1
|
Al Ghorani H, Kulenthiran S, Lauder L, Recktenwald MJM, Dederer J, Kunz M, Götzinger F, Ewen S, Ukena C, Böhm M, Mahfoud F. Ultra-long-term efficacy and safety of catheter-based renal denervation in resistant hypertension: 10-year follow-up outcomes. Clin Res Cardiol 2024:10.1007/s00392-024-02417-2. [PMID: 38451261 DOI: 10.1007/s00392-024-02417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Randomized sham-controlled trials have confirmed the efficacy and safety of catheter-based renal denervation in hypertension. Data on the very long-term effects of renal denervation are scarce. AIMS This study evaluates the 10-year safety and efficacy of renal denervation in resistant hypertension. METHODS This prospective single-center study included patients with resistant hypertension undergoing radio-frequency renal denervation between 2010 and 2012. Office blood pressure, 24-h ambulatory blood pressure, antihypertensive medication, color duplex sonography, and renal function were assessed after 1-, 2- and 10-years. RESULTS Thirty-nine patients completed the 10-year follow-up (mean follow-up duration 9.4 ± 0.7 years). Baseline office and 24-h ambulatory systolic blood pressure were 164 ± 23 mmHg and 153 ± 16 mmHg, respectively. After 10 years, 24-h ambulatory and office systolic blood pressure were reduced by 16 ± 17 mmHg (P < 0.001) and 14 ± 23 mmHg (P = 0.001), respectively. The number of antihypertensive drugs remained unchanged from 4.9 ± 1.4 to 4.5 ± 1.2 drugs (P = 0.087). The estimated glomerular filtration rate declined within the expected range from 69 (95% CI 63 to 74) to 60 mL/min/1.73m2 (95% CI 53 to 68; P < 0.001) through 10-year follow-up. Three renal artery interventions were documented for progression of pre-existing renal artery stenosis in two patients and one patient with new-onset renal artery stenosis. No other adverse events were observed during the follow-up. CONCLUSION Renal denervation was safe and sustainedly reduced ambulatory and office blood pressure out to 10 years in patients with resistant hypertension.
Collapse
Affiliation(s)
- Hussam Al Ghorani
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany.
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Michael Johannes Maria Recktenwald
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Juliane Dederer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Michael Kunz
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Felix Götzinger
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
- Medizinische Klinik II - Kardiologie/Angiologie, Marien Hospital Herne - Universitätsklinikum der Ruhr Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 100, Gebäude 41, 66421, Homburg/Saar, Germany
| |
Collapse
|
2
|
Gurlek Demirci B, Karakan MS. Effect of Body Composition on Graft Function and Cardiovascular Outcomes in Normotensive Renal Transplant Recipients. EXP CLIN TRANSPLANT 2024; 22:108-113. [PMID: 38511981 DOI: 10.6002/ect.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES We evaluated the effects of body composition on graft function and cardiovascular outcomes in normotensive renal transplant recipients. MATERIALS AND METHODS In this cross-sectional study, we analyzed ambulatory blood pressure monitoring data from 136 renal transplant recipients with stable allograft function after living related donor transplant. We enrolled 87 normotensive recipients. We analyzed left ventricular mass index, renal resistive index, and body composition of recipients. We divided recipients into 2 groups according to mean lean body mass, defined by bioimpedance analysis, with 38 in group 1 (lean body mass <47 kg) and 49 in group 2 (lean body mass ≥47 kg). RESULTS Mean time posttransplant was 35.0 ± 23.3 months. Mean renal resistive index, left ventricular mass index, lean body mass, body mass index, and fat mass were 0.67 ± 0.1, 195.0 ± 118.5 g/m2, 47.3 ± 9.1 kg, 25.9 ± 5.0 kg, and 44.6±10.5 kg,respectively. Lean body mass was positively correlated to sex (r = 0.36, P = .03), body mass index (r = 0.04, P = .416),renalresistive index (r = 0.495, P = .01), and left ventricular mass index (r = 0.713, P = .02) but negatively correlated to serum albumin levels (r=-0.343, P=0.04). Lean body mass was significantly higher in males than in females (P = .03). Patients in group 2 had significantly higher left ventricular mass index (P = .01) and renal resistive index (P = .03). In multiple regression analysis, lean body mass (P = .01) and left ventricular mass index (P = .01) were predictors of renal resistive index. CONCLUSIONS Lean body mass significantly influences left ventricular mass index and renal resistive index. Hence, body composition analysis could be an early predictor of graft function and cardiovascular outcomes in normotensive renal transplant recipients.
Collapse
Affiliation(s)
- Bahar Gurlek Demirci
- From the Department of Nephrology, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | | |
Collapse
|
3
|
Bellini MI, Gissey LC, Nemeth DV, D'Andrea V, Illuminati G, Marchitelli S, Lai S, Casella G. Sleeve gastrectomy and one-year outcomes: Impact on cardiovascular, renal and metabolic parameters. Surg Open Sci 2024; 17:65-69. [PMID: 38298437 PMCID: PMC10828425 DOI: 10.1016/j.sopen.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Background Cardiovascular and renal diseases represent a major determinant for the morbidity and mortality associated with obesity and type 2 diabetes mellitus (T2DM). Bariatric surgery is considered one of the few treatments with the potential to reverse cardiovascular, renal and metabolic disease. Methods Prospective study of patients undergoing sleeve gastrectomy collecting pre- and post-surgery creatinine, eGFR, glucose, insulin, total, LDL/HDL cholesterol, triglycerides, parathyroid hormone, vitamin D3, C- Reactive Protein (CRP), blood count, weight, body mass index (BMI), bilateral carotid intima media thickness (IMT), flow-mediated dilation (FMD) and epicardial adipose tissue (EAT). Measurements were compared at 1 year follow up. Results 24 patients were included in the study. Cardiovascular parameters, as HDL-cholesterol (p = 0.002), IMT (p = 0.003), EAT (p < 0.001) and FMD (p = 0.001) showed significant improvement after surgery. Secondary renal outcomes including Vitamin D3 (p < 0.0001), Calcium (p = 0.006), RBCs (p = 0.007), HCO3- (p = 0.05) also ameliorated as well as BMI (p < 0.001). Conclusions Sleeve gastrectomy has a positive impact on cardiovascular, renal, and metabolic parameters in patients with morbid obesity, suggesting it may halt the progression of these diseases even in the preclinical stage. Further research is needed to explore the long-term effects underlying these improvements.
Collapse
Affiliation(s)
| | | | - Denise V. Nemeth
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX 78235, USA
| | - Vito D'Andrea
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulio Illuminati
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Serena Marchitelli
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Casella
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| |
Collapse
|
4
|
Mahadappa P, Jeyaraja K, Thirunavakkarasu PS, Krishnaswamy N. Association between systolic blood pressure and target organ damage in naturally occurring cases of systemic hypertension in the dog. Top Companion Anim Med 2024; 58:100843. [PMID: 37979614 DOI: 10.1016/j.tcam.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Chronic elevation in the systolic blood pressure (SBP) adversely affects the lifespan in the dog by causing injury to the eye, heart, kidney and brain. Understanding the association between SBP and target organ damage (TOD) helps in risk categorization and treatment planning. Therefore, a prospective study was undertaken to find the association between SBP and renal resistive index (RI) in naturally occurring cases of canine systemic hypertension. Based on the ACVIM guidelines 2018, dogs (n=135) were categorized into four risk groups of SBP, viz., A (minimal), B (low), C (moderate), and D (high). Ophthalmoscopy and echocardiography were used to assess ocular and cardiac changes, respectively. Nephrosonography, urinalysis, and RI were used to assess kidney damage. Odds ratio (OR) was used to quantify the risk of TOD for different categories of SBP. One-way Anova with Tukey's post-hoc test was used to test the effect of different SBP risk groups on urine protein creatinine ratio (UPC) and RI as well as the effect of number of TOD on the RI. Pearson's correlation test was done to see the relation of SBP with UPC and RI. Tortuous retinal vessels were common in group B with an OR of 11 (95% CI: 0.59-207). Retinal hemorrhage and left ventricular hypertrophy were common in group D with an OR of 13 (95% CI: 0.67-234) and 11 (95% CI: 0.61-207), respectively. A significant strong positive correlation of SBP with UPC (R2=0.65) and RI (R2=0.58) was observed. The renal RI significantly increased when the number of TOD was ≥ 2. It was concluded that SBP and RI are associated with the number and severity of TOD and might be valuable in risk classification in hypertensive dogs.
Collapse
Affiliation(s)
- Priyanka Mahadappa
- Indian Veterinary Research Institute, Hebbal Campus, Bengaluru, 560024, India.
| | - K Jeyaraja
- Madras Veterinary College, TANUVAS, Chennai, 600007, India
| | | | | |
Collapse
|
5
|
Moriconi D, Mengozzi A, Duranti E, Cappelli F, Taddei S, Nannipieri M, Bruno RM, Virdis A. The renal resistive index is associated with microvascular remodeling in patients with severe obesity. J Hypertens 2023; 41:1092-1099. [PMID: 37071436 PMCID: PMC10242520 DOI: 10.1097/hjh.0000000000003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Renal hemodynamics is impaired since the early stage of cardiometabolic disease. However, in obesity, its noninvasive ultrasound assessment still fails to provide pathophysiologic and clinical meaningfulness. We aimed to explore the relationship between peripheral microcirculation and renal hemodynamics in severe obesity. METHODS We enrolled fifty severely obese patients with an indication for bariatric referring to our outpatient clinic. Patients underwent an extensive reno-metabolic examination, paired with Doppler ultrasound and measurement of the renal resistive index (RRI). On the day of the surgery, visceral fat biopsies were collected to perform an ex-vivo complete microcirculatory assessment. Media-to-lumen ratio (M/L) and vascular response to acetylcholine (ACh), alone or co-incubated with N G -nitro arginine methyl ester (L-NAME), were measured. RESULTS Patients were stratified according to their normotensive (NT) or hypertensive (HT) status. HT had lower estimated glomerular filtration rate and higher RRI compared to NT, while the presence and extent of albuminuria were similar between the two groups. Concerning microcirculatory assessment, there were no differences between groups as regards the microvascular structure, while the vasorelaxation to ACh was lower in HT ( P = 0.042). Multivariable analysis showed a relationship between M/L and RRI ( P = 0.016, St. β 0.37) and between albuminuria and the inhibitory response of L-NAME to Ach vasodilation ( P = 0.036, St. β = -0.34). Notably, all these correlations were consistent also after adjustment for confounding factors. CONCLUSIONS The RRI and albuminuria relationship with microvascular remodeling in patients affected by severe obesity supports the clinical implementation of RRI to improve risk stratification in obesity and suggests a tight pathophysiologic connection between renal haemodynamics and microcirculatory disruption.
Collapse
Affiliation(s)
- Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
6
|
The relationship between renal renal resistive index and hypertensive end-organ damage. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients.
Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria).
Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034).
Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.
Collapse
|
7
|
Cafarotti A, Marcovecchio ML, Lapergola G, Di Battista C, Marsili M, Basilico R, Di Donato G, David D, Pelliccia P, Chiarelli F, Breda L. Kidney function and renal resistive index in children with juvenile idiopathic arthritis. Clin Exp Med 2022:10.1007/s10238-022-00898-x. [PMID: 36129558 DOI: 10.1007/s10238-022-00898-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic disease. Renal manifestations have been rarely observed in JIA, although amyloidosis could be a renal complication in systemic JIA (sJIA). To investigate renal damage in JIA children and to establish the relationship with treatment. Blood urea nitrogen (BUN), creatinine, cystatin C (CysC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urinary albumin excretion (UAE), estimated glomerular filtration rate (eGFR), and renal resistive index (RRI) were assessed in 49 JIA children (9 boys/40 girls, mean age 10.3 ± 3.8 years) and in 49 healthy controls (24 boys/25 girls, mean age 11.3 ± 3.4 years). Twenty-two JIA patients were on methotrexate (MTX) therapy (group A) and 27 on biologic drugs (group B). CysC and BUN (respectively, 0.8 ± 0.1 vs. 0.7 ± 0.1 mg/dl; 13.3 ± 2.9 vs. 11.7 ± 1.4 mg/dl) were higher (p ≤ 0.001) whereas creatinine and eGFR (respectively, 0.5 ± 0.1 vs. 0.6 ± 0.1 mg/dl; 99.2 ± 10.5 vs. 122.5 ± 19.8 ml/min/1.73 m2) were lower in JIA children as compared to controls (p < 0.001). UAE resulted higher in patients than in controls (p = 0.003). Mean RRI was higher in JIA children than controls (0.7 ± 0.04 vs. 0.6 ± 0.04; p < 0.001). Group B showed higher mean RRI than group A (0.7 ± 0.1 vs. 0.7 ± 0.04; p < 0.001). Associations were found between RRI and ESR, JADAS-27, disease state, BMI-SDS (p < 0.001), CRP (p = 0.003) and eGFR (p = 0.001). JIA children had reduced eGFR, increased UAE and higher RRI values, than controls. RRIs were higher in patients on biologic drugs than MTX group and were associated with inflammation indexes and disease state, suggesting a direct effect of the disease.
Collapse
Affiliation(s)
| | | | | | | | - Manuela Marsili
- Department of Paediatrics, University "G. d'Annunzio", Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Giulia Di Donato
- Department of Paediatrics, University "G. d'Annunzio", Chieti, Italy
| | - Daniela David
- Department of Paediatrics, University "G. d'Annunzio", Chieti, Italy
| | | | | | - Luciana Breda
- Pediatric Rheumatology Unit, S.S. Annunziata Hospital, Via dei Vestini 5, Chieti, Italy.
| |
Collapse
|
8
|
Ye BM, Hyeon JM, Kim SJ, Kim MJ, Kim SR, Kim IY, Lee SB, Lee DW. Analysis of Risk Factors for Delayed Graft Function After Kidney Transplantation. Transplant Proc 2022; 54:2154-2158. [PMID: 36114044 DOI: 10.1016/j.transproceed.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/25/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is a serious complication associated with worsening outcomes in kidney transplantation. To facilitate DGF risk reduction, this study aimed to identify the incidence and modifiable risk factors of this condition in kidney transplant patients. METHODS This retrospective chart review included 220 patients who underwent kidney transplants between 2012 and 2021 at our kidney transplant center. Delayed graft function was defined as the requirement of hemodialysis within a week of transplantation. Clinical data from patients with DGF and those without this condition were compared to identify risk factors of DGF. RESULTS Of 205 eligible patients, 20 (9.76%) developed DGF. In the univariate analysis, high hemoglobin level, deceased-donor type, and longer warm and cold ischemic times were significantly associated with DGF (P < .05). In the variable selection in logistic regression analysis, high hemoglobin level, with a cutoff value of 11.35 g/dL, and deceased-donor transplants were associated with higher DGF incidence (P < .05 for both factors). CONCLUSIONS Our findings newly demonstrated that DGF occurred more frequently in patients with hemoglobin level >11.35 g/dL. As such, improvement in kidney transplantation outcomes could be achieved by reducing this modifiable risk factor.
Collapse
Affiliation(s)
- Byung Min Ye
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Je Min Hyeon
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Su Ji Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Min Jeong Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Seo Rin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Il Young Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soo Bong Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| |
Collapse
|
9
|
Romano G, Mioni R, Danieli N, Bertoni M, Croatto E, Merla L, Alcaro L, Pedduzza A, Metcalf X, Rigamonti A, Catena C, Sechi LA, Colussi G. Elevated Intrarenal Resistive Index Predicted Faster Renal Function Decline and Long-Term Mortality in Non-Proteinuric Chronic Kidney Disease. J Clin Med 2022; 11:jcm11112995. [PMID: 35683384 PMCID: PMC9181195 DOI: 10.3390/jcm11112995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background. Intrarenal resistive index (RI) ≥ 0.80 predicts renal outcomes in proteinuric chronic kidney disease (CKD). However, this evidence in non-proteinuric patients with CKD of unknown etiology is lacking. In this study, we assessed the effect of intrarenal RI on renal function and all-cause mortality in non-proteinuric patients with CKD of unknown etiology despite an extensive diagnostic work-up. Methods. Non-proteinuric CKD patients were evaluated in a retrospective longitudinal study. Progression of renal disease was investigated by checking serum creatinine levels at 1, 3, and 5 years and defined by a creatinine level increase of at least 0.5 mg/dL. The discrimination performance of intrarenal RI in predicting the 5-year progression of renal disease was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Results. One-hundred-thirty-one patients (76 ± 9 years, 56% males) were included. The median follow-up was 7.5 years (interquartile range 4.3−10.5) with a cumulative mortality of 53%, and 5-year renal disease progression occurred in 25%. Patients with intrarenal RI ≥ 0.80 had a faster increase of serum creatinine levels compared to those with RI < 0.80 (+0.06 mg/dL each year, 95% CI 0.02−0.10, p < 0.010). Each 0.1-unit increment of intrarenal RI was an independent determinant of 5-year renal disease progression (odds ratio 4.13, 95% CI 1.45−12.9, p = 0.010) and predictor of mortality (hazards ratio 1.80, 95% CI 1.05−3.09, p = 0.034). AUROCs of intrarenal RI for predicting 5-year renal disease progression and mortality were 0.66 (95% CI 0.57−0.76) and 0.67 (95% CI 0.58−0.74), respectively. Conclusions. In non-proteinuric patients with CKD of unknown etiology, increased intrarenal RI predicted both a faster decline in renal function and higher long-term mortality, but as a single marker, it showed poor discrimination performance.
Collapse
Affiliation(s)
- Giulio Romano
- Nephrology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.R.); (N.D.); (M.B.)
| | - Roberto Mioni
- Division of Nephrology, Academic Hospital of Udine “Santa Maria della Misericordia”, 33100 Udine, Italy;
| | - Nicola Danieli
- Nephrology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.R.); (N.D.); (M.B.)
| | - Martina Bertoni
- Nephrology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.R.); (N.D.); (M.B.)
| | - Elisa Croatto
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Lucia Merla
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Lucia Alcaro
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Antonio Pedduzza
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Xenia Metcalf
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Alessandra Rigamonti
- Department of Radiology, Academic Hospital of Udine “Santa Maria della Misericorida”, 33100 Udine, Italy;
| | - Cristiana Catena
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Leonardo A. Sechi
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - GianLuca Colussi
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
- Correspondence: ; Tel.: +39-0432-559-829; Fax: +39-0432-559-490
| |
Collapse
|
10
|
Renal Acoustic Radiation Force Impulse Elastography in Hypertensive Nephroangiosclerosis Patients. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112210612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Hypertensive nephroangiosclerosis (HN) represents the second most common cause of chronic kidney disease. Kidney damage secondary to high blood pressure favors the appearance of serum and urinary changes, but also imaging, highlighted by ultrasonography (B-mode, Doppler, Acoustic Radiation Force Impulse Elastography). Acoustic Radiation Force Impulse Elastography (ARFI) represents a new imagistic method which characterizes renal stiffness in the form of shear wave velocity (SWV). Aim: This study aims to investigate renal stiffness in HN patients, and to assess the correlations between it and urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and intrarenal resistive index (RRI). Material and Methods: This cross-sectional study was performed on a group of 80 HN patients and 50 healthy, sex and age-matched, as controls. UACR (urinary immunoturbidimetry), eGFR (Jaffe method), RRI, and renal SWV (Siemens Acuson 2000) were determined in all patients and controls. Data were expressed as mean ± standard deviation. Statistical analysis was done by means Pearson’s test and t-Student test, p values of less than 0.05 were considered statistically significant. Results: UACR, eGFR, RRI and SWV showed statistically significant differences between the HN patients and controls (p < 0.0001). In the hypertensive patients group, statistically significant correlations were observed between the SWV and UACR (r = −0.7633, p < 0.00001), eGFR (r = 0.7822, p = 0.00001), and RRI (r = −0.7978, p = 0.00001). Conclusions: Kidney sonoelastography characterizes imagistically the existence of intrarenal lesions associated with essential hypertension, offering a new diagnosis method for these patients.
Collapse
|
11
|
Bakirdogen S, Kurt HA, Kamış F, Bek S, Erbayraktar A. The Association Between Delayed Graft Function and Renal Resistive Index in Kidney Transplant Recipients. Cureus 2021; 13:e17315. [PMID: 34557363 PMCID: PMC8449821 DOI: 10.7759/cureus.17315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background and objectives Delayed graft function (DGF) may increase the risk for kidney graft dysfunction. Renal resistive index (RRI) in Doppler ultrasonography is useful in measuring blood flow changes in kidneys which is indicative of tubulointerstitial damage. Most of the diseases in DGF etiology are related to tubulointerstitium and arteries of the kidneys. In this study, we investigated whether there is a relationship between delayed graft function and renal resistive index in kidney transplant recipients (KTR). Materials and methods Patients who underwent kidney transplantation were included in this retrospective study. KTR were divided into two groups as DGF (+) and DGF (−). Comparison of RRI values of DGF (+) and DGF (−) groups according to the measurements at different times. Results The findings showed that both RRI measurements (post-transplant in the first week and the end of the first year) of the DGF (+) group were higher than DGF (−) group (p=0.001 and p=0.003, respectively). The interaction of measurements and DGF did not have an effect on RRI (p>0.05). Conclusion The value of RRI in the DGF (−) group was lower than DGF (+) group in the first week after kidney transplantation.
Collapse
Affiliation(s)
| | - Hasan Anil Kurt
- Urology, Canakkale Onsekiz Mart University, School of Medicine, Canakkale, TUR
| | - Fatih Kamış
- Internal Medicine, Canakkale Onsekiz Mart University, School of Medicine, Canakkale, TUR
| | - Sibel Bek
- Nephrology, Kocaeli University Hospital, Kocaeli, TUR
| | - Aysegul Erbayraktar
- Internal Medicine, Canakkale Onsekiz Mart University, School of Medicine, Canakkale, TUR
| |
Collapse
|
12
|
Kusunoki H, Iwashima Y, Kawano Y, Ohta Y, Hayashi SI, Horio T, Shinmura K, Ishimitsu T, Yoshihara F. Associations Between Arterial Stiffness Indices and Chronic Kidney Disease Categories in Essential Hypertensive Patients. Am J Hypertens 2021; 34:484-493. [PMID: 33031505 DOI: 10.1093/ajh/hpaa163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients. METHODS Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria. RESULTS The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change. CONCLUSIONS In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.
Collapse
Affiliation(s)
- Hiroshi Kusunoki
- Department of General Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshio Iwashima
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Nephrology and Hypertension, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yuhei Kawano
- Department of Medical Technology, Teikyo University, Omuta, Fukuoka, Japan
| | - Yuko Ohta
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of General Internal Medicine, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - Shin-Ichiro Hayashi
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Horio
- Department of Internal Medicine, Ishikiriseiki Hospital, Higashiosaka, Osaka, Japan
| | - Ken Shinmura
- Department of General Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiko Ishimitsu
- Department of Nephrology and Hypertension, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Fumiki Yoshihara
- Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| |
Collapse
|
13
|
Liu KH, Lee MC, Kong APS, Chen L, Chan JCN, Wing Chu WC. Associations of Renal Augmented Velocity Index with Arterial Stiffness, Carotid Intima-Media Thickness and Blood Pressure, in Comparison with Renal Resistive Index. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1279-1288. [PMID: 33551242 DOI: 10.1016/j.ultrasmedbio.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
The augmented velocity index (Avi) is a new Doppler index associated with arterial stiffness. We examined associations of renal Avi with blood pressure (BP), aortic stiffness and carotid intima-media thickness (IMT), and compared its performance with that of resistive index (RI). One hundred forty-seven volunteers were recruited. Renal Avi had significant positive correlations with systolic BP (r = 0.37, p < 0.001), diastolic BP (r = 0.2, p = 0.016), mean arterial pressure (r = 0.29, p < 0.001), pulse pressure (r = 0.31, p < 0.001), carotid-femoral pulse wave velocity (r = 0.49, p < 0.001) and carotid IMT (r = 0.23, p = 0.005). RI correlated positively with pulse pressure (r = 0.3, p < 0.001) only. After adjustments for co-variables, the associations remained similar. Patients with abnormal BP values (≥130/80 mm Hg), IMT and aortic stiffness (≥1 standard deviation of mean value) had higher Avi than those with normal values, but not RI. In conclusion, renal Avi had stronger associations with BP, arterial stiffness and carotid IMT than RI in apparently healthy volunteers, and was significantly increased in abnormal patients.
Collapse
Affiliation(s)
- Kin Hung Liu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ming Chung Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ling Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, China
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
14
|
KAMIŞ F, BAKİRDOGEN S, ÇAM B. The relationship between renal resistive index and simple hematologic indices in patients with chronic kidney disease. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.807280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
15
|
Bedside Renal Doppler Ultrasonography and Acute Kidney Injury after TAVR. J Clin Med 2020; 9:jcm9040905. [PMID: 32218228 PMCID: PMC7230258 DOI: 10.3390/jcm9040905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/24/2022] Open
Abstract
Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is associated with a dismal prognosis. Elevated renal resistive index (RRI), through renal Doppler ultrasound (RDU) evaluation, has been associated with AKI development and increased systemic arterial stiffness. Our pilot study aimed to investigate the performance of Doppler based RRI to predict AKI and outcomes in TAVR patients. From May 2018 to May 2019, 100 patients with severe aortic stenosis were prospectively enrolled for TAVR and concomitant RDU evaluation at our institution (Nouvel Hôpital Civil, Strasbourg University, France). AKI by serum Creatinine (sCr-AKI) was defined according to the VARC-2 definition and AKI by serum Cystatin C (sCyC-AKI) was defined as an sCyC increase of greater than 15% with baseline value. Concomitant RRI measurements as well as renal and systemic hemodynamic parameters were recorded before, one day, and three days after TAVR. It was found that 10% of patients presented with AKIsCr and AKIsCyC. The whole cohort showed higher baseline RRI values (0.76 ± 0.7) compared to normal known and accepted values. AKIsCyC had significant higher post-procedural RRI one day (Day 1) after TAVR (0.83 ± 0.1 vs. 0.77 ± 0.6, CI 95%, p = 0.005). AUC for AKIsCyC was 0.766 and a RRI cut-off value of ≥ 0.795 had the most optimal sensitivity/specificity (80/62%) combination. By univariate Cox analysis, Mehran Risk Score, higher baseline right atrial pressure at baseline > 0.8 RRI values one day after TAVR (HR 6.5 (95% CI 1.3-32.9; p = 0.021) but not RRI at baseline were significant predictors of AKIsCyC. Importantly, no significant impact of baseline biological parameters, renal or systemic parameters could be demonstrated. Doppler-based RRI can be helpful for the non-invasive assessment of AKI development after TAVR.
Collapse
|
16
|
An assessment of the utility and repeatability of the renal resistive index in horses. PLoS One 2019; 14:e0226941. [PMID: 31877188 PMCID: PMC6932750 DOI: 10.1371/journal.pone.0226941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to establish the value of the renal resistive index (RI) of intrarenal arteries in healthy warmblood non-racing horses of different ages to assess the influence of physiologic factors and repeatability of measurement. The kidney ultrasonography examination was performed in three age groups: 15 foals, 15 adults and 15 elderly horses. The procedure was performed in unsedated standing animals. RI values were measured using pulsed-wave Doppler at the medial part of each kidney in the intrarenal arteries. To evaluate repeatability, all measurements were repeated two hours after the first examination. Statistical analysis of the relationship between groups was carried out using Fisher’s test. The relationship between the RI value and the physiological parameters was evaluated using linear regression. Repeatability of measurements was determined based on the Bland-Altman plot. The mean RI value in the studied horses was 0.48 ± 0.05 in the left kidney and 0.49 ± 0.05 in the right kidney. There were no statistically significant differences between the RI values in foals and adult horses. The elderly horses had a significantly higher RI value. Pulse pressure was the only physiological parameter affecting the RI value. The repeatability coefficient was 0.089 for the right kidney and 0.09 for the left kidney. The presented result suggest that elderly healthy horses have higher RI values than younger animals, which should be taken into account in clinical practice. The arterial pulse pressure should also be considered when interpreting RI values. The measurements have high repeatability, but in the authors’ opinion, this procedure is time consuming and requires experience.
Collapse
|
17
|
Bruni C, Rosato E, Maestripieri V, Gigante A, Tesei G, Bellando-Randone S, Guiducci S, Chiostri M, El Aoufy K, Blagojevic J, Moggi-Pignone A, De Paulis A, Furst DE, Boddi M, Matucci-Cerinic M. The Renal Resistive Index in systemic sclerosis: Determinants, prognostic implication and proposal for specific age-adjusted cut-offs. Eur J Intern Med 2019; 70:43-49. [PMID: 31540806 DOI: 10.1016/j.ejim.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/19/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal Resistive Index (RRI), reflects changes in both renal vascular and tubular-interstitial compartments and in systemic vascular compliance related to age and comorbidities. OBJECTIVES a) To investigate determinants of RRI in SSc population, b) its association with SSc-related features and c) to test its prognostic impact on organ specific worsening or death. METHODS 380 SSc patients ≥18 years were enrolled after giving informed consent. Baseline data on RRI, laboratory, instrumental and therapeutic features were retrospectively collected. Age-SSc adjusted cut-offs were created by dividing the population in age quartiles and considering RRI values >75th percentile as pathologic. Clinical follow-up was performed until last available visit or the development/worsening of specific internal organ involvement or death. RESULTS RRI was independently predicted by age and systolic pulmonary arterial pressure on Echo. Therefore, we created Age-SSc adjusted pathologic RRI cut-offs, which were significantly associated with various disease related skin and lung fibrotic manifestations, as well as vasculopathic complications. After a mean follow-up of 3.6 ± 2.6 years, RRI was one of the independent predictors (together with modified Rodnan skin score, interstitial lung disease, presence of dyspnoea and late nailfold-videocapillaroscopy pattern) for mortality, with 0.68 as best cut-off (sensitivity 88.5%, specificity 50.9%). CONCLUSION If corroborated, Renal Resistive Index cut-offs might be used to evaluate renal and extrarenal involvement in SSc and could serve as predictors of mortality.
Collapse
Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy; Department Cardio-Thorax-Vascular Medicine, Division of General Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Vanessa Maestripieri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Tesei
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy
| | - Jelena Blagojevic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy; Department of Internal Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University Federico II, Naples, Italy
| | - Daniel E Furst
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Department of Medicine, Division of Rheumatology, University of California at Los Angeles, USA; University of Washington, Seattle, WA, USA
| | - Maria Boddi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy; University of Washington, Seattle, WA, USA
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| |
Collapse
|
18
|
Jaques DA, Pivin E, Pruijm M, Ackermann D, Guessous I, Ehret G, Wei F, Staessen JA, Pechère‐Bertschi A, Vermeer C, Vogt B, Burnier M, Martin P, Bochud M, Ponte B. Renal Resistive Index Is Associated With Inactive Matrix Gla (γ-Carboxyglutamate) Protein in an Adult Population-Based Study. J Am Heart Assoc 2019; 8:e013558. [PMID: 31510823 PMCID: PMC6818003 DOI: 10.1161/jaha.119.013558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023]
Abstract
Background Increased renal resistive index (RRI) has been associated with target organ damage as well as renal and cardiovascular outcomes. Matrix Gla (γ-carboxyglutamate) protein (MGP) is a strong inhibitor of soft tissue calcification. Its inactive form (dephospho-uncarboxylated MGP [dp-ucMGP]) has been associated with vascular stiffness, cardiovascular outcomes, and mortality. In this study, we hypothesized that high levels of dp-ucMGP were associated with increased RRI. Methods and Results We recruited participants via a multicenter family-based cross-sectional study in Switzerland. Levels of dp-ucMGP were measured in plasma by sandwich ELISA. RRI was measured by Doppler ultrasound in 3 segmental arteries in both kidneys. We used mixed regression models to assess the relationship between dp-ucMGP and RRI. We adjusted for common determinants of RRI as well as renal function and cardiovascular risk factors. We included 1006 participants in our analyses: 526 women and 480 men. Mean values were 0.44±0.20 nmol/L for dp-ucMGP and 64±5% for RRI. After multivariable adjustment, dp-ucMGP was positively associated with RRI (P=0.001). In subgroup analysis by age tertiles, this association was not significant in the youngest age group (<38 years; P=0.62), whereas it was significant in older age groups (38-55 and >55 years; P=0.016 and P<0.001, respectively). Conclusions Levels of dp-ucMGP are positively and independently associated with RRI after adjustment for common determinants of RRI, cardiovascular risk factors, and renal function. The stronger association among older adults is probably due, in part, to age-related arterial stiffness. RRI thus seems to reflect the global atherosclerotic burden in a general adult population.
Collapse
Affiliation(s)
- David A. Jaques
- Division of NephrologyGeneva University HospitalsGenevaSwitzerland
| | - Edward Pivin
- Division of Chronic DiseaseUniversity Institute of Social and Preventive MedicineLausanne University HospitalLausanneSwitzerland
| | - Menno Pruijm
- Division of Nephrology and HypertensionLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Daniel Ackermann
- University Clinic for Nephrology, Hypertension and Clinical PharmacologyBern University HospitalBernSwitzerland
| | - Idris Guessous
- Division of Primary Care MedicineDepartment of Primary Care MedicineGeneva University HospitalsGenevaSwitzerland
| | - Georg Ehret
- Division of CardiologyGeneva University HospitalsGenevaSwitzerland
| | - Fang‐Fei Wei
- Studies Coordinating CentreResearch Unit of Hypertension and Cardiovascular EpidemiologyKU Leuven Department of Cardiovascular SciencesUniversity of LeuvenBelgium
| | - Jan A. Staessen
- Studies Coordinating CentreResearch Unit of Hypertension and Cardiovascular EpidemiologyKU Leuven Department of Cardiovascular SciencesUniversity of LeuvenBelgium
| | | | - Cees Vermeer
- R&D Group VitaKMaastricht UniversityMaastrichtThe Netherlands
| | - Bruno Vogt
- University Clinic for Nephrology, Hypertension and Clinical PharmacologyBern University HospitalBernSwitzerland
| | - Michel Burnier
- Division of Nephrology and HypertensionLausanne University Hospital and University of LausanneLausanneSwitzerland
| | | | - Murielle Bochud
- Division of Chronic DiseaseUniversity Institute of Social and Preventive MedicineLausanne University HospitalLausanneSwitzerland
| | - Belen Ponte
- Division of NephrologyGeneva University HospitalsGenevaSwitzerland
- Division of Chronic DiseaseUniversity Institute of Social and Preventive MedicineLausanne University HospitalLausanneSwitzerland
| |
Collapse
|
19
|
Cowan V, Grusie T, McKinnon J, Blakley B, Singh J. Arterial Responses in Periparturient Beef Cows Following a 9-Week Exposure to Ergot (Claviceps purpurea) in Feed. Front Vet Sci 2019; 6:262. [PMID: 31440521 PMCID: PMC6694205 DOI: 10.3389/fvets.2019.00262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/26/2019] [Indexed: 11/17/2022] Open
Abstract
Ergot alkaloids are vasoconstrictors frequently detected in low concentrations in livestock feed. The Canadian Food Inspection Agency permits up to 3,000 μg ergot alkaloids per kg cattle feed. The objective of this study was to examine the effects of feeding low concentrations of ergot alkaloids over 9-weeks on vascular dynamics in the caudal and internal iliac arteries of beef cows. A relationship between ergot alkaloid concentration in feed and hemodynamic changes in the caudal and internal iliac arteries was hypothesized. Periparturient beef cows were randomized into four groups and group fed mixed rations containing <15 μg ergot alkaloids per kg of dry matter intake (Control, n = 9), 48 μg/kg (Low, n = 9), 201 μg/kg (Medium, n = 8), and 822 μg/kg (High, n = 6). Three experimental periods comprised the study: pre-treatment (2 weeks), treatment (9 weeks), and post-treatment (3 weeks). B-mode and Doppler ultrasonography was performed weekly to measure hemodynamic endpoints. Plasma prolactin concentrations and rectal temperatures were measured weekly. Caudal artery diameter decreased (Treatment*Experimental Period i.e., Tx*EP, p < 0.001) by 14% in the High group during the treatment period. Reductions (Tx*EP, p < 0.001) in caudal artery blood flow (37%, 29%) and blood volume per pulse (29%, 11%) were recorded during the treatment period in the High and Medium groups. Internal iliac artery diameter and blood flow decreased (Tx*EP, p ≤ 0.004) by 13% and 40% during the treatment period in the Medium group. Moderate reductions (Tx*EP, p ≤ 0.042; 12–25%) in the mean blood velocity during the treatment and post-treatment periods and decreases (Tx*EP, p ≤ 0.01; 12–17%) in the peak systolic velocity of both arteries during the post-treatment period were also detected. Prolactin did not change in any group during the treatment period (p = 0.462). Rectal temperatures were within the normal physiological range for beef cows. In conclusion, we documented moderate vasoconstriction in the caudal artery and the internal iliac artery in cows fed 201–822 μg ergot alkaloids per kg of dry matter intake for 9-week period near parturition. The pattern of alterations was similar between the caudal and internal iliac arteries. Results of this study suggest that feeding up to 822 μg/kg produce reversible pharmacological changes in beef cow vasculature and warrant reconsideration of current regulations for cattle.
Collapse
Affiliation(s)
- Vanessa Cowan
- Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Taylor Grusie
- Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - John McKinnon
- Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan, Saskatoon, SK, Canada
| | - Barry Blakley
- Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Toxicology Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jaswant Singh
- Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
20
|
Koc AS, Demirtas D, Gorgulu FF, Sumbul HE. Diurnal variation of renal resistive index over 24-hour period in hypertensive patients and healthy controls. Abdom Radiol (NY) 2019; 44:1010-1018. [PMID: 30293108 DOI: 10.1007/s00261-018-1798-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There are no data in the literature to our knowledge related to changes in renal resistive index (RRI) values over 24-h period and the importance of detecting these changes in patients who have hypertension (HT). In this study, we aimed to investigate the variation of RRI values over 24-h period and its usability in hypertensive patients. METHODS A total of 118 subjects (80 with HT and 38 healthy controls) were included in the study. Morning, midday, evening, and midnight RRI, renal pulsatility index, and accelerated time were measured by Doppler ultrasonography (US). B-mode US and elastograpic assessment were performed only in the morning. RESULTS Temporal RRI varied significantly (p < 0.001). The highest and lowest levels were found in the morning and evening, respectively. All temporal RRI levels were significantly higher in patients with HT (both p < 0.001). The absolute and relative increases in RRI (ΔRRI) levels were similar in two groups. All temporal RRI measurements positively correlated with the patient age, pulse pressure, renal cortical thickness, and cortical stiffness. However, absolute-ΔRRI and relative-ΔRRI positively correlated with the age. Absolute-ΔRRI positively correlated with the pulse pressure and cortical stiffness, and no correlation was observed between relative-ΔRRI and these variables. Of the four temporal measurements, morning RRI were found to be independently associated with cortical stiffness (p < 0.001). CONCLUSIONS RRI measurements varied over 24-h period in patients with HT and/or healthy controls. Morning RRI was significantly higher than other day time, and it is also related to renal cortical stiffness.
Collapse
Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
| | - Derya Demirtas
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Feride Fatma Gorgulu
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| |
Collapse
|
21
|
Hypertension is Common in Patients with Newly Diagnosed Acromegaly and is Independently Associated with Renal Resistive Index. High Blood Press Cardiovasc Prev 2018; 26:69-75. [PMID: 30535798 DOI: 10.1007/s40292-018-0293-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/23/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION There are conflicting results regarding the frequency of hypertension (HT) and values of related parameters in patients with acromegaly. AIM We aimed to determine the frequency of HT and values of its associated parameters in patients with acromegaly. METHODS 57 patients with newly diagnosed acromegaly were included in this study. Renal ultrasonography (US) was performed in addition to routine evaluation of acromegaly. Renal resistive index (RRI), renal pulsatility index (RPI), and accelerated time were measured using Doppler US. RESULTS Hypertension was detected in 16 patients (28.1%) with newly diagnosed acromegaly. Serum triglyceride, TSH, growth hormone, and insulin growth factor 1 levels were higher and HDL levels were lower in acromegaly patients with HT. RRI and RPI values were found to be higher in acromegaly patients with HT. In logistic regression analysis, only the RRI value was found to be independently related to the presence of HT. Based on this analysis, it was determined that the frequency of HT increases 2.99 times for each increase in RRI of 0.05 units. When ROC analysis was performed, it was found that the area under the ROC curve was 0.781. In the same analysis, when the cutoff value for RRI was taken to be 0.70, the development of HT in acromegaly patients was determined with 75% sensitivity and 78% specificity. CONCLUSIONS In patients with newly diagnosed acromegaly, HT frequency was significantly increased and it was independently associated with the RRI value. Therefore, these patients should be closely monitored for HT-the most frequent and important cardiovascular risk factor-and treated before they develop target organ damage.
Collapse
|
22
|
Di Nicolò P, Granata A. Renal intraparenchymal resistive index: the ultrasonographic answer to many clinical questions. J Nephrol 2018; 32:527-538. [PMID: 30539416 DOI: 10.1007/s40620-018-00567-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
The use of renal resistive indices (RRIs) for the study of renal microcirculation has in the past been proposed for the identification of renal organ damage or even to specifically identify injury to some areas of the renal parenchyma. Nevertheless, according to the most recent evidences from literature this organ-based conception of RRIs has been proven to be partial and unable to explain the RRIs variations in clinical settings of sepsis or combined organ failure of primitively extrarenal origin or, more generally, the deep connection between RRIs and hemodynamic factors such as compliance and pulsatility of the large vessels. The aim of this review is to explain the physiopathological basis of RRIs determination and the most common interpretative errors in their analysis. Moreover, through a comprehensive vision of these Doppler indices, the traditional and emerging clinical application fields for RRIs are discussed.
Collapse
Affiliation(s)
- Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit, "S. Maria della Scaletta" Hospital, Via Montericco n. 4, 40026, Imola, BO, Italy.
| | - Antonio Granata
- Nephrology and Dialysis Unit, "S. Giovanni di Dio" Hospital, Agrigento, Italy
| |
Collapse
|
23
|
Cilsal E, Koc AS. Renal resistive index significantly increased in hypertensive children and it is independently related to the pulse pressure and left ventricular mass index. Clin Exp Hypertens 2018; 41:607-614. [PMID: 30285504 DOI: 10.1080/10641963.2018.1523920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To the best our knowledge there is no data in the literature related to changes in renal resistive index (RRI) values in children who have hypertension (HT). In this study, we aimed to investigate the changes of RRI values and it is usability in children with HT. Methods: A total of 75 children; 48 with newly diagnosed HT and 27 healthy controls were included in the study. Routine history, physical examination, and laboratory examinations were performed. Left ventricular (LV) dimensions and systolic-diastolic functions, septum and posterior wall thickness (IVSd and PWd) and LV mass index (LVMI) were calculated by echocardiography. In addition to routine renal ultrasonography (US), renal pulsatility indexes (RPI), accelerated time and RRI were measured. Increased RRI was accepted as >0.70. Results: Increased RRI was detected in 25 (52%) of HT patients. Systolic and diastolic blood pressure (SBP and DBP), and pulse pressure (PP), low-density lipoprotein cholesterol and triglyceride levels, RRI, RPI, kidney length, IVSd, PWd, and LVMI were significantly higher in patients with HT (both p < 0.05). SBP and PP, PWd, LV ejection fraction, LV fractional shortening, and LVMI were positively correlated with the RRI. High-density lipoprotein cholesterol was negatively correlated with the RRI. Of these measurements, RRI values were found to be independently associated with PP and LVMI (p < 0.05). Conclusions: In hypertensive children, RRI was significantly higher than healthy controls and it is also related with LVMI and PP.
Collapse
Affiliation(s)
- Erman Cilsal
- a Department of Pediatric Cardiology, University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
| | - Ayse Selcan Koc
- b Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
| |
Collapse
|
24
|
Madubueze G, Ugwa E. A comparative ultrasonographic evaluation of intrarenal artery resistive index among hypertensive and normotensive adults in a black African population compared to a European population. Acta Radiol Open 2018; 7:2058460117752033. [PMID: 29375893 PMCID: PMC5777559 DOI: 10.1177/2058460117752033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022] Open
Abstract
Background Hypertensive nephropathy is an important medical problem among the black African population. Early detection of renovascular changes using ultrasonography can provide opportunity for immediate intervention towards preventing or at least delaying the irreversible hypertensive nephropathy. Purpose To compare intrarenal resistive index (RI) in healthy normotensive and hypertensive adults in Kano, Nigeria. Material and Methods A prospective comparative study of intrarenal RI using ultrasound in 150 hypertensives and 150 normotensive controls. The mean renal RI of the interlobar arteries of both kidneys were measured and recorded. The data were analyzed with the aid of computer-based SPSS 16.0 software for Windows. Results The age range of the study participants was 35–70 years. The mean interlobar artery RI values were 0.59 ± 0.04 and 0.59 ± 0.03 on the right and left sides, respectively, in normotensive control individuals while those of hypertensive individuals were 0.73 ± 0.03 and 0.73 ± 0.03 for the mean interlobar artery RI values on the right and left sides, respectively. Conclusion The intrarenal RIs were lower in normotensives when compared with the hypertensive participants, which were statistically significant. These showed that hypertension has significant effects on the kidneys, and with early detection and intervention, irreversible renal damage may be prevented.
Collapse
Affiliation(s)
| | - Emmanuel Ugwa
- Health Systems Development, Jhpiego-Affiliate of Johns Hopkins University, Abuja, Nigeria
| |
Collapse
|
25
|
Afsar B, Elsurer R. Increased renal resistive index in type 2 diabetes: Clinical relevance, mechanisms and future directions. Diabetes Metab Syndr 2017; 11:291-296. [PMID: 27594114 DOI: 10.1016/j.dsx.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022]
Abstract
Type 2 diabetes is a global health challenge. In type 2 diabetes both microvascular (nephropathy, retinopathy, neuropathy) and macrovascular complications arise. In kidney, renal pathological changes leading to diabetic nephropathy are mainly secondary to atherosclerosis of the intra and extra renal arteries together with microangiopathy of the glomerular capillaries, afferent arterioles and efferent arterioles. Renal resistive index (RRI) is defined as a ratio of the difference between maximum and minimum (end-diastolic) flow velocity to maximum flow velocity derived from the Doppler measurements of main renal and intrarenal (segmental/interlobar) arteries. Renal resistive index is tightly related to renal arteriolosclerosis, and represents an integrated index of arterial compliance, pulsatility and downstream microvascular impedance. In meantime, growing suggest that RRI has also been closely related with atherosclerosis. Most studies performed in type 2 diabetes showed RRI is increased in type 2 diabetes. In this review, we summarize the data regarding RRI with regard to performed studies, pathogenesis and prognosis, especially focusing on type 2 diabetes (T2D). We also review the data regarding the development of metabolic syndrome (MetS) and RRI.
Collapse
Affiliation(s)
- Baris Afsar
- Associate Professor of Nephrology and Internal Medicine, Konya Numune State Hospital, Department of Nephrology, Postal Code: 42250, Selcuklu, Konya, Turkey.
| | - Rengin Elsurer
- Associate Professor of Nephrology and Internal Medicine, Selcuk University, Department of Nephrology, Postal Code: 42250, Selcuklu, Konya, Turkey.
| |
Collapse
|
26
|
Kosaki K, Kamijo-Ikemori A, Sugaya T, Tanahashi K, Kumagai H, Sawano Y, Osuka Y, Tanaka K, Kimura K, Shibagaki Y, Maeda S. Association between muscular strength and intrarenal vascular resistance in middle-aged and older individuals. Exp Gerontol 2017; 91:72-78. [DOI: 10.1016/j.exger.2017.02.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
|
27
|
Phosphodiesterase-5 inhibition preserves renal hemodynamics and function in mice with diabetic kidney disease by modulating miR-22 and BMP7. Sci Rep 2017; 7:44584. [PMID: 28294194 PMCID: PMC5353686 DOI: 10.1038/srep44584] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/09/2017] [Indexed: 01/13/2023] Open
Abstract
Diabetic Nephropathy (DN) is the leading cause of end-stage renal disease. Preclinical and experimental studies show that PDE5 inhibitors (PDE5is) exert protective effects in DN improving perivascular inflammation. Using a mouse model of diabetic kidney injury we investigated the protective proprieties of PDE5is on renal hemodynamics and the molecular mechanisms involved. PDE5i treatment prevented the development of DN-related hypertension (P < 0.001), the increase of urine albumin creatinine ratio (P < 0.01), the fall in glomerular filtration rate (P < 0.001), and improved renal resistive index (P < 0.001) and kidney microcirculation. Moreover PDE5i attenuated the rise of nephropathy biomarkers, soluble urokinase-type plasminogen activator receptor, suPAR and neutrophil gelatinase-associated lipocalin, NGAL. In treated animals, blood vessel perfusion was improved and vascular leakage reduced, suggesting preserved renal endothelium integrity, as confirmed by higher capillary density, number of CD31+ cells and pericyte coverage. Analysis of the mechanisms involved revealed the induction of bone morphogenetic protein-7 (BMP7) expression, a critical regulator of angiogenesis and kidney homeostasis, through a PDE5i-dependent downregulation of miR-22. In conclusion PDE5i slows the progression of DN in mice, improving hemodynamic parameters and vessel integrity. Regulation of miR-22/BMP7, an unknown mechanism of PDE5is in nephrovascular protection, might represent a novel therapeutic option for treatment of diabetic complications.
Collapse
|
28
|
Renal Resistive Index: not only kidney. Clin Exp Nephrol 2016; 21:359-366. [DOI: 10.1007/s10157-016-1323-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/11/2016] [Indexed: 12/11/2022]
|
29
|
Gaipov A, Solak Y, Zhampeissov N, Dzholdasbekova A, Popova N, Molnar MZ, Tuganbekova S, Iskandirova E. Renal functional reserve and renal hemodynamics in hypertensive patients. Ren Fail 2016; 38:1391-1397. [DOI: 10.1080/0886022x.2016.1214052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
30
|
Viazzi F, Cappadona F, Pontremoli R. Microalbuminuria in primary hypertension: a guide to optimal patient management? J Nephrol 2016; 29:747-753. [PMID: 27417557 DOI: 10.1007/s40620-016-0335-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/04/2016] [Indexed: 01/01/2023]
Abstract
Accurate assessment of the global risk profile is considered a prerequisite for the optimal management of hypertensive patients. In particular, the evaluation of subclinical organ damage, namely left ventricular hypertrophy, peripheral atherosclerosis and renal function, plays a key role in optimizing therapeutic targets and strategy in individual patients. Urine albumin excretion is a low-cost, easy-to-use test and a powerful predictor of cardiovascular diseases. The search for albuminuria has, therefore, become routine in the evaluation of hypertensive patients. Moreover, albuminuria has been shown to be associated with early signs of extra-renal organ damage such as left ventricular hypertrophy, and carotid atherosclerosis. Under effective antihypertensive treatment, changes in subclinical organ damage over time, especially regression of left ventricular hypertrophy, are paralleled by modification of risk status and may serve as intermediate endpoints for treatment. More recently, changes in albuminuria have also been proposed to reflect changes in the risk of cardiovascular events. If this is confirmed by large well-designed studies, microalbuminuria may not simply be regarded as a risk predictor but become itself an independent target for treatment.
Collapse
Affiliation(s)
- Francesca Viazzi
- Università degli Studi di Genova and IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, Genoa, Italy
| | - Francesca Cappadona
- Università degli Studi di Genova and IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, Genoa, Italy
| | - Roberto Pontremoli
- Università degli Studi di Genova and IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, Genoa, Italy.
| |
Collapse
|
31
|
Sperandeo M, Varriale A, D'Amico G, Sperandeo G, Piattelli M, de Cata A, Greco A, Prigigallo F, Annese M, Cedrone L, Vendemiale G. Intrarenal Resistive Index in Patients with Type 2 Diabetes Mellitus with and without Microalbuminuria. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x0700500207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diabetic nephropathy affects a subset of about 30% of patients with type 1 Diabetes Mellitus (DM); it also develops in a less defined percentage (20–30%) of patients with type 2, after a period of 15–20 years. It is usually divided into stages. The aim of this study is to assess the usefulness of duplex sonography with Doppler wave form analysis in the evaluation of early diabetic nephropathy, in order to detect patients at risk for irreversible renal disease. 262 patients (61 males, 201 females; age range: 48–81 years) with type 2 diabetes mellitus were studied; 100 healthy volunteers with no evidence of diabetes mellitus (74 females, 26 males; age range: 50–80 years) composed the control group. All of them underwent duplex Doppler sonography of the kidneys; a scanner with a 3.5 MHz transducer (Toshiba 270 SSA) was used, Pulsatily Index (P.I.) and Resistive Index (R.I.) of Doppler waveform were obtained at the intrarenal arteries; the average value of 3 bilateral measurements was taken. Doppler sonography was done by the same authors without knowledge of the patient group (case or control). Both indexes (PI. and R.I.) resulted to be higher in patients with DM compared to controls in patients with microalbuminuria: PI. = 1.49 +/- 0.34 vs. 1.07 +/- 0.06, p< 0.05; R.I. = 0.79 +/- 0.15 vs 0.60 +/- 0.03, p<0.05. Even if our data have to be confirmed by further studies, they suggest that duplex Doppler sonography may be a useful complementary test in the evaluation of diabetic nephropathy, especially in the early stages, in order to identify more patients at risk of developing diabetic nephropathy.
Collapse
Affiliation(s)
| | | | | | - G. Sperandeo
- Radiology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Usefulness of the renal resistive index to predict an increase in urinary albumin excretion in patients with essential hypertension. J Hum Hypertens 2016; 31:66-69. [DOI: 10.1038/jhh.2016.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/12/2016] [Accepted: 04/26/2016] [Indexed: 11/09/2022]
|
33
|
Can we predict outcome by noninvasive assessment of renal haemodynamics in hypertension? The role of renal resistive index. J Hypertens 2016; 34:1047-9. [DOI: 10.1097/hjh.0000000000000934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
34
|
Dilli D, Ozkan E, Ozkan MB, Aydin B, Özyazici A, Fettah N, Zenciroğlu A, Okumuş N. Umbilical cord asymmetric dimethylarginine levels and ultrasound assessment of carotid arteries in neonates born small for gestational age. J Matern Fetal Neonatal Med 2016; 30:492-496. [PMID: 27072784 DOI: 10.1080/14767058.2016.1176136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND To examine asymmetric dimethylarginine (ADMA) level as an endothelial function parameter in addition to ultrasonographic evaluation of carotid arteries in babies born small for gestational age (SGA). METHODS Twenty-six neonates born SGA and 34 appropriate for gestational age (AGA) controls were included in the study. The serum levels of ADMA were measured. Intima-media thickness (cIMT) and resistive index (cRI) of the both carotid arteries were determined by ultrasonography. RESULTS The mean ADMA level was higher in SGA neonates compared to AGAs (16 267.7 ± 6050 versus 12 810.2 ± 3302 ng/L; p = 0.01). The mean cIMT (0.34 ± 0.02 versus 0.31 ± 0.03 mm; p = 0.001) and cRI (0.66 ± 0.07 versus 0.61 ± 0.04, p = 0.003) were also higher in SGAs. Serum ADMA levels were positively correlated to the mean cIMT (r = 0.41, p = 0.001). Although there was a weak correlation between cIMT and mean cRI (r = 0.26, p = 0.04), no correlation was found between ADMA and mean cRI (r = 0.17, p = 0.18). CONCLUSIONS Neonates born SGA have elevated cord blood ADMA level in addition to thicker IMT and higher RI of carotid arteries at birth. ADMA was correlated to cIMT, suggesting that higher ADMA levels might influence vascular health in later life in these neonates.
Collapse
Affiliation(s)
- Dilek Dilli
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Elif Ozkan
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Mehmet Burak Ozkan
- b Department of Radiology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey
| | - Banu Aydin
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Ahmet Özyazici
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Nurdan Fettah
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Ayşegül Zenciroğlu
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Nurullah Okumuş
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| |
Collapse
|
35
|
Morreale M, Mulè G, Ferrante A, D'ignoto F, Cottone S. Association of Renal Resistive Index with Markers of Extrarenal Vascular Changes in Patients with Systemic Lupus Erythematosus. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1103-10. [PMID: 26924695 DOI: 10.1016/j.ultrasmedbio.2015.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/03/2015] [Accepted: 12/22/2015] [Indexed: 05/23/2023]
Abstract
Recent data suggest that renal hemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RRI), may be associated with systemic vascular changes. We evaluated the relationships between RRI and arterial stiffness, assessed by aortic pulse wave velocity, and between RRI and subclinical atherosclerosis, assessed by measuring carotid intima-media thickness in patients with systemic lupus erythematosus. We enrolled 39 patients with systemic lupus erythematosus (mean age 39 y) compared with 19 healthy controls, matched for age and sex. Each participant underwent 24 h of ambulatory blood pressure, aortic pulse wave velocity, carotid intima-media thickness and RRI measurements. RRI correlated significantly with aortic pulse wave velocity (r = 0.44, p = 0.006), and with carotid intima-media thickness (r = 0.46, p = 0.003). Both correlations held (p = 0.01), even after correction for age, mean arterial pressure and glomerular filtration rate. Our results suggest that the RRI may be considered a marker of systemic vascular changes and probably a predictor of cardiovascular risk in patients with systemic lupus erythematosus.
Collapse
Affiliation(s)
- Massimiliano Morreale
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, Society of Hypertension Excellence, Centre Università di Palermo, Italy.
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, Society of Hypertension Excellence, Centre Università di Palermo, Italy
| | | | - Francesco D'ignoto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, Society of Hypertension Excellence, Centre Università di Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, Society of Hypertension Excellence, Centre Università di Palermo, Italy
| |
Collapse
|
36
|
Gigante A, Barbano B, Di Mario F, Rosato E, Simonelli M, Rocca AR, Conti F, Ceccarelli F, Giannakakis K, Valesini G, Cianci R. Renal parenchymal resistance in patients with biopsy proven glomerulonephritis: Correlation with histological findings. Int J Immunopathol Pharmacol 2016; 29:469-74. [PMID: 27091839 DOI: 10.1177/0394632016645590] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/23/2016] [Indexed: 11/15/2022] Open
Abstract
Renal Doppler ultrasound is increasingly used in nephrology for the evaluation of renovascular disease, allograft dysfunction, and chronic nephropathies. We compared intrarenal hemodynamic parameters to biopsy findings of glomerular sclerosis, tubular atrophy, interstitial fibrosis, crescents, arteriolosclerosis, and clinical variables in 100 patients. A positive correlation exists between renal function and percentage of glomerular sclerosis (P <0.01, r = 0.26), conversely a negative correlation exists between glomerular filtrate rate and percentage of glomerular sclerosis(P <0.0001, r = -0.35). The percentage of glomerular sclerosis correlate positively with pulsatile index (PI) (P <0.05, r = 0.21) and renal resistive index (RI) (P <0.05, r = 0.20). The percentage of crescents correlates positively with PI(P <0.05, r = 0.21) and RI (P <0.05, r = 0.20). Classifying arteriolosclerosis in four groups according to a severity scale, from absence to severe, PI (P <0.05) and RI (P <0.01) were significantly different. In the post hoc analysis, the median values of PI and RI are significantly different in patients with severe arteriolosclerosis than others. Ultrasound examination is a non-invasive diagnostic technique used on patients with suspected or established renal disease. Our study shows a close correlation between kidney function, ultrasound parameters, and histological findings. Measurement of renal parenchymal resistance by ultrasound could be used in association with biopsy and glomerular function for the evaluation of renal damage in patients with glomerulonephritis.
Collapse
Affiliation(s)
| | - Biagio Barbano
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| | | | - Edoardo Rosato
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| | - Marzia Simonelli
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| | | | - Fabrizio Conti
- Lupus Clinic, Rheumatology Unit, Sapienza University of Rome, Italy
| | | | | | - Guido Valesini
- Lupus Clinic, Rheumatology Unit, Sapienza University of Rome, Italy
| | - Rosario Cianci
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| |
Collapse
|
37
|
Left ventricular dilatation and subclinical renal damage in primary hypertension. J Hypertens 2016; 33:605-11; discussion 611. [PMID: 25426568 DOI: 10.1097/hjh.0000000000000430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A new classification of left ventricular geometry based on left ventricular dilatation and concentricity has recently been developed. This classification identifies subgroups differing with regard to systemic haemodynamics, left ventricular function and cardiovascular prognosis. We investigated the relationship between the new classification of left ventricular geometry and subclinical renal damage, namely urine albumin excretion and early intrarenal vascular changes in primary hypertensive patients. METHODS A total of 449 untreated hypertensive patients were studied. Four different patterns of left ventricular hypertrophy (eccentric nondilated, eccentric dilated, concentric nondilated and concentric dilated hypertrophy) were identified by echocardiography. Albuminuria was measured as the albumin-to-creatinine ratio. Early intrarenal vascular changes, expressed as the renal volume to resistive index ratio, were evaluated by ultrasound and Doppler scan. RESULTS Patients with concentric dilated left ventricular hypertrophy had higher albumin excretion rates (P = 0.0258) and prevalence of microalbuminuria (P < 0.0001) and lower renal volume to resistive index ratio than patients with concentric nondilated hypertrophy (P = 0.0093). Patients with eccentric dilated hypertrophy showed a higher prevalence of microalbuminuria than patients with eccentric nondilated hypertrophy (P < 0.0001). Moreover, patients with chamber dilatation showed a higher prevalence of microalbuminuria (P = 0.0002) and lower renal volume to resistive index ratio (P = 0.0107) than patients without chamber dilatation. After adjusting for potentially confounding variables, left ventricular chamber dilatation was an independent predictor of subclinical renal damage. CONCLUSION Left ventricular dilatation is associated with subclinical renal damage in hypertension. These findings extend previous reports and provide a pathophysiological rationale for the observed unfavourable prognosis in patients with left ventricular dilatation.
Collapse
|
38
|
Geraci G, Mulè G, Costanza G, Mogavero M, Geraci C, Cottone S. Relationship Between Carotid Atherosclerosis and Pulse Pressure with Renal Hemodynamics in Hypertensive Patients. Am J Hypertens 2016; 29:519-27. [PMID: 26232780 PMCID: PMC4886487 DOI: 10.1093/ajh/hpv130] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/16/2015] [Accepted: 07/13/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Structural atherosclerotic damage, arterial stiffness, pulse pressure (PP), and renal hemodynamics may interact and influence each other. Renal resistance index (RRI) appears as a good indicator of systemic vascular changes. The aim of our study was to assess the independent relationships of carotid intima-media thickness (cIMT), aortic pulse wave velocity (aPWV), and peripheral PP with RRI in hypertensives with various degrees of renal function. METHODS We enrolled 463 hypertensive patients (30-70 years) with normal renal function (group 0; n = 280) and with chronic kidney disease (groups I-V; n = 183). All subjects underwent ultrasonographic examination of intrarenal and carotid vasculature, as well as a 24-h ambulatory blood pressure monitoring. RESULTS A statistically significant difference in RRI, cIMT, aPWV, and clinic PP was observed in the different 6 groups (all P < 0.001), even after adjustment for age. RRI correlated with cIMT (r = 0.460, P < 0.001), aPWV (r = 0.386, P < 0.001), clinic PP (r = 0.279, P < 0.001), and 24-h PP (r = 0.229, P < 0.001) in the entire study population. These correlations were similar in subjects with and without renal dysfunction. In the overall study population, the association between RRI, cIMT, and clinic PP remained statistically significant even after adjustment for various confounding factors, whereas the relationship between RRI and aPWV was lost in multivariate analysis. CONCLUSIONS cIMT and clinic PP rather than directly aPWV are associated with intrarenal hemodynamics. Our results confirm that in hypertensives RRI not only detects derangement of intrarenal circulation but may also be considered as a sensor of systemic vascular changes, independently of level of renal function.
Collapse
Affiliation(s)
- Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy.
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Giuseppa Costanza
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Manuela Mogavero
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Calogero Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy
| |
Collapse
|
39
|
Boddi M. Renal Ultrasound (and Doppler Sonography) in Hypertension: An Update. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:191-208. [PMID: 27966109 DOI: 10.1007/5584_2016_170] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound (US) allows the non-invasive evaluation of morphological changes of kidney structure (by means of B-Mode) and patterns of renal and extrarenal vascularization (by means of color-Doppler and contrast-enhanced US). In hypertensive subjects it offers a relevant contribution to the diagnosis of early renal damage, acute or chronic nephropathies and nephrovascular disease. However, morphological changes are often detected late and non-specific and in recent years evidence has increased regarding the clinical relevance of renal resistive index (RRI) for the study of vascular and renal parenchymal renal abnormalities. RRI is measured by Doppler sonography in an intrarenal artery, as the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. At first RRI was proved to be a marker of renal disease onset and progression; later the influence of systemic vascular properties on RRI was shown and authors claimed its use as an independent predictor of cardiovascular risk rather than of renal damage. Indeed, renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, pulse pressure) determinants that concur to determine RRI individual values but not the most important one. The clinical relevance of RRI measurement as a surrogate endpoint of specific renal damage or/and as surrogate endpoint of atherosclerotic diffuse vascular damage is still debated.To summarize, from the literature: (a) In hypertensives with normal renal function and no albuminuria, especially in younger people, RRI is an early marker of renal damage that is especially useful when hypertension and diabetes concur in the same subjects. In these subjects RRI could improve current clinical scores used to stratify early renal damage. In older subjects RRI increases in accordance with the increase in systemic vascular stiffness and, because of this close relationship, RRI is also a marker of systemic atherosclerotic burden and the role of renal determinants can weaken. The clinical relevance was not specifically investigated. (b) In transplant kidney and in chronic renal disease high (>0.80) RRI values can independently predict renal failure. The recent claim that systemic (pulse pressure) rather than renal hemodynamic determinants sustain this predictive role of RRI, does not significantly reduce this predictive role of RRI. (c) Doppler ultrasound allows diagnosis and grading of renal stenosis in both fibromuscolar dysplastic and atherosclerotic diseases. Moreover, by RRI assay Doppler ultrasound can indirectly measure the hemodynamic impact of renal artery stenosis on the homolateral kidney, by virtue of the stenosis-related decrease in pulse pressure. However, in elderly subjects with atherosclerotic renal artery stenosis coexisting renal diseases can independently increase RRI by the augmentation in renal vascular stiffness and tubulo-interstitial pressure and hidden changes due to renal artery stenosis.
Collapse
Affiliation(s)
- Maria Boddi
- Experimental and Clinical Department, University of Florence, Florence, Italy.
| |
Collapse
|
40
|
Chen HY, Lien YH, Huang HP. Association of Renal Resistive Index, Renal Pulsatility Index, Systemic Hypertension, and Albuminuria with Survival in Dogs with Pituitary-Dependent Hyperadrenocorticism. Int J Endocrinol 2016; 2016:3814034. [PMID: 27340403 PMCID: PMC4906188 DOI: 10.1155/2016/3814034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/15/2022] Open
Abstract
An increased renal resistive index (RI) and albuminuria are markers of target organ damage secondary to systemic hypertension. This study evaluated associations between systemic blood pressure (SBP), renal RI, pulsatility index (PI), and albuminuria in dogs with pituitary-dependent hyperadrenocorticism (PDH). Predictors of overall mortality were investigated. Twenty client-owned dogs with PDH and 20 clinically healthy client-owned dogs as matched controls were included. Incidence rates of systemic hypertension (SBP ≥ 160 mmHg), albuminuria, and increased renal RI (≥ 0.70) and PI (≥ 1.45) in the control group were 5%, 0%, 5%, and 0%, respectively, compared to 35%, 40%, 50%, and 35%, respectively, in the PDH group (P = 0.001, P < 0.001, P < 0.001, and P = 0.001, resp.). No association between systemic hypertension, renal RI, renal PI, and albuminuria was observed. PDH was the only predictor of albuminuria and increased renal RI. Survival was not affected by increased renal PI, systemic hypertension, or albuminuria. Increased renal RI (≥ 0.70) was the only predictor of overall mortality in dogs with PDH.
Collapse
Affiliation(s)
- Hung-Yin Chen
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei 100, Taiwan
| | - Yu-Hsin Lien
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei 100, Taiwan
- Azu Clinic for Animals, No. 92, Section 1, Kin-Shan South Road, Taipei 100, Taiwan
| | - Hui-Pi Huang
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei 100, Taiwan
- *Hui-Pi Huang:
| |
Collapse
|
41
|
Hussein AM, Botros SM, Saleh SA. Relation between hyper-uricemia and renal resistivity index in non diabetic non hypertensive patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
42
|
Boddi M, Natucci F, Ciani E. The internist and the renal resistive index: truths and doubts. Intern Emerg Med 2015; 10:893-905. [PMID: 26337967 DOI: 10.1007/s11739-015-1289-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/21/2015] [Indexed: 01/05/2023]
Abstract
The renal resistive index (RRI) is measured by Doppler sonography in an intrarenal artery, and is the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. The RRI is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. Renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, aortic stiffness, pulse pressure) determinants that combine to determine the RRI values, and not the most important one. RRI cannot always be considered a specific marker of renal disease. To summarize from the literature: (1) hydronephrosis, abdominal hypertension, renal vein thrombosis and acute kidney injury are all associated with an acute increase in interstitial and venous pressure that determine RRI values. In all these conditions, RRI is a reliable marker of the severity of renal damage. (2) The hemodynamic impact of renal artery stenosis can be assayed by the RRI decrease in the homolateral kidney by virtue of decreasing pulse pressure. However, renal diseases that often coexist, increase renal vascular stiffness and hide the hemodynamic effect of renal stenosis. (3) In transplant kidney and in chronic renal disease, high RRI values (>0.80) can independently predict renal and clinical outcomes, but systemic (pulse pressure) rather than renal hemodynamic determinants sustain the predictive role of RRI. (4) Higher RRI detects target renal organ damage in hypertension and diabetes when renal function is still preserved, as a marker of systemic atherosclerotic burden. Is this the fact? We attempt to answer.
Collapse
Affiliation(s)
- Maria Boddi
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
| | - Fabrizia Natucci
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy.
| | - Elisa Ciani
- Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, 50134, Florence, Italy
| |
Collapse
|
43
|
Zhu J, Wen K, He H. Diagnostic value of urinary protein and creatinine in combination with renal ultrasound examination in early renal damage of patients with hypertension. Pak J Med Sci 2015; 31:899-902. [PMID: 26430426 PMCID: PMC4590400 DOI: 10.12669/pjms.314.7513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To evaluate the diagnostic value of urinary protein and creatinine in combination with renal Doppler ultrasound examination in early renal damage of patients with hypertension. Methods: One hundred twenty two hypertensive patients who were treated in our hospital from December 2013 to June 2014 were selected for this study, including 33, 41 and 48 cases of Stage I, Stage II and Stage III hypertension respectively. Meanwhile, 30 healthy subjects were selected as the control group. They received urinary protein, creatinine and renal Doppler ultrasound examination. Results: The urinary protein levels of Stage I, II and Stage III hypertensive patients were significantly different from that of the control group (p<0.05). Urinary creatinine levels were similar (p>0.05) in stage I and II but different from control (p<0.05) in stage III. Doppler ultrasound examination showed that Stage I hypertensive patients had similar renal longest diameter (RLD), renal parenchymal thickness (RPT) and ratio of RPT/renal sinus thickness to those of the control group (p>0.05), and RLDs of Stage II hypertensive patients and the control group were not significantly different (p>0.05). Conclusion: Urinary protein and creatinine levels in combination with renal Doppler ultrasound examination could diagnose early renal damage in patients with hypertension.
Collapse
Affiliation(s)
- Jihong Zhu
- Jihong Zhu, Huaihe Hospital of Henan University, Kaifeng 475000, P. R. China
| | - Ke Wen
- Ke Wen, Huaihe Hospital of Henan University, Kaifeng 475000, P. R. China
| | - Hongwen He
- Hongwen He, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, P. R. China
| |
Collapse
|
44
|
Delsart P, Meurice J, Midulla M, Bauters C, Haulon S, Mounier-Vehier C. Prognostic Significance of the Renal Resistive Index After Renal Artery Revascularization in the Context of Flash Pulmonary Edema. J Endovasc Ther 2015; 22:801-5. [PMID: 26250746 DOI: 10.1177/1526602815599964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the prognostic value of the renal resistive index (Ri) after renal artery revascularization in the context of flash pulmonary edema. METHODS Between 2000 and 2008, 43 patients (mean age 72.1±10.9 years; 23 women) underwent renal artery angioplasty/stenting in the context of flash pulmonary edema. Intrarenal Ri was assessed using duplex ultrasound. The majority (97.7%) of patients had hypertension, and nearly half (46.5%) had diabetes mellitus. For this retrospective analysis, the patients were divided into 2 groups according to the median Ri (<0.8 and ≥0.8) of the population. A Cox proportional hazards model was used to identify predictors of all-cause mortality (primary endpoint) and rehospitalization for heart failure; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). The mean follow-up was 49.8±30.6 months. RESULTS There was no difference between the groups regarding clinical characteristics. A high Ri was associated with the risk of all-cause death (HR 2.54, 95% CI 1.15 to 5.60, p=0.021). This relationship was still statistically significant after adjustment for age, gender, diabetes, glomerular filtration rate, and treatment with a renin-angiotensin system inhibitor (HR 1.74, 95%CI 1.08 to 2.81, p=0.032). A high Ri was also associated with cardiovascular death in unadjusted and adjusted analyses. In contrast, a high Ri was not associated with the risk of rehospitalization for heart failure. CONCLUSION After renal artery revascularization for flash pulmonary edema, a high intrarenal Ri is independently associated with all-cause mortality. Determination of the intrarenal Ri after this procedure may be useful for identifying at-risk patients.
Collapse
Affiliation(s)
- Pascal Delsart
- Médecine Vasculaire et HTA, Hôpital Cardiologique, CHRU de Lille, France
| | - Jonathan Meurice
- Service de Cardiologie, Centre Hospitalier de Boulogne sur Mer, France
| | - Marco Midulla
- Radiologie Vasculaire, Hôpital Cardiologique, CHRU de Lille, France
| | - Christophe Bauters
- Clinique de Cardiologie, Hôpital Cardiologique, CHRU de Lille, France Faculté de Médecine de Lille, France
| | - Stephan Haulon
- Faculté de Médecine de Lille, France Chirurgie Vasculaire, Hôpital Cardiologique, CHRU Lille, France
| | - Claire Mounier-Vehier
- Médecine Vasculaire et HTA, Hôpital Cardiologique, CHRU de Lille, France Faculté de Médecine de Lille, France
| |
Collapse
|
45
|
Toledo C, Thomas G, Schold JD, Arrigain S, Gornik HL, Nally JV, Navaneethan SD. Renal resistive index and mortality in chronic kidney disease. Hypertension 2015; 66:382-8. [PMID: 26077569 DOI: 10.1161/hypertensionaha.115.05536] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/13/2015] [Indexed: 01/30/2023]
Abstract
Renal resistive index (RRI) measured by Doppler ultrasonography is associated with cardiovascular events and mortality in hypertensive, diabetic, and elderly patients. We studied the factors associated with high RRI (≥0.70) and its associations with mortality in chronic kidney disease patients without renal artery stenosis. We included 1962 patients with an estimated glomerular filtration rate of 15 to 59 mL/min per 1.73 m(2) who also had RRI measured (January 1, 2005, to October 2011) from an existing chronic kidney disease registry. Participants with renal artery stenosis (60%-99% or renal artery occlusion) were excluded. Multivariable logistic regression model was used to study factors associated with high RRI (≥0.70), and its association with mortality was studied using Kaplan-Meier plots and Cox proportional hazards model. Hypertension was prevalent in >90% of the patients. In the multivariable logistic regression, older age, female sex, diabetes mellitus, coronary artery disease, peripheral vascular disease, higher systolic blood pressure, and the use of β blockers were associated with higher odds of having RRI≥0.70. During a median follow-up of 2.2 years, 428 patients died. After adjusting for covariates, RRI≥0.70 was associated with increased mortality (adjusted hazard ratio, 1.29; 95% confidence interval, 1.02-1.65; P<0.05). This association was more pronounced among younger patients and those with stage 3 chronic kidney disease. Noncardiovascular/non-malignancy-related deaths were higher in those with RRI≥0.70. RRI≥0.70 is associated with higher mortality in hypertensive chronic kidney disease patients without clinically significant renal artery stenosis after accounting for other significant risk factors. Its evaluation may allow early identification of those who are at risk thereby potentially preventing or delaying adverse outcomes.
Collapse
Affiliation(s)
- Clarisse Toledo
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH
| | - George Thomas
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH
| | - Jesse D Schold
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH
| | - Susana Arrigain
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH
| | - Heather L Gornik
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH
| | - Joseph V Nally
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH
| | - Sankar D Navaneethan
- From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
| |
Collapse
|
46
|
Tipisca V, Murino C, Cortese L, Mennonna G, Auletta L, Vulpe V, Meomartino L. Resistive index for kidney evaluation in normal and diseased cats. J Feline Med Surg 2015; 18:471-5. [PMID: 26012866 DOI: 10.1177/1098612x15587573] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objectives were to determine the resistive index (RI) in normal cats and in cats with various renal diseases, and to evaluate the effect of age on RI. METHODS The subjects were cats that had ultrasonography (US) of the urinary tract and RI measurement at our centre between January 2003 and April 2014. Based on clinical evaluation, biochemical and haematological tests, urinalysis and US, the cats were classified as healthy or diseased. RI measurements were made from the interlobar or arcuate arteries. Data were analysed for differences between the right and the left kidney, the two sexes, different age groups in healthy cats, and between healthy and diseased cats. RESULTS A total of 116 cats (68 males, 48 females) were included: 24 healthy and 92 diseased. In the healthy cats, RI (mean ± SD) differed significantly (P = 0.02) between the right kidney (0.54 ± 0.07) and the left kidney (0.59 ± 0.08). For the left kidney, RI was significantly higher in cats with chronic kidney disease (0.73 ± 0.12) and acute kidney injury (0.72 ± 0.08) (P = 0.0008). For the right kidney, RI was significantly higher in cats with chronic kidney disease (0.72 ± 0.11), acute kidney injury (0.74 ± 0.08), polycystic kidney disease (0.77 ± 0.11) and renal tumour (0.74 ± 0.001) (P <0.0001). There was no significant effect on RI value in either kidney in terms of age or sex. CONCLUSIONS AND RELEVANCE RI could be considered a valuable diagnostic tool in cats, useful in the differential diagnosis of diffuse renal diseases. While it does not change with the age of the cat, ultrasonographers should be aware that RI may differ between the two kidneys.
Collapse
Affiliation(s)
- Vlad Tipisca
- Veterinary Medicine Faculty, University "Ion Ionescu de La Brad", Iasi, Romania
| | - Carla Murino
- Interdepartmental Centre of Veterinary Radiology, University "Federico II", Naples, Italy
| | - Laura Cortese
- Department of Veterinary Medicine and Animal Productions, University "Federico II", Naples, Italy
| | - Giuseppina Mennonna
- Interdepartmental Centre of Veterinary Radiology, University "Federico II", Naples, Italy
| | | | - Vasile Vulpe
- Veterinary Medicine Faculty, University "Ion Ionescu de La Brad", Iasi, Romania
| | - Leonardo Meomartino
- Interdepartmental Centre of Veterinary Radiology, University "Federico II", Naples, Italy
| |
Collapse
|
47
|
Tanimura M, Dohi K, Matsuda M, Sato Y, Sugiura E, Kumagai N, Nakamori S, Yamada T, Fujimoto N, Tanigawa T, Yamada N, Nakamura M, Ito M. Renal resistive index as an indicator of the presence and severity of anemia and its future development in patients with hypertension. BMC Nephrol 2015; 16:45. [PMID: 25884723 PMCID: PMC4393622 DOI: 10.1186/s12882-015-0040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined whether renal resistive index (RI), a simple index of renal vascular resistance, is associated with the presence and severity of anemia, and can predict the future development of anemia in patients with hypertension. METHODS We retrospectively examined 175 patients with hypertension (mean age 67 ± 11 years, 32-85 years, 134 males) who underwent renal ultrasonography. Anemia was defined as a reduction in the concentration of hemoglobin <13.0 g/dL for men and <12.0 g/dL for women. Renal RI was measured in the interlobar arteries. RESULTS Anemia was present in 37% of men and 34% of women. The mean estimated glomerular filtration rate (eGFR) was 58 ± 23 ml/min/1.73 m(2) (median: 56 ml/min/1.73 m(2), range: 16-168 ml/min/1.73 m(2)) and the mean renal RI was 0.70 ± 0.09 (median: 0.70, range: 0.45-0.92). Proteinuria was present in 29% of patients. Both eGFR and renal RI correlated significantly with hemoglobin levels. In the stepwise multivariate linear regression analysis, renal RI was associated with hemoglobin levels independently of potential confounders including eGFR. During the follow-up period (median: 959 days, range: 7-3595 days), Kaplan-Meier curves demonstrated that patients with renal RI above the median value had a higher incidence of the future development of anemia than other patients. Cox regression analysis showed that renal RI (hazard ratio 1.18, 95% CI 1.02-1.37 per 0.05 rises in renal RI, p =0.03) and the presence of proteinuria were (hazard ratio 1.80, 95% CI 1.08-3.01, p =0.03) were independently associated with the future development of anemia after correcting for confounding factors. CONCLUSIONS Measurement of renal RI can be useful for elucidating the pathogenesis of anemia and for inferring its potential risk in patients with hypertension.
Collapse
Affiliation(s)
- Muneyoshi Tanimura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Masumi Matsuda
- Central Clinical Laboratories, Mie University Hospital, Tsu, Japan.
| | - Yuichi Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Emiyo Sugiura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Naoto Kumagai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Tomomi Yamada
- Department of Translational Medical Science, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Naoki Fujimoto
- Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Takashi Tanigawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Mashio Nakamura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
| |
Collapse
|
48
|
Kuznetsova T, Cauwenberghs N, Knez J, Thijs L, Liu YP, Gu YM, Staessen JA. Doppler indexes of left ventricular systolic and diastolic flow and central pulse pressure in relation to renal resistive index. Am J Hypertens 2015; 28:535-45. [PMID: 25241047 DOI: 10.1093/ajh/hpu185] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The cardio-renal interaction occurs via hemodynamic and humoral factors. Noninvasive assessment of renal hemodynamics is currently possible by assessment of renal resistive index (RRI) derived from intrarenal Doppler arterial waveforms as ((peak systolic velocity - end-diastolic velocity)/peak systolic velocity). Limited information is available regarding the relationship between RRI and cardiac hemodynamics. We investigated these associations in randomly recruited subjects from a general population. METHODS In 171 participants (48.5% women; mean age, 52.2 years), using pulsed wave Doppler, we measured RRI (mean, 0.60) and left ventricular outflow tract (LVOT) and transmitral (E and A) blood flow peak velocities and its velocity time integrals (VTI). Using carotid applanation tonometry, we measured central pulse pressure and arterial stiffness indexes such as augmentation pressure and carotid-femoral pulse wave velocity. RESULTS In stepwise regression analysis, RRI independently and significantly increased with female sex, age, body weight, brachial pulse pressure, and use of β-blockers, whereas it decreased with body height and mean arterial pressure. In multivariable-adjusted models with central pulse pressure and arterial stiffness indexes as the explanatory variables, we observed a significant and positive correlation of RRI only with central pulse pressure (P < 0.0001). Among the Doppler indexes of left ventricular blood flow, RRI was significantly and positively associated with LVOT and E peak velocities (P ≤ 0.012) and VTIs (P ≤ 0.010). CONCLUSIONS We demonstrated that in unselected subjects RRI was significantly associated with central pulse pressure and left ventricular systolic and diastolic Doppler blood flow indexes. Our findings imply that in addition to the anthropometric characteristics, cardiac hemodynamic factors influence the intrarenal arterial Doppler waveform patterns.
Collapse
Affiliation(s)
- Tatiana Kuznetsova
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium;
| | - Nicholas Cauwenberghs
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Judita Knez
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yan-Ping Liu
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yu-Mei Gu
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- The Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Epidemiology, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
49
|
Nicolau C, Salvador R, Artigas J. Manejo diagnóstico del cólico renal. RADIOLOGIA 2015; 57:113-22. [DOI: 10.1016/j.rx.2014.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/13/2014] [Accepted: 11/03/2014] [Indexed: 11/26/2022]
|
50
|
Diagnostic management of renal colic. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|