La vasculatura sistémica en la enfermedad renal crónica. Segunda parte

  • Felipe Inserra Grupo de Trabajo Hipertensión Arterial y Daño Vascular, Sociedad Argentina de Nefrología, Buenos Aires, Argentina
  • Gustavo Lavenia Grupo de Trabajo Hipertensión Arterial y Daño Vascular, Sociedad Argentina de Nefrología, Buenos Aires, Argentina
  • Pedro Forcada Laboratorio Vascular No Invasivo, Centro de Hipertensión, Hospital Universitario Austral, Buenos Aires, Argentina
  • Carlos Castellaro Bello Maestría de Mecánica Vascular e Hipertensión Arterial, Universidad Austral, Buenos Aires, Argentina
Palabras clave: enfermedad renal crónica; rigidez arterial; velocidad de onda de pulso (VOP), índice de presión arterial sistólica tobillo-brazo; aterosclerosis subclínica

Resumen

Existen cambios estructurales importantes de la pared arterial en, prácticamente, todas las etapas clínicas de la enfermedad renal crónica. Son un marcador pronóstico y, al mismo tiempo, un factor de progresión y de eventos, tanto cardiovasculares como renales. Es por ello que tener una estimación del daño vascular y, mejor aún, un diagnóstico adecuado es esencial.
La evaluación vascular en la consulta clínica, mediante la determinación de la presión del pulso y el índice de presión arterial sistólica tobillo-brazo, sirven como una orientación inicial del daño arterial de estos pacientes. Hoy podemos valorar, de manera accesible, las lesiones estructurales de las arterias mediante la cuantificación y caracterización, por ecografía vascular, de las placas ateroscleróticas de carótidas y femorales y por la velocidad de onda del pulso. En la gran mayoría de los pacientes renales la velocidad de onda del pulso está muy aumentada, comparada con poblaciones sanas, como consecuencia de múltiples mecanismos patogénicos. Las alteraciones vasculares, tanto de los grandes vasos como de la microcirculación, están fuertemente vinculados con la progresión de la enfermedad renal crónica, así como con complicaciones y eventos renales, cardiacos y cerebrales.
En conclusión, en individuos con riesgo de desarrollar enfermedad renal crónica, o en quienes ya la padecen, la medición de la rigidez arterial y de los daños ateroscleróticos de la pared vascular serían parámetros centrales para su evaluación y uno de los objetivos a considerar al diseñar estrategias preventivas del deterioro de los órganos blanco y eventos.

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Publicado
2020-08-27
Cómo citar
1.
Inserra F, Lavenia G, Forcada P, Castellaro Bello C. La vasculatura sistémica en la enfermedad renal crónica. Segunda parte. Rev Nefrol Dial Traspl. [Internet]. 27 de agosto de 2020 [citado 28 de marzo de 2024];40(1):62-5. Disponible en: http://www.revistarenal.org.ar/index.php/rndt/article/view/510
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