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Vol. 35. Núm. 1.Enero 2015
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Vol. 35. Núm. 1.Enero 2015
Páginas 1-124
DOI: 10.3265/Nefrologia.pre2014.Oct.12612
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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
Water renal management is altered more frequently than albuminuria in children in the G1 stage of the 2012 KDIGO Guideline
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Víctor M. García-Nietoa, Fernán Fortichb, M. Isabel Luis-Yanesa, Cinzia Tripodia, Pedro Arango-Sanchoa
a Secci??n de Nefrolog??a Pedi??trica, Hospital Universitario Nuestra Se??ora de Candelaria, Santa Cruz de Tenerife,
b Servicio de Nefrolog??a, Hospital Universitario Nuestra Se??ora de Candelaria, Santa Cruz de Tenerife,
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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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Bibliografía
[1]
Areses Trapote R, Sanahuja Ib????ez MJ, Navarro M; Investigadores Centros Participantes en el REPIR II. Epidemiology of chronic kidney disease in Spanish pediatric population. REPIR II Project. Nefrologia 2010;30:508-17.
[2]
Van der Heijden BJ, Van Dijk PC, Verrier-Jones K, Jager KJ, Briggs JD. Renal replacement therapy in children: data from 12 registries in Europe. Pediatr Nephrol 2004;19:213-21. [Pubmed]
[3]
Faust WC, D??az M, Pohl HG. Incidence of postpyelonephritic renal scarring: a metaanalysis of the dimercapto-succinic acid literature. J Urol 2009;181:290-7.
[4]
Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010;126:1084-91. [Pubmed]
[5]
Ditchfield MR, Grimwood K, Cook DJ, Powell HR, Sloane R, Gulati S, et al. Persistent renal cortical scintigram defects in children 2 years after urinary tract infection. Pediatr Radiol 2004;34:465-71. [Pubmed]
[6]
Lin KY, Chiu NT, Chen MJ, Lai CH, Huang JJ, Wang YT, et al. Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol 2003;18:362-5. [Pubmed]
[7]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013;3:1-150.
[8]
Schwartz GJ, Mu??oz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009;20:629-37. [Pubmed]
[9]
Rodr??guez-Soriano J, Vallo A, Oliveiros R. Renal handling of water and sodium in infancy and childhood: a study using clearance methods during hypotonic saline diuresis. Kidney Int 1981;20:700-4. [Pubmed]
[10]
Garc??a Nieto V, Luis Yanes MI, Monge Zamorano M, Hern??ndez Gonz??lez MJ, Peralta Aros C, Garin EH. Renal concentrating capacity as a marker for glomerular filtration rate. Acta Paediatr 2008;97:96-9. [Pubmed]
[11]
Aronson AS, Svenningsen NW. DDAVP test for estimation of renal concentrating capacity in infants and children. Arch Dis Child 1974;49:654-9. [Pubmed]
[12]
Monnens L, Smulders Y, van Lier H, de Boo T. DDAVP test for assessment of renal concentrating capacity in infants and children. Nephron 1981;29:151-4. [Pubmed]
[13]
Gibb DM, Shah V, Preece M, Martin Barratt T. Variability of urine albumin excretion in normal and diabetic children. Pediatr Nephrol 1989;3:414-9. [Pubmed]
[14]
Yap C, Yap HK, Chio LF. Urine microalbumin/creatinine ratios in Singapore children. J Singapore Paediatr Soc 1991;33:101-6. [Pubmed]
[15]
Caballo Roig N, Yep Chullen G, De la Torre E, Ruiz Jarabo C, Asensio Ant??n J, S??nchez Bayle M. Variaci??n de la excreci??n de N-acetil-glucosaminidasa en el primer a??o de vida. An Esp Pediatr 1991;34:142-4. [Pubmed]
[16]
Garc??a Nieto V, Muros M, Le??n C, Duque J, Oliva C, Duque R, et al. Estudio de la eliminaci??n urinaria de N-acetil-glucosaminidasa y ??2-microglobulina en la infancia. Trastorno de su excreci??n en la diabetes mellitus y en patolog??a renal. Nefrologia 1990;10:393-9.
[17]
Astor BC, Bhavsar NA. Is there something better than the best marker of kidney function? J Am Soc Nephrol 2011;22:1779-81. [Pubmed]
[18]
Tomonaga Y, Risch L, Szucs TD, Ambuehl PM. The prevalence of chronic kidney disease in a primary care setting: a swiss cross-sectional study. PLoS One 2013;8:e67848. [Pubmed]
[19]
Szczech LA. The development of urinary biomarkers for kidney disease is the search for our renal troponin. J Am Soc Nephrol 2009;20:1656-7. [Pubmed]
[20]
McCullough PA, Shaw AD, Haase M, Bouchard J, Waikar SS, Siew ED, et al. Diagnosis of acute kidney injury using functional and injury biomarkers: workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference. Contrib Nephrol 2013;182:13-29. [Pubmed]
[21]
Hjortrup PB, Haase N, Wetterslev M, Perner A. Clinical review: Predictive value of neutrophil gelatinase-associated lipocalin for acute kidney injury in intensive care patients. Crit Care 2013;17:211. [Pubmed]
[22]
Coutarel P, Grimaldi A, Bosquet F, Bureau G, Thervet F. Which method of urine collection and expression of results for albuminuria when screening for incipient diabetic nephropathy? Diabetes Care 1988;11:371-2. [Pubmed]
[23]
Dahlquist G, Stattin EL, Rudberg S. Urinary albumin excretion rate and glomerular filtration rate in the prediction of diabetic nephropathy; a long term follow-up study of childhood onset type-1 diabetic patients. Nephrol Dial Transplant 2001;16:1382-6. [Pubmed]
[24]
Vergouwe Y, Soedamah-Muthu SS, Zgibor J, Chaturvedi N, Forsblom C, Snell-Bergeon JK, et al. Progression to microalbuminuria in type 1 diabetes: development and validation of a prediction rule. Diabetologia 2010;53:254-62. [Pubmed]
[25]
Brown WW, Peters RM, Ohmit SE, Keane WF, Collins A, Chen SC, et al. Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2003;42:22-35. [Pubmed]
[26]
Palatini P, Mormino P, Dorigatti F, Santonastaso M, Mos L, De Toni R, et al.; HARVEST Study Group. Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1 hypertension: the HARVEST. Kidney Int 2006;70:578-84. [Pubmed]
[27]
Bricker NS, Dewey RR, Lubowitz H, Stokes J, Kirkensgaard T. Observations on the concentrating and diluting mechanisms of the diseased kidney. J Clin Invest 1959;38:516-23. [Pubmed]
[28]
Weinstein E, Manitius A, Epstein FH. The importance of aerobic metabolism in the renal concentrating process. J Clin Invest 1969;48:1855-61. [Pubmed]
[29]
Kokko JP, Rector FC Jr. Countercurrent multiplication system without active transport in inner medulla. Kidney Int 1972;2:214-23. [Pubmed]
[30]
Fenton RA, Knepper MA. Mouse models and the urinary concentrating mechanism in the new millennium. Physiol Rev 2007;87:1083-112. [Pubmed]
[31]
Noda Y, Sohara E, Ohta E, Sasaki S. Aquaporins in kidney pathophysiology. Nat Rev Nephrol 2010;6:168-78. [Pubmed]
[32]
Alving AS, Van Slyke DD. The significance of concentration and dilution tests in Bright's disease. J Clin Invest 1934;13:969-98. [Pubmed]
[33]
Garc??a Nieto V, Gonz??lez Cerrato S, Garc??a Rodr??guez VE, Mesa Medina O, Hern??ndez Gonz??lez MJ, Monge Zamorano M, et al. Should a cystography be performed on all breastfeeding infants with mild to moderate dilatation of the urinary tract? Renal function tests can help to answer this quiestion. Nefrologia 2011;31:192-8. [Pubmed]
[34]
Garc??a Nieto VM, Afonso-Coderch M, Garc??a-Rodr??guez VE, Monge-Zamorano M, Hern??ndez-Gonz??lez MJ, Luis-Yanes MI. Diagnostic efficiency and quality indexes of several markers of renal function for detecting loss of parenchyma in paediatric patients. Nefrologia 2012;32:486-93. [Pubmed]
[35]
Epstein FH. Disorders of renal concentrating ability. Yale J Biol Med 1966;39:186-95. [Pubmed]
[36]
Sherman RL, Drayer DE, Leyland-Jones BR, Reidenberg MM. N-acetyl beta-glucosaminidase and beta 2-microglobulin. Their urinary excretion in patients with renal parenchymal disease. Arch Intern Med 1983;143:1183-5. [Pubmed]
[37]
Powell JH, Reidenberg MM. Further studies of the response of kidney lysosomes to aminoglycosides and other cations. Biochem Pharmacol 1983;32:3213-20. [Pubmed]
[38]
Glass S, Plant ND, Spencer DA. The effects of intravenous tobramycin on renal tubular function in children with cystic fibrosis. J Cyst Fibros 2005;4:221-5. [Pubmed]
[39]
Zager RA. Uremia induces proximal tubular cytoresistance and heme oxygenase-1 expression in the absence of acute kidney injury. Am J Physiol Renal Physiol 2009;296:F362-8. [Pubmed]
[40]
Nakagawa S, Masuda S, Nishihara K, Inui K. mTOR inhibitor everolimus ameliorates progressive tubular dysfunction in chronic renal failure rats. Biochem Pharmacol 2010;79:67-76. [Pubmed]
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