n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 Revista de la Sociedad Española de Nefrología www.revistanefrologia.com Editorial Kidneys also speak Spanish: Initiatives towards standardisation of our nephrology nomenclature Los riñones también hablan español: iniciativas hacia la estandarización de nuestra nomenclatura nefrológica Jordi Bover a,∗ , Ricardo Bosch b , José Luis Górriz c , Pablo Ureña d , Alberto Ortiz e , Iara daSilva f , Ramón A. García-Trabanino g , Miguel Hueso h,i , Pedro Trinidad j , Aquiles Jara k , Mónica Furlano a , Rosana Gelpi a , Ana Vila-Santandreu a , César A. Restrepo l,m , Maya Sánchez-Baya a , Carolt Arana a , Marián Goicoechea n , Verónica Coll a , Julián Segura o , Orlando Gutiérrez p , Kamyar Kalantar-Zadeh q , Emilio Sánchez r , Alejandro Ferreiro s , Rafael García-Maset t a Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain b Departamento de Biología de Sistemas, Unidad de Fisiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain c Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain d AURA Nord Saint Ouen, Saint Ouen, Francia y Department of Renal Physiology, Necker Hospital, University of Paris Descartes, París, France e Servicio de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain f Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma, Badalona, Spain g Centro de Hemodiálisis de San Salvador, Fondo Social de Emergencia para la Salud de Tierra Blanca, El Salvador, Spain h Servicio de Nefrología, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain i Grupo de trabajo sobre BigData e Inteligencia Artificial (BigSEN) de la Sociedad Española de Nefrología, Barcelona, Spain j Departamento de Nefrología, HECMN siglo XXI, IMSS, Ciudad de México, Mexico k Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile l Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain m Servicio de Nefrología, Hospital de Caldas, Universidad de Caldas, Manizales, Colombia n Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain o Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain p Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA q Division of Nephrology and Hypertension and Kidney Transplantation, Orange, University of California Los Angeles, Los Angeles, CA, USA r Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, Spain s Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay t Servicio de Nefrología, Hospital de Manises, Valencia, Spain DOI of original article: https://doi.org/10.1016/j.nefro.2021.04.011. ∗ Corresponding author. E-mail address: jbover.ics@gencat.cat (J. Bover). 2013-2514/© 2021 Sociedad Española de Nefrologı́a. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 224 n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 decades earlier by another even more important guideline, Introduction devoted to the evaluation and management of CKD, (contain- ing CKD classification and stratification), initially developed The standardization of scientific nomenclature, including by the National Kidney Foundation (NKF) Kidney disease outcomes widely employed acronyms (often excessively used even Quality Initiative (KDOQI) which was later adopted, with minor orally), has classically been a goal in many languages but it modifications, by the KDIGO.8,9 has been achieved only partially. This standardization attempt These guidelines on CKD had the positive impact of chang- tries to establish a well-defined lexicon, allowing any informa- ing the concept of CKD as a severe condition, which required tion to be recognized, compared, reused in calculations, used the assistance by nephrologists, to a very frequent situation, for research or statistics and be stored in documents, without often asymptomatic, and with a wide range of secondary losing information and maintain meaning.3 Several initiatives manifestations that also required the attention of general of different scope have served to this purpose, such as the practitioners, and the implementation of strategies for pre- basic International Classification of Diseases Ninth or tenth Revision vention, detection and early management.10 There is no (ICD-9 or ICD-10) or the International Classification of Diseases doubt that these guidelines had a very important effect not 9/10 (ICD-9/ICD-10), even though its initial purpose was not only in clinical practice, by unifying the definition, classifica- necessarily clinically oriented. It is well known that these sys- tion and risks associated with CKD, but also in the field of tems do not adequately identify patients with chronic kidney nephrology research and health policies, although they also disease (CKD) and although ICD-10-CM includes CKD (code generated notable and persistent controversies (eg, in rela- N18) with its stages (eg: N18.1–N18.5), it is not used frequently tion to the importance of the age factor or methodological and contains frequent errors. Attempts have also been made inaccuracies).11 to standardize the guides of style in the various scientific jour- Following the aforementioned KDIGO9 guidelines, several nals devoted to specific areas of health sciences.4 national and local initiatives, such as those led by the Spanish In this declaration of intention, more specifically concern- Society of Nephrology (SEN) and the Spanish Society of Labora- ing clinical laboratory sciences, where an extremely large tory Medicine (SEQC), in which several authors of this editorial number of results are produced every day, it is necessary the were involved, resulted in the publication of the recommen- standardization of nomenclature (and units) and they have dations on the use of equations for estimating the glomerular been pioneers in this field.5 Regarding initiatives in Spanish, filtration rate (GFR) in adults (2006),12 tables using the formula it is of note the document published in 2018 on nomenclature derived from the Modification of Diet in Renal Disease (MDRD) and units3 as well as the collaboration between the “Work- study,13 as well as the first consensus document on CKD of ing Group on Nomenclature and Spanish Translations of the the Spanish Society of Family and Community Medicine (SEN- International Federation of Clinical Chemistry and Clinical SemFYC) in 2008.14 Subsequently, the recommendations on Laboratory Sciences”, together with the “Scientific Committee the assessment of proteinuria regarding the diagnosis and of the Latin American Confederation of Clinical Biochemistry”, follow-up of CKD were published,15 as well as the assessment and the Terminology Commission and Publications Commit- of the new Chronic Kidney Disease-Epidemiology Collaboration tee of the Spanish Society of Clinical Chemistry (SEQC). All (CKD-EPI) for GFR estimation,16 and tables using the new agreed upon the application of international recommenda- formula.17 Finally, KDIGO published in 2012 the guide of clin- tions, publishing an extensive list of examples6 (sample in ical practice for the evaluation and management of CKD.18 In Table 1). These recommendations were poorly accepted per- 2014, it was published an important consensus document in haps due the practical complexity or lack of involvement of Spain, under the direction of the SEN together with other nine clinicians. It was no longer just that the word “bicarbonate” medical societies, on the detection and management of CKD should not be used but “hidrogenocarbonato”; it was that, for addressed to professionals of different specialties, directly example, considering the words “creatinine” or angiotensin- or indirectly related to renal patient care, including primary converting enzyme (ACE) as “incorrect” and should be changed care.1,19 Similarly, the Latin American Society of Nephrology to “creatininio” or “peptidyl-dipeptidase-A”.6 The idea is not and Hypertension (SLANH) published in the same year 2014 to transform our daily reality (Table 1).6 6b It is true that some a clinical practice guideline on the prevention, diagnosis and of the suggested terms did have unquestionable interest in treatment of CKD stages 1–5, with the participation of 30 exter- terms of their scientific and linguistic precision.6 nal reviewers.20 Finally, in 2016 the Spanish Ministry of Health published its guide on CKD21 and a new update of the consen- sus with ten different specialties will soon be published in this From the definition of chronic kidney disease to journal.2 the standardization of the (English) Following the same mode of action of the KDIGO on nomenclature nomenclature and supporting its own recommendations,7 in November 2020 we claimed in a letter to the Editor in Kidney In the area purely concerning Nephrology, it is a remarkable International,22 and more recently in Nefrologia,23 the need for milestone the publication of a Kidney Disease: Improving Global homogenization of the nephrological nomenclature in each Outcomes (KDIGO) guideline whose main objective was the language, Spanish in our case, with special emphasis on the standardization of the nephrology nomenclature for scien- acronyms used. Likewise, we revealed the existence of a cer- tific articles written in English, following as a fundamental tain discrimination against classical medical terminology of principle the best possible understanding by patients (English Latin origin,22,23 shared by other groups and forums.24,25 In speaking patients).7 This publication was preceded almost two fact, it came to our attention that one of the main recom- n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 225 Table 1 – Selection of terminology previously recommended (in Spanish alphabetical order) by the Working Group on Nomenclature and Translations in Spanish of the International Federation of Clinical Chemistry and Clinical Laboratory Sciences, together with the Scientific Committee of the Latin American Confederation of Clinical Biochemistry and the Terminology Commission and Publications Committee of the Spanish Society of Clinical Chemistry and Molecular Pathology.6 Term considered Previously recommended Comment incorrect term6 Acido Urico Urato The IFCC and IUPAC recommend, and the SEQC assumed the recommendation, that for those molecular entities that give rise to acid-base pairs (according to Brønsted), these pairs be considered as a single component and named using the name of the most ionized form, but omitting the word ion. Refers to uric acid (“ácido úrico”) plus the urate (“urato”) ion The same rule should be followed for creatinine (“creatininio”), ammonia (ammonium or “amoníaco”), folic acid (folate), phosphoric acid (phosphate), lactic acid (lactate), citric acid (citrate), and similars. Albuminemia Concentración de albúmina It is commented that the same rule should be followed for calcemia en el plasma (o el suero) (concentration of calcium in plasma or serum), cholesterolemia (concentration of. . .), creatininemia (concentration of creatinine) and similar construction for the “incorrect” glycemia/glucemia (concentration of. . .), kalemia/potasemia, lipemia, natremia, proteinemia, sideremia or uricemia.* Albuminuria Concentración de albúmina It is commented that the same rule should be followed for calciuria (calcium en la orina concentration in the urine) and similar construction for phosphaturia (concentration of. . .), glycosuria/glucosuria, kaliuria, natriuria, proteinuria, uricosuria and similars. Anión Gap Diferencia iónica Bicarbonato Hidrogenocarbonato Clearance de creatinina Depuración de creatininio Obviously, barbarisms should be avoided Colecalciferol Calciol “Colecalciferol” continues to be the most widespread term by unwritten consensus in relation to vitamin D3 * Creatinina Creatininio See “Acido úrico” See http://www.ifcc.org/ria/terminology/6 creat ECA Peptidil-dipeptidasa A Actually, it has no clinical sense, especially in reference to the use of a commonly used acronym (iECA or inhibitor of ECA, unwritten consensus) for angiotensin (II) converting enzyme inhibitors (ACEi) Epinefrina Adrenalina, adrenalinio Fósforo Fosfato “Fósforo” as such would be the ionic, reactive and flammable form. GFR Caudal de Filtracion Obviously it would be incorrect to use the English acronym. The term glomerular considered by the authors as correct would be highly debatable in the nephrology field. Hemoglobina Glicohemoglobin glicada/glicosilada Nefrona Nefrón Undoubtedly, the term “nefrona” remains as the most widespread by unwritten consensus Parathormone/PTH Paratrina Reabsorción tubular Resorción tubular Unidades Por ejemplo, mmol/L Apart from recommending the use of the international system of measurement units adopted and recommended by the General Conference on Weights and Measures and declared of legal use in Spain, in all areas, in 1967, the International Union of Pure and Applied Chemistry and the International Federation of Clinical Chemistry recommend that, if the compound unit is a quotient, the prefix should never accompany the unit found in the denominator (mmol/mL would be incorrect and, obviously, mg/dL would not be either). IFCC: International Federation of Clinical Chemistry and Laboratory Medicine; IUPAC: International Union of Pure and Applied Chemistry; SEQC: Spanish Society of Clinical Chemistry. As it can be seen, despite the “consensus”, many of these terms have not had, currently have, and will not have any possibility of clinical implantation for purely historical reasons of common use in the usual medical language. For example, although from a formal point of view, the terms ending in -emia or -uria, partly adapted from English medical constructions, were considered incorrect. However, there is no doubt that they allow language-saving constructions (hyper -xxx -emia, hipo-xxx- emia, hiper -xxx- uria, hipo-xxx- uria) that are very commonly used in clinical communications and publications in Spanish. ∗ We recommend addressing to the appropriate sources (eg reference [6]6b). 226 n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 mendations made by the KDIGO was to use the term kidney nology led us, a broad confluence of nephrologists from very instead of the term “renal” for general descriptions of kid- diverse Spanish-speaking countries, to expand our previous ney function and kidney disease since it was stated, in the claims22–24 and applaud the great initiative of the first proposal context of English speaking patients, that the word (noun) by SLANH.26,27 However, this editorial is claiming to create kidney was more familiar than the adjective “renal”.7,23,24 It a broad and open basis for discussion among nephrologists is also definitely of great interest that the Latin American Reg- in our language (Table 2). Likewise, we praise its approach istry of Kidney Dialysis and Transplantation and the SLANH to the original KDIGO proposals, already universalized and Acute Kidney Injury Committee (IRA) have just published implanted (for example, in the staging G1–G5, A1–A3), whose in December 2020 an Ibero -American consensus proposal to translation would only generate discrepancies, and avoids standardize such nomenclature (initiative now also described harsh terms such as «terminal» or «final», or avoid anglicisms in Nefrologia).26,27 Members of the Brazilian, Portuguese and and literal translations that have other connotations in Span- Spanish Society of Nephrology were included in this proposal ish (such as «injuria»-for damage or lesion - or «severo» -for and certainly, it represents a great first step to achieve the grave-) (Table 2). Unfortunately, there are still some contradic- desired objective for each of the Latin languages that stick us tions (eg renal “failure” with two different definitions) and, together. on the other hand, some terms that we have used histori- cally should perhaps disappear when the final consensus is achieved and published. From the standardization of the English For all these reasons, with great consideration for all these nomenclature to the standardization of the initiatives that have already been launched, we underline the Spanish nomenclature need to share with all Spanish-speaking nephrologists the remaining points of discussion, some of them reflected in As said, it is not a matter of not recognizing with humble- this article. In fact, for the elaboration of a final, broad and ness that English is currently the richest and most universal shared consensus document, we will have to make conces- language; it is currently the most widespread in politics, sions (linguistically speaking) since, being the same language commerce, finance, technology, public demonstrations and (Spanish), there are terms that are more familiar to us depend- science.23 In fact, we must accept and applaud the KDIGO ing on where we received our training without considering initiative, but claiming at the same time for the use of a non- that the “not chosen” terms are incorrect. The uniformity and english terminology that is absolutely correct, precise and homogenization of terms acquires greater relevance every day even very frequently used in various languages (including when we think about efficiency, not only in our bibliographic English itself!). Not only is Spanish the second most widely searches but, even more importantly, anticipating and think- spoken language in the world, but some of the proposed ing about Artificial Intelligence/Machine - Learning tools and the changes (eg, the one mentioned on the adjective “renal”) affect exploitation of Big-Data.29 In this way, the implementation of many other languages. Furthermore, ‘renal’ stands in relation computerized medical records is generating a large volume to anatomical structures (eg ‘renal artery’), historical names of data that offers a great opportunity to promote knowl- such as the United Kingdom Renal Association,22 or nephrologi- edge of diseases, improve daily clinical practice, research and cal journals (Journal of Renal Nutrition). Moreover, we advise in education.29 Obviously, a key point for structuring medical our letters22,23 not to abandon the use of this term «renal» so information is to encode each variable so that it is unique that the bibliographic searches are as broad and inclusive as and correctly defined to allow technical and semantic inter- possible (eg, meta-analyses), and we underline the real need operability between different databases allowing exchange of to launch an initiative similar to the KDIGO in our language information. In this sense, beyond the ICD mentioned, there (such as the one already initiated by SLANH and which also are general initiatives such as the Simple Knowledge Organi- includes Portuguese), homogenizing keywords for scientific zation System (SKOS), (http://skos.um.es/unesco6/00),29 29b the articles, records, as well as meta - tags in search systems.22,23 project of international standardidazation of nomenclature The anglophile fixation of the KDIGO has also had a notable for science and technology, Logical Observation Identifiers Names impact on social networks and specialized websites.27 27b and Codes (LOINC),29 29c (http://loinc.org), or the creation of a dictionary of clinical terminologies using international standards such as the Systematized Nomenclature of Medicine Initiatives towards standardization –Clinical Terms (SNOMED-CT),29 29d which is the broadest, most accurate and comprehensive codified clinical multilingual ter- Independently of frequent misconceptions (eg, the very minology, developed in the world. own definition of chronic kidney disease, kidney failure or Finally, we believe that it is important to highlight that it insufficiency),28 the arrival of new renal terminology of English is no longer a question of defending our common language origin (eg, Acute Kidney Injury [AKI]), has caused an evident dis- and that “renal” is our natural adjective for the kidney in the persion (from “fallo o falla, fracaso, insuficiencia, daño, lesión o scientific field, but rather and above all, we clinicians cannot injuria”, with its different acronyms). Likewise, there is a lack of forget that, in the current scenario the individual patient plays unification of other terms (eg, glomerular filtrate or glomeru- a central role in making decisions that must be shared.23,30 lar filtration (GF) or “tasa” of GF and, more specifically, in This fact is particularly relevant in our specialty, where the frequently used laboratory parameters such as CAC-IAC-RAC degree of evidence of our decisions and clinical actions are (for “cociente, índice, razón, relación” -quotient-index-ratio- generally more in the degree of “suggestions” (evidence grade of albumin/creatinine in urine). All this dispersion of termi- 2) than that of “recommendations” (grade 1).30 Therefore, we Table 2 – Example of terms that would require a broad consensus to unify the nephrology nomenclature used in Spanish. Format adapted from the KDIGO guidelines and the SLANH 2020 document.7,26 Most used Interpretation of the SLANH Avoid (Final consensus Comments acronym acronym required) FG Filtrado o filtración Tasa de filtración Índice de FG It should be specified if it is measured or estimated, as well as the correct units glomerular glomerular (TFG) (mL/min/1.73 m2 -the most common in GFR estimation formulas- or mL/min). GFR is not the same as creatinine clearance (Acl Cr ) The acronyms TFG or FG should be unified. Some authors consider that the use of the word “tasa” (literal English translation) also complicates the acronym on whether it has been measured or estimated with formulas (TFGm or TFGe) (See next) FGm Filtrado o filtración Filtración Índice de FGm Glomerular filtration specifically measured with different techniques. glomerular medid@ glomerular The method must be specified (eg 51 Cr, iothalamate, iohexol . . .) medida (FGm) FGe Filtrado o filtración Filtración Estimated glomerular filtration rate by formulas glomerular estimad@ glomerular The formula used must be specified [p. eg CKD-EPI, MDRD (IDMS), MDRD-4, FAS, estimada (FGe) BIS1. . .] n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 The biomarker used (eg, creatinine, cystatin, or both) should also be specified as a suffix (eg, eGFR Cis -Cr ). Units must be expressed (usually mL/min/1.73 m2 ) although the correction for standard body surface area (GFR x Body Surface Area/1.73 m2 ) can be eliminated (eg, for dosing of highly toxic drugs)2 ,* AclCr Aclaramiento de Aclaramiento Depuración de “Depuración” is a correct term but its acronym is not familiar creatinina (medido) medido (por ej, creatinina FG is not the same as clearance (“depuración”) of a specific substance (biomarker) (eg, de creatin- Clearance de creatinina creatinine)*. ina = AclmCr ) Units must be expressed (often in mL/min) Clearance of urea, calcium or others can also be expressed similarly, changing the suffix AcleCr Aclaramiento estimado Acle (por ej., de “Aclaramiento” estimated by formulas (eg Cockcroft-Gault)* de creatinina creatin- ina = AcleCr ) FR Fallo renal Falla renal Consenso necesario Impaired kidney function (acute or chronic) Literal English translation (renal or kidney failure), not very specific, whose use (if at all) should be agreed upon and clearly defined. The term “fallo o falla” contains contradictions in the KDIGO and SLANH guidelines themselves, being defined in one place simply as duration of kidney disease >3 m and, in another, as equivalent to kidney “failure” or CKD G5 (with or without RRT)* ERC Enfermedad renal Enfermedad Insuficiencia renal Abnormalities of renal structure or function, present for more than 3 months, with crónica renal crónica crónica (IRC) health implications.* (ERC) Fallo (falla) renal crónico It is classified according to the CGA format, based on the Cause, FG (G) and Deterioro, disfunción Albuminuria (A).* renal crónica Staging according to KDIGO G1–G5, G5D, 1T–5T (D = Dialysis, T = Kidney transplant).*/** Stages (according to categories of G and A) G1–2 require kidney “damage” markers to be classified as CKD* Chronic renal “insufiiciency” initially referred only to CKD ≥ G3* The KDIGO classification thus defines risk categories (low, moderate, high and very high)* 227 228 – Table 2 (Continued) Most used Interpretation of the SLANH Avoid (Final consensus Comments acronym acronym required) ERC G1–G5 ERC estadio/categoría ERC estadio Estadio (no existe este It is important to keep in mind that for a correct description of CKD, the KDIGO G1–G5 (determinado por G1–G5 término en español) guidelines recommend classification following the CGA criteria el Filtrado Glomerular) Grado [Cause-G(FG)-Albuminuria] that takes into account the original cause (C)* G1–G5 allows international homogeneity* It is recalled that stages G1–2 require that the patient present markers of kidney damage in order to be classified as having CKD. CKD G3a defines a mild to moderate decrease in GFR (KDIGO)* CKD G3b defines a mild to moderate decrease in GFR (KDIGO)* CKD G4 defines a moderate to severe decrease in GFR (KDIGO)* CKD G5 defines a severe decrease in GFR (KDIGO)* SLANH recommends avoiding the terms mild, moderate, severe, early, advanced* n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 ERC G5 ERC estadio/categoría 5 GFR < 15 mL/min/1.73 m2 without renal replacement therapy (determinado por el ERC G5ND (non-dialysis) is commonly used as opposed to ERC G5D (see below) Filtrado Glomerular < 15 mL/min/1,73 m2 ) ERC G5D ERC estadio/categoría No especificado Consenso necesario GFR < 15 mL/min/1.73 m2 in dialysis 5D ERC terminal According to KDIGO, renal “failure” or “failure” refers to stage 5 CKD (eGFR ERT <15 mL/min/1.73 m2 or on dialysis) IRCT The term “failure” contains contradictions in the KDIGO guidelines themselves, being defined in one place as equivalent to kidney “failure” and, in another, to simple duration of kidney disease >3 m The use of the adjective “terminal” as a pejorative, as well as the adjectives “definitive” or “final” is discouraged. G5D allows international homogeneity* ERA Enfermedad renal aguda Enfermedad Discusión en curso¥ New term under discussion that refers to deterioration of renal function of LESS renal aguda Consenso necesario¥ than 3 months of evolution (>7 days) It generally refers to the evolution after an acute episode in transition to CKD criteria It would be advisable not to stage or clarify whether the staging attempt refers to AKI staging (for acute kidney injury) or CKD. IRA Insuficiencia renal Lesión renal Discusión en curso¥ “IRA” can be confused with Acute Respiratory Failure (“Insuficiencia Respiratoria aguda aguda (LRA) Consenso necesario¥ Aguda”) The SLANH proposal specifies that the definition of the KDIGO guidelines (“IRA is a subcategory of ERA”) should be followed, avoiding the terms IRA and FRA. A clear distinction should be made between the terms acute kidney “lesión” (damage) and dysfunction. It should be clearly specified that it should be followed by current staging (according to AKI 1–3) based on serum creatinine and urine output* (see below) – Table 2 (Continued) Most used Interpretation of the SLANH Avoid (Final consensus Comments acronym acronym required) FRA Fracaso renal agudo Disfunción renal Discusión en curso¥ “Fracaso” should be equivalent to Acute Kidney Injury (AKI) stage 3 in Anglo-Saxon aguda, estadio 3 Consenso necesario¥ terminology [Increase in Crs > 300% from baseline or Crs ≥ 4 mg/dL (≥354 ␮mol/L) after an acute increase greater than 0.5 mg/dL (44 ␮mol/L)].* The terms acute renal “daño, injuria, lesión, fallo o falla” (for damage, injury, injury, failure” do not necessarily imply renal “fracaso”. If their use is agreed upon, they should necessarily be followed by current staging (according to AKI 1–3)* It has been suggested not to use acute kidney “daño” or “injuria” for several reasons** n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 A clear distinction should be made between the terms IRA and FRA. FRA (for acute renal failure instead of IRA) avoids confusion with Acute Respiratory Failure but would not apply to IRA 1–2 FRA 3D Fracaso renal agudo 3D Disfunción renal Stage 3 acute renal failure-dysfunction (AKI 3) treated with dialysis aguda (DRA), estadio 3D FENa Fracción excretada de Fracción de Excreción fraccional de Excreted fraction of urea and others can also be expressed similarly, changing the sodio excreción de sodio suffix sodio CACo Cociente Relación Razón The acronym should underscore the need to use “orina” (urine) (“o”) or urinaria (u) albúmina/creatinina en albumin- creatinine for the ratio calculation. orina (CACO, CACror ) uria/creatininuria “Relación” as a term and acronym expressed as an index? (I Albu /Creatu ) Albumin/creatinine “cociente” is the term used in the Spanish SEN-SEQC guidelines CACb Urea, phosphorus, etc. can also be expressed similarly, changing to suffix. CPCo Cociente Relación protein- PCR The acronym should underscore the need to use urine (“o”) or urinary (“u”) creatinine proteína/creatinina en uria/creatininuria Razón for the ratio calculation. orina (I Protu /Creatu ) A1-3 Categorías de Categorías de This acronym underscores the need to use urine creatinine for the ratio calculation. albuminuria o albuminuria There may be more proteins in the urine than just albumin (eg, nonselective proteinuria según según KDIGO proteinuria, light chains). KDIGO A2 Aumento moderado de Microalbuminuriad Albuminuria or moderately increased proteinuria [CACo 30–300 mg/g la concentración de (3–30 mg/mmol; 30mg/d]* albúmina en orina [CPCo 150–500 mg/d; 150–500 mg/g (15–50 mg/mmol)]* 229 230 – Table 2 (Continued) Most used Interpretation of the SLANH Avoid (Final consensus Comments acronym acronym required) A3 Aumento grave de la Macroalbuminuriad Albuminuria or severely increased proteinuria [CACo > 300 mg/g (>30 mg/mmol); concentración de >30 mg/d]* albúmina en orina [CPCo >500 mg/d; >500 mg/g (>50 mg/mmol)]* Síndrome Albu > This clarification of the analytical values of the KDIGO (and SLANH) is important for nefrótico 2.200 mg/día the definition of nephrotic syndrome when only the excretion of albumin in the (IAlbu /Creatu > urine (instead of proteinuria) is taken into account. Pending of final publication of 200 mg/g (> 220 the new KDIGO guidelines on glomerular disease. mg/mmol) It should be clearly specified whether a nephrotic RANGE proteinuria is with or Protu > without nephrotic SYNDROME, as indicated by the presence of hypoalbuminemia 3.500 mg/día (with edema and hyperlipidemia in most cases), as it is helpful in its differential (IAlbu /Creatu diagnosis (eg primary or secondary focal and segmental glomerulosclerosis) and for >3.500 mg/g subsequent therapeutic decisions. (>350 mg/mmol) Attention should be paid to the use of commas as thousands separators, which is n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 inappropriate in Spanish (in Spanish thousands are separated by periods and only decimals are separated by commas). In English it is exactly the opposite. Note that the corrected definition corresponds to, eg, Alb u > 2,2 g/day and the classic Prot u > 3,5 g/day. TRS Tratamiento renal Tratamiento Tratamiento de Includes dialysis and transplant, so it must be specified sustitutivo (TSR) renal de reemplazo renal The SLANH guidelines also use the term “sustitutivo” and the long term sustitución (TRS) Terapia renal sustitutiva (with/without renal replacement therapy), but note that the term could be revised at Terapia de reemplazo the KDIGO AKD consensus conference (Acute Kidney Disease) renal Discusión en curso¥ Consenso necesario¥ TRe Trasplante renal Trasplante renal Transplante renal Kidney transplant (functioning or not) Several registries use the term FUNCTIONING kidney transplant with the acronym TRF. a When describing grades (categories, stages) of CKD, the use of the adjective “severo/a” should be avoided and the use of “grave” should be used instead. Severa is a literal translation of the English “severe”, but in Spanish the word “severe” does not mean serious but rigorous. c SEN-SEQC = Spanish Society of Nephrology-Spanish Society of Clinical Chemistry and Molecular Pathology. ∗ We recommend addressing to the appropriate sources. ∗∗ It has been suggested not to use acute kidney «daño» or «injuria» for several reasons: (1) lack of tradition, (2) the term “injuria” is a merely cosmetic change since it continues to be defined by renal function and not by objective markers of damage, independent of renal function. Theoretically, it would be possible for there to be patients with acute renal function impairment [IRA (AKI 1–3) or FRA (AKI 3)] and acute kidney injury, but also patients with acute kidney injury but without IRA or FRA. b The acronym CAC does seem to be considered subliminally in the SLANH proposal. d Despite the enormous implantation of these terms, especially beyond nephrology, it was considered that the terms micro- or macro- were not adequate because it is not about the existence of a “small” or a “big” albumin. e It is possible that the nomenclature associated with transplantation, barely existing in the KDIGO initiative on nomenclature and with Anglo-Saxon terminology well established even in daily practice (eg borderline, DGF due to delayed graft function, etc.), deserves itself an initiative of the respective transplant societies. It should be assessed whether a translation would improve the understanding of the texts, expand or speed up the results of search engines, improve the exchange of information between the different actors in the world of transplantation or, on the contrary, it would be a “new learning” that it would displace an already integrated knowledge without additional input. n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 231 cannot forget that, for our patients, what is really fundamen- 11. Delanaye P, Jager KJ, Bökenkamp A, Christensson A, Dubourg tal is not that we scientists or nephrologists use to understand L, Eriksen BO, et al. CKD: a call for an age-adapted definition. J each other by using a common scientific language, but rather Am Soc Nephrol. 2019;30:1785–805. 12. Gracia-Garcia S, Montañés-Bermudez R, Bover-Sanjuan J, that our “kidney” (“renal”) patient understands from us by Cases-Amenós A, Deulofeu-Piquet R, de Francisco ALM. using plain words of any origin, adapted individually, and even Recomendaciones sobre la utilización de ecuaciones para la resorting to colloquial or more popular language, whether we estimación del filtrado glomerular en adultos. Nefrologia. are for him “nefró-logos” or “riñón-logos”.23 2006;26:658–65. 13. Canal C, Pellicer R, Rocha CI, Calero F, Gracia S, Montañés R, et al. Tables estimating glomerular filtration rate from plasma Financing creatinine. Nefrologia. 2008;28:317–24. 14. Alcázar A, Egocheaga MI, Orte L, Lobos JM, González Parra E, Alvarez Guisasola F, et al. SEN-SEMFYC consensus document The production of this editorial has not received any financial on chronic kidney disease. Nefrologia. 2008;28:273–82. support. 15. Montañés-Bermúdez R, Gràcia-García S, Pérez-Surribas D, Martínez-Castelao A, Bover-Sanjuán J. Documento de Consenso. Recomendaciones sobre la valoración de la Conflict of interests proteinuria en el diagnóstico y seguimiento de la enfermedad renal crónica. Nefrologia. 2011;31:331–45. The authors have no conflicts of interest related to this article. 16. Montañés-Bermúdez R, Bover-Sanjuán J, Oliver-Samper A, Ballarín-Castán JA, Gràcia-García S. Valoración de la nueva ecuación CKD-EPI para la estimación del filtrado glomerular. references Nefrología. 2010;30:185–94. 17. Canal C, Pellicer R, Facundo C, Gràcia-Garcia S, Montañés-Bermúdez R, Ruiz-García C, et al. Tables for estimating the glomerular filtration rate using the new 1. Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, CKD-EPI equation from serum creatinine concentration. Cebollada J, Escalada J, et al. Documento de consenso para la Nefrologia. 2014;34:223–9. detección y manejo de la enfermedad renal crónica. 18. IMproving Global Outcomes (KDIGO) 2012 Clinical Practice Nefrologia. 2014;34:243–62. Guideline for the Evaluation and Management of Chronic 2. García-Maset R, et al. Actualización del documento de Kidney Disease. Kidney Int Suppl. 2013;3:1–150. consenso para la detección y manejo de la enfermedad renal 19. Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, crónica. Nefrologia. 2021. Cebollada J, Escalada J. Documento de consenso para la 3. Gella Tomás FJ, Andrés-Otero MJ, Rigo-Bonnin R, detección y manejo de la enfermedad renal crónica. Aten Canalias-Reverter F, Cano-Corres R, Esteve-Poblador S, et al. Primaria. 2014;46:501–19. Nomenclatura y unidades de las propiedades biológicas. 20. Obrador-Vera GT, Bourlón de los Ríos MT, Gómez-Sámano MA, Recomendación (2016). Rev Lab Clin. 2018;11:87–92. Laris-González A, Contreras-Estrada D, Correa-Rotter R, et al. 4. Fuentes-Arderiu X. Diccionario de ciencias de laboratorio Guías Latinoamericanas de Práctica Clínica sobre la clínico. Interamericana de España S.L: McGraw-Hill; 1998. Prevención, Diagnóstico y Tratamiento de los Estadios 1-5 de ISBN 8448602013. la Enfermedad Renal Crónica. [Accessed 24 December 2020] 5. Olesen H. Properties and units in the clinical laboratory Available from: https://www.slanh.net/wp-content/ sciences, I. Syntax and semantic rules (recommendation uploads/2014/07/enfermedad renal cronica.pdf. 1995). International Union of Pure and Applied Chemistry 21. Grupo de trabajo de la Guía de Práctica Clínica sobre la (IUPAC) and International Federation of Clinical Chemistry Detección y el Manejo de la Enfermedad Renal Crónica. Guía (IFCC). Eur J Clin Chem Clin Biochem. 1995;33:627–36. de Práctica Clínica sobre la Detección y el Manejo de la 6. Fuentes-Arderiu X, Antoja-Ribó F, Castiñeiras-Lacambra MJ. Enfermedad Renal Crónica. Ministerio de Sanidad, Servicios Manual de estilo para la redacción de textos científicos y Sociales e Igualdad. Instituto Aragonés de Ciencias de la profesionales. Barcelona, Universitaria de Bellvitge, 2003. Salud. 2016 [Accessed 24 December 2020]. Available from: [E-book]. https://portal.guiasalud.es/wp-content/uploads/2018/12/ https://universoabierto.org/2015/12/14/manual-de-estilo- GPC 559 ERC IACS compl.pdf. para-la-redaccion-de-textos-cientificos-y-profesionales/ 22. Bover J, Haarhaus ML, Furlano M, Ureña P, Vervloet M, DaSilva (última visita 24/12/2020 International Federation of Clinical I, et al. English-Latin nomenclature conundrum: should we Chemistry and Laboratory Medicine. Comentarios de use kidneylogy, kidneylogist? Kidney Int. 2020;98:1352–3. Terminología. [consultado 7 Ago 2021]. Disponible en: 23. Bover J, Bosch R, Ureña P, Trinidad P, Jara A, Górriz JL, et al. Los http://www.ifcc.org/ria/terminology/#creat. riñones también hablan español. Nefrologia. 7. Levey AS, Kai-Uwe Eckardt KU, Dorman NM, Christiansen SL, https://doi.org/10.1016/j.nefro.2020.11.002 [Accessed 5 Hoorn EJ, Ingelfinger JR, et al. Nomenclature for kidney December 2020]. Available from: https://www. function and disease: report of a Kidney Disease: Improving revistanefrologia.com/es-los-rinones-tambien-hablan- Global Outcomes (KDIGO) Consensus Conference. Kidney Int. espanol-avance-S0211699520301818. 2020;97:1117–29. 24. da Silva-Santos I, Araújo MJCLNA, Jorgetti V, ELias RM, Bover J. 8. National Kidney Foundation. K/DOQI clinical practice Rins também falam portugués. Braz J Nephrol (J Bras Nefrol). guidelines for chronic kidney disease: evaluation, 2021, http://dx.doi.org/10.1590/2175-8239-jbn-2020-0264 classification, and stratification. Am J Kidney Dis. 2002;39(S1). [Accessed 7 August 2021]. Available from: 43. 9. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert 25. Kalantar-Zadeh K, McCullough PA, Agarwal SK, Beddhu S, J, et al. Definition and classification of chronic kidney disease: Boaz M, Brunchfeld A, et al. Nomenclature in Nephrology: a position statement from Kidney Disease: Improving Global Preserving ‘Renal’ and ‘Nephro’ in the Glossary of Kidney Outcomes (KDIGO). Kidney Int. 2005;67:2089. Health and Disease. J Nephrol. 2021;34, 639–548. (in press) 10. Levey AS, Stevens LA, Coresh J. Conceptual model of CKD: https://www.springer.com/journal/40620 applications and implications. Am J Kidney Dis. 2009;53:S4. 232 n e f r o l o g i a. 2 0 2 2;4 2(3):223–232 26. Ferreiro-Fuentes A, González-Bedat MC, Lombardi R, Lugon J, et al. Clarifying the concept of chronic kidney disease for Mastroianni G, Mira F, et al. Consenso iberoamericano para non-nephrologists. Clin Kidney J. 2020;12:258–61. uniformar la nomenclatura de la función y las enfermedades 29. Hueso M, Haro L, Calabia J, Dal-Ré R, Tebé C, Gibert K, Cruzado renales: una propuesta de la SLANH. Nefro Latinoam. JM, Vellido A. Leveraging data science for a personalized 2020;17:55–67. haemodialysis. Kidney Dis (Basel). 2020;6:385–94. Proyecto de 27. Sánchez-Alvarez JE, Ferreiro-Fuentes A, Gonzalez-Bedat MC, nomenclatura internacional normalizada relativa a la ciencia Rosa-Diez GJ, Limbardi R, Lugón J, Mira F, Mastroianni G. y la tecnología. [Accessed 7 August 2021]. Available from: Sobre ña necesidad de armonizar la terminología nefrológica https://skos.um.es/unesco6/00/html en los países latinoamericanos. Nefrología 2021 (en prensa) 30. Bover J, Ureña-Torres P, Mateu S, DaSilva I, Gràcia S, Marlene Busko.’Kidney’ vs’Renal’: Experts say words matter. Sánchez-Baya M, et al. Evidence in chronic kidney [consultado 7 Ago 2021]. Disponible en: disease–mineral and bone disorder guidelines: is it time to https://www.medscape.com/viewarticle/940518. treat or time to wait? Clin Kidney J. 2020;13:513–21. 28. Perez-Gomez V, Bartsch LA, Castillo-Rodriguez E, Fernandez-Prado R, Fernandez-Fernandez B, Martin-Cleary C,