Circulando com o Sangue. Schema showing the interaction of risk factors for CKD progression with...
Transcript of Circulando com o Sangue. Schema showing the interaction of risk factors for CKD progression with...
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Circulando com o Sangue
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Schema showing the interaction of risk factors for CKD progression with pathophysiological mechanisms that contribute to a vicious
cycle of progressive nephron loss. Ang II – angiotensin II; FSGS – focal and segmental glomerulosclerosis; PGC – glomerular capillary
hydraulic pressure; SNGFR – single nephron glomerular filtration rate; TIF – tubulointerstitial fibrosis.
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Doença Cardiovascular
• IRC associada com aumento do risco CV e Doença CV é também
associada com risco aumentado de IRC.
• Presença de IRC associada com cardiopatia aumenta o risco de
morte e de IRCT.
• IRC e doença CV tem os mesmos fatores de risco: Obesidade,
Síndrome Metabólica, DM, HAS, Dislipidemia, Tabagismo.
• Doença CV afeta diretamente a perfusão renal.
• Aterosclerose renal foi constatada em 39% de pacientes
submetidos à angiografia coronária.
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Estados de Hiperfiltração
• Resposta hemodinâmica capilar à perda de nefrons
e hiperglicemia crônica:
– Aumento da Pressão Hidráulica Capilar Glomerular
– Aumento da TFG de cada nefro (single)
São fatores críticos no estabelecimento
do circulo vicioso da perda de nefrons
característica da IRC.
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Estados de Hiperfiltração:Diminuição do Número de Nefrons
• “Dote” de Nefrons
– Diminuído predispõe à IRC por aumentar a TFG no nefro
isolado levando a redução da reserva renal.
– Baixo peso ao nascer é relacionado com reduzido número de
nefrons e com risco para HAS e DM.
• Déficit Adquirido de Nefrons.
– Perda focal por extração, doença renal primária, doenças
multisistêmicas, exposição a nefrotoxinas e também por
adaptações hemodinâmicas nos nefrons remanescentes.
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Estados de Hiperfiltração:Pressão Arterial
• HAS leva a Hipertensão Glomerular que
Acelera o Dano Glomerular.
• HAS é um risco preditivo de IRC.
• Aumento da PA Sistólica é risco independente.
• Efeito protetor com controle ótimo:
(PA:125X75mmHg).
• Associação entre HAS e proteinúria:
risco aumentado.
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Estados de Hiperfiltração:Obesidade e Síndrome Metabólica
• Obesidade associada com HAS, proteinúria e
doença renal progressiva com hipertensão e
hiperfiltração glomerular.
• Obesidade pode causar glomerulopatia (GESF).
• Sindrome Metabólica / Resistência à Insulina
(obesidade abdominal, dislipidemia, HAS e
hiperglicemia de jejum) é risco para IRC
proporcional ao número de traços presentes.
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Estados de Hiperfiltração:Alta Ingesta Proteica
• Aumenta a TFG levando à alterações
hemodinâmicas associadas com hiperfiltração
glomerular e acelera a injúria glomerular.
• Associada com HAS + DM leva à
microalbuminúria.
• Acelera o declínio da função renal.
• Redução na ingesta proteica tem efeito
renoprotetor.
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Lance D. Dworkin & Douglas G. Shemin
www.cibernephrology.com/education/nephrologists/Schrieratlas/
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L. Gabriel Navar and L. Lee Hamm
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L. Gabriel Navar and L. Lee Hamm
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Marc A. Pohl
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Ware L and Matthay M. N Engl J Med 2005;353:2788-2796
Physiology of Microvascular Fluid
Exchange in the Lung
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