{"id":115076,"date":"2018-03-11T10:43:26","date_gmt":"2018-03-11T10:43:26","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/biomarcadores-plasmaticos-y-urinarios-en-pacientes-con-insuficiencia-cardiaca-aguda-nt-probnp-y-la-influencia-de-la-disfuncion-renal-en-su-aclaramiento-y-valor-pronostico\/"},"modified":"2018-03-11T10:43:26","modified_gmt":"2018-03-11T10:43:26","slug":"biomarcadores-plasmaticos-y-urinarios-en-pacientes-con-insuficiencia-cardiaca-aguda-nt-probnp-y-la-influencia-de-la-disfuncion-renal-en-su-aclaramiento-y-valor-pronostico","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/bioquimica\/biomarcadores-plasmaticos-y-urinarios-en-pacientes-con-insuficiencia-cardiaca-aguda-nt-probnp-y-la-influencia-de-la-disfuncion-renal-en-su-aclaramiento-y-valor-pronostico\/","title":{"rendered":"Biomarcadores plasm\u00e1ticos y urinarios en pacientes con insuficiencia cardiaca aguda. nt-probnp y la influencia de la disfunci\u00f3n renal en su aclaramiento y valor pron\u00f3stico"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Miguel Boronat Garcia <\/strong><\/h2>\n<p>Resumen   objetivos 1. Evaluar como influye la funci\u00f3n renal glomerular, medida por tfge, en la concentraci\u00f3n de nt-probnp urinario. 2. Evaluar la relaci\u00f3n entre las concentraciones de marcadores bioqu\u00edmicos espec\u00edficos de funci\u00f3n renal glomerular y tubular y las concentraciones de nt-probnp, para ayudar a identificar su mecanismo de eliminaci\u00f3n renal. 3. Evaluar el valor pron\u00f3stico de los niveles de nt-probnp urinario y compararlo con el de nt-probnp plasm\u00e1tico en pacientes con ica.   material y m\u00e9todos se incluyeron prospectivamente 138 pacientes consecutivos ingresados, diagnosticados de ica, en el hospital virgen de la arrixaca. Se recogieron simult\u00e1neamente muestras de sangre y orina al ingreso. Los par\u00e1metros de laboratorio medidos en suero fueron: glucosa, creatinina, urea, alb\u00famina, sodio, \u00e1cido \u00farico, pcr, troponina t, cistatina c, btp y nt-probnp. Y en orina: alfa-1 microglobulina, alb\u00famina (mau) y nt-probnp.  resultados 1. Nt-probnp plasm\u00e1tico y urinario fue m\u00e1s elevado en pacientes con un mayor deterioro de la tfge (p&lt;0,001). Nt-probnp plasm\u00e1tico correlacion\u00f3 positivamente con los valores de nt-probnp urinario (r=0,61, p&lt;0,001) las correlaciones tfge &#8211; nt-probnp tambi\u00e9n fueron significativas aunque menos potentes (r=-0,44; nt-probnp plasm\u00e1tico y r=-0,37; nt-probnp urinario, p&lt;0,001 para ambos). Tfge, tras ajuste multivariable, tan s\u00f3lo fue predictora independiente de las concentraciones plasm\u00e1ticas de nt-probnp (y de una forma d\u00e9bil). El principal predictor independiente de las concentraciones urinarias de nt-probnp fue el nt-probnp en plasma. 2. Los niveles urinarios de alfa-1 microglobulina (? = 0,50; p &lt;0,001) y el nt-probnp plasm\u00e1tico (? = 0,29; p &lt;0,001) fueron los principales predictores independientes de los niveles de nt-probnp urinario mientras que la creatinina, mdrd, cistatina c, btp y mau no alcanzaron significaci\u00f3n estad\u00edstica. 3. Los pacientes que presentaron eventos cl\u00ednicos ten\u00edan una concentraci\u00f3n plasm\u00e1tica superior de nt-probnp (4.561 pg\/ml [2.191-8.631] frente a 2.906 pg\/ml [1.643-5.823]; p=0,03) pero su concentraci\u00f3n urinaria de nt-probnp fue similar (78 pg\/ml [42-294] frente a 71 pg\/ml [41-189]; p=0,62) en comparaci\u00f3n con las de los pacientes que no sufrieron eventos cl\u00ednicos. en los an\u00e1lisis de regresi\u00f3n de cox univariables y multivariables, la concentraci\u00f3n plasm\u00e1tica de nt-probnp por encima de la mediana (3.345 pg\/ml) se asoci\u00f3 a un mayor riesgo de eventos cl\u00ednicos adversos (hr=2,35; ic del 95%, 1,41-3,93; p=0,001). Sin embargo, la concentraci\u00f3n urinaria de nt-probnp por encima de la mediana (73 pg\/ml) no alcanz\u00f3 significaci\u00f3n estad\u00edstica como factor predictivo del pron\u00f3stico de eventos en el an\u00e1lisis univariable (hr=1,2; ic del 95%, 0,79-1,96; p=0,46)  conclusiones 1. El deterioro de la funci\u00f3n renal glomerular se asocia con un aumento de las concentraciones de nt-probnp plasm\u00e1ticas y urinarias. Sin embargo, el filtrado glomerular renal no es predictor independiente de nt-probnp urinario.  2a. Nt-probnp plasm\u00e1tico fue el mayor predictor de las concentraciones urinarias de nt-probnp. Podr\u00eda deberse a una mayor producci\u00f3n de nt-probnp a nivel cardiaco como consecuencia del mayor estr\u00e9s cardiovascular de los enfermos con afectaci\u00f3n cardiaca y renal concomitante.  2b. Sugerimos que la presencia de disfunci\u00f3n tubular renal podr\u00eda estar implicada en el aumento de niveles de nt-probnp urinarios observados en pacientes con ir ya que, a diferencia de los marcadores de filtrado glomerular renal, alfa-1 microglobulina (par\u00e1metro de funci\u00f3n tubular renal) fue predictor independiente de nt-probnp urinario. As\u00ed, una disminuci\u00f3n de la reabsorci\u00f3n de nt-probnp a nivel del t\u00fabulo proximal favorecer\u00eda un aumento de los niveles urinarios de nt-probnp. 3. Consideramos que nt-probnp urinario no debe ser utilizado con fines pron\u00f3sticos en pacientes con ica debido a que los niveles plasm\u00e1ticos de nt-probnp se asocian de forma independiente con el pron\u00f3stico de los pacientes con ica pero, por el contrario, los niveles urinarios de nt-probnp no presentan asociaci\u00f3n con la aparici\u00f3n de eventos durante el seguimiento en este tipo de pacientes.            universidad de murcia departamento de bioqu\u00edmica, biolog\u00eda molecular (b) e inmunolog\u00eda    plasma and urinary biomarkers in patients with acute heart failure. Nt-probnp and the influence of renal dysfunction in clearance and prognostic value                     abstract  d. Miguel boronat garc\u00eda 2013   objectives 1. Evaluate how glomerular renal function, as measured by egfr, influences on urinary nt-probnp concentration. 2. To evaluate the relationship between specific glomerular and tubular renal function biomarkers and nt-probnp concentrations, to help identify the mechanism of renal elimination. 3. To evaluate the prognostic value of urinary nt-probnp levels compared with plasmatic nt-probnp levels in patients with ahf.  methods we prospectively included 138 consecutive patients, diagnosed of ica in hospital virgen de la arrixaca. Blood and urine samples were simultaneously collected on admission. Laboratory parameters were measured in serum:  glucose, creatinine, urea, albumin, sodium, uric acid, crp, troponin t, cystatin c, and nt-probnp btp; and in urine: alpha-1 microglobulin, albumin (mau) and nt-probnp.  results 1. Plasma and urinary nt-probnp was higher in patients with a lower egfr (p &lt;0.001). Plasma nt-probnp concentration correlated positively with urinary nt-probnp (r = 0.61, p &lt;0.001) correlations egfr &#8211; nt-probnp were also significant although less robust (r = -0.44, nt-probnp r = -0.37, nt-probnp, p &lt;0.001 for both). After multivariable adjustment, efgr was only an independent predictor of plasma nt-probnp concentrations. Plasma nt-probnp was the main independent predictor of urinary nt-probnp concentration. 2. Urinary alpha-1 microglobulin levels (? = 0.50, p &lt;0.001) and plasma nt-probnp (? = 0.29, p &lt;0.001) were the main independent predictor of urinary nt-probnp concentration while creatinine, mdrd, cystatin c, btp and mau concentrations were not accepted as statistically significant. 3. Patients with clinical events had a higher plasma nt-probnp concentration (4.561 pg \/ ml [2191-8631] vs 2,906 pg \/ ml [1643-5823], p = 0.03) but urinary nt-probnp concentration was similar (78 pg \/ ml [42-294] vs 71 pg \/ ml [41-189], p = 0.62) compared with those patients who did not experience clinical events. in cox regression univariate and multivariate analysis, the plasma nt-probnp concentration above the median (3345 pg \/ ml) was associated with an increased risk of adverse clinical events (hr = 2.35, 95% , 1.41 to 3.93, p = 0.001). However, the urinary nt-probnp concentration above the median (73 pg \/ ml) did not reach statistical significance as a predictor of prognosis of events in the univariate analysis (hr = 1.2, 95%, 0, 79 to 1.96, p = 0.46)  conclusions 1. Glomerular kidney disfunction is associated with increased plasma and urinary nt-probnp concentration. However, glomerular filtration rate is not an independent predictor of urinary nt-probnp. 2a. Plasma nt-probnp was the main predictor of urinary nt-probnp concentration. This may be due to increased cardiac production of nt-probnp as a result of increased cardiovascular stress of patients with concomitant cardiac and renal involvement. 2b. Because alpha-1 microglobulin (renal tubular function parameter) was an independent predictor of urinary nt-probnp unlike renal glomerular filtration biomarkers, we suggest that the presence of renal tubular dysfunction could be involved in increased urinary nt-probnp levels observed in patients with renal disfunction. Thus, a decrease in nt-probnp reabsorption at the proximal tubule would favor an increase urinary nt-probnp levels. 3. We consider that urinary nt-probnp should not be used for prognostic purposes in patients with ahf because plasma nt-probnp levels was independently associated with prognosis of patients with ahf but, instead, urinary nt-probnp levels have no association with the occurrence of events during follow-up in these patients.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Biomarcadores plasm\u00e1ticos y urinarios en pacientes con insuficiencia cardiaca aguda. nt-probnp y la influencia de la disfunci\u00f3n renal en su aclaramiento y valor pron\u00f3stico<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Biomarcadores plasm\u00e1ticos y urinarios en pacientes con insuficiencia cardiaca aguda. nt-probnp y la influencia de la disfunci\u00f3n renal en su aclaramiento y valor pron\u00f3stico <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Miguel Boronat Garcia <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 20\/12\/2013<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Mar\u00eda  Dolores Albaladejo Oton<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: stella Moreno grau <\/li>\n<li>angel Gil izquierdo (vocal)<\/li>\n<li>Francisco Mar\u00edn ortu\u00f1o (vocal)<\/li>\n<li>Juli\u00e1n Diaz fernandez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Miguel Boronat Garcia Resumen objetivos 1. Evaluar como influye la funci\u00f3n renal glomerular, medida por tfge, en [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[160,932,8235],"tags":[71336,196223,61057,227821,227820,4523],"class_list":["post-115076","post","type-post","status-publish","format-standard","hentry","category-bioquimica","category-cardiologia","category-murcia","tag-angel-gil-izquierdo","tag-francisco-marin-ortuno","tag-julian-diaz-fernandez","tag-maria-dolores-albaladejo-oton","tag-miguel-boronat-garcia","tag-stella-moreno-grau"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/115076","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=115076"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/115076\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=115076"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=115076"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=115076"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}