RESUMO
La Nefropatía Diabética es la principal complicación crónica de la Diabetes MellitusTipo 2, es considerada hoy en día una enfermedad de alto costo social, económico y causa principal de ingreso a tratamiento dialítico en el mundo. Nuestro objetivo general es identificar los factores de riesgo que influyen en la progresión hacia la Nefropatía Diabética en pacientes ingresados al servicio de hemodiálisis del Hospital Viedma. Se realizó un estudio descriptivo, retrospectivo y longitudinal, donde el universo fué de 1314 pacientes que ingresaron al servicio de hemodiálisis, con una muestra de 81 pacientes. Para el presente estudio se recolectaron los datos requeridos a partir de Historias clínicas, registros de sesiones de hemodiálisis y además se utilizó un formulario de datos diseñado para su recolección. Dentro de los factores de riesgo en el desarrollo de la Nefropatía Diabética, destacaron: ausencia de consumo de Estatinas 88%, y Antagonista de Receptor de Aldosterona 70%, inasistencia a controles médicos 86%, sedentarismo 84%, consumo ocasional de alcohol 69%, y mal cumplimiento de la dieta 67%. Concluimos que los datos presentados demuestran un inadecuado cuidado en los pacientes en etapas precoces de la diabetes, una tardía referencia al nefrólogo que obliga a la diálisis de urgencia. Durante el periodo de diálisis, se demuestra un pobre control de la glicemia y de la presión arterial, todo esto asociado a una elevadísima morbimortalidad en referencia a otros pacientes con insuficiencia renal crónica. Lo que demuestra que es muy importante que, los niveles de presión arterial, la glucosa y los lípidos deben ser tratados de forma agresiva.
Diabetic nephropathy is the leading chronic complication of type 2 diabetes mellitus, today is considered a disease of high social, economic cost and income leading cause of dialysis in the world. Our overall goal is to understand the risk factors that influence the progression to diabetic nephropathy in patients admitted in the Viedma Hospital hemodialysis. We performed a descriptive, retrospective and longitudinal study, where the universe was 1314 patients that were admitted to the hemodialysis, with a sample of 81 patients. For this study the required data were collected from medical records, records of hemodialysis sessions and also used a questionnaire designed for data collection. Among the risk factors in the development of diabetic nephropathy, noted: absence of statin use 88%, and 70% ARA, missed medical controls 86%, 84% sedentary, occasional alcohol consumption 69%, and poor compliance 67%. We conclude that the data presented demonstrate inadequate care for patients in early stages of diabetes, a reference to the late nephrologist requiring emergency dialysis. During the dialysis period, shows a poor glycemic control and blood pressure, all associated with a very high morbimortalidad comparing them to other pacients with cronic nephopathye, showing that it is very important that the levels of blood pressure, glucose and lipids should be aggressively treated.
RESUMO
Renal anatomopathological lesions were studied among 119 AIDS patients from Faculdade de Medicina do Triângulo Mineiro's University Hospital (Uberaba, MG, Brazil). From formalin-fixed blocks, slides were obtained and studied by light microscopy. Of 119 patients, 67 presented tubulointerstitial nephritis (TIN), 18 inespecific, 2 xantogranulomatous and infections agents were found in 48 as follows: mycosis in 28 (16 Cryptococcus sp; 9 Histoplasma sp, 1 Candida sp e 2 Paracoccidioides brasiliensis); bacteria in 18 (9 Mycobacterium sp), virus in 6 (Cytomegalovirus). Acute tubular necrosis was found in 43 cases (36.1%). Other diagnosis were: nefrocalcinosis (15.1%), arteriolar hyalinosis (22.7%), two cases of focal segmental glomerulosclerosis (1.7%) and one case of diffuse mesangial hyperplasia (0.8%). We conclude that the renal involvement in patients with AIDS, presents a wide spectrum of pathologies, secondary to complications related to opportunistic infections, therapeutic and diagnostic management, and the nephropathies associated to HIV.
As alterações anatomopatológicas renais foram estudadas em 119 casos de indivíduos com a síndrome da imunodeficiência humana adquirida (SIDA) no Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba MG. A partir das amostras de rim fixadas em formol, foram confeccionadas lâminas e analisadas ao microscópio de luz. Dos 119 casos estudados, 67 tiveram diagnóstico de nefrite túbulo intersticial (NTI), sendo 18 inespecíficas, 2 xantogranulomatosas e encontrou-se agente infeccioso em 48: fungos em 28 (16 Cryptococcus sp, 9 Histoplasma sp, 1 Candida sp e 2 Paracoccidioides brasiliensis); bactérias em 18 (9 Mycobacterium sp); vírus em 6, Citomegalovírus. Em 43 havia necrose tubular aguda (NTA). Outros diagnósticos foram: nefrocalcinose (15,1%) e hialinose arteriolar (22,7%). Encontrou-se também 2 casos com glomeruloesclerose segmentar focal (GESF) e um caso de hiperplasia mesangial difusa. Houve predomínio da NTI, que pode ser devido às infecções oportunistas, predominando as fúngicas; a toxicidade por drogas ou ainda devido a possível ação direta do próprio vírus. A necrose tubular aguda (NTA), foi a segunda causa em freqüência, de acometimento renal da amostra. Concluiu-se que o envolvimento renal nos pacientes com SIDA apresenta um espectro variado de processos patológicos, principalmente relacionados com infecções oportunistas, o tratamento e os procedimentos para diagnósticos, e ainda as nefropatias associadas ao vírus da imunodeficiência humana (VIH).