RESUMEN
O potássio tem função fisiológica fundamental no volume intracelular e na manutenção funcional de nervos e músculos. Distúrbios do potássio são comuns e estão associados a aumento na mortalidade nos portadores de doenças cardiovasculares, entre elas a hipertensão arterial. Assim a manutenção de um equilíbrio entre o potássio intra e extracelular é de fundamental importância para nervos, músculos e o sistema cardiovascular. Há décadas os diuréticos tiazídicos são uma das principais drogas utilizadas no tratamento da hipertensão arterial. Entre suas principais reações adversas relacionam-se os distúrbios eletrolíticos e metabólicos, os quais se tornaram menos frequentes com o uso de doses menores do que as habitualmente empregadas no seu início. Neste artigo os principais efeitos adversos do uso crônico dos diuréticos tiazídicos bem como suas consequências serão discutidos.
Potassium has a fundamental physiological function without intracellular volume and in the functional maintenance of nerves and muscles. Potassium disorders are common and are associated with increased mortality in patients with cardiovascular diseases, including hypertension. Thus, maintaining a balance between intracellular and extracellular potassium is of fundamental importance for the nerves, muscles and cardiovascular system. Thiazide diuretics have been one of the main drugs used in the treatment of hypertension for decades. Among its main adverse reactions are related electrolyte and metabolic disturbances, which become less frequent with the use of lower doses than those usually used at the beginning. In this article, the main adverse effects of the chronic use of thiazide diuretics as well as their consequences will be discussed.
Asunto(s)
Humanos , Inhibidores de los Simportadores del Cloruro de Sodio/efectos adversos , HipopotasemiaRESUMEN
Estenoses da artéria renal (EAS) é um estreitamento ou bloqueio de uma artéria para os rins. Pode causar insuficiência renal e pressão alta. Fumantes e ex-fumantes têm maior risco de contrair RAS. Os homens são afetados com essa condição duas vezes mais que as mulheres. É mais comum nas idades de 50 e 70. Colesterol alto, diabetes, excesso de peso e histórico familiar de doenças cardíacas também são fatores de risco para RAS. A pressão alta é uma causa e resultado do RAS. A causa mais comum de bloqueio da artéria renal é a arteriosclerose (espessamento e endurecimento das paredes da artéria) com acúmulo de colesterol e placa. Isso é semelhante ao que é visto nas artérias coronárias do coração, nas artérias carótidas, no cérebro e nos vasos das pernas. Apresentamos um caso de doença vascular renal em um homem diabético e ex-fumante e é apresentada uma atualização sobre a doença.
Renal artery stenoses (RAS) is a narrowing or blockage of an artery to the kidneys. It may cause kidney failure and high blood pressure. Smokers and ex-smokers have a greater risk of getting RAS. Men are affected with this condition twice as often as women. It>s most common in the ages of 50 and 70. High cholesterol, diabetes, being overweight, and having a family history of heart disease are also risk factors for RAS. High blood pressure is both a cause and a result of RAS. The most common cause of renal artery blockages is arteriosclerosis (the thickening and hardening of artery walls) with cholesterol and plaque build-up. This is similar to what is seen in the coronary arteries of the heart, the carotid arteries to the brain and the leg vessels.We presente a case of renal vascular disease in a diabetic and ex-smoker man and an up to date about the disease is presented.
RESUMEN
There is a very well known correlation between diabetes and cardiovascular disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious cardiovascular diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and cardiovascular disease: Glicemic Control, Cardiovascular Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology.
RESUMEN
FUNDAMENTO: O envelhecimento e a aterosclerose estão relacionados à hipertensão renovascular em indivíduos idosos. Independentemente das comorbidades, a estenose de artéria renal é, por si só, importante causa de morbidade e mortalidade cardiovascular. OBJETIVO: Definir a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo dos exames não invasivos utilizados no diagnóstico de estenose da artéria renal. MÉTODOS: Um grupo de 61 pacientes recrutados permitiram a análise de 122 artérias e a definição de sensibilidade, especificidade e da contribuição relativa de cada exame realizado (Doppler, cintilografia e angiotomografia, comparados a arteriografia renal). RESULTADOS: A média das idades foi de 65,43 (desvio padrão: 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas estiveram correlacionadas à estenose da artéria renal, à disfunção renal e aos triglicerídeos. A mediana do ritmo de filtração glomerular foi de 52,8 mL/min/m². O Doppler identificou sensibilidade de 82,90%, especificidade de 70%, valor preditivo positivo de 85% e valor preditivo negativo de 66,70%. Para a tomografia, encontraram-se sensibilidade de 66,70%, especificidade de 80%, valor preditivo positivo de 87,50% e valor preditivo negativo de 55,20%. Esses achados permitiram identificar os exames que melhor detectavam a estenose. CONCLUSÃO: A tomografia e o Doppler mostraram qualidade e grande possibilidade no diagnóstico de estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, ocorre em diabéticos e associa-se à disfunção renal e à disfunção ventricular esquerda grave.
BACKGROUND: Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. OBJECTIVE: To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. METHODS: In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). RESULTS: The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m². Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. CONCLUSION: Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diagnóstico por Imagen/métodos , Obstrucción de la Arteria Renal/diagnóstico , Aterosclerosis/complicaciones , Hipertensión Renovascular/complicaciones , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Obstrucción de la Arteria Renal/etiología , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Ultrasonografía DopplerRESUMEN
BACKGROUND: Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. OBJECTIVE: To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. METHODS: In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). RESULTS: The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m². Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. CONCLUSION: Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction.
Asunto(s)
Diagnóstico por Imagen/métodos , Obstrucción de la Arteria Renal/diagnóstico , Anciano , Aterosclerosis/complicaciones , Femenino , Humanos , Hipertensión Renovascular/complicaciones , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Obstrucción de la Arteria Renal/etiología , Factores de Riesgo , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Ultrasonografía DopplerRESUMEN
A crescente incidência da aterosclerose na população adulta e a obstrução da artéria renal são condições relacionadas à hipertensão renovascular. Independente das comorbidades presentes, a estenose de artéria renal é, por si só, importante causa de mortalidade cardiovascular...