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      Síndrome cardiorrenal: fisiopatologia e tratamento

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          Abstract

          A doença renal crônica (DRC) é um dos principais problemas de saúde pública mundial. A anemia é um frequente achado na DRC, afetando aproximadamente 90% dos pacientes. A relação entre anemia e doença cardiovascular já é bastante estabelecida e resulta de alterações na estrutura do ventrículo esquerdo e sua função. A anemia per se pode induzir significante morbidade cardíaca na ausência de doença renal e é um fator de risco independente para complicações cardíacas em paciente com insuficiência renal. O presente artigo de revisão avalia as inter-relações entre anemia, insuficiência cardíaca e doença renal, incluídas recentemente na chamada síndrome da anemia cardiorrenal.

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          Most cited references63

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          The cardiomyopathy of overload: an unnatural growth response in the hypertrophied heart.

          Heart failure is a progressive condition with a 5-year survival of less than 50%. This poor prognosis, which can be reproduced by overloading the hearts of experimental animals, may reflect molecular abnormalities caused when overload stimulates adult cardiac myocytes to undergo hypertrophy. Because these terminally differentiated cells have little or no capacity to divide, hypertrophy represents an unnatural growth response; however, the mechanism by which overload shortens survival remains speculative. Modification of this unnatural growth response by converting enzyme inhibitors and nitrates, which have growth inhibitory as well as vasodilator effects, may contribute to the ability of these drugs to improve prognosis in patients with heart failure.
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            Reversal of Anemia by Erythropoietin Therapy Retards the Progression of Chronic Renal Failure, Especially in Nondiabetic Patients

            Therapy with human recombinant erythropoietin (EPO) has been accepted as effective for renal anemia in dialysis patients. However, studies in rats have shown that correcting anemia with EPO may affect the progression of renal dysfunction. In humans, however, the effect of EPO on residual renal function is a matter of controversy. We, therefore, investigated whether the long-term administration of EPO to predialysis patients influences residual renal function. Anemic patients at the predialysis stage with a serum creatinine (Cr) concentration ranging from 2 to 4 (average 2.9) mg/dl and a hematocrit (Ht) of less than 30% were randomly assigned to two groups which consisted of anemic patients not treated with EPO (group I, untreated anemic controls, n = 31) and anemic patients treated with EPO (group II, treated anemics, n = 42). Patients with nonsevere or moderate anemia (Ht > 30%) with a Cr ranging from 2 to 4 (average 2.6) mg/dl were also recruited as nonanemic controls (group III, untreated nonanemic controls, n = 35). Blood pressure was controlled to the same degree among the three groups by combined treatment with calcium antagonists and angiotensin-converting enzyme inhibitors. All patients were kept strictly on a low-protein (0.6 g/kg/day) and a low-salt (7 g/day) diet. The degree of control of dietary protein and blood pressure and the frequency of angiotensin-converting enzyme inhibitor administration were comparable among the three groups. The primary end point for each patient was a doubling of the baseline Cr which yielded cumulative renal survival rates which were plotted against time. Ht rose significantly from 27.0 ± 2.3 to 32.1 ± 3.2% in group II (n = 42, p < 0.001) with a rate of increase of 0.4 ± 0.06%/week. However, it declined from 27.9 ± 1.8 to 25.3 ± 1.9% in group I (n = 31, p < 0.001) and from 35.9 ± 3.5 to 32.2 ± 3.9% in group III (n = 35, p < 0.001). Cr doubled in 26 patients (84%) in group I as compared with 22 (52%) in group II and 21 (60%) in group III. The cumulative renal survival rates in groups II and III were significantly better than that in group I: p = 0.0003 (group I vs. group II) and p = 0.0024 (group I vs. group III). However, there was no difference in the renal survival rate between groups II and III (p = 0.3111). The better survival rate obtained in group II was attributable to the better survival rate for the nondiabetic patients in this group. The present study suggests that anemia, per se, is a factor in the progression of end-stage renal failure and that reversal of anemia by EPO can retard the progression of renal failure, especially in nondiabetic patiens, provided that blood pressure control, rate of increase in Ht, and dietary protein restriction are appropriate.
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              Monokines inhibiting erythropoietin production in human hepatoma cultures and in isolated perfused rat kidneys

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                Author and article information

                Journal
                RAMB
                Revista da Associação Médica Brasileira
                Rev. Assoc. Med. Bras.
                FapUNIFESP (SciELO)
                0104-4230
                2009
                2009
                : 55
                : 1
                : 89-94
                Article
                10.1590/S0104-42302009000100022
                94a7d1ca-b7eb-479b-92cc-818d7e0812ee
                © 2009

                https://www.elsevier.com/tdm/userlicense/1.0/

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