Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.02.007
{"title":"Nefropatía IgA tras tratamiento prolongado con infliximab por enfermedad de Crohn, a propósito de dos casos","authors":"","doi":"10.1016/j.nefro.2023.02.007","DOIUrl":"10.1016/j.nefro.2023.02.007","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 599-601"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000346/pdfft?md5=460d082aa65d39675f6b0cefc16b4077&pid=1-s2.0-S0211699523000346-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46354041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2022.12.007
{"title":"Uno de los pocos casos reportados de glomerulonefritis fibrilar en nefropatía lúpica","authors":"","doi":"10.1016/j.nefro.2022.12.007","DOIUrl":"10.1016/j.nefro.2022.12.007","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 590-592"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699522002041/pdfft?md5=fafb2e38e18e34235a006f8e13a96f0f&pid=1-s2.0-S0211699522002041-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43075099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.03.006
{"title":"Hodgkin lymphoma in a patient with kidney transplantation","authors":"","doi":"10.1016/j.nefro.2023.03.006","DOIUrl":"10.1016/j.nefro.2023.03.006","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 601-603"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000450/pdfft?md5=516d571beaeae8fddd4279c0806d7c54&pid=1-s2.0-S0211699523000450-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49068428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.10.006
{"title":"Epidemiología, comportamiento clínico y pronóstico de la patología glomerular asociada a infección o vacunación del SARS-CoV-2: nuestra experiencia","authors":"","doi":"10.1016/j.nefro.2023.10.006","DOIUrl":"10.1016/j.nefro.2023.10.006","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 582-583"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001716/pdfft?md5=8925b329eb61a74cdef5e270bf82e935&pid=1-s2.0-S0211699523001716-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.05.003
{"title":"Glomerulonefritis fibrilar: ¿Más frecuente de lo que parece? La importancia de la inmunohistoquímica en el diagnóstico","authors":"","doi":"10.1016/j.nefro.2023.05.003","DOIUrl":"10.1016/j.nefro.2023.05.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 608-611"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000723/pdfft?md5=0c8b85f9a2ec17557ec412d33c6de6e4&pid=1-s2.0-S0211699523000723-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47887926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2024.01.002
Introduction and aim
Hepatitis C virus infection and chronic kidney disease are major public health issues all over the world. It has been suggested a role of HCV as a risk factor for the development and progression of chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) in the general population but conflicting findings have been given.
Material and methods
A systematic review of the published medical literature was conducted to assess whether positive HCV serologic status is associated with greater rate of proteinuria in the adult general population. We used a random-effect model to generate a summary estimate of the relative risk of proteinuria with HCV across the published studies.
Results
We identified 23 studies (n = 198,967 unique patients) and performed separate meta-analyses according to the study design. Overall effect estimate was significant in cross-sectional (OR, 1.47, 95%CI, 1.3; 1.66) (P < 0.001) and obvious between-study heterogeneity was observed (Q value by Chi-squared [χ2] test 27.3, P = 0.02). The risk of proteinuria after exposure to HCV was also consistent among longitudinal studies (HR, 1.79, 95% CI, 1.17; 2.74) (P < 0.001) and between-study heterogeneity occurred (Q value, 27.82 by X2 test, P = 0.0001). Stratified analysis did not report heterogeneity in several comparisons-pooling studies based on urine protein/creatinine ratio (UACR) showed that the adjusted OR with HCV was 1.64 (95% CI, 1.41; 1.91, P < 0.001) without heterogeneity (Q value by Chi-squared [χ2] test 9.98, P = NS). Meta-regression recorded a link between greater prevalence of proteinuria in males with HCV exposure (P = 0.03). Studies based on univariate analysis (n = 6, n = 72, 551 unique patients) gave similar results, pooled OR 1.54 (95% CI, 1.08; 2.19) (P = 0.0001).
Conclusions
An important relationship between HCV infection and higher risk of proteinuria in the general population exists. Research aimed to understand the biological mechanisms underlying such association is under way. We encourage to screen all patients with HCV exposure for proteinuria.
{"title":"Hepatitis C virus infection is associated with proteinuria according to a systematic review with meta-analysis","authors":"","doi":"10.1016/j.nefro.2024.01.002","DOIUrl":"10.1016/j.nefro.2024.01.002","url":null,"abstract":"<div><h3>Introduction and aim</h3><p>Hepatitis C virus infection and chronic kidney disease are major public health issues all over the world. It has been suggested a role of HCV as a risk factor for the development and progression of chronic kidney disease (defined by reduced glomerular filtration rate and/or detectable proteinuria) in the general population but conflicting findings have been given.</p></div><div><h3>Material and methods</h3><p>A systematic review of the published medical literature was conducted to assess whether positive HCV serologic status is associated with greater rate of proteinuria in the adult general population. We used a random-effect model to generate a summary estimate of the relative risk of proteinuria with HCV across the published studies.</p></div><div><h3>Results</h3><p>We identified 23 studies (<em>n</em> <!-->=<!--> <!-->198,967 unique patients) and performed separate meta-analyses according to the study design. Overall effect estimate was significant in cross-sectional (OR, 1.47, 95%CI, 1.3; 1.66) (<em>P</em> <!--><<!--> <!-->0.001) and obvious between-study heterogeneity was observed (<em>Q</em> value by Chi-squared [<em>χ</em><sup>2</sup>] test 27.3, <em>P</em> <!-->=<!--> <!-->0.02). The risk of proteinuria after exposure to HCV was also consistent among longitudinal studies (HR, 1.79, 95% CI, 1.17; 2.74) (<em>P</em> <!--><<!--> <!-->0.001) and between-study heterogeneity occurred (<em>Q</em> value, 27.82 by <em>X</em><sup>2</sup> test, <em>P</em> <!-->=<!--> <!-->0.0001). Stratified analysis did not report heterogeneity in several comparisons-pooling studies based on urine protein/creatinine ratio (UACR) showed that the adjusted OR with HCV was 1.64 (95% CI, 1.41; 1.91, <em>P</em> <!--><<!--> <!-->0.001) without heterogeneity (<em>Q</em> value by Chi-squared [<em>χ</em><sup>2</sup>] test 9.98, <em>P</em> <!-->=<!--> <!-->NS). Meta-regression recorded a link between greater prevalence of proteinuria in males with HCV exposure (<em>P</em> <!-->=<!--> <!-->0.03). Studies based on univariate analysis (<em>n</em> <!-->=<!--> <!-->6, <em>n</em> <!-->=<!--> <!-->72, 551 unique patients) gave similar results, pooled OR 1.54 (95% CI, 1.08; 2.19) (<em>P</em> <!-->=<!--> <!-->0.0001).</p></div><div><h3>Conclusions</h3><p>An important relationship between HCV infection and higher risk of proteinuria in the general population exists. Research aimed to understand the biological mechanisms underlying such association is under way. We encourage to screen all patients with HCV exposure for proteinuria.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 486-495"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S021169952400002X/pdfft?md5=cb7687c6d17c6e9285a9c8d1fbdef5ce&pid=1-s2.0-S021169952400002X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.05.010
Background and objective
Extracellular vesicles (EVs) reflect the pathophysiological state of their cells of origin and are a reservoir of renal information accessible in urine. When biopsy is not an option, EVs present themselves as sentinels of function and damage, providing a non-invasive approach. However, the analysis of EVs in urine requires prior isolation, which slows down and hinders translation to clinical practice. The aim of this study is to show the applicability of the “single particle interferometric reflectance imaging sensor” (SP-IRIS) technology through the ExoView® platform for the direct analysis of urine EVs and proteins involved in renal function.
Materials and methods
The ExoView® technology enables the quantification and phenotyping of EVs present in urine and the quantification of their membrane and internal proteins. We have applied this technology to the quantification of urinary EVs and their proteins with renal tubular expression, amnionless (AMN) and secreted frizzled-related protein 1 (SFRP1), using only 5 μl of urine. Tubular expression was confirmed by immunohistochemistry.
Results
The mean size of the EVs analysed was 59 ± 16 nm for those captured by tetraspanin CD63, 61 ± 16 nm for those captured by tetraspanin CD81, and 59 ± 10 nm for tetraspanin CD9, with CD63 being the majority EVs subpopulation in urine (48.92%). The distribution of AMN and SFRP1 in the three capture tetraspanins turned out to be similar for both proteins, being expressed mainly in CD63 (48.23% for AMN and 52.1% for SFRP1).
Conclusions
This work demonstrates the applicability and advantages of the ExoView® technique for the direct analysis of urine EVs and their protein content in relation to the renal tubule. The use of minimum volumes, 5 μl, and the total analysis time not exceeding three hours facilitate the translation of EVs to daily clinical practice as source of diagnostic information.
{"title":"La orina más allá de los electrolitos: diagnóstico a través de las vesículas extracelulares","authors":"","doi":"10.1016/j.nefro.2023.05.010","DOIUrl":"10.1016/j.nefro.2023.05.010","url":null,"abstract":"<div><h3>Background and objective</h3><p>Extracellular vesicles (EVs) reflect the pathophysiological state of their cells of origin and are a reservoir of renal information accessible in urine. When biopsy is not an option, EVs present themselves as sentinels of function and damage, providing a non-invasive approach. However, the analysis of EVs in urine requires prior isolation, which slows down and hinders translation to clinical practice. The aim of this study is to show the applicability of the “single particle interferometric reflectance imaging sensor” (SP-IRIS) technology through the ExoView® platform for the direct analysis of urine EVs and proteins involved in renal function.</p></div><div><h3>Materials and methods</h3><p>The ExoView® technology enables the quantification and phenotyping of EVs present in urine and the quantification of their membrane and internal proteins. We have applied this technology to the quantification of urinary EVs and their proteins with renal tubular expression, amnionless (AMN) and secreted frizzled-related protein 1 (SFRP1), using only 5<!--> <!-->μl of urine. Tubular expression was confirmed by immunohistochemistry.</p></div><div><h3>Results</h3><p>The mean size of the EVs analysed was 59<!--> <!-->±<!--> <!-->16<!--> <!-->nm for those captured by tetraspanin CD63, 61<!--> <!-->±<!--> <!-->16<!--> <!-->nm for those captured by tetraspanin CD81, and 59<!--> <!-->±<!--> <!-->10 nm for tetraspanin CD9, with CD63 being the majority EVs subpopulation in urine (48.92%). The distribution of AMN and SFRP1 in the three capture tetraspanins turned out to be similar for both proteins, being expressed mainly in CD63 (48.23% for AMN and 52.1% for SFRP1).</p></div><div><h3>Conclusions</h3><p>This work demonstrates the applicability and advantages of the ExoView® technique for the direct analysis of urine EVs and their protein content in relation to the renal tubule. The use of minimum volumes, 5<!--> <!-->μl, and the total analysis time not exceeding three hours facilitate the translation of EVs to daily clinical practice as source of diagnostic information.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 503-508"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000796/pdfft?md5=ca353debbe51ddc7a75b81da32ee8110&pid=1-s2.0-S0211699523000796-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44072154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.03.008
<div><h3>Background and objectives</h3><p>Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed.</p></div><div><h3>Material and method</h3><p>In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality.</p></div><div><h3>Results</h3><p>Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60–78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.</p><p>The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4–10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (<em>p</em> <!--><<!--> <!-->0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55).</p></div><div><h3>Conclusions</h3><p>Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor
{"title":"Caracterización de la población con fracaso renal agudo durante la hospitalización por COVID-19 en España: tratamiento renal sustitutivo y mortalidad. Datos del Registro FRA-COVID SEN","authors":"","doi":"10.1016/j.nefro.2023.03.008","DOIUrl":"10.1016/j.nefro.2023.03.008","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed.</p></div><div><h3>Material and method</h3><p>In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality.</p></div><div><h3>Results</h3><p>Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60–78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.</p><p>The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4–10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (<em>p</em> <!--><<!--> <!-->0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55).</p></div><div><h3>Conclusions</h3><p>Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor ","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 527-539"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9712480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.05.006
The multidimensional view of the disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide multidisciplinary care tailored to the needs of each individual.
Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute settings, potentially irreversible situations or interventions that do not improve life expectancy.
To ensure excellence in care, it is important to assess indicators of palliative care and renal support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families.
Palliative and renal care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.
{"title":"Nomenclatura en cuidados paliativos y de soporte renal: no solo al final de la vida","authors":"","doi":"10.1016/j.nefro.2023.05.006","DOIUrl":"10.1016/j.nefro.2023.05.006","url":null,"abstract":"<div><p>The multidimensional view of the disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide multidisciplinary care tailored to the needs of each individual.</p><p>Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute settings, potentially irreversible situations or interventions that do not improve life expectancy.</p><p>To ensure excellence in care, it is important to assess indicators of palliative care and renal support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families.</p><p>Palliative and renal care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 475-485"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523000759/pdfft?md5=7a65592a70a3af314bc17be1c832e04a&pid=1-s2.0-S0211699523000759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46133631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.nefro.2023.12.005
Classically, aldosterone actions are associated with the stability of the effective circulating volume and with blood pressure control, while parathormone actions are linked to bone mineral metabolism, calcium, and phosphate homeostasis. Nevertheless, the relationship between these two hormonal axes surpasses these areas. A bidirectional interrelation between calcium-phosphorus metabolism and blood pressure control can lead to alterations in both. This can have significant implications for the evolution and treatment of patients. To illustrate this relationship, we present two clinical cases that demonstrate the pathophysiology involved.
{"title":"Hiperaldosteronismo e hiperparatiroidismo. Una amistad inquietante","authors":"","doi":"10.1016/j.nefro.2023.12.005","DOIUrl":"10.1016/j.nefro.2023.12.005","url":null,"abstract":"<div><p>Classically, aldosterone actions are associated with the stability of the effective circulating volume and with blood pressure control, while parathormone actions are linked to bone mineral metabolism, calcium, and phosphate homeostasis. Nevertheless, the relationship between these two hormonal axes surpasses these areas. A bidirectional interrelation between calcium-phosphorus metabolism and blood pressure control can lead to alterations in both. This can have significant implications for the evolution and treatment of patients. To illustrate this relationship, we present two clinical cases that demonstrate the pathophysiology involved.</p></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"44 4","pages":"Pages 496-502"},"PeriodicalIF":2.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0211699523001935/pdfft?md5=4ec3f743a73ccba737f063bdd274e285&pid=1-s2.0-S0211699523001935-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139394051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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