Daño vascular en la enfermedad renal crónica

Jara, Aquiles; Mezzano, Sergio

Keywords: atherosclerosis, diabetic nephropathies, cardiovascular diseases, kidney diseases

Abstract

Cardiovascular disease is a frequent complication of renal failure and is the most common cause of death in patients with chronic kidney disease (CKD). Accelerated atherogenesis has been widely documented in CKD and diabetic nephropathy is the leading cause of renal failure worldwide. Furthermore, CKD promotes hypertension and dyslipidemia, which in turn may contribute to the progression of renal failure. All together, hypertension, dyslipidemia and diabetes are considered major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Elevated inflammatory mediators and activation of the renin-angiotensin system contribute through enhanced production of reactive oxygen species, to atherogenesis in CKD. Vascular calcification is also important. Calcification of arteries occurs in the intima in association with atherosclerosis, where it may contribute to plaque formation, and in the media, where it causes stiffening. Increased serum levels of calcification promoters, such as hyperphosphatemia, and a decrease in circulating and local inhibitors of calcification, favor vascular calcification. On the other hand, transdifferentiation of vascular smooth muscle cells to osteblast-like cells would be the pivotal event in calcification. Bone morphogenetic protein agonists and antagonists are playing a role in this osteogenic differentiation. Accelerated atherosclerosis and media calcification will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with CKD .

Más información

Título según SCIELO: Daño vascular en la enfermedad renal crónica
Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 136
Número: 11
Editorial: SOC MEDICA SANTIAGO
Fecha de publicación: 2008
Página de inicio: 1476
Página final: 1484
Idioma: es
URL: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008001100016&lng=en&nrm=iso&tlng=en
DOI:

10.4067/S0034-98872008001100016

Notas: SCIELO