Análise do sódio urinário e seletividade da proteinúria na doença renal crônica não dialítica
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Data
2017-02-22
Autores
Martinez, Marila Gaste [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Fundamentação. As doenças renais têm assumido papel cada vez mais relevante na carga de sofrimento humano nos dias de hoje, e a seletividade da proteinúria é importante marcador de evolução dessas doenças. Melhorar essa seletividade constitui objetivo a ser almejado no sentido de atenuar o crescimento da prevalência de insuficiência renal. Por outro lado, a ingestão de sódio associa-se, por mecanismos hemodinâmicos e não hemodinâmicos, a aumento da quantidade de proteinúria, o que prevê pior evolução. Se a ingestão de sódio é capaz de influenciar não só a quantidade, mas também a seletividade da proteinúria é um assunto ainda não conhecido. Apenas um pequeno estudo transversal realizado em portadores de nefropatia diabética avaliou essa questão. Nenhum estudo, de nosso conhecimento, avaliou a associação da excreção de sódio em 24 horas e a seletividade da proteinúria na nefropatia hipertensiva e nas doenças glomerulares. Assim, temos como hipótese que a menor excreção de sódio possa se associar à melhora da seletividade da proteinúria nesses pacientes e o objetivo do corrente estudo foi avaliar de maneira longitudinal e prospectiva a associação entre ingestão de sódio e a seletividade da proteinúria nos pacientes do ambulatório de nefrologia da Faculdade de Medicina de Botucatu. Pacientes e Métodos. Este trabalho foi um estudo longitudinal, observacional, prospectivo. Após avaliação inicial, foram colhidas amostras de urina e sangue para as análises que foram descritas abaixo. Os pacientes foram reavaliados em seis meses. Após as análises efetuadas os pacientes foram divididos em quatro grupos quanto ao sódio urinário em 24 horas e o seu comportamento no decorrer do tempo. Foram avaliadas amostras de urina de 24h quanto a sua albuminúria, proteinúria, Índice de seletividade, creatinina, sódio, potássio e uréia. Imunoglobulina do tipo G (IgG) foi dosada em amostra na primeira urina da manhã. Foram colhidas amostras de sangue de cada paciente e foram avaliadas quanto a proteínas totais (albumina e globulina), sódio sérico, creatinina, uréia, IgG sérica, glicose, potássio, ácido úrico e hemoglobina glicada. Resultados. A variação da ingestão estimada de sódio apresentou associação direta com a variação da proteinúria, albuminúria e excreção urinária de IgG. A fração de excreção de albumina e a fração de excreção de IgG também se associaram ao sódio urinário. O índice de seletividade se associou, em análise univariada, com a ingestão estimada de sódio. Essa associação perdeu significância estatística ao ser ajustada para a presença de glomerulopatias. Tanto a albumina como a IgG séricas apresentaram associação inversa com a ingestão estimada de sódio. A pressão arterial sistólica e diastólica acompanhou a excreção urinária de sódio e excreção da proteinúria e albuminúria. Conclusão. Em portadores de doença renal crônica, a ingestão estimada de sódio não apresentou associação com a seletividade da proteinúria, que é um forte marcador prognóstico. Porém, essa ingestão associou-se com a quantidade da proteinúria, que também é importante preditor de sobrevida renal. Esses dados nos levam a crer que a ingestão de sódio nesses pacientes deva ser mais bem monitorada para diminuir a progressão da doença renal crônica e melhorar a expectativa de vida desses pacientes.
Introduction: Renal diseases have assumed an increasingly relevant role in the burden of human suffering today, and the selectivity of proteinuria is an important marker of the evolution of these diseases. Improving this selectivity is an objective to be aimed at attenuating the growth of the prevalence of renal failure. On the other hand, sodium intake is associated, through hemodynamic and non-hemodynamic mechanisms, with an increase in the amount of proteinuria, which predicts worse evolution. If sodium intake is able to influence not only quantity but also the selectivity of proteinuria is a subject not yet known. Only a small cross-sectional study of diabetic nephropathy patients evaluated this question. No study, to our knowledge, has evaluated the association of sodium excretion within 24 hours and the selectivity of proteinuria in hypertensive nephropathy and glomerular diseases. Thus, it is hypothesized that lower sodium excretion may be associated with improved proteinuria selectivity in these patients and the objective of the present study was to longitudinally and prospectively evaluate the association between sodium intake and proteinuria selectivity in ambulatory patients Department of Nephrology at Botucatu Medical University. Patients and Methods: This was a longitudinal, observational, prospective study. After initial evaluation, urine and blood samples were collected for the analyzes that were described below. The patients were reassessed in six months. After the analyzes, the patients were divided into four groups regarding urinary sodium in 24 hours and their behavior over time. Urine samples of 24hs were evaluated for albuminuria, proteinuria, selectivity index, creatinine, sodium, potassium, urea and immunoglobulin type G (IgG). Blood samples were collected from each patient and evaluated for total proteins (albumin and globulin), serum sodium, creatinine, urea, serum IgG, glucose, potassium, uric acid, glycated hemoglobin. Results: The variation of the estimated sodium intake was directly associated with the variation of proteinuria, albuminuria and urinary IgG excretion. The fraction of excretion of albumin and the fraction of excretion of IgG were also associated with urinary sodium. The selectivity index was associated, in univariate analysis, with the estimated sodium intake in the study participants, this association lost statistical significance when adjusted for the presence of glomerulopathies. Both serum albumin and IgG had an inverse association with estimated sodium intake. Blood pressure (both SBP and DBP) of the study participants followed urinary sodium excretion and excretion of proteinuria and albuminuria. Conclusion: In patients with chronic kidney disease, the estimated sodium intake was not associated with proteinuria selectivity, which is a strong prognostic marker. However, this ingestion was associated with the amount of proteinuria, which is also an important predictor of renal survival. These data lead us to believe that sodium intake in these patients should be better monitored to decrease the progression of chronic kidney disease and improve the life expectancy of these patients.
Introduction: Renal diseases have assumed an increasingly relevant role in the burden of human suffering today, and the selectivity of proteinuria is an important marker of the evolution of these diseases. Improving this selectivity is an objective to be aimed at attenuating the growth of the prevalence of renal failure. On the other hand, sodium intake is associated, through hemodynamic and non-hemodynamic mechanisms, with an increase in the amount of proteinuria, which predicts worse evolution. If sodium intake is able to influence not only quantity but also the selectivity of proteinuria is a subject not yet known. Only a small cross-sectional study of diabetic nephropathy patients evaluated this question. No study, to our knowledge, has evaluated the association of sodium excretion within 24 hours and the selectivity of proteinuria in hypertensive nephropathy and glomerular diseases. Thus, it is hypothesized that lower sodium excretion may be associated with improved proteinuria selectivity in these patients and the objective of the present study was to longitudinally and prospectively evaluate the association between sodium intake and proteinuria selectivity in ambulatory patients Department of Nephrology at Botucatu Medical University. Patients and Methods: This was a longitudinal, observational, prospective study. After initial evaluation, urine and blood samples were collected for the analyzes that were described below. The patients were reassessed in six months. After the analyzes, the patients were divided into four groups regarding urinary sodium in 24 hours and their behavior over time. Urine samples of 24hs were evaluated for albuminuria, proteinuria, selectivity index, creatinine, sodium, potassium, urea and immunoglobulin type G (IgG). Blood samples were collected from each patient and evaluated for total proteins (albumin and globulin), serum sodium, creatinine, urea, serum IgG, glucose, potassium, uric acid, glycated hemoglobin. Results: The variation of the estimated sodium intake was directly associated with the variation of proteinuria, albuminuria and urinary IgG excretion. The fraction of excretion of albumin and the fraction of excretion of IgG were also associated with urinary sodium. The selectivity index was associated, in univariate analysis, with the estimated sodium intake in the study participants, this association lost statistical significance when adjusted for the presence of glomerulopathies. Both serum albumin and IgG had an inverse association with estimated sodium intake. Blood pressure (both SBP and DBP) of the study participants followed urinary sodium excretion and excretion of proteinuria and albuminuria. Conclusion: In patients with chronic kidney disease, the estimated sodium intake was not associated with proteinuria selectivity, which is a strong prognostic marker. However, this ingestion was associated with the amount of proteinuria, which is also an important predictor of renal survival. These data lead us to believe that sodium intake in these patients should be better monitored to decrease the progression of chronic kidney disease and improve the life expectancy of these patients.
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Palavras-chave
Sódio urinário, Proteinúria, Doença renal crônica não dialítica