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Control Cardiovascular Autónomo en Pacientes Normotensivos con Enfermedad Renal Poliquística Autosomal Dominante
Daniel Ribeiro Rocha1, Ana Carolina Anauate1, Milene Subtil Ormanji1
1Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil.
Kidney360
|August 28, 2025
Resumen
La enfermedad renal poliquística autosómica dominante temprana (ADPKD, por sus siglas en inglés) no muestra disfunción autónoma, pero sí niveles elevados de angiotensinógeno y albúmina urinaria, lo que sugiere que la sobreactivación de la RAAS intrarenal contribuye a la hipertensión.
Área de la Ciencia:
- Nefrología
- Fisiología cardiovascular
- Biología molecular
Sus antecedentes:
- La enfermedad renal poliquística autosómica dominante (ADPKD) es un trastorno renal genético común.
- La hipertensión es una complicación temprana frecuente de ADPKD con orígenes poco claros.
- Investigar los cambios cardiovasculares y moleculares tempranos es crucial para comprender la patogénesis de la ADPKD.
Objetivo del estudio:
- Evaluar el control autónomo cardiovascular en pacientes jóvenes con EADP normalizada.
- Investigar los factores humoral y urinario involucrados en la regulación de la presión arterial.
- Identificar los marcadores tempranos que preceden a la hipertensión y la disfunción renal en la EADP.
Principales métodos:
- Comparación de la variabilidad de la frecuencia cardíaca, la variabilidad de la presión arterial y la sensibilidad al barorreflejo en 18 pacientes con ADPKD y 19 controles.
- Evaluación de la reactividad cardiovascular mediante pruebas de presión en frío, de Stroop y de agarre.
- Se han medido marcadores séricos y urinarios que incluyen el angiotensinógeno (AGT), la proteína quimioatractora monocítica-1 (MCP-1) y la albúmina.
Principales resultados:
- No hay diferencias significativas en la función autónoma o en la reactividad cardiovascular entre los pacientes con EADP y los controles.
- No hay diferencias en los marcadores séricos o urinarios de MCP-1.
- Se observaron niveles significativamente más altos de AGT y albúmina urinaria en pacientes con ADPKD.
Conclusiones:
- En la etapa temprana, la ADPKD carece de desregulación autónoma, inflamación sistémica o disfunción endotelial.
- La hiperactivación intrarenal del sistema renina- angiotensina- aldosterona (RAAS, por sus siglas en inglés) está implicada en la hipertensión relacionada con la ADPKD.
- La AGT urinaria y la albúmina pueden servir como indicadores tempranos de la participación del RAAS en la ADPKD.
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