Hipertensão renovascular levando à nefrectomia unilateral: relato de caso / Renovascular hypertension leading to unilateral nephrectomy: case report

Objetivo: Relatar o caso de uma paciente jovem portadora de Hipertensão Arterial Secundária à estenose da artéria renal, que evoluiu com perda renal em decorrência de necessidade de nefrectomia unilateral, enfatizado a importância do diagnóstico e da abordagem adequada desta patologia para o controle da pressão arterial e preservação da função renal. Método: Os dados foram obtidos através de entrevista com a paciente, análise de prontuário, laudos de técnicas diagnósticas, as quais a paciente foi submetida, entre julho e novembro de 2019, durante as consultas médicas e revisão bibliográfica. Conclusão: A nefrectomia unilateral mostrou-se eficaz no controle da hipertensão arterial, na melhora do desempenho renal, possibilitando a melhoria na qualidade de vida do indivíduo afetado

Objective: To report the case of a young patient with SAH secondary to renal artery stenosis, who developed renal loss due to the need for unilateral nephrectomy, emphasizing the importance of the diagnosis and the appropriate approach of this pathology for the control of blood pressure and preservation of renal function. Method: The data were obtained through interview with the patient, analysis of medical records, reports of diagnostic techniques, which the patient was submitted between July and November 2019, during medical consultations and literature review. Conclusion: Unilateral Nephrectomy proved to be effective in controlling arterial hypertension, improving renal performance and in the evolution of renal insufficiency that is difficult to control from the renovascular root, enabling improvement in the affected individual's quality of life

Aspectos ultraestructurales del riñón remanente en ratas uninefrectomizadas sometidas a dietas hipoproteicas suplementadas con aminoácidos esenciales y no esenciales / Ultrastructural aspects of remaining kidney of unilaterally nephrectomized rats receiving hypoproteic diets enriched with amino acids

Es bien conocido el efecto benéfico de la restricción en la ingesta proteica de la dieta para la preservación de la función renal, cuando la masa renal se encuentra reducida, en un intento de aumentar la sobrevida de los pacientes. Sin embargo, la literatura al respecto es extremadamente contradictoria. En este trabajo estudiamos el efecto de la alimentación con dietas hipoprotéicas ricas en aminoácidos esenciales (lisina y arginina) y no esenciales (asparagina, prolina y ácido glutámico) sobre la ultraestructura del riñón remanente de ratas uninefrectomizadas. Después de 9 semanas de realizada la intervención quirúrgica, bajo Nesdonal, durante las cuales las ratas uninefrectomizadas fueron alimentadas con dietas especialmente diseñadas para el experimento, se retiraron los riñones remanentes y se procesaron para ser observados al Microscopio Electrónico de transmisión, siguiendo el procedimiento convencional. Como conclusión del estudio microscópico, para todas las dietas estudiadas se observó una vacuolización prominente de las células tubulares proximales así como hinchamiento tanto de las mitocondrias como pérdida de material en áreas tubulares. Se apreciaron túbulos con lúmina dilatada, mitocondrias dispuestas irregularmente y con un engrosamiento de la membrana basal, característica inespecífica pero constante de las enfermedades renales en diabéticos y glomérulos alterados. Por consiguiente, la adición de ciertos aminoácidos a la dieta no parece proteger eficientemente contra el deterioro histológico en riñones fisiológicamente comprometidos.

Dietary restriction of proteins has been used in patients with kidney failure in an attempt to preserve renal functionand prolong their lives. However, literature shows contradictory results. We studies the effects of diets enriched with essential (lysine, arginine) or non-essential (asparagine, proline or glutamic acid) amino acids on the ultrastructure of remaining kidney of uninephrectomized rats. The kidney was removed under barbiturate anesthesia and after that the animals received specially designed diets during nine weeks. Then, the remaining kidney was removed and conventionally processed to be studies by transmission electronic microscope. For all the diets used, we observed a prominent vacuolisation of proximal tubular cells, as well as mithocondrial edema and tissue loss at the tubular level. The preparations showed tubules with dilated lumen, irregularly placed mithocondria and basal membrane thickening, a non-specific but constant finding in diabetic kidneys and in some glomerulopathies. In conclusion, amino acid-enriched diets are not effective to protect functionally compromised kidneys against progressive anatomical changes.