Papel do sistema nervoso autônomo no risco cardiovascular em pacientes com Litíase Renal

Introduction: Kidney stone (KS) is a highly prevalent disease worldwide. Studies indicate that there is a direct correlation between the presence of KS and CVD and that individuals with KS are more likely to develop hypertension compared to individuals without KS. Aim: To investigate the possible role of the autonomic nervous system (ANS) in cardiovascular risk (CVR) of patients with kidney stone. Patients and Methods: We included in the KS group 19 patients of both sexes aged 18-60 years and diagnosed with KS. The control group (CTL) was composed of 21 individuals without diagnosis of KS. MAP, SBP, DBP and HR at rest and in response to cardiovascular challenges in orthostatism, modified orthostatism, Cold Pressor test (CPT) and Stroop test were evaluated. Biochemical analyzes were performed on blood and urine. For statistical analysis the General Linear Model (GLM) of repeated measures was used for comparison between groups. Results: Regarding biochemical and urinary parameters, the LR group presented higher LDL cholesterol fraction (KS: 102.9 ± 24.0 vs CTL: 92.4 ± 33.0 mg / dL, p = 0.02), blood glucose (KS: 87.5 ± 8.5 vs CTL: 80.3 ± 7.3 mg / dL, p = 0.003) and urinary volume (KS: 1966 ± 789 vs CTL: 1600 ± 574 mL, p = 0.006) compared to the CTL group. During orthostatism the KS group showed orthostatic hypertension during recovery different from the CTL group (SBP, KS: 126 ± 15 vs CTL: 122 ± 9 mmHg, p <0.05 and DBP, KS: 81 ± 8 vs CTL: 79 ± 7mmHg, p <0.05). No differences were observed in heart rate variability and baroreflex sensitivity. In the Stroop test there was no statistical difference between the groups during its performance and recovery. However, differences in the analysis of SBP absolute delta (KS: 9 ± 10 vs CTL: 2 ± 8 mmHg, p <0.05) and HR (KS: 13 ± 7 vs CTL: 8 ± 7bpm, p <0.05) were observed. the groups. Regarding CPT, no statistically significant differences were observed between groups. Conclusion: Subtle evidence of possible autonomic alterations in response to orthostatism and emotional stress testing was found, which could be related to the role of ANS in cardiovascular risk of patients with RS. However, further and more comprehensive studies are needed to determine the possible involvement of ANS in the cardiovascular risk of patients with KS.Introdução: A litíase renal (LR) é uma doença de alta prevalência mundial. Estudos indicam que existe uma correlação direta entre a presença de LR e as DCV e que indivíduos com LR são mais propensos a desenvolverem HAS comparados a indivíduos sem LR. Objetivo: Investigar o possível papel do sistema nervoso autônomo (SNA) no risco cardiovascular (RCV) dos pacientes com litíase renal. Casuística e Métodos: Foram incluídos no grupo LR, 19 pacientes de ambos os sexos com idades entre 18-60 anos e diagnóstico de LR. O grupo controle (CTL) foi composto por 21 indivíduos sem diagnóstico de LR. Foram avaliadas a PAM, PAS, PAD e FC em repouso e em resposta a desafios cardiovasculares no ortostatismo, ortostatismo modificado, Cold Pressor teste (CPT) e o teste de Stroop. Foram realizadas análises bioquímicas no sangue e na urina. Para a análise estatística foi utilizado o Modelo Linear Geral (GLM) de medidas repetidas para a comparação entre os grupos. Resultados: Em relação aos parâmetros bioquímicos e urinários, o grupo LR apresentou maior fração de colesterol LDL (LR: 102,9±24,0 vs CTL: 92,4±33,0 mg/dL, p=0,02), glicemia (LR: 87,5±8,5 vs CTL: 80,3±7,3 mg/dL, p=0,003) e volume urinário (LR: 1966±789 vs CTL: 1600±574 mL, p=0,006) comparado ao grupo CTL. Durante o ortostatismo o grupo LR apresentou hipertensão ortostática durante a recuperação diferente do grupo CTL (PAS, LR: 126±15 vs CTL: 122±9 mmHg, p<0,05 e PAD, LR: 81±8 vs CTL: 79±7 mmHg, p<0,05). Não foram observadas diferenças na variabilidade da frequência cardíaca e na sensibilidade barorreflexa. No teste de Stroop não houve diferença estatística entre os grupos durante sua realização e recuperação. No entanto, foi observada diferença na análise dos deltas absolutos da PAS (LR:9±10 vs CTL: 2±8 mmHg, p<0,05) e FC (LR: 13±7 vs CTL: 8±7 bpm, p