La enfermedad renal crónica en la hipertensión arterial y en la enfermedad cardiovascular Chronic Kidney Disease in Hypertension and Cardiovascular Disease.

Abstract

Chronic kidney disease is frequently present among patients in high cardiovascular risk that are assisted by clinicians and cardiologists. The prevalence of chronic kidney disease among patients with type 2 diabetes mellitus, high blood pressure, or coronary or cardiovascular disease ranges between 25 to 40%. Its presence contributes significantly to increasing cardiovascular risk, to such an extent that the relative importance of other risk factors becomes minimal. As it is asymptomatic until its advanced stages, it hinders its diagnosis. This is based on the systematic screening, during the initial medical consultations of patients with diabetes mellitus, high blood pressure, multiple risk factors or with cardiovascular disease, over 60 years old or those who have family members with chronic kidney disease. The responsibility for the screening also includes cardiologists. The presumptive diagnosis of chronic kidney disease is based on two simple and routinely laboratory tests: 1) common urine test or dipstick in a spot urine sample to search proteinuria; 2) measurement of serum creatinine levels, and renal function assessment by estimation formula (MDRD or CKD-EPI) using the calculators that are available. The diagnosis of chronic renal disease confirms the existence of a very high risk patient, and at this point, renal function and proteinuria, if it exists, should periodically be reevaluated. Renal function reduction may determine that several of the drugs that we frequently use can require dose adjustment, or need careful use and even interruption of treatment. Moreover, proteinuria evolution is an important point in the follow-up of the treatment results. Additionally, these laboratory results are essential to decide a consultation with a nephrologist timely and not late, as it usually happens.