Video Experimental Relacionado
Updated: Jun 18, 2026
08:22
Combined Intravital Microscopy and Contrast-enhanced Ultrasonography of the Mouse Hindlimb to Study Insulin-induced Vasodilation and Muscle Perfusion
Published on: March 20, 2017
Revascularización coronaria en pacientes diabéticos insulinodependientes con insuficiencia renal crónica
1Department of Medicine, University of Minnesota, School of Medicine, Minneapolis.
Lancet (London, England)
|October 24, 1992
Resumen
La revascularización coronaria redujo significativamente los eventos cardíacos en pacientes diabéticos insulinodependientes con insuficiencia renal crónica y enfermedad arterial coronaria sin síntomas. Se recomienda la detección de la enfermedad coronaria silenciosa para estos pacientes.
Área de la Ciencia:
- Cardiología Cardiología.
- Nefrología Nefrología.
- Diabetología Diabetología.
Sus antecedentes:
- Los pacientes diabéticos dependientes de insulina que se someten a una evaluación de trasplante renal a menudo tienen una enfermedad arterial coronaria significativa (CAD).
- El CAD sustancial en esta población se asocia con una supervivencia de 2 años pobre (<50%).
- El manejo de CAD asintomático o mínimamente sintomático en estos pacientes es controvertido.
Objetivo del estudio:
- Investigar si la revascularización de la arteria coronaria reduce la incidencia combinada de angina inestable, infarto de miocardio y muerte cardíaca.
- Evaluar el impacto de la revascularización frente al manejo médico en los resultados cardiovasculares en candidatos a trasplante renal diabético seleccionados.
Principales métodos:
- La angiografía coronaria se realizó en 151 candidatos diabéticos insulinodependientes para el trasplante renal.
- Se identificaron 31 pacientes con CAD grave (estenosis >75%), dolor torácico atípico / sin dolor torácico y fracción de eyección preservada.
- 26 pacientes fueron asignados al azar para recibir tratamiento médico (bloqueador de los canales de calcio + aspirina) o revascularización (angioplastia / cirugía de derivación).
Principales resultados:
- La revascularización disminuyó significativamente los puntos finales cardiovasculares en comparación con el tratamiento médico (2/13 frente a 10/13 pacientes, p < 0,01).
- La administración médica se asoció con una mayor incidencia de eventos cardiovasculares, incluidas 4 muertes por infarto de miocardio.
- La mediana de seguimiento fue de 8,4 meses.
Conclusiones:
- La revascularización coronaria parece disminuir la morbilidad y mortalidad cardíacas en pacientes diabéticos insulinodependientes con insuficiencia renal crónica y estenosis coronaria severa asintomática.
- La detección de la enfermedad coronaria silenciosa se sugiere para los pacientes diabéticos que se consideran para el trasplante renal.
- La revascularización puede ser una estrategia beneficiosa para esta población de alto riesgo.
Videos de Conceptos Relacionados
01:36Carbohydrate Metabolism
Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in the...
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in the...
01:28Kidney Transplant I: Introduction
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
01:26Type I Diabetes II: Pathophysiology
Type 1 diabetes mellitus arises from an immune-mediated destruction of pancreatic β-cells, resulting in an absolute deficiency of insulin. This process develops in genetically susceptible individuals when autoimmunity, environmental exposures, and immunologic dysregulation converge to trigger a targeted attack on the insulin-producing cells of the pancreas. The β-cells are located within the islets of Langerhans and are essential for regulating blood glucose by facilitating cellular uptake of...
01:24Type II Diabetes II: Pathophysiology
PathophysiologyType 2 diabetes mellitus (T2DM ) is a chronic metabolic disorder characterized by insulin resistance and progressive pancreatic β-cell dysfunction, leading to impaired glucose homeostasis. It results from interactions among genetic predisposition, environmental factors, and metabolic stressors, such as overnutrition and a sedentary lifestyle.Insulin Resistance and Glucose DysregulationEarly T2DM involves insulin resistance in skeletal muscle, adipose tissue, and the liver.
01:22Complications of Diabetes Mellitus
Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.Acute ComplicationsAcute complications result from sudden metabolic imbalance.Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency,...
01:28Diabetic Nephropathy
Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration occur due to afferent arteriolar...