Letters to the editor – Brief comment on a clinical case
Hypertensive crisis in a patient with a medullary lesion
Crisis hipertensiva en paciente con lesión medular
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Morales-Umpiérrez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Katia" "apellidos" => "Toledo-Perdomo" "email" => array:1 [ 0 => "katia.toledo.perdomo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Yareli" "apellidos" => "Viña-Cabrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Basilio" "apellidos" => "Martín-Urcuyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Adelaida" "apellidos" => "Morales-Umpiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital José Molina Orosa, Arrecife, Las Palmas, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Atención Primaria, Centro de Salud Valterra, Arrecife, Las Palmas, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Crisis hipertensiva en paciente con lesión medular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1243 "Ancho" => 2486 "Tamanyo" => 210976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blood pressure outpatient monitoring (BPOM).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient is a 22-year-old quadriplegic male with trauma was referred to us due to hypertensive emergency with blood pressure values of 250/150<span class="elsevierStyleHsp" style=""></span>mmHg associated with headache, blushing, perspiration, bradycardia and somnolence. Two years earlier patient had trauma that caused tetraplegia due to craneoencephalic and vertebro-medullary injury resulting in C5 fracture and anterior cervical arthrodesis with complete medullary motor C5 and sensitive C4 lesions. The patient was dependent on others to perform everyday activities and required intermittent urinary catheterization. At medical examination, the patient was conscious and oriented, eupneic in resting position with normal skin and mucosae colouration. Heart sounds were regular at 60 heartbeats per minute without murmurs or audible extra sounds; normal respiratory sounds. Abdomen was soft, nontender, without masses and palpable organomegaly, with no abdominal murmurs. Palpable and symmetric pedial pulse in both lower extremities was noticed. No oedemas were found. A summary of blood tests: haemogram; haemoglobin 13.2<span class="elsevierStyleHsp" style=""></span>g/dl, haematocrit 37.1%, leukocytes 7.200/mm<span class="elsevierStyleSup">3</span>, platelet count 307.000/mm<span class="elsevierStyleSup">3</span>; biochemistry: glucose 65<span class="elsevierStyleHsp" style=""></span>mg/dl, urea 37<span class="elsevierStyleHsp" style=""></span>mg/dl, creatinine 0.63<span class="elsevierStyleHsp" style=""></span>mg/dl, GF >60<span class="elsevierStyleHsp" style=""></span>ml/min/MDRD4, cholesterol 140<span class="elsevierStyleHsp" style=""></span>mg/dl, LDL 73<span class="elsevierStyleHsp" style=""></span>mg/dl, Triglycerides 60<span class="elsevierStyleHsp" style=""></span>mg/dl, AST 28<span class="elsevierStyleHsp" style=""></span>U/l, ALT36 U/l, GGT 29<span class="elsevierStyleHsp" style=""></span>U/l, sodium 140<span class="elsevierStyleHsp" style=""></span>meq/l, potassium 4.7<span class="elsevierStyleHsp" style=""></span>meq/l, calcium 9.4<span class="elsevierStyleHsp" style=""></span>mg/dl, phosphate 4.3<span class="elsevierStyleHsp" style=""></span>mg/dl urine screening without alterations or sediments; 24-h urine sample collection: sodium 262<span class="elsevierStyleHsp" style=""></span>meq/24<span class="elsevierStyleHsp" style=""></span>h, ClCr 187.9<span class="elsevierStyleHsp" style=""></span>ml/min, proteins 198<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, albumin 15.6<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h; endocrine screening: TSH 3.3<span class="elsevierStyleHsp" style=""></span>mcIU/ml, cortisol 13.2<span class="elsevierStyleHsp" style=""></span>mcg/dl, 24<span class="elsevierStyleHsp" style=""></span>h urine free cortisol 41.8<span class="elsevierStyleHsp" style=""></span>mcg/24<span class="elsevierStyleHsp" style=""></span>h. Catecholamine and metanephrine in urine were normal. Echocardiogram showed no dilation or hypertrophy of left ventricle with preserved systolic function and normal wall motion. No dilation in right cavities; no valve abnormalities; no pericardial effusion. Normal Eye fundi; chest X-ray: no abnormal findings; normal kidneys by ultrasound. A 24-hour outpatient blood pressure (BP) monitoring was performed with the following results: average BP while awake 125/86<span class="elsevierStyleHsp" style=""></span>mmHg with average heart rate (HR) 75<span class="elsevierStyleHsp" style=""></span>b/m. Average BP during sleep was 144/74<span class="elsevierStyleHsp" style=""></span>mmHg with average HR of 80<span class="elsevierStyleHsp" style=""></span>b/m. The variation between the average BP between wakefulness and sleep state was of 19/6<span class="elsevierStyleHsp" style=""></span>mmHg (15%/9%). The variation of the average HR between wakefulness and sleep was of 5<span class="elsevierStyleHsp" style=""></span>b/m (7%). The following values of BP were recorded: 150/97<span class="elsevierStyleHsp" style=""></span>at 9:40<span class="elsevierStyleHsp" style=""></span>p.m.; 158/84, 154/72, 166/95<span class="elsevierStyleHsp" style=""></span>mmHg at 4:00–5:00<span class="elsevierStyleHsp" style=""></span>a.m. It could not be demonstrated that blood pressure elevation occured prior to the procedure of bladder catheterization (when bladder was replete). The patient mentioned that around 5:00–6:00<span class="elsevierStyleHsp" style=""></span>a.m., he usually undergoes perspiration and headache that wakes him up, which disappear after the catheterization (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The first suspicion was autonomic dysreflexia (AD); other possible causes assessed were primary hypertension (AMPA and Holter results did not show continuous high BP), pheochromocytoma (catecholamine and methanephrine within normal boundaries), migraine headache (he only mentioned headache coinciding with episodes of high BP) and the presence of brain tumours (though ophthalmoscopic examination was normal, but no imaging tests were performed to rule out tumors). Therefore we believe this is a case of AD in a patient with medullary injury, probably caused by bladder stimulation and, as a consequence, by blood pressure rising. AD is an acute syndrome due to excessive and uncontrolled sympathetic response produced in patients with spinal cord injuries.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> It usually appears after the medullary injury and affects between 48% and 90% of patients with medullary lesions affecting T6 or higher. As far as the pathophysiology, after spinal cord lesion, the sympathetic modulation of impulses travelling from the bladder zone to the brain through the spine is lost. In patients with injuries above T6, medulla afferent reflexes stimulate a sympathetic response, which originates in the mid-lateral cells column which are still operational despite the medullary injury; this is associated to an inadequate supraspinal control because the parasympathetic stimulus cannot travel through the injured medulla. The results include: hypertension as a sympathetic response, and bradycardia, perspiration, piloerection and headache a parasympathetic response.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> As far as treatment, first, avoid pharmacological treatment, and apply postural changes to lay the patient in supine position, removal of tight-fitting garments which perpetuate bladder stimulus. The search and elimination of the sympathetic stimulus is crucial for the case to be controlled; it must be initially addressed to discard its origin in bladder and rectum, which are responsible for triggering AD in more than 80% of the crises.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> It must be checked that the bladder catheterization is permeable, that it is not causing injuries, that it is not painful when removed, etc. A second most frequent cause of hypertensive crises must be taken into account, i.e., gastrointestinal tract stimuli, such as constipation due to faecal impaction.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> Other causes, though less frequent, are cutaneous stimuli, menstruation, trauma, etc. (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In such a case that the triggering cause cannot be eliminated, a rapid-acting oral pharmacological treatment should be initiated. The most commonly used drugs are nifedipine and nitrites. Alpha-blockers (phenoxybenzamine) and alpha-agonists (clonidine) are also effective drugs in an AD crisis; other drugs used are hydralazine and, if necessary and under monitoring, IV sodium nitroprusside. Some studies advise the use of angiotensin converting enzyme inhibitors (ACEi) as a second option. Finally, alpha-blockers such us doxazosin can be used as prophylaxis and, therefore, as baseline treatment in such crisis in patients with recurrent episodes that cannot be prevented.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> AD is a specific complication in patients with medullary injury that can involve risk of death, therefore a hypertensive crisis must be known and suspected of in this group of patients. Its management will be focused on its detection and avoiding the triggering cause of hypertensive crisis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Toledo-Perdomo K, Viña-Cabrera Y, Martín-Urcuyo B, Morales-Umpiérrez A. Crisis hipertensiva en paciente con lesión medular. Nefrologia. 2015;35:329–331.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1243 "Ancho" => 2486 "Tamanyo" => 210976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blood pressure outpatient monitoring (BPOM).</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Stimuli that can trigger AD: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Bladder distension, vesical lithiasis, urinary sepsis, traumatic catheterization, cystoscopy, urodynamic testing \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Rectal distension, faecal impaction, complicated haemorrhoids, rectoscopy/colonoscopy, gastroduodenitis, gastroduodenal ulcer, “Silent” acute abdomen, gastroscopy, gallstones \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Tight garments, footwear or orthosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Menstruation, pregnancy, particularly during labour, vaginitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Epididymitis, ejaculation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Pressure ulcers, burns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Traumas: fractures, dislocations and sprains, heterotopic ossification \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Lymphangitis, deep vein thrombosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">- Surgical procedures \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942065.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Possible AD causes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomic dysreflexia: an important cardiovascular complication in spinal cord injury patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Gunduz" 1 => "D.F. Binak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cardiol J" "fecha" => "2012" "volumen" => "19" "paginaInicial" => "215" "paginaFinal" => "219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22461061" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regulation of cerebral blood flow after spinal cord injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.A. Phillips" 1 => "P. Ainslie" 2 => "A.V. Krassioukov" 3 => "D.E. Warburton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/neu.2013.2972" "Revista" => array:6 [ "tituloSerie" => "J Neurotrauma" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "1551" "paginaFinal" => "1563" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23758347" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic complications of spinal cord injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Abrams" 1 => "M. Wakasa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2013" "editorial" => "UptoDate" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomic dysreflexia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.K. Karlsson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Spinal Cord" "fecha" => "1999" "volumen" => "37" "paginaInicial" => "383" "paginaFinal" => "391" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10432257" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Lindan" 1 => "E. Joiner" 2 => "A.A. Freehafer" 3 => "C. Hazel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sc.1980.51" "Revista" => array:6 [ "tituloSerie" => "Paraplegia" "fecha" => "1980" "volumen" => "18" "paginaInicial" => "285" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7443280" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of the management of autonomic dysreflexia after spinal cord injury" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Spinal Cord Injury Rehabilitation Evidence Research Team" "etal" => false "autores" => array:4 [ 0 => "A. Krassioukov" 1 => "D.E. Warburton" 2 => "R. Teasell" 3 => "J.J. Eng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.apmr.2008.10.017" "Revista" => array:6 [ "tituloSerie" => "Arch Phys Med Rehabil" "fecha" => "2009" "volumen" => "90" "paginaInicial" => "682" "paginaFinal" => "695" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19345787" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomic dysreflexia in a tetraplegic patient due to a blocked urethral catheter: spinal cord injury patients with lesions above T-6 require prompt treatment of an obstructed urinary catheter to prevent life-threatening complications of autonomic dysreflexia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Vaidyanathan" 1 => "B. Soni" 2 => "T. Oo" 3 => "P. Hughes" 4 => "G. Singh" 5 => "K. Pulya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Emerg Med" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "665" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient and caregiver knowledge of autonomic dysreflexia among youth with spinal cord injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Schottler" 1 => "L. Vogel" 2 => "R. Chafetz" 3 => "M.J. Mulcahey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sc.2009.12" "Revista" => array:6 [ "tituloSerie" => "Spinal Cord" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "681" "paginaFinal" => "686" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19274058" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rehabilitation of spinal cord injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Kirshblum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Physical medicine and rehabilitation principles and practice" "paginaInicial" => "1715" "paginaFinal" => "1751" "serieFecha" => "2004" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomic dysreflexia: pharmacological management of hypertensive crises in spinal cord injured patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.E. Naftchi" 1 => "J.S. Richardson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Spinal Cord Med" "fecha" => "1997" "volumen" => "20" "paginaInicial" => "355" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9261783" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003500000003/v4_201511060045/S2013251415000188/v4_201511060045/en/main.assets" "Apartado" => array:4 [ "identificador" => "42662" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief comments on case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000003/v4_201511060045/S2013251415000188/v4_201511060045/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000188?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 53 | 48 | 101 |
| 2024 September | 51 | 35 | 86 |
| 2024 August | 76 | 69 | 145 |
| 2024 July | 54 | 34 | 88 |
| 2024 June | 68 | 34 | 102 |
| 2024 May | 63 | 36 | 99 |
| 2024 April | 60 | 37 | 97 |
| 2024 March | 42 | 24 | 66 |
| 2024 February | 50 | 48 | 98 |
| 2024 January | 31 | 23 | 54 |
| 2023 December | 32 | 27 | 59 |
| 2023 November | 43 | 31 | 74 |
| 2023 October | 41 | 38 | 79 |
| 2023 September | 48 | 31 | 79 |
| 2023 August | 42 | 25 | 67 |
| 2023 July | 44 | 22 | 66 |
| 2023 June | 40 | 26 | 66 |
| 2023 May | 51 | 38 | 89 |
| 2023 April | 39 | 13 | 52 |
| 2023 March | 48 | 22 | 70 |
| 2023 February | 36 | 26 | 62 |
| 2023 January | 39 | 26 | 65 |
| 2022 December | 52 | 26 | 78 |
| 2022 November | 50 | 22 | 72 |
| 2022 October | 63 | 43 | 106 |
| 2022 September | 52 | 31 | 83 |
| 2022 August | 56 | 48 | 104 |
| 2022 July | 54 | 50 | 104 |
| 2022 June | 53 | 27 | 80 |
| 2022 May | 62 | 40 | 102 |
| 2022 April | 98 | 57 | 155 |
| 2022 March | 100 | 41 | 141 |
| 2022 February | 119 | 49 | 168 |
| 2022 January | 73 | 32 | 105 |
| 2021 December | 55 | 39 | 94 |
| 2021 November | 46 | 40 | 86 |
| 2021 October | 42 | 37 | 79 |
| 2021 September | 51 | 34 | 85 |
| 2021 August | 48 | 49 | 97 |
| 2021 July | 81 | 24 | 105 |
| 2021 June | 73 | 32 | 105 |
| 2021 May | 88 | 34 | 122 |
| 2021 April | 134 | 55 | 189 |
| 2021 March | 85 | 23 | 108 |
| 2021 February | 71 | 20 | 91 |
| 2021 January | 58 | 12 | 70 |
| 2020 December | 47 | 24 | 71 |
| 2020 November | 34 | 13 | 47 |
| 2020 October | 21 | 12 | 33 |
| 2020 September | 44 | 11 | 55 |
| 2020 August | 38 | 17 | 55 |
| 2020 July | 60 | 14 | 74 |
| 2020 June | 39 | 13 | 52 |
| 2020 May | 62 | 12 | 74 |
| 2020 April | 59 | 21 | 80 |
| 2020 March | 43 | 19 | 62 |
| 2020 February | 48 | 21 | 69 |
| 2020 January | 65 | 17 | 82 |
| 2019 December | 67 | 29 | 96 |
| 2019 November | 76 | 25 | 101 |
| 2019 October | 42 | 13 | 55 |
| 2019 September | 51 | 16 | 67 |
| 2019 August | 36 | 15 | 51 |
| 2019 July | 34 | 30 | 64 |
| 2019 June | 41 | 12 | 53 |
| 2019 May | 39 | 17 | 56 |
| 2019 April | 72 | 37 | 109 |
| 2019 March | 35 | 19 | 54 |
| 2019 February | 19 | 16 | 35 |
| 2019 January | 29 | 15 | 44 |
| 2018 December | 108 | 35 | 143 |
| 2018 November | 196 | 21 | 217 |
| 2018 October | 152 | 18 | 170 |
| 2018 September | 80 | 14 | 94 |
| 2018 August | 40 | 12 | 52 |
| 2018 July | 49 | 5 | 54 |
| 2018 June | 53 | 12 | 65 |
| 2018 May | 74 | 13 | 87 |
| 2018 April | 62 | 8 | 70 |
| 2018 March | 58 | 8 | 66 |
| 2018 February | 39 | 4 | 43 |
| 2018 January | 36 | 11 | 47 |
| 2017 December | 33 | 6 | 39 |
| 2017 November | 38 | 12 | 50 |
| 2017 October | 38 | 10 | 48 |
| 2017 September | 28 | 10 | 38 |
| 2017 August | 31 | 12 | 43 |
| 2017 July | 37 | 11 | 48 |
| 2017 June | 55 | 20 | 75 |
| 2017 May | 32 | 11 | 43 |
| 2017 April | 28 | 23 | 51 |
| 2017 March | 27 | 24 | 51 |
| 2017 February | 20 | 12 | 32 |
| 2017 January | 21 | 14 | 35 |
| 2016 December | 65 | 8 | 73 |
| 2016 November | 104 | 13 | 117 |
| 2016 October | 142 | 11 | 153 |
| 2016 September | 174 | 6 | 180 |
| 2016 August | 196 | 6 | 202 |
| 2016 July | 167 | 10 | 177 |
| 2016 June | 108 | 0 | 108 |
| 2016 May | 147 | 0 | 147 |
| 2016 April | 149 | 0 | 149 |
| 2016 March | 103 | 0 | 103 |
| 2016 February | 145 | 0 | 145 |
| 2016 January | 129 | 0 | 129 |
| 2015 December | 119 | 0 | 119 |
| 2015 November | 130 | 0 | 130 |
| 2015 October | 142 | 0 | 142 |
| 2015 September | 144 | 0 | 144 |
| 2015 August | 144 | 0 | 144 |
| 2015 July | 6 | 0 | 6 |
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