RESUMO
Intradialytic hypotension is a major complication during hemodialysis session, associated with increased risk of cardiovascular events and mortality. Its pathophysiology is believed to be multifactorial and remains not well elucidated. The aim of this study is to put forward new mechanisms behind the development of intradialytic hypotension. The study included sixty-five subjects on chronic hemodialysis, divided into two groups: intradialytic hypotensive (n=12) and normotensive (n=53), according to the variation of systolic blood pressure between post-dialysis and pre-dialysis measurements. Renin and angiotensin converting enzyme I plasma concentrations increased in both groups but more likely in normotensive group. Aldosterone plasma concentration is increased in the normotensive group while it decreased in the intradialytic hypotension group. Plasma endothelin concentrations showed higher values in intradialytic hypotension group. Post-dialysis asymmetric dimethylarginine and angiotensin converting enzyme 2 plasma concentrations were significantly higher in intradialytic hypotension group as compared to normotensive one. Collectrin plasma concentrations were significantly lower in intradialytic hypotension group. Finally, post-dialysis vascular endothelial growth factor C plasma concentration significantly increased in intradialytic hypotension group. In conclusion, endothelial dysfunction characterized by a lower level of vasoactive molecule seems to play a critical role in intradialytic hypotension development.
Assuntos
Pressão Sanguínea , Endotélio Vascular/fisiopatologia , Hipotensão/etiologia , Nefropatias/terapia , Diálise Renal/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Aldosterona/sangue , Enzima de Conversão de Angiotensina 2 , Arginina/análogos & derivados , Arginina/sangue , Biomarcadores/sangue , Endotelina-1/sangue , Endotélio Vascular/metabolismo , Feminino , Humanos , Hipotensão/sangue , Hipotensão/fisiopatologia , Nefropatias/sangue , Nefropatias/fisiopatologia , Masculino , Glicoproteínas de Membrana/sangue , Pessoa de Meia-Idade , Peptidil Dipeptidase A/sangue , Renina/sangue , Fatores de Tempo , Fator C de Crescimento do Endotélio Vascular/sangueAssuntos
Ciclosporina/farmacocinética , Monitoramento de Medicamentos/métodos , Imunossupressores/farmacocinética , Transplante de Rim/imunologia , Contagem de Linfócitos , Linfócitos/imunologia , Biópsia , Ciclosporina/uso terapêutico , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/patologia , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/patologia , Linfócitos/efeitos dos fármacos , Reprodutibilidade dos TestesAssuntos
Azatioprina/uso terapêutico , Transfusão de Sangue , Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Prednisolona/uso terapêutico , Doadores de Tecidos , Fatores Etários , Distribuição de Qui-Quadrado , Creatinina/sangue , Quimioterapia Combinada , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/prevenção & controle , Teste de Histocompatibilidade , Humanos , Incidência , Masculino , Fatores de Tempo , Resultado do TratamentoRESUMO
Nephrogenic ascites is a complex problem with a poorly understood pathophysiology. We report the case of a patient with nephrogenic ascites and concomitant secondary hyperparathyroidism who was resistant to the usual treatment but had a complete resolution after subtotal parathyroidectomy. We believe that secondary hyperparathyroidism might be implicated in the pathogenesis of nephrogenic ascites.
