Estenosis de arteria renal en riñón único funcionante / Renal artery stenosis in single functioning kidney

La estenosis de arteria renal en riñón único se asocia con un aumento de la morbimortalidad, y en la actualidad existe un dilema sobre su tratamiento: si es más conveniente realizar tratamiento conservador o revascularización. Presentamos el caso de una mujer de 72 años con hipertensión arterial, sin episodios de edema agudo de pulmón, riñón único funcionante derecho y estenosis de arteria renal derecha en la que se decide realizar tratamiento conservador dado el control de la tensión arterial con tratamiento farmacológico y por mantener una función renal estable en el último año. Se revisa la literatura y se discute sobre su tratamiento

Renal artery stenosis in single kidney is associated with an increase in morbidity-mortality. There is currently a dilemma on its treatment, on if it is better to perform a conservative treatment or revascularization. We present the case of a 72 year old woman with arterial hypertension, without episodes of acute pulmonary edema, right single functioning kidney and right renal artery stenosis, in which it was decided to perform conservative treatment given the control of the blood pressure with drug treatment and because she had maintained stable kidney function in the last year. The literature is reviewed and its treatment discussed

Descenso nocturno de la presión arterial: factores determinantes y relación con daño orgánico secundario a hipertensión / Night-time drop in blood pressure: determining factors and relationship with organic damage as a side-effect of hypertension

Objetivos. Evaluar el descenso nocturno de la presión arterial en los pacientes con hipertensión ligera y determinar su posible relación con la presencia de daño en órganos diana. Diseño. Estudio transversal. Emplazamiento. Ocho centros de salud urbanos. Pacientes. Cuatrocientos dieciocho pacientes adultos con hipertensión arterial ligera-moderada. Intervenciones. a) Lectura de la presión arterial en 3 visitas; b) monitorización ambulatoria de la presión durante 24 horas; c) ecocardiografía (en 219 pacientes), y d) determinación de albuminuria (en 134 pacientes). Se definió como descenso nocturno de presión arterial la diferencia entre las presiones ambulatorias diurna y nocturna, y como descenso relativo al porcentaje de descenso de la presión nocturna respecto de la diurna. Resultados. El descenso nocturno de las presiones sistólica y diastólica fue de 13,6 (10,7) y 12,1 (8,6) mmHg, respectivamente. Los factores predictores del descenso nocturno de PA (por ciento) fueron, en sentido directo, la presión arterial ambulatoria diurna (p < 0,05) y el sexo femenino (p < 0,05) y, en sentido inverso, la edad (p < 0,05). No se observó asociación entre el descenso nocturno de presión arterial y la masa del ventrículo izquierdo. Solamente en mujeres se observó una relación independiente, en sentido inverso, entre el descenso nocturno de presión arterial y la excreción urinaria de albúmina (p < 0,05). Conclusiones. El descenso nocturno relativo ( por ciento) de la presión arterial es mayor en las mujeres que en los varones, disminuye con la edad y depende de la presión ambulatoria diurna. En las mujeres, un menor descenso nocturno de la presión arterial se asocia a mayor daño orgánico (AU)

[Nocturnal drop of arterial blood pressure: determinant factors and relationship with organic damage secondary to hypertension]. / Descenso nocturno de la presión arterial: factores determinantes y relación con daño orgánico secundario a hipertensión.

OBJECTIVES: To evaluate the night-time drop in blood pressure in patients with light hypertension and to determine its possible relationship with damage in key organs. DESIGN: Cross-sectional study. SETTING: Eight urban health centres. PATIENTS: Four hundred and eighteen adults with light-moderate hypertension. INTERVENTIONS: a) Blood pressure reading on three visits; b) ambulatory monitoring of pressure for 24 hours; c) echocardiograph (in 219 patients); d) albuminuria determination (in 134 patients). A night-time drop in blood pressure was defined as the difference between day and night ambulatory pressures; and relative drop, as the night-time pressure drop as a percentage of the day-time pressure. RESULTS: Night-time drop in systolic and diastolic pressures was 13.6 (10.7) and 12.1 (8.6) mmHg, respectively. The predictive factors of night-time drop in blood pressure were, directly, daily ambulatory blood pressure (p < 0.05) and female gender (p < 0.05) and, inversely, age (p < 0.05). No association was observed between night-time drop in blood pressure and left ventricular mass. Only in women was an independent relationship found, inversely, between night-time drop in blood pressure and urinary excretion of albumin (p < 0.05). CONCLUSIONS: Relative night-time drop in blood pressure is greater in women than in men, diminishes with age and depends on the day-time ambulatory pressure. In women a minor night-time drop in blood pressure is associated with greater organic damage.

Monoclonal gammopathy associated with crescentic glomerulonephritis and antimyeloperoxidase antibodies.

A 68-year-old male patient suffering from dizziness, gait instability, deafness, and visual loss showed proteinuria, hematuria, reduced creatinine clearance, and a monoclonal IgA lambda component. Renal biopsy revealed crescentic glomerulonephritis. Serum antibodies against myeloperoxidase were identified. These antibodies were IgG, not related to the IgA monoclonal component. This clinical description adds new information to the spectrum of diseases associated with glomerulonephritis and antimyeloperoxidase antibodies and illustrates that a monoclonal component cannot be directly implicated in the pathogenesis of a vasculitic process associated with antineutrophil cytoplasm antibodies.

[Alcohol withdrawal syndrome at the internal medicine department of a general hospital; epidemiology and hospital costs]. / Síndrome de abstinencia alcohólica en el servicio de medicina interna de un hospital general; epidemiología y coste hospitalario.

Alcohol withdrawal syndrome (AWS) is an admission problem and can also occur in hospitalized patients. We endeavoured to ascertain the exact epidemiology and hospital cost of AWS based on a review of the charts of patients admitted during 1986, 1987, 1988 (total = 78). The statistical analysis of the differences was performed by chi-square test with a significant level = or less than of 0.05. The results were: total hospital prevalence of AWS = 2.44%, hospital prevalence by season = 3.33% (spring), 2.04% (summer), 2.28% (fall), 2.19% (winter). Outpatients presentation = 79.49%, highlighting fever syndrome of unknown origin (FSUO) (16.4%) and pneumonia (11.48%); hospital presentation = 20.51% focusing acute pancreatitis (31.25%) and pneumonia (25%) as first causes of admission. The significant association between FSUO and spring and winter (84.62%); relation male: female = 5.5: 1; mean age = 42.57 years; decade distributions = 1st decade 0%, second = 1.28%, third = 11.64%, fourth = 35.90%, fifth = 24.36%, sixth = 16.67%, seventh = 8.97%, eighth = 1.28%, ninth = 0%; mean admission time = 14.12 days; total hospital cost of out-patients presentation = 15.087.370 pesetas.