Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain.

BACKGROUND: Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV). OBJECTIVES: To evaluate the mortality and it's causes and CVD and its vascular risk factors (VRFs) in AAV patients in Andalusia. METHODS: A multicenter cohort of 220 AAV patients followed-up from 1979 until June 2020 was studied in Andalussia, south of Spain. The information, including socio-demographic and clinical data was recorded retrospectively through chart review. Data was analysed using Chi2, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval (CI). RESULTS: During a mean ± standard deviation follow-up of 96.79 ± 75.83 months, 51 patients died and 30 presented at least one CVE. Independent prognostic factors of mortality were age (HR 1.083, p=0.001) and baseline creatinine (HR 4.41, p=0.01). Independent prognostic factors of CVE were age [hazard ratio (HR) 1.042, p=0.005] and the presence of hypertension (HTN) six months after diagnosis (HR 4.641, p=0.01). HTN, diabetes and renal failure, all of these important VRFs, are more prevalent in AAV patients than it is described in matched general population. CONCLUSIONS: Age and baseline renal function, but not CVEs, are predictors of mortality and age and early HTN are independent predictors for having a CVE. CVD screening in AAV patients is demanded.

[Non-arteritic ischaemic optic neuropathy as a target organ lesion in arterial hypertension]. / Neuropatía óptica isquémica no arterítica como lesión de órgano diana en la hipertensión arterial.

A 39-year-old black male who consulted with sudden and painless loss of vision in his right eye in the context of a hypertensive crisis. A history of essential arterial hypertension uncontrolled at home due to lack of therapeutic adherence and with target organ involvement: lacunar infarct, grade IV hypertensive retinopathy and left ventricular concentric hypertrophy. Renal function was normal, without albuminuria. The clinical picture was classified as non-arteritic ischaemic optic neuropathy after ruling out vascular, traumatic, infectious and autoimmune disease. The patient presented discrete improvement of the visual deficit with the control of blood pressure. From his history and complementary tests, it was concluded that the ischaemic optic neuropathy was due to malignization of his arterial hypertension.

[HYpertension due to sympathetic hyperactivity after severe head injury]. / Hipertensión arterial por hiperactividad simpática tras traumatismo craneoencefálico grave.

We present the case of a 34-year-old patient with severe head trauma and severe brain involvement. The patient deteriorated progressively and required several reinterventions for bleeding and brain herniation. We were consulted by neurosurgery due to irregular blood pressure control despite treatment with calcium antagonists. The patient had associated diaphoresis, tachypnoea and tachycardia, together with persistent high-grade fever with no microbiological evidence. Laboratory tests showed normal kidney function, with no proteinuria and no signs of left ventricular hypertrophy to suggest previous arterial hypertension. This led us to consider sympathetic hyperactivity syndrome as a first possible diagnosis due to severe neurological damage. In line with this suspicion, antihypertensive therapy was initiated which included non-cardioselective beta-blockers, alpha-2 agonists, benzodiazepines and GABA receptor agonists. Thus, we were able to improve the labile blood pressure levels, which supports the diagnosis.

Neuropatía óptica isquémica no arterítica como lesión de órgano diana en la hipertensión arterial / Non-arteritic ischaemic optic neuropathy as a target organ lesion in arterial hypertension

Varón de 39 años, de raza negra que consultó por pérdida de visión súbita e indolora del ojo derecho en el contexto de una crisis hipertensiva. Antecedente de hipertensión arterial esencial, sin control domiciliario por falta de adherencia terapéutica y con afectación de órganos diana: infarto lacunar, retinopatía hipertensiva grado IV e hipertrofia concéntrica del ventrículo izquierdo. La función renal era normal, sin albuminuria. El cuadro clínico se etiquetó de neuropatía óptica isquémica no arterítica tras descartarse enfermedad vascular, traumática, infecciosa o autoinmune. Presentó una discreta mejoría del déficit visual con el control de la presión arterial. Dados los antecedentes y las pruebas complementarias, se concluyó que la neuropatía óptica isquémica fue debida a malignización de su hipertensión arterial. (AU)

A 39-year-old black male who consulted with sudden and painless loss of vision in his right eye in the context of a hypertensive crisis. A history of essential arterial hypertension uncontrolled at home due to lack of therapeutic adherence and with target organ involvement: lacunar infarct, grade IV hypertensive retinopathy and left ventricular concentric hypertrophy. Renal function was normal, without albuminuria. The clinical picture was classified as non-arteritic ischaemic optic neuropathy after ruling out vascular, traumatic, infectious and autoimmune disease. The patient presented discrete improvement of the visual deficit with the control of blood pressure. From his history and complementary tests, it was concluded that the ischaemic optic neuropathy was due to malignization of his arterial hypertension. (AU)

Embarazo en una paciente con lupus eritematoso sistémico en hemodiálisis / Pregnancy in a patient with systemic lupus erythematosus on hemodialysis

Presentamos un caso de gestación en una paciente de 29 años de edad en tratamiento sustitutivo renal durante 7 años en hemodiálisis por nefropatía lúpica, y que finalizó el embarazo con éxito. Describimos la evolución de la gestación desde su diagnóstico y el tratamiento seguido. Concluimos que el embarazo en pacientes con lupus eritematoso sistémico en tratamiento sustitutivo con hemodiálisis supone un riesgo para la madre y para el feto, aunque se observa un aumento del éxito en las gestaciones en pacientes en diálisis (AU)

We report a case of successful pregnancy in a 29-year-old woman who had been undergoing renal replacement treatment for 7 years due to systemic lupus erythematosus (SLE). We describe the course of the pregnancy from diagnosis and its management. We conclude that pregnancy in patients with SLE on renal replacement with hemodialysis is a risk factor for the mother and fetus; nevertheless the number of successful pregnancies in patients on hemodialysis is increasing (AU)