Potassium supplementation with a salt-substitute: effects on office and 24-hour ambulatory blood pressure monotoring in patients with essential hypertension

Comparamos o efeito da utilizacao de um sal de cozinha composto de 50 por cento de cloreto de sodio e 50 por cento de cloreto de potassio (SK) com o sal comum que contem 100 por cento cloreto de sodio (SN), na pressao arterial de hipertensos primarios leves sem tratamento farmacologico anti-hipertensivo. Avaliamos se a utilizacao da mistura SK determinaria uma reducao na inGestão de sodio ao mesmo tempo em que suplementaria o potassio na dieta e teria efeito sobre a pressao arterial. Nossos resultados confirmaram que a suplementacao de potassio em pacientes hipertensos leves em tratamento nao medicamentoso teve efeito hipotensor quer sobre a pressao arterial sistolica quer sobre a pressao arterial diastolica avaliadas pela monitorizacao ambulatorial da pressao arterial de 24 horas. No grupo SK houve aumento da excrecao urinaria de potassio e reducao da relacao sodio/potassio urinaria, sem haver entretanto reducao da excrecao urinaria de sodio. Concluimos que esta forma de suplementacao de potassio na dieta e eficaz e pode ajudar no controle da pressao arterial elevada, mesmo quando o paciente nao reduz a inGestão de sodioBV UNIFESP: Teses e dissertaçõe

Insuficiência Renal Induzida por Calculo de Sulfadiazina: Relato de Caso e Revisão da Literatura

Introduction: Renal calculi is a prevalent disease and has some causes described. The drug calculi origin are rare, accounting for around 1% to 2% of cases. The crystals of sulfadiazine are formed in 20% to 45% of cases, but between 0.4% and 4.5% are associated with renal failure. We present a case report and a review of the literature on diagnosis and treatment of this entity, given its rarity and specificity. Case Report: A 48-year-old male, diabetic, during treatment for acute toxoplasmosis with sulfadiazine initiated renal colic associated with renal failure. The hypothesis of drug calculation was considered, because during the diagnostic investigation of toxoplasmosis, imaging studies were performed and presented without renal calculi. Initially he was treated conservatively with hyperhydration and alpha-blocker, but since he did not present improvement in the exams, he underwent ureterolithotripsy and double j stent. Conclusion: We present a report of urinary lithiasis of pharmacological origin associated with renal insufficiency and a review of the literature.Introdução: A litiase renal é uma doença prevalente e têm algumas causas descritas, sendo os cálculos de origem medicamentosa são raros, atinigindo em torno de 1% a 2% dos casos. Os cristais de sulfadiazina são formados em 20% a 45% dos casos, mas entre 0,4% e 4,5% estão associados à insuficiência renal. Apresentamos um relato de caso e uma revisão da literatura sobre diagnóstico e tratamento desta entidade, dada a sua raridade e especificidade. Caso Clínico: Homem de 48 anos, diabético, durante tratamento para toxoplasmose aguda com sulfadiazina iniciou um quadro de cólica renal associada à insuficiência renal. A hipótese de cálculo medicamentoso foi considerada, pois durante a investigação diagnóstica da toxoplasmose, exames de imagem foram realizados e não apresentavam cálculos. Inicialmente foi tratado conservadoramente com hiperidratação e alfa-bloqueador, mas como não apresentava melhora nos exames, foi submetido a ureterolitotripsia e duplo jota. Conclusão: Apresentamos um relato de litíase urinária de origem farmacológica associado à insuficiência renal e uma revisão da literatura

Acetylcysteine for Prevention of Renal Outcomes in Patients Undergoing Coronary and Peripheral Vascular Angiography Main Results From the Randomized Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT)

Background-It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury. Methods and Results-We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P = 0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P = 0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment. Conclusions-In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography.Ministério da Saúde do BrasilBrazilian Ministry of Healt

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy