Insufficienza renale cronica e ipertensione arteriosa

Insufficienza renale cronica e ipertensione arteriosa.

L’insufficienza renale cronica (IRC) è associata all’ipertensione arteriosa (IA) nel 22% dei casi quando è al I stadio e addirittura nell’80% dei casi quando è al IV stadio, ma non è chiaro se le sue manifestazioni cliniche e le sue complicazioni siano diverse in rapporto al fatto che l’IA sia presente o meno. Si è recentemente occupata dell’argomento un’ampia metanalisi, pubblicata su Lancet, che ha raccolto una serie di studi selezionati in accordo ai criteri del Chronic Kidney Disease Prognosis Consortium. È stato analizzato il rischio mortalità e di insufficienza renale ultimo stadio (ESRD) in rapporto al filtrato glomerulare (calcolato come eGFR) e alla proteinuria (calcolata come Rapporto Albumina/Creatinina [ACR]) in soggetti ipertesi e normotesi.

Mahmoodi BK et al. Lancet 2012; 380: 1649’61

 

Chronic kidney disease: Staging CKD: can we rely on estimated GFRs? : Article : Nature Reviews Nephrology

Chronic kidney disease: Staging CKD: can we rely on estimated GFRs? : Article : Nature Reviews Nephrology.

di Piero Ruggenenti & Giuseppe Remuzzi  

Including proteinuria in the NKF KDOQI staging system for chronic kidney disease will increase the accuracy of risk stratification, but will not improve the precision of glomerular filtration rate (GFR) estimation by prediction formulas. Using markers of glomerular filtration other than serum creatinine will hopefully enable implementation of novel formulas that more precisely estimate true GFR, especially in individuals with near-normal renal function.

 

Federal Dialysis Program Is Questioned by Kidney Specialists – NYTimes.com

Federal Dialysis Program Is Questioned by Kidney Specialists – NYTimes.com.

qualcuno comincia a pensare che mettere in dialisi persone troppo anziane possa essere un errore (e non solo per i costi)

Some Specialists Urging Certain Elderly Kidney Patients To Consider Forgoing Dialysis.

On its front page, the New York Times  (4/1, A1, Kolata) reports, “A law passed by Congress 39 years ago provides nearly free care to almost all patients whose kidneys have failed, regardless of their age or ability to pay,” was originally intended to assist younger and middle-aged end-stage renal disease patients stay alive and even productive. But, “many of the patients who take advantage of the law are old and have other medical problems, often suffering through dialysis as a replacement for their failed kidneys, but not living long because the other chronic diseases kill them.” Because of this, some “kidney specialists are pushing doctors to be more forthright with elderly people who have other serious medical conditions, to tell the patients that even though they are entitled to dialysis, they may want to decline such treatment and enter a hospice instead.

 

Fluid and nutrient intake and risk of chronic kidney disease – STRIPPOLI – 2011 – Nephrology – Wiley Online Library

Fluid and nutrient intake and risk of chronic kidney disease – STRIPPOLI – 2011 – Nephrology – Wiley Online Library.

 

Il grande Strippli alla ribalta

 

Predicting Development of CKD in the General Population—Early Days in a Rapidly Evolving Field

Predicting Development of CKD in the General Population—Early Days in a Rapidly Evolving Field.