RESUMO
BACKGROUND: Left ventricular hypertrophy (LVH) is common in kidney transplant (KT) recipients. LVH is associated with a worse outcome, though m-TOR therapy may help to revert this complication. We therefore conducted a longitudinal study to assess morphological and functional echocardiographic changes after conversion from CNI to m-TOR inhibitor drugs in nondiabetic KT patients who had previously received RAS blockers during the follow-up. METHODS: We undertook a 1-year nonrandomized controlled study in 30 non-diabetic KT patients who were converted from calcineurin inhibitor (CNI) to m-TOR therapy. A control group received immunosuppressive therapy based on CNIs. Two echocardiograms were done during the follow-up. RESULTS: Nineteen patients were switched to SRL and 11 to EVL. The m-TOR group showed a significant reduction in LVMi after 1 year (from 62 ± 22 to 55 ± 20 g/m2.7; P=0.003, paired t-test). A higher proportion of patients showing LVMi reduction was observed in the m-TOR group (53.3 versus 29.3%, P=0.048) at the study end. In addition, only 56% of the m-TOR patients had LVH at the study end compared to 77% of the control group (P=0.047). A significant change from baseline in deceleration time in early diastole was observed in the m-TOR group compared with the control group (P=0.019). CONCLUSIONS: Switching from CNI to m-TOR therapy in non-diabetic KT patients may regress LVH, independently of blood pressure changes and follow-up time. This suggests a direct non-hemodynamic effect of m-TOR drugs on cardiac mass.
Assuntos
Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/prevenção & controle , Transplante de Rim/efeitos adversos , Inibidores de Proteínas Quinases/administração & dosagem , Serina-Treonina Quinases TOR/antagonistas & inibidores , Quimioterapia Combinada , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Imunossupressores/administração & dosagem , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Presentamos el caso de un varón de 39 años de edad, que en el curso de una leptospirosis grave, con fracaso renal agudo, edema agudo de pulmón e ictericia importante, comienza con manifestaciones clínicas de afección neurológica (cefalea, disartria y paresia de la extremidad superior derecha). Se evidencian en tomografía computarizada (TC) y resonancia magnética (RM) hematomas subdurales múltiples y bilaterales. Leptospira puede producir una vasculitis difusa con lesión capilar, dando lugar a distintas manifestaciones hemorrágicas, concretamente en el sistema nervioso es una causa conocida de hemorragia subaracnoidea; el hematoma subdural intracraneal representa un hallazgo no descrito en la bibliografía revisada (AU)