Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.

Dyslipidemia in young patients with type 1 diabetes mellitus

Objective The association between type 1 diabetes mellitus (T1D) and dyslipidemia (DLP) increases the risk of cardiovascular disease (CVD). The aim of this study was to evaluate the presence of dyslipidemia in young T1D patients.Materials and methods The study design was cross-sectional and descriptive. We reviewed medical records of T1D patients followed at an endocrinology service, from 1998-2012. Data collected: gender, actual age and age at diagnosis, duration of T1D since diagnosis, body mass index (BMI), pubertal stage, glycemic control (GC) determined by glycated hemoglobin (HbA1c), total cholesterol (TC), HDL, LDL, triglycerides (TG). To analyze lipid profile and metabolic control, we used the Brazilian Society of Diabetes Guidelines.Results Were included 239 T1D patients, 136 (56.9%) females; mean ± SD: actual age 15.7 ± 5.0 years and at T1D diagnosis 7.3 ± 3.9; T1D duration 10.6 ± 6.4 years, 86.6% puberty, 15.1% overweight. The prevalence of DLP was 72.5%, 63.3% females, 86.6% puberty, mean ± SD: actual age 15.4 ± 4.8 years and at T1D diagnosis 7.2 ± 4.1 years, duration of T1D 10.7 ± 6.1 years. We found high-CT in 56.7%, low-HDL = 21.7%, high LDL = 44.0%, high-TG = 11.8%. Between females with DLP, 83.5% was in puberty. We find correlation between the presence of DLP, a poor GC and BMC.Conclusion We found a high prevalence of DLP in young patients with T1D, particularly in puberty females. Programs targeting the prevention of dyslipidemia should be adopted, especially for this group, in order to prevent/delay chronic complications and cardiovascular disease. Arch Endocrinol Metab. 2015;59(3):215-9.

Hipertensión arterial secundaria en el adulto: evaluación diagnóstica y manejo / Secondary arterial hypertension in adults: diagnostic assesment and management

La Hipertensión arterial (HTA) es un grave problema de salud pública mundial. En efecto, sus complicaciones causan anualmente 9,4 millones de muertes. La HTA también es un problema de salud de alto impacto en Chile. De hecho, la Encuesta Nacional de Salud (ENS) 2009-2010 del Ministerio de Salud, reportó una prevalencia del 26,9%. La HTA se define como una Presión arterial sistólica (PAS) 140mmHg y/o una Presión arterial diastólica (PAD) 90mmHg. Tradicionalmente, se ha clasificado la HTA en primaria o esencial, que agrupa a más del 90% de los hipertensos adultos; y en secundaria, que reúne a menos del 10% de los hipertensos. En la evaluación inicial de un paciente con HTA, se debe: Confirmar el diagnóstico; 2) Detectar causas de HTA secundaria, y 3) Evaluar riesgo cardiovascular (CV), daño orgánico y comorbilidades. Para ello, se necesita determinar la Presión Arterial (PA) y la historia clínica, que incluya antecedentes familiares, examen físico, pruebas de laboratorio y pruebas diagnósticas adicionales. En un pequeño porcentaje de adultos con HTA, se puede identificar una causa específica y potencialmente reversible; no obstante, debido a su elevada prevalencia, las formas secundarias pueden afectar a millones de pacientes en todo el mundo. Se puede sospechar una forma secundaria de HTA por un alza marcada de la PA, la aparición o empeoramiento repentinos de una HTA, una mala respuesta de la PA al tratamiento farmacológico y por un daño orgánico desproporcionado para la duración de la HTA. Si la evaluación inicial hace pensar que el paciente tiene una HTA secundaria, entonces se debe tener en consideración las causas más relevantes, que se describen en este artículo.

Arterial hypertension is a serious public health problem worldwide. Indeed, its complications cause 9.4 million deaths annually. Hypertension is also a health problem with high impact in Chile. In fact, the National Health Survey 2009-2010, conducted by the Ministry of Health, showed a prevalence of 26.9%. Arterial hypertension is defined as systolic blood pressure (SBP) 140mmHg and/or diastolic blood pressure (DBP) 90mmHg. Traditionally, hypertension has been classified into primary or essential, which represents over 90% of adults with hypertension; and secondary, which includes less than 10% of hypertensive patients. The initial evaluation of a patient with hypertension should: 1) Confirm the diagnosis of hypertension; 2) Detect causes of secondary hypertension; and 3) Assess cardiovascular risk, organ damage (OD) and concomitant clinical conditions. This calls for blood pressure (BP) measurement, medical history including family history, physical examination, laboratory investigations and further diagnostic tests. A specific, potentially reversible cause of BP elevation can be identified in a relatively small proportion of adult patients with hypertension. However, because of the overall high prevalence of hypertension, secondary forms can affect millions of patients worldwide. A secondary form of hypertension can be indicated by a severe elevation in BP, sudden onset or worsening of hypertension, poor BP response to drug therapy and OD disproportionate to the duration of hypertension. If the initial assessment suggests that the patient has a secondary hypertension, then you should take into consideration the relevant causes, which are described in this article.

Quantitative evaluation of pulomnary neuroendocrine cells and the role of nitric oxide in experimentally induced renovascular hypertension in male albino rats

Renovascular hypertension is the most common cause of secondary hypertension that leads to disorders in many systems and organs including the lung. The present work was carried out to determine how experimentally induced renovascular hypertension affects rat lung tissue with a special focus on the disorders in nitric oxide [NO] production as well as the number of pulmonary neuroendocrine cells. Twenty-one adult male albino rats were used; they were divided into three groups. Group I included five control rats, group II included eight rats that were sham operated, and group III included eight rats that were subjected to a renovascular hypertension procedure. Lower segments of the right lung lobes were obtained and then subjected to H and E and Masson's trichrome stains. Endothelial nitric oxide synthase [eNOS] and calcitonin antibody-2 were also used as immunohistochemical stains. Morphometric measurements included the area% of collagen fibers, the optical density of eNOS immunoreaction, and the number of calcitonin-positive neuroendocrine cells. Data were recorded and analyzed statistically. In group III, H and E-stained sections showed thickening of the tunica media of pulmonary arteries and alveolar walls with predominantly type II pneumocytes. Consequently, the thickened arteries showed a significant increase in the mean area% of collagen fibers, together with a significant decrease in the mean optical density of eNOS immunoreactivity when compared with the control group. The mean number of calcitonin immunoreactive neuroendocrine cells of group III showed a significant increase versus the control group. The current study showed an increased number of pulmonary neuroendocrine cells with renovascular hypertension. This increase may represent a compensatory mechanism to overcome renovascular hypertension. Thus, clinical trials could be conducted to prove the possible role of calcitonin-producing pulmonary neuroendocrine cells in controlling renovascular hypertension

Avaliação da sensibilidade e especificidade dos exames não invasivos no diagnóstico da estenose de artéria renal / Analysis of the sensitivity and specificity of noninvasive imaging tests for the diagnosis of renal artery stenosis

FUNDAMENTO: O envelhecimento e a aterosclerose estão relacionados à hipertensão renovascular em indivíduos idosos. Independentemente das comorbidades, a estenose de artéria renal é, por si só, importante causa de morbidade e mortalidade cardiovascular. OBJETIVO: Definir a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo dos exames não invasivos utilizados no diagnóstico de estenose da artéria renal. MÉTODOS: Um grupo de 61 pacientes recrutados permitiram a análise de 122 artérias e a definição de sensibilidade, especificidade e da contribuição relativa de cada exame realizado (Doppler, cintilografia e angiotomografia, comparados a arteriografia renal). RESULTADOS: A média das idades foi de 65,43 (desvio padrão: 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas estiveram correlacionadas à estenose da artéria renal, à disfunção renal e aos triglicerídeos. A mediana do ritmo de filtração glomerular foi de 52,8 mL/min/m². O Doppler identificou sensibilidade de 82,90%, especificidade de 70%, valor preditivo positivo de 85% e valor preditivo negativo de 66,70%. Para a tomografia, encontraram-se sensibilidade de 66,70%, especificidade de 80%, valor preditivo positivo de 87,50% e valor preditivo negativo de 55,20%. Esses achados permitiram identificar os exames que melhor detectavam a estenose. CONCLUSÃO: A tomografia e o Doppler mostraram qualidade e grande possibilidade no diagnóstico de estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, ocorre em diabéticos e associa-se à disfunção renal e à disfunção ventricular esquerda grave.

BACKGROUND: Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. OBJECTIVE: To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. METHODS: In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). RESULTS: The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m². Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. CONCLUSION: Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction.

Tratamento endovascular da estenose da artéria renal em rim único / Endovascular treatment of renal stenosis in solitary kidney

CONTEXTO: O tratamento endovascular da doença renal hipertensiva, em doentes com rim único, conseqüente à estenose de artéria renal, mostrou ser efetivo na prevenção da falência do órgão, sua função e controle da hipertensão. Quando indicado após avaliação criteriosa, tanto bioquímica como por imagens e sinais do doente, o tratamento endovascular apresenta benefícios clínicos de forma efetiva e pouco invasiva. OBJETIVO: Estudar a doença hipertensiva renovascular e avaliar a eficácia do tratamento endovascular no controle da hipertensão arterial sistêmica e da insuficiência renal secundárias à estenose da artéria renal e como medida de prevenção de falência renal em doentes com rim único funcionante. MÉTODO: Estudo realizado com protocolo de atendimento previamente elaborado, no Centro de Referência de Alta Complexidade em Cirurgia Endovascular do Hospital de Clínicas da Universidade de Campinas, de abril de 1997 a junho de 2005, em 10 doentes com diagnóstico de estenose da artéria renal em rim único funcionante, submetidos ao tratamento endovascular. Foi avaliada a melhora da hipertensão e função renal através de seguimento clínico e laboratorial com medidas de pressão arterial, dosagens séricas de uréia, creatinina e clearance. Exames pelo eco-color-Doppler foram realizados no pós-operatório de 30 dias, 3 meses, 6 meses e anualmente; no caso de haver alguma dúvida na obtenção de imagens ou sinais, foi realizada a aortografia e arteriografia seletiva renal. Nesta casuística, 90 por cento dos doentes apresentavam hipertensão arterial, 70 por cento eram tabagistas, 40 por cento, hiperlipidêmicos, 30 por cento apresentavam doença oclusiva cerebral extracraniana, 60 por cento, obstrução arterial crônica nos membros inferiores, e 20 por cento, diabetes melito. RESULTADOS: O sucesso inicial foi de 100 por cento. O seguimento médio foi de 40 meses. Houve controle da pressão arterial em 90 por cento, diminuição significativa dos níveis de uréia...

BACKGROUND: Endovascular treatment of hypertensive renal disease in patients with a solitary kidney secondary to renal artery stenosis proved to be effective to prevent organ failure and function, as well as hypertension control. When indicated after judicious evaluation using both biochemical methods and the patient's images and signs, endovascular treatment has effective clinical benefits and is little invasive. OBJECTIVE: To study renal artery stenosis with hypertension and evaluate the effectiveness of endovascular treatment in the control of hypertension, renal failure secondary to renal artery stenosis, and in the prevention of renal failure in patients with a solitary kidney. METHODS: This study was performed at the Reference Center of High Complexity in Endovascular Surgery of Hospital de Clínicas da Universidade de Campinas from April 1997 through June 2005 using a previously developed protocol. Ten patients with renal artery stenosis and solitary kidney submitted to endovascular treatment were included. Improvement in hypertension and renal function was assessed through clinical follow-up and laboratory tests using measurements of blood pressure, serum urea levels, creatinine and clearance. Color-flow Doppler ultrasound was performed 30, 90, 180 days after the surgery and yearly thereafter. Aortography and selective renal arteriography were performed in case of doubt as to images or signs. For this population, 90 percent had hypertension, 70 percent were smokers, 40 percent had hyperlipidemia, 30 percent had carotid artery occlusive disease, 60 percent had chronic lower limb arterial occlusion, and 20 percent had diabetes mellitus. RESULTS: Immediate success was 100 percent. Mean follow-up time was 40 months. Control of blood pressure occurred in 90 percent of the cases, and in 10 percent there was significant reduction in urea and creatinine levels and worsening of hypertension after the procedure. CONCLUSION: Endovascular...

Hipertensão secundária - renovascular: diagnóstico e tratamento / Secondary hypertension - renovascular hypertension: diagnosis and treatment

O presente artigo revisa o importante papel do diagnóstico e tratamento da doença renovascular, que pode ou não ser causa de hipertensão arterial. Infelizmente ainda não dispomos na atualidade de evidências científicas robustas que nos orientem sobre o melhor momento e a melhor terapêutica para pacientes portadores de doença renovascular. É certo que, independentemente da opção terapêutica utilizada, além da necessidade de se alcançar melhor controle da pressão arterial e preservação da função renal, é imperativo que todas as co-morbidades presentes sejam corrigidas, quando se buscam melhores resultados finais pós-intervenção. Assim, a investigação precoce baseada em critérios clínicos de probabilidade somada ao auxílio de exames complementares permitirão maiores chances de acerto diagnóstico, cuja certeza só existirá após a realização da intervenção escolhida. Infelizmente a mesma certeza que temos nas melhores opções diagnósticas não dispomos em relação aos resultados tardios no que tange à evolução clínica dessa população. Necessário será aguardarmos os resultados de estudos em andamento e que estes possam revelar nossas maiores dúvidas quanto a melhor forma de tratamento.

The hyponatremic hypertensive syndrome in renal artery stenosis: an infrequent cause of hyponatremia.

The hyponatremic hypertensive syndrome is a rare but serious complication of reno-vascular disease. The syndrome is characterized by hypertension and profound natriuresis, leading to body sodium and water depletion. Hypertension is typically refractory to treatment. We report an 82-year-old patient with this syndrome and describe the results of an audit of the clinical records of patients admitted to a teaching hospital over a two-year period with confirmed renal artery stenosis and hyponatremia. The syndrome should be suspected in patients in whom severe hypertension is associated with hyponatremia without other apparent cause, especially in the presence of reno-vascular disease.

Avanços na avaliação e no tratamento da hipertensão renovascular / Advances on evaluation and treatment of renovascular hypertension

A hipertensão renovascular é secundária à isquemia renal. É causada principalmente por doença aterosclerótica da artéria renal e displasia fibromuscular. A ativação do eixo renina-angiotensina-aldosterona e suas conseqüências hemodinâmicas é o principal fator fisiopatológico. A investigação diagnóstica está indicada em pacientes com características clínicas sugestivas da doença. A avaliação é feita através de métodos não-invasivos, como a ultra-sonografia com Doppler, a ressonância nuclear magnética, a tomografia computadorizada espiral e a cintilografia renal com captopril. A avaliação invasiva com a arteriografia permanece o padrão-ouro no diagnóstico da hipertensão renovascular. Há duas escolhas possíveis de tratamento: o medicamentoso e a revascularização cirúrgica ou percutânea. As indicações mais claras de angioplastia em estenoses hemodinamicamente significativas são a displasia fibromuscular e, no caso de doença aterosclerótica, hipertensão não-controlada, perda de função renal progressiva e edema pulmonar recorrente sem causa cardíaca identificada.

Persistent hypertension in Thai children: etiologies and outcome.

A retrospective study was done in 66 children (0.21% of all admitted children) below the age of 18 years with persistent hypertension diagnosed at the Department of Pediatrics, Faculty of Medicine Siriraj Hospital from Jan 1999 to Dec 2003. Male to female ratio was 1.4:1 with 54.5% aged between 6-12 years old and 9.1% aged less than 1 year. Hypertension was found to be severe (BP more than the 99th percentile for age, sex and height) in 79.1% but most (78.6%) of the patients did not have symptoms related to hypertension. Chronic headaches were found in 10%, hypertensive encephalopathy in 8.6%, epistaxis in 1.4% and visual disturbance in 1.4%. The most common cause of hypertension was renal parenchymal diseases (62.7%) mainly lupus nephritis (26.9%), idiopathic nephrotic syndrome (16.4%) and chronic renal failure (16.4%). Other causes of hypertension included renovascular diseases (7.5%), drug-induced (7.5%), essential (7.5%), tumors (4.5%), coarctation of aorta (3.0%), bronchopulmonary dysplasia (3.0%), and pheochromocytoma (1.5%). Obesity and overweight (body mass index, BMI more than 25) was found in only 10 patients (15.1%).The proportion of children with BMI more than 25 was not different between essential and secondary hypertension (p = 0.15). Left ventricular hypertrophy was noted in 7.5%, hypertensive retinopathy in 3.0%, and hypertensive encephalopathy in 9.0%. One-third of the patients had normal BP within 1 month and another 47.0% had normal BP within 6 months of diagnosis. One-fifth of the patients also needed surgical intervention for specific underlying diseases. The authors suggest that since a large number of children with hypertension have secondary hypertension, intensive investigation and prompt management should be done in all. Obesity and overweight is not reliable in the differentiation between primary and secondary hypertension. Short term outcome of hypertension is good with medications and surgery in selected cases but long term outcome is still unknown.

O Scan Duplex para diagnósticos de hipertensao renovascular / Scan Duplex in the diagnosis of renovascular hypertension

Objetivo: O objetivo deste estudo é de demonstrar a capacidade do SD em identificar lesões de artérias renais em pacientes com hipertensão arterial sistêmica de causa renovascular (HRV).Pacientes e métodos: Foram incluídos 39 pacientes hipertensos com suspeita de HRV avaliados pelo SD. Os seguintes parâmetros para o diagnóstico de estenose igual ou superior a 60 por cento da luz do vaso so SD: pico de velocidade sistólica no local da estenose da artéia renal igual ou superior a 180cm/s, índice renal aórtico acima de 3,5 e presença de fluxo intrarrenal alterado, com tempo de aceleração acima de 70ms e morfologia tardus parvus. Foram utilizadas, também, assimetria renal de 1,5cm e visulaização da artéria com ausência de fluxo ao Doppler e fluxo a cores para oclusão arterial. Resultados: Dos 30 pacientes examinados, seis apresentaram, critérios para estenose igual ou acima de 60 por cento ou oclusão, e foram avaliados pela angiografia, que confirmou as achados pelo SD, 12 artérias examinadas...

Hipertensão arterial renovascular: resultados imediatos e evolução intra hospitalar após intervenção percutânea de artéria renal / Renovascular arterial hypertension: outcome and in hospital evolution after renal artery percutaneous intervention

Objetivo: Avaliar características clínicas e angiográficas, resultados imediatos e evolução intra hospitalar de pacientes submetidos à intervenção percutânea de artéria renal.Método: Foram realizados 46 procedimentos no período compreendido entre 1981 e 2004, subdivididos em dois grupos: Grupo A, compreendendo 25 procedimentos realizados em 23 pacientes, utilizando-se somente o balão, no período de 1981 e 1992, quando não estava disponível o stent para intervenção em artéria renal; Grupo N, compreendendo as intervenções realizadas de 1993 a 2004, quando foi usado balão e/ou stent, a critério do operador.Resultados: As características clínicas e angiográficas e os resultados imediatos do grupo A e N foram respectivamente: idade 45,8 e 62,17 (p igual 0,0037); sexo feminino 13(52 por cento) e 9(42,9 por cento) e masculino 12(48 por cento) e 12(52 por cento), (p igual 0,5363), etiologia aterosclerótica 17 (68 por cento) e 19(90,5 por cento); displasia fibromuscular 7(28 por cento) e 2(9,5 por cento) e arterite de Takayasu 2(4 por cento) e 0(0 por cento), (p igual 0,2928); extensão da doença unilateral 22(88,8 por cento) e 19(90,5 por cento) e bilateral 3(11,2 por cento) e 2(9,5 por cento), (p igual 0,5849), localização da doença ostial 3(12 por cento) e 5(23,8 por cento) e não ostial 22 (88 por cento) e 16(76,2 por cento), (p igual 0,2536) e sucesso 21 (84 por cento) e 21 (100 por cento) e insucesso 4(16 por cento) e 0(0 por cento), (p igual 0,0775). No grupo A, utilizou-se apenas balão nos 25 procedimentos e no grupo N, balão em 8(38,1 por cento) e stent em 13 (61,9 por cento), (p menor 0,0001). Os níveis de pressão eram semelhantes nos grupos A e N antes da intervenção, havendo queda significativa dos níveis pressóricos em ambos os grupos. Nos subgrupos de etiologia aterosclerótica e de displasia fibromuscular, a queda da pressão arterial pós procedimento e da pressão diastólica foi semelhante em ambos.Conclusão: O grupo A era mais jovem, não houve diferença significativa para sexo, etiologia, extensão da doença e localização da lesão, e houve tendência para maior sucesso no grupo N. Houve significativa queda da pressão arterial sistólica e diastólica pós procedimento, nos grupos estudados

Effect of losartan and enalapril on cognitive deficit caused by Goldblatt induced hypertension.

The present study was designed to evaluate the learning and memory, in an altered physiological state associated with increased blood pressure and activated renin angiotensin system in Wistar rats. The role of angiotensin in cognitive function was assessed by treatment with angiotensin converting enzyme (ACE) inhibitor enalapril (2 mg/kg), angiotensin 1 receptor (AT(1)) antagonist losartan (5 mg/kg) and their combination. The experimental renal hypertension was induced by the method of Goldblatt. Learning and memory was assessed using the radial arm maze test. Acetylcholine esterase (AChE) levels in the pons medulla, hippocampus, striatum and frontal cortex were measured as a cholinergic marker of learning and memory. Results indicate that in comparison to normotensive rats, renal hypertensive rats committed significantly higher number of errors and took more trials and days to learn the radial arm maze learning and exhibited memory deficit in the radial arm maze retrieval after two weeks of retention interval, indicating impaired acquisition and memory. Treatment with enalapril, losartan and their combination attenuated the observed memory deficits indicating a possible role of renin angiotensin system in cognitive function. AChE level was reduced in hippocampus and frontal cortex of renal hypertensive rats which could be attributed to the observed memory deficit in hypertensive rats. It can be concluded that, renal hypertensive rats had a poor acquisition, retrieval of the learned behavior, perhaps a possible disturbance in memory consolidation process and that this state was reversed with ACE inhibitor enalapril and AT 1 receptor antagonist losartan.

Hipertensão renovascular por displasia fibromuscular / Renovascular hypertension due to fibromuscular dysplasia

Os autores relatam um caso de hipertensão renovascular por displasia fibromuscular em paciente de 34 anos, do sexo feminino, caucasiana, encaminhada ao serviço hospitalar devido a queixa de zumbido na região cervical bilateral há aproximadamente 8 meses, mais acentuado à esquerda. Relatava, também tonteiras ocasionais e hipertensão arterial. O diagnóstico foi confirmado por arteriografia, que evidenciou lesões com aspecto em colar de contas em artérias carotidas interna, artéria renal direita e arterias iliacas externas. Este artigo tem como objetivo chamar a atenção para as doenças raras, que muitas vezes passam desapercebidas, e estimular o exercício do diagnóstico diferencial.

Edema pulmonar relámpago, flash pulmonary edema: cuando el riñón descompensa al corazón / Flash pulmonary edema, report of 2 cases

Flash pulmonary edema is a paroxismal pulmonary edema associated to a hypertensive crisis, that subsides in hours with the usual therapeutic measures. It occurs in patients with renal artery stenosis. We report two male patients aged 71 and 74 years old, presenting with acute dyspnea and high blood pressure. Diffuse rales were auscultated and arterial blood pressure was high in both. Dyspnea subsided in few hours with diuretics and oxygen. In both, a critical renal arterial stenosis was found and an angioplasty with stent placement was performed. After 5 and 6 months of follow up, the patients remain asymptomatic

Bilateral renal artery stenosis presenting as hypertensive retinopathy and choroidopathy.

This report describes a rare case of hypertensive retinopathy with choroidopathy secondary to bilateral renal artery stenosis in a young non-pregnant female patient.

Abnormal proliferative response of the carotid artery of spontaneously hypertensive rats after angioplasty may be related to the depolarized state of its smooth muscle cells

Hypertension is one of the major precursors of atherosclerotic vascular disease, and vascular smooth muscle abnormal cell replication is a key feature of plaque formation. The present study was conducted to examine the relationship between hypertension and smooth muscle cell proliferation after balloon injury and to correlate neointima formation with resting membrane potential of uninjured smooth muscle cells, since it has been suggested that altered vascular function in hypertension may be related to the resetting of the resting membrane potential in spontaneously hypertensive rats (SHR). Neointima formation was induced by balloon injury to the carotid arteries of SHR and renovascular hypertensive rats (1K-1C), as well as in their normotensive controls, i.e., Wistar Kyoto (WKY) and normal Wistar (NWR) rats. After 14 days the animals were killed and the carotid arteries were submitted to histomorphometric and immunohistochemical analyses. Resting membrane potential measurements showed that uninjured carotid arteries from SHR smooth muscle cells were significantly depolarized (-46.5 + or - 1.9 mV) compared to NWR (-69 + or - 1.4 mV), NWR 1K-1C (-60.8 + or - 1.6 mV), WKY (-67.1 + or - 3.2 mV) and WKY 1K-1C (-56.9 + or - 1.2 mV). The SHR arteries responded to balloon injury with an enhanced neointima formation (neo/media = 3.97 + or - 0.86) when compared to arteries of all the other groups (NWR 0.93 + or - 0.65, NWR 1K-1C 1.24 + or - 0.45, WKY 1.22 + or - 0.32, WKY 1K-1C 1.15 + or - 0.74). Our results indicate that the increased fibroproliferative response observed in SHR is not related to the hypertensive state but could be associated with the resetting of the carotid smooth muscle cell resting membrane potential to a more depolarized state