Latin American registry of dialysis and renal transplantation: 1993 annual dialysis data report

Mazzuchi, Nelson; Schwedt, Emma; Fernández, Juan M.; Cusumano, Ana María; Anção, Meide Silva; Poblete, Hugo; Saldaña-Arévalo, M.; Espinosa, Nathaly; Centurión, Claudia; Castillo, Heylin Montiel; González, Francisco E.; Milanés, Carmen Luisa; Infante, Mar; Ariza, Marcos

doi:10.1093/ndt/12.12.2521

Cited by 40 publications

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“…In contrast, it remains uncertain whether benign nephrosclerosis (BN) consequent to essential hypertension can also cause ESRD. [1][2][3] Recent data reported by the United States Renal Data System (USRDS) 4 and by European 5 and Latin American 6 registries indicate that hypertensive nephrosclerosis (HN) is a frequent and growingly important presumed cause of ESRD among patients initiating replacement therapy. Although early epidemiological data indicated that few hypertensive patients eventually develop renal injury, 2 more recent clinical observations revealed that the relative risk of developing ESRD is increased by up to 20 times in hypertensive patients.…”

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Hypertensive Nephrosclerosis as a Relevant Cause of Chronic Renal Failure

et al. 2001

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Abstract-It is currently unclear whether hypertensive nephrosclerosis (HN), usually diagnosed solely on clinical grounds, is a relevant cause of end-stage renal disease. We biopsied 81 hypertensive outpatients (blood pressure Ն160/ 95 mm Hg) with moderate renal insufficiency, who were referred to our service from 1988 to 1998. Patients with known causes of hypertension, systemic disorders, rheumatic disease, or nephrotic syndrome were excluded. In 65% of patients, HN was the sole histological abnormality associated with renal dysfunction. Benign nephrosclerosis (BN), defined as isolated arteriolar hyalinosis and/or intimal fibrosis, was found in 18 HN patients (22%), whereas malignant nephrosclerosis (MN), denoted mainly by myointimal cell proliferation, appeared in 35 HN patients (43%). Previously undiagnosed primary nephritis (PN) was found in 13 patients (16%), whereas focal and segmental glomerulosclerosis, which might be either primary or secondary to hypertension, appeared in 15 patients (19% Usually, the diagnosis of HN is entirely made on clinical grounds, without renal biopsy or any evidence that hypertension actually preceded renal disease. Thus, HN can be easily mistaken for primary or ischemic nephropathies, which may also exhibit an insidious nature. Only 2 large biopsy-based studies of HN have been reported so far. Zucchelli and Zuccala 8 showed "true" HN in only 48% of 56 white patients clinically diagnosed as such. Fogo et al 9 showed an 85% agreement between clinical and histological diagnoses of HN in African Americans.We performed a 10-year follow-up of 81 hypertensives with impaired renal function and no clinical evidence of primary or ischemic renal disease. We could thus evaluate the frequency of HN among them and whether HN can be safely diagnosed on a clinical basis. Methods PatientsBetween 1988 and 1998, a selected, nonsystematic cohort of 90 hypertensive patients, referred to the Hypertension Clinic of the Renal Division, Department of Clinical Medicine, University of São Paulo, was investigated. Inclusion criteria were arterial hypertension and renal insufficiency. A patient was determined to have arterial hypertension if (1) systolic blood pressure (SBP) was Ն160 mm Hg and/or diastolic blood pressure (DBP) was Ն95 mm Hg, following the then most recent World Health Organization guidelines, 10 or (2) there was a persistent need for antihypertensives. Blood pressure was determined as the average of 2 sphygmomanometric measurements, taken in the seated position after a 5-minute rest. Renal insufficiency was defined by serum creatinine concentration (S creat ) Ͼ133 mol/L (1.5 mg/dL). Exclusion criteria were (1) renal artery stenosis (diagnosed by renal arteriography); (2) other definite causes of hypertension; (3) diabetes mellitus; (4) immune-mediated disease; (5) heart failure (stages III and IV); (6) liver disease; (7) nephrotic syndrome, defined by proteinuria Ͼ3.5 g/d, hypoalbuminemia, edema, and hypercholesterolemia; (8) polycystic nephropathy; (9) urinary obstruction; (10) pregnancy...

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Hypertensive Nephrosclerosis as a Relevant Cause of Chronic Renal Failure

et al. 2001

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“…This diagnosis was suspected clinically in this patient, with her strong family history of hypertension, moderate proteinuria, and no evidence of systemic disease, and confirmed by renal biopsy, as clinical observations may be misleading. [7][8][9][10] The possibility that the patient had a primary renal disease that could conceivably benefit from MMF was considered, but the demonstration of a prominent interstitial infiltrate suggested that a trial with MMF may be useful, especially as antihypertensive treatment had not altered the progressive increment in serum creatinine.…”

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Transient Improvement of Hypertension-Induced Chronic Renal Failure with Mycophenolate Mofetil Treatment

2006

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“…Atualmente, a hipertensão é a segunda maior causa de insuficiência renal crônica terminal 4,5,6 . As duas patologias podem estar ligadas principalmente de duas maneiras: a hipertensão arterial, quando em fase maligna, pode levar a quadro de nefroangiosclerose por endarterite obliterante e arteriolite necrotisante; e a forma dita "benigna" pode levar ao quadro de nefrosclerose hipertensiva e perda progressiva e lenta da função renal 7 .…”

Section: Introductionunclassified

“…Dessa forma, temos que grande parte dos pacientes em diálise chegou a esta situação tendo como causa básica a hipertensão arterial 4 . No entanto, a minoria dos hipertensos desenvolve insuficiência renal.…”

Section: Introductionunclassified

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial

Moraes

Cerolli²,

Silva³

et al. 2009

Rev. Assoc. Med. Bras.

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ResumoObjetivO. Testar variáveis clínicas relacionadas à evolução para insuficiência renal crônica avaliadas rotineiramente em hipertensos e que possam ser utilizadas como instrumento preditivo, possibilitando seu acesso em qualquer nível de assistência. MétOdOs. Foram avaliados 358 pacientes do Centro de Hipertensão Arterial da Faculdade de Medicina de Botucatu -UNESP. Destes, 210 apresentavam uma segunda avaliação da filtração glomerular e foram utilizados na análise. Aplicou-se regressão logística para identificar características clínicas que se associassem de maneira independente com o desfecho filtração glomerular final igual ou inferior a 60 ml/min. ResultadOs. No total da casuística, apenas a proteinúria à urina I associou-se de maneira independente ao desfecho. Entre os 175 pacientes com filtração glomerular inicial superior a 60 ml/min, a presença de proteinúria à urina I, o gênero feminino e a idade igual ou superior a 50 anos foram preditores da evolução para filtração glomerular final igual ou inferior a 60 ml/min. COnClusãO. A proteinúria avaliada à urina I foi um fator de risco associado ao desenvolvimento de insuficiência renal crônica independente de outros co-fatores analisados. Hipertensos primários com proteinúria à urina I devem receber atenção redobrada no sentido de prevenir a evolução para insuficiência renal crônica. Unitermos intROduçãOHipertensão é definida como pressão arterial igual ou superior a 140 x 90 mm Hg em adultos com mais de 18 anos, medida em repouso de quinze minutos e confirmada em três aferições consecutivas e em várias visitas médicas 1 . Os rins são órgãos-chave na fisiopatologia da hipertensão arterial, sendo que a capacidade de excreção de sódio e a exacerbação da secreção de renina desenvolvem papel primordial na gênese desta patologia 2 .O aumento do nível pressórico tem sido ligado à doença renal desde 1835, quando Richard Bright descreveu uma doença na qual a necropsia mostrava pacientes com rins contraídos e coração hipertrofiado 3 . Atualmente, a hipertensão é a segunda maior causa de insuficiência renal crônica terminal 4,5,6 . As duas patologias podem estar ligadas principalmente de duas maneiras: a hipertensão arterial, quando em fase maligna, pode levar a quadro de nefroangiosclerose por endarterite obliterante e arteriolite necrotisante; e a forma dita "benigna" pode levar ao quadro de nefrosclerose hipertensiva e perda progressiva e lenta da função renal 7 .A insuficiência renal crônica terminal (IRCT), quadro em que há necessidade de diálise ou transplante renal, é uma situação clínica cuja prevalência no Brasil é de aproximadamente 391/ 1.000.000 de habitantes 8 . A prevalência e incidência da IRCT têm aumentado progressivamente em escala mundial com crescente aumento nos custos para o sistema de saúde 6,10 .No Multiple Risk Intervention Trial, aproximadamente 350.000 hipertensos foram seguidos e o risco de desenvolvimento de IRCT foi de 15 / 100.000 hipertensos por ano 11 . Dessa forma, temos que grande parte dos pacientes em diálise chegou a esta situ...

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Latin American registry of dialysis and renal transplantation: 1993 annual dialysis data report

Abstract: In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.

Cited by 40 publications

References 1 publication

Hypertensive Nephrosclerosis as a Relevant Cause of Chronic Renal Failure

Hypertensive Nephrosclerosis as a Relevant Cause of Chronic Renal Failure

Transient Improvement of Hypertension-Induced Chronic Renal Failure with Mycophenolate Mofetil Treatment

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial

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