Vol.7, No 1, 2000 pp. 116 -123
UC 612.17
ASYMPTOMATIC CAROTID ARTERY STENOSIS IN PATIENTS
WITH PRIMARY CHRONIC GLOMERULONEPHRITIS
Ligia Petrica1, Maxim Petrica2, Adalbert Schiller1, Silvia Velciov1, Gheorghe Gluhovschi1, Virginia Trandafirescu1,
Bozdog Gheorghe1, Cristina Gluhovschi1, Flaviu Bob1, Corina Vernic3, Alina Popescu1, Adriana Stanciu1, Luminiţa Militaru1, Doru Săndesc1
University of Medicine and Pharmacy, Timişoara, Romania
1Dept. of Nephrology, 2 Dept. of Neurology, 3 Dept. of Medical Informatics and Biostatistics
E-mail: ortoal@mail.dnttm.ro
Summary. Cardiovascular complications are the leading cause of morbidity and mortality in renal patients (p). Atherosclerosis is the major factor responsible for death-threatening events, such as myocardial infarction and stroke. Asymptomatic carotid artery stenoses (ACASs) are an important predictor of atherosclerotic involvement, not only in the brain, but also in other vascular territories (heart, lower limbs).
The study was conducted prospectively on 3 groups of p matched by sex and age, with primary chronic glomerulonephritis (CGN), essential hypertension (EHT) and normal controls (NC). Exclusion criteria were diabetes mellitus and symptoms or history of cerebrovascular disease. All p were assessed concerning the major risk factors (RF): blood pressure (BP), cholesterol (C), LDL-C, HDL-C, triglycerides (T), serum creatinine (SC), proteinuria (P), fibrinogen (F), leukocytes (L), smoking habits. ACASs were diagnosed by means of an extracranian velocimeter Doppler with spectral analysis. All p underwent ECG and an exercise ECG when necessary, to identify concomitant coronary heart disease (CHD). Peripheral vascular disease (PVD) was proven clinically and by Doppler scan.
The prevalence of ACASs was 32.51% in p with CGN (in p with NS - 25%; NS+CRF - 42.92%); 20.25% in EHT; 7.89% in NC. The degree of ACASs was in the range of grades II - III in all groups. More significant cerebrovascular RF were found in group 1 than in groups 2, 3 for: age (P<0.001), F (P<0.001), L (P<0.001), proteinuria (P<0.01), smoking (P<0.001), HT (P<0.0001), SC (P<0.001), C (P<0.001), LDL-C (P<0.0001), T (P<0.001), male gender (P<0.01). The stenosis index correlated strongly with the following RF: age, SBP, LDL-C, F, SC, proteinuria in groups 1; with SBP, LDL-C, age in group 2 and group 3, respectively. Of the p with CHD, 39.13% presented ACASs and of the p with PVD, 84.37% presented ACASs (group 1).
The prevalence of ACASs is far more significant in p with CGN and is strongly related to cerebrovascular RF. Mild and moderate ACASs overcome severe ACASs and are highly significant in p with nephrotic syndrome and chronic renal failure. ACASs p associate frequently CHD and PVD. Extracranian ultrasound Doppler should be recommended as routine examination in p with CGN in order to reveal ACASs in early stages.
Key words:  Asymptomatic carotid artery stenosis, cerebrovascular risk factors, coronary heart disease,
Doppler ultrasonography, peripheral vascular disease, chronic glomerulonephritis
ASIMPTOMATSKA STENOZA KAROTIDNE ARTERIJE
U BOLESNIKA SA PRIMARNIM GLOMERULONEFRITISOM

Kratak sadržaj: Kardiovaskularne komplikacije su vodeći uzrok morbiditeta i mortaliteta u bubrežnih bolesnika. Ateroskleroza je glavni faktor odgovoran za po život opasna stanja kao što su infarkt miokarda i šlog. Asimptomatske stenoze karotidne arterije (ACAS) su značajne za procenu raširenosti ateroskleroze, ne samo u mozgu već i u drugim organima i tkivima (srce, donji udovi).
Ovo ispitivanje je učinjeno prospektivno na tri grupe pacijenata, sličnog pola i uzrasta, i to obolelih od primarnog hroničnog glomerulonefritisa (CGN), esencijalne hipertenzije (EHT) i zdravih kontrola (NC). Iz ispitivanja su isključene osobe koje su imale šećernu bolest i simptome ili anamnestičke podatke o cerebrovaskularnom oboljenju. Svi bolesnici su ispitivani u odnosu na glavne faktore rizika (RF): krvni pritisak (BP), holesterol (C), LDL-C, HDL-C, trigliceride (T), serum kreatinin (SC), proteinuriju (P), fibrinogen (F), leukocite (L) i pušenje. ACAS su dijagnostikovane pomoću ekstrakranijalnog Dopplera sa spektralnom analizom. Svim bolesnicima urađen je ECG, a EKG u testu opterećenja ako je to bilo potrebno da bi se potvrdila koronarna bolest (CHD). Periferno vaskularno oštećenje (PVD) dokazivano je klinički i upotrebom Dopplera.
Prevalenca ACAS bila je 32.5% u bolesnika sa CGN (u bolesnika sa NS - 25%, NS+CRF 42.92%); 20% u EHT; 7.89% u NC. U svim grupama stepen oštećenja je bio II-III. Značajniji cerebrovaskularni faktori rizika nađeni su u grupi 1 nego u grupama 2 i 3 za: uzrast (p < 0,001), F (p < 0,001), L (p < 0,001), proteinuriju (p < 0,01), pušenje
(p < 0,001), HT (p < 0,0001), SC (p < 0,001), C (p < 0,001), LDL (p < 0,0001), T(p < 0,001), muški pol (p < 0,01). Indeks stenoze visoko je korelirao sa sledećim faktorima rizika: uzrast, SBP, LDL-C, F, SC, proteinurija u grupi 1; sa SBP, LDC i uzrastom u grupama 2 ili 3. U bolesnika sa CHD 39,13%, je imalo ACAS, a u bolesnika sa PVD 84.37% je imalo ACAS.
Prevalenca ACAS bila je značajno viša u bolesnika sa CGN i visoko je korelirala sa faktorima rizika. Blagi i umeren stepen ACAS preovlađivao je nad teškim ACAS, i bio je značajno češći u bolesnika sa nefrotskim sindromom i hroničnom bubrežnom insuficijencijom. ACAS je često bio udružen sa CHD i PVD. Ekstrakranijalno ultrazvučno Doppler ispitivanje treba preporučiti kao rutinsko ispitivanje bolesnika sa CGN, da bi se otkrio ACAS u ranom stadijumu.
Ključne reči:  Asimptomatska stenoza karotidne arterije, faktori cerebrovaskularnog rizika, Doppler ultrasonografija, koronarna bolest srca, periferno vaskularno oboljenje