[Validation, adaptation and translation of the MacCAT-T into Spanish: a tool to assess the ability to make health decisions].

Introduction: Capacity assessment is an essential element of the informed consent process and is the duty of the physician. The MacCAT-T instrument explores four skills needed to consent a treatment. There is no Spanish version, and the main objective of this work is to validate, adapt and translate the MacCAT-T into Spanish.

Exploring the opinion of CKD patients on dialysis regarding end-of-life and Advance Care Planning.

Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD.

[Atheroembolic renal disease: analysis of clinical and therapeutic factors that influence its progression].

Cholesterol embolism is a disease caused by distal showering of cholesterol crystal released from disintegration of arterial atheromatous plaques. It may occur spontaneously or more often after invasive vascular procedures or thrombolytic/anticoagulant agents. Forty five cases were diagnosed between 1989 and 2005 in three Spanish hospitals.

[Gadolinium-induced systemic fibrosis in advanced kidney failure].

Nephrogenic systemic fibrosis is a debilitating disease occurring exclusively in patients with severe renal failure. Originally it was described as nephrogenic fibrosing dermopathy. The pathogenesis of the disease is not yet known, but the observations suggest a close association with the exposure to gadolinium-containing contrast agents.

[Idiopathic retroperitoneal fibrosis: clinico-pathological characteristics].

Idiopathic retroperitoneal fibrosis is a rare disease often causing obstructive uropathy because the fibrosis entraps the ureters. The retroperitoneal tissue is constituted by a fibrous component and a chronic inflammatory infiltrate with the former characterized by miofibroblasts. The infiltrate displayed perivascular.

[Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis].

We report a case of a 49 year old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hypersensibility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several immunosuppressive drugs during four years follow up with temporally total remission of the disease.

[Advance directives in chronic dialysis patients].

Background And Objective: Knowledge of the life-sustaining treatment preferences of the dialysis patients would be extremely helpful to substitute decision-makers and nephrologists in deciding whether to continue or stop a treatment. The population of the Mediterranean countries show this opinion with less frequency. The objective of this study is: 1) the knowledge of the patient's view for the advance directives; it may increase the likelihood to get the correct decisions of the staff when complications break the normal course of chronic dialysis, and 2) the statement of the advance directives.

[Choosing not to dialysis in chronic renal failure in stage V (Renal Failure). Evolution of the characteristics of patients between 1992-1995 and 2000-2003].

Background: The incidence of chronic renal failure increase with the age. The selection of patient to dialysis has been increasing in spite of the high comorbidity. Moreover, in our clinical practice the aged patient is not contraindicated to dialysis.

[Diagnosis and prognosis of atheroembolic disease].

Atheroembolic disease is recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small arteries. The kidney is a frequent target organ for cholesterol emboli because of proximity of the renal arteries to abdominal aorta and it receive an enormous amount of blood flows.

[Ischemic renal disease: revascularization or conservative treatment?].

Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations.

[Arteriovenous fistula: complication of renal biopsy. Superselective embolization].

The arteriovenous fistula can be a major and late complication of percutaneous renal biopsies of native kidneys. The incidence of arteriovenous fistulas appears to be low and has been infrequently mentioned in large series of biopsies although there are a number of individual reports. In most part of cases, no systemic effects of the arteriovenous fistulas were observed, so they close by themselves.

[Acute renal insufficiency associated to cocaine consumption].

Acute renal insufficiency associated to cocaine consumption is well known, and normally secondary to rhabdomyolisis. The possibility that renal failure is related to hypertension and to renal histopathological findings indistinguishable of other malignant hypertension conditions is a not as well known fact. Certain derivatives of cocaine are powerful vasospasm inducers, which could be the key of the origin of the ischemic lesions that appears not only in the kidney but in other organs, especially in the nervous system.

[An outbreak of gram-negative bacteremia (GNB), especially enterobacter cloacae, in patients with long-term tunnelled haemodialysis catheters].

Vascular access through a venous catheter for haemodialysis is associated with increased risk of thrombosis, central venous stenosis, short access survival and inadequate dialysis. The most important catheter-related complications, which determine method survival, are infection and dysfunction. In particular, infectious episodes are in some studies the leading cause for untimely catheter removal and for catheter-related morbidity but also for morbidity in dialysis patients.

[40-year-old man with primary antiphospholipid syndrome].

We report the case o a 40-year-old male patient with "primary antiphospholipid syndrome" who developed ischemic cerebral infarctions and renal microangiopathy with infarction. A review of the literature on renal involvement in the primary antiphospholipid syndrome disclosed the differences from the antiphospholipid syndrome in the systemic lupus erythematosus. We describe the evolution of the patient at eight years, and we emphasize the importance of the treatment with warfarin.

[Patients with end-stage chronic renal insufficiency on programmed withdrawal from dialysis].

Unlabelled: The voluntary discontinuation of dialysis by patients is a common mode of death in dialysis programmes. Unfortunately the Spanish experience has not been related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21st century.

Clinical characteristics of ischaemic renal disease.

Background: Longer life expectancy has favoured the ever more frequent development of ischaemic nephropathy characterized by the presence of atherosclerotic stenosis in both renal arteries.

Methods: This is an observational and multicentre study carried out during a 14-month follow-up period in 20 hospitals in SPAIN: Inclusion criteria were the presence of bilateral renal artery stenosis > 50% and a creatinine level of > or = 1.5 mg/dl.

[Diagnostic role of magnetic resonance in the renal involvement in nocturnal paroxysmal hemoglobinuria].

Paroxysmal nocturnal haemoglobinuria or Machiafava-Micheli disease is an acquired clonal stem cell disorder characterized by defective haematopoiesis, which results in an increased sensitivity of the erythrocytes to complement-mediated intravascular haemolysis. Renal damage is rare but it can lead to chronic renal failure. Micro-infarctions due to repeated episodes of microvascular thrombosis and cortical haemosiderosis are thought to be the main contributors to the development of chronic renal failure in paroxysmal nocturnal haemoglobinuria.

Mesangioproliferative glomerulonephritis and antibodies to phospholipids in a patient with acute Q fever: case report.

Glomerulonephritis is a rare complication of Q fever and is usually associated with the chronic form of disease, i.e., infectious endocarditis.

[Necrotizing vasculitis with predominant kidney involvement].

We report five patients with necrotizing vasculitis with predominant renal involvement; the diagnostic and therapeutics was effected completely at regional hospital. We detach: a) the clinical presentation's forms with rapidly progressive renal failure with microscopic hematuria and minimal proteinuria; b) the biopsy of kidney with necrotizing vasculitis or necrotizing glomerulonephritis (microscopic polyarteritis). We review the necrotizing vasculitis with predominant renal involvement in its pathogenic, clinical and histological aspects, and we insist that the diagnostic and early treatment are fundamental for prognostic's improvement of these patients.