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1.
Nefrologia (Engl Ed) ; 44(3): 338-343, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38964947

RESUMO

Up to 50% of patients admitted for heart failure (HF) have congestion at discharge despite diagnostic and therapeutic advances. Both persistent congestion and diuretic resistance are associated with worse prognosis. The combination of hypertonic saline and loop diuretic has shown promising results in different studies. However, it has not yet achieved a standardized use, partly because of the great heterogeneity in the concentration of sodium chloride, the dose of diuretic or the amount of sodium in the diet. Classically, the movement of water from the intracellular space due to an increase in extracellular osmolarity has been postulated as the main mechanism involved. However, chloride deficit is postulated as the main up-regulator of plasma volume changes, and its correction may be the main mechanism involved. This "chloride centric" approach to heart failure opens the door to therapeutic strategies that would include diuretics to correct hypochloremia, as well as sodium free chloride supplementation.


Assuntos
Insuficiência Cardíaca , Sódio , Humanos , Insuficiência Cardíaca/tratamento farmacológico , Solução Salina Hipertônica/uso terapêutico , Sódio/sangue , Cloretos/sangue , Cloro , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico
9.
Nefrologia (Engl Ed) ; 41(3): 337-346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-36166249

RESUMO

INTRODUCTION: Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors. MATERIAL AND METHODS: Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months. RESULTS: We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33 ml/min with significant decrease to 30.9 ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR. CONCLUSIONS: A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Placa Aterosclerótica , Insuficiência Renal Crônica , Calcinose/epidemiologia , Calcinose/etiologia , Cálcio , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Fósforo , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco
10.
Nefrologia (Engl Ed) ; 41(3): 337-346, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33358625

RESUMO

INTRODUCTION: Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors. MATERIAL AND METHODS: Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months. RESULTS: We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33ml/min with significant decrease to 30.9ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR. CONCLUSIONS: A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.


Assuntos
Calcinose/epidemiologia , Calcinose/etiologia , Doenças das Valvas Cardíacas/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Valva Mitral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
12.
Calcif Tissue Int ; 108(4): 410-422, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33190187

RESUMO

The key players of the chronic kidney disease-mineral and bone disorders (CKD-MBD) are calcium, phosphate, PTH, FGF23, and the vitamin D hormonal system. The progressive reduction of kidney function greatly modifies the tightly interrelated mechanisms that control these parameters. As a result, important changes occur in the bone and mineral hormonal axis, leading to changes in bone turnover with relevant consequences in clinical outcomes, such as decrease in bone mass with increased bone fragility and bone fractures and increased vascular and valvular calcification, also with great impact in the cardiovascular outcomes. So far, the knowledge of the mineral and bone disorders in CKD and the increased variety of efficacious therapies should lead to a better prevention and management of CKD-MBD.


Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica , Insuficiência Renal Crônica , Densidade Óssea , Cálcio , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Fator de Crescimento de Fibroblastos 23 , Humanos , Fosfatos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Vitamina D
17.
Nefrología (Madr.) ; 35(5): 493-496, sept.-oct. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-144805

RESUMO

Se describe el caso de una paciente con síndrome de Berardinelli-Seip, un tipo de lipodistrofia congénita generalizada, que inició a los 20 años, con marcada resistencia insulínica y complicaciones micro- y macroangiopáticas, entre ellas una enfermedad renal crónica que la ha llevado a iniciar tratamiento renal sustitutivo en la modalidad de diálisis peritoneal. Para ello llevamos un repaso de la historia de la paciente desde la edad pediátrica (momento en el que ya aparecen los primeros signos de la enfermedad) hasta la actualidad. Más allá de lo infrecuente de esta enfermedad, es de destacar que lo excepcional del caso es que se trata del único caso (al menos registrado en la literatura) de pacientes afectos de síndrome de Berardinelli-Seip en programa de diálisis (AU)


A case of Berardinelli-Seip syndrome, a congenital generalised lipodystrophy, is reported. Symptoms first appeared when the patient was 20 years old. She showed severe insulin resistance aswell as micro- and macro-angiopathic complications, including chronic kidney disease, which required renal replacement therapy with peritoneal dialysis. The patient’s clinical course was reviewed since paediatric age (when initial signs of the disease being already evident) to present time. Berardinelli-Seip syndromeis very uncommon, and the present case is particularly rare because it is the only case (at least as reported in the literature) in a patient receiving dialysis (AU)


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Lipodistrofia Generalizada Congênita/complicações , Insuficiência Renal Crônica/complicações , Diálise Peritoneal , Angiopatias Diabéticas/complicações
18.
Nefrologia ; 35(5): 493-6, 2015.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26391816

RESUMO

A case of Berardinelli-Seip syndrome, a congenital generalised lipodystrophy, is reported. Symptoms first appeared when the patient was 20 years old. She showed severe insulin resistance as well as micro- and macro-angiopathic complications, including chronic kidney disease, which required renal replacement therapy with peritoneal dialysis. The patient's clinical course was reviewed since paediatric age (when initial signs of the disease being already evident) to present time. Berardinelli-Seip syndrome is very uncommon, and the present case is particularly rare because it is the only case (at least as reported in the literature) in a patient receiving dialysis.


Assuntos
Lipodistrofia Generalizada Congênita , Diálise Peritoneal Ambulatorial Contínua , Acromegalia/etiologia , Cardiomiopatia Hipertrófica/etiologia , Criança , Diagnóstico Tardio , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/terapia , Diagnóstico Diferencial , Éxons/genética , Feminino , Subunidades gama da Proteína de Ligação ao GTP/genética , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulonefrite Membranoproliferativa/etiologia , Glomerulonefrite Membranoproliferativa/terapia , Humanos , Resistência à Insulina , Leptina/uso terapêutico , Lipodistrofia Generalizada Congênita/complicações , Lipodistrofia Generalizada Congênita/diagnóstico , Lipodistrofia Generalizada Congênita/genética
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