Abstract Background: Albuminuria was widely considered as the first clinical sign of diabetic kidney disease (DKD), which is why it has traditionally been used as a screening test for DKD. However, increasing evidence has shown that a significant number of type 2 diabetes mellitus (DM) patients have a decreased glomerular filtration rate (GFR) without significant albuminuria, known as non-albuminuric DKD (NA-DKD). The aim of this study was to determine the prevalence and the demographic and clinical characteristics of patients with NA-DKD. Methods: This was a 1-year retrospective study that included 146 type 2 diabetic patients with GFR < 75 mL/min followed-up in a diabetes outpatient department. Patients were divided into two groups according to their ACR status - NA-DKD and albuminuric DKD (A-DKD). Results: Of the 146 patients included in the study, 53.4% had A-DKD and 46.6% had NA-DKD. According to the multivariable analysis performed, patients with NA-DKD tended to be older (p = 0.021), female (p = 0.045) and with a lower GFR (p = 0.004) than A-DKD patients. There was no difference between the groups in terms of body mass index, metabolic control of DM, duration of DM diagnosis and prevalence of metabolic syndrome. Conclusions: The majority of patients with DKD had albuminuria, but a significant proportion had a non-albuminuric phenotype (46.6% in this population). These patients exhibit distinct clinical features that could have screening, therapeutic and prognosis implications.

Resumen Introducción: La albuminuria fue ampliamente considerada como el primer signo clínico de la enfermedad renal diabética (DKD), por lo que se ha utilizado tradicionalmente como prueba de detección para DKD. Sin embargo, el aumento de la evidencia ha demostrado que un número importante de pacientes con diabetes mellitus tipo 2 (DM) tenían disminución de la filtración glomerular (TFG), sin albuminuria significativa (DKD sin albuminuria (NA-DKD). El objetivo de este estudio fue determinar la prevalencia y las características demográficas y clínicas de los pacientes con NA-DKD. Métodos: Este fue un estudio retrospectivo de un año que incluyó a 146 diabéticos tipo 2 con TFG < 75 ml/min seguidos en el departamento de diabetes. Los pacientes fueron divididos en 2 grupos de acuerdo a su estado de ACR NA-DKD y DKD albuminúrica (A-DKD). Resultados: De los 146 pacientes incluidos en el estudio, 53,4% tienen A-DKD y 46,6% tienen a NA-DKD. En comparación con los pacientes con A-DKD, aquellos con NA-DKD eran más propensos a ser de mayor edad (p = 0,021), a ser mujeres (p = 0,045) y tenían una TFG menor (p = 0,004), datos confirmados en el análisis multivariante. El índice de masa corporal, el control metabólico de la DM, la duración del diagnóstico de DM y la prevalencia de síndrome metabólico no fueron diferentes entre los grupos. Conclusiones: La mayoría de los pacientes con DKD presentan albuminuria, pero una proporción significativa tiene un fenotipo de no albuminuria (46,6% en esta población). Estos pacientes presentan características clínicas diferentes, lo que podría tener relevancia en la proyección, el pronóstico o implicaciones terapéuticas.

A perturbação Gilles de la Tourette é um distúrbio neuropsicológico crónico, que resulta de anomalias ao nível dos neurotransmissores cerebrais. É caracterizada por fenómenos compulsivos, que originam tiques motores e vocais e origina problemas a nível social, emocional e particularmente na adaptação e integração no meio escolar. Este artigo procura promover um melhor conhecimento desta perturbação, da sintomatologia associada e essencialmente elaborar estratégias de intervenção educativa destinadas aos diversos agentes educativos, de modo a promover uma integração escolar e social mais eficiente.

Gilles de la Tourette syndrome is a neuropsychological condition, caused by multiple disorders in brain neurotransmitters. It is characterized by compulsive phenomena that give rise to motor and vocal tics, resulting in social and emotional problems, especially in integration and adaptation in school. The present article aims to improve knowledge of this disorder, including related symptoms, as well as to develop educational intervention strategies for various educational agents, so as to foster more efficient school and social integration.