RENAL OUT-OF-HOSPITAL CLINIC - A 2 YEARS EXPERIENCE

Nephrology departments have been treated as ivory towers in hospitals. The evolution of health care and that of the specialty make it necess ary to change this conception. Nephrology has a potential relevance in the integration between primary and tertiary care that has remained f orgotten. In February 1992 we set up a pilot study of a renal out-of-h ospital clinic in the Center for Secondary Specialized Care of the 4th Health Area in Madrid, which covers 400.000 people. This was communic ated to all primary physicians and other specialists, to attract patie nts with nephropathies or severe arterial hypertension (AH). The prese nt study summarizes the experience of 2 years. We have attended 693 co nsecutive new patients, and 1.643 follow-ups, 58.4 % referred by gener al practitioners and the rest by specialists. The diagnoses at referra l were: AH (60,7 %), AH with chronic renal failure (CRF) (18.9 %), CRF without AH (6.5 %), asymptomatic urinary abnormalities (6.8 %), other (7.1 %). Age was 58.3 +/- 15.9 years, 44 % were male. At first visit, only 10.9 % had well-controlled blood pressure, 37 % had AH WHO grade s II-III. CRF was observed in 32.7 %, and 16.7 % were diabetics. Ninet y per cent of diabetics were hypertensive, and 47 % had CRF. AH was es sential in 93.6 %, and the rest were secondary renal (5.7 %) and adren al (0.7 %). Principal clinical diagnoses were AH without any renal dis order (n = 383), AH and normal renal function but with renal alteratio ns (n = 45) AH with CRF (n = 149), CRF without AH (n = 30), isolated m icrohematuria without AH (n = 29), other (n = 33), no disease (n = 24) . Only 1.7 % were admitted to hospital, 2.4 % are being reviewed in ou r hospital outpatient renal clinic, 11.6 % have been definitively disc harged and 84.3 % continue to attend the out-of-hospital unit. The out -of-hospital renal clinic draws together and integrates primary and te rtiary care, facilitates communication between general practitioners a nd specialists, allows patients with potentially serious disorders in their early stages to obtain nephrological care, and lightens the load on the hospital. Early detection and treatment of renal disorders and the provision of a referral centre for the rational treatment of AH a re the basic objectives. The establishment of such units should be fos tered in the National Health System.