[Proteinuria in patients with congestive heart failure. Role of arterial hypertension]. / Proteinúria em pacientes com insuficiência cardíaca congestiva. Papel da hipertensão arterial.

PURPOSE: To evaluate the role of arterial hypertension (AH) in the development of proteinuria in patients with decompensated congestive heart failure (CHF). METHODS: Twenty-four-hour urinary protein determinations were obtained from 30 patients with decompensated CHF, before and after therapy of CHF. The patients were divided in two groups according with the presence of AH as cause of CHF: group A, 18 patients with CHF due to AH and group B, 12 patients with CHF due to idiopathic dilated or chagasic cardiomyopathy without previous AH. RESULTS: There was no differences between the groups concerning age, sex, renal function and duration of CHF. Before treatment, 88% of group A presented proteinuria exceeding 150 mg/24h compared to 25% of group B (p < 0.01). After treatment of CHF, proteinuria > 150 mg/24 h remained in 38% of group A and in none of group B. Proteinuria did not reverse after 6 months of follow-up in 2 patients, one of them showed benign nephrosclerosis in renal biopsy. CONCLUSION: Patients with decompensated CHF, unrelated to AH, presented mild proteinuria reversible after the treatment, that improved renal function. In patients with CHF due to AH, proteinuria was more frequent, more severe and did not improve after the treatment, suggesting renal lesion.

Trends in bacterial resistance and implications for treatment of infections.

The development of resistance to antibiotics can present a major problem when treating serious bacterial infections. Resistance may be increased due to indiscriminate prescribing and variations in resistance to an antibiotic may reflect different prescribing habits. In Latin American countries, where use of antibiotics is poorly controlled, resistance to gentamicin, tobramycin and amikacin, for example, is considerably higher than that found in Europe and the USA, where tighter restrictions are imposed. It is concluded that vigilance in the prescribing of antibiotics should be observed to prevent further increases in resistance.