RESUMO
SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Doppler echocardiography showed cardiac abnormalities in 16/21 (76%) hypertensive patients. CONCLUSION Cardiac abnormalities and hypertension in patients with Williams-Beuren syndrome are common. Thus, thorough evaluation and follow-up are necessary to reduce cardiovascular risks and mortality of these patients
RESUMO OBJETIVO Descrever a incidência, o diagnóstico e o tratamento da hipertensão arterial sistêmica relacionada com estenose da artéria renal em pacientes com síndrome de Williams-Beuren. MÉTODOS Sessenta e cinco pacientes com síndrome de Williams-Beuren foram avaliados quanto à presença de hipertensão. Os pacientes foram submetidos à ultrassonografia com Doppler das artérias renais e ecocardiograma Doppler. Aqueles com suspeita de hipertensão renovascular foram submetidos à tomografia computadorizada ou angiografia por ressonância magnética da aorta e vasos renais ou angiografia convencional. RESULTADOS A hipertensão arterial sistêmica foi diagnosticada em 21/65 pacientes com síndrome de Williams-Beuren (32%, 13 do sexo masculino), com idade média de 13,9 anos (5 meses-20 anos). Em 8/21 pacientes foi detectada a hipertensão renovascular. Angioplastia não teve sucesso em cinco pacientes com estenose da artéria renal, necessitando de tratamento adicional. O ecocardiograma Doppler mostrou anormalidades cardíacas em 16/21 (76%) pacientes hipertensos. CONCLUSÃO As anormalidades cardíacas e hipertensão arterial em pacientes com síndrome de Williams-Beuren são muito frequentes, sendo necessários uma avaliação minuciosa e seguimento para diminuir o risco cardiovascular e a morbimortalidade desses pacientes
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Obstrução da Artéria Renal/complicações , Síndrome de Williams/complicações , Hipertensão/etiologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/diagnóstico por imagem , Brasil/epidemiologia , Ecocardiografia Doppler , Incidência , Estudos Prospectivos , Ultrassonografia Doppler , Angiografia por Ressonância Magnética , Síndrome de Williams/epidemiologia , Síndrome de Williams/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/diagnóstico por imagemRESUMO
AIM: To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS: Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS: Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Doppler echocardiography showed cardiac abnormalities in 16/21 (76%) hypertensive patients. CONCLUSION: Cardiac abnormalities and hypertension in patients with Williams-Beuren syndrome are common. Thus, thorough evaluation and follow-up are necessary to reduce cardiovascular risks and mortality of these patients.
Assuntos
Hipertensão/etiologia , Obstrução da Artéria Renal/complicações , Síndrome de Williams/complicações , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Ecocardiografia Doppler , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Incidência , Lactente , Angiografia por Ressonância Magnética , Masculino , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Ultrassonografia Doppler , Síndrome de Williams/diagnóstico por imagem , Síndrome de Williams/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Transplant renal artery stenosis (TRAS), the most common vascular complication after transplant (Tx), leads to resistant hypertension, impaired renal function, and even loss of the graft. The purpose of the study was to investigate the prevalence and factors associated with TRAS in northeastern Brazil. METHODS: The study was conducted as a retrospective case-control study in a population of Tx recipients in a renal Tx center in northeastern Brazil. Demographic and clinical characteristics of the recipients and donors, data related to the surgery, laboratory data, and number of anti-hypertensive drugs were assessed. Statistical analysis was performed with the use of SPSS 17.0. RESULTS: A total of 494 of 529 recipients were assessed, of which 24 had TRAS. The prevalence of TRAS was 4.8%. Twelve patients (50%) were men with a mean age of 46.7 ± 13.5 years. The mean time of diagnosis was 89.9 days after Tx. The risk factors associated with TRAS were number of anti-hypertensive drugs ≥2 (odds ratio, 17.0; confidence interval, 4.1 to 70.4; P = .001) and grafting with 2 or more arteries (odds ratio, 8.9; confidence interval, 1.4 to 56.6; P = .021). There was a significant reduction in mean systolic blood pressure (147.1 ± 23.7 to 127.8 ± 15.2 mm Hg, P = .001) and diastolic blood pressure (86.6 ± 13.0 to 77.6 ± 9.4 mm Hg, P = .001) after TRAS repair and in serum creatinine (2.8 ± 2.4 to 1.9 ± 1.8 mg/dL, P = .04). CONCLUSIONS: Grafts with 2 or more arteries are associated with TRAS, as well as patients who use a higher number of anti-hypertensive drugs. TRAS repair was associated with improved blood pressure control and renal function.
Assuntos
Oclusão de Enxerto Vascular/etiologia , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/etiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Rim/irrigação sanguínea , Rim/cirurgia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Insuficiência Renal/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Women have higher risk of contrast-induced nephropathy than men. The purpose of this study was to determine the relative impact of gender on long-term renal function after percutaneous renal interventions (PRI). METHODS AND RESULTS: We included all patients undergoing PRI. Men (n = 72) and women (n = 28) had similar age, men had more diabetes, coronary and peripheral artery disease, higher serum creatinine and similar glomerular filtration rate (GFR), and prevalence of chronic kidney disease (CKD) stage > or =3 when compared with females. At follow-up, men had a significant improvement in GFR and systolic blood pressure, while females did not. The presence of severe CKD and male gender were the only predictors of long-term GFR improvement. CONCLUSION: Male patients and patients with poor baseline renal function showed an important benefit with PRI, suggesting that it is not too late for renal revascularization if properly indicated.
Assuntos
Taxa de Filtração Glomerular , Obstrução da Artéria Renal/terapia , Stents , Idoso , Creatinina/sangue , Progressão da Doença , Feminino , Humanos , Rim/irrigação sanguínea , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Estudos Retrospectivos , Fatores SexuaisRESUMO
Atherosclerotic renal artery stenosis (RAS) and coronary artery disease (CAD) arise from the same multiple risk factors. The purpose of this study was to assess the frequency of previously undiagnosed CAD in patients with angiographically confirmed RAS, by conducting coronary arteriography in the same setting. Of 57 consecutive patients referred for renal arteriography on clinical grounds during a 14-month period, 28 had no RAS and 6 had RAS, but previously documented CAD. Of the remainder 23 patients, 17 (74%; CI 56%-92%) had both RAS and CAD (7 single vessel, 4 two-vessel, and 7 multivessel disease). The clinical characteristics, such as age, blood pressure (BP) levels, signs of heart failure, were no different between those with and without CAD, although the 4 diabetic patients, the 4 patients with fundoscopic findings of grade III retinopathy, 11 of 14 with peripheral arterial disease, and 7 of 8 patients with prior stroke belonged in the CAD group. None developed complications as a result of the two consecutive procedures. The data suggest that in patients with RAS the frequency of silent CAD is high and cannot be predicted on clinical grounds alone, therefore coronary angiography should be routinely recommended in the same setting.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Idoso , Angiografia , Angiografia Coronária , Feminino , Humanos , Falência Renal Crônica/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To determine the prevalence of renal artery stenosis (RAS) in patients who have undergone cineangiocoronariography. METHODS: Prospective study of cineangiocoronariography and aortography examinations conducted between January 2002 and February 2004 on 1,656 hypertensive and normotensive patients who underwent the examinations to confirm the diagnosis of obstructive coronary artery disease or valve disease. RESULTS: The average age of the 1,656 patients was 61.6 +/- 11.8 years. Eight hundred and ninety-one (53.8%) were male, 169 (10.2%) were diabetic and 1,054 (63.8%) presented obstructive coronary artery disease. Renal stenosis greater than 50% was observed in 228 (13.8%) patients, and 25 (1.5%) had bilateral stenosis. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50% of the vessel lumen, in one, two or three main arteries, classified as single, double or triple vessels, respectively. Quantification was conducted using visual analysis of the angiography. Comparison of the groups with and without renal artery obstruction > or = 50%, revealed significant statistical differences in relation to gender, age, diabetes mellitus, blood pressure and left ventricular function. However, no statistical difference was noted in relation to the occurrence of coronary artery obstructions > or = 50%. Nevertheless, renal artery obstructions > or = 70%, revealed significant differences in relation to blood pressure, coronary artery obstructions > or = 50% and left ventricular function, which were all higher in the renal artery obstruction group. CONCLUSION: The prevalence of RAS found in our study was comparable to that reported by major medical literature case studies. RAS is associated with systemic hypertension (SH), end-stage renal disease (ESRD) and its sequelae, emphasizing how important it is that we are aware of possible candidates for angiographic diagnosis of this disease.
Assuntos
Doença das Coronárias/complicações , Hipertensão/complicações , Obstrução da Artéria Renal/epidemiologia , Aortografia , Cateterismo Cardíaco , Cineangiografia , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico por imagemRESUMO
OBJETIVO: Determinar a prevalência de estenose da artéria renal (EAR) em pacientes submetidos a cineangiocoronariografia. MÉTODOS: Estudo prospectivo, considerando 1.656 cinean-giocoronariografias seguidas de aortografia, entre janeiro/2002 e fevereiro/2004, de pacientes encaminhados à cineangiocoronariografia diagnóstica com história ou não de hipertensão arterial sistêmica (HAS). RESULTADOS: Dos 1.656 pacientes, a idade média foi de 61,6 ± 11,8 anos, 53,8 por cento eram do sexo masculino, 10,2 por cento eram diabéticos, 63,8 por cento apresentavam coronariopatia obstrutiva. A presença de EAR maior que 50 por cento foi observada em 228 (13,8 por cento) pacientes, e em 25 (1,5 por cento) destes, ocorreu bilateralmente. A coronariopatia obstrutiva foi definida como estenose que causa redução do lúmen do vaso em 50 por cento ou mais, em um, dois ou três vasos principais, denominados uniarterial, biarterial ou triarterial, respectivamente.A quantificação era realizada através da análise visual da angiografia. Comparando os grupos com e sem EAR > 50 por cento, observou-se diferença estatisticamente significativa quanto a gênero, idade, ocorrência de diabete melito, PA e função ventricular esquerda. Não houve diferença significativa, no entanto, quanto à ocorrência de obstrução coronariana > 50 por cento. Quando, porém, a EAR considerada é > 70 por cento, observa-se diferença significativa quanto a PA, associação à obstrução coronariana > 50 por cento e à disfunção ventricular esquerda, maiores no grupo com EAR. CONCLUSÃO: A prevalência de EAR neste estudo foi comparável àquela das grandes casuísticas da literatura e, em razão de sua importância pela associação com HAS e doença renal terminal (DRT) e suas seqüelas, devemos estar atentos para seu diagnóstico angiográfico.
OBJECTIVE: To determine the prevalence of renal artery stenosis (RAS) in patients who have undergone cineangiocoronariography. METHODS: Prospective study of cineangiocoronariography and aortography examinations conducted between January 2002 and February 2004 on 1,656 hypertensive and normotensive patients who underwent the examinations to confirm the diagnosis of obstructive coronary artery disease or valve disease. RESULTS: The average age of the 1,656 patients was 61.6 ± 11.8 years. Eight hundred and ninety-one (53.8 percent) were male, 169 (10.2 percent) were diabetic and 1,054 (63.8 percent) presented obstructive coronary artery disease. Renal stenosis greater than 50 percent was observed in 228 (13.8 percent) patients, and 25 (1.5 percent) had bilateral stenosis. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50 percent of the vessel lumen, in one, two or three main arteries, classified as single, double or triple vessels, respectively. Quantification was conducted using visual analysis of the angiography. Comparison of the groups with and without renal artery obstruction > 50 percent, revealed significant statistical differences in relation to gender, age, diabetes mellitus, blood pressure and left ventricular function. However, no statistical difference was noted in relation to the occurrence of coronary artery obstructions > 50 percent. Nevertheless, renal artery obstructions > 70 percent, revealed significant differences in relation to blood pressure, coronary artery obstructions > 50 percent and left ventricular function, which were all higher in the renal artery obstruction group. CONCLUSION: The prevalence of RAS found in our study was comparable to that reported by major medical literature case studies. RAS is associated with systemic hypertension (SH), end-stage renal disease (ESRD) and its sequelae, emphasizing how important it is that we are aware of possible candidates for angiographic diagnosis of this disease.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença das Coronárias/complicações , Hipertensão/complicações , Obstrução da Artéria Renal/complicações , Aortografia , Cateterismo Cardíaco , Cineangiografia , Angiografia Coronária , Doença das Coronárias , Métodos Epidemiológicos , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria RenalRESUMO
Graft thrombosis is the most common cause of first year graft failure in pediatric renal transplantation. The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database was analyzed for cases of graft failure due to thrombosis among patients transplanted from 1998 to 2004. The impact of interleukin-2 (IL-2) receptor antagonists as induction therapy was determined. There were a total of 51 graft failures due to thrombosis among the 2750 reported renal transplants (1.85%) (95% CI (1.39%, 2.41%)). This represents the most common cause of graft loss during the first year post-transplant accounting for 35% of first year losses and 18% of all graft losses. The incidence of thrombosis among patients who received IL-2 receptor antibodies was 1.07% (12/1126) compared to 2.40% (39/1624) among patients who did not (OR 0.44, 95% CI 0.23, 0.84, p = 0.014). Use of IL-2 receptor blockade was the only significant prognostic factor in a multivariate model with previously identified risk factors. Analysis of NAPRTCS data found that the use of IL-2 receptor antibodies as induction therapy is associated with a significantly decreased risk of graft failure due to thrombosis. This provocative finding requires further investigation to determine whether thrombotic failure can be decreased by this therapeutic strategy.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Receptores de Interleucina-2/antagonistas & inibidores , Obstrução da Artéria Renal/prevenção & controle , Trombose/prevenção & controle , Adolescente , Canadá/epidemiologia , Criança , Pré-Escolar , Costa Rica/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , México/epidemiologia , Receptores de Interleucina-2/imunologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Transplante Homólogo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Renal artery stenosis (RAS) is a potentially reversible cause of hypertension and renal insufficiency and is associated with poor prognosis. METHODS: We aimed to identify simple predictors of significant RAS among patients undergoing coronary angiography. Prospective data were collected on 843 consecutive patients who underwent cardiac catheterization and abdominal aortography. Stenoses > or = 75% were considered significant. Multivariable logistic regression was used to assess the relationship between baseline characteristics and coronary anatomy with significant RAS. A simple risk score was derived from the model. RESULTS: The prevalence of RAS > or = 75% was 11.7%. Independent predictors of significant RAS were older age, higher creatinine levels, peripheral vascular disease, number of cardiovascular drugs, hypertension, female sex, and 3-vessel coronary artery disease or previous coronary artery bypass graft. The concordance index of the model was 0.802. These variables were used to develop a simple predictive score of significant RAS for patients undergoing cardiac catheterization. The prevalence of RAS increased stepwise with increasing score values: 0.6% for a score < or = 5, 1.5% for 6 to 7, 6.1% for 8 to 9, 12.2% for 10 to 11, 18.7% for 12 to 14, 35.7% for 15 to 17, and 62.1% for > or = 18 (P < .001). Approximately one third of the patients had a score > or = 11, which yielded a sensitivity of 76% and a specificity of 71%. CONCLUSIONS: Renal artery stenosis is a relatively common finding among patients referred for coronary angiography. A simple score can predict the presence of significant RAS among patients referred for cardiac catheterization.
Assuntos
Cateterismo Cardíaco , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Adulto , Idoso , Argentina/epidemiologia , Pressão Sanguínea , Colesterol/sangue , Angiografia Coronária , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doenças Vasculares Periféricas/epidemiologia , Análise de RegressãoRESUMO
UNLABELLED: Kidney transplantation is the permanent and safe treatment for patients with chronic renal failure, although surgical treatment is susceptible both to urological and many vascular complications, and post-transplantation, renal artery stenosis being the most important. OBJECTIVE: To verify the incidence of renal artery stenosis of 676 patients submitted to renal transplants, from living and cadaver donors, in the period of February of 1985 to December of 1994, when compared the end-to-end and end-to-side anastomosis with the external iliac-artery of the recipient. METHODS: The data shown were obtained from charts of 676 patients submitted to renal transplants performed by the same surgery staff at the Hospital São Paulo--Universidade Federal de São Paulo--Escola Paulista de Medicina, between 1985 and 1994. RESULTS: Eleven cases (1.63%) of post-transplantation renal artery stenosis were found. CONCLUSION: 1) Frequency of post-transplantation renal artery stenosis was low and observed only in recipients of cadavers donors. 2) Frequency of post-transplantation renal artery stenosis with end-to-end artery anastomosis did not significantly differ from end-to-side anastomosis. 3) Age, sex and ethnic groups of patients did not interfere in the frequency of renal artery stenosis.