André Falcão Pedrosa Costa

Electrocardiography in the diagnosis of ventricular hypertrophy in patients with chronic renal disease.

BACKGROUND Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 + or - 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearsons linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > or = 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterizacion y prevalencia en la enfermedad renal cronica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnostico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiograficos, correlacionandolos al indice de masa del ventriculo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. METODOS: Estudio transversal que incluyo a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 anos) con ERC de todas las etiologias, desde hace al menos 6 meses en hemodialisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el termino de las sesiones de HD. RESULTADOS: La HVI se detecto en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estandar concentrico y 27 (32,6%) el estandar excentrico de HVI. Todos los metodos electrocardiograficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnosticas superiores al 50%. Mediante la correlacion lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presento coeficiente > 0,50. Sin embargo, el calculo de la razon de verosimilitud evidencio que el ECG tiene poder discriminatorio para diagnostico de HVI en la poblacion estudiada, con enfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlacion entre IMVI con el QTc y su dispersion. CONCLUSION: El ECG es un metodo util, eficaz y de alta reproductibilidad en el diagnostico de HVI de los pacientes en HD. En esa poblacion, el criterio de Producto de Cornell fue mas fiable para la deteccion de HVI.

O eletrocardiograma no diagnóstico da hipertrofia ventricular de pacientes com doença renal crônica

BACKGROUND Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 + or - 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearsons linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > or = 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterizacion y prevalencia en la enfermedad renal cronica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnostico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiograficos, correlacionandolos al indice de masa del ventriculo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. METODOS: Estudio transversal que incluyo a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 anos) con ERC de todas las etiologias, desde hace al menos 6 meses en hemodialisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el termino de las sesiones de HD. RESULTADOS: La HVI se detecto en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estandar concentrico y 27 (32,6%) el estandar excentrico de HVI. Todos los metodos electrocardiograficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnosticas superiores al 50%. Mediante la correlacion lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presento coeficiente > 0,50. Sin embargo, el calculo de la razon de verosimilitud evidencio que el ECG tiene poder discriminatorio para diagnostico de HVI en la poblacion estudiada, con enfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlacion entre IMVI con el QTc y su dispersion. CONCLUSION: El ECG es un metodo util, eficaz y de alta reproductibilidad en el diagnostico de HVI de los pacientes en HD. En esa poblacion, el criterio de Producto de Cornell fue mas fiable para la deteccion de HVI.

Association of PTH and carotid thickness in patients with chronic kidney failure and secondary hyperparathyroidism

INTRODUCTION Cardiovascular diseases (CVDs) are the leading cause of death in terminal patients with chronic kidney failure (CKF). Diverse risk factors are involved in the pathogenesis, and are classified as traditional, which affect the general population; and non-traditional, which are peculiar to patients with CKF. Secondary hyperparathyroidism, a non-traditional and common factor in CKF, can cause an increased rate of bone absorption with mobilization of calcium and phosphorus. If the product of calcium x phosphorus is increased, the solubility of this ionic pair may be exceeded and deposition of calcium phosphate in cardiac and vascular tissues occur (called metastatic calcification). OBJECTIVE To verify eventual relationship between the thickness of the common carotid artery and the levels of PTH in patients with CKF. METHODS Evaluations by Doppler ultrasonography were performed to measure the width of the carotid artery wall and to search for possible correlations between different values of PTH serum levels, mineral disturbances and traditional risk factors in the carotid changes found in individuals with dialytic CKF and secondary hyperparathyroidism. RESULTS Differences in the cholesterol level and age were observed in patients with signals of arterial calcification. A significant relationship was also observed between the PTH serum levels and the carotid artery wall thickness (r = 0.31, p = 0.03). CONCLUSION Data from this study show the possible concomitance of traditional factors and factors related to CKF in the genesis of CVDs in uremia.

Acute kidney injury in leptospirosis: the Kidney Disease Improving Global Outcomes (KDIGO) criteria and mortality .

Acute kidney injury (AKI) is one of the most serious complications of leptospirosis. In recent years, studies have evaluated this complication using the risk, injury, failure, loss, and end-stage kidney disease and the acute kidney injury network classification systems. More recently, the kidney disease improving global outcomes (KDIGO) criteria have been developed to increase accuracy in detecting AKI. The aim of the present study was to determine the prevalence and factors associated with AKI and mortality in patients with leptospirosis, using KDIGO criteria. We conducted a retrospective analysis of patients with clinical and epidemiological diagnosis of leptospirosis between January 2007 and December 2011. AKI was defined and classified according to KDIGO guidelines. Independent risk factors for AKI and death were evaluated using logistic regression. Of the 205 patients included, only 10 patients (4.8%) exhibited Weils syndrome. AKI occurred in 182 patients (88.7%), 33 (16.1%) of whom were classified as KDIGO 1, 36 (17.6%) as KDIGO 2, and 113 (55.1%) as KDIGO 3. There was an independent correlation between AKI and the incidence of hyperbilirubinemia and leukocytosis. KDIGO 3 and the need for mechanical ventilation were independently correlated with mortality. We observed a high prevalence of AKI using KDIGO criteria, even in patients with milder forms of leptospirosis. Hyperbilirubinemia and leukocytosis were independent risk factors for AKI. KDIGO 3 was independently associated with mortality.
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Lupus cystitis presenting with hidronephrosis and gastrointestinal involvement

INTRODUCTION Lupus cystitis is a rare manifestation of systemic lupus erythematosus, characterized by thickening of the bladder wall, associated with ureterohydronephrosis. In several cases gastrointestinal symptoms are the main manifestation. The optimal immunosuppressive regimen is still unknown. METHODS 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting. An abdominal CT scan demonstrated moderate bilateral dilation from the pelvis to the ureterovesical junction, and the bladder exhibited reduced capacity and diffusely thickened walls. A diagnosis of chronic interstitial cystitis was performed and treatment with high dose methylprednisolone resulted in a significant relief of gastrointestinal and urinary symptoms and a reduction of the bladder thickness with improvement of their capacity. CONCLUSION Lupus cystitis is a rare and underdiagnosed urinary manifestation of LES and the presence of mild urinary symptoms and abdominal pain may alert about this possibility.

Left ventricular mass and cardiothoracic index in patients with chronic renal disease on hemodialysis

INTRODUCTION Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD). OBJECTIVE To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD. METHODS Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions. RESULTS LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The following were the sensitivity, specificity and accuracy, respectively, for the variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and index of left ventricular mass (LVMI) was 0.552 (p < 0.05) and positive likelihood ratio of 2.2. CONCLUSION Chest radiography is a safe and useful as a diagnostic tool of LVH in CKD patients on HD.

El electrocardiograma en el diagnóstico de la hipertrofia ventricular de pacientes con enfermedad renal crónica

BACKGROUND Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 + or - 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearsons linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > or = 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterizacion y prevalencia en la enfermedad renal cronica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnostico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiograficos, correlacionandolos al indice de masa del ventriculo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. METODOS: Estudio transversal que incluyo a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 anos) con ERC de todas las etiologias, desde hace al menos 6 meses en hemodialisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el termino de las sesiones de HD. RESULTADOS: La HVI se detecto en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estandar concentrico y 27 (32,6%) el estandar excentrico de HVI. Todos los metodos electrocardiograficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnosticas superiores al 50%. Mediante la correlacion lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presento coeficiente > 0,50. Sin embargo, el calculo de la razon de verosimilitud evidencio que el ECG tiene poder discriminatorio para diagnostico de HVI en la poblacion estudiada, con enfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlacion entre IMVI con el QTc y su dispersion. CONCLUSION: El ECG es un metodo util, eficaz y de alta reproductibilidad en el diagnostico de HVI de los pacientes en HD. En esa poblacion, el criterio de Producto de Cornell fue mas fiable para la deteccion de HVI.