posters submitted - SMIBA

162
ABSTRACTS
NEPHROLOGY / NEFROLOGÍA
P-11-41 | HYPERKALEMIA AS A CONSEQUENCE OF
THE USE OF SPIRONOLACTONE AND ACE INHIBITORS
IN SEVERE HEART FAILURE
Figueiredo, Felipe
Universidade Federal do Estado do Rio de Janeiro- UNIRIO-; Brazil
Introduction: Heart failure (HF) is one of the priorities of World Health Organization with
regard to chronic diseases. It is estimated that there are about 15 million people, worldwide,
affected by HF, and it is the leading cause of hospitalization of adult population.This is reflected
in 5% of total admissions, excluding pregnancy, childbirth and puerperium. This clinical
review aims to confront theories and medical articles regarding the use of spironolactone in
this condition.
Material and Methods: In this medical literature review, several articles were selected, each
one with its perspective on the treatment of severe heart failure and among the various peculiarities
of each drug, focused on the association of spironolactone inhibitor and angiotensinconverting
enzyme (ACE) and its possible deleterious effects.
Results: It is known that aldosterone plays important role in the development of fibrosis,
both in the remodeling of systolic HF and in the development of left ventricular hypertrophy
(LVH). In the study “Randomized Aldactone (spironolactone) Evaluation Study for Congestive
Heart Failure (RALES)”, the patients in the placebo group with the highest serum markers of
collagen degradation had the worst developments, but that was the best response to spironolactone
therapy. Among patients who had been hospitalized for heart failure, the frequency
of prescription of spironolactone was 34 per 1000 patients in 1994 and has risen immediately
after the publication of RALES study, to 149 per 1000 patients in 2001. At the same time, the
frequency of hospitalization for hyperkalemia increased from 2.4 per 1000 patients in 1994 to
11 per 1000 patients in 2001.
Discussion: Looking up the reason of these hospitalizations by hyperkalemia, we see that also
had been prescribed ACE inhibitors for these patients, which, in combination with spironolactone,
can attend persistent and deadly hyperkalemia.
Conclusion: The use of spironolactone in a low dose (25mg/day) is beneficial, acting directly in
reducing morbimortality of HF and should only be emphasized the importance of monitoring
serum potassium, when used in combination with ACE inhibitors.
P-11-43 | THERAPEUTIC INTERVENTIONS FOR CHRON-
IC INFLAMMATION IN HEMODIALYSED PATIENTS
Tirlea, Felicia; Bako, G.; Farcas, Dorina María.; Burta, Ligia.; Burta, O.
City Hospital of Oradea, Internal Medicine Department Faculty of Medi-
cine and Pharmacy of Oradea. Romania.;
Aim: Patients undergoing chronic hemodialysis have a chronic inflammatory syndrome, which
represents nowadays a major cardiovascular risk factor.We evaluated the effect of ACE inhibitors
and statins on the markers of inflammation.
MATERIAL AND Method:The study included 60 patients in hemodialysis , with normal or
elevated blood pressure, who didn’t use Ace inhibitors or statins before.We evaluated:the
proinflammatory cytokine TNF-alpha( Elisa chemoluminescence,R&D Systems, Minneapolis),
blood pressure, C reactive protein, alpha 1, alpha 2 globulins, total cholesterol, LDL, HDLcholesterol,
triglycerides. Then patients were divided in 2 groups: one received Perindopril 2
mg/48h , the other Perindopril 2 mg/48h and Simvastatin 20 mg/day, one month. We evaluated
TNF alpha after the first dose, at 14 days and at one month. At the end the other parameters
were measured again.
Results:TNF had increased values in all hemodialysed patients:25,72+/-1,36 pg/ml(normal
values! 2,9+/-0,8 pg/ml). After the first dose(in both groups), there was only a slight decrease
of TNF;23,44+/-1,18 pg/ml. After 2 weeks, TNF value in group 1 was 16,43+/-o,82 pg/ml
and 15,11 +/-0,98 pg/ml,respectively At the end of therapy, TNF value in first group was
11,69+/-0,52 pg/ml and in the other 9,74 +/-0,59 pg/ml. The BP was elevated in 24 patients;
it decreased from 163,33/97,66 mmHg to 136/81,33 mmHg. In group 2 , with patients with
dyslipidemia , cholesterol level became normal in 40% of patients, LDL-chol in 50% and the
HDL- chol didn’t change. CRP was measured semiquatitative; it was found elevated in 55% of
patients and it was normalized in 22% of patients from group 1 and in 28 % of patients from
group 2.
Conclusions:TNF alpha is a very sensitive marker of chronic inflammation, being found elevated
in all hemodialysed patients; ACE inhibitors and statins decrease these values, with the
best results in the group with combined therapy. The overall decrease w! as with 55% in group
1 and 62,2% in group 2. CRP and lipids had improvements in their values, with better results
in the group with combined therapy.
P-11-42 | INFLUENCE OF ERYTHROPOIETIN THERAPY
ON SERUM PROHEPCIDIN LEVELS IN DIALYSIS PA-
TIENTS
Arabul, Mahmut; Gullulu, Mustafa; Yilmaz, Yusuf; Ali Eren, Mehmet; Baran,
Bulent;
Uludag University Medical School, Bursa. Turkey
Background: Anemia is a common finding in dialysis patients. Recent evidence has accrued
that hepcidin, an iron regulatory peptide, may play a crucial role in the pathophysiology of this
condition. In this study, we sought to investigate the effect of erythropoietin (EPO) therapy
onserum levels of prohepcidin - the pro-hormone of hepcidin - in patients with end stage
renal disease (ESRD) undergoing chronic dialysis treatment.
Materials and Methods: A total of 40 ESRD patients with renal anemia receiving either hemodialysis
or peritoneal dialysis were included in this study. Patients were randomly allocated to
EPO (subcutaneous 2000 ug three times weekly) plus parenteral iron (n = 23) or parental iron
only (n = 17). Serum prohepcidin levels were measured before and at the end of the study.
Results: Both groups were comparable in their demographic and aboratory characteristics.
No significant differences were found in hemoglobin, hematocrit, iron store indices and serum
levels of prohepcidin at the study entry. A significant increase in both hemoglobin and
hematocrit as well as a decrease in serum prohepcdin level were evident in the EPOgroup at
the end of the 6-month follow-up in comparison to their values at the study entry compared
to the control group (P < 0.01).
Conclusions: We conclude that EPO therapy - besides enhancing erythropoiesis - modulates
serum prohepcidin levels in dialysis patients. Key Words: end stage renal disease; dialysis;
anemia; erythropoietin; hepcidin.
P-11-44 | NEPHROTIC SYNDROME AS INITIAL MANIFES-
TATION OF SYSTEMIC LUPUS ERYTHEMATOSUS.
Rodrigues Pereira, Antonio.; Oliveira, C.; Contreras, R.; Lemos Costa,
Carla.; Gomes, Marta.
Hospital Santa María Maior. Barcelos; Portugal.
Introduction: The Nephrotic Syndrome may occure in association with a wide variety of primary
and systemic diseases. In adults, approximately 30 percent have a systemic disease such
as systemic lupus erythematosus(SLE), diabetes mellitus or amyloidosis. We report a case of a
24 year-old woman with a lupus nephritis.
Description: A 24 year-old woman with a history of depression (diagnosed one year early), exsmoker
and a voluntary interruption of pregnancy(two years early). She was medicated with
mexazolam 1mg and oral contraceptive. She have history of LES in family ( her mother). She
was admitted in the hospital with anasarca. First noticed in lower extremities followed by progression
over 8 days to anasarca. She presented a normal vital signs. Heart sounds are normal
and pulmonary auscultation are normal. Abdominal distension, exuberant edema of lower
extremities and periorbital edema. Laboratory exams revealed creatinine and urea in plasma
normal; hypercholesteremia (296mg/dl), hypoalbuminemia (2,3g/dl), proteinuria (7.4g/24h),
decrease of immunoglobuline(A,G and M); presence of antinuclear antibodies (stippled pattern
in titers higher than 1/640); positive anti-ds-DNA and Anti-SS-a , consumption of the
complement C3 fraction and crioglobulinemia. Serology for Syphilis, Hepatitis B, Hepatitis C
and HIV 1 and 2 were negative. The chest x-rays, kidney ultrassound, electrocardiogram and
echocardiogram were normal. Computed tomography of chest, abdomen and pelvis revealed
small pleural effusion bilateral and mild hepatomegaly homogeneous and moderate ascites.
Renal biopsy showed a lupus nephritis in classe IV. The patient is making monthly pulses of cyclophosphamide
and prednisolone 60 mg per day. It is in the fifth month of treatment Actually
she presents a regression of proteinuria (3.6 g/24 hours), but an increase of hypercholesterolaemia
(348 mg / dL) and hypertriglyceridemia (397/mg/dL). In spite of creatinine clearance
is 95,8 ml/minute.
Conclusion: This patient presented as the initial manifestation of SLE the nephrotic syndrome.
The lupus nephritis is one of the most serious manifestations of SLE because it is a major cause
of mortality in the first decade of the disease. As a group, approximately 20 % of patients with
lupus nephritis will reach end-stage disease, requiring dialysis or transplantation.