Cardiovascular risk in patients with autoimmune diseases and chronic kidney disease

Kardiovaskularne bolesti vodeći su uzrok smrti u svijetu. Tradicionalni kardiovaskularni rizični čimbenici uključuju dob, spol, pušenje, povišen krvni tlak, hiperkolesterolemiju i šećernu bolest. Kardiovaskularni rizik bolesnika sa sistemskim lupusom i reumatoidnim artritisom upućuje na prijevremenu aterosklerozu, i ne može se objasniti samo tradicionalnim KV rizicima. Pacijenti sa SLE imaju 5-8 puta veću učestalost koronarne bolesti nego opća populacija, što se povezuje s dislipidemijom, prisutnošću LDL fenotipa-B te istovremeno prisutnom sistemskom upalom. Prerana ateroskleroza kod tih bolesnika rezultat je tradicionalnih KVR čimbenika, čimbenika specifičnih za autoimunu bolest i upalnih medijatora. Obzirom da su KVB vodeći uzrok smrti postavlja se sve češće pitanje o preventivnoj kardiološkoj obradi. Ukoliko se razvije bubrežno oštećenje situacija postaje još ozbiljnija. Bubrežne promjene u RA i SLE su česte, dok u ostalih autoimunih bolesti poput sklerodermije I psorijaze se rjeđe nalaze. U svih bolesnika s RA treba pratiti bubrežnu funkciju s određivanjem klirensa kreatinina, pregledom sedimenta urina i 24 h proteinurije. Kronična bubrežna bolest je veliki javnozdravstveni problem. Definira se kao prisutnost oštećenja bubrega ili kao smanjena bubrežna funkcija u periodu od 3 mjeseca ili duže. Kod kronične bubrežne bolesti oštećene su sve bubrežne funkcije: ekskrecijska, endokrina i metabolička funkcija. Početak je uglavnom spor i neprepoznat što je otegotna okolnost jer dio neuspjeha preventivnih mjera leži u kasnom otkrivanju kronične bubrežne bolesti, kada su mogućnosti djelovanja već male, što je dodatno komplicirano u pacijenata s autoimunim bolestima.Cardiovascular diseases are the leading cause of death worldwide. Traditional cardiovascular risk factors include age, gender, smoking, hypertension, hypercholesterolemia and diabetes. Cardiovascular risk in patients with systemic lupus erythematosus and rheumatoid arthritis refers to early atherosclerosis, can not be explained by traditional CV risk. Patients with SLE have a 5-8 times higher incidence of coronary heart disease than the general population, which is associated with dyslipidemia, the presence of LDL-phenotype B and simultaneously present systemic inflammation. Premature atherosclerosis in these patients is the result of traditional KVR factors, factors specific to autoimmune disease and inflammatory mediators. Since the CVD are leading cause of death raises the question increasingly on preventive cardiology treatment. If kidey failure is developed situation becomes even more serious.Renal changes in RA and SLE are common, while in other autoimmune diseases Chronic kidney disease is a major public health problem. Defined as the presence of kidney damage or decreased kidney function over a period of 3 months or longer. In chronic renal disease all renal functions are damaged: excretion rates, endocrine and metabolic function. The beginning is slow and mostly unrecognized as an aggravating circumstance as part of the failure of preventive measures lies in the late such as scleroderma and psoriasis are rarely found. All patients with RA should monitor renal function with the determination of creatinine clearance, urine sediment examination and 24 h proteinuria. detection of chronic kidney disease,when the possibilities of action are small, which is further complicated in patients with autoimmune diseases