in 123 patients. Age; sex; cholesterol, triglycerides, creatinine and microalbuminuria levels and vascular risk factors were determined. Descriptive and inferential statistics were used. Results: The 40.7 percent of patients belong to the group of patients of age more than 70 years, predominating the male sex (65 percent); 62.6 percent of them presented microalbuminuria and 97.3 percent had risk factors associated with an increased prevalence of smoking, dyslipidemia, obesity, and vascular diseases associated with RP> 1. The group of patients older than 70 years, male, and with presence of microalbuminuria predominated in the study. The presence of more than three risk factors was associated with microalbuminuria. The presence of microalbuminuria increased with the years of evolution of the disease. Stage 3 of chronic kidney disease predominated in patients with arterial hypertension and microalbuminuria and it was directly related to the years of evolution of arterial hypertension. Conclusions: The determination of microalbuminuria in patients with arterial hypertension is a simple and important risk marker to determine subclinical kidney damage and it is closely related to the increase in the age of the patient, the years of hypertension, and the association with other risk factors for vascular disease(AU)

Diagnóstico de albuminuria en pacientes mayores de 55 años en una red asistencial / Albuminuria diagnosis in patients over 55 years of a care network

Objetivo. Determinar el diagnóstico de albuminuria (microalbuminuria, macroalbuminuria) en pacientes mayores de 55 a±os de la Red Asistencial Rebagliati (RAR), mediante el cociente albúmina/creatinina (A/CR). Materiales y Métodos. Se realizó un estudio transversal descriptivo durante 2012, en adultos mayores de 55 a±os de la RAR, de ambos sexos, a quienes se les realizó los test de albúmina y creatinina en orina. Se utilizó el cociente A/CR para la valoración de albuminuria (microalbuminuria, macroalbuminuria). resultadOs. Participaron en el estudio 3 943 pacientes. La mediana de edad fue 70 ± 8,96 a±os, y 57,10 % (N = 2250) fueron mujeres. El 23 % (N = 918) de pacientes presentaron albuminuria; 17,92 % (N = 706), microalbuminuria; 5,38 % (N = 212), macroalbumi nuria. El Hospital III Sußrez Angamos presentó el mayor porcentaje de pacientes con albuminuria. Cuando se evalúa la fuerza de concordancia kappa entre el método albúmina en orina y el cociente A/CR, se observa una concordancia considerable (k = 0,789) entre estos métodos diagnósticos. Conclusiones. El 23,30 % de los pacientes mayores de 55 a±os de la RAR presentaron albuminuria. Un total de 212 (5,68 %) pacientes presentó macroalbuminuria. Una intervención terapéutica a este tipo de pacientes con micro o macroalbuminuria disminuirß eficazmente el aumento de la ERC en la RAR.

Objective. To determine the diagnosis of albuminuria (microalbuminuria, macroalbuminuria) in patients over 55 years of Rebagliati Care Network (RCN) using the albumin/creatinine ratio (A/CR). Materials and Methods. We performed a cross-sectional, descriptive during 2012, in adults over 55 years of RAR, of both sexes, who have conducted tests on urine albumin and creatinine. We used the ratio A/CR for the assessment of albuminuria (microalbuminuria, macroalbuminuria). results. The study involved 3943 patients. The median age was 70 ± 8,96 years and 57,10 % (N = 2250) were women. The 23 % (N = 918) of patients had albuminuria, 17,92 % N = 706) microalbuminuria and 5,38 % (N = 212) macroalbuminuria. The Hospital III Sußrez Angamos had the highest percentage of patients with albuminuria. When evaluating the strength of Kappa between urinary albumin method versus the ratio A/CR observe a substantial concordance (k = 0,789) between these diagnostic methods. ConClusions. The 23,30 % of patients over 55 years of RCN, presented albuminuria. A total of 212 (5,68 %) patients had macroalbuminuria. A therapeutic intervention for these patients with microalbuminuria or macroalbuminuria, effectively decrease the increase of chronic kidney disease in the RCN.

Enfermedad renal crónica: Clasificación, identificación, manejo y complicaciones / Clinical guidelines on identitication, management and complications of chronic kidney disease

The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10 percent, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.

O laboratório clínico no rastreamento de doenças renais / The clinical pathology laboratory and the screening of renal diseases

Testes diagnósticos podem ser usados para rastreamento de anormalidades diversas, desde que sejam de aplicação fácil, não sejam dispendiosos, tenhamalta sensibilidade e boa especificidade. Vale ressaltar que, nesse contexto, é importante que a detecção de alguma anormalidade leve a uma conduta quealtere o prognóstico do indivíduo. Recentemente várias organizações ligadas à Nefrologia têm defendido a aplicação de procedimentos de rastreamento, com vistas à detecção precoce de pacientes com lesões renais e à adoção subseqüente de medidas que prolonguem a sobrevida do indivíduo sem necessidade de terapia substitutiva da função renal. Destacam-se entre os testes de maior aplicabilidade no rastreamento da doença renal crônica:dosagem sérica de creatinina, pesquisa de proteinúria e de microalbuminúria, e mesmo o exame completo de urina. São aqui discutidas peculiaridadesdesses testes e as situações em que seu uso está indicado para fins de triagem.

Diagnostic tests can be used for screening of several abnormalities, since they are of easy application, non expensive, and they have high specificity and sensitivity. In such context it is important that the detection of some abnormality conduct to measures with potential to change the prognosis of the indivi -dual. Recently many organizations related to Nephrology have supported the application of screening procedures in order to detect early patients with renal lesions and to use subsequently measures that increase survival of the individual without renal substitutive therapy. The tests more applicable for scree -ning of chronic renal disease are: determination of serum creatinine, proteinuria and microalbuminuria, and even a complete urinalysis. Here we discuss peculiar aspects of these tests and situations in which their use is indicated for screening.