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Trentin-Sonoda M, Zimpelmann J, Tailor K, Gillard JW, Yoganathan N, Sulea T, Burns KD. Effects of Two Soluble ACE2-Fc Variants on Blood Pressure and Albuminuria in Hypertensive Mice: Research Letter. Can J Kidney Health Dis 2023; 10:20543581231207146. [PMID: 37881406 PMCID: PMC10594958 DOI: 10.1177/20543581231207146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
Background Angiotensin-converting enzyme 2 (ACE2) hydrolyzes angiotensin (Ang) II to Ang-(1-7), promoting vasodilatation, and inhibiting oxidative stress and inflammation. Plasma membrane ACE2 is the receptor for all known SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) viral variants. In COVID-19 infection, soluble ACE2 variants may act as decoys to bind and neutralize the coronavirus, reducing its tissue infectivity. Furthermore, soluble ACE2 variants have been proposed as potential therapeutics for kidney disease and hypertensive disorders. Objective Soluble ACE2 variants conjugated to human Fc domains and selected for high-potency viral SARS-CoV-2 neutralization were prepared and evaluated for ACE2 activity in vitro. Lead candidates were then tested for systemic ACE2 activity, stability, and effects on blood pressure and albuminuria in mice with Ang II-induced hypertension. Methods ACE2 activity of 10 soluble ACE2 variants was first assessed in cell-free conditions using a fluorogenic substrate, or by Ang II hydrolysis to Ang-(1-7). Hypertension was induced in male or female mice by implantation of osmotic minipumps containing Ang II. Two lead ACE2 variants were injected intravenously (i.v.) into hypertensive mice, followed by measurements of blood pressure (tail-cuff plethysmography), albuminuria, and tissue ACE2 activity and protein (immunoblots). Results Soluble ACE2-Fc variants demonstrated significant ACE2 enzymatic activity, with kinetics comparable with human recombinant ACE2. In hypertensive mice, single dose i.v. injection of ACE2-Fc variant K (10 mg/kg) significantly decreased systolic blood pressure at 24 hours, with partial lowering sustained to 48 hours, and tendency to reduce albuminuria at 72 hours. By contrast, ACE2-Fc variant I had no effect on blood pressure or albuminuria in hypertensive mice; ACE2-Fc variant K was detected by immunoblotting in plasma, kidney, heart, lung, liver, and spleen lysates 72 hours after injection, associated with significantly increased ACE2 activity in all tissues except kidney and spleen. Angiotensin-converting enzyme 2-Fc variant I had no effect on plasma ACE2 activity. Conclusions Soluble ACE2-Fc variant K reduces blood pressure and tends to lower albuminuria in hypertensive mice. Furthermore, soluble ACE2-Fc variant K has prolonged tissue retention, associated with increased tissue ACE2 activity. The results support further studies directed at the therapeutic potential of soluble ACE2-Fc variant K for cardiovascular and kidney protection.
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Affiliation(s)
- Mayra Trentin-Sonoda
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Joseph Zimpelmann
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Karishma Tailor
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | | | | | - Traian Sulea
- Human Health Therapeutics Research Centre, National Research Council Canada, Montreal, QC, Canada
| | - Kevin D. Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
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Lee T, Cheng MP, Vinh DC, Lee TC, Tran KC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove DM, Singer J, Patrick DM, Marshall JC, Burns KD, Murthy S, Mann PK, Hernandez G, Donohoe K, Russell JA. Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave. CMAJ Open 2023; 11:E672-E683. [PMID: 37527902 PMCID: PMC10400083 DOI: 10.9778/cmajo.20220194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves. METHODS This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic. RESULTS During the Omicron wave, 28-day mortality was significantly lower in vaccinated (n = 19/237) than unvaccinated hospitalized patients (n = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15-0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24-0.59; and 0.42, 95% CI 0.26-0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43-1.51) and had less organ dysfunction than in the first 2 waves. INTERPRETATION Patients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.
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Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Matthew P Cheng
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Donald C Vinh
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Todd C Lee
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Karen C Tran
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Brent W Winston
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - David Sweet
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - John H Boyd
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Keith R Walley
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Greg Haljan
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Allison McGeer
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Francois Lamontagne
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Robert Fowler
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - David M Maslove
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Joel Singer
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - David M Patrick
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - John C Marshall
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Kevin D Burns
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Srinivas Murthy
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Puneet K Mann
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Geraldine Hernandez
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Kathryn Donohoe
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - James A Russell
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
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3
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Gutsol AA, Hale TM, Thibodeau JF, Holterman CE, Nasrallah R, Correa JWN, Touyz RM, Kennedy CRJ, Burger D, Hébert RL, Burns KD. Comparative Analysis of Hypertensive Tubulopathy in Animal Models of Hypertension and Its Relevance to Human Pathology. Toxicol Pathol 2023; 51:160-175. [PMID: 37632371 DOI: 10.1177/01926233231191128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Assessment of hypertensive tubulopathy for more than fifty animal models of hypertension in experimental pathology employs criteria that do not correspond to lesional descriptors for tubular lesions in clinical pathology. We provide a critical appraisal of experimental hypertension with the same approach used to estimate hypertensive renal tubulopathy in humans. Four models with different pathogenesis of hypertension were analyzed-chronic angiotensin (Ang) II-infused and renin-overexpressing (TTRhRen) mice, spontaneously hypertensive (SHR), and Goldblatt two-kidney one-clip (2K1C) rats. Mouse models, SHR, and the nonclipped kidney in 2K1C rats had no regular signs of hypertensive tubulopathy. Histopathology in animals was mild and limited to variations in the volume density of tubular lumen and epithelium, interstitial space, and interstitial collagen. Affected kidneys in animals demonstrated lesion values that are significantly different compared with healthy controls but correspond to mild damage if compared with hypertensive humans. The most substantial human-like hypertensive tubulopathy was detected in the clipped kidney of 2K1C rats. For the first time, our study demonstrated the regular presence of chronic progressive nephropathy (CPN) in relatively young mice and rats with induced hypertension. Because CPN may confound the assessment of rodent models of hypertension, proliferative markers should be used to verify nonhypertensive tubulopathy.
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Affiliation(s)
- Alex A Gutsol
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Taben M Hale
- The University of Arizona, Phoenix, Arizona, USA
| | | | | | | | | | | | - Chris R J Kennedy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Dylan Burger
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Richard L Hébert
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
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4
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Salehi R, Wyse BA, Asare-Werehene M, Esfandiarinezhad F, Abedini A, Pan B, Urata Y, Gutsol A, Vinas JL, Jahangiri S, Xue K, Xue Y, Burns KD, Vanderhyden B, Li J, Osuga Y, Burger D, Tan SL, Librach CL, Tsang BK. Androgen-induced exosomal miR-379-5p release determines granulosa cell fate: cellular mechanism involved in polycystic ovaries. J Ovarian Res 2023; 16:74. [PMID: 37046285 PMCID: PMC10091561 DOI: 10.1186/s13048-023-01141-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is a complex multi-factorial syndrome associated with androgen excess and anovulatory infertility. In the current study, we investigated the role of dihydrotestosterone-induced exosomal miR-379-5p release in determining the destiny of the developing follicles. Our hypothesis was that androgen regulates granulosa cell miR-379-5p content by facilitating its exosomal release in a follicular-stage dependent manner, a process which determines granulosa cell fate. Compared to human non-PCOS subjects, individuals with PCOS exhibit higher follicular fluid free testosterone levels, lower exosomal miR-379-5p content and granulosa cell proliferation. Androgenized rats exhibited lower granulosa cell miR-379-5p but higher phosphoinositide-dependent kinase-1 (PDK1; a miR-379-5p target) content and proliferation. Androgen reduced granulosa cell miR-379-5p content by increasing its exosomal release in preantral follicles, but not in antral follicles in vitro. Studies with an exosomal release inhibitor confirmed that androgen-induced exosomal miR-379-5p release decreased granulosa cell miR-379-5p content and proliferation. Ovarian overexpression of miR-379-5p suppressed granulosa cell proliferation, and basal and androgen-induced preantral follicle growth in vivo. These findings suggest that increased exosomal miR-379-5p release in granulosa cells is a proliferative response to androgenic stimulation specific for the preantral stage of follicle development and that dysregulation of this response at the antral stage is associated with follicular growth arrest, as observed in human PCOS.
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Affiliation(s)
- Reza Salehi
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Obstetrics and Gynecology, and Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- CReATe Fertility Centre, Toronto, ON, Canada
| | | | - Meshach Asare-Werehene
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Obstetrics and Gynecology, and Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Fereshteh Esfandiarinezhad
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Obstetrics and Gynecology, and Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Atefeh Abedini
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bo Pan
- Department of Animal BioScience, University of Guelph, Guelph, ON, Canada
| | - Yoko Urata
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Alex Gutsol
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Jose L Vinas
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | | | - Kai Xue
- Department of Gynecology, The Affiliated Obstetrics and Gynecology Hospital, Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Yunping Xue
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Vanderhyden
- Departments of Obstetrics and Gynecology, and Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Julang Li
- Department of Animal BioScience, University of Guelph, Guelph, ON, Canada
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Dylan Burger
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Seang-Lin Tan
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
- Originelle Fertility Clinic and Women's Health Centre, Ottawa, ON, Canada
| | - Clifford L Librach
- CReATe Fertility Centre, Toronto, ON, Canada
- Departments of Obstetrics and Gynaecology, Physiology, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Benjamin K Tsang
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Departments of Obstetrics and Gynecology, and Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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Salehi R, Asare-Werehene M, Wyse BA, Abedini A, Pan B, Gutsol A, Jahangiri S, Szaraz P, Burns KD, Vanderhyden B, Li J, Burger D, Librach CL, Tsang BK. Granulosa cell-derived miR-379-5p regulates macrophage polarization in polycystic ovarian syndrome. Front Immunol 2023; 14:1104550. [PMID: 37033997 PMCID: PMC10081157 DOI: 10.3389/fimmu.2023.1104550] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is associated with hyperandrogenemia and ovarian antral follicle growth arrest. We have previously demonstrated that androgen-induced exosomal release of miR-379-5p (miR379) from preantral follicle granulosa cells increases the proliferation of target cells via phosphoinositide-dependent kinase 1 (PDK1) upregulation. Androgen also increases inflammatory M1 macrophage abundance, but reduces anti-inflammatory M2 polarization in rat antral and preovulatory follicles. However, the role of small extracellular vesicles (sEVs; also known as exosomes) secretion in determining the cellular content and function of miRNAs in exosome-receiving cells is largely unknown. Our objectives were to determine: 1) the regulatory role of granulosa cells (GC)-derived exosomal miR379 on macrophage polarization and ovarian inflammation; 2) whether miR379-induced M1 polarization regulates GC proliferation; and 3) if this regulated process is follicular stage-specific. Compared with non-PCOS subjects, PCOS subjects had a higher M1/M2 ratio, supporting the concept that PCOS is an inflammatory condition. Ovarian overexpression of miR379 increased the number of M1 macrophages and the M1/M2 ratio in preantral follicles specifically. Transfection of macrophages with a miR379 mimic reduced the cellular content of PDK1 and induced M0→M1 polarization; whereas its inhibitor polarized M0→M2. Conditioned media from macrophages transfected with miR379 mimic and follicular fluid from PCOS subjects had higher galectin-3 content, a pro-inflammatory cytokine which specifically suppresses human antral follicle GC proliferation. These results indicate that miR379 inhibits M2 macrophage polarization, a condition which suppresses GC proliferation in a follicle stage-dependent manner, as exhibited in PCOS.
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Affiliation(s)
- Reza Salehi
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
- CReATe Fertility Centre, Toronto, ON, Canada
| | - Meshach Asare-Werehene
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
| | | | - Atefeh Abedini
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bo Pan
- Department of Animal BioScience, University of Guelph, Guelph, ON, Canada
| | - Alex Gutsol
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Kevin D. Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Vanderhyden
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Julang Li
- Department of Animal BioScience, University of Guelph, Guelph, ON, Canada
| | - Dylan Burger
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Clifford L. Librach
- CReATe Fertility Centre, Toronto, ON, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Benjamin K. Tsang
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
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6
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Burns KD, Douvris A. Protecting the kidney in sepsis: resident macrophages to the rescue. Kidney Int 2023; 103:461-463. [PMID: 36822750 DOI: 10.1016/j.kint.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 02/24/2023]
Abstract
Kidney resident macrophages exert pro-inflammatory or reparative effects in experimental acute kidney injury, but their role in sepsis is unclear. In a mouse model of sepsis, Privratsky et al. show that kidney resident F4/80hi macrophages protect against kidney injury by expressing interleukin-1 receptor antagonist, which blocks interleukin-6 production selectively from endothelial cells. Discovery of this novel autocrine loop enhances opportunities for targeted therapies to diminish kidney injury during sepsis.
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Affiliation(s)
- Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Adrianna Douvris
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bugeja A, Eldaba M, Ahmed S, Shorr R, Clark EG, Burns KD, Knoll G, Hiremath S. Kidney function, cardiovascular outcomes and survival of living kidney donors with hypertension: a systematic review protocol. BMJ Open 2022; 12:e064132. [PMID: 36521905 PMCID: PMC9756152 DOI: 10.1136/bmjopen-2022-064132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hypertension has been considered a contraindication for living kidney donation in the past. Since transplantation from living kidney donors remains the best modality for kidney failure, there is now an increased acceptance of living kidney donors with hypertension. However, the safety of this practice for the cardiovascular and kidney health of the donor is unclear. We will conduct a systematic review to summarise and synthesise the existing literature on this topic. METHODS AND ANALYSIS A systematic review of prospective randomised and non-randomised and retrospective studies will be conducted. MEDLINE, EMBASE, Cochrane CENTRAL and EBM reviews published from January 1946 to December 2021 will be reviewed. Primary outcome will be the difference in the survival, major adverse cardiovascular events, estimated glomerular filtration rate of 45 mL/min or less and development of end-stage kidney failure, between living kidney donors with and without hypertension. Study screening, selection, and data extraction will be performed by two independent reviewers. Studies must fulfil all eligibility criteria for inclusion into the systematic review and meta-analysis. The Risk of Bias in Non-Randomised studies tool will be used to assess bias. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review. The results of this review will be disseminated in a peer-reviewed, open-access journal to ensure access to all stakeholders in kidney transplantation and to inform clinical guidelines on the evaluation and follow-up care of living kidney donor candidates. PROSPERO REGISTRATION NUMBER CRD42022300119.
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Affiliation(s)
- Ann Bugeja
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Kidney Research Centre, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mariam Eldaba
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Sumaiya Ahmed
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Kidney Research Centre, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Kidney Research Centre, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Kidney Research Centre, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Kidney Research Centre, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Hundemer GL, White CA, Norman PA, Knoll GA, Tangri N, Sood MM, Hiremath S, Burns KD, McCudden C, Akbari A. Performance of the 2021 Race-Free CKD-EPI Creatinine- and Cystatin C-Based Estimated GFR Equations Among Kidney Transplant Recipients. Am J Kidney Dis 2022; 80:462-472.e1. [PMID: 35588905 DOI: 10.1053/j.ajkd.2022.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/11/2022] [Indexed: 01/29/2023]
Abstract
RATIONALE & OBJECTIVE Race-free estimated glomerular filtration rate (eGFR) equations incorporating creatinine with and without cystatin C were recently developed and recommended for routine use. However, the performance of these equations among kidney transplant recipients (KTRs) remains unknown. STUDY DESIGN Cross-sectional study to validate the 2021 race-free Chronic Kidney Disease (CKD) Epidemiology Collaboration (CKD-EPI) eGFR equation based on creatinine alone (eGFRcr) or based on creatinine and cystatin C (eGFRcr-cys) among KTRs. SETTING & PARTICIPANTS KTRs in stable condition (N = 415) from Canada and New Zealand with same-day measurements of creatinine, cystatin C, and glomerular filtration rate (GFR) using radiolabeled diethylenetriaminepentaacetic acid. TESTS COMPARED The 2009 CKD-EPI eGFRcr, 2021 CKD-EPI eGFRcr, 2012 CKD-EPI eGFRcr-cys, 2021 CKD-EPI eGFRcr-cys, 2012 CKD-EPI eGFRcys, and Modification of Diet in Renal Disease (MDRD) Study eGFR equations were compared with measured GFR. OUTCOMES Bias, precision, accuracy, and correct classification by CKD stage. Bias was defined as the difference between estimated and measured GFR. Precision was represented by the interquartile range. Accuracy was defined as the percentages of participants with eGFRs within 10%/20%/30% (P10/P20/P30) of measured GFR, root mean square error, and mean absolute error. RESULTS 87% of patients studied were White, 3% Black, and 10% other races. Mean measured GFR was 53 ± 19 (SD) mL/min/1.73 m2. The 2009 and 2021 CKD-EPI eGFRcr equations demonstrated similar median bias (-2.3 vs -0.2 mL/min/1.73 m2, respectively), precision (14.5 vs 14.9 mL/min/1.73 m2), and accuracy (P10/P20/P30, 32%/65%/84% vs 33%/63%/84%). The 2012 and 2021 CKD-EPI eGFRcr-cys equations also demonstrated similar median bias (-3.6 vs 0.3 mL/min/1.73 m2, respectively), precision (13.3 vs 14.3 mL/min/1.73 m2), and accuracy (P10/P20/P30, 32%/63%/80% vs 32%/67%/83%). No clear difference in performance was detected between the 2021 CKD-EPI eGFRcr and eGFRcr-cys equations among KTRs. The proportion of correct classification by CKD stage was similar across all eGFR equations. LIMITATIONS Moderate sample size, few patients had a GFR <30 mL/min/1.73 m2, and the large majority of patients were White. CONCLUSIONS Among KTRs, the 2021 race-free CKD-EPI eGFR equations perform similarly to the previous CKD-EPI equations that included race correction terms. No significant difference in performance was observed between the 2021 CKD-EPI eGFRcr and eGFRcr-cys equations in the kidney transplant population.
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Affiliation(s)
- Gregory L Hundemer
- Department of Medicine, Division of Nephrology, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | | | - Patrick A Norman
- Department of Public Health Sciences, Kingston, Ontario; Queen's University, Kingston General Health Research Institute, Kingston, Ontario
| | - Greg A Knoll
- Department of Medicine, Division of Nephrology, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Navdeep Tangri
- Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Manish M Sood
- Department of Medicine, Division of Nephrology, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Swapnil Hiremath
- Department of Medicine, Division of Nephrology, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | - Kevin D Burns
- Department of Medicine, Division of Nephrology, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa
| | | | - Ayub Akbari
- Department of Medicine, Division of Nephrology, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa
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9
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Madken M, Gotra A, Qazi S, Fairhead T, Burns KD. Successful Endovascular Management of Resistant Hypertension Post Kidney Transplant: A Case Report. Can J Kidney Health Dis 2022; 9:20543581221119896. [PMID: 36160314 PMCID: PMC9493670 DOI: 10.1177/20543581221119896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Rationale: Transplant renal artery stenosis (TRAS) is a well-recognized and potentially reversible
cause of resistant hypertension post transplantation and can affect 1% to 23% of
recipients. Stenosis of the iliac segment proximal to the transplant renal artery
(proximal TRAS) causing dysfunction of the transplanted kidney is less common with
reported incidence of 2% to 3%. Presentation typically occurs between 3 months and 2
years post transplant but may happen at any time. Noninvasive investigations such as
Doppler ultrasound, computed tomography (CT) angiogram, and magnetic resonance angiogram
are useful in initial evaluation, but definitive diagnosis of hemodynamically
significant stenosis often requires formal angiogram. Transplant renal artery stenosis
should be suspected in any kidney transplant recipient with worsening hypertension
and/or deterioration in kidney function which is otherwise unexplained. We present the
case of a kidney transplant recipient with resistant hypertension and impaired graft
function, secondary to severe impairment of graft blood flow from proximal iliac system
occlusion. Presenting concerns of the patient: A 74-year-old female 15 years post live donor kidney transplant presented with graft
dysfunction (serum Cr 229 μmol/L) and resistant hypertension, requiring use of 8
antihypertensive medications. On physical examination, blood pressure was 160/92 mm Hg
with no tenderness over the renal graft in the right lower abdominal quadrant and no
audible bruit in kidney allograft area. Diagnosis: Transplant Doppler ultrasound showed reversal of flow in the right external iliac
artery suggestive of ipsilateral proximal iliac occlusion. Pre-procedure CT demonstrated
severe atherosclerotic burden within the aorta and bilateral iliac systems. The
anastomosed right renal artery appeared patent. Interventions: Conventional angiogram showed occlusion of the right common and proximal external iliac
arteries with retrograde perfusion of the transplant kidney via the contralateral left
iliac system and aorta. Subintimal recanalization of the right iliac system was
performed with angioplasty and kissing stent placement at the aortic bifurcation with
stents extending into the proximal right external iliac artery. Post deployment
angiogram demonstrated renewed patency of the right iliac system, with restoration of
antegrade perfusion to the transplant kidney. Outcomes: The patient’s blood pressure decreased significantly after the procedure, with
improvement in graft function. After 6 months, the patient continued to have optimally
controlled blood pressure (on 3 medications) and stable graft function (serum Cr 74
μmol/L). Teaching points: Our case describes proximal TRAS and the contribution of renal hypoperfusion to
hypertension and impaired graft function, with the potential for reversibility.
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Affiliation(s)
- Mohit Madken
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Akshat Gotra
- Division of Vascular & Interventional Radiology, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Shakeel Qazi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Todd Fairhead
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
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10
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Douvris A, Viñas J, Burns KD. miRNA-486-5p: signaling targets and role in non-malignant disease. Cell Mol Life Sci 2022; 79:376. [PMID: 35731367 PMCID: PMC9217846 DOI: 10.1007/s00018-022-04406-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
MicroRNAs (miRNAs) are short non-coding RNAs, highly conserved between species, that are powerful regulators of gene expression. Aberrant expression of miRNAs alters biological processes and pathways linked to human disease. miR-486-5p is a muscle-enriched miRNA localized to the cytoplasm and nucleus, and is highly abundant in human plasma and enriched in small extracellular vesicles. Studies of malignant and non-malignant diseases, including kidney diseases, have found correlations with circulating miR-486-5p levels, supporting its role as a potential biomarker. Pre-clinical studies of non-malignant diseases have identified miR-486-5p targets that regulate major signaling pathways involved in cellular proliferation, migration, angiogenesis, and apoptosis. Validated miR-486-5p targets include phosphatase and tensin homolog (PTEN) and FoXO1, whose suppression activates phosphatidyl inositol-3-kinase (PI3K)/Akt signaling. Targeting of Smad1/2/4 and IGF-1 by miR-486-5p inhibits transforming growth factor (TGF)-β and insulin-like growth factor-1 (IGF-1) signaling, respectively. Other miR-486-5p targets include matrix metalloproteinase-19 (MMP-19), Sp5, histone acetyltransferase 1 (HAT1), and nuclear factor of activated T cells-5 (NFAT5). In this review, we examine the biogenesis, regulation, validated gene targets and biological effects of miR-486-5p in non-malignant diseases.
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Affiliation(s)
- Adrianna Douvris
- Division of Nephrology, Department of Medicine and Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON, K1H 7W9, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jose Viñas
- Division of Nephrology, Department of Medicine and Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON, K1H 7W9, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine and Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON, K1H 7W9, Canada. .,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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11
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Rosecrans AM, Moen MA, Harris RE, Rice MS, Augustin VS, Stracker NH, Burns KD, Rives ST, Tran KM, Callahan CW, Dzirasa LK. Implementation of Baltimore City's COVID-19 Isolation Hotel. Am J Public Health 2022; 112:876-880. [PMID: 35446607 DOI: 10.2105/ajph.2022.306778] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In May 2020, Baltimore City, Maryland, implemented the Lord Baltimore Triage, Respite, and Isolation Center (LBTC), a multiagency COVID-19 isolation and quarantine site tailored for people experiencing homelessness. In the first year, 2020 individuals were served, 78% completed isolation at LBTC, and 6% were transferred to a hospital. Successful isolation can mitigate outbreaks in shelters and residential recovery programs, and planning for sustainable isolation services integrated within these settings is critical as the COVID-19 pandemic continues. (Am J Public Health. Published online ahead of print April 21, 2022: e1-e5. https://doi.org/10.2105/AJPH.2022.306778).
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Affiliation(s)
- Amanda M Rosecrans
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Marik A Moen
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Robert E Harris
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Molly S Rice
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Vanessa S Augustin
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Norberth H Stracker
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Kevin D Burns
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Sarah T Rives
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Katherine M Tran
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Charles W Callahan
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
| | - Letitia K Dzirasa
- Amanda M. Rosecrans, Robert E. Harris, Norberth H. Stracker, and Sarah T. Rives are with the Baltimore City Health Department and the School of Medicine, Johns Hopkins University, Baltimore, MD. Marik A. Moen is with the University of Maryland Medical System and the School of Nursing, University of Maryland, Baltimore. Molly S. Rice, Vanessa S. Augustin, Kevin D. Burns, Katherine M. Tran, and Charles W. Callahan are with the University of Maryland Medical System, Baltimore. Letitia K. Dzirasa is with the Baltimore City Health Department
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12
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Lee T, Cheng MP, Vinh DC, Lee TC, Tran KC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Burns KD, Murthy S, Mann PK, Hernandez G, Donohoe K, Rocheleau G, Russell JA. Organ dysfunction and death in patients admitted to hospital with COVID-19 in pandemic waves 1 to 3 in British Columbia, Ontario and Quebec, Canada: a cohort study. CMAJ Open 2022; 10:E379-E389. [PMID: 35440485 PMCID: PMC9022939 DOI: 10.9778/cmajo.20210216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There have been multiple waves in the COVID-19 pandemic in many countries. We sought to compare mortality and respiratory, cardiovascular and renal dysfunction between waves in 3 Canadian provinces. METHODS We conducted a substudy of the ARBs CORONA I study, a multicentre Canadian pragmatic observational cohort study that examined the association of pre-existing use of angiotensin receptor blockers with outcomes in adults admitted to hospital with acute COVID-19 up to April 2021 from 9 community and teaching hospitals in 3 Canadian provinces (British Columbia, Ontario and Quebec). We excluded emergency department admissions without hospital admission, readmissions and admissions for another reason. We used logistic and 0-1-inflated β regression models to compare 28-day and in-hospital mortality, and the use of invasive mechanical ventilation, vasopressors and renal replacement therapy (RRT) between the first 3 waves of the COVID-19 pandemic in these provinces. RESULTS A total of 520, 572 and 245 patients in waves 1, 2 and 3, respectively, were included. Patients in wave 3 were on average younger and had fewer comorbidities than those in waves 1 and 2. The unadjusted 28-day mortality rate was significantly lower in wave 3 (7.8%) than in wave 1 (18.3%) (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.24-0.78) and wave 2 (16.3%) (OR 0.46, 95% CI 0.27-0.79). After adjustment for differences in baseline characteristics, the difference in 28-day mortality remained significant (adjusted OR wave 3 v. wave 1: 0.46, 95% CI 0.26-0.81; wave 3 v. wave 2: 0.52, 95% CI 0.29-0.91). In-hospital mortality findings were similar. Use of invasive mechanical ventilation or vasopressors was less common in waves 2 and 3 than in wave 1, and use of RRT was less common in wave 3 than in wave 1. INTERPRETATION Severity of illness decreased (lower mortality and less use of organ support) across waves among patients admitted to hospital with acute COVID-19, possibly owing to changes in patient demographic characteristics and management, such as increased use of dexamethasone. Continued application of proven therapies may further improve outcomes. STUDY REGISTRATION ClinicalTrials.gov, no. NCT04510623.
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Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Matthew P Cheng
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Donald C Vinh
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Todd C Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Karen C Tran
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Brent W Winston
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Sweet
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John H Boyd
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Keith R Walley
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Greg Haljan
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Allison McGeer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - François Lamontagne
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Robert Fowler
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Maslove
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David M Patrick
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John C Marshall
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kevin D Burns
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Srinivas Murthy
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Puneet K Mann
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Geraldine Hernandez
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kathryn Donohoe
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Genevieve Rocheleau
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - James A Russell
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
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Gutsol AA, Blanco P, Hale TM, Thibodeau JF, Holterman CE, Nasrallah R, Correa JWN, Afanasiev SA, Touyz RM, Kennedy CRJ, Burger D, Hébert RL, Burns KD. Comparative analysis of hypertensive nephrosclerosis in animal models of hypertension and its relevance to human pathology. Glomerulopathy. PLoS One 2022; 17:e0264136. [PMID: 35176122 PMCID: PMC8853553 DOI: 10.1371/journal.pone.0264136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/03/2022] [Indexed: 01/09/2023] Open
Abstract
Current research on hypertension utilizes more than fifty animal models that rely mainly on stable increases in systolic blood pressure. In experimental hypertension, grading or scoring of glomerulopathy in the majority of studies is based on a wide range of opinion-based histological changes that do not necessarily comply with lesional descriptors for glomerular injury that are well-established in clinical pathology. Here, we provide a critical appraisal of experimental hypertensive glomerulopathy with the same approach used to assess hypertensive glomerulopathy in humans. Four hypertensive models with varying pathogenesis were analyzed–chronic angiotensin II infused mice, mice expressing active human renin in the liver (TTRhRen), spontaneously hypertensive rats (SHR), and Goldblatt two-kidney one-clip rats (2K1C). Analysis of glomerulopathy utilized the same criteria applied in humans–hyalinosis, focal segmental glomerulosclerosis (FSGS), ischemic, hypertrophic and solidified glomeruli, or global glomerulosclerosis (GGS). Data from animal models were compared to human reference values. Kidneys in TTRhRen mice, SHR and the nonclipped kidneys in 2K1C rats had no sign of hyalinosis, FSGS or GGS. Glomerulopathy in these groups was limited to variations in mesangial and capillary compartment volumes, with mild increases in collagen deposition. Histopathology in angiotensin II infused mice corresponded to mesangioproliferative glomerulonephritis, but not hypertensive glomerulosclerosis. The number of nephrons was significantly reduced in TTRhRen mice and SHR, but did not correlate with severity of glomerulopathy. The most substantial human-like glomerulosclerotic lesions, including FSGS, ischemic obsolescent glomeruli and GGS, were found in the clipped kidneys of 2K1C rats. The comparison of affected kidneys to healthy control in animals produces lesion values that are numerically impressive but correspond to mild damage if compared to humans. Animal studies should be standardized by employing the criteria and classifications established in human pathology to make experimental and human data fully comparable for comprehensive analysis and model improvements.
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Affiliation(s)
- Alex A. Gutsol
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
| | - Paula Blanco
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Taben M. Hale
- Basic Medical Sciences Faculty, University of Arizona, Tucson, AZ, United States of America
| | - Jean-Francois Thibodeau
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Chet E. Holterman
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Rania Nasrallah
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Jose W. N. Correa
- Department of Physiological Sciences, Biological Sciences Institute, Federal University of Amazonas, Manaus, Brazil
| | | | - Rhian M. Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Chris R. J. Kennedy
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Burger
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard L. Hébert
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin D. Burns
- Ottawa Hospital Research Institute & Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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14
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Harper KC, Salameh JP, Akhlaq N, McInnes MDF, Ivankovic V, Beydoun MH, Clark EG, Zeng W, Blew BDM, Burns KD, Sood MM, Bugeja A. The impact of measuring split kidney function on post-donation kidney function: A retrospective cohort study. PLoS One 2021; 16:e0253609. [PMID: 34214103 PMCID: PMC8253423 DOI: 10.1371/journal.pone.0253609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Studies have reported agreement between computed tomography (CT) and renography for the determination of split kidney function. However, their correlation with post-donation kidney function remains unclear. We compared CT measurements with renography in assessment of split kidney function (SKF) and their correlations with post-donation kidney function. Methods A single-centre, retrospective cohort study of 248 donors from January 1, 2009-July 31, 2019 were assessed. Pearson correlations were used to assess post-donation kidney function with renography and CT-based measurements. Furthermore, we examined high risk groups with SKF difference greater than 10% on renography and donors with post-donation eGFR less than 60 mL/min/1.73m2. Results 62% of donors were women with a mean (standard deviation) pre-donation eGFR 99 (20) and post-donation eGFR 67 (22) mL/min/1.73m2 at 31 months of follow-up. Post-donation kidney function was poorly correlated with both CT-based measurements and renography, including the subgroup of donors with post-donation eGFR less than 60 mL/min/1.73m2 (r less than 0.4 for all). There was agreement between CT-based measurements and renography for SKF determination (Bland-Altman agreement [bias, 95% limits of agreement] for renography vs: CT volume, 0.76%, -7.60–9.15%; modified ellipsoid,1.01%, -8.38–10.42%; CC dimension, 0.44%, -7.06–7.94); however, CT missed SKF greater than 10% found by renography in 20 out 26 (77%) of donors. Conclusions In a single centre study of 248 living donors, we found no correlation between CT or renography and post-donation eGFR. Further research is needed to determine optimal ways to predict remaining kidney function after donation.
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Affiliation(s)
- Kelly C. Harper
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Paul Salameh
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Natasha Akhlaq
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew D. F. McInnes
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | | | - Mahdi H. Beydoun
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Wanzhen Zeng
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brian D. M. Blew
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D. Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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15
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Viñas JL, Spence M, Porter CJ, Douvris A, Gutsol A, Zimpelmann JA, Campbell PA, Burns KD. micro-RNA-486-5p protects against kidney ischemic injury and modifies the apoptotic transcriptome in proximal tubules. Kidney Int 2021; 100:597-612. [PMID: 34181969 DOI: 10.1016/j.kint.2021.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
Acute kidney injury (AKI) carries high morbidity and mortality, and effective treatments are lacking. Preclinical models support involvement of micro-RNAs (miRs) in AKI pathogenesis, although effects on the kidney transcriptome are unclear. We previously showed that injection of cord blood endothelial colony forming cell-derived exosomes, enriched in miR-486-5p, prevented ischemic AKI in mice. To further define this, we studied direct effects of miR-486-5p in mice with kidney ischemia-reperfusion injury. RNA-Seq was used to compare the impact of miR-486-5p and exosomes on the transcriptome of proximal tubules and kidney endothelial cells 24 hours after ischemia-reperfusion. In mice with AKI, injection of miR-486-5p mimic increased its levels in proximal tubules and endothelial cells, and improved plasma creatinine, histological injury, neutrophil infiltration, and apoptosis. Additionally, miR-486-5p inhibited expression of its target phosphatase and tensin homolog, and activated protein kinase B. In proximal tubules, miR-486-5p or exosomes reduced expression of genes associated with ischemic injury and the tumor necrosis factor (TNF) pathway, and altered distinct apoptotic genes. In endothelial cells, genes associated with metabolic processes were altered by miR-486-5p or exosomes, although TNF pathway genes were not affected. Thus, our results suggest that miR-486-5p may have therapeutic potential in AKI.
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Affiliation(s)
- Jose L Viñas
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Spence
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher J Porter
- Ottawa Bioinformatics Core Facility, the Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrianna Douvris
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alex Gutsol
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph A Zimpelmann
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pearl A Campbell
- Regenerative Medicine Program, the Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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16
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Zankar S, Trentin-Sonoda M, Viñas JL, Rodriguez RA, Bailey A, Allan D, Burns KD. Therapeutic effects of micro-RNAs in preclinical studies of acute kidney injury: a systematic review and meta-analysis. Sci Rep 2021; 11:9100. [PMID: 33907298 PMCID: PMC8079678 DOI: 10.1038/s41598-021-88746-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
AKI has a high mortality rate, may lead to chronic kidney disease, and effective therapies are lacking. Micro-RNAs (miRNAs) regulate biologic processes by potently inhibiting protein expression, and pre-clinical studies have explored their roles in AKI. We conducted a systematic review and meta-analysis of miRNAs as therapeutics in pre-clinical AKI. Study screening, data extraction, and quality assessments were performed by 2 independent reviewers. Seventy studies involving 42 miRNA species were included in the analysis. All studies demonstrated significant effects of the miRNA intervention on kidney function and/or histology, with most implicating apoptosis and phosphatase and tensin homolog (PTEN) signaling. Fourteen studies (20.0%) examined the effect of miRNA-21 in AKI, and meta-analysis demonstrated significant increases in serum creatinine and kidney injury scores with miR-21 antagonism and pre-conditioning. No studies reported on adverse effects of miRNA therapy. Limitations also included lack of model diversity (100% rodents, 61.4% ischemia-reperfusion injury), and predominance of male sex (78.6%). Most studies had an unclear risk of bias, and the majority of miRNA-21 studies were conducted by a single team of investigators. In summary, several miRNAs target kidney function and apoptosis in pre-clinical AKI models, with data suggesting that miRNA-21 may mediate protection and kidney repair.Systematic review registration ID: CRD42019128854.
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Affiliation(s)
- Sarah Zankar
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Mayra Trentin-Sonoda
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Rm. 535, Ottawa, ON, K1H 7W9, Canada
| | - Jose L Viñas
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Rm. 535, Ottawa, ON, K1H 7W9, Canada
| | - Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Adrian Bailey
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - David Allan
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Rm. 535, Ottawa, ON, K1H 7W9, Canada.
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17
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Douvris A, Burger D, Rodriguez RA, Clark EG, Viñas J, Lalu MM, Shorr R, Burns KD. MicroRNA in Human Acute Kidney Injury: A Systematic Review Protocol. Can J Kidney Health Dis 2021; 8:20543581211009999. [PMID: 33996109 PMCID: PMC8072838 DOI: 10.1177/20543581211009999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of hospitalization with high morbidity and mortality for which no effective treatments exist and for which current diagnostic tools have limitations for earlier identification. MicroRNAs (miRNAs) are small non-coding RNAs that have been implicated in the pathogenesis of AKI, and some miRNAs have shown promise as therapeutic tools in animal models of AKI. However, less is known about the role of miRNAs in human AKI. OBJECTIVE To evaluate the role of miRNAs in human subjects with AKI. DESIGN Systematic review and meta-analysis. MEASUREMENTS Quantification of miRNA levels from human blood, urine, or kidney biopsy samples, and measures of renal function as defined in the study protocol. METHODS A comprehensive search strategy for Ovid MEDLINE All, Embase, Web of Science, and CENTRAL will be developed to identify investigational studies that evaluated the relationship between miRNA levels and human AKI. Primary outcomes will include measurements of kidney function and miRNA levels. Study screening, review and data extraction will be performed independently by 2 reviewers. Study quality and certainty of evidence will be assessed with validated tools. A narrative synthesis will be included and the possibility for meta-analysis will be assessed according to characteristics of clinical and statistical heterogeneity between studies. LIMITATIONS These include (1) lack of randomized trials of miRNAs for the prevention or treatment of human AKI, (2) quality of included studies, and (3) sources of clinical and statistical heterogeneity that may affect strength and reproducibility of results. CONCLUSION Previous studies of miRNAs in different animal models of AKI have generated strong interest on their use for the prevention and treatment of human AKI. This systematic review will characterize the most promising miRNAs for human research and will identify methodological constraints from miRNA research in human AKI to help inform the design of future studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201253.
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Affiliation(s)
- Adrianna Douvris
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Dylan Burger
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa and The Ottawa Hospital, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
| | - Rosendo A. Rodriguez
- Department of Medicine, The University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Jose Viñas
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Manoj M. Lalu
- Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Clinical Epidemiology and Regenerative Medicine Programs, Blueprint Translational Research Group, The Ottawa Hospital Research Institute, The University of Ottawa and The Ottawa Hospital, Canada
| | - Risa Shorr
- Department of Medicine, The University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Kevin D. Burns
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa and The Ottawa Hospital, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
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18
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Bugeja A, Shams I, Harris S, Clark EG, Burns KD, Sood MM, Akbari A. Cannabis and Cigarette Use Before and After Living Kidney Donation. Can J Kidney Health Dis 2021; 8:2054358121997243. [PMID: 33717493 PMCID: PMC7923981 DOI: 10.1177/2054358121997243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background: It is unclear whether kidney donation leads to lifestyle changes in terms of cannabis and cigarette use. Objective: To describe cigarette and cannabis use before and after kidney donation and to determine their associations with lifestyle and clinical factors. Design: Retrospective cohort study. Setting: The Living Kidney Donor program in the Champlain Local Health Integration Network at The Ottawa Hospital in Ottawa, Canada. Patients: The study included 178 living kidney donors who donated between January 2009 and December 2018. Measurements: Donors were screened for cannabis and cigarette use by telephone interview. Their clinical characteristics and changes in kidney function before and after donation were recorded. Methods: Cannabis and cigarette use before and after kidney donation were compared using chi-square test. Risk factors associated with their use was examined by univariate and multivariate logistic regression. Wilcoxon rank sum test was used to examine the association of cannabis and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) estimated glomerular filtration rate (eGFR) at donation and at last follow-up. T-test was used to examine the association of cigarette smoking and CKD-EPI eGFR at donation and at last follow-up. Results: Among 305 donors, 262 met inclusion criteria and 178 participated (mean of 4.7 ± 2.9 years from kidney donation). Cannabis and cigarette use were reported by 5% (9 of 178) and 13% (23 of 178) at donation. After donation, 8% (14 of 178) and 5% (9 of 178) started cannabis and cigarettes, respectively; 74% (17 of 23) of smokers remained smokers after donation and 88% (53 of 60) who quit smoking before donation did not restart after donation. In multivariate analysis, non-married/common-in-law status was associated with cannabis use (odds ratio, 2.73; 95% confidence interval, 1.05-7.11; P = .04). There was no difference in eGFR pre- or post-donation among cannabis or cigarette users. Limitations: The single-center study design limits generalizability. Social desirability bias may have affected survey responses and cigarette smoking was not quantified. Conclusions: Cannabis and cigarette use was uncommon in the studied population and was not associated with remaining kidney function. Cannabis use increased post-donation. Most smokers remained smokers after donation and most donors who quit smoking before donation did not restart after donation. This warrants education and support for potential donors who smoke, to quit smoking prior to donation to reduce risks of cardiovascular and end-stage kidney disease. Trial Registration: Not applicable as this is not a clinical trial.
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Affiliation(s)
- Ann Bugeja
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa and The Ottawa Hospital Research Institute, ON, Canada
| | - Ieta Shams
- Faculty of Medicine, University of Ottawa, ON, Canada
| | | | - Edward G Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa and The Ottawa Hospital Research Institute, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa and The Ottawa Hospital Research Institute, ON, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa and The Ottawa Hospital Research Institute, ON, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa and The Ottawa Hospital Research Institute, ON, Canada
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19
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Rodriguez RA, Trentin Sonoda M, Agharazii M, Shorr R, Burns KD. Effects of living kidney donation on arterial stiffness: a systematic review protocol. BMJ Open 2021; 11:e045518. [PMID: 34006035 PMCID: PMC7942241 DOI: 10.1136/bmjopen-2020-045518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/06/2021] [Accepted: 02/17/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Kidney donors have been reported to have accelerated progression of aortic stiffness and decreased glomerular filtration compared with healthy non-donors. This is a concern because increased aortic stiffness is an independent predictor of overall cardiovascular disease and all-cause mortality in the general population. To confirm if arterial stiffness increases after donation, we will systematically review all studies that evaluated indices of arterial stiffness in healthy individuals who underwent unilateral nephrectomy for kidney donation compared with age-matched healthy non-nephrectomised controls. METHODS/ANALYSIS We will comprehensively search for studies published between 1 January 1960 and 15 March 2021 in MEDLINE, EMBASE, Cochrane Central, OVID and EBM reviews. All prospective (cohort, case-control, case series and before-and-after studies) and retrospective non-randomised studies reporting indices of arterial stiffness in nephrectomised and non-nephrectomised healthy participants will be included. Primary outcome will be the difference in the functional metrics of arterial stiffness between donors and non-donors. Secondary outcomes will be the differences in systolic/diastolic blood pressures, serum creatinine, glomerular filtration, carotid artery intima-media thickness and vascular calcification. Study screening, selection and data extraction will be performed by two independent reviewers. Risk of bias will be independently assessed with the ROBINS-I tool and confidence in evidence by the Grading of Recommendations Assessment, Development and Evaluation recommendations. Qualitative and quantitative data syntheses as well as clinical and statistical heterogeneity (Forest plots, I2 and Cochran's Q statistics) will be evaluated. If clinical and statistical heterogeneity are acceptable, inverse variance-weighted effects will be analysed by random effect models. ETHICS AND DISSEMINATION No ethical approval is necessary. Our results will be disseminated through peer-review publication and presentations to guide stakeholders on the evaluation and follow-up care of kidney donors. PROSPERO REGISTRATION NUMBER CRD42020185551.
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Mayra Trentin Sonoda
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohsen Agharazii
- Division of Nephrology, CHU de Québec-Université Laval Research Centre, Quebec City, Québec, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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20
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Lawler PR, Liu H, Frankfurter C, Lovblom LE, Lytvyn Y, Burger D, Burns KD, Brinc D, Cherney DZI. Changes in Cardiovascular Biomarkers Associated With the Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Ertugliflozin in Patients With Chronic Kidney Disease and Type 2 Diabetes. Diabetes Care 2021; 44:e45-e47. [PMID: 33436398 DOI: 10.2337/dc20-2265] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/25/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ontario, Canada.,Heart & Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada
| | - Hongyan Liu
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada .,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | - Leif Erik Lovblom
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dylan Burger
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Davor Brinc
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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21
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Hundemer GL, Knoll GA, Petrcich W, Hiremath S, Ruzicka M, Burns KD, Edwards C, Bugeja A, Rhodes E, Sood MM. Kidney, Cardiac, and Safety Outcomes Associated With α-Blockers in Patients With CKD: A Population-Based Cohort Study. Am J Kidney Dis 2021; 77:178-189.e1. [DOI: 10.1053/j.ajkd.2020.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/04/2020] [Indexed: 01/10/2023]
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22
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Russell JA, Marshall JC, Slutsky A, Murthy S, Sweet D, Lee T, Singer J, Patrick DM, Du B, Peng Z, Cheng M, Burns KD, Harhay MO. Study protocol for a multicentre, prospective cohort study of the association of angiotensin II type 1 receptor blockers on outcomes of coronavirus infection. BMJ Open 2020; 10:e040768. [PMID: 33293316 PMCID: PMC7722825 DOI: 10.1136/bmjopen-2020-040768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The COVID-19 epidemic grows and there are clinical trials of antivirals. There is an opportunity to complement these trials with investigation of angiotensin II type 1 receptor blockers (ARBs) because an ARB (losartan) was effective in murine influenza pneumonia. METHODS AND ANALYSIS Our innovative design includes: ARBs; alignment with the WHO Ordinal Scale (primary endpoint) to align with other COVID-19 trials; joint longitudinal analysis; and predictive biomarkers (angiotensins I, 1-7, II and ACE1 and ACE2). Our hypothesis is: ARBs decrease the need for hospitalisation, severity (need for ventilation, vasopressors, extracorporeal membrane oxygenation or renal replacement therapy) or mortality of hospitalised COVID-19 infected adults. Our two-pronged multicentre pragmatic observational cohort study examines safety and effectiveness of ARBs in (1) hospitalised adult patients with COVID-19 and (2) out-patients already on or not on ARBs. The primary outcome will be evaluated by ordinal logistic regression and main secondary outcomes by both joint longitudinal modelling analyses. We will compare rates of hospitalisation of ARB-exposed versus not ARB-exposed patients. We will also determine whether continuing ARBs or not decreases the primary outcome. Based on published COVID-19 cohorts, assuming 15% of patients are ARB-exposed, a total sample size of 497 patients can detect a proportional OR of 0.5 (alpha=0.05, 80% power) comparing WHO scale of ARB-exposed versus non-ARB-exposed patients. ETHICS AND DISSEMINATION This study has core institution approval (UBC Providence Healthcare Research Ethics Board) and site institution approvals (Health Research Ethics Board, University of Alberta; Comite d'etique de la recerche, CHU Sainte Justine (for McGill University and University of Sherbrook); Conjoint Health Research Ethics Board, University of Calgary; Queen's University Health Sciences & Affiliated Hospitals Research Ethics Board; Research Ethics Board, Sunnybrook Health Sciences Centre; Veritas Independent Research Board (for Humber River Hospital); Mount Sinai Hospital Research Ethics Board; Unity Health Toronto Research Ethics Board, St. Michael's Hospital). Results will be disseminated by peer-review publication and social media releases. TRIAL REGISTRATION NUMBER NCT04510623.
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Affiliation(s)
- James A Russell
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Arthur Slutsky
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Srinivas Murthy
- Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Sweet
- Emergency Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Terry Lee
- Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Patrick
- Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bin Du
- Medical ICU, Peking University, Beijing, China
| | - Zhiyong Peng
- Medicine, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Matthew Cheng
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kevin D Burns
- Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael O Harhay
- Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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23
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Xu JJ, Rasuli P, Burns KD. Case Report: Segmental Arterial Mediolysis, a Rare Cause of Hypertension. Can J Kidney Health Dis 2020; 7:2054358120950885. [PMID: 32913655 PMCID: PMC7444149 DOI: 10.1177/2054358120950885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
Rationale: The differential diagnosis for hypertension with elevated plasma renin is broad. This case illustrates one of the rarer, and therefore underrecognized, causes of high renin hypertension. Presenting concerns of the patient: A 41-year-old man with a medical history significant for multiple ischemic strokes and dyslipidemia presented for assessment of decreased renal function and resistant hypertension. His initial workup for secondary causes of hypertension was remarkable for an elevated plasma renin and normal aldosterone. Further investigation with computed tomography (CT) angiography was performed, which demonstrated multiple bilateral renal aneurysms and infarcts. Diagnoses: After ruling out other potential causes of bilateral renal aneurysms and infarcts, a diagnosis of segmental arterial mediolysis (SAM) was made. Interventions: Optimization of antihypertensive regimen, counseling regarding regular home blood pressure monitoring, and smoking cessation. Outcomes: The patient achieved excellent blood pressure control, stable renal function, and had no further strokes or other vascular events. Teaching points: Our case demonstrates the importance of considering SAM in the diagnosis of hypertension with elevated plasma renin and as a vasculitis mimic. It also highlights the importance of considering renal vascular imaging in the workup of resistant hypertension.
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Affiliation(s)
- Jieqing Jessica Xu
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Pasteur Rasuli
- Department of Radiology, Division of Angiography and Interventional Radiology, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
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24
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Gilbert RE, Caldwell L, Misra PS, Chan K, Burns KD, Wrana JL, Yuen DA. Overexpression of the Severe Acute Respiratory Syndrome Coronavirus-2 Receptor, Angiotensin-Converting Enzyme 2, in Diabetic Kidney Disease: Implications for Kidney Injury in Novel Coronavirus Disease 2019. Can J Diabetes 2020; 45:162-166.e1. [PMID: 32917504 PMCID: PMC7368650 DOI: 10.1016/j.jcjd.2020.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Objectives Diabetes is associated with adverse outcomes, including death, after coronavirus disease 19 (COVID-19) infection. Beyond the lungs, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the etiologic agent of the COVID-19 pandemic, can infect a range of other tissues, including the kidney, potentially contributing to acute kidney injury in those with severe disease. We hypothesized that the renal abundance of angiotensin-converting enzyme (ACE) 2, the cell surface receptor for SARS-CoV-2, may be modulated by diabetes and agents that block the renin-angiotensin-aldosterone system (RAAS). Methods The expression of ACE 2 was examined in 49 archival kidney biopsies from patients with diabetic kidney disease and from 12 healthy, potential living allograft donors using next-generation sequencing technology (RNA Seq). Results Mean ACE 2 messenger RNA was increased approximately 2-fold in diabetes when compared with healthy control subjects (mean ± SD, 13.2±7.9 vs 7.7±3.6 reads per million reads, respectively; p=0.001). No difference in transcript abundance was noted between recipients and nonrecipients of agents that block the RAAS (12.2±6.7 vs 16.2±10.7 reads per million reads, respectively; p=0.25). Conclusions Increased ACE 2 messenger RNA in the diabetic kidney may increase the risk and/or severity of kidney infection with SARS-CoV-2 in the setting of COVID-19 disease. Further studies are needed to ascertain whether this diabetes-related overexpression is generalizable to other tissues, most notably the lungs.
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Affiliation(s)
- Richard E Gilbert
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Lauren Caldwell
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Paraish S Misra
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Ontario, Canada
| | - Kin Chan
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey L Wrana
- Center for Systems Biology, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Darren A Yuen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
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25
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Amin SO, Ruzicka M, Burns KD, Bence‐Bruckler IA, Ryan SE, Hadziomerovic A, Hiremath S. Renovascular hypertension from the BCR‐ABL tyrosine kinase inhibitor ponatinib. J Clin Hypertens (Greenwich) 2020; 22:678-682. [DOI: 10.1111/jch.13843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Syed O. Amin
- Division of Nephrology Department of Medicine University of Ottawa Ottawa ON Canada
| | - Marcel Ruzicka
- Division of Nephrology Department of Medicine University of Ottawa Ottawa ON Canada
| | - Kevin D. Burns
- Division of Nephrology Department of Medicine University of Ottawa Ottawa ON Canada
| | | | - Stephen E. Ryan
- Division of Vascular/Interventional Radiology Department of Medical Imaging University of Ottawa Ottawa ON Canada
| | - Adnan Hadziomerovic
- Division of Vascular/Interventional Radiology Department of Medical Imaging University of Ottawa Ottawa ON Canada
| | - Swapnil Hiremath
- Division of Nephrology Department of Medicine University of Ottawa Ottawa ON Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa ON Canada
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26
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Nasrallah R, Zimpelmann J, Robertson SJ, Ghossein J, Thibodeau JF, Kennedy CRJ, Gutsol A, Xiao F, Burger D, Burns KD, Hébert RL. Prostaglandin E2 receptor EP1 (PGE2/EP1) deletion promotes glomerular podocyte and endothelial cell injury in hypertensive TTRhRen mice. J Transl Med 2020; 100:414-425. [PMID: 31527829 DOI: 10.1038/s41374-019-0317-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022] Open
Abstract
Prostaglandin E2 receptor EP1 (PGE2/EP1) promotes diabetic renal injury, and EP1 receptor deletion improves hyperfiltration, albuminuria, and fibrosis. The role of EP1 receptors in hypertensive kidney disease (HKD) remains controversial. We examined the contribution of EP1 receptors to HKD. EP1 null (EP1-/-) mice were bred with hypertensive TTRhRen mice (Htn) to evaluate kidney function and injury at 24 weeks. EP1 deletion had no effect on elevation of systolic blood pressure in Htn mice (HtnEP1-/-) but resulted in pronounced albuminuria and reduced FITC-inulin clearance, compared with Htn or wild-type (WT) mice. Ultrastructural injury to podocytes and glomerular endothelium was prominent in HtnEP1-/- mice; including widened subendothelial space, subendothelial lucent zones and focal lifting of endothelium from basement membrane, with focal subendothelial cell debris. Cortex COX2 mRNA was increased by EP1 deletion. Glomerular EP3 mRNA was reduced by EP1 deletion, and EP4 by Htn and EP1 deletion. In WT mice, PGE2 increased chloride reabsorption via EP1 in isolated perfused thick ascending limb (TAL), but PGE2 or EP1 deletion did not affect vasopressin-mediated chloride reabsorption. In WT and Htn mouse inner medullary collecting duct (IMCD), PGE2 inhibited vasopressin-water transport, but not in EP1-/- or HtnEP1-/- mice. Overall, EP1 mediated TAL and IMCD transport in response to PGE2 is unaltered in Htn, and EP1 is protective in HKD.
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Affiliation(s)
- Rania Nasrallah
- Department of Cellular and Molecular Medicine, Faculty of Medicine, Kidney Research Centre, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada
| | - Joseph Zimpelmann
- Department of Cellular and Molecular Medicine, Faculty of Medicine, Kidney Research Centre, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada
| | | | - Jamie Ghossein
- Department of Cellular and Molecular Medicine, Faculty of Medicine, Kidney Research Centre, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada
| | | | - C R J Kennedy
- Department of Cellular and Molecular Medicine, Faculty of Medicine, Kidney Research Centre, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Alex Gutsol
- Ottawa Hospital Research Institute, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Fengxia Xiao
- Ottawa Hospital Research Institute, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Burger
- Ottawa Hospital Research Institute, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Kevin D Burns
- Department of Cellular and Molecular Medicine, Faculty of Medicine, Kidney Research Centre, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Richard L Hébert
- Department of Cellular and Molecular Medicine, Faculty of Medicine, Kidney Research Centre, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada.
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27
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Rodriguez RA, Spence M, Hae R, Agharazii M, Burns KD. Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2020; 7:2054358120906974. [PMID: 32128224 PMCID: PMC7036505 DOI: 10.1177/2054358120906974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Increased carotid-femoral pulse wave velocity (cf-PWV), a surrogate of
increased aortic stiffness, is a risk factor for cardiovascular events and
all-cause mortality in end-stage renal disease (ESRD). To minimize the
deleterious effects of an increased aortic stiffness in ESRD patients,
several interventions have been developed and cf-PWV has been used to
monitor responses. Objective: The aim of this study was to determine the effects of pharmacologic
interventions that target aortic stiffness on cf-PWV and systolic blood
pressure (SBP) in adults with ESRD. Study design: This study implements a systematic review and meta-analysis. Data sources: MEDLINE, EMBASE, Cochrane Central, Health Technology Assessment, and EBM
databases were searched. Study eligibility, participants, and interventions: Randomized and non-randomized studies involving adults (>18 years) with
ESRD of any duration, receiving or not renal replacement therapy
(hemodialysis, peritoneal dialysis) and exposed to a pharmacologic
intervention whose effects were assessed by cf-PWV. Methods: Study screening, selection, data extraction, and quality assessments were
performed by 2 independent reviewers. Narrative synthesis and quantitative
data analysis summarized the review. Results: We included 1027 ESRD participants from 13 randomized and 5 non-randomized
studies. Most pharmacologic interventions targeted bone mineral metabolism
disorder or hypertension. Treatment with vitamin D analogues or cinacalcet
did not decrease cf-PWV or SBP over placebo or matched controls
(P > .05). Calcium-channel blockers (CCB) decreased
cf-PWV and SBP compared with placebo or standard care (P
< .05). Renin-angiotensin system inhibitors did not show any advantage
over placebo in decreasing cf-PWV (P > .05). Limitations: Quality of evidence ranged from very low to moderate. Overall evidence was
limited by the low number of studies, small sample sizes, and methodological
inconsistencies. Conclusions: Pharmacologic interventions targeting aortic stiffness in ESRD have mixed
effects on reducing cf-PWV, with some strategies suggesting potential
benefit. The quality of evidence, however, is insufficient to draw
definitive conclusions on their use to slow progression of aortic stiffness
in ESRD. Further well-designed studies are needed to confirm these
associations and their impact on cardiovascular outcomes in ESRD. Registered in PROSPERO (CRD42016033463)
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Matthew Spence
- Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada
| | - Richard Hae
- Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada
| | - Mohsen Agharazii
- CHU de Québec-Université Laval Research Center, Quebec City, Canada
| | - Kevin D Burns
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada.,Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada.,Ottawa Hospital Research Institute, ON, Canada
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28
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Zankar S, Rodriguez RA, Vinas JL, Burns KD. The therapeutic effects of microRNAs in preclinical studies of acute kidney injury: a systematic review protocol. Syst Rev 2019; 8:235. [PMID: 31601257 PMCID: PMC6788089 DOI: 10.1186/s13643-019-1150-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) causes significant morbidity and mortality in humans, and there are currently no effective treatments to enhance renal recovery. MicroRNAs (miRNAs) are short chain nucleotides that regulate protein expression and have been implicated in the pathogenesis of AKI. Recently, preclinical studies in vivo have uncovered a therapeutic role for administration of specific miRNAs in AKI. However, the overall benefits of this strategy in preclinical studies have not been systematically reviewed, and the potential for translation to human studies is unclear. AIM The primary aim is to conduct a systematic review of the therapeutic properties of miRNAs in preclinical studies of AKI. The secondary aim is to determine potential adverse effects of miRNA administration in these studies. METHODS A comprehensive search strategy will identify relevant studies in AKI in vivo models, using the MEDLINE, EMBASE, OVID, PUBMED, and Web of Science databases. The search strategy will include terms for mammalian (non-human) AKI models, including injury related to ischemia/reperfusion, nephrotoxicity, sepsis, contrast agents, cardio-pulmonary bypass, and hemorrhagic shock. Interventions will be defined as direct administration of exogenous miRNAs or antagonists of miRNAs, as well as maneuvers that alter expression of miRNAs that are mechanistically linked to AKI outcomes. The primary outcomes will be indices of kidney function and structure, and there will be no restriction on comparator interventions. Two independent investigators will initially screen abstracts, and selected articles that meet eligibility criteria will be reviewed for data abstraction and analysis. The SYRCLE RoB tool for animal studies will determine risk of bias, and meta-analysis will be performed as appropriate. The GRADE methodology will assess the quality of evidence. DISCUSSION The administration of selective miRNA mimics or antagonists exerts beneficial effects in mammalian models of AKI, although multiple obstacles must be addressed prior to translation to human clinical trials. The proposed systematic review will document key miRNA candidates, and determine effect size estimates and sources of outcome bias. The review will also identify gaps in knowledge and guide future directions in AKI research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019128854.
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Affiliation(s)
- Sarah Zankar
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Rosendo A. Rodriguez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Jose Luis Vinas
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Rm. 535, Ottawa, Ontario K1H 7W9 Canada
| | - Kevin D. Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Rm. 535, Ottawa, Ontario K1H 7W9 Canada
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29
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Rodriguez RA, Hae R, Spence M, Shea B, Agharazii M, Burns KD. A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease. Kidney Int Rep 2019; 4:1109-1121. [PMID: 31440701 PMCID: PMC6698308 DOI: 10.1016/j.ekir.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) indicates enhanced aortic stiffness and mortality risk. We conducted a systematic review and meta-analysis of nonpharmacologic interventions in adults with ESRD to determine their effects on cf-PWV, systolic blood pressure (SBP), and intervention-associated adverse events. Methods MEDLINE, EMBASE, and EBM databases were searched. Study screening, selection, data collection, and methodological quality assessments were performed by 2 independent reviewers. Pooled-effect estimates from mean differences and 95% confidence intervals (CIs) were calculated using random effect models. Results A total of 2166 subjects with ESRD from 33 studies (17 randomized; 16 nonrandomized) were included. Four intervention-comparator pairs were meta-analyzed. Quality of evidence ranged from very low to moderate. Kidney transplantation decreased cf-PWV (−0.70 m/s; CI: –1.3 to −0.11; P = 0.02) and SBP (−8.3 mm Hg; CI: −13.2 to −3.3; P < 0.001) over pretransplantation. In randomized trials, control of fluid overload by bio-impedance reduced cf-PWV (−1.90 m/s; CI: −3.3 to −0.5); P = 0.02) and SBP (−4.3 mm Hg; CI: −7.7 to −0.93); P = 0.01) compared with clinical assessment alone. Cross-sectional studies also demonstrated significantly lower cf-PWV and SBP in normovolemia compared with hypervolemia (P ≤ 0.01). Low calcium dialysate decreased cf-PWV (−1.70 m/s; CI: −2.4 to −1.0; P < 0.00001) without affecting SBP (−1.6 mm Hg; CI: −8.9 to 5.8; P = 0.61). Intradialytic exercise compared with no exercise reduced cf-PWV (−1.13 m/s; CI: −2.2 to −0.03; P = 0.04), but not SBP (+0.5 mm Hg; CI: −9.5 to 10.4); P = 0.93). Conclusions Several nonpharmacologic interventions effectively decrease aortic stiffness in ESRD. The impact of these interventions on cardiovascular outcomes and mortality risk reduction in ESRD requires further study.
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Hae
- Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Spence
- Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Kevin D Burns
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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30
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Gutsol AA, Blanco P, Samokhina SI, Afanasiev SA, Kennedy CRJ, Popov SV, Burns KD. A novel method for comparison of arterial remodeling in hypertension: Quantification of arterial trees and recognition of remodeling patterns on histological sections. PLoS One 2019; 14:e0216734. [PMID: 31112562 PMCID: PMC6529011 DOI: 10.1371/journal.pone.0216734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/26/2019] [Indexed: 01/01/2023] Open
Abstract
Remodeling of spatially heterogeneous arterial trees is routinely quantified on tissue sections by averaging linear dimensions, with lack of comparison between different organs and models. The impact of experimental models or hypertension treatment modalities on organ-specific vascular remodeling remains undefined. A wide variety of arterial remodeling types has been demonstrated for hypertensive models, which include differences across organs. The purpose of this study was to reassess methods for measurement of arterial remodeling and to establish a morphometric algorithm for standard and comparable quantification of vascular remodeling in hypertension in different vascular beds. We performed a novel and comprehensive morphometric analysis of terminal arteries in the brain, heart, lung, liver, kidney, spleen, stomach, intestine, skin, skeletal muscle, and adrenal glands of control and Goldblatt hypertensive rats on routinely processed tissue sections. Mean dimensions were highly variable but grouping them into sequential 5 μm intervals permitted creation of reliable linear regression equations and complex profiles. Averaged arterial dimensions demonstrated seven remodeling patterns that were distinct from conventional inward-outward and hypertrophic-eutrophic definitions. Numerical modeling predicted at least nineteen variants of arterial spatial conformations. Recognition of remodeling variants was not possible using averaged dimensions, their ratios, or the remodeling and growth indices. To distinguish remodeling patterns, a three-dimensional modeling was established and tested. The proposed algorithm permits quantitative analysis of arterial remodeling in different organs and may be applicable for comparative studies between animal hypertensive models and human hypertension. Arterial wall tapering is the most important factor to consider in arterial morphometry, while perfusion fixation with vessel relaxation is not necessary. Terminal arteries in organs undergo the same remodeling pattern in Goldblatt rats, except for organs with hemodynamics affected by the arterial clip. The existing remodeling nomenclature should be replaced by a numerical classification applicable to any type of arterial remodeling.
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Affiliation(s)
- Alex A. Gutsol
- Kidney Research Centre, Ottawa Hospital Research Institute, ON, Canada
| | - Paula Blanco
- Department of Pathology and Laboratory Medicine, University of Ottawa, ON, Canada
| | | | | | | | | | - Kevin D. Burns
- Kidney Research Centre, Ottawa Hospital Research Institute, ON, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada
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31
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Bugeja A, Harris S, Ernst J, Burns KD, Knoll G, Clark EG. Changes in Body Weight Before and After Kidney Donation. Can J Kidney Health Dis 2019; 6:2054358119847203. [PMID: 31105965 PMCID: PMC6506908 DOI: 10.1177/2054358119847203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Living kidney donors remain at low risk of end-stage kidney disease (ESKD),
but the risk for obese and overweight donors is increased. The Kidney
Disease Improving Global Outcomes (KDIGO) clinical guideline recommends that
overweight and obese patients pursue weight loss before donation and
maintain a healthy post-donation weight. Objective: To determine the trajectory of weight changes before and after living kidney
donation. Design: Retrospective cohort study. Setting: The Living Kidney Donor program in the Champlain Local Health Integration
Network at The Ottawa Hospital in Ottawa, Canada. Patients: The study included 151 living kidney donors who donated between January 2009
and December 2017. Measurements: Date of kidney donation, relationship to the transplant recipient, and cause
of ESKD in the transplant recipient were documented. Demographic data,
markers of glycemic control, and weights at the time of clinic visits were
recorded. Methods: The analysis included use of paired Student’s t tests to
compare mean differences in weight at kidney donation relative to the time
of initial assessment and at last follow-up. Results: The median (interquartile range [IQR]) follow-up was 392 (362, 1096) days
post-donation. Among donors with normal body mass index (BMI; 18.5-24.9
kg/m2), weight loss occurred before donation (62.8 ± 3.1 kg
to 61.5 kg ± 2.9 kg; mean difference 1.1 ± 2.7 kg, P <
.01) and did not change significantly post-donation. Among overweight/obese
donors (BMI ≥25 kg/m2), weight did not change significantly
pre-donation, but increased significantly post-donation (86.0 ± 2.1 kg to
88.8 ± 2.7 kg; mean difference 2.3 ± 0.9 kg, P <
.0001). Limitations: The single-center design of the study limits generalizability. Conclusions: Donors with normal BMI experienced significant weight loss before donation
and maintained healthy body weight post-donation. Conversely, donors with
BMI ≥25 kg/m2 at donation experienced significant weight gain
over 1-year post-donation. Our findings suggest the need for enhanced weight
control efforts among obese and overweight kidney donors to reduce the risk
of ESKD.
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Affiliation(s)
- Ann Bugeja
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, ON, Canada.,University of Ottawa, ON, Canada
| | | | - Jaclyn Ernst
- University of Ottawa, ON, Canada.,Division of General Internal Medicine, Department of Medicine, The Ottawa Hospital, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, ON, Canada.,University of Ottawa, ON, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, ON, Canada.,University of Ottawa, ON, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, ON, Canada.,University of Ottawa, ON, Canada
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32
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Burns KD, Cherney D. Renal Angiotensinogen and Sodium-Glucose Cotransporter-2 Inhibition: Insights from Experimental Diabetic Kidney Disease. Am J Nephrol 2019; 49:328-330. [PMID: 30921790 DOI: 10.1159/000499598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - David Cherney
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada,
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada,
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada,
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33
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Gershkovich B, McCudden C, Burns KD. A Unique Case of Metformin-Associated Lactic Acidosis. Case Rep Nephrol 2018; 2018:4696182. [PMID: 30581638 PMCID: PMC6276391 DOI: 10.1155/2018/4696182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022] Open
Abstract
Metformin-associated lactic acidosis [MALA] is a potentially fatal condition characterized by an elevation in serum lactate in patients with metformin exposure. An 82-year-old man with no prior renal history was brought to hospital after being found by his family in a confused state. He had a history of type 2 diabetes mellitus, and his medications included regular metformin. On arrival to our hospital he was conscious but confused and noted recent decreased oral intake. Initial investigations revealed severe acidemia (pH <6.75, undetectable bicarbonate), with elevated serum lactate, urea, creatinine, and hyperkalemia. He was treated with intravenous dextrose, crystalloids, and bicarbonate and underwent urgent hemodialysis. The patient responded well to supportive therapies and achieved full renal recovery one week after admission. He was discharged feeling well, with a new antihyperglycemic medication regimen. This case highlights the potential for life-threatening acidemia in cases of MALA. The case is further unique in that the patient was conscious and responded to questions on arrival, despite the serious metabolic disturbance, and recovered completely. From a safety standpoint, health care providers should advise and educate their patients about discontinuing metformin and other potentially harmful medications in the context of acute illness with volume contraction.
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Affiliation(s)
- Benjamin Gershkovich
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher McCudden
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin D. Burns
- Department of Medicine, Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Sood MM, Murphy MS, Hawken S, Wong CA, Potter BK, Burns KD, Tsampalieros A, Atkinson KM, Chakraborty P, Wilson K. Association Between Newborn Metabolic Profiles and Pediatric Kidney Disease. Kidney Int Rep 2018; 3:691-700. [PMID: 29854978 PMCID: PMC5976820 DOI: 10.1016/j.ekir.2018.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Metabolomics offers considerable promise in early disease detection. We set out to test the hypothesis that routine newborn metabolic profiles at birth, obtained through screening for inborn errors of metabolism, would be associated with kidney disease and add incremental information to known clinical risk factors. METHODS We conducted a population-level cohort study in Ontario, Canada, using metabolic profiles from 1,288,905 newborns from 2006 to 2015. The primary outcome was chronic kidney disease (CKD) or dialysis. Individual metabolites and their ratio combinations were examined by logistic regression after adjustment for established risk factors for kidney disease and incremental risk prediction measured. RESULTS CKD occurred in 2086 (0.16%, median time 612 days) and dialysis in 641 (0.05%, median time 99 days) infants and children. Individual metabolites consisted of amino acids, acylcarnitines, markers of fatty acid oxidation, and others. Base models incorporating clinical risk factors only provided c-statistics of 0.61 for CKD and 0.70 for dialysis. The addition of identified metabolites to risk prediciton models resulted in significant incremental improvement in the performance of both models (CKD model: c-statistic 0.66 NRI 0.36 IDI 0.04, dialysis model: c-statistic 0.77 NRI 0.57 IDI 0.09). This was consistent after internal validation using bootstrapping and a sensitivity analysis excluding outcomes within the first 30 days. CONCLUSION Routinely collected screening metabolites at birth are associated with CKD and the need for dialytic therapies in infants and children, and add incremental information to traditional clinical risk factors.
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Affiliation(s)
- Manish M. Sood
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | | | - Steven Hawken
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, University of Ottawa, Ontario, Canada
| | - Coralie A. Wong
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Beth K. Potter
- Clinical Epidemiology Program, University of Ottawa, Ontario, Canada
| | - Kevin D. Burns
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne Tsampalieros
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Pranesh Chakraborty
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, University of Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Levin A, Adams E, Barrett BJ, Beanlands H, Burns KD, Chiu HHL, Chong K, Dart A, Ferera J, Fernandez N, Fowler E, Garg AX, Gilbert R, Harris H, Harvey R, Hemmelgarn B, James M, Johnson J, Kappel J, Komenda P, McCormick M, McIntyre C, Mahmud F, Pei Y, Pollock G, Reich H, Rosenblum ND, Scholey J, Sochett E, Tang M, Tangri N, Tonelli M, Turner C, Walsh M, Woods C, Manns B. Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD): Form and Function. Can J Kidney Health Dis 2018; 5:2054358117749530. [PMID: 29372064 PMCID: PMC5774731 DOI: 10.1177/2054358117749530] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE OF REVIEW This article serves to describe the Can-SOLVE CKD network, a program of research projects and infrastructure that has excited patients and given them hope that we can truly transform the care they receive. ISSUE Chronic kidney disease (CKD) is a complex disorder that affects more than 4 million Canadians and costs the Canadian health care system more than $40 billion per year. The evidence base for guiding care in CKD is small, and even in areas where evidence exists, uptake of evidence into clinical practice has been slow. Compounding these complexities are the variations in outcomes for patients with CKD and difficulties predicting who is most likely to develop complications over time. Clearly these gaps in our knowledge and understanding of CKD need to be filled, but the current state of CKD research is not where it needs to be. A culture of clinical trials and inquiry into the disease is lacking, and much of the existing evidence base addresses the concerns of the researchers but not necessarily those of the patients. PROGRAM OVERVIEW The Canadian Institutes of Health Research (CIHR) has launched the national Strategy for Patient-Oriented Research (SPOR), a coalition of federal, provincial, and territorial partners dedicated to integrating research into care. Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) is one of five pan-Canadian chronic kidney disease networks supported through the SPOR. The vision of Can-SOLVE CKD is that by 2020 every Canadian with or at high risk for CKD will receive the best recommended care, experience optimal outcomes, and have the opportunity to participate in studies with novel therapies, regardless of age, sex, gender, location, or ethnicity. PROGRAM OBJECTIVE The overarching objective of Can-SOLVE CKD is to accelerate the translation of knowledge about CKD into clinical research and practice. By focusing on the patient's voice and implementing relevant findings in real time, Can-SOLVE CKD will transform the care that CKD patients receive, and will improve kidney health for future generations.
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Affiliation(s)
- Adeera Levin
- The University of British Columbia, Vancouver, Canada
- BC Provincial Renal Agency, Vancouver, Canada
| | - Evan Adams
- The University of British Columbia, Vancouver, Canada
- First Nations Health Authority, West Vancouver, British Columbia, Canada
| | - Brendan J. Barrett
- Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | | | - Kevin D. Burns
- University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ontario, Canada
| | - Helen Hoi-Lun Chiu
- BC Provincial Renal Agency, Vancouver, Canada
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - Kate Chong
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - Allison Dart
- University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jack Ferera
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | | | | | - Amit X. Garg
- Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Richard Gilbert
- St. Michael’s Hospital, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Heather Harris
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | | | - Brenda Hemmelgarn
- University of Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
- The Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | | | | | | | - Paul Komenda
- University of Manitoba, Winnipeg, Canada
- Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | | | - Christopher McIntyre
- Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Farid Mahmud
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - York Pei
- University of Toronto, Ontario, Canada
- Toronto General Hospital, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Graham Pollock
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - Heather Reich
- University of Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Norman D. Rosenblum
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Scholey
- University of Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Mila Tang
- BC Provincial Renal Agency, Vancouver, Canada
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Navdeep Tangri
- University of Manitoba, Winnipeg, Canada
- Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Marcello Tonelli
- University of Calgary, Alberta, Canada
- The Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
| | | | - Michael Walsh
- McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Cathy Woods
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - Braden Manns
- University of Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
- The Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada
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Burger D, Turner M, Xiao F, Munkonda MN, Akbari S, Burns KD. High glucose increases the formation and pro-oxidative activity of endothelial microparticles. Diabetologia 2017; 60:1791-1800. [PMID: 28601907 DOI: 10.1007/s00125-017-4331-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/18/2017] [Indexed: 01/03/2023]
Abstract
AIMS/HYPOTHESIS Individuals with diabetes exhibit increases in circulating endothelial microparticles (eMPs, also referred to as endothelial microvesicles), which are associated with endothelial dysfunction and a heightened risk of cardiovascular complications. We have shown that eMPs are markers and mediators of vascular injury although their role in diabetes is unclear. We hypothesised that the composition and biological activity of eMPs are altered in response to high glucose exposure. We assessed the effects of high glucose on eMP formation, composition and signalling in cultured HUVECs. METHODS eMPs were isolated from the media of HUVECs cultured under conditions of normal glucose (eMPNG), high glucose (eMPHG) or osmotic control of L-glucose (eMPLG). eMP size, concentration and surface charge were assessed by nanoparticle tracking analysis and flow cytometry. eMP protein composition was assessed by liquid chromatography-tandem mass spectrometry, and eMP-mediated effects on coagulation, reactive oxygen species (ROS) production and vessel function were assessed. RESULTS Exposure of HUVECs to high glucose for 24 h caused a threefold increase in eMP formation, increased mean particle size (269 ± 18 nm vs 226 ± 11 nm) and decreased surface charge. Compared with eMPNG or eMPLG, eMPHG possessed approximately threefold greater pro-coagulant activity, stimulated HUVEC ROS production to a greater extent (~250% of eMPNG) and were more potent inhibitors of endothelial-dependent relaxation. Proteomic analysis of eMPs identified 1212 independent proteins of which 68 were exclusively found in eMPHG. Gene ontology analysis revealed that eMPHG-exclusive proteins were associated with signalling pathways related to blood coagulation, cell signalling and immune cell activation. CONCLUSIONS/INTERPRETATION Our results indicate that elevated glucose is a potent stimulus for eMP formation that also alters their molecular composition leading to increased bioactivity. Such effects may contribute to progressive endothelial injury and subsequent cardiovascular complications in diabetes.
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Affiliation(s)
- Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Room 535, Ottawa, ON, K1H 7W9, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, 2513-451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Maddison Turner
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Room 535, Ottawa, ON, K1H 7W9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, 2513-451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Fengxia Xiao
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Room 535, Ottawa, ON, K1H 7W9, Canada
| | - Mercedes N Munkonda
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Room 535, Ottawa, ON, K1H 7W9, Canada
| | - Shareef Akbari
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Room 535, Ottawa, ON, K1H 7W9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, 2513-451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Kevin D Burns
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Room 535, Ottawa, ON, K1H 7W9, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, 2513-451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
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Ismail B, deKemp RA, Croteau E, Hadizad T, Burns KD, Beanlands RS, DaSilva JN. Treatment with enalapril and not diltiazem ameliorated progression of chronic kidney disease in rats, and normalized renal AT1 receptor expression as measured with PET imaging. PLoS One 2017; 12:e0177451. [PMID: 28542215 PMCID: PMC5438116 DOI: 10.1371/journal.pone.0177451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/27/2017] [Indexed: 12/23/2022] Open
Abstract
ACE inhibitors are considered first line of treatment in patients with many forms of chronic kidney disease (CKD). Other antihypertensives such as calcium channel blockers achieve similar therapeutic effectiveness in attenuating hypertension-related renal damage progression. Our objective was to explore the value of positron emission tomography (PET) imaging of renal AT1 receptor (AT1R) to guide therapy in the 5/6 subtotal-nephrectomy (Nx) rat model of CKD. Ten weeks after Nx, Sprague-Dawley rats were administered 10mg/kg/d enalapril (NxE), 30mg/kg/d diltiazem (NxD) or left untreated (Nx) for an additional 8-10 weeks. Kidney AT1R expression was assessed using in vivo [18F]fluoropyridine-losartan PET and in vitro autoradiography. Compared to shams, Nx rats exhibited higher systolic blood pressure that was reduced by both enalapril and diltiazem. At 18-20 weeks, plasma creatinine and albuminuria were significantly increased in Nx, reduced to sham levels in NxE, but enhanced in NxD rats. Enalapril treatment decreased kidney angiotensin II whereas diltiazem induced significant elevations in plasma and kidney levels. Reduced PET renal AT1R levels in Nx were normalized by enalapril but not diltiazem, and results were supported by autoradiography. Reduction of renal blood flow in Nx was restored by enalapril, while no difference was observed in myocardial blood flow amongst groups. Enhanced left ventricle mass in Nx was not reversed by enalapril but was augmented with diltiazem. Stroke volume was diminished in untreated Nx compared to shams and restored with both therapies. [18F]Fluoropyridine-Losartan PET allowed in vivo quantification of kidney AT1R changes associated with progression of CKD and with various pharmacotherapies.
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Affiliation(s)
- Basma Ismail
- Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rob A. deKemp
- Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Etienne Croteau
- Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Tayebeh Hadizad
- Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kevin D. Burns
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Rob S. Beanlands
- Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean N. DaSilva
- Cardiac PET Centre, Department of Medicine (Division of Cardiology), University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal; University of Montreal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada
- * E-mail:
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Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33:557-576. [PMID: 28449828 DOI: 10.1016/j.cjca.2017.03.005] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 01/29/2023] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Steven E Gryn
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Praveena Sivapalan
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Stroke, Heart and Stroke Foundation of Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Gregory Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Southern Medical Program, Kelowna, British Columbia, Canada
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janusz Kaczorowski
- Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- McMaster University, Hamilton Health Sciences Population Health Research Institute, Hamilton, Ontario, Canada
| | - Debra Reid
- Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais, Groupes de médecine de famille (GMF) de Wakefield, Wakefield, Quebec, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London and the St George's Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Burns KD, Levin A, Fowler E, Butcher L, Turcotte M, Makarchuk MJ, Macaluso B, Larivière V, Sherman PM. The KRESCENT Program (2005-2015): An Evaluation of the State of Kidney Research Training in Canada. Can J Kidney Health Dis 2017; 4:2054358117693354. [PMID: 28270932 PMCID: PMC5317037 DOI: 10.1177/2054358117693354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Kidney Research Scientist Core Education and National Training (KRESCENT) Program was launched in 2005 to enhance kidney research capacity in Canada and foster knowledge translation across the 4 themes of health research. OBJECTIVE To evaluate the impact of KRESCENT on its major objectives and on the careers of trainees after its first 10 years. METHODS An online survey of trainees (n = 53) who had completed or were enrolled in KRESCENT was conducted in 2015. Information was also obtained from curriculum vitae (CVs). A bibliometric analysis assessed scientific productivity, collaboration, and impact in comparison with unsuccessful applicants to KRESCENT over the same period. The analysis included a comparison of Canadian with international kidney research metrics from 2000 to 2014. RESULTS Thirty-nine KRESCENT trainees completed the survey (74%), and 44 trainees (83%) submitted CVs. KRESCENT trainees had a high success rate at obtaining grant funding from the Canadian Institutes of Health Research (CIHR; 79%), and 76% of Post-Doctoral Fellows received academic appointments at the Assistant Professor level within 8 months of completing training. The majority of trainees reported that KRESCENT had contributed significantly to their success in securing CIHR funding (90%), and to the creation of knowledge (93%) and development of new methodologies (50%). Bibliometric analysis revealed a small but steady decline in total international kidney research output from 2000 to 2014, as a percentage of all health research, although overall impact of kidney research in Canada increased from 2000-2005 to 2009-2014 compared with other countries. KRESCENT trainees demonstrated increased productivity, multiauthored papers, impact, and international collaborations after their training, compared with nonfunded applicants. CONCLUSIONS The KRESCENT Program has fostered kidney research career development and contributed to increased capacity, productivity, and collaboration. To further enhance knowledge creation and translation in kidney research in Canada, programs such as KRESCENT should be sustained via long-term funding partnerships.
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Affiliation(s)
- Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Leah Butcher
- The Kidney Foundation of Canada, Montreal, Quebec, Canada
| | - Marc Turcotte
- Institute of Nutrition, Metabolism, and Diabetes, Canadian Institutes of Health Research, Ottawa, Ontario, Canada
| | - Mary-Jo Makarchuk
- Institute of Nutrition, Metabolism, and Diabetes, Canadian Institutes of Health Research, Ottawa, Ontario, Canada
| | - Benoît Macaluso
- Observatoire des sciences et des technologies, Centre interuniversitaire de recherche sur la science et la technologie, Université du Québec à Montréal, Canada; École de bibliothéconomie et des sciences de l'information, Université de Montréal, Québec, Canada
| | - Vincent Larivière
- Observatoire des sciences et des technologies, Centre interuniversitaire de recherche sur la science et la technologie, Université du Québec à Montréal, Canada; École de bibliothéconomie et des sciences de l'information, Université de Montréal, Québec, Canada
| | - Philip M Sherman
- Institute of Nutrition, Metabolism, and Diabetes, Canadian Institutes of Health Research, Ottawa, Ontario, Canada
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Burns KD, Lytvyn Y, Mahmud FH, Daneman D, Deda L, Dunger DB, Deanfield J, Dalton RN, Elia Y, Har R, Van JA, Bradley TJ, Slorach C, Hui W, Xiao F, Zimpelmann J, Mertens L, Moineddin R, Reich HN, Sochett E, Scholey JW, Cherney DZI. The relationship between urinary renin-angiotensin system markers, renal function, and blood pressure in adolescents with type 1 diabetes. Am J Physiol Renal Physiol 2017; 312:F335-F342. [DOI: 10.1152/ajprenal.00438.2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 02/05/2023] Open
Abstract
The relationship between the renal renin-angiotensin aldosterone system (RAAS) and cardiorenal pathophysiology is unclear. Our aims were to assess 1) levels of urinary RAAS components and 2) the association between RAAS components and HbA1c, the urine albumin/creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and blood pressure (BP) in otherwise healthy adolescents with type 1 diabetes mellitus (TID) vs. healthy controls (HC). Urinary angiotensinogen and angtionsin-converting enzyme (ACE) 2 levels, activity of ACE and ACE2, BP, HbA1c, ACR, and eGFR were measured in 65 HC and 194 T1D from the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT). Urinary levels of all RAAS components were higher in T1D vs. HC ( P < 0.0001). Higher HbA1c was associated with higher urinary angiotensinogen, ACE2, and higher activity of ACE and ACE2 ( P < 0.0001, P = 0.0003, P = 0.003, and P = 0.007 respectively) in T1D. Higher ACR (within the normal range) was associated with higher urinary angiotensinogen ( P < 0.0001) and ACE activity ( P = 0.007), but not with urinary ACE2 activity or ACE2 levels. These observations were absent in HC. Urinary RAAS components were not associated with BP or eGFR in T1D or HC. Otherwise healthy adolescents with T1D exhibit higher levels of urinary RAAS components compared with HC. While levels of all urinary RAAS components correlate with HbA1c in T1D, only urinary angiotensinogen and ACE activity correlate with ACR, suggesting that these factors reflect an intermediary pathogenic link between hyperglycemia and albuminuria within the normal range.
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Affiliation(s)
- Kevin D. Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Yuliya Lytvyn
- Department of Pharmacology, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Farid H. Mahmud
- Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) SickKids Multicenter Clinical Trial Center
| | - Denis Daneman
- Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) SickKids Multicenter Clinical Trial Center
| | - Livia Deda
- Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) SickKids Multicenter Clinical Trial Center
| | - David B. Dunger
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - John Deanfield
- University College Hospital, Heart Hospital and Great Ormond Street Hospital, London, United Kingdom
| | - R. Neil Dalton
- WellChild Laboratory, Evelina Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | - Yesmino Elia
- Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) SickKids Multicenter Clinical Trial Center
| | - Ronnie Har
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Julie A.D. Van
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Timothy J. Bradley
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; and
| | - Cameron Slorach
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; and
| | - Wei Hui
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; and
| | - Fengxia Xiao
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Zimpelmann
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Mertens
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; and
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Heather N. Reich
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - Etienne Sochett
- Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada, JDRF-Canadian Clinical Trial Network (JDRF-CCTN) SickKids Multicenter Clinical Trial Center
| | - James W. Scholey
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - David Z. I. Cherney
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
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Ruzicka M, Burns KD, Hiremath S. Precision Medicine for Hypertension Management in Chronic Kidney Disease: Relevance of SPRINT for Therapeutic Targets in Nondiabetic Renal Disease. Can J Cardiol 2017; 33:611-618. [PMID: 28365055 DOI: 10.1016/j.cjca.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/22/2016] [Accepted: 01/01/2017] [Indexed: 01/13/2023] Open
Abstract
In this review we evaluate the literature to determine if lower blood pressure (BP) targets are beneficial for patients with nondiabetic chronic kidney disease (CKD). Modification of Diet in Renal Disease (MDRD), African American Study of Kidney Disease and Hypertension (AASK), and Ramipril Efficacy in Nephropathy-2 (REIN-2), designed to assess the benefit of lower BP on progression of nondiabetic CKD, generally came to the same negative conclusion. They were not designed and powered to assess an effect of lower BP on cardiovascular outcomes. The Systolic Blood Pressure Intervention Trial (SPRINT) was the first trial designed and powered to address this issue, and showed a clear benefit of a lower targeted and achieved BP. SPRINT did not show any renal benefits from lower BP, and it was not designed to assess this outcome, and it enrolled patients with less "renal risk" per se. A distinguishing feature of SPRINT compared with other large trials is that it highlighted the importance of precise BP measurement methods in defining targets in hypertension treatment. Accordingly, we propose that SPRINT is truly a "game-changing" clinical trial that sets the bar for management of hypertension in select patients with nondiabetic CKD. In these patients, systolic BP target depends critically on the BP measurement method: < 140 mm Hg when derived from 3 readings using a mercury sphygmomanometer after 5 minutes of rest, < 130 mm Hg when calculated from at a minimum of 3 readings using an automated oscillometric device, and < 120 mm Hg when taken using an automated oscillometric device after 5 minutes of unattended rest.
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Affiliation(s)
- Marcel Ruzicka
- Renal Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Kidney Research Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Kevin D Burns
- Renal Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Renal Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Kidney Research Centre, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Viñas JL, Burger D, Zimpelmann J, Haneef R, Knoll W, Campbell P, Gutsol A, Carter A, Allan DS, Burns KD. Transfer of microRNA-486-5p from human endothelial colony forming cell–derived exosomes reduces ischemic kidney injury. Kidney Int 2016; 90:1238-1250. [DOI: 10.1016/j.kint.2016.07.015] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/09/2016] [Accepted: 07/07/2016] [Indexed: 12/24/2022]
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Rodriguez RA, Shea B, Hae R, Burns KD. The impact of intervention strategies that target arterial stiffness in end-stage renal disease: a systematic review protocol. Syst Rev 2016; 5:118. [PMID: 27431798 PMCID: PMC4950258 DOI: 10.1186/s13643-016-0286-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/OBJECTIVES Vascular damage contributes to the high cardiovascular morbidity and mortality in end-stage renal disease (ESRD). Increased aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a strong and independent predictor of the cardiovascular risk in ESRD patients. Recently, there has been considerable interest in developing strategies to lessen the progression of arterial stiffness in ESRD patients using cf-PWV as a tool to monitor therapeutic responses, but their benefit on the long-term cardiovascular risk is not known. Appraisal of the effects of existing stiffness-based interventions on the cf-PWV would facilitate selecting optimal therapies to be tested in randomized clinical trials. The aim of this systematic review will be to evaluate the impact of arterial stiffness-based interventions on the cf-PWV in ESRD patients. Secondarily, for each intervention, we will determine the minimal duration needed to achieve a significant reduction of cf-PWV, the minimal cf-PWV reduction threshold or effect size, and adverse events. METHODS/DESIGN This review will be conducted using MEDLINE, EMBASE, and EBM Reviews. We will select clinical trials and observational studies (cohort, case-control, and before/after studies and case series) that evaluated pharmacologic or non-pharmacologic interventions in which the primary effect is to improve structural and/or dynamic components of arterial stiffness in adults with stage 5 chronic kidney disease. The primary outcome of interest will be cf-PWV. Study selection and data collection will be performed by two reviewers. Validated tools will be used to assess the methodological quality and risk of bias among different study designs. We will describe all included citations according to study characteristics, methodological quality, and outcomes. Suitability for meta-analysis will be determined by the degree of clinical and statistical heterogeneity between studies. If appropriate, we will calculate effect estimates by obtaining the relative risks with 95 % confidence intervals pooled according to study design using a random effects model. DISCUSSION This review will summarize evidence regarding effects of interventions targeting arterial stiffness in ESRD patients. Our results will inform clinicians and researchers on the type of existing arterial stiffness-based interventions for ESRD patients and their potential efficacy and safety, with a goal to guide future clinical trials aimed at reducing adverse cardiovascular events. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033463.
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. .,The Ottawa Methods Centre, Ottawa Hospital Research Institute, Centre for Practice Changing Research Building, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
| | - Beverley Shea
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Centre for Practice Changing Research Building, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Richard Hae
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Ottawa, Ontario, K1H 7W9, Canada
| | - Kevin D Burns
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Ottawa, Ontario, K1H 7W9, Canada
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Affiliation(s)
- Edward G Clark
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Hassouneh R, Nasrallah R, Zimpelmann J, Gutsol A, Eckert D, Ghossein J, Burns KD, Hébert RL. PGE2 receptor EP3 inhibits water reabsorption and contributes to polyuria and kidney injury in a streptozotocin-induced mouse model of diabetes. Diabetologia 2016; 59:1318-28. [PMID: 26995650 DOI: 10.1007/s00125-016-3916-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS The first clinical manifestation of diabetes is polyuria. The prostaglandin E2 (PGE2) receptor EP3 antagonises arginine vasopressin (AVP)-mediated water reabsorption and its expression is increased in the diabetic kidney. The purpose of this work was to study the contribution of EP3 to diabetic polyuria and renal injury. METHODS Male Ep 3 (-/-) (also known as Ptger3 (-/-)) mice were treated with streptozotocin (STZ) to generate a mouse model of diabetes and renal function was evaluated after 12 weeks. Isolated collecting ducts (CDs) were microperfused to study the contribution of EP3 to AVP-mediated fluid reabsorption. RESULTS Ep 3 (-/-)-STZ mice exhibited attenuated polyuria and increased urine osmolality compared with wild-type STZ (WT-STZ) mice, suggesting enhanced water reabsorption. Compared with WT-STZ mice, Ep 3 (-/-)-STZ mice also had increased protein expression of aquaporin-1, aquaporin-2, and urea transporter A1, and reduced urinary AVP excretion, but increased medullary V2 receptors. In vitro microperfusion studies indicated that Ep 3 (-/-) and WT-STZ CDs responded to AVP stimulation similarly to those of wild-type mice, with a 60% increase in fluid reabsorption. In WT non-injected and WT-STZ mice, EP3 activation with sulprostone (PGE2 analogue) abrogated AVP-mediated water reabsorption; this effect was absent in mice lacking EP3. A major finding of this work is that Ep 3 (-/-)-STZ mice showed blunted renal cyclooxygenase-2 protein expression, reduced renal hypertrophy, reduced hyperfiltration and reduced albuminuria, as well as diminished tubular dilation and nuclear cysts. CONCLUSIONS/INTERPRETATION Taken together, the data suggest that EP3 contributes to diabetic polyuria by inhibiting expression of aquaporins and that it promotes renal injury during diabetes. EP3 may prove to be a promising target for more selective management of diabetic kidney disease.
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Affiliation(s)
- Ramzi Hassouneh
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada, K1H 8M5
| | - Rania Nasrallah
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada, K1H 8M5
| | - Joe Zimpelmann
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Alex Gutsol
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Eckert
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada, K1H 8M5
| | - Jamie Ghossein
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada, K1H 8M5
| | - Kevin D Burns
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada, K1H 8M5
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Richard L Hébert
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Room 2514, Ottawa, ON, Canada, K1H 8M5.
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Xiao F, Zimpelmann J, Burger D, Kennedy C, Hébert RL, Burns KD. Protein Kinase C-δ Mediates Shedding of Angiotensin-Converting Enzyme 2 from Proximal Tubular Cells. Front Pharmacol 2016; 7:146. [PMID: 27313531 PMCID: PMC4887483 DOI: 10.3389/fphar.2016.00146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
Angiotensin-converting enzyme 2 (ACE2) degrades angiotensin (Ang) II to Ang-(1–7), and protects against diabetic renal injury. Soluble ACE2 fragments are shed from the proximal tubule, and appear at high levels in the urine with diabetes. High glucose-induced shedding of ACE2 from proximal tubular cells is mediated by the enzyme “a disintegrin and metalloproteinase-17″ (ADAM17). Here, we investigated the mechanism for constitutive shedding of ACE2. Mouse proximal tubular cells were cultured and ACE2 shedding into the media was assessed by enzyme activity assay and immunoblot analysis. Cells were incubated with pharmacologic inhibitors, or transfected with silencing (si) RNA. Incubation of proximal tubular cells with increasing concentrations of D-glucose stimulated ACE2 shedding, which peaked at 16 mM, while L-glucose (osmotic control) had no effect on shedding. In cells maintained in 7.8 mM D-glucose, ACE2 shedding was significantly inhibited by the pan-protein kinase C (PKC) competitive inhibitor sotrastaurin, but not by an inhibitor of ADAM17. Incubation of cells with the PKC-α and -β1-specific inhibitor Go6976, the PKC β1 and β2-specific inhibitor ruboxistaurin, inhibitors of matrix metalloproteinases-2,-8, and -9, or an inhibitor of ADAM10 (GI250423X) had no effect on basal ACE2 shedding. By contrast, the PKC-δ inhibitor rottlerin significantly inhibited both constitutive and high glucose-induced ACE2 shedding. Transfection of cells with siRNA directed against PKC-δ reduced ACE2 shedding by 20%, while knockdown of PKC-ε was without effect. These results indicate that constitutive shedding of ACE2 from proximal tubular cells is mediated by PKC-δ, which is also linked to high glucose-induced shedding. Targeting PKC-δ may preserve membrane-bound ACE2 in proximal tubule in disease states and diminish Ang II-stimulated adverse signaling.
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Affiliation(s)
- Fengxia Xiao
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
| | - Joseph Zimpelmann
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
| | - Dylan Burger
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
| | - Christopher Kennedy
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
| | - Richard L Hébert
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
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Rodriguez RA, Cronin V, Ramsay T, Zimmerman D, Ruzicka M, Burns KD. Reproducibility of carotid-femoral pulse wave velocity in end-stage renal disease patients: methodological considerations. Can J Kidney Health Dis 2016; 3:20. [PMID: 27042326 PMCID: PMC4818522 DOI: 10.1186/s40697-016-0109-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/03/2016] [Indexed: 11/15/2022] Open
Abstract
Background In end-stage renal disease (ESRD) patients, increased arterial stiffness detected by carotid-femoral pulse wave velocity (cf-PWV) is associated with fatal cardiovascular events and all-cause mortality. Since cf-PWV is an operator-dependent technique, poor reproducibility may be a source of bias in the estimation of arterial stiffness. Objectives We assessed the week-to-week reproducibility of cf-PWV and radial artery pulse wave analysis in healthy subjects and ESRD patients. We also determined the extent of patient eligibility, enrollment, acceptance, and comfort. Methods In a cohort study design, independent tonometric examinations of carotid, femoral, and radial arteries were conducted in 20 healthy subjects and 15 ESRD patients attending chronic hemodialysis treatments according to a randomized sequence by two operators on 2 days scheduled 1-week apart. cf-PWV, augmentation index (AIx@HR75) and central pulse pressure (CPP) were the outcome measures. Patients were tested at mid-week and prior to dialysis treatment. The variability on the distance measured between the suprasternal notch and femoral site using two different methods (standard vs direct) was compared. A post-examination survey assessed acceptance and comfort associated with examinations. Reproducibility was evaluated by intra-class correlations (ICCs). Results The mean age for healthy subjects and ESRD patients was 45 ± 12 and 63 ± 16 years, respectively. ESRD patients had higher cf-PWV (p = 0.0002), elevated AIx@HR75 (p = 0.003), and increased CPP (p = 0.001) compared to healthy subjects. The mean inter-visit differences for all stiffness indices were non-significant (p > 0.05), but the mean inter-operator differences for the cf-PWV were significant only in the healthy subject group (−0.7 m/s; p = 0.02). The ICCs between operators and visits were higher for the ESRD group compared to the healthy subjects (between operators, 0.870 vs 0.461; between visits, 0.830 vs 0.570). Distances were longer (p < 0.001), but less variable with the standard method compared to the direct method (healthy subjects, p = 0.036; ESRD, p = 0.39). There was a high rate of patient acceptance and minimal discomfort. Conclusions Week-to-week measurements of cf-PWV and pulse wave analysis are highly reproducible in ESRD patients prior to hemodialysis treatment. The high reproducibility and minimal test-to-test variations encourage use of cf-PWV to monitor changes in arterial stiffness and the efficacy of interventions in ESRD patients. Trial registration ClinicalTrials.gov, NCT02196610. Electronic supplementary material The online version of this article (doi:10.1186/s40697-016-0109-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosendo A Rodriguez
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Centre for Practice-Changing Research, Room L-2217, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada ; The Ottawa Methods Centre, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Valerie Cronin
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada
| | - Timothy Ramsay
- The Ottawa Methods Centre, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Dr., Rm. 535, Ottawa, ON K1H 7W9 Canada
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Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Lebel M, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Trudeau L, Petrella RJ, Hiremath S, Drouin D, Lavoie KL, Hamet P, Fodor G, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Harris KC, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol 2016; 32:569-88. [PMID: 27118291 DOI: 10.1016/j.cjca.2016.02.066] [Citation(s) in RCA: 329] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 12/28/2022] Open
Abstract
Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Marcel Lebel
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- Division of Endocrinology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Best Practices and Performance, Heart and Stroke Foundation, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Pierre Larochelle
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard I Ogilvie
- University Health Network, Departments of Medicine and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Robert J Petrella
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - George Fodor
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- The Canadian Stroke Network, Ottawa, Ontario, Canada
| | - Debra Reid
- Canadian Forces Health Services, Department of National Defence and Dietitians of Canada, Ottawa, Ontario, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London, London, United Kingdom
| | | | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Burger D, Erdbrügger U, Burns KD. Re: Microparticles: markers and mediators of sepsis-induced microvascular dysfunction, immunosuppression, and AKI. Kidney Int 2015; 88:915. [PMID: 26422626 DOI: 10.1038/ki.2015.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Uta Erdbrügger
- Division of Nephrology, Department of Medicine, University of Virginia, Virginia, USA
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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Burger D, Viñas JL, Akbari S, Dehak H, Knoll W, Gutsol A, Carter A, Touyz RM, Allan DS, Burns KD. Human endothelial colony-forming cells protect against acute kidney injury: role of exosomes. Am J Pathol 2015; 185:2309-23. [PMID: 26073035 DOI: 10.1016/j.ajpath.2015.04.010] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 01/16/2023]
Abstract
The administration of certain progenitor cells is protective in experimental acute kidney injury (AKI), and mechanisms may involve the release of paracrine factors. Endothelial colony-forming cells (ECFCs) are endothelial precursor cells with a high proliferative capacity and pro-angiogenic potential. We examined the effects of human umbilical cord blood-derived ECFCs and their extracellular vesicles in a mouse model of ischemic AKI and in cultured human umbilical vein endothelial cells subjected to hypoxia/reoxygenation. In mice with ischemic AKI, administration of ECFCs (i.v.) at the time of reperfusion significantly attenuated increases in plasma creatinine, tubular necrosis, macrophage infiltration, oxidative stress, and apoptosis, without cell persistence in the kidneys. In cultured human umbilical vein endothelial cells, hypoxia/reoxygenation stimulated apoptosis. This effect was inhibited by incubation with conditioned medium or exosomes (40- to 100-nm diameter) derived from ECFCs, but not by microparticles (100- to 1000-nm diameter) or vesicle-depleted conditioned medium. Administration of exosomes (i.v.) directly to mice with ischemic AKI attenuated renal injury, as assessed by plasma creatinine, tubular necrosis, and apoptosis. Taken together, these studies indicate protective effects of human cord blood-derived ECFCs in experimental AKI and suggest that ECFC-derived exosomes may mediate the protective response via inhibition of endothelial cell apoptosis.
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Affiliation(s)
- Dylan Burger
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jose L Viñas
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shareef Akbari
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Hajira Dehak
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - William Knoll
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alex Gutsol
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony Carter
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Rhian M Touyz
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - David S Allan
- Division of Hematology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Kidney Research Centre, Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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