La vasculatura sistémica en la enfermedad renal crónica. Segunda parte

Contenido principal del artículo

Felipe Inserra
Gustavo Lavenia
Pedro Forcada
Carlos Castellaro Bello

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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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 24 de junio de 2021];40(1):62-5. Disponible en: https://www.revistarenal.org.ar/index.php/rndt/article/view/510
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