Conceptos Categóricos

DOENÇA CARDIOVASCULAR E TRANSPLANTE RENAL

DOENÇA CARDIOVASCULAR E TRANSPLANTE RENAL

(especial para SIIC © Derechos reservados)
Desafios para a redução do risco de complicações cardiovasculares em pacientes com IRC incluem desde melhor estratificação de risco clínica e laboratorial até estratégias para prevenção e tratamento da doença cardiovascular.
wolff9.jpg Autor:
Luís Henrique Wolff Gowdak
Columnista Experto de SIIC
Artículos publicados por Luís Henrique Wolff Gowdak
Coautores
Flávio Jota de Paula* José Jayme Galvão De Lima** 
MD, Universidade de São Paulo, São Paulo, Brasil*
MD, PhD, Universidade de São Paulo, São Paulo, Brasil**
Recepción del artículo
1 de Noviembre, 2006
Aprobación
4 de Enero, 2007
Primera edición
16 de Febrero, 2007
Segunda edición, ampliada y corregida
23 de Mayo, 2007

Resumen
Pacientes com insuficiência renal crônica constituem um dos grupos de mais alto risco para complicações cardiovasculares graves. Assim, a avaliação clínica cuidadosa de pacientes candidatos a transplante renal, com ênfase na detecção de doença arterial coronária (DAC), é etapa crucial para se assegurar evolução segura no período pós-transplante. Entre os desafios de otimização de estratégias para a redução do risco de complicações cardiovasculares nesta população, destacam-se: validação prospectiva de sistema de estratificação de risco clínica, o que levaria à identificação de pacientes que merecem estratificação adicional (não-invasiva ou invasiva); a escolha de métodos com elevada sensibilidade/especificidade nesta população e em quais subgrupos devem ser empregados; e, finalmente, melhores estratégias para prevenção e tratamento da doença cardiovascular e eventos associados. Neste trabalho, procuraremos discutir criticamente estes pontos através de revisão da literatura ou da experiência acumulada pelo nosso grupo. Somente olhando criticamente para a doença cardiovascular em candidatos a transplante renal, é que poderemos identificar novos desafios e reduzir a incidência de eventos após o transplante renal, permitindo maior sobrevida aos transplantados renais.

Palabras clave
insuficiência renal crônica, diálise, doença cardiovascular, risco, transplante renal


Artículo completo

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Abstract
Patients with end-stage renal disease (ESRD) are one of the highest-risk groups for serious cardiovascular events. So, careful clinical assessment of renal transplant candidates, with special interest in the detection of significant coronary artery disease, is a crucial step to warrant a better long-term outcome after transplantation. Major challenges for greater reduction in the incidence of cardiovascular complications in this special population include: prospective validation of clinical risk stratification tools, leading to the identification of patients in whom additional workup may be needed (either non-invasive or invasive); selection of diagnostic methods with elevated sensitivity/specificity; and, finally, better therapeutic strategies for prevention and treatment of cardiovascular disease and comorbidities in patients with ESRD. In this paper, we will critically discuss those issues by reviewing the current literature and our own experience in the field. It is only through a critical appraisal of cardiovascular disease in renal transplant candidates that we will be able to identifiy new challenges in order to reduce the incidence of cardiovascular events after renal transplantation, yielding a better long-term survival.

Key words
chronic kidney disease, dialysis, cardiovascular disease, risk, renal transplantation


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Trasplantes
Relacionadas: Cardiología, Diagnóstico por Laboratorio, Medicina Interna, Nefrología y Medio Interno



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Enviar correspondencia a:
Luís Henrique Wolff Gowdak, Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, 05403-000, Av. Dr. Enéas de Carvalho Aguiar 44, São Paulo, Brasil
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