RESUMO
Systemic sclerosis (SSc) is an immune-mediated rheumatic disease characterized by vascular abnormalities, tissue fibrosis, and inflammation. Renal disease occurring in patients with SSc may have a variable clinicopathological picture. However, the most specific renal condition associated with this disease is the scleroderma renal crisis (SRC), characterized by acute onset of renal failure and severe hypertension. SRC develops in about 20% of cases of SSc, especially in those patients with diffuse cutaneous disease. The prognosis of this condition is often negative, with a rapid progression to end-stage renal disease (ESRD). The advent of the antihypertensive angiotensin-converting enzyme inhibitors in 1980 was associated with a significant improvement in patients' survival and recovery of renal function. However, the prognosis of these patients can still be improved. The dialytic condition is associated with early death, and mortality is significantly higher than among patients undergoing renal replacement therapy (RRT) due to other conditions. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for kidney transplantation (KT). In this review, we reported the most recent advances in KT in patients with ESRD due to SSc, with a particular overview of the risk of disease recurrence after transplantation and the evolution of other disease manifestations.
Assuntos
Injúria Renal Aguda , Hipertensão Renal , Falência Renal Crônica , Transplante de Rim , Esclerodermia Localizada , Escleroderma Sistêmico , Injúria Renal Aguda/terapia , Humanos , Hipertensão Renal/complicações , Hipertensão Renal/diagnóstico , Hipertensão Renal/terapia , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/patologia , Escleroderma Sistêmico/terapiaRESUMO
WHAT IS KNOWN AND OBJECTIVE: Angiotensin-converting enzyme inhibitors (ACEIs) are widely used in the treatment of scleroderma renal crisis (SRC), and their use prior to the onset of SRC in patients with systemic sclerosis (SSc) has received wide attention in recent years. We undertook an evidence-based approach to identify whether the use of ACEIs prior to the onset of SRC is beneficial for patients with SSc. METHODS: We searched PubMed and Embase for any published studies produced between database inception and 22 October 2021. Articles obtained after using appropriate keywords were selected independently by two reviewers according to the established inclusion and exclusion criteria. RESULTS: Nine studies were included. Pooled results indicated that using ACEIs prior to SRC was associated with a higher incidence of SRC than no ACEIs prior to SRC (RR 2.05, 95% confidence interval 1.08-3.91, p = 0.03). Compared with patients who did not use ACEIs prior to the onset of SRC, a higher proportion of patients with SRC who used ACEIs prior to its onset had a poorer prognosis (RR 1.46, 95% confidence interval 1.20-1.78, p < 0.01). The difference in mortality between patients who used ACEIs prior to SRC onset and those who did not was not statistically significant (RR 1.12, 95% confidence interval 0.76-1.65, p = 0.57). WHAT IS NEW AND CONCLUSIONS: We recommend against using ACEIs prior to SRC in SSc patients. The use of ACEIs prior to SRC is associated with a higher incidence of SRC and poorer prognosis, especially in patients with progressive SSc or SSc-related renal vasculopathy (SSc-related hypertension and proteinuria).
Assuntos
Injúria Renal Aguda , Hipertensão Renal , Hipertensão , Escleroderma Sistêmico , Injúria Renal Aguda/induzido quimicamente , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Humanos , Hipertensão/complicações , Hipertensão Renal/etiologia , Hipertensão Renal/terapia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/tratamento farmacológicoRESUMO
Hypertension-mediated organ damage frequently includes renal function decline in which several mechanisms are involved. The present review outlines the state of the art on extracellular vesicles in hypertension and hypertension-related renal damage. Emerging evidence indicates that extracellular vesicles, small vesicles secreted by most cell types and body fluids, are involved in cell-to-cell communication and are key players mediating biological processes such as inflammation, endothelial dysfunction or fibrosis, mechanisms present the onset and progression of hypertension-associated kidney disease. We address the potential use of extracellular vesicles as markers of hypertension-mediated kidney damage severity and their application as therapeutic agents in hypertension-associated renal damage. The capacity of exosomes to deliver a wide variety of cargos to the target cell efficiently makes them a potential drug delivery system for treatment of renal diseases.
Assuntos
Vesículas Extracelulares/fisiologia , Hipertensão Renal/terapia , Nefrite/terapia , Biomarcadores , Sistemas de Liberação de Medicamentos , Exossomos , Humanos , Hipertensão Renal/etiologia , Células-Tronco Mesenquimais/ultraestrutura , MicroRNAs/fisiologia , Nefrite/etiologiaRESUMO
The estimated morbidity rate of chronic kidney disease is 8% to 16% worldwide, and many patients with chronic kidney disease eventually develop renal failure. Thus, the development of new therapeutic strategies for preventing renal failure is crucial. In this study, we assessed the effects of daily low-intensity pulsed ultrasound (LIPUS) therapy on experimental hypertensive nephropathy and diabetic nephropathy. Unilateral nephrectomy and subcutaneous infusion of angiotensin II via osmotic mini-pumps were used to induce hypertensive nephropathy in mice. Immunohistochemistry revealed that daily LIPUS treatment ameliorated renal fibrosis and infiltration of inflammatory cells induced by angiotensin II. A similar therapeutic effect was also observed in mice with angiotensin II-induced hypertensive nephropathy in which splenectomy was performed. In addition, LIPUS treatment significantly decreased systolic blood pressure after 21 days. Subsequently, db/db mice with unilateral nephrectomy developed proteinuria; daily LIPUS treatment significantly reduced proteinuria after 42 days. In addition, immunohistochemistry revealed that renal fibrosis was significantly ameliorated by LIPUS treatment. Finally, LIPUS stimulation suppressed TGF-ß1 (transforming growth factor-ß1)-induced phosphorylation of Smad2 and Smad3 in HK-2 (human proximal tubular cell line) cells. LIPUS treatment may be a useful therapy for preventing the progression of renal fibrosis in patients with chronic kidney disease.
Assuntos
Nefropatias Diabéticas/terapia , Hipertensão Renal/terapia , Rim/patologia , Nefrite/terapia , Terapia por Ultrassom/métodos , Ondas Ultrassônicas , Actinas/genética , Actinas/metabolismo , Animais , Linhagem Celular , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/fisiopatologia , Modelos Animais de Doenças , Fibrose/terapia , Humanos , Hipertensão Renal/metabolismo , Hipertensão Renal/fisiopatologia , Inflamação/metabolismo , Inflamação/terapia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Miócitos de Músculo Liso/metabolismo , Nefrite/metabolismo , Nefrite/fisiopatologia , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismoRESUMO
OBJECTIVE: To investigate the clinical features, treatments, and long-term outcomes of Chinese patients with scleroderma renal crisis (SRC). METHODS: We retrospectively reviewed the clinical and laboratory data of 538 patients with systemic sclerosis (SSc) at our center from January 2009 to December 2016, including 29 SRC and 509 SSc without SRC patients. The treatments and long-term outcomes of patients with SRC were also retrospectively analyzed. RESULTS: The prevalence of SRC was 5.4% in our cohort. Male gender (odds ratio [OR] =4.194 [95% CI 1.494-11.773]), glucocorticoid exposure (OR = 3.666 [1.484-9.056]), pericardial effusion (OR = 11.180 [4.515-27.681]), and myocardial involvement (OR = 7.958 [1.664-38.064]) were associated with an increased risk of development of SRC. Despite the wide use of angiotensin-converting enzyme inhibitors, the permanent dialysis rate of patients with SRC was 48.3%. Sixteen patients died during follow-up, and the estimated 1- and 5-year survival rates of patients with SRC were 62.1% and 47.3%, respectively. Withdrawal of dialysis (5 patients) and myocardial complications (3 patients) were the main causes of death in patients with SRC. Patients with serum creatinine level >500 µmol/L before treatment (log rank test 5.051, P = 0.025) and/or those who needed dialysis at the onset of SRC (log rank test 12.870, P < 0.001) showed poorer prognosis. CONCLUSION: SRC is a rare but severe complication in patients with SSc. Male gender, glucocorticoid exposure, pericardial effusion, and myocardial involvement were risk factors in the development of SRC. Withdrawal of dialysis and myocardial complications were the main causes of death in Chinese patients with SRC.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hipertensão Renal/terapia , Diálise Renal/métodos , Escleroderma Sistêmico/complicações , Adulto , Pequim/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão Renal/epidemiologia , Hipertensão Renal/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Escleroderma Sistêmico/mortalidade , Escleroderma Sistêmico/terapia , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do TratamentoAssuntos
Anti-Hipertensivos/administração & dosagem , Biópsia/efeitos adversos , Drenagem/métodos , Dor no Flanco , Hematoma , Hipertensão Renal , Rim , Hemorragia Pós-Operatória , Adulto , Biópsia/métodos , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Dor no Flanco/diagnóstico , Dor no Flanco/etiologia , Hematoma/etiologia , Hematoma/fisiopatologia , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/etiologia , Hipertensão Renal/metabolismo , Hipertensão Renal/terapia , Rim/diagnóstico por imagem , Rim/metabolismo , Rim/patologia , Rim/fisiopatologia , Masculino , Metabolismo , Hemorragia Pós-Operatória/fisiopatologia , Sistema Renina-Angiotensina , Tomografia Computadorizada por Raios X/métodosRESUMO
This was an unusual case of a large renal artery pseudoaneurysm with impending rupture, which was successfully treated with an endovascular stent-graft in a solitary kidney.
Assuntos
Falso Aneurisma , Angiografia/métodos , Implante de Prótese Vascular , Procedimentos Endovasculares/métodos , Artéria Renal , Rim Único/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/diagnóstico , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Feminino , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/terapia , Artéria Renal/diagnóstico por imagem , Artéria Renal/patologia , Artéria Renal/cirurgia , Stents , Resultado do TratamentoRESUMO
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
Assuntos
Displasia Fibromuscular , Hipertensão Renal , Hipertensão Renovascular , Nefrite , Obstrução da Artéria Renal , Displasia Fibromuscular/complicações , Displasia Fibromuscular/diagnóstico , Displasia Fibromuscular/fisiopatologia , Displasia Fibromuscular/terapia , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/etiologia , Hipertensão Renal/fisiopatologia , Hipertensão Renal/terapia , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/fisiopatologia , Hipertensão Renovascular/terapia , Nefrite/diagnóstico , Nefrite/etiologia , Nefrite/fisiopatologia , Nefrite/terapia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/terapiaRESUMO
BACKGROUND: Posterior urethral valve (PUV) is the most serious form of congenital anomalies of kidney and urinary tract (CAKUT) in boys with significant risk of progression to chronic kidney disease (CKD). We present our long-term results in children with PUV. METHODS: Retrospective chart review of 113 children with PUV followed within the years of 1996-2018 was performed. Clinical, laboratory and epidemiologic parameters were analyzed for their impact on renal outcome. RESULTS: The median age of diagnosis was 1.00 month (1.00-132.00) and the median follow-up period was 70 months (60.00-216.00). Antenatal diagnosis was present in 33 patients (51.5%) mainly with bilateral hydronephrosis and oligohydramnios. The most common postnatal presentation was recurrent urinary tract infection (UTI) in 14 cases (21.9%) and incontinence in three cases (4.7%). Vesicoureteral-reflux (VUR) was present in 31 cases (48.4%). All patients had surgery and urinary diversion was needed in 18 (28.2%). Varying stages of chronic kidney disease (CKD) developed in 23 cases (35.9%) and rise in serum creatinine was especially prominent after the 4th year of follow-up. Of 23 CKD patients, seven (10.9%) were in ESRD and on dialysis. Mortality occurred in one (1.5%) patient. Hypertension, proteinuria and high initial serum creatinine (>1.28 mg/dL) were statistically significant risk factors for CKD, as expected. Surprisingly VUR and UTI did not show such a significant impact on CKD development. Antenatal detection was with significantly less risk for CKD. CONCLUSIONS: Our results confirm that PUV has a considerable risk for CKD development. Antenatal diagnosis, management of proteinuria and hypertension may modify this progression. But already injured kidneys still have a potential risk. The need for further research to evaluate the impact of any intervention on long term renal outcome is obvious.
Assuntos
Uretra/anormalidades , Uretra/cirurgia , Obstrução Uretral/congênito , Obstrução Uretral/cirurgia , Idade de Início , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipertensão Renal/etiologia , Hipertensão Renal/terapia , Lactente , Recém-Nascido , Falência Renal Crônica/etiologia , Masculino , Gravidez , Diagnóstico Pré-Natal , Proteinúria/etiologia , Proteinúria/terapia , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Obstrução Uretral/diagnóstico , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos , Refluxo VesicoureteralAssuntos
Hipertensão Renal/etiologia , Nefropatias/etiologia , Esclerodermia Difusa/complicações , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão Renal/diagnóstico , Hipertensão Renal/imunologia , Hipertensão Renal/terapia , Nefropatias/diagnóstico , Nefropatias/imunologia , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Fotoferese , Troca Plasmática , Diálise Renal , Esclerodermia Difusa/diagnóstico , Esclerodermia Difusa/imunologia , Esclerodermia Difusa/terapia , Resultado do TratamentoRESUMO
We report here a typical case of a patient on hemodialysis (HD) for end-stage renal disease (ESRD) in India that highlights some of the management issues encountered in a country with an enormous burden of ESRD and major challenges of underdialysis and management of comorbidities. The patient, a 42-year-old multiparous woman with chronic kidney disease (CKD) stage V, type 2 diabetes mellitus, and hypertension is a homemaker from a middle-class family, living in a large city, with no family history of CKD. From May 2013 to December 2016, she has been receiving twice-weekly maintenance HD for 4 h (intermittent HD); access was via an internal jugular line initially and then via a left brachiocephalic arteriovenous fistula (AVF) from late June 2013. Medical problems in this patient included poor medication and dietary compliance, underdialysis, anemia, volume overload, congestive cardiac failure with recurrent pulmonary edema, and hypertensive crisis. In December 2016, she complained of pain in the fistula arm during dialysis, and in January 2017, she developed edema of the arm. Specific endovascular intervention with balloon angioplasty resulted in a resolution of the stenosis of the venous side of the AVF and the edema. Counselling for dietary compliance and drug adherence resulted in good blood pressure control. Unlike in most other dialysis units, we have been able to increase her HD to thrice weekly and institute several ancillary services, including skilled dietary counselling, cardiac care, and regular bioimpedance analysis with favorable outcomes. Thus, a multidisciplinary team approach offering such ancillary services would allow for better management and improved outcomes in patients with ESRD in resource-poor settings.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/terapia , Hipertensão Renal/terapia , Falência Renal Crônica/terapia , Diálise Renal/métodos , Adulto , Feminino , Humanos , Hipertensão Renal/etiologia , Índia , Falência Renal Crônica/etiologia , Diálise Renal/normasRESUMO
In order to further elucidate the potential correlations and treatments of IgA nephropathy (IgAN) and hypertensive nephropathy (HT), bioinformatics analysis of IgAN and HT was performed. The mRNA expression profiles of human renal biopsy samples from patients with IgAN, patients with HT and pretransplant healthy living controls (LD) were downloaded from the Gene Expression Omnibus database. Then, the differentially expressed genes (DEGs) were identified and functions of DEGs were analyzed. Finally, the regulatory networks containing DEGs and relatedtranscription factors (TFs) were constructed using Cytoscape software. When compared with the LD group, 134 and 188 DEGs were obtained in the IgAN and HT groups, respectively. A total of 39 genes were altered in the HT group when compared with the IgAN group. In addition, 66 genes were shared in the IgAN and HT groups when compared with the LD group, 6 of which [early growth response 1, activating transcription factor 3, nuclear receptor subfamily 4 group A member 2 (NR4A2), NR4A1, vmaf avian musculoaponeurotic fibrosarcoma oncogene homolog F and Kruppel like factor 6] were identified as TFs. In addition, DEGs including interleukin (IL) 1 receptor antagonist, collagen type 4 α2 chain, IL8, FBJ murine osteosarcoma viral oncogene homolog and somatostatin were enriched in a number of inflammationassociated biological processes, and DEGs including structural maintenance of chromosomes protein 3, vcrk avian sarcoma virus CT10 oncogene homolog and myosin 6 were enriched in noninflammationassociated biological processes. Therefore, the differentially expressed TF genes and the genes associated with inflammation may be effective as potential therapeutic targets for IgAN and HT.
Assuntos
Biomarcadores/metabolismo , Biologia Computacional , Glomerulonefrite por IGA/genética , Glomerulonefrite por IGA/terapia , Hipertensão Renal/genética , Hipertensão Renal/terapia , Terapia de Alvo Molecular , Nefrite/genética , Nefrite/terapia , Análise por Conglomerados , Perfilação da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Anotação de Sequência Molecular , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Fatores de Transcrição/metabolismoRESUMO
BACKGROUND: Blood pressure (BP) variation is commonly encountered during hemodialysis (HD) procedure. Both intradialysis hypotension and hypertension have implications for outcome of treatment and overall morbidity and mortality of the patients. METHODOLOGY: A retrospective study was carried out in the dialysis unit of a tertiary health institution in Benin City among patients who had HD for acute kidney injury (AKI) or chronic kidney disease (CKD) over a 3-year period. Data retrieved included age, gender, type of kidney disease, cause of kidney disease, systolic BP at onset of dialysis and at end of dialysis, and diastolic BP (DBP) at onset of and at end of dialysis. RESULTS: Complete data were available for 217 patients. One hundred and seven patients (49.3%) had no significant change in BP; 30.9% had intradialytic hypertension (IDHT) while 19.8% had intradialytic hypotension (IDH). IDH was more prevalent among patients with diabetic kidney disease while IDHT was more common among patients with hypertensive nephropathy (P = 0.002). Female patients had higher mean BP parameters compared to male patients pre- and post-dialysis, but only changes in DBP were statistically significant (P = 0.029). Patients with CKD had higher mean BP parameters pre- and post-dialysis compared to patients with acute AKI and the differences were statistically significant. CONCLUSION: Females had higher mean BP parameters than males. Patients with CKD had higher mean BP parameters compared with AKI patients. IDHT is a significant problem among patients on HD in our center. Measures to curtail this trend should be instituted with the goal of reducing morbidity and mortality.
Assuntos
Injúria Renal Aguda/terapia , Pressão Sanguínea/fisiologia , Hipertensão Renal/terapia , Hipertensão/etiologia , Hipotensão/etiologia , Nefrite/terapia , Diálise Renal/efeitos adversos , Adulto , Idoso , Feminino , Unidades Hospitalares de Hemodiálise , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Bone marrow derived-mesenchymal stem cells (BM-MSCs) have brought great attention in regenerative medicine field, various experimental & clinical trials were held to investigate their therapeutic effects in different disorders. We designed a histological & immunohistochemical study to evaluate effectiveness of MSCs therapy in withhold of end-stage renal disease (ESRD) secondary to hypertension which has become a growing & striking public health problem. 30 adult male albino rats were utilized, 20 of them were exposed to experimental induction of hypertension, then divided equally to MSCs treated group (injected with 1×106 fluorescent labeled cell i.v./rat), while the second one was left without treatment. Renal specimens were subjected to histopathological, ultrastructural and immunohistochemical examination for Nrf2 in addition to biochemical estimation of serum urea & creatinine. Our results documented that BM-derived MSCs exerts considerable reversing effect of histopathologic and ultrastructural hypertensive nephropathy. Moreover, immunohistochemical results clearly pointed to relevant role of Nrf2 pathway in MSCs related renal therapeutic effects.
Assuntos
Hipertensão Renal/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Fator 2 Relacionado a NF-E2/genética , Nefrite/terapia , Animais , Células da Medula Óssea/citologia , Regulação da Expressão Gênica/genética , Humanos , Hipertensão Renal/induzido quimicamente , Hipertensão Renal/genética , Hipertensão Renal/fisiopatologia , Rim/citologia , Rim/patologia , Masculino , Nefrite/induzido quimicamente , Nefrite/genética , Nefrite/fisiopatologia , RatosRESUMO
Chronic kidney disease is defined by decreased glomerular filtration rate or proteinuria. Diabetic nephropathy and hypertensive renal damage are responsible for the majority of cases. The initiation of therapy has to consider if causal treatment of the underlying disease is possible and indicated. In all patients, even if specific treatment is not possible, therapy should aim at reducing progression of kidney failure. Chronic kidney diseases tend to intrinsic deterioration that persists after cessation of the causative damaging pathomechanism. Progression of disease can be delayed; the most important measures include strict blood pressure control, reduction of proteinuria, and avoidance of further renal harm. Kidney disease induces typical sequelae such as left ventricular hypertrophy, vascular calcification, anemia, and renal osteodystrophy. While these are well understood nowadays therapeutic options are limited. The uremic syndrome is to be avoided by renal replacement therapy.
Assuntos
Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Progressão da Doença , Humanos , Hipertensão Renal/complicações , Hipertensão Renal/terapia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Proteinúria/etiologia , Proteinúria/terapia , Insuficiência Renal Crônica/etiologiaAssuntos
Insuficiência da Valva Aórtica/etiologia , Hipertensão Renal/terapia , Assistência de Longa Duração , Diálise Peritoneal/métodos , Arterite de Takayasu/complicações , Idoso , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/terapia , Feminino , Seguimentos , Humanos , Hipertensão Renal/etiologia , Hipertensão Renal/fisiopatologia , Testes de Função Renal , Índice de Gravidade de Doença , Arterite de Takayasu/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND/INTRODUCTION: The efficacy of catheter-based renal sympathetic denervation (RDN) in terms of blood pressure (BP) reduction has been questioned, while "real-world" data from registries are needed. In this study, we report the complete set of 12-month data on office and ambulatory BP changes as well as the predictors for BP response to RDN from a national registry. METHODS: In 4 Greek hospital centers, 79 patients with severe drug-resistant hypertension (age 59 ± 10 years, 53 males, body mass index 33 ± 5 kg/m2; office BP and 24-h ambulatory BP were 176 ± 15/95 ± 13 and 155 ± 14/90 ± 12 mmHg, respectively, 4.4 ± 0.9 antihypertensive drugs) underwent RDN and were followed-up for 12 months in the Greek Renal Denervation Registry. Bilateral RDN was performed using percutaneous femoral approach and standardized techniques. RESULTS: Reduction in office systolic/diastolic BP at 6 and 12 months from baseline was -30/-12 and -29/-12 mmHg, while the reduction in 24-h ambulatory BP was -16/-9 and -15/-9 mmHg, respectively (p < 0.05 for all). Patients that were RDN responders (85%, n = 58), defined as an at least 10-mmHg decrease in office systolic BP at 12 months, compared to non-responders were younger (57 ± 9 vs 65 ± 8 years, p < 0.05), had higher baseline office systolic BP (176 ± 17 vs 160 ± 11 mmHg, p < 0.05) and 24-h systolic BP (159 ± 13 vs 149 ± 11 mmHg, p < 0.05). Stepwise logistic regression analysis revealed that age, obesity parameters, and baseline office BP were independent predictors of RDN response (p < 0.05 for both), but not the type of RDN catheter or the use of aldosterone antagonists. At 12 months, there were no significant changes in renal function and any new serious device or procedure-related adverse events. CONCLUSIONS: In our "real-world" multicenter national registry, the efficacy of renal denervation in reducing BP as well as safety is confirmed during a 12-month follow-up. Moreover, younger age, obesity, and higher levels of baseline systolic BP are independently related to better BP response to RDN.
Assuntos
Determinação da Pressão Arterial/estatística & dados numéricos , Pressão Sanguínea , Hipertensão Renal/fisiopatologia , Hipertensão Renal/terapia , Rim/fisiopatologia , Sistema de Registros , Simpatectomia/métodos , Doença Crônica , Feminino , Grécia , Humanos , Hipertensão Renal/diagnóstico , Rim/inervação , Rim/cirurgia , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
Hypertensive rats with chronic kidney disease (CKD) exhibit enhanced gamma-aminobutyric acid (GABA)B receptor function and regulation within the nucleus tractus solitarii (NTS). For CKD with hypertension, renal denervation (RD) interrupts the afferent renal sympathetic nerves, which are connecting to the NTS. The objective of the present study was to investigate how RD improves CKD-induced hypertension. Rats underwent 5/6 nephrectomy for 8 weeks, which induced CKD and hypertension. RD was induced by applying phenol to surround the renal artery in CKD. RD improved blood pressure (BP) by lowering sympathetic nerve activity and markedly restored the baroreflex response in CKD. The GABAB receptor expression was increased in the NTS of CKD; moreover, the central GABA levels were reduced in the cerebrospinal fluid, and the peripheral GABA levels were increased in the serum. RD restored the glutamic acid decarboxylase activity in the NTS in CKD, similar to the effect observed for central treatment with baclofen, and the systemic administration of gabapentin reduced BP. RD slightly improved renal function and cardiac load in CKD. RD may improve CKD-induced hypertension by modulating the baroreflex response, improving GABA system dysfunction and preventing the development and reducing the severity of cardiorenal syndrome type 4 in CKD rats.
Assuntos
Barorreflexo/fisiologia , Hipertensão Renal/terapia , Hipertensão/terapia , Rim/inervação , Nefrite/terapia , Insuficiência Renal Crônica/terapia , Animais , Barorreflexo/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Denervação/métodos , Humanos , Hipertensão/complicações , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Hipertensão Renal/metabolismo , Hipertensão Renal/fisiopatologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Nefrectomia/efeitos adversos , Nefrite/metabolismo , Nefrite/fisiopatologia , Neurônios Aferentes/efeitos dos fármacos , Fenol/efeitos adversos , Ratos , Receptores de GABA-B/metabolismo , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Núcleo Solitário/metabolismo , Núcleo Solitário/fisiopatologiaRESUMO
Scleroderma renal crisis (SRC) is a rare, potentially life-threatening complication that affects 2-15% of patients with systemic sclerosis (SSc, also known as scleroderma). SRC typically presents in patients with early, rapidly progressive, diffuse cutaneous SSc within the first 3-5 years after the onset of a non-Raynaud sign or symptom. SRC is characterized by an acute, usually symptomatic increase in blood pressure, a rise in serum creatinine levels, oliguria and thrombotic microangiopathy in about 50% of patients. The prognosis of SRC substantially improved in the 1980s with the introduction of angiotensin-converting-enzyme inhibitors for rapid blood pressure control, with additional antihypertensive agents as required. However, the survival of patients with SRC can still be improved. Current patient survival is 70-82% at 1 year, but decreases to 50-60% at 5 years despite dialysis support. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for transplantation. In this Review, we discuss progress made in the identification and proactive management of patients at risk of SRC and make recommendations aimed at optimizing management for those who progress to chronic kidney failure.