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      Rápida progresión de la enfermedad renal crónica en población peruana - réplica Translated title: Rapid progression of chronic kidney disease in the peruvian population - reply

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          Documento de la Sociedad Española de Nefrología sobre las guías KDIGO para la evaluación y el tratamiento de la enfermedad renal crónica

          Las nuevas guías internacionales del consorcio KDIGO (Kidney Disease: Improving Global Outcomes) sobre la enfermedad renal crónica (ERC) y sobre el manejo de la presión arterial (PA) en pacientes con ERC constituyen la actualización de las correspondientes guías KDOQI (Kidney Disease Outcomes Quality Initiative) de 2002 y 2004. El objetivo de estos documentos es ofrecer una guía actualizada para el diagnóstico, la evaluación, el manejo y el tratamiento del paciente con ERC. La primera guía conserva la definición de ERC de 2002, pero ofrece una clasificación pronóstica mejorada. Además, se revalúan los conceptos sobre el pronóstico de la ERC, y se establecen recomendaciones para el manejo de los pacientes y sobre los criterios de derivación al especialista en nefrología. La segunda guía conserva el objetivo de una PA 300 mg/g), pero recomienda el objetivo menos estricto de PA < 140/90 mmHg para pacientes con albuminuria normal. El desarrollo de las guías siguió un proceso predeterminado de revisión y evaluación de las evidencias disponibles. Las recomendaciones sobre el manejo y el tratamiento están basadas en la revisión sistemática de los estudios relevantes. El sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) se utilizó para evaluar la calidad de la evidencia y emitir el grado de recomendación. También se discuten las áreas de incertidumbre de los distintos aspectos tratados.
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            Nephrotic Proteinuria as a Result of Essential Hypertension

            Background: The presence of nephrotic-range proteinuria in a nondiabetic hypertensive patient is generally indicative of an underlying glomerular disease. A few published reports have noted nephrotic proteinuria in some patients with hypertensive nephrosclerosis. The frequency of this association is unknown. Methods: We retrospectively reviewed renal biopsy reports on all cases of nephrotic syndrome over an 8-year period (1993–2000). We excluded all cases of diabetes mellitus, lupus, hepatitis, human immunodeficiency virus, and chronic use of nonsteroidal anti-inflammatory drugs. Biopsy specimens showing glomerular eosinophilic hyalinosis lesions, positive immunofluorescence staining, or dense deposits on electron microscopy were also excluded. Thirteen of the remaining 237 (5.5%) biopsy specimens satisfied the standard histological criteria for hypertensive nephrosclerosis. Results: All patients were African-Americans with a mean age of 47.5 ± 13 years and an average mean arterial blood pressure of 122 ± 19 mm Hg. The mean values for urinary protein excretion, serum creatinine, albumin, and cholesterol were 8.9 g/day, 3.3 mg/dl, 3.1 g/dl, and 245 mg/dl, respectively. Optimal blood pressure control required at least three antihypertensive agents. Progression to end-stage renal disease occurred over a mean duration of 8.3 ± 6.5 months. Multivariate regression showed a strong but nonsignificant association between the level of proteinuria at the time of biopsy, duration of hypertension, and number of blood pressure medications (R 2 = 0.56, p = 0.38). Conclusions: Nephrotic syndrome may be more common in poorly controlled essential hypertension than previously realized. In African-American patients, the differential diagnosis of nephrotic syndrome should include hypertensive nephrosclerosis, but abrogation of renal biopsy is not implied.
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              Nefroangioesclerosis hipertensiva, a propósito de un caso con proteinuria en rango nefrótico, sin hipoalbuminemia ni edemas

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rins
                Revista Peruana de Medicina Experimental y Salud Publica
                Rev. perú. med. exp. salud publica
                Instituto Nacional de Salud (Lima, , Peru )
                1726-4634
                September 2017
                : 34
                : 3
                : 570-571
                Affiliations
                Lima orgnameHospital Nacional Edgardo Rebagliati Martins orgdiv1Departamento de Nefrología orgdiv2Unidad de Salud Renal Perú
                Article
                S1726-46342017000300570
                10.17843/rpmesp.2017.343.3098

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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