Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana , Valor Preditivo dos Testes , Calcificação Vascular , Humanos , Calcificação Vascular/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Reprodutibilidade dos Testes , Masculino , Feminino , Técnicas de Imagem de Sincronização Cardíaca , Vasos Coronários/diagnóstico por imagem , Pessoa de Meia-Idade , Idoso , Índice de Gravidade de DoençaRESUMO
Background: The occurrence of acute and chronic kidney diseases has been rising in the last decades. Although drug use is a common risk factor for impaired kidney function, changes in utilization of potential nephrotoxic drugs have received little attention. Purpose: To describe temporal trends in the utilization of potentially nephrotoxic drugs in Denmark between 1999 and 2021. Methods: Specific drugs known or suspected to be nephrotoxic were identified in the literature. Data on the sold defined daily doses (DDDs) of potentially nephrotoxic drugs between 1999 and 2021 were retrieved using the Danish Register of Medical Product Statistics. Trends in sales of DDDs per 1000 inhabitants per day were tabulated and illustrated graphically. Results: From 1999 to 2021, the total sale of all selected drugs increased from 286 to 457 DDDs per 1000 inhabitants per day. The overall sale reached a preliminary peak in 2012 with 449 DDDs per 1000 inhabitants per day and remained relatively stable thereafter until reaching an all-time high in 2021 with 457 DDDs per 1000 inhabitants per day. Contributing with the majority in volume, sales of drugs inhibiting the renin-angiotensin-aldosterone system (RAAS) increased dramatically throughout the period. The same was observed for acetaminophen, methotrexate, tacrolimus, and iodinated contrast dye. In contrast, the sales of diuretics, acetylsalicylic acid, and ciclosporin decreased during the last decade of the study period. Conclusion: From 1999-2021 considerable changes in sales of potentially nephrotoxic drugs were observed. In general, the sales increased, in volume predominated by RAAS inhibiting drugs. This increase in sales of potential nephrotoxins could contribute to an increasing occurrence of kidney diseases.
RESUMO
Complete heart block (CHB) is a serious condition, usually affecting older patients. We report a case of CHB in a 31-year-old pregnant woman treated with sertraline in whom atrioventricular (AV) conduction normalized after discontinuation of sertraline. Results of subsequent genetic investigations for inherited cardiomyopathy and ion-channel disease and a pharmacogenetic study of sertraline pharmacokinetics were negative. Reversible CHB in this younger pregnant patient was temporally related to sertraline. This case underlines the importance of identifying reversible causes when a young patient presents with AV block with unknown trajectory and prognosis, as well as regular recording of electrocardiograms in pregnant patients on psychotropic medications.
Le bloc cardiaque complet (BCC) est une affection sérieuse, qui touche généralement les patients âgés. Nous présentons un cas de BCC chez une femme enceinte de 31 ans traitée par sertraline chez qui la normalisation de la conduction atrioventriculaire (AV) a été constatée après l'arrêt de la sertraline. Les résultats des examens génétiques subséquents de cardiomyopathie héréditaire et de maladies des canaux ioniques, et d'une étude pharmacogénétique de la pharmacocinétique de la sertraline étaient négatifs. LE BCC réversible chez cette jeune patiente enceinte était temporairement lié à la sertraline. Ce cas montre l'importance de cerner les causes réversibles lorsqu'un jeune patient présente un bloc AV à la trajectoire et au pronostic inconnus, et de faire régulièrement des électrocardiogrammes chez les patientes enceintes qui prennent des psychotropes.
