RESUMEN
Apparent resistant hypertension (aTRH) is a significant public health issue. Once low adherence to antihypertensive treatment has been ruled out and true resistant hypertension is diagnosed, aldosterone-direct-renin-ratio (ADRR) aids in the screening of an aldosterone-producing adenoma (APA) and primary aldosteronism (PA). Once PA and other secondary causes have been ruled out, the values of aldosterone and renin allow patients to be classified into phenotypes such as low renin hypertension (LRH), Liddle's-like (LLph), and primary hyperaldosteronism (PAph). These classifications could aid in the treatment decision-making process. However, optimal cut-off points for these classifications remain uncertain. This study aims to assess the prevalence of these phenotypes and the behavior of different cut-offs of the ADRR in an Afro-Colombian population with apparent resistant hypertension, as well to describe their sodium consumption. Afro-descendant individuals 18 years of age or older, diagnosed with resistant hypertension and attending to a primary care center in Colombia were recruited as volunteers. As part of the study, their plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) were measured. The phenotypes were categorized into three groups based on multiple cut-off points from different authors: low renin and low aldosterone phenotype (LLph), low renin and high aldosterone phenotype (PAph), and high renin and high aldosterone phenotype, referred to as the renal phenotype (Rph). The prevalence of ADRR values exceeding the cut-off and phenotypes were calculated. A linear regression model was derived to assess the effect of sodium consumption with PAC, PRC and ADRR. A total of 88 patients with aTRH were included. Adherence to at least 3 antihypertensive medications was 62.5%. The median age was 56 years (IQR 48-60), 44% were female, and 20% had diabetes. The study found that the prevalence of ADRR values exceeding the cut-off ranged from 4.5 to 23%, while low-renin hypertension (LRH) varied from 15 to 74%, Rph was found in approximately 30 to 34% of patients, PAph in 30 to 51%, and the LLph in 15 to 41%, respectively, depending on the specific cut-off value by different authors. Notably, sodium consumption was associated with lower aldosterone (ß - 0.15, 95% CI [- 0.27, - 0.03]) and renin concentrations (ß - 0.75, 95% CI [- 1.5, - 0.02]), but ADRR showed no significant association with sodium consumption. There were no significant differences in prevalences between the groups taking < 3 vs ≥ 3 antihypertensive medications. Altered aldosterone-direct-renin-ratio, low renin hypertension, Liddle's-like, and primary hyperaldosteronism are prevalent phenotypes in patients within Afro-Colombian patients with apparent treatment-Resistant hypertension.
Asunto(s)
Aldosterona , Antihipertensivos , Hipertensión , Fenotipo , Renina , Humanos , Renina/sangre , Aldosterona/sangre , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/sangre , Femenino , Persona de Mediana Edad , Masculino , Adulto , Antihipertensivos/uso terapéutico , Hiperaldosteronismo/sangre , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/tratamiento farmacológico , Hiperaldosteronismo/epidemiología , Población Negra , Anciano , Resistencia a MedicamentosRESUMEN
Background Lupus nephritis (LN) is one of the most frequent complications of SLE and occurs in up to 50% of cases depending on the studied population. Of these, approximately 20% progress to end-stage renal disease (ESRD), with the treatment of choice being a kidney transplant. Objective The objective of this study was to describe the clinical outcome of patients transplanted due to LN, compared with patients transplanted for other causes, in a Latin American population from the Fundación Valle del Lili in Cali, Colombia. Methods Observational, retrospective case study with controls matched by age, sex and type of donor in a single center between 1996 and 2014. Results Sixty-five kidney transplants were performed in patients with LN and ESRD. The survival of patients with LN was 98% at 1, 10 and 15 years ( p = .99). For controls by age and sex, survival was also 98% at 15 years post-transplant, and for controls by donor, the survival rate was 100% at 5 years and 98% at 15 years. Graft survival in patients with LN to 1, 5 and 15 years was 92%, 83% and 71%, respectively; for controls by age and sex, it was 90%, 84% and 64%, respectively, and for the controls by donor, it was 89%, 86% and 79%, respectively ( p = .7718). There were no statistically significant differences found in the cumulative incidence of acute graft rejection in the first year, but it was found that acute rejection is a factor that relates to the loss of function of the renal graft ( p = .032). Of the patients transplanted for LN, two (3.1%) experienced a recurrence of the disease. One patient died after a diagnosis of recurrence of LN due to an infection. Conclusions Kidney transplantation is a good option for patients with ESRD due to LN. In this Hispanic population, the survival of patients, graft survival, and cumulative incidence of graft rejection are not different from those of other transplanted patients. In addition, recurrence of LN was rare, showing the benefits of renal transplantation in LN patients with ESRD.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón , Nefritis Lúpica/cirugía , Enfermedad Aguda , Adulto , Colombia , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Humanos , Incidencia , Estimación de Kaplan-Meier , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Nefritis Lúpica/diagnóstico , Nefritis Lúpica/mortalidad , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Complicaciones Posoperatorias/epidemiología , Prevalencia , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
El motivo de presentar esta paciente es hacer consciencia entre el cuerpo médico de la existencia de esta entidad, de la cual hay muy pocos casos reportados en la literatura y sólo informe reciente en nuestro país. La colitis colágena es una entidad de etiología no aclarada que se caracteriza histológicamente por la presencia de una banda de colágeno mayor de 7 micras a nivel subepitelial de la mucosa colorrectal y clínicamente por diarrea crónica acuosa profusa, que puede asociarse con dolor abdominal tipo cólico, y estudios tanto de laboratorio como endoscópicos negativos. Se presenta un caso de esta entidad manejado recientemente en el Hospital Universitario del Valle, en quien se tomaron las biopsias aún en presencia de cambios endoscópicos. La respuesta terapéutica a la sulfasalazina y esteroides ha sido aceptable. Finalmente, sugerimos como recomendación que en pacientes con diarrea crónica no explicada, deben tomarse biopsias de colon y recto, a pesar de no presentar cambios endoscópicos