Free Radicals and Biomarkers Related to the Diagnosis of Cardiorenal Syndrome

The National Heart, Lung, and Blood Institute Working Group has postulated the cardiorenal syndrome (CRS) as an interaction between the kidneys and the cardiovascular system in which therapy to relieve congestive heart failure (HF) symptoms is limited by the further worsening renal function. CRS is classified from type I to V, taking into account the progression of the symptoms in terms of mechanisms, clinical conditions, and biomarkers. Experimental and clinical studies have shown the kidney as both a trigger and a target to sympathetic nervous system (SNS) overactivity. Renal damage and ischemia, activation of the renin angiotensin aldosterone system (RAAS), and dysfunction of nitric oxide (NO) system are associated with kidney adrenergic activation. Indeed, the imbalances of RAAS and/or SNS share an important common process in CRS: the activation and production of free radicals, especially reactive oxygen species (ROS). The present chapter addresses connections of the free radicals as potential biomarkers as the imbalances in the RAAS and the SNS are developed. Understanding the involvement of free radicals in CRS may bring knowledge to design studies in order to develop accurate pharmacological interventions

Hipertensão arterial sistêmica primária

Hipertensão Arterial Sistêmica (HAS) é doença de alta prevalência e determinante de alta morbidade e mortalidade senão adequadamente diagnosticada e apropriadamente tratada.O diagnóstico depende da medida correta da pressão arterial (PA), utlizando-se atualmente métodos alternativos à medida convencional de consultório como a Monitorização Ambulatorial da Pressão Arterial (MAPA) ou a Monitorização Residencial da Pressão Arterial (MRPA).Uma adequada estratificação do risco adicional ao valor da PA obtido é indispensável para uma planificação do tratamento e o alcance das metas desejadas para cada grupo de indivíduos.Manter os pacientes sob o tratamento é necessário e desejável para que os benefícios auferidos com o tratamento, medicamentoso e não medicamentoso, sejam obtidos.Systemic Arterial Hypertension (SAH) is a highly prevalent disease causing high morbidity and mortality if not adequately diagnosed and properly treated.The diagnosis depends on a correct measurement of arterial blood pressure (ABP), with alternative methods to the conventional office measurement being currently used, such as Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM).An appropriate stratification of the additional risk besides the ABP value is essential for treatment planning and for archieving the desired goals for each group of individuals. It is necessary and desirable to maintain the patients under treatment in order to obtain the benefits derived from pharmacological or non-pharmacological treatment

6ª Diretriz de monitorização ambulatorial da pressão arterial e 4ª diretriz de monitorização residencial da pressão arterial

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What Is the Meaning of Homocysteine in Patients on Dialysis?

Objective: To evaluate the determinants of total plasma homocysteine levels and their relations with nutritional parameters, inflammatory status, and traditional risk factors for cardiovascular disease in renal failure patients on dialysis treatment. Design: The study was conducted on 70 clinically stable patients, 50 of them on hemodialysis (70% men; 55.3 +/- 14.5 years) and 20 on peritoneal dialysis (50% men; 62 +/- 13.7 years). Patients were analyzed in terms of biochemical parameters (serum lipids, creatinine, homocysteine [Hcy], creatine-kinase [Ck], folic acid, and vitamin B(12)), anthropometric data, markers of inflammatory status (tumor necrosis factor-alpha, C-reactive protein, interleukin-6), and adapted subjective global assessment. Results: The total prevalence of hyperhomocysteinemia (>15 mu mol/L) was 85.7%. Plasma folic acid and plasma vitamin B(12) were within the normal range. Multiple regression analysis (r(2) - 0.20) revealed that the determinants of total Hcy were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Hcy was positively correlated with albumin and creatinine and negatively correlated with total cholesterol, high density lipoprotein cholesterol, folic acid, and vitamin B(12). Conclusions: The determinants of total Hcy in the study sample were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Evidently, the small sample size might have had an effect on the statistical analyses and further studies are needed. However, Hcy in patients on dialysis treatment may not have the same effect as observed in the general population. In this respect, the association between malnutrition and inflammation may be a confounding factor in the determination of the true relationship between Hcy, nutritional status, and cardiovascular risk factors in this group. (C) 2011 by the National Kidney Foundation, Inc. All rights reserved