Proteinuria en pacientes con nefropatía diabética y su asociación con síndrome de fragilidad

Antecedentes: con el tiempo, el concepto de fragilidad ha tenido una serie de cambios, por lo que ahora se define como síndrome geriátrico. Fried y colaboradores, en los últimos 25 años, definieron el síndrome de fragilidad y encontraron enfermedades correlacionadas con esta enfermedad. En la actualidad, para el diagnóstico de fragilidad se cuenta con la escala de Fried, que evalúa una serie de cinco parámetros: fuerza, pérdida de peso, disminución de la actividad física y del desempeño físico y cansancio. Objetivo: determinar si existe asociación entre la proteinuria en pacientes con nefropatía diabética y el síndrome de fragilidad. Material y método: estudio descriptivo, observacional, transversal y analítico, realizado en pacientes con diabetes mellitus tipo 2, que cumplieran con criterios de fragilidad; también se evaluaron los pacientes que no tuvieran alguna enfermedad de base; posteriormente se aplicó el cuestionario de Fried y se recolectaron proteínas en orina de 24 horas. El estudio se realizó de agosto de 2012 a diciembre de 2013, en el Hospital General Ticomán. Resultados: mediante el análisis de proteinuria, en el grupo control encontramos 12 pacientes sin proteinuria significativa y 23 pacientes con proteinuria significativa; mientras que en el grupo de casos encontramos 13 pacientes sin proteinuria significativa y 22 tenían proteinuria significativa, con p=0.80 para asociación entre proteinuria y fragilidad con prueba c2. Conclusiones: no existe asociación estadísticamente significativa entre el grado de proteinuria y fragilidad en pacientes con nefropatía diabética.

Palabras clave: nefropatía diabética, proteinuria, fragilidad, Fried

Background: Overtime the concept of frailty has undergone a series of changes, the above to define it in a better way as a geriatric syndrome. Fried and his colleagues over the last 25 years have defined fragility syndrome and diseases found correlated with the disease. Aging can be defined as a functional individual deterioration due to decreased with the environment. During the aging process the homeostasis as reserves are lost, the above as a result of a series of alterations in the anabolism of protein, fat and carbohydrates as well as an activation of genes whose reservation results in decreased cell level functioning. Currently the diagnosis of frailty has the Fried scale, which evaluates a series of 5 parameters: strength, weight loss, decreased physical activity, fatigue and decreased physical performance. Although searched a number of markers such as C-reactive protein, interferon, interleukins and leptin have not yet been developed to validate them as prognostic markers of frailty. Objective: To determine if there is a degree of association between proteinuria in patients with diabetic nephropathy and frailty syndrome. Material and method: A descriptive, observational, transversal and analytical study, performed in patients with diabetes mellitus 2 that met criteria of fragility; also were evaluated patients without any underlying disease; then, Freid questionnaire was applied and protein in 24 hours urine was collected. Study was done from August 2012 to December 2013 at General Hospital Ticoman. Results: By the analysis of proteinuria in the control group, in 12 patients no significant proteinuria was found and 23 patients had significant proteinuria; where as in the case group 13 patients had no significant proteinuria and 22 had significant proteinuria, with a p=0.80 for association between proteinuria and frailty with c2 test. Conclusions: There is not a statistically significant association between the degree of proteinuria and fragility in patients with diabetic nephropathy.

Keywords: diabetic nephropathy, proteinuria, fragility, fried