RESUMEN
Collapsing focal segmental glomerulosclerosis is well described in its idiopathic form, mostly seen in young African American patients, and in association with HIV virus. Its clinical presentation typically includes proteinuria and renal failure rapidly progressing to end stage renal disease. However, a new form has recently been described related to treatment with high doses of intravenous bisphosphonates, especially pamidronate. We report two cases of collapsing focal segmental glomerulosclerosis in patients treated with intravenous pamidronate. In opposition to previous reports, interruption of pamidronate administration did not improve renal function. The latter should be evaluated before initiating treatment with bisphosphonates and regularly monitored. For patients with chronic kidney disease, introduction of bisphosphonates should be reconsidered given the risk of rapid progression to end stage renal disease and the lack of evidence for reduction of fracture risk in this population.
Asunto(s)
Difosfonatos/efectos adversos , Glomeruloesclerosis Focal y Segmentaria/inducido químicamente , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Difosfonatos/administración & dosificación , Difosfonatos/farmacología , Femenino , Fracturas Espontáneas/tratamiento farmacológico , Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Humanos , Infusiones Intravenosas , Enfermedades Renales/etiología , Enfermedades Renales/fisiopatología , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Glomérulos Renales/efectos de los fármacos , Glomérulos Renales/patología , Masculino , Mieloma Múltiple/complicaciones , Mieloma Múltiple/tratamiento farmacológico , Pamidronato , Podocitos/efectos de los fármacos , Podocitos/patología , Diálisis RenalRESUMEN
OBJECTIVES: This study was designed to assess the prevalence of major cardiovascular risk factors in familial premature coronary artery disease (P-CAD), affecting two or more siblings within one sibship. BACKGROUND: Premature CAD has a genetic component. It remains to be established whether familial P-CAD is due to genes acting independently from major cardiovascular risk factors. METHODS: We recruited 213 P-CAD survivors from 103 sibships diagnosed before age Asunto(s)
Enfermedades Cardiovasculares
, Enfermedad Coronaria/genética
, Adulto
, Edad de Inicio
, Femenino
, Humanos
, Hipercolesterolemia/epidemiología
, Hipertensión/epidemiología
, Masculino
, Persona de Mediana Edad
, Infarto del Miocardio/genética
, Obesidad/epidemiología
, Linaje
, Prevalencia
, Factores de Riesgo
, Fumar/epidemiología
RESUMEN
BACKGROUND: Hypertension, hypercholesterolemia, obesity and smoking are highly prevalent among patients with familial premature coronary artery disease (FP-CAD). Whether these risk factors equally affect other family members remains unknown. METHODS: We examined 222 FP-CAD patients, 158 unaffected sibs, 197 offspring and 94 spouses in 108 FP-CAD families (> or = 2 sibs having survived CAD diagnosed before age 51 (M)/56 (F)), and compared them to population controls. RESULTS: Unaffected sibs had a higher prevalence of hypertension (49% versus 24%, p<0.001), hypercholesterolemia (47% versus 34%, p=0.002), abdominal obesity (35% versus 24%, p=0.006) and smoking (39% versus 24%, p=0.001) than population controls. Offspring had a higher prevalence of hypertension (females), hypercholesterolemia and abdominal obesity than population controls. No difference was observed between spouses and controls. Compared to unaffected sibs, FP-CAD affected sibs had a similar risk factor profile, except for smoking, which was more prevalent (76% versus 39%, p=0.008). CONCLUSIONS: Hypertension, obesity and hypercholesterolemia are highly prevalent among first-degree relatives, but not spouses, of patients with FP-CAD. These persons deserve special medical attention due to their familial/genetic susceptibility to atherogenic metabolic abnormalities. In these families, smoking may be the trigger for FP-CAD.
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/genética , Familia , Grasa Abdominal , Adulto , Hijos Adultos , Edad de Inicio , Índice de Masa Corporal , Femenino , Predisposición Genética a la Enfermedad/epidemiología , Humanos , Hipercolesterolemia/epidemiología , Hipercolesterolemia/genética , Hipertensión/epidemiología , Hipertensión/genética , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/genética , Prevalencia , Factores de Riesgo , Hermanos , Fumar/epidemiología , Fumar/genética , Esposos/estadística & datos numéricosRESUMEN
Cases of severely hypercholesterolemic HIV-infected children taking protease inhibitors (PIs) have been reported. Because high cholesterol levels (> or =15 mmol/L), as seen in homozygous familial hypercholesterolemia (FH), may lead to heart disease in childhood, the authors performed a systematic retrospective survey of all plasma lipid levels recorded for children who had received ritonavir or nelfinavir between 1995 and 2001 in Switzerland. Administration of PIs was associated with a significant increase in plasma cholesterol levels, which was more pronounced for those given ritonavir (from 3.3 +/- 0.7 mmol/L, n = 5 to 6.3 +/- 2.8 mmol/L, n = 19 [mean +/- SD]; p =.03) than for nelfinavir (from 3.0 +/- 0.7 mmol/L, n = 11 to 4.9 +/- 1.0 mmol/L, n = 30; p = <.001). Cholesterol levels exceeded 10.0 mmol/L in 3 of 49 (6%) PI-treated children and culminated at 13.8 mmol/L. Plasma cholesterol levels in PI-treated children were comparable with levels reported for heterozygous FH children but were all lower than in homozygous FH children. Because heterozygous FH patients usually develop heart disease in middle age, the authors conclude that the risk for heart disease in PI-treated children is minimal. Long-term monitoring of these children, however, will be necessary.