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Rev Med Suisse ; 17(750): 1567-1570, 2021 Sep 15.
Artigo em Francês | MEDLINE | ID: mdl-34528420


High blood pressure and dementia are both frequent age-related diseases. The purpose of this article is to review the treatment of hypertension and his effects on cognition, and to propose key points to improve hypertension's treatment in dementia suffering patients. The management of hypertension in middle-life patients seems to be very important to avoid or decrease the progression of cognitive impairment or dementia. Nevertheless, there is no guidelines regarding blood pressure in patients concerned by dementia. To personalize the treatment, to take other comorbidities into account, and the frequent reevaluation of the medication are keys of an optimal management of hypertension in general and becomes crucial more specific in this population.

Disfunção Cognitiva , Demência , Hipertensão , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Cognição , Disfunção Cognitiva/etiologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia
Rev Med Suisse ; 16(706): 1673-1675, 2020 Sep 16.
Artigo em Francês | MEDLINE | ID: mdl-32936546


White coat hypertension is a frequent phenomenon. Its diagnosis is based on 24-hours ambulatory blood pressure monitoring or repeated home blood pressure measurement. It has been recognised now as a hypertension phenotype of which innocence is under debate. Some recent studies have suggested an association with an increased risk of cardiovascular disease. The European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) guidelines put strong emphasis on detecting it and taking it in charge with lifestyle changes in addition to drug treatment in specific situations, to lower cardiovascular risk.

Doenças Cardiovasculares/complicações , Hipertensão do Jaleco Branco/complicações , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Fatores de Risco , Hipertensão do Jaleco Branco/diagnóstico
Rev Med Suisse ; 14(595): 426-429, 2018 Feb 21.
Artigo em Francês | MEDLINE | ID: mdl-29465875


Calciphylaxis is a rare disease with a poor prognostic that mostly occurs in patients with renal failure. Diagnosis is difficult and skin biopsy is the gold standard diagnostic procedure, although it may aggravate skin lesions. Identification of the typical cutaneous signs is important to initiate adequate medical care. Several differential diagnoses must be excluded. Treatments should include appropriate pain management, local wound pain, daily dialysis, intravenous sodium thiosulfate treatment, hyperbaric oxygenotherapy, thigh control of calcium-phosphate metabolism and interruption of medications that could contribute to calciphylaxis. Palliative care should be considered in uncontrolled clinical course.

Calciofilaxia , Falência Renal Crônica , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Calciofilaxia/terapia , Humanos , Falência Renal Crônica/complicações , Fosfatos , Diálise Renal , Pele
BMC Nephrol ; 18(1): 380, 2017 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-29287584


BACKGROUND: We aimed to describe clinical characteristics of patients with community-acquired acute kidney injury (CA-AKI), the effectiveness of initial management of CA-AKI, its prognosis and the impact of medication on its occurrence in patients with previous chronic kidney injury (CKI). METHODS: We undertook a prospective observational study within the Emergency Department (ED) of a University Hospital, screening for any patient >16 years admitted with an eGFR <60 ml/mn/1.73 m2 and a rise in serum creatinine as compared to previous values. Patients' medical files were reviewed by a panel of nephrologists in the subsequent days and at one and three-years follow-up. RESULTS: From May 1st to June 21st 2013, there were 8464 admissions in the ED, of which 653 had an eGFR <60 ml/mn/1.73 m2. Of these, 352 had previous CKI, 341 had CA-AKI, and 104 had CA-ACKI (community-acquired acute on chronic kidney injury). Occurrence of superimposed CA-AKI in CKI patients was associated with male gender and with use of diuretics, but not with use of ARBs or ACEIs. Adequate management of CA-AKI defined as identification, diagnostic procedures and therapeutic intervention within 24 h, was recorded in 45% of the cases and was not associated with improved outcomes. Three-year mortality was 21 and 48% in CKI and CA-ACKI patients respectively, and 40% in patients with only CA-AKI (p < 0.001). Mortality was significantly associated with age, hypertension, ischemic heart disease and CA-AKI. Progression of renal insufficiency was associated with male gender and age. CONCLUSIONS: CA-AKI is more frequently encountered in male patients and those treated with diuretics and is an independent risk factor for long-term mortality. Its initial adequate management failed to improve outcomes.

Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Gerenciamento Clínico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Características de Residência , Injúria Renal Aguda/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Insuficiência Renal Crônica/terapia , Fatores de Risco
Rev Med Suisse ; 12(507): 382-6, 2016 Feb 24.
Artigo em Francês | MEDLINE | ID: mdl-27039602


Kidney diseases are frequent, but most of the time, they develop unnoticed. This paucity of symptoms may lead to delayed diagnosis with important consequences on their outcome. Nevertheless, specific systemic signs such as skin lesions, joint pain or electrolytes disturbances may sometimes alert the clinician and direct the diagnosis to an underlying nephropathy. A high awareness of clinicians is warranted to recognize these red flags and diagnose these diseases early, as illustrated by two clinical cases discussed in this article.

Artrite Gotosa/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Angiomiolipoma/complicações , Angiomiolipoma/diagnóstico , Artrite Gotosa/complicações , Artrite Gotosa/genética , Diagnóstico Diferencial , Saúde da Família , Feminino , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/genética , Esclerose Tuberosa/complicações , Esclerose Tuberosa/diagnóstico , Uromodulina/genética , Adulto Jovem