[Relationship between renal size and blood pressure profile in patients with autosomal dominant polycystic kidney disease without renal failure]. / Relación entre el tamaño renal y el perfil de presión arterial en pacientes con poliquistosis renal autosómica dominante sin insuficiencia renal.

BACKGROUND: Enlargement of renal size plays an important role in the development of hypertension in patients with autosomic dominant polycystic kidney disease (ADPKD) and normal renal function. METHODS: A 24h blood pressure monitoring (ABPM) and a renal echography have been performed in 37 patients with ADPKD and estimated glomerular filtration rate > 60 ml/min/1.73 m(2) to study the relationship between renal size and an altered blood pressure profile in prehypertension stages. RESULTS: 13 patients had normal blood pressure, 11 were diagnosed of masked hypertension, 4 had white coat hypertension and 9 had hypertension. We have found in the normotensive group with a dipper blood pressure profile a positive and statistically significant relationship between renal size and diastolic blood pressure variability. CONCLUSIONS: ABPM helps to make an early diagnosis of hypertension and to identify those patients with masked hypertension. This study suggests a relationship between renal size and a blood pressure profile linked to a major cardiovascular risk in normotensive patients with ADPKD.

Modification over time of pulse wave velocity parallel to changes in aortic BP, as well as in 24-h ambulatory brachial BP.

Arterial stiffness as assessed by carotid-femoral pulse wave velocity (cfPWV) is a marker of preclinical organ damage and a predictor of cardiovascular outcomes, independently of blood pressure (BP). However, limited evidence exists on the association between long-term variation (Δ) on aortic BP (aoBP) and ΔcfPWV. We aimed to evaluate the relationship of ΔBP with ΔcfPWV over time, as assessed by office and 24-h ambulatory peripheral BP, and aoBP. AoBP and cfPWV were evaluated in 209 hypertensive patients with either diabetes or metabolic syndrome by applanation tonometry (Sphygmocor) at baseline(b) and at 12 months of follow-up(fu). Peripheral BP was also determined by using validated oscillometric devices (office(o)-BP) and on an outpatient basis by using a validated (Spacelabs-90207) device (24-h ambulatory BP). ΔcfPWV over time was calculated as follows: ΔcfPWV=[(cfPWVfu-cfPWVb)/cfPWVb] × 100. ΔBP over time resulted from the same formula applied to BP values obtained with the three different measurement techniques. Correlations (Spearman 'Rho') between ΔBP and ΔcfPWV were calculated. Mean age was 62 years, 39% were female and 80% had type 2 diabetes. Baseline office brachial BP (mm Hg) was 143±20/82±12. Follow-up (12 months later) office brachial BP (mm Hg) was 136±20/79±12. ΔcfPWV correlated with ΔoSBP (Rho=0.212; P=0.002), Δ24-h SBP (Rho=0.254; P<0.001), Δdaytime SBP (Rho=0.232; P=0.001), Δnighttime SBP (Rho=0.320; P<0.001) and ΔaoSBP (Rho=0.320; P<0.001). A multiple linear regression analysis included the following independent variables: ΔoSBP, Δ24-h SBP, Δdaytime SBP, Δnighttime SBP and ΔaoSBP. ΔcfPWV was independently associated with Δ24-h SBP (ß-coefficient=0.195; P=0.012) and ΔaoSBP (ß-coefficient= 0.185; P=0.018). We conclude that changes in both 24-h SBP and aoSBP more accurately reflect changes in arterial stiffness than do office BP measurements.

[Is blood pressure control different in women than in men?]. / ¿Es distinto el control de la presión arterial en mujeres que en hombres?

Blood pressure (BP) evolves with age; until the 50's it is higher in men than in women, equaling and even then increasing in women. The prevalence of controlled BP appears to be similar between the sexes, but the prevalence of cardiovascular disease is higher in women than in men. The possibility that BP influences the cardiovascular risk differently according to sex must therefore be considered. While some studies suggest no difference exists, others have shown evidence of an increased risk in women with respect to men despite equal BP. In this way, it seems that the measurement of ambulatory BP, but not office BP, would mark the differences in the association between BP-gender and cardiovascular risk. It should therefore be investigated the possibility of a different BP goal for women and men, especially by evaluating ambulatory BP.

¿Es distinto el control de la presión arterial en mujeres que en hombres? / Is blood pressure control different in women than in men?

La presión arterial (PA) evoluciona con la edad; hasta la década de los 50 es superior en hombres que en mujeres, igualándose entonces e incluso pasando a ser más elevada en mujeres. La prevalencia de PA controlada parece ser similar entre ambos sexos, pero la prevalencia de enfermedad cardiovascular es más elevada en mujeres que en hombres. Debe plantearse, pues, la posibilidad de que la PA influya en el riesgo cardiovascular de forma distinta según el sexo. Mientras algunos estudios no muestran diferencias, otros evidencian un mayor riesgo en mujeres que en hombres a igualdad de cifras de PA. Según estos últimos, parece que la medida de PA ambulatoria, y no la PA clínica, es la que marcaría las diferencias en esta asociación entre PA-sexo y riesgo cardiovascular. Debería, por tanto, investigarse la posibilidad de un objetivo de PA distinto en mujeres y hombres, evaluando especialmente la PA ambulatoria

Blood pressure (BP) evolves with age; until the 50’s it is higher in men than in women, equaling and even then increasing in women. The prevalence of controlled BP appears to be similar between the sexes, but the prevalence of cardiovascular disease is higher in women than in men. The possibility that BP influences the cardiovascular risk differently according to sex must therefore be considered. While some studies suggest no difference exists, others have shown evidence of an increased risk in women with respect to men despite equal BP. In this way, it seems that the measurement of ambulatory BP, but not office BP, would mark the differences in the association between BP-gender and cardiovascular risk. It should therefore be investigated the possibility of a different BP goal for women and men, especially by evaluating ambulatory BP

Relación entre el tamaño renal y el perfil de presión arterial en pacientes con poliquistosis renal autosómica dominante sin insuficiencia renal / Relationship between kidney size and blood pressure profile in patients with autosomal dominant polycystic kidney disease without renal failure

Antecedentes: El aumento del tamaño renal desempeña un papel importante en el desarrollo de la hipertensión arterial (HTA) en pacientes con poliquistosis renal autosómica dominante (PQRAD) con función renal normal. Material y métodos: Se han practicado a 37 pacientes con PQRAD, filtrado glomerular estimado (FGe) por MDRD>60 ml/min/1,73 m2y supuestamente normotensos, una monitorización de la presión arterial (MAPA) y una ecografía renovesical para investigar la posible relación entre el aumento del tamaño renal y un perfil patológico de presión arterial (PA) en estadios de prehipertensión. Resultados: 13 pacientes resultaron ser normotensos, 11 presentaron HTA enmascarada, cuatro tuvieron HTA de bata blanca y nueve, HTA verdadera. Se ha observado en los pacientes normotensos con patrón reductor de la PA una correlación positiva y estadísticamente significativa entre el tamaño renal y la variabilidad de la presión arterial diastólica (PAD). Conclusiones: La MAPA permite realizar un diagnóstico precoz de la HTA e identificar apacientes con hipertensión enmascarada. Este trabajo sugiere que en pacientes normotensos con PQRAD existe una posible relación entre el tamaño renal y un perfil de PA con mayor riesgo cardiovascular (AU)

Background: Enlargement of renal size plays an important role in the development of hypertension in patients with autosomal dominant polycystic kidney disease (ADPKD)and normal renal function. Methods: A 24h blood pressure monitoring (ABPM) and a renal ecography have been performed in 37 patients with ADPKD and estimated glomerular filtration rate >60 ml/min/1,73 m2to study the relationship between renal size and an altered blood pressure profile in prehypertension stages. Results: 13 patients had normal blood pressure, 11 were diagnosed of masked hypertension, 4 had white coat hypertension and 9 had hypertension. We have found in the normotensive group with a dipper blood pressure profile a positive and statistically significant relationship between renal size and diastolic blood pressure variability. Conclusions: ABPM helps to make an early diagnosis of hypertension and to identify those patients with masked hypertension. This study suggests a relationship between renal size and a blood pressure profile linked to a major cardiovasular risk in normotensive patients with ADPKD (AU)

Mieloma múltiple y fracaso renal agudo / Multiple mieloma and acute renal failure

El mieloma múltiple es una proliferación neoplásica de células plasmáticas que producen una inmunoglobulina de forma monoclonal. Representa el 1% de todas las enfermedades malignas y el 10% de las enfermedades malignas hematológicas siendo más frecuente en hombres con una edad media al diagnóstico de 66 años. La afectación renal en el mieloma múltiple es frecuente y en el momento de presentación, la alteración de la función renal puede ser presente en el 50% de los casos. Se presenta el caso de uan paciente de 71 años que fue diagnosticada de mieloma múltiple a raíz de un fracaso renal agudo. Se realizó una biopsia renal objetivándose imágenes compatibles con nefropatía por mieloma. Tras llegar al diagnóstico de mieloma múltiple a través de biopsia de médula ósea se realizó tratamiento quimioterápico con vincristina, adriamicina y dexametasona sin presentar respuesta de su enfermedad de base

The múltiple myeloma is a neoplasis proliferation of plasma cells that produce an immunoglobulin of monoclonal form. It represents the 1% of all the malignant diseases and 10% of the haematological malignant diseases, being more frequent in men with a middle ages to the diagnosis of 66 years. The renal affectation in the multiple myeloma is frequent and in the moment of presentation, the renal function alteration can be present in the 50% of cases. The case appears of patient of 71 years who was diagnosed of multiple myeloma immediately after a renal sharp failure. It was realized a renal biopsy with the vision of images compatible with nephropathy by myeloma. After coming to the diagnosis of multiple myeloma through bone marrow´s biopsy, it was made a chemotherapeutic treatment with vincristina, adriamicina and dexametasona without to show response of his base disease