Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis.

INTRODUCTION: The detection of the renal artery stenosis in hypertensive patients can be a signal of systemic arterial atherosclerosis. AIMS: To identify and characterize clinical-epidemiologically the hypertensive patients with renal artery stenosis, evaluating factors of cardiovascular risk and presence of symptomatic multiarterial atherosclerotic. METHOD: Were selected the hypertensive patients who were assisted at the Nephrological Clinic of Universidade Federal do Triângulo Mineiro (UFTM) between 2000-2010, with diagnosis of renal artery stenosis of atherosclerotic etiology. Epidemiological data were evaluated (gender, age, ethnicity), factors of cardiovascular risk (diabetes, hypercholesterolemia, hypertriglyceridemia, tabagism, metabolic syndrome), information on hypertension (time of diagnosis, family report, number of used medicines), previous cardiovascular events (acute myocardial infarctation, ischemic stroke, peripheral arterial disease). Blood pressure levels, global cardiovascular risk and Score Framingham were stratified. RESULTS: Casuistry of 30 patients, feminine majority (73.3%), average of 66 year-old age, 86.67% white, medium time of hypertension of 19.94 years, 89.92 without family report, 13.8 with diabetes, 65.51% smoking, 17.25% hypertriglyredemia, 62.06% with hypercholesterolemia and 66.7% with metabolic syndrome. Average number of medicines in use: 3.26. Dominant right-sided renal artery stenosis separately (46.7%) and in proximal third (56.7%). High creatinine levels in 40% of the patients. As for the hypertension phase, majority phase 2 (47%) and 73.3% with high global cardiovascular risk. Average Framingham Score of 13%. 66.7% presented atherosclerotic disease in another place, being infarctation the main one (53.3%). CONCLUSION: The most common correlation was with acute myocardial infarctation, what implicates in the search of the coronary compromising to the diagnosis of renal artery stenosis in hypertensive patients to try avoid future damages to the patient.

Pesquisa de doença aterosclerótica multiarterial em pacientes hipertensos com estenose de artéria renal / Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis

INTRODUÇÃO: A detecção de estenose de artéria renal em pacientes hipertensos pode ser um sinal de aterosclerose arterial sistêmica. OBJETIVOS: Identificar e caracterizar do ponto de vista clínico e epidemiológico os pacientes hipertensos com estenose de artéria renal, avaliando fatores de risco cardiovascular e presença de doença aterosclerótica multiarterial sintomática. MÉTODO: Foram selecionados os pacientes hipertensos atendidos no ambulatório de Nefrologia da Universidade Federal do Triângulo Mineiro (UFTM) entre 2000-2010, com diagnóstico de estenose de artéria renal de etiologia aterosclerótica. Avaliaram-se dados epidemiológicos (gênero, idade, etnia), fatores de risco cardiovascular (Diabetes Mellitus, hipercolesterolemia, hipertrigliceridemia, tabagismo, síndrome metabólica), informações relativas à hipertensão (tempo de diagnóstico, histórico familiar, número de medicamentos utilizados), eventos cardiovasculares prévios (infarto agudo do miocárdio, acidente vascular encefálico isquêmico, doença arterial periférica). Estratificaram-se os níveis pressóricos, risco cardiovascular global e escore Framingham. RESULTADOS: Casuística de 30 pacientes, maioria feminina (73,3%), média de idade de 66 anos, 86,67% brancos. Tempo médio de HAS de 19,94 anos, 89,28% sem histórico familiar, 13,8% com diabetes, 65,51% tabagistas, 17,25% com hipertrigliceridemia, 62,06% com hipercolesterolemia e 66,7% com síndrome metabólica. Número médio de medicamentos em uso: 3,26. Estenose de artéria renal predominante à direita quando isoladamente (46,7%) e em terço proximal (56,7%). Creatinina elevada em 40% dos pacientes. Quanto ao estágio de hipertensão, maioria estágio 2 (47%) e 73,3% com risco cardiovascular global alto. Escore Framingham Médio de 13%. 66,7% apresentavam doença aterosclerótica em outro sítio, sendo coronariano o principal (53,3%). CONCLUSÃO: A correlação mais comum foi com o infarto agudo do miocárdio, o que implica na busca do comprometimento coronário quando do diagnóstico de estenose de artéria renal em pacientes hipertensos, para tentar evitar danos futuros ao paciente.

INTRODUCTION: The detection of the renal artery stenosis in hypertensive patients can be a signal of systemic arterial atherosclerosis. AIMS: To identify and characterize clinical-epidemiologically the hypertensive patients with renal artery stenosis, evaluating factors of cardiovascular risk and presence of symptomatic multiarterial atherosclerotic. METHOD: Were selected the hypertensive patients who were assisted at the Nephrological Clinic of Universidade Federal do Triângulo Mineiro (UFTM) between 2000-2010, with diagnosis of renal artery stenosis of atherosclerotic etiology. Epidemiological data were evaluated (gender, age, ethnicity), factors of cardiovascular risk (diabetes, hypercholesterolemia, hypertriglyceridemia, tabagism, metabolic syndrome), information on hypertension (time of diagnosis, family report, number of used medicines), previous cardiovascular events (acute myocardial infarctation, ischemic stroke, peripheral arterial disease). Blood pressure levels, global cardiovascular risk and Score Framingham were stratified. RESULTS: Casuistry of 30 patients, feminine majority (73.3%), average of 66 year-old age, 86.67% white, medium time of hypertension of 19.94 years, 89.92 without family report, 13.8 with diabetes, 65.51% smoking, 17.25% hypertriglyredemia, 62.06% with hypercholesterolemia and 66.7% with metabolic syndrome. Average number of medicines in use: 3.26. Dominant right-sided renal artery stenosis separately (46.7%) and in proximal third (56.7%). High creatinine levels in 40% of the patients. As for the hypertension phase, majority phase 2 (47%) and 73.3% with high global cardiovascular risk. Average Framingham Score of 13%. 66.7% presented atherosclerotic disease in another place, being infarctation the main one (53.3%). CONCLUSION: The most common correlation was with acute myocardial infarctation, what implicates in the search of the coronary compromising to the diagnosis of renal artery stenosis in hypertensive patients to try avoid future damages to the patient.

Acute glomerulonephritis after upper airway or skin infection: descriptive analysis of 82 cases between 14 and 64 years-old.

INTRODUCTION: Acute glomerulonephritis (AGN) after infection of the upper airways or skin is a kidney disease usually caused by streptococcal nephritogenic strains and may present with sudden onset of gross hematuria, hypertension, edema and, occasionally, acute renal failure, is common in childhood and little incident in adults and younger individuals. OBJECTIVE: To analyze, in a descriptive way, data from the initial presentation of GNA after infection of the upper airways or skin in patients over 14 years of age, with emphasis on its epidemiological and clinical aspects. PATIENTS AND METHODS: We reviewed the clinical data of 82 patients treated at our department during the period 1972-2001, divided into three groups: group 1, with individuals between 14 and 20 years (n = 52), group 2, between 21 and 30 years (n = 19) and group 3, aged ≥; 31 years (n = 11). RESULTS: There was a predominance of the table among younger patients (group 1), male and white, mostly preceded by infection of the skin, appearing most commonly on lower extremity edema and/or face. In some cases, even with nephrotic syndrome, and hypertension, especially in adults over 30 years (group 3), being the least frequent finding of gross hematuria, and rarely, acute renal failure. CONCLUSION: Our findings underscore the importance of studying the AGN after infection of the upper airways or skin in younger individuals and adults, seeking to better characterize its clinical, mainly because it is a group of patients where the disease is less incident.

Acute glomerulonephritis after upper airway or skin infection: descriptive analysis of 82 cases between 14 and 64 years-old / Glomerulonefrite aguda após infecção de vias aéreas superiores ou pele: análise descritiva de 82 pacientes entre 14 e 64 anos de idade

INTRODUÇÃO: A glomerulonefrite aguda (GNA) após infecção de vias aéreas superiores ou pele é uma doença renal causada geralmente por cepas estreptocócicas nefritogênicas, podendo cursar com quadro súbito de hematúria macroscópica, hipertensão arterial, edema e, ocasionalmente, insuficiência renal aguda, sendo comum na infância e pouco incidente em adultos e indivíduos mais jovens. OBJETIVO: Analisar, de forma descritiva, os dados da apresentação inicial da GNA após infecção de vias aéreas superiores ou pele em pacientes com mais de 14 anos de idade, com ênfase em seus aspectos epidemiológicos e clínicos. PACIENTES E MÉTODOS: Foram analisados os dados clínicos de 82 pacientes, atendidos em nosso Serviço no período de 1972 a 2001, distribuídos em três grupos etários: grupo 1, com indivíduos entre 14 e 20 anos (n = 52); grupo 2, entre 21 e 30 anos (n = 19); e grupo 3, com idade > 31 anos (n = 11). RESULTADOS: Houve um predomínio do quadro entre pacientes mais jovens (grupo 1), do sexo masculino e da cor branca, precedido, principalmente, por infecção de pele, manifestando-se mais comumente por edema de membros inferiores e/ou face. Em alguns casos, até com síndrome nefrótica, e hipertensão arterial, sobretudo nos adultos com mais de 30 anos (grupo 3), sendo menos frequente o achado de hematúria macroscópica e, raramente, de insuficiência renal aguda. CONCLUSÃO: Nossos achados ressaltam a importância de se estudar a GNA após infecção de vias aéreas superiores ou pele em indivíduos mais jovens e adultos, procurando melhor caracterizar seus aspectos clínicos, sobretudo por se tratar de um grupo de pacientes no qual a doença é menos incidente.

INTRODUCTION: Acute glomerulonephritis (AGN) after infection of the upper airways or skin is a kidney disease usually caused by streptococcal nephritogenic strains and may present with sudden onset of gross hematuria, hypertension, edema and, occasionally, acute renal failure, is common in childhood and little incident in adults and younger individuals. OBJECTIVE: To analyze, in a descriptive way, data from the initial presentation of GNA after infection of the upper airways or skin in patients over 14 years of age, with emphasis on its epidemiological and clinical aspects. PATIENTS AND METHODS: We reviewed the clinical data of 82 patients treated at our department during the period 1972-2001, divided into three groups: group 1, with individuals between 14 and 20 years (n = 52), group 2, between 21 and 30 years (n = 19) and group 3, aged >; 31 years (n = 11). RESULTS: There was a predominance of the table among younger patients (group 1), male and white, mostly preceded by infection of the skin, appearing most commonly on lower extremity edema and/or face. In some cases, even with nephrotic syndrome, and hypertension, especially in adults over 30 years (group 3), being the least frequent finding of gross hematuria, and rarely, acute renal failure. CONCLUSION: Our findings underscore the importance of studying the AGN after infection of the upper airways or skin in younger individuals and adults, seeking to better characterize its clinical, mainly because it is a group of patients where the disease is less incident.

Renal transplantation outcomes: a comparative analysis between elderly and younger recipients.

Renal transplantation is presently the best treatment for end-stage renal disease, although considered contraindicated for elderly patients. However, more investigation is needed due to higher life expectancy rates of the general population and the increasing number of over 60-yr-old patients with chronic renal failure dependent upon dialysis. This study aims to determine graft and patient survival rates of renal transplant patients 60 yr and older compared to a younger group (50-59 yr old). Relevant pre- and post-transplant clinical data related to graft and patient survival in both groups were also investigated. Three-hundred and twenty consecutive renal transplant patients were enrolled in this study and grouped based on age at the time of the transplantation: one-hundred and ten patients at or over 60 yr old (elderly group) and 210 patients ranging from 50 to 59 yr old (younger group). There were no statistical differences in either group regarding clinical characteristics and immunological risk factors. The incidence of acute rejection was higher in the younger group (37.6%) than in the elderly (22.7%) (p = 0.01). Censored to death graft survivals at five yr were respectively 86.7% for patients > or = 60 yr and 82.1% for patients 50-59 yr old (p = 0.49). Patient survival rates at five yr were respectively 76.2% for patients > or = 60 yr and 81.6% for patients 50-59 yr old (p = 0.33). Our data show that renal transplantation for elderly patients has similar results to those found in younger individuals, which does not make age, in and of itself, a contraindication for transplantation.