El manejo renal del agua se ve alterado con más frecuencia que la albuminuria en niños en el estadio G1 de la Guía KDIGO de 2012

García-Nieto, Víctor M.; Fortich, Fernán; Luis-Yanes, M. Isabel; Tripodi, Cinzia; Arango-Sancho, Pedro

doi:10.3265/Nefrologia.pre2014.Oct.12612

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Antecedentes: El estadio G1 de la enfermedad renal crónica (ERC) se define en la Guía KDIGO de 2012 como el daño renal caracterizado por anomalías estructurales o funcionales del riñón y sin deterioro del filtrado glomerular. Tanto la albuminuria como las anomalías que afectan a los electrolitos debido a trastornos tubulares se consideran marcadores de daños funcionales. No obstante, en esta guía no se explicitan cuáles son los cambios que se producen en el manejo renal del agua. En este estudio, se utilizó una muestra grande de niños en estadio G1 con gammagrafías con ácido dimercaptosuccínico (DMSA) anormales. Métodos: Llevamos a cabo un estudio transversal ambispectivo para evaluar las historias clínicas de 116 pacientes pediátricos. En el primer grupo, se incluyó a 100 pacientes en estadio G1 y a 16 pacientes en los estadios G2-G5 de la ERC de la clasificación de la Guía KDIGO. Las gammagrafías con DMSA de todos los pacientes revelaban patologías renales. Se calcularon las TFG, la osmolalidad urinaria máxima y los cocientes de albúmina/creatinina y de NAG/creatinina. Resultados: En comparación con los pacientes con TFG reducidas, los pacientes con TFG normales presentaron valores de osmolalidad urinaria máxima significativamente superiores, así como volúmenes urinarios y cocientes de albúmina/creatinina y de NAG/creatinina significativamente inferiores. Las alteraciones que se observaron con mayor frecuencia en los niños en estadio G1 de la Guía KDIGO afectaban al manejo renal del agua. Entre ellas, se encontraban fallos en la capacidad de concentración de la orina (29%) y un aumento del volumen urinario (20%). Sin embargo, se observó que la frecuencia de niños en los que aumentó la eliminación a través de la orina de albúmina (12%) y NAG (3%) era mucho menor. Por su parte, todos los niños en los estadios G2-G5 de la Guía KDIGO presentaban alteraciones en el manejo renal del agua. Conclusiones: Aquellos parámetros relacionados con el manejo renal del agua se ven afectados con más frecuencia que la albuminuria en niños con pérdidas de parénquima renal y TFG normales.

Palabras clave:

Enfermedad renal crónica

Palabras clave:

CAKUT

Palabras clave:

NAG

Palabras clave:

Albuminuria

Palabras clave:

Volumen urinario

Palabras clave:

Capacidad de concentración

Background: The G1 stage of chronic kidney disease (CKD) is defined in the 2012 KDIGO Guideline as kidney damage characterized by structural or functional kidney abnormalities without deterioration of glomerular filtration rate. Albuminuria and electrolyte abnormalities due to tubular disorders are considered functional markers of kidney damage. Changes in renal water handling are not explicitly cited in these guidelines. A large sample of children with abnormal dimercaptosuccinic acid (DMSA) scan located in the G1 stage was used in this study. Methods: Ambispective, cross-sectional study to evaluate the clinical histories of 116 pediatric patients. 100 patients were included in the first group (G1 stage) and 16 patients in the G2-G5 stages according to the classification of CKD Guideline KDIGO. All the patients had a renal pathologic DMSA scan. GFR, maximum urine osmolality and albumin/creatinine and NAG/creatinine ratios were determined. Results: The patients with normal GFR, in relation to those with reduced GFR, had significantly higher values of maximum urine osmolality and significantly reduced values of urine volume and albumin/creatinine and NAG/creatinine ratios. The most frequently observed alterations in children in the KDIGO G1 stage were those involving the water renal management such as urinary concentrating ability defect (29%) and increased urinary volume (20%). The frequency of children with increased urinary elimination of albumin (12%) and NAG (3%) was more lower. All children in KDIGO G2-G5 stages had alterations in water renal management. Conclusions: The parameters related with the water renal management are affected more frequently than albumin urinary excretion in children who have loss of parenchyma and normal GFR.

Keywords:

Cronic kidney disease

Keywords:

CAKUT

Keywords:

NAG

Keywords:

Albuminuria

Keywords:

Urinary volume

Keywords:

Concentrating capacity

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