RESUMO
AIM: Calciuria has been reported to decrease in preeclampsia. We compared calciuria among groups of normal, hypertensive and preeclamptic pregnant women, and assessed its correlation with the severity of the disease. MATERIAL AND METHODS: We conducted a case-control study of mild and severe preeclampsia, chronic hypertension, and normal pregnancy, with 14 patients in each group. The groups were analyzed by one-way anova (variance analysis) for symmetrical distribution and Kruskal-Wallis test for asymmetrical distribution when comparing quantitative variables, and by crossed tables when comparing qualitative variables. RESULTS: There were statistically significant differences between the groups when comparing severe preeclampsia with chronic hypertension, and severe preeclampsia with the control group (P < 0.0001). The calciuria medians were 81.5 mg/24 h for severe preeclampsia, 118 mg/24 h for mild preeclampsia, 226 mg/24 h for chronic hypertension, and 272 mg/24 h for the control group. In a ROC (receiver operating characteristic) curve analysis, the best cutoff point for preeclampsia diagnosis was 167 mg/24 h, with a sensitivity of 75% and a specificity of 85%. The outcomes were more severe as the level of calciuria dropped. CONCLUSION: Measurement of calciuria can differentiate between severe preeclampsia and chronic hypertension, and hypocalciuria is also a marker for disease severity.
Assuntos
Cálcio/urina , Pré-Eclâmpsia/urina , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/urina , Gravidez , Curva ROC , Índice de Gravidade de Doença , Ácido Úrico/sangueRESUMO
BACKGROUND: Acute kidney injury is a common disorder in critical ill patients and it is associated with high mortality. Few studies focus on long-term perspectives such as health-related quality of life (HRQOL) and dialysis dependence. METHODS: Prospective cohort study at the intensive care unit (ICU) of a Brazilian tertiary hospital. All patients requiring dialysis over a 2-year enrollment period were included. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) assessed the HRQOL along with patient status and dialysis dependence. RESULTS: 408 patients (11%) required dialysis. ICU, hospital, and after-hospital cumulative fatality rates were 70%, 74%, and 80%, respectively. A total of 68 of 82 eligible patients were interviewed in an average of 256 days after hospital discharge, while 8 patients (11.8%) were in regular dialysis. There was no association between Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, mechanical ventilation, creatinine, number of dialysis, and SF-36 scores. Better HRQOL was associated with previous conditions, as younger age and no chronic kidney disease; condition related to severity of acute illness, as have not had sepsis, short period at ICU, and hospital; and conditions after discharge, considered working currently. CONCLUSIONS: Previous chronic kidney disease was strongly associated with permanence in dialysis and lower further HRQOL. Younger survivors who have not had sepsis or long stays at hospitals, able to return to their jobs, had better HRQOL.
Assuntos
Injúria Renal Aguda/terapia , Qualidade de Vida , Diálise Renal , APACHE , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , SobreviventesAssuntos
Humanos , Aptidão Física , Diálise Renal , Insuficiência Renal Crônica , Consumo de OxigênioRESUMO
A hipercalciúria idiopática é a normalidade metabólica mais prevalente na litíase do cálcio. É caracterizada por hipercalciúria persistente e normocalcemia. Existem quatro mecanismos envolvidos em sua fisiopatogênese: hiperabsorçäo intestinal de cálcio, hipercalciúria renal, perda tubular primária de fosfato e distúrbio na regulaçäo da vitamina D. O método diagnóstico mais empregado para diferenciar as formas absortiva e renal é o teste de sobrecarga oral de cálcio. O tratamento adequado e específico dos diferentes tipos pode prevenir ou diminuir a recorrência de cálculos. É possível que a produçäo excessiva de vitamina D3 pelo rim seja o fator inicial na gênese da hipercalciúria idiopática
Assuntos
Humanos , Masculino , Feminino , Distúrbios do Metabolismo do Cálcio/fisiopatologia , Diagnóstico Diferencial , Distúrbios do Metabolismo do Cálcio/diagnósticoRESUMO
Os agentes bloqueadores dos canais do cálcio foram inicialmente utilizados no tratamento da angina de peito. Posteriormente, vários estudos mostraram a utilidade dessas drogas em outras patologias como a hipertensäo pulmonar, hipertensäo arterial sistêmica, miocardiopatia hipertrófica, arritmias, asma, fenômeno de Raynaud, espasmo esofágico, espasmo arterial cerebral e enxaqueca. Os íons cálcio têm papel central na modulaçäo da contrabilidade do miocárdio e no tônus do músculo liso vascular. O antagonismo farmacológico nos canais lentos do cálcio interfere no complexo excitaçäo-contraçäo diminuindo a contratilidade miocárdica. No músculo liso vascular, as alteraçöes de tônus dependem do movimento do cálcio do espaço extracelular para o intracelular onde se liga a calmodulina. Uma diminuiçäo na entrada celular dos íons cálcio reduz o tônus da musculatura lisa vascular e provoca vasodilataçäo. A nifedipina, o verapamil e provoca vasodilataçäo. A nifedipina, o verapamil e o diltiazem continuam tendo sua eficácia avaliada em patologias cardiovasculares e näo cardiovasculares, pois säo drogas com pequena incidência de efeitos adversos e resultados efetivos