NEFROESCLEROSE HIPERTENSIVA MALIGNA

Débora Dornelas da  Cunha; Barbara Lopes  Farace; Breno Alves  Araujo; Luiza Aguiar  Falci; Luiza Esther De Aragão  Ramos

doi:10.51161/rems/2770

NEFROESCLEROSE HIPERTENSIVA MALIGNA

Autores

Débora Dornelas da Cunha
Barbara Lopes Farace
Breno Alves Araujo
Luiza Aguiar Falci
Luiza Esther De Aragão Ramos

DOI:

https://doi.org/10.51161/rems/2770

Palavras-chave:

NEFROESCLEROSE HIPERTENSIVA MALIGNA, SÍNDROME CORONARIANA AGUDA, HIPERTENSÃO ARTERIAL SECUNDÁRIA, ANEMIA HEMOLÍTICA MICROANGIOPÁTICA

Resumo

Introdução Emergência hipertensiva em paciente jovem sem fatores de risco evidenciando a importância de abordagem sindrômica inicial e manejo após diagnóstico etiológico. síndrome coronariana aguda (SCA) é uma emergência hipertensiva comum no pronto socorro e de manejo bem documentado. Já a nefroesclerose hipertensiva maligna (NHM) é uma entidade clínica mais complexa e com diagnósticos diferenciais desafiadores que merecem reconhecimento precoce, tratamento e manejo adequado. Objetivo: Ressaltar a importância do atendimento da emergência hipertensiva, bem como elencar diagnósticos diferenciais importantes e a propedêutica necessária. Material e Métodos: Relato de experiência, partir de vivência com o atendimento da emergência hipertensiva complementado com revisão de literatura em base de dados como PUBMED e SCIELO. Resultados: 37 anos, sexo masculino, previamente hígido, relatava dor epigástrica recorrente há 3 meses, em aperto, e dispneia aos esforços. Apresentou perda ponderal de 5Kg nos últimos 3 meses, espumaria e períodos de turvação visual transitória com cefaléia recorrente. Admitido com hipertensão importante, dor epigástrica e o ECG evidenciava infra de ST e inversão de onda T em parede inferior, sendo diagnosticado inicialmente síndrome coronariana aguda sem supra de ST (SCASST). Marcadores de necrose miocárdica positivos e com curva ascendente. Iniciado protocolo de SCA e vasodilatador venoso com desmame gradual. Fundo de olho com papiledema bilateral, exames com anemia hemolítica microangiopática (AHMA) e disfunção renal grave. Assim, aventada também hipótese de nefroesclerose hipertensiva maligna (NHM), foi otimizado o tratamento do quadro hipertensivo. Evoluiu com piora progressiva de função renal. Durante a internação, manteve hipertensão de difícil controle. Iniciada diálise por piora das escórias (Cr 9,7 e Ur 221). Propedêutica inicial com dosagem sérica de aldosterona e atividade de renina plasmática elevadas, doppler de artérias renais sem estenoses, propedêutica para feocromocitoma e função tireoideana normal. A cinética do cálcio evidenciou hiperparatireoidismo secundário (HPTS) e, ao ultrassom, foram vistos rins reduzidos de tamanho, em estágio terminal, sendo iniciado o manejo de doença renal crônica e HPTS. Conclusão. Percebe-se que NHM apresenta importantes caractisticas complexas sendo necessário uum correto diagnostico e abordagem. Há uma diferenciação entre eles os casos citados, à exemploo, a propedêutica adequada e a rápida tomada de decisão, essenciais para a boa evolução do paciente e melhora do prognóstico, já que requerem tratamentos distintos.

Publicado

2021-12-16

Como Citar

Cunha, D. D. da ., Farace, B. L. ., Araujo, B. A. ., Falci, L. A. ., & Ramos, L. E. D. A. . (2021). NEFROESCLEROSE HIPERTENSIVA MALIGNA. Revista Multidisciplinar Em Saúde, 2(4), 18. https://doi.org/10.51161/rems/2770

Baixar Citação

Edição

v. 2 n. 4 (2021)

Seção

I Congresso Brasileiro de Saúde Pública On-line: Uma abordagem Multiprofissional

Licença

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.

O conteúdo desta revista foi migrado para https://editoraintegrar.com.br

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Dispatcher.dispatch(Object:Request) % line  281, file: PKPApplication.inc.php
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   PKPPageRouter.route(Object:Request) % line  143, file: Dispatcher.inc.php
Dispatcher.dispatch(Object:Request) % line  281, file: PKPApplication.inc.php
PKPApplication.execute() % line   68, file: index.php

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                                                            ArticleSearchDAO.getPhraseResults(Object:Journal, Array[1], null, null, , 500, 1) % line  201, file: SubmissionSearch.inc.php
                                                         SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[1], , null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                      SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[4], , null, null, 500, 1) % line  194, file: SubmissionSearch.inc.php
                                                   SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[4], null, null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[3], null, null, null, 500, 1) % line  132, file: SubmissionSearch.inc.php
                                             SubmissionSearch._getMergedArray(Object:Journal, Array[1], null, null) % line  263, file: SubmissionSearch.inc.php
                                          SubmissionSearch.retrieveResults(Object:Request, Object:Journal, Array[1], null, null, null, Object:DBResultRange, Array[1]) % line   92, file: RecommendBySimilarityPlugin.inc.php
                                       RecommendBySimilarityPlugin.callbackTemplateArticlePageFooter(Templates::Article::Footer::PageFooter, Array[3]) % line  107, file: HookRegistry.inc.php
                                    HookRegistry.call(Templates::Article::Footer::PageFooter, Array[3]) % line 1267, file: PKPTemplateManager.inc.php
                                 PKPTemplateManager.smartyCallHook(Array[1], Object:Smarty_Internal_Template) % line   43, file: 42362804174f266c598cdb32c3208fc745b92101^1c372c95cd85572e0fbc9a53d0323a0b229cfc78_0.app.frontendpagesarticle.tpl.php
                              content_6781613650b432_13896783(Object:Smarty_Internal_Template) % line  123, file: smarty_template_resource_base.php
                           Smarty_Template_Resource_Base.getRenderedTemplateCode(Object:Smarty_Internal_Template) % line  114, file: smarty_template_compiled.php
                        Smarty_Template_Compiled.render(Object:Smarty_Internal_Template) % line  216, file: smarty_internal_template.php
                     Smarty_Internal_Template.render(false, 1) % line  232, file: smarty_internal_templatebase.php
                  Smarty_Internal_TemplateBase._execute(Object:Smarty_Internal_Template, null, 42362804174f266c598cdb32c3208fc745b92101, null, 1) % line  134, file: smarty_internal_templatebase.php
               Smarty_Internal_TemplateBase.display(frontend/pages/article.tpl, null, 42362804174f266c598cdb32c3208fc745b92101, null) % line  924, file: PKPTemplateManager.inc.php
            PKPTemplateManager.display(frontend/pages/article.tpl) % line  292, file: ArticleHandler.inc.php
         ArticleHandler.view(Array[1], Object:Request) % line  391, file: PKPRouter.inc.php
      PKPRouter._authorizeInitializeAndCallRequest(Array[2], Object:Request, Array[1], false) % line  231, file: PKPPageRouter.inc.php
   PKPPageRouter.route(Object:Request) % line  143, file: Dispatcher.inc.php
Dispatcher.dispatch(Object:Request) % line  281, file: PKPApplication.inc.php
PKPApplication.execute() % line   68, file: index.php

                                                                  ADOConnection.CacheExecute(3600, SELECT 				o.submission_id, 				MAX(s.context_id) AS journal_id, 				MAX(i.date_published) AS i_pub, 				MAX(p.date_published) A..., Array[2]) % line  132, file: DAO.inc.php
                                                               DAO.retrieveCached(SELECT 				o.submission_id, 				MAX(s.context_id) AS journal_id, 				MAX(i.date_published) AS i_pub, 				MAX(p.date_published) A..., Array[2], 3600) % line   91, file: ArticleSearchDAO.inc.php
                                                            ArticleSearchDAO.getPhraseResults(Object:Journal, Array[1], null, null, , 500, 1) % line  201, file: SubmissionSearch.inc.php
                                                         SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[1], , null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                      SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[4], , null, null, 500, 1) % line  194, file: SubmissionSearch.inc.php
                                                   SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[4], null, null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[3], null, null, null, 500, 1) % line  132, file: SubmissionSearch.inc.php
                                             SubmissionSearch._getMergedArray(Object:Journal, Array[1], null, null) % line  263, file: SubmissionSearch.inc.php
                                          SubmissionSearch.retrieveResults(Object:Request, Object:Journal, Array[1], null, null, null, Object:DBResultRange, Array[1]) % line   92, file: RecommendBySimilarityPlugin.inc.php
                                       RecommendBySimilarityPlugin.callbackTemplateArticlePageFooter(Templates::Article::Footer::PageFooter, Array[3]) % line  107, file: HookRegistry.inc.php
                                    HookRegistry.call(Templates::Article::Footer::PageFooter, Array[3]) % line 1267, file: PKPTemplateManager.inc.php
                                 PKPTemplateManager.smartyCallHook(Array[1], Object:Smarty_Internal_Template) % line   43, file: 42362804174f266c598cdb32c3208fc745b92101^1c372c95cd85572e0fbc9a53d0323a0b229cfc78_0.app.frontendpagesarticle.tpl.php
                              content_6781613650b432_13896783(Object:Smarty_Internal_Template) % line  123, file: smarty_template_resource_base.php
                           Smarty_Template_Resource_Base.getRenderedTemplateCode(Object:Smarty_Internal_Template) % line  114, file: smarty_template_compiled.php
                        Smarty_Template_Compiled.render(Object:Smarty_Internal_Template) % line  216, file: smarty_internal_template.php
                     Smarty_Internal_Template.render(false, 1) % line  232, file: smarty_internal_templatebase.php
                  Smarty_Internal_TemplateBase._execute(Object:Smarty_Internal_Template, null, 42362804174f266c598cdb32c3208fc745b92101, null, 1) % line  134, file: smarty_internal_templatebase.php
               Smarty_Internal_TemplateBase.display(frontend/pages/article.tpl, null, 42362804174f266c598cdb32c3208fc745b92101, null) % line  924, file: PKPTemplateManager.inc.php
            PKPTemplateManager.display(frontend/pages/article.tpl) % line  292, file: ArticleHandler.inc.php
         ArticleHandler.view(Array[1], Object:Request) % line  391, file: PKPRouter.inc.php
      PKPRouter._authorizeInitializeAndCallRequest(Array[2], Object:Request, Array[1], false) % line  231, file: PKPPageRouter.inc.php
   PKPPageRouter.route(Object:Request) % line  143, file: Dispatcher.inc.php
Dispatcher.dispatch(Object:Request) % line  281, file: PKPApplication.inc.php
PKPApplication.execute() % line   68, file: index.php

                                                                  ADOConnection.CacheExecute(3600, SELECT 				o.submission_id, 				MAX(s.context_id) AS journal_id, 				MAX(i.date_published) AS i_pub, 				MAX(p.date_published) A..., Array[2]) % line  132, file: DAO.inc.php
                                                               DAO.retrieveCached(SELECT 				o.submission_id, 				MAX(s.context_id) AS journal_id, 				MAX(i.date_published) AS i_pub, 				MAX(p.date_published) A..., Array[2], 3600) % line   91, file: ArticleSearchDAO.inc.php
                                                            ArticleSearchDAO.getPhraseResults(Object:Journal, Array[1], null, null, , 500, 1) % line  201, file: SubmissionSearch.inc.php
                                                         SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[1], , null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                      SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[4], , null, null, 500, 1) % line  194, file: SubmissionSearch.inc.php
                                                   SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[4], null, null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[3], null, null, null, 500, 1) % line  132, file: SubmissionSearch.inc.php
                                             SubmissionSearch._getMergedArray(Object:Journal, Array[1], null, null) % line  263, file: SubmissionSearch.inc.php
                                          SubmissionSearch.retrieveResults(Object:Request, Object:Journal, Array[1], null, null, null, Object:DBResultRange, Array[1]) % line   92, file: RecommendBySimilarityPlugin.inc.php
                                       RecommendBySimilarityPlugin.callbackTemplateArticlePageFooter(Templates::Article::Footer::PageFooter, Array[3]) % line  107, file: HookRegistry.inc.php
                                    HookRegistry.call(Templates::Article::Footer::PageFooter, Array[3]) % line 1267, file: PKPTemplateManager.inc.php
                                 PKPTemplateManager.smartyCallHook(Array[1], Object:Smarty_Internal_Template) % line   43, file: 42362804174f266c598cdb32c3208fc745b92101^1c372c95cd85572e0fbc9a53d0323a0b229cfc78_0.app.frontendpagesarticle.tpl.php
                              content_6781613650b432_13896783(Object:Smarty_Internal_Template) % line  123, file: smarty_template_resource_base.php
                           Smarty_Template_Resource_Base.getRenderedTemplateCode(Object:Smarty_Internal_Template) % line  114, file: smarty_template_compiled.php
                        Smarty_Template_Compiled.render(Object:Smarty_Internal_Template) % line  216, file: smarty_internal_template.php
                     Smarty_Internal_Template.render(false, 1) % line  232, file: smarty_internal_templatebase.php
                  Smarty_Internal_TemplateBase._execute(Object:Smarty_Internal_Template, null, 42362804174f266c598cdb32c3208fc745b92101, null, 1) % line  134, file: smarty_internal_templatebase.php
               Smarty_Internal_TemplateBase.display(frontend/pages/article.tpl, null, 42362804174f266c598cdb32c3208fc745b92101, null) % line  924, file: PKPTemplateManager.inc.php
            PKPTemplateManager.display(frontend/pages/article.tpl) % line  292, file: ArticleHandler.inc.php
         ArticleHandler.view(Array[1], Object:Request) % line  391, file: PKPRouter.inc.php
      PKPRouter._authorizeInitializeAndCallRequest(Array[2], Object:Request, Array[1], false) % line  231, file: PKPPageRouter.inc.php
   PKPPageRouter.route(Object:Request) % line  143, file: Dispatcher.inc.php
Dispatcher.dispatch(Object:Request) % line  281, file: PKPApplication.inc.php
PKPApplication.execute() % line   68, file: index.php

                                                                  ADOConnection.CacheExecute(3600, SELECT 				o.submission_id, 				MAX(s.context_id) AS journal_id, 				MAX(i.date_published) AS i_pub, 				MAX(p.date_published) A..., Array[2]) % line  132, file: DAO.inc.php
                                                               DAO.retrieveCached(SELECT 				o.submission_id, 				MAX(s.context_id) AS journal_id, 				MAX(i.date_published) AS i_pub, 				MAX(p.date_published) A..., Array[2], 3600) % line   91, file: ArticleSearchDAO.inc.php
                                                            ArticleSearchDAO.getPhraseResults(Object:Journal, Array[1], null, null, , 500, 1) % line  201, file: SubmissionSearch.inc.php
                                                         SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[1], , null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                      SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[4], , null, null, 500, 1) % line  194, file: SubmissionSearch.inc.php
                                                   SubmissionSearch._getMergedPhraseResults(Object:Journal, Array[4], null, null, null, 500, 1) % line  146, file: SubmissionSearch.inc.php
                                                SubmissionSearch._getMergedKeywordResults(Object:Journal, Array[3], null, null, null, 500, 1) % line  132, file: SubmissionSearch.inc.php
                                             SubmissionSearch._getMergedArray(Object:Journal, Array[1], null, null) % line  263, file: SubmissionSearch.inc.php
                                          SubmissionSearch.retrieveResults(Object:Request, Object:Journal, Array[1], null, null, null, Object:DBResultRange, Array[1]) % line   92, file: RecommendBySimilarityPlugin.inc.php
                                       RecommendBySimilarityPlugin.callbackTemplateArticlePageFooter(Templates::Article::Footer::PageFooter, Array[3]) % line  107, file: HookRegistry.inc.php
                                    HookRegistry.call(Templates::Article::Footer::PageFooter, Array[3]) % line 1267, file: PKPTemplateManager.inc.php
                                 PKPTemplateManager.smartyCallHook(Array[1], Object:Smarty_Internal_Template) % line   43, file: 42362804174f266c598cdb32c3208fc745b92101^1c372c95cd85572e0fbc9a53d0323a0b229cfc78_0.app.frontendpagesarticle.tpl.php
                              content_6781613650b432_13896783(Object:Smarty_Internal_Template) % line  123, file: smarty_template_resource_base.php
                           Smarty_Template_Resource_Base.getRenderedTemplateCode(Object:Smarty_Internal_Template) % line  114, file: smarty_template_compiled.php
                        Smarty_Template_Compiled.render(Object:Smarty_Internal_Template) % line  216, file: smarty_internal_template.php
                     Smarty_Internal_Template.render(false, 1) % line  232, file: smarty_internal_templatebase.php
                  Smarty_Internal_TemplateBase._execute(Object:Smarty_Internal_Template, null, 42362804174f266c598cdb32c3208fc745b92101, null, 1) % line  134, file: smarty_internal_templatebase.php
               Smarty_Internal_TemplateBase.display(frontend/pages/article.tpl, null, 42362804174f266c598cdb32c3208fc745b92101, null) % line  924, file: PKPTemplateManager.inc.php
            PKPTemplateManager.display(frontend/pages/article.tpl) % line  292, file: ArticleHandler.inc.php
         ArticleHandler.view(Array[1], Object:Request) % line  391, file: PKPRouter.inc.php
      PKPRouter._authorizeInitializeAndCallRequest(Array[2], Object:Request, Array[1], false) % line  231, file: PKPPageRouter.inc.php
   PKPPageRouter.route(Object:Request) % line  143, file: Dispatcher.inc.php
Dispatcher.dispatch(Object:Request) % line  281, file: PKPApplication.inc.php
PKPApplication.execute() % line   68, file: index.php

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