Dr. Rosa Sanchez
Nephrology is a specialty dedicated to the prevention, diagnosis and treatment of diseases that affect the kidney and associated complications.
Pathologies AREAS OF APPROACH IN CONSULTATION OF HYPERTENSION AND CARDIOVASCULAR RISK Arterial hypertension is the cause and consequence of the development not only of renal insufficiency, but of cardiovascular pathologies such as myocardial infarction, heart failure and arrhythmias, cerebrovascular accidents or aneurysm rupture. From the Nephrology consultations we are especially sensitized, not only in the management of Arterial Hypertension, but also in the global assessment of CARDIOVASCULAR RISK. This assessment is completed with examinations such as the blood pressure Holter (SAPA), the arterial and supraaortic trunks EcoDoppler, the Electrocardiogram. The objective is to offer the patient an individualized treatment and follow-up. GLOBAL MANAGEMENT OF THE PATIENT WITH CHRONIC RENAL DISEASE The objective is preventive and therapeutic. The early diagnosis of the patient with CKD allows to delay the progression of the disease in any of its stages, treat the associated complications and assess together with the patient the best treatment for the patient when the CKD advances. The integral assessment of the patient with CKD implies: Nutritional Valuation: Diet and nutritional assessment, control of AHT and lifestyle changes are basic pillars in the management of the patient with CKD. Protein intake is different depending on the stages of CKD. A good nutritional and body composition assessment by a trained specialist helps to delay the progression of CKD and prevents protein caloric malnutrition, very common in these patients. Anemia control: CKD especially in advanced stages causes anemia Control of early anemia with the use of erythropoietic agents and iron, delays the progression of CKD and improves the patient's quality of life. Control of bone and mineral metabolism: CKD is associated with vitamin D deficiency and elevations of parathyroid hormone which lead to alterations in calcium, magnesium and phosphorus. The bone alters its mineralization and vascular calcifications occur with progression of arteriosclerosis. Currently there are drugs that control these alterations Control of hydroelectrolytic alterations and acid base: the accumulation of potassium is frequent in advanced stages of CKD and can be dangerous in high numbers. It is important dietary advice, correction of acidosis and when you need medications that prevent its absorption at the intestinal level Control of volume overload: water and sodium retention in CKD to edema, resistant hypertension and dyspnea due to insufficiency cardiac The clinical assessment of the state of hydration and its control is essential so that this does not happen. Functional assessment and body composition: CKD is associated in advanced stages with functional impairment, fatigue and loss of muscle mass. Physical exercise is another treatment of CKD and should be adapted to each stage of the disease Control of physical and psychological symptoms: patients with CKD frequently have pain, fatigue, respiratory distress, itching, cramping, insomnia, nausea, loss of appetite , nocturia, restless legs, depression and anxiety. Its correct control can improve the patient's quality of life significantly Preparation for Substitute Renal Therapy. Information for renal replacement therapy (transplantation, hemodialysis, peritoneal dialysis) should be given properly so that the patient is prepared and can choose the appropriate technique when the CKD progresses. The clinic has means to perform vascular accesses for dialysis (Angiology and Vascular Surgery). Support and palliative management of patients with advanced CKD in conservative renal management: Many patients, especially elderly, with high comorbidity and functional impairment prefer management CKD conservative renal. The objective in these patients, in addition to delaying the progression of CKD and treating its complications is the treatment of symptoms and management from a palliative point of view. The Nephrologist-Paliativist vision allows to help the patient and the family to manage the complications, physical, psychological that arise when the kidney disease progresses and carry out a plan of advanced palliative care and at the end of life. The psychosocial and functional assessment of the patient with ACE counselor is also included in the care of these patients. METABOLIC STUDY OF LITHIASIS. PREVENTION AND TREATMENT OF URINARY INFECTIONS The metabolic study of lithiasis will allow to diagnose the etiology of stone formation, prevent its formation, in some cases treat conservatively and avoid as much as possible the appearance of nephritic colic, obstructive uropathy, infections urinary recurrence and sepsis of urinary origin.The study and prevention of recurrent urine infections is another objective of this section GLOBAL APPROACH TO DIABETIC NEPHROPATHY Control, prevention and treatment of diabetic nephropathy.Diabetes is the first cause of CKD and dialysis in Spain and in the world. Prevention is crucial to reverse this trend. Any diabetic patient should follow regular renal function checks to prevent the development of diabetic nephropathy. Patients with established nephropathy will need different dietary recommendations and hypoglycemic drugs depending on the stage they are in. CLINICAL NEFROLOGY Includes very varied pathologies from diagnosis and treatment of acute renal failure, acute and chronic glomerulopathies, hereditary renal diseases, immunological diseases with renal involvement, tubulointerstitial nephropathies, renal polycystosis, study and monitoring of renal cysts, ischemic nephropathy, diagnostic and therapeutic management of renal artery stenosis, reflux nephropathy, etc. Prevention of nephrotoxicity and acute renal failure: prior nephrologic assessment is useful when procedures are used where iodinated contrasts, catheterization and invasive cardiological and vascular studies are used. Interventionists. Preoperative assessments of surgical risk in patients with CKD help the rest of the doctors to adjust drugs in patients with AHT and CKD.
