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Introduction

Few studies have evaluated the functional and mental status of older persons with chronic kidney disease (CKD) not under dialysis. The aim of this study was to determine functional and mental status in a cohort of older patients with distinct degrees of renal function.

Methods

A total of 54 clinically stable, older individuals were included (74.1% women) from geriatric and nephrology consultations. We established 2 groups according to levels of glomerular filtration rate (GFR) calculated on the basis of the Modification of Diet in Renal Disease (MDRD) equation: Group 1 (n = 17: MDRD ≥ 60 ml/min) and group 2 (n = 37: MDRD < 60 ml/min).

Mental and functional status were analyzed in a cross section between January and April, 2008 in older patients attending consultations since 2006. We registered demographic information, renal function parameters, antecedents of vascular disease, and the type of antihypertensive treatment. We analyzed the results of the Barthel Index (BI) and the mini–mental state examination (MMSE). The statistical analysis was carried out with the SPSS 11.0 program.

Results

There were no significant differences in vascular comorbidities or antihypertensive treatment. MMSE scores were lower in group 2 (22.62 ± 10) than in group 1 (28.4 ± 4) (P=.010). No differences were found in functional status between the 2 groups. The results of the BI and the MMSE showed no correlations with renal function parameters. The results of the Barthel Index correlated with those of the MMSE (r =.74; P=.000). The results of the MMSE were inversely correlated with age (r =−0.27; P=.047).

Conclusions

The results of this study suggest a possible association between renal disease and cognitive deterioration in older individuals.

IgA nephropathy is a common pattern of glomerulonephritis defined by mesangial IgA deposits. Rapidly progressive renal failure is unusual in IgA nephropathy; it may result from acute tubular necrosis or superimposed crescentic nephritis. In this uncommon situation, the risk–benefit balance is most strongly in favour of intense immunosuppressive therapy because if crescentic IgA nephritis is not treated, there will almost inevitably be rapid progression to end-stage renal disease. We report the clinical and histological features of a patient with crescentic IgA nephropathy treated successfully with intensive immunosuppression.

Introduction

Tubulointerstitial nephritis associated with the BK virus is a complication of kidney transplantation. Markers of BK virus replication include the presence of viral inclusions called «Decoy cells» in urine cytology and high titers of ADN viral load in plasma, urine, and renal tissue.

Objective

To evaluate the diagnostic utility of urine cytology for the early identification of BK virus infection by using 3 different types of cytological screening.

Results

Urinary cytology as a diagnostic test showed high sensitivity (81.4%) in identifying renal transplant recipients with BK virus infection. Specificity was only 22.6%. The 3 methods of urine cytology screening appeared to have similar effectiveness in quantifying cell density.

Conlusions

Urine cytology is a reliable test for the detection of Decoy cells but is not diagnostic. Irrespective of the screening method used, detection of Decoy cells may be an indirect and sensitive method for estimating the existence of BK viral replication, although urinary polymerase chain reaction and kidney biopsy have greater specificity in the diagnosis of BK virus nephritis.

One of the most important health goals in the last 40 years has been that more people with end stage renal disease (ESRD), especially elderly patients, survive because of the better access to dialysis.

Nevertheless, dialysis as renal substitution therapy of it is not risk-free. It has important limitations and morbidity and mortality for patients and it significantly affects the quality of life perceived by the patients and their families. Dialysis with high technical standards may improve the biomedical parameters of these patients, but it does not not necessarily mean that it enhances their quality of life.

In this context, the search for new models of healing, more focused on the sick person than on the treatment, has made it possible to integrate palliative medicine principles into the care of the renal patient. The main purposes of this model are conceived to provide an increase in the quality of life of the patients and to respond to the affective-emotional, social and spiritual aspects related to the disease. The inclusion of this new model would allow several problems that affect the renal patients to be addressed in a more integrated and appropriate manner: to manage pain relief and the symptoms associated with the dialysis therapy; the ethical dilemmas related to the appropriate initiation of and withdrawal from dialysis; and the support during the process of dying and mourning in the final phases of the ESRD.

Several scientific societies and organizations in nephrology around the world have adopted this model of work, promoting the integration of palliative care support into nephrology/dialysis units and nephrology fellowship training program curricula.

We present the case of female patient, aged 19, who developed progressive anemia at 4 weeks of receiving renal allograft, which is accentuated by a change in hemoglobin level from 11.3 to 3.7 g/dl, in anemic syndrome developing is decided transfuse. All routine laboratories were reported as normal except line erythrocyte normochromic normocytic anemia and severe reticulocytopenia which prompted a search of parvovirus B19 and performing a bone marrow aspirate showed pure red cell aplasia. Quantification of viral DNA was reported to > 100,000,000 copies/ml, so she was treated with intravenous gamma globulin for 5 days, which resolved completely without recurrence. At all times the renal function remained normal. As part of the study considering thoracic tomography association with red cell aplasia thymoma, which confirmed the suspect, however, assessing risk/benefit ratio and due to the absence of weakness syndrome or other tracking finding decided paraneoplastic imaging with scheduling of elective thymectomy.

Background

Renal biopsy is the gold standard for the diagnosis of kidney diseases. Our aim was to analyze the indications, safety and histopathological results of renal biopsy in persons aged 65 years or older, divided into 2 groups: a group of elderly patients (aged 65 to 79 years) and a group of very elderly patients (80 years or more).

Material and methods

We carried out a descriptive retrospective study of 79 native renal biopsies performed in persons aged 65 years or older in the General Hospital of Segovia between 2004 and 2012. Overall, the mean age of the patients was 76.50 ± 5.6 years (range 66-89 years); 58.2% were men and 41.8% were women. Renal biopsy was performed percutaneously under ultrasound guidance in real time, using a 16 G automatic needle. The statistical analysis was performed with SPSS 15.0.

Results

A total of 45.4% of the renal biopsies performed in our hospital corresponded to persons aged 65 years or more: 76% in elderly patients and 24% in very elderly patients. Overall, diagnosis was based on renal biopsy alone in 93.7% of the patients. The mean number of glomeruli per renal biopsy was 10.91 ± 6 (range, 2-29). There were only 2 major complications. The main indications for renal biopsy were acute renal failure/rapidly progressive renal failure and nephrotic syndrome. IgA nephritis was found only in the group aged 65-79 years. There were no cases of lupus nephritis.

Conclusions

According to our data, renal biopsy is a safe and effective procedure that is less frequently performed in persons aged 80 years old or older.