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INTERRELACION ENTRE HIPERTROFIA VENTRICULAR IZQUIERDA Y NEFROPATIA DIABETICA

INTERRELACION ENTRE HIPERTROFIA VENTRICULAR IZQUIERDA Y NEFROPATIA DIABETICA

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La hipertrofia ventricular izquierda (HVI) en pacientes con nefropatía diabética (ND) se asocia con un aumento del riesgo de enfermedad cardiovascular y progresión de la ND. El tratamiento intensivo debe dirigirse a producir la regresión de la HVI y el enlentecimiento de la ND.
boner9.jpg Autor:
Geoffrey Boner
Columnista Experto de SIIC
Artículos publicados por Geoffrey Boner
Aprobación
23 de Mayo, 2007
Primera edición
15 de Junio, 2007
Segunda edición, ampliada y corregida
12 de Junio, 2007

Resumen
La diabetes mellitus (DM) y sus muchas complicaciones son causas importantes de morbimortalidad. El propósito de esta revisión es examinar las relaciones entre hipertrofia ventricular izquierda (HVI) y nefropatía diabética (ND). La HVI es un componente del síndrome de resistencia a la insulina aun en ausencia de hipertensión. La DM es un fuerte factor de predicción de enfermedad cardiovascular y puede asociarse con HVI incluso en ausencia de hipertensión. En un estudio de gran tamaño de sujetos hipertensos con HVI se observó un aumento del riesgo de microalbuminuria y proteinuria franca. Esto también se puso en evidencia en personas con DM. En los pacientes con ND existe una asociación positiva entre HVI y albuminuria. Un nuevo análisis de los datos del estudio Reduction of Endpoints in NIDDM with Angiotensin II Antagonist (RENAAL) mostró que en los pacientes con ND, la presencia de HVI era un factor de riesgo importante para enfermedad cardiovascular y mortalidad y para la progresión de la ND. El tratamiento antihipertensivo con diferentes agentes produjo regresión de la HVI. Además, en el estudio RENAAL el tratamiento con un bloqueante del receptor de angiotensina se asoció con una disminución importante del riesgo, tanto cardíaco como renal. Por lo tanto, la presencia de ND e HVI se asocia con un aumento del riesgo de enfermedad cardiovascular y renal, que puede reducirse con el tratamiento apropiado.

Palabras clave
hipertorfia ventricular izquierda, nefropatía diabética, bloqueante del receptor de angiotensina, progresión de la enfermedad renal, RENAAL


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Abstract
Diabetes mellitus (DM) and its many complications are major causes of morbidity and mortality. The purpose of this review is to examine the relationships between left ventricular hypertrophy (LVH) and diabetic nephropathy (DN). LVH is a component of the insulin resistance syndrome even in the absence of hypertension. DM is a strong predictor of cardiovascular (CV) disease and may be associated with LVH even in the absence of hypertension. In a large study of hypertensive subjects with LVH there was an increased risk for microalbuminuria and overt proteinuria. This was also evident in those subjects with DM. In patients with DN there is a positive association between LVH and albuminuria. A new analysis of data from the Reduction of Endpoints in MIDDM with Angiotensin II Antagonist (RENAAL) study has shown that in patients with DN the presence of LVH was a significant risk factor for CV and mortality and for the progression of DN. Antihypertensive therapy with different agents has caused a regression in LVH. Moreover, in the RENAAL study treatment with a angiotensin receptor blocker was associated with a significant improvement in both the cardiac and renal risk. The presence of DN and LVH is thus associated with an increased risk for both CV and renal disease, which can be reduced by appropriate treatment.

Key words
LVH, diabetic nephropathy, angiotensin receptor blocker, progression of renal disease, RENAAL


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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

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



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Enviar correspondencia a:
Geoffrey Boner, Sackler Medical Faculty, Tel Aviv University , 40295, 81 Kochav Hayam, Tel Aviv, Israel
Patrocinio y reconocimiento:
Agradecimiento: Al Profesor Mark E. Cooper, del Baker Research Institute, Melbourne, Australia, quien me inspiró y ayudó en la investigación de la asociación entre hipertrofia ventricular izquierda y nefropatía diabética. La investigación inicial y la revisión de la bibliografía se realizaron durante un año sabático en su departamento.
Bibliografía del artículo
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