Jornal SBC 191 | Junho 2018

SBC/DERC O departamento divulga os nomes dos palestrantes internacionais confirmados no Congresso DERC, em Florianópolis (www.congressoderc.com.br) , de 25 a 27 de outubro: Salvador Borges-Neto (Professor de Medicina e Radiologia da Duke University Medical Center , autoridade em Cardiologia Nuclear), Sanjay Sharma ( St George’s, University of London , autori- dade em cardiopatias de atleta e diretor médico da Maratona de Londres) e Josef Niebauer ( Paracelsus Medical University Salzburg-Austria, Institute of Sports Medicine, Prevention and Rehabilitation ). Departamentos SBC/DA O Departamento de Aterosclerose realizará o tradicional Simpósio, durante o 73º Congresso Brasileiro de Cardiologia, em Brasília, e convida a todos os associados e participantes do evento que reservarem a data em suas agendas para essa atividade! O Simpósio do DA acontecerá em 14 de setembro, das 9h às 12h30. SBC/DCC/CP A incidência das cardiopatias congênitas é de oito a dez por mil nascidos vivos. No Brasil, 28,9 mil crianças nascem com cardio- patia congênita por ano (1% do total de nascimento). Destas, cerca de 80% (23,8 mil) necessitam de cirurgia cardíaca, e metade pre- cisa operar ainda no primeiro ano de vida. Devido a estes motivos, o congresso nacional instituiu o dia 12 de junho como Dia Nacional de Conscientização da Cardiopatia Congênita, por meio de proje- to de lei, para promover, anualmente, eventos com a finalidade de conscientizar a sociedade das cardiopatias congênitas, suas mani- festações e necessidade de diagnóstico precoce e tratamento. A di- vulgação deste dia mobiliza e amplia a seguridade social da popu- lação e das crianças. Diversos Estados e municípios já aderiram à data. O conteúdo completo do DCC/CP pode ser acessado no link : http://jornal.cardiol.br/2018/junho/dep_DCC_CP.html SBC/DCC Adequação terapêutica e investigação diag- nóstica no paciente cardiopata devem ser planejadas de forma a evitar iatrogenias. Des- tacamos a excelente revisão sobre nefropro- teção em farmacologia, publicado por Mark Anthony Perazella, da Universidade Yale, na qual aspectos relacionados a fármacos como bloqueadores de receptores da angiotensina (BRA), inibidores da enzima conversora de angiotensina (IECA) e estatinas, e a meios de contraste, como iodo e gadolíneo, são avalia- dos com foco na prevenção da injúria renal. O conteúdo encontra-se disponível no en- dereço: http://cjasn.asnjournals.org/content/ early/2018/04/04/CJN.00150118.full.pdf Nephropharmacology for the Clinician Pharmacology behind Common Drug Nephrotoxicities MarkA.Perazella Abstract Patientsareexposedtonumerousprescribedandover-the-countermedications.Unfortunately,drugsremain arelativelycommoncauseofacuteandchronickidneyinjury.Acombinationoffactorsincludingtheinnate nephrotoxicityofdrugs,underlyingpatientcharacteristicsthatincreasetheirriskforkidneyinjury,andthe metabolismandpathwayofexcretionbythekidneysofthevariousagentsadministeredenhanceriskfordrug- inducednephrotoxicity.Thispaperwillreviewtheseclinicallyrelevantaspectsofdrug-inducednephrotoxicityfor theclinicalnephrologist. ClinJAmSocNephrol 14: ccc – ccc ,2018.doi: https://doi.org/10.2215/CJN.00150118 Introduction Medications are a relatively common cause of kid- neyinjury(1 – 12).Theepidemiologyofdrug-induced nephrotoxicity is currently based on literature focus- ing on AKI. Drug-induced nephrotoxicity in adults is approximately 14% – 26% in prospective cohort studies ofAKI,whereas16%ofhospitalizedAKIisduetodrugs in the pediatric population (1 – 4). Drug-induced neph- rotoxicityismorecommoninhospitalizedpatients,in particularintensivecareunitpatients(2,5). Importantly, the general population is exposed to a large number of prescribed and over-the-counter drugs as well as a variety of substances available at health food stores (natural products, supplements, herbalremedies)(6 – 20).Variousimagingagentsused fordiagnosticpurposesarealsoassociatedwithneph- rotoxicity (21 – 23). However, not all patients exposed to the various potential nephrotoxins develop kidney disease.Thus,thenephrotoxicityofmedications,drugs, andotheringestedsubstancesisacomplicatedprocess thatinvolvesacombinationoffactors.Theseincludethe inherentnephrotoxicpotentialofthedrug,underlying patientcharacteristicsthatenhancetheirriskforkidney injury,andthemetabolismandexcretionofthepoten- tialoffendingagentbythekidney(6 – 9). Aspartofthe ClinicalJournaloftheAmericanSociety of Nephrology series “ Nephropharmacology for the Clinician, ” thisreviewwillcoversomeofthecommon nephrotoxicdrugsthatthekidneyisexposedtoinclin- icalpractice,thefactorsthatincreasevulnerabilityofthe kidneytothesepotentialtoxins,provideinsightintothe mechanismsbywhichkidneyinjuryoccurs,andcover some ofthe associated clinical kidney syndromes that developinresponsetotheseagents(1 – 33). Factors Associated with Drug-Induced Nephrotoxicity The development of drug-induced nephrotoxicity can be best understood by examining the factors that contribute tonephrotoxicity (1 – 9). Exposure toa potentially nephrotoxic medication is an obvious re- quirement. Drugs may be modestly nephrotoxic or maintainhighrisktocausekidneyinjuryonthebasis oftheirstructure,dose,metabolichandling,excretory pathway through the kidney, and other characteris- tics (5 – 9). Underlying patient characteristics, such as comorbid conditions, genetic determinants of drug metabolismandtransport,andimmuneresponsegenes, arealsoimportantindrugnephrotoxicity(5 – 9).Asthe kidneymetabolizesandexcretes(through fi ltrationand tubularsecretion)manyingesteddrugs,theinteraction of these substances with various parts of the nephron maybeassociatedwithnephrotoxicity(5 – 9).Forkidney injury to occur, some combination of these three risk factorsisgenerallypresent.Moreoftenthannot,more thanoneispresent.Itisthedifferencesinstructureof the ingested drug, underlying patient characteristics, andalterationsinkidneyhandlingoftheingestedsub- stancethatlikelyexplainthevariabilityandheteroge- neityobservedwithdrug-inducednephrotoxicity. The Drug The initial step in the development of kidney in- juryinvolvesexposuretoapotentiallytoxicoffending agent.Thegeneralpopulationisexposedtoavariety of potential nephrotoxic substances including pre- scribedtherapeuticagents,over-the-counterproducts, diagnostic agents, and environmental substances (Table 1). Examples of potentially nephrotoxicdrugs that are utilized to treat various disease processes include antimicrobial agents, anticancer drugs, anal- gesics, and immunosuppressive agents (1 – 34). Fur- thermore, a large number of new medications with unknownnephrotoxicpotentialmakeitthroughclin- ical trials and are subsequently released into clinical practicewheretheycausekidneyinjury.Thisislikely related to exposure of these new drugs in patients who have comorbidities or other characteristics that increase nephrotoxic risk that were not included in clinical trials. Although clinicians prescribe the vast Sectionof Nephrology, Departmentof Medicine,Yale University,New Haven,Connecticut andVeteransAffairs MedicalCenter,West Haven,Connecticut Correspondence: Dr.MarkA.Perazella, BB114,330Cedar Street,Newhaven,CT 06410.Email:mark. perazella@yale.edu www.cjasn.orgVol 14January,2018 Copyright©2018bytheAmericanSocietyofNephrology 1 .PublishedonApril 5, 2018 asdoi:10.2215/CJN.00150118 CJASN ePress Os corações em todo Brasil ... Dia 12 de junho – Dia nacional da Conscientização da Cardiopatia Congênita Vão pulsar no dia 12 de junho pelos corações com CARDIOPATIA CONGÊNITA PULSA BRASIL!!! 20