bluuebunny/crossref_metadata_2025 huggingface dataset:
INVESTIGATION OF THE CLINICAL FACTOR ASSOCIATED WITH INTRADIALYTIC HYPOTENSION: INSIGHT FROM KIDS REGISTRY
Authors: Tokushige Akihiro , Ikeda Yoshiyuki , Kanda Daisuke , Sonoda Takeshi , Yoshikawa Akiko , Imamura Masakazu , Ohishi Mitsuru
Published: April 2021

Objective:

Intradialytic hypotension (IDH) is a major complication during hemodialysis (HD)session, associated with increased risk of cardiovascular events and mortality. Its pathophysiology is believed to be multifactorial and remains not well elucidated. The aim of this study is to investigate the clinical factor associated with IDH.

Design and method:

The KIDS Registry is a prospective cohort study in patients with maintenance dialysis at 4 facilities in Kagoshima Prefecture in Japan were consecutively enrolled (531 patients) June 2015 to the present. 345 patients who were finished over 1-year follow-up and available blood pressure data during HD were made to be an analysis subject, and divided into two groups according to the severity of decrease in systolic blood pressure (SBP) during HD; hypotension (IDH group, n = 148) and non-hypotension (non-IDH group, n = 197) groups showing an SBP decrease during HD of 20 mmHg or more, and less than 20 mmHg, respectively, compared with the SBP value before HD.

Results:

Prior peripheral vascular disease (PVD), history of diabetes mellitus (DM), history of hypertension and pre-urea nitrogen value were significantly higher in hypotension group than in non-hypotension group. We performed multivariate logistic regression to test for the independent contribution to IDH. Prior PVD(Odds Ratio (OR): 1.77, 95% Confidence Interval (CI): 1.01 to 3.09), history of DM (OR: 2.34, 95%CI: 1.39 to 3.93), and pre-urea nitrogen value (OR: 1.03, 95%CI: 1.01 to 1.05) were independent associating factors to IDH after adjusted by several clinical relevant factors.

Conclusions:

Atherosclerotic disease such as PVD and DM which was the important disease leading to atherosclerosis were significant associating factors with IDH. IDH may be associated with atherosclerosis in HD patients.
URINARY EXOSOME MIR-146A IS A POTENTIAL MARKER OF ALBUMINURIA IN ESSENTIAL HYPERTENSION
Authors: Ortega Ana , Martínez-Arroyo Olga , Perez-Hernandez Javier , Chaves Felipe J. , Redon Josep , Cortes Raquel
Published: April 2021

Objective:

There is increasing interest in using extracellular vesicle-derived microRNAs (miRNAs) as biomarkers in renal dysfunction and injury. Preliminary evidence indicates that miRNAs regulate the progression of glomerular disease. Indeed, exosomes from the renal system have provided novel evidence in the clinical setting of albuminuria. Thus, the aim of this study was to quantify the urinary miRNAs present in exosome and microvesicles (MVs), and to assess their association with the presence of increased urinary albumin excretion (UAE) in essential hypertension.

Design and method:

Exosomes were isolated from urine specimens from a cohort of hypertensive patients with (n = 24) or without albuminuria (n = 28), and from 20 healthy volunteers as a control group. Urinary exosomes were phenotyped by Western blot, tunable resistive pulse sensing (TRPS), electronic microscopy and western blot. Expression of exosomal miR-146a and miR-335∗ was analysed by qRT-PCR and any associations between albuminuria and exosomal miRNAs were established.

Results:

Urinary miRNAs are highly enriched in exosome subpopulations compared to MVs, both in patients with or without increased UAE (p < 0.001), but not in the control group. High albuminuria was associated with 2.5-fold less miR-146a in exosomes (p = 0.017), whereas miR-146a levels in MV did not change. In addition, exosome miR-146a levels were inversely associated with albuminuria (r = 0.65, p < 0.0001), and discriminated the presence of urinary albumin excretion presence [area under the curve (AUC) = 0.80, 95% confidence interval: 0.66–0.95; p = 0.0013).

Conclusions:

Our results indicate that miRNAs were enriched in the urinary exosome subpopulation in hypertensive patients and that low miR-146a expression in exosomes was associated with the presence of albuminuria. Thus, urinary exosome miR-146a may be a potentially useful tool for studying early renal injury in hypertension.
THYMOQUINONE PROTECTS AGAINST ANGIOTENSIN II-INDUCED RENAL DAMAGE VIA ANTI-FIBROSIS AND ANTI-INFLAMMATORY EFFECTS IN APOE-DEFICIENT MICE
Authors: Pei Zuowei , Zhu Huolan , Yang Chenguang , Ren Yirong , Meng Xuyang , Li Yi , Wang Fang
Published: April 2021

Objective:

Many studies showed that angiotensin II(Ang II) is a potent biologically active product of renin-angiotensin system and a key regulator of renal inflammation and fibrosis. Thymoquinone (TQ) is an herbal medicine which has been shown to have anti-inflammatory and anti-fibrosis effects in previous our studies. The aim of this study was to determine the role of TQ in Ang II-induced renal damage.

Design and method:

In present study, we used a model of Ang II-induced renal damage in ApoE-deficient (ApoE−/−) mice. Thirty eight-week-old male ApoE-/- mice were randomly divided into three groups: a control group, Ang II group and Ang II + TQ group. All groups mice were with different treated for 4 weeks. Blood samples were obtained from the inferior vena cava and collected in serum tubes; the blood samples were stored at minus 80°C until use. Coronal sections of kidney tissues were fixed in 10% formalin and then embedded in paraffin for histological evaluation. The kidney was stored in liquid nitrogen for immunoblotting or mRNA analysis. All data are presented as the mean ± SEM. Statistical analysis was performed using SPSS software version 23.0 (SPSS Inc., Chicago, IL, USA). Inter-group variation was measured by one-way ANOVA and subsequent Tukey's test. The minimal level of significance was P < 0.05.

Results:

The Ang II group showed a marked increase in CRE levels in ApoE-/- mice, but these parameters were significantly decreased in the Ang II + TQ group(Table1). There were significant pathophysiological changes (HE and Masson staining) in Ang II group mice, but the pathophysiological changes were inhibited in Ang II + TQ group(Figure1). Thymoquinone reduced Ang II-induced kidney fibrosis and inflammation in ApoE-/- mice(Figure2 and 3).

Conclusions:

Our data established that thymoquinone helps mitigate AngII-induced renal damage as shown by the downregulation of fibrosis expression and the suppression of inflammatory markers.
A CASE OF ACUTE KIDNEY INJURY CAUSED BY INTERSTITIAL NEPHRITIS COMPLICATED WITH DRESS SYNDROME
Authors: Oshima Yoichi , Tokuyama Hirobumi , Minakuchi Hitoshi , Wakino Shu , Itoh Hiroshi
Published: April 2021

Objective:

Drug reaction with eosinophilia with systemic symptoms (DRESS) syndrome is a life threatening hyperactivation of immune system by relevant drug use. Lethality accounts up to 10% of all patients. Herein, we present a successful treatment of a DRESS syndrome which complicated with end-stage renal disease, liver dysfunction, eosinophilia, congestive heart failure, skin rash and severe systemic symptoms.

Design and method:

Fifty-six- year-old Japanese woman was admitted to our hospital for the treatment of duodenal tumor by endoscopic submucosal dissection which accidentally caused perforation. She was treated by piperacillin tazobactam and acetoaminophen. Although the intraperitoneal abscess was cured, she had developed end-stage renal disease, liver dysfunction, eosinophilia, congestive heart failure, skin rash and severe systemic symptoms with high fever of 40 degrees Celcius and tachycardia. Plain CT scan showed kidney enlargement and gallium scintigraphy showed increased accumulation in the bilateral kidneys. eGFR declined to 12 ml/min/1.73m2 from the baseline of 75 and urine tubular makers were elevated. RegiSCAR score was six, and we diagnosed this case as DRESS syndrome. Drug-induced lymphocyte stimulation test turned out positive for both piperacillin tazobactam and acetoaminophen.

Results:

We decided to administer corticosteroids for the treatment of severe organ involvement. After 30 milligrams of intravenous prednisolone (0.6 mg/kg/day), the above symptoms subsided immediately without causing any adverse effects. The corticosteroids were tapered carefully because it is known that autoimmune disorders such as reactive arthritis, systemic lupus erythematosus and autoimmune hemolytic anemia could develop during the treatment course. The patient's renal function recovered to eGFR of 60 without induction of dialysis. After 12 months of treatment, the patient is free of corticosteroids without any relapse of DRESS syndrome.

Conclusions:

DRESS syndrome could be caused by a series of drugs, and could be a lethal disease. Immediate diagnosis and treatment are required for acceptable prognosis. Careful follow up should be made because of the relapses, reactivation of viruses such as cytomegaro virus and HHV-6, and autoimmune complications.
WHEN WE DON’T HAVE ENOUGH-A CASE OF SECONDARY HYPERTENSION
Authors: Mihailescu Anamaria , Balahura Ana Maria , Hostiuc Mihaela , Bartos Daniela , Badila Elisabeta
Published: April 2021

Objective:

Diabetic nephropathy (DN) is a significant cause of chronic kidney disease (CKD) and end-stage renal failure globally. Hypertension is approximately twice as prevalent in patients with diabetes compared to the general population. The major causes of hypertension in DN include activation of local (renal) renine-angiotensin-aldosterone system (RAAS), increased or abnormal sympathetic nervous system (SNS) activity, oxidative stress and abnormal nitric oxide (NO) metabolism. These mechanisms are responsible for the onset and worsening of hypertension in this population.

Design and method:

We report the case of a type I diabetic 47 years old man, with multiple complications (retinopathy, nephropathy, polineuropathy), stage 5 chronic kidney disease in hemodialysis program, hypertensive (ambulatory treatment: calcium channel blocker, and alpha2 central receptors), presented to the emergency department with tonic-clonic seizure, hypertension (with a blood pressure value of 185/98 mmHg), hyperglycemia (glycemia over 750 mg/dl), metabolic acidosis (ph 7.23), moderate hyponatremia (Na 124 mmol/l). Taking into consideration the characteristics of the particularly case presented above, the patient is considered to meet the admission criteria for intensive care unit (ICU). The evolution was favorable with insulin, acid-base and hydro electrolytic re equilibration, prevention of stress ulcer, venous thromboembolism prophylaxis and anti-hypertensive treatment (nitroglycerine, alpha1-adrenoreceptor blocker- urapidil, angiontensin-converting enzyme inhibitor, calcium channel blocker, loop diuretic) and the patient was transferred to internal medicine ward.

Results:

Despite the use of the treatment to the maximum tolerated plus the addition of alpha2 central receptors blocker (clonidine), the patient's blood pressure was uncontrolled (maximum 260/130 mm Hg), far from the target. The new regimen reduced the blood pressure values by systolic blood pressure 170 mm Hg.

Conclusions:

Although the prevalence of secondary hypertension is approximately 10 % the risks associated with are significantly higher. We reported a case of secondary hypertension with uncontrolled values of blood pressure despite maximal treatment.
DIFFERENCES IN PREVALENCE OF CHRONIC KIDNEY DISEASE USING BERLIN INITIATIVE STUDY 1 AND CKD-EPI EQUATIONS IN ELDERY SUBJECTS (ENAH STUDY)
Authors: Matasin Marija , Domislovic Viktor , Fucek Mirjana , Josipovic Josipa , Dapic Kresimir , Jelakovic Ana , Dika Zivka , Vrkic Tajana Zeljkovic , Kos Jelena , Premuzic Vedran , Jelakovic Bojan
Published: April 2021

Objective:

Glomerular filtration rate (GFR) is considered to be the best indicator of renal function in health and disease, and according to the guidelines should be estimated using CKD-Epi equation. CKD-Epi has a limitation when estimating GFR for elderly subjects. Recently, Berlin Initiative Study 1 equation (BIS1) was suggested to be more appropriate for subjects aged 70 or older. Our aim was to analyze differences in estimation GFR and prevalence of CKD when using CKD-Epi and BIS1.

Design and method:

Data on 2194 adult subjects (random sample of rural population; 383 > = 70 yr, 39.2% male) were analyzed. CKD-Epi and BIS1 were used to estimate eGFR in total group, elderly (> = 70 yr) and younger than 70 yr. Differences between equations were analyzed using chi-square test, kappa inter-rater agreement and Bland-Altman plot analysis.

Results:

Significant difference in proportion of patients in CKD stages when comparing CKD-Epi vs BIS1 for subjects older than 70 years, p < 0.001 was observed. When estimating GFR with two equations we observed a higher difference in prevalence in elderly subjects for eGFR values < 60 ml/min and > = 60 ml/min than in subjects <70 years (Figure 1). The difference in prevalence between CKD-Epi and BIS1 for older subjects was 22.7%, while for younger 0.008%, p < 0.001 (Figure 1). The agreement between CKD-Epi and BIS1 in older patients was lower than in younger subjects (kappa 0.56 vs kappa 0.67). When analyzing the total population there were more patients in stage 3a CKD using BIS1 equation than using CKD-Epi equation (10.2% vs. 5.8%). A systematic difference was found between the formulas, with BIS1 mean value 8.0 ml/min being lower than that of CKD-Epi (95% limits of agreement: +1.9 to -17.8).

Conclusions:

Significant difference between CKD-Epi and BIS1 was found. There was a higher difference in CKD prevalence in older subjects and also agreement between two formulas was lower in that subgroup. Our results suggest that specific equation suitable for elderly subjects should be used.
HYPERTENSION IN IGA NEPHROPATHY WITH MICROANGIOPATHY
Authors: Mannai Khouloud , Gaied Hanene , Jerbi Mouna , Trabelsi Raja Aoudia , Bacha Mongi , Harzallah Amal , Gorsane Imen , Abderrahim Ezzeddine , Goucha Rym , Abdallah Taieb Ben
Published: April 2021

Objective:

Our study aimed to describe blood pressure (BP) in case of thrombotic microangiopathy (TMA) associated with primitive IgA nephropathy (IgAN), its correlation with histological lesions and its prognostic impact.

Design and method:

We reviewed files of IgAN patients admitted and followed-up in our department between 1980 and 2017. We included adults showing at least one TMA lesion at their biopsy. Patients with IgA vasculitis or secondary IgAN were excluded.

Results:

Fifty files were studied. IgAN was revealed by malignant hypertension (MH) in 42% of cases. At admission, 68% of patients were under antihypertensive treatment. Mean arterial pressure (MAP), systolic pressure (SP) and diastolic pressure (DP) were respectively 113, 155 and 93 mmHg. Hypertension was found in 96% of patients, and was graded 1, 2 and 3 in 32%, 40% and 28% of cases. Only 30 patients had initial cardiac ultrasound and eye fundus revealing hypertensive cardiopathy in 53% and hypertensive retinopathy in 47% of cases. Mean proteinuria was 3.2 g/day ± 1.8. Median serum creatinine was 310 μmol/L. SP was correlated to C2 crescents (p = 0.015); DP to M1 mésangial hypercellularity (p = 0.033) and PAM to S1 glomerulosclerosis and C2 crescents (p = 0.045; p = 0.023). Those lesions were associated with more severe hypertension. After biopsy, all patients received antihypertensive agents (2.22 drugs per person): 80% had calcic inhibitors and 62% had renin angiotensin system inhibitors. At six months, among the 26 patients not on dialysis, only three had controlled BP. Dialysis risk was associated with initial MAP > = 100 mmHg (p = 0.027; OR = 12) and initial MH (p = 0.007; OR = 7.7). This risk was correlated with a higher SP at six months: 146 mmHg if dialysis versus 132 mmHg if not (p = 0.043). Renal survival was significantly reduced for patients with initial grade 3 hypertension (log Rank p = 0.043).

Conclusions:

Hypertension is frequent and severe in IgAN associated with TMA. Renal prognosis would be poorer in case of malignant, severe or persistent hypertension.
AMILORIDE ATTENUATES ALDOSTERONE-INDUCED RENAL INJURIES VIA THE SUPPRESSION OF PLASMIN ACTIVITY IN THE KIDNEY
Authors: Kakizoe Yutaka , Iwata Yasunobu , Nakagawa Terumasa , Deng Qinyuan , Adachi Masataka , Izumi Yuichiro , Kuwabara Takashige , Mukoyama Masashi
Published: April 2021

Objective:

Aldosterone has been known to exert direct detrimental effects on the kidney independently of its hemodynamic effects. We have reported that a serine protease plasmin was highly activated in the kidney of aldosterone/salt-treated rats and that plasmin caused kidney injuries through the induction of inflammatory and profibrotic cytokines. Amiloride is one of the potassium-sparing diuretics and it inhibits epithelial sodium channel (ENaC). On the other hand, it was reported that lower dose amiloride attenuated renal injuries without blood pressure (BP) lowering effect in salt-sensitive hypertension model rats. Because amiloride has a pleiotropic effect to inhibit urokinase-type plasminogen activator (uPA), we evaluated whether amiloride could attenuate aldosterone-induced renal injuries via the suppression of uPA-plasmin cascade in the kidney.

Design and method:

Nine-week old male uninephrectomized Sprague-Dawley rats were divided into following groups (1) normal salt diet (0.3%NaCl; NS), (2) aldosterone + high salt diet (0.75 μg/kg/h, subcutaneously + 8.0% NaCl; Ald+HS), and (3) aldosterone + high salt diet + amiloride (1 mg/kg/day, subcutaneously; Ami). Systolic BP (SBP) measurement and 24 h urine collection were performed every second week, and rats were sacrificed at 4 week. Renal plasmin activities were evaluated by zymography.

Results:

Amiloride did not affect either electrolytes in serum and urine nor blood pressure, indicating that the current dose of amiloride did not inhibit ENaC in the distal nephron [SBP (mmHg): NS, 115 ± 11; Ald+HS, 169 ± 17; Ami, 161 ± 21.]. Amiloride suppressed renal plasmin activation, and mitigated urinary protein excretion, renal dysfunction and histological damages as well as mRNA expression of kidney injury markers induced by aldosterone/salt [urinary protein (mg/day): NS, 10 ± 3; Ald + HS, 381 ± 61; Ami, 161 ± 22.].

Conclusions:

Our findings indicate that pleiotropic effects of amiloride to inhibit uPA-plasmin cascade may be beneficial for the treatment of aldosterone-associated renal injuries.
IMPACT OF PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY ON LEFT VENTRICULAR MASS AND ITS RELATIONSHIP TO CARDIOVASCULAR OUTCOME IN HYPERTENSIVE PATIENTS WITH RENAL ARTERY STENOSIS
Authors: Iwashima Yoshio , Fukuda Tetsuya , Horio Takeshi , Kusunoki Hiroshi , Hayashi Shin-Ichiro , Kamide Kei , Kawano Yuhei , Yoshihara Fumiki , Ishimitsu Toshihiko
Published: April 2021

Objective:

Renal artery stenosis (RAS) is associated with secondary hypertension, which is often resistant to antihypertensive medication.The aim of the present study was to evaluate the impact of renal angioplastry on left ventricular (LV) mass, as measured by echocardiography, and further to determine whether LV mass reduction is associated with reduced rates of cardiovascular events in hypertensive patients with RAS.

Design and method:

A total of 144 hypertensive patients with RAS (mean age 69 years; 22.2% fibromuscular dysplasia [FMD]) who underwent angioplasty were included. Echocardiography was performed at baseline and after one year, and were thereafter followed up for a median of 5.6 years for the primary composite outcomes. The primary endpoint of this study was first occurrence of the composite of cardiovascular events including all-cause death, myocardial infarction, stroke, or adverse aortic event.

Results:

In both the FMD and atherosclerotic stenosis (ARAS) groups, LV mass decreased after angioplasty, but the decrease in LV mass index (-15.4 ± 18.3% versus -0.8 ± 27.8%, p < 0.01) as well as the regression rate of LV hypertrophy was greater in FMD. Multiple logistic regression analysis indicated that FMD (odds ratio [OR] 2.94, p < 0.01), severe RAS (greater than or equal to 90%) (OR 2.94, p < 0.05), and higher LV mass index at baseline (OR 2.94 for 1 standard deviation increase, p < 0.001) were independent predictors of LV mass index decrease of at least 20%. The primary composite outcomes occurred in 45 patients (31.3%). In FMD, lower LV mass index after one year (hazard ratio 2.81 for 1 standard deviation increase, p < 0.05) or regression of LV mass (hazard ratio 0.75 for 5% decrease, p = 0.054) showed a tendency to be associated with better outcomes; however, these associations were not found in ARAS.

Conclusions:

Hypertensive patients with ARAS have less regression of LV mass in response to angioplasty than those with FMD, and LV mass regression is less useful as a surrogate marker of outcomes especially in ARAS.
EARLY RENAL DAMAGE IN YOUNG HYPERTENSIVE SUBJECTS: LINK WITH OFFICE AND 24-HOUR AMBULATORY SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
Authors: Ezhova Nadezhda , Khomova Irina , Shavarova Elena , Bazdyreva Elena , Kobalava Zhanna
Published: April 2021

Objective:

Hypertension (HTN) and target organ damage rate in young subjects is underestimated in clinical practice according to latest population studies and treatment strategy of HTN is not well defined due to minor and controversial data of clinical studies. As a part of cohort study of HTN detection and evaluation in young population we investigated renal function in untreated hypertensive subjects with primary diagnosed essential hypertension.

Design and method:

We performed office BP evaluation and ambulatory blood pressure monitoring with oscillometric cuff-based device in 102 young subjects with untreated essential hypertension defined with ESH criteria of HTN according to office and ambulatory blood pressure monitoring (age 26.2 ± 7.7 (M ± SD) years, 88.3% male, office SBP 134.7 ± 15.8 mm Hg, office DBP 73.2 ± 12.4 mm Hg). Serum creatinine and albumin/creatinine ratio in urine were measured. GFR was calculated with CKD-EPI. For comparison of variables in quartiles of blood pressure we used one-way ANOVA for parametric ones and Kruskal-Wallis test – for non-parametric variables.

Results:

We compared glomerular filtration rate (GFR) and albumin/creatinine ratio (ACR) in quartiles of office and 24 h systolic and diastolic blood pressure. Significant difference in GFR was registered in office SBP quartiles: GFR in 1st and 4th quartiles was 105,1 ± 21,7 vs 90,3 ± 14 ml/min/1,73m2, with F 4.035, P value 0,0097 while there was no any significant difference of ACR levels according to office BP levels. ACR was significantly different in quartiles of mean nighttime DBP: ACR median in 1st quartile – 4 [0,75; 5,0] vs 8 [3,0; 29,0] in last quartile, P value 0,0056 with no significant difference for daytime DBP and daytime and nighttime SBP. Significant correlation between mean nighttime DBP and ACR was observed: r 0,243, P value 0,023. R for office SBP and GFR was (-0,325) with P value 0,002.

Conclusions:

In young untreated hypertensive subjects elevation of office SBP is associated with GFR decline while ACR has association with nighttime DBP elevation.
SEX, METABOLIC AND PHARMACOLOGICAL MODULATORS OF SODIUM HANDLING IN POPULATION WITH PREVAILING SODIUM INTAKE
Authors: Cwynar Marcin , Stolarz-Skrzypek Katarzyna , Gasowski Jerzy , Gryglewska Barbara , Wojciechowska Wiktoria , Olszanecka Agnieszka , Dzieza Anna , Bednarski Adam , Barton Henryk , Czarnecka Danuta , Grodzicki Tomasz
Published: April 2021

Objective:

Renal sodium handling is associated with sex, ethnic, central adiposity and hypertensive treatment.

Design and method:

In a sample of caucasian population without diuretic treatment (351 subjects) with prevailing sodium consumption (153,6 mmol/d), we studied the associations between renal sodium reabsorption in proximal (FPRNa) and distal (FDRNa) tubules assessed by endogenous lithium clearance, daily sodium intake measured by 24-h excretion of sodium (UNaV) and measures of obesity in the context of chronic treatment with ACEI or ARB.

Results:

In the entire population in linear regression model, we found a relation between sex and FPRNa (β = 1.06 ± 0.30, P = 0.0005), with higher sodium reabsorption in proximal tubules in men. In subjects with FPRNa below the median value, we displayed a significant reverse relation between FPRNa and ACEI/ARB treatment (β = -0.40 ± 0.18, P = 0.03) with no relation for BMI (P = 0.42). Contrary, in subjects with FPRNa above the median value, a significant positive relation between FPRNa and BMI (β = 0.10 ± 0.03, P = 0.004) was revealed, with no relation for ACEI/ARB treatment (P = 0.55). For FDRNa (P > 0.10) and UNaV (P > 0.06) we found no relation for ACE/ARB treatment in entire population and after divided by median.

Conclusions:

We found that sex, obesity and chronic treatment with ACEI/ARB influence sodium reabsorption in renal proximal tubules. This may impact both on the research and clinical practice.
DRUG RELATED PROBLEMS AND ASSOCIATED FACTORS AMONG PATIENTS SUFFERING FROM CHRONIC KIDNEY DISEASE IN HYDERABAD
Authors: Shaheen Sumera
Published: April 2021

Objective:

To analyze the occurrence of medication related problems and associated factors among patients suffering from chronic kidney disease in Hyderabad, Pakistan.

Design and method:

The prospective and observational study was conducted among 103 patients who had confirmed diagnosis of chronic kidney disease based on GFR from April to September 2019. Data related with the patient's demographic details, medications, diagnosis and other necessary information were collected through patient's medications profiles. Data was analyzed by using M.S Excel and (SPSS) version 21.0.

Results:

Out of 103 patients, 79 (76.69%) had MRPs. The rate of whole MRPs was 32.90 %. The most common MRPs among CKD patients were non-adherence (31%), dose too low (18%) and need of drug additional therapy (18%). The most common cause of need of additional drug therapy (24%) was those medical conditions which were untreated non-adherence 8.5% was mostly due to the forgetfulness of either the patient or his caregiver.

Conclusions:

The current study revealed that Medications related problems are high among CKD patients due to creatinine clearance and all the health care professionals should work for lowering down it.
DOES MICROANGIOPATHY INFLUENCE ARTERIAL PRESSURE IN IGA NEPHROPATHY?
Authors: Mannai Khouloud , Hajri Malika , Gaied Hanene , Jerbi Mouna , Harzallah Amel , Bacha Mouhamed Mongi , Trabelsi Raja , Lounissi Mondher , Barbouch Samia , Hedri Hafedh , Kaaroud Hayet , Laabidi Jannet , Abderrahim Ezzeddine , Hmida Fathi Ben , Younsi Fethi El , Goucha Rym , Abdallah Taieb Ben
Published: April 2021

Objective:

This study aimed to establish clinical particularities of patients with primitive IgA nephropathy (IgAN) in case of associated thrombotic microangiopathy (TMA); comparatively with patients without TMA.

Design and method:

We compared two groups of patients diagnosed with primitive IgAN, from 1995 to 2017. The group1 (G1) comprised all patients with at least one TMA lesion in their renal biopsy. The group 2 (G2) was a randomly chosen sample of patients without TMA. Inclusion criteria were: patients older than 16, and followed up by our team. Exclusion criteria were: secondary IgAN or IgA vascularites, incomplete files and inconclusive IF results. We collected the initial clinical parameters. Then, using the “U” test of Mann-Witney test, we compared the two groups.

Results:

We selected 50 patients for G1 and 74 patients for G2. Baseline characters of all subjects were: mean age 33, men to women ratio 1.95, mean BMI 24.6 [17–38], mean albuminemia 33 [8–53] g/l, median serum creatinine (SCr) 207 [49–1800]μmol/l, mean eGFR 47 [2–156] ml/min and mean proteinuria 2.9 [0–11] g/day. Mean systolic and diastolic pressure were 139 [90–200] and 85 [50–120] mmHg. Seventy two patients (58%) had hypertension: grade 1, grade 2 and grade 3 for 23.4%, 23.4% and 11.3%. Comparing the two groups (G1 vs G2) the difference was significant for: systolic pressure (p = 0.000, 155 vs 128 mmHg), diastolic pressure (p = 0.000, 93 vs 79 mmHg), hypertension frequency (p = 0.000, 96% vs 32%), grade 2 hypertension (p = 0.000, 38% vs 13.5%), grade 3 hypertension (p = 0.000, 24% vs 2.7%) and SCr (p = 0.000, 501 vs 231 μmol/l). There was no significant difference forage (p = 0.10), BMI (p = 0.26), albuminemia (p = 0.14) and proteinuria (p = 0.059).

Conclusions:

Founding a TMA lesion in our patients’ biopsies should alert us to a more severe form of IgAN, with a more frequent hypertension and more advanced renal failure.
MAJOR CORRELATIVE RISK FACTORS OF CHRONIC KIDNEY DISEASE AND CO-MORBIDITIES IN PAKISTAN
Authors: Ali Muhammad
Published: April 2021

Objective:

End-stage kidney disease or chronic kidney disease is an alarming and major public health problem. Its multi factorial reasons such as insufficient and lack of health related wakefulness, and most important the high burden of co-morbidity such as age, diabetes, cardiovascular, peripheral vascular, and hepatic disease add-on kidney diseases, makes these observations knotty to interpret.

Chronic kidney disease is progressive loss of half or more than half of normal kidney and risk of adverse outcomes has been increase day by day. This study was used to consider the frequency of kidney disease and to determine its association with avoidable factors of risk such as Diabetes & Hypertension. The main purpose of this study was to evaluate the incidence and clinical factors linked with kidney diseases.

Design and method:

A descriptive study was performed on 300 participants aged above than 40 years in five clinical setup of Hyderabad, Pakistan. This study was carried out from March to December 2019. A special proforma was formed to gather the data. Routine following information was collected e.g diet routine & physical activity, smoking status, co-morbidities, Serum level of creatinine and glomerular filtration rate was checked by using the kidney diseases epidemiology collaboration equation.

Results:

Results show that the overall prevalence of kidney disease was 24.7%. 97% had their serum creatinine checked. Among them, 62.4% had GFR >90, 19.8 were in chronic kidney disease stage 2 with eGFR 60–89, and 8.9% in Chronic kidney problem stage 3 with eGFR 30–59. Chronic kidney disease patients were notably older, performed limited physically actives, have diabetes, high blood pressure, heart disease & stroke as compared to other. A strong association was reported between kidney disease & hyperglycaemia & hypertension. 71.3% patients with diabetes were found during study.

Conclusions:

It shows that a kidney disease is more common in Pakistani population. The high risk factors & poor management of diabetes & hypertension among patients with kidney disease emphasize the need to provide kidney disease awareness, management & prevention in the primary care services in Pakistan.
SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS ARE PROTECTIVE AGAINST ACUTE KIDNEY INJURY ACROSS THE CARDIOVASCULAR AND RENAL OUTCOME TRIALS: AN UPDATED META-ANALYSIS
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Toumpourleka Maria , Kalogirou Maria-Styliani , Koutsampasopoulos Konstantinos , Tegou Zoi , Mavridou Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael
Published: April 2021

Objective:

Acute kidney injury (AKI) has a significant prognostic impact on chronic kidney disease development and progression, cardiovascular morbidity and mortality and all-cause mortality both in the in-hospital and in the outpatient setting. Initial concerns of increased risk of AKI with the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors have partially limited their broad use.

Design and method:

We searched PubMed from its inception to 28 September 2020. We sought to determine the effect of SGLT-2 inhibitors on AKI regardless of diabetes status across the hallmark cardiovascular and renal outcome trials. No efficacy outcomes were assessed.

Results:

Besides trialists of the EMPEROR-Reduced trial who did not report any data regarding the incidence of AKI in the two treatment arms, the rest cardiovascular and renal outcome trials provided corresponding data. Therefore, we pooled available data from seven randomized controlled trials in a total of 55,966 enrolled participants. SGLT-2 inhibitor treatment resulted in a significant decrease in the risk of AKI equal to 25% (RR = 0.75, 95% CI; 0.66 to 0.85, I2 = 0%). The observed effect was primarily driven by the cardiovascular outcome trials (RR = 0.71, 95% CI; 0.61 to 0.83, I2 = 0%), while, no significant effect was observed in the dedicated renal outcome trials (RR = 0.83, 95% CI; 0.66 to 1.05, I2 = 0%).

Conclusions:

The observed protective effect of SGLT-2 inhibitors against AKI in the high or very high risk patients enrolled in the published cardiovascular and renal outcome trials is very important and should influence decision making.
COMPARISON OF SYSTEMIC ARTERIAL STIFFNESS IN PATIENTS WITH NEW DIAGNOSED IDIOPATHIC PULMONARY AND SYSTEMIC ARTERIAL HYPERTENSION
Authors: Radchenko Ganna , Zhyvylo Irina , Titov Eugeniy , Sirenko Yuriy
Published: April 2021

Objective:

This study is the first attempt to use cardio-ankle vascular index (CAVI) for evaluation of systemic arterial stiffness in patients with idiopathic pulmonary arterial hypertension (IPAH).

Design and method:

45 patients with IPAH, 32 patients with arterial hypertension (AH), 35 healthy persons adjusted by age were included in study. RHC, ECG, 6 minute walk test (6 MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe) and muscular artery stiffness (PWVm), CAVI, NT-proBNP level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI.

Results:

IPAH patients had significant (P < 0.001) shorter 6MWT distance and higher Borg dyspnea score than patients with AH (systolic/diastolic BP- 146.1 ± 3.7/94.2 ± 3.8mmHg) and control group - 330.2 ± 14.6 vs 523.8 ± 35.3 and 560.9 ± 30.2m respectively and 6.2 ± 1.8 vs 1.2 ± 2.1 and 0.9 ± 2.8 points. The PWVm and PWVe were highest in hypertensive patients - 10.3 ± 1.5 and 11.42 ± 1.70m/s. The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significant (P < 0.003/0.008) higher in IPAH patients, than in control group - 8.1 ± 1.9/8.49 ± 1.92vs6.63 ± 1.34/7.29 ± 0.87m/s. The CAVIs on both sides were significant lower in healthy subjects (5.91 ± 0.99/5.98 ± 0.87 right/left side). Patients with IPAH did not differ from AH patients by CAVIs in comparison with control group - 7.40 ± 1.32/7.22 ± 1.32vs7.19 ± 0.78/7.2 ± 1.1. PWVe did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r = 0.58, P < 0.001), NT-proBNP (r = 0.33, P = 0.03) and male gender (r = 0.37, P = 0.013) at Spearman analysis, but not at multifactorial linear regression analysis. Unlike the CAVI correlated with age and parameters characterized functional capacity (6 MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right or/and left side had correlation with age, 6MWT distance, TAPSE, but independent correlation was only with age (beta = 1.104,P = 0.008) and TAPSE (beta = 0.66,P = 0.016).

Conclusions:

Patients with IPAH had significant stiffer arteries than healthy persons and they were comparable with AH patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients.
AMBULATORY BLOOD PRESSURE PHENOTYPES, VASCULAR INFLAMMATION AND ARTERIAL STIFFNESS IN ESSENTIAL HYPERTENSION
Authors: Mahmud Azra , Alahaideb Ruba , Alshammary Haifa , Alfawwaz Afnan , Abanumay Mayar , Alhelabi Sara , Alonazy Amgad , Al-Zaibag Muayed
Published: April 2021

Objective:

Hypertension is the leading risk factor for cardiovascular(CV) disease worldwide. Ambulatory blood pressure(ABPM) is the gold standard for the management of hypertension and its various phenotypes may provide prognostic information beyond clinic blood pressure (BP). The aim was to study the prevalence of various ABPM phenotypes and their relationship with target organ damage(TOD) i.e., urine albumin-creatinine ratio (ACR), and arterial stiffness as pulse wave velocity (PWV)vascular inflammation as high-sensitivity C-reactive protein(hs-CRP) in a Saudi hypertensive population.

Design and method:

We studied consecutive patients aged > 18 yr-old referred to the Hypertension Clinic at King Abdul Aziz Cardiac Center, Riyadh, Saudi Arabia. ABPM was performed for a 24 hour period with an oscillometric device. Masked uncontrolled hypertension (MUCH) was defined as controlled clinic BP with daytime elevated BP (definition-1); 24-hr ambulatory BP (definition-2); and either daytime or nighttime elevated BP (definition-3). Dipping was defined as a 10–20% fall in nocturnal BP; reverse-dipping as less than 0% and extreme dipping as more than 20%. The study had Institutional Ethics Committee permission.

Results:

The study population included 428 subjects, (mean age 53.5 ± 14 years, female = 45%). Nine percent of the population had WC; 30% had MUCH which was driven by nocturnal hypertension with higher prevalence in patients with pre-hypertension; 24 hr, 68%; daytime, 56% and nighttime 86%(p < 0.0001). Overall, 71% of the patients had MUCH which was driven by nocturnal hypertension vs. 24-hr or daytime (70%. vs. 42% vs. 32%, P < 0.0001) respectively. Eighty percent of the cohort had non-dipping with similar prevalence in MUCH and uncontrolled hypertension. Compared with controlled BP, patients with MUCH had significantly higher ACR (18.8 ± 8 vs 6.2 ± 6, p < 0.01), PWV(11.2 vs. 9.9, p < 0.001) and hs-CRP (1.6 ± 1.4 vs. 6.4 ± 2.3, p < 0.01).

Conclusions:

This is the first study exploring ABPM phenotypes in a Saudi hypertensive population, showing a high prevalence of MUCH in apparently well-controlled patients, driven by nocturnal hypertension and associated with prehypertension. The MUCH population had greater TOD than those with controlled BP associated with a non-dipping pattern. Our results highlight the importance of ABPM in the management of hypertension in Saudi Arabia.
ENDOVASCULAR INTERVENTIONS FOR CHILDHOOD TAKAYASU ARTERITIS: A 16-YEAR REVIEW
Authors: Luyun Fan , Lirui Yang , Dongmei Wei , Wenjun Ma , Ying Lou , Lei Song , Jin Bian , Huimin Zhang , Jun Cai
Published: April 2021

Objective:

Evidence-based studies on endovascular approaches for childhood Takayasu arteritis(c-TA) are limited. This study presented the real-world scenario of largest cohort up-to-date for c-TA patients undergoing interventions and their post-interventional outcomes.

Design and method:

Patients with c-TA satisfying the 1990 ACR or 2010 EULAR/PRINTO/PReS criteria were recruited from January 2002 to December 2017. Data on clinical, laboratory, imaging features, treatment and post-interventional outcomes were collected. Statistical analysis was performed based on data distribution. Complication-free survival and Re-intervention-free survival were projected by Kaplan-Meier methods and compared by Log-rank tests. Associated factors for intervention (or stenting) and predictors for post-interventional complications (or re-interventions) were assessed via Logistic regression and COX regression models, respectively.

Results:

Among 101 patients enrolled, 69(68.3%) underwent 121 interventions (Angioplasty 95; Stenting 26) during a median 3.1 years of follow-up. Compared with the medical treatment group, the intervention group appeared with fewer male population(18.8% vs 39.3%, OR = 0.2, p = 0.017) and more type IV disease(47.8% vs. 17.9%, OR = 10.60, p = 0.002). Male sex also indicated the risk for re-intervention(HR = 4.72, p = 0.016). Retinopathy(OR = 4.8, p = 0.027), time of delay in diagnosis per year(OR = 1.76, p = 0.016) and descending thoracic aorta involvement(OR = 10.19, p = 0.003) associated with stent insertion. Hypertension secondary to renal artery(59.4%) or mid-aorta(14.5%) stenosis, heart failure(21.7%), claudication(21.7%) served as leading clinical hints for interventions. Anti-inflammatory and anti-platelet therapies covered 89.9% and 91.3% patients, respectively. The technical success rate was 96.7%. Over median 2.88 years since intervention, 36 lesions occurred complications in 28 patients and 22 lesions in 17 patients, majorly on renal artery or mid-aorta. The 5-year complication-free and re-intervention survivals were 50.7% and 65.8%, separately. Dual antiplatelet therapy(HR = 0.28, p = 0.011), concurrent surgery(HR = 14.84, p = 0.002), retinopathy secondary to hypertension(HR = 3.54, p = 0.004), and pulmonary artery hypertension(HR = 3.0, p = 0.024) were independent predictors for complications.

Conclusions:

Over two-thirds c-TA patients require interventions and the 5-year complication-free survival is 50.7%. Male sex, retinopathy, and pulmonary artery hypertension alert unfavorable outcomes. Dual anti-platelet therapy appears to protect c-TA patients from post-interventional complications. Endovascular approaches can be a choice for mid-aorta and/or renal artery lesions caused by c-TA.
RELATIONSHIP OF ARTERIAL STIFFNESS AND RENAL DYSFUNCTION IN PATIENTS WITH HYPERTENSIVE DISEASE WITH A HIGH ADDITION TO TREATMENT
Authors: Koziolova Natalya , Chernyavina Anna
Published: April 2021

Objective:

Objective: to assess the relationship between changes in the carotid-femoral pulse wave velocity (PWVcf) with glomerular and tubular function in patients with hypertension with a high adherence to treatment.

Design and method:

Materials and methods: 82 hypertensive patients with a high adherence to treatment were examined (average age 50.23 ± 7.16), who were divided into 2 groups depending on PWVcf. Group 1 - 41 patients with PWVcf less than 10 m / s, Group 2 - 40 patients with PWVcf more than 10 m / s. To determine the level of CFS, all patients underwent volume sphygmopletismography. To assess the renal filtration function, the serum level of cystatin C was determined by ELISA and GFR was calculated using the CKD-EPI formula for cystatin C. Also, for the assessment of tubular renal function, the level of serum NGAL was determined by the method ELISA.

Results:

Results: patients in the groups did not significantly differ in age, gender, risk factors, concomitant diseases and therapy, blood pressure and lipid profile. In group 2, the NGAL level was 1.68 ± 0.83 ng/ml, which is more than in group 1 - 1.27 ± 0.57 ng/ml (p = 0.032). At the same time, the patients did not statistically significantly differ in the level of cystatin C and GFR based on cystatin C. Correlation analysis showed a direct moderate relationship between PWVcf and the level of NGAL (r = 0.31; p < 0.05) in these patients was found.

Conclusions:

Conclusions: in hypertensive patients with a high adherence to treatment, along with an PWVcf increase, there is a significant deterioration in tubular renal function, estimated by an increase in NGAL level. GFR with high adherence to treatment was not associated with changes in PWVcf.
FATTY LIVER INDEX IS POSITIVELY ASSOCIATED WITH ARTERIAL STIFFNESS IN A CHINESE POPULATION
Authors: Junli Zuo , Yueliang Hu , Jiehui Zhao , Isabella Tan , Mark Butlin , Alberto Avolio
Published: April 2021

Objective:

Non-alcoholic fatty fiver disease (NAFLD) is a metabolic liver injury closely related to insulin resistance. Fatty liver index (FLI) can be used as a surrogate marker and validated index for NAFLD. This study aimed to explore the relationship between FLI and arterial stiffness in a Chinese population.

Design and method:

From December 2017 to March 2019, a total of 405 inpatients (mean age 51.16 ± 11.92 years) were recruited for cardiovascular disease screening at Ruijin Hospital North, Shanghai.Measurement of brachial systolic, diastolic, mean and pulse pressure. Carotid-femoral pulse wave velocity (cfPWV) was measured (SphygmoCor) to assess the arterial stiffness.

Results:

Subjects were divided into 3 groups according to their FLI <30,normal; 30–59, intermediate fatty liver index; > = 60, NAFLD. The proportion of subjects with hepatic steatosis (FLI> 60), intermediate FLI (30–59), and no steatosis (FLI <30) was 34.6%, 31.6% and 33.8%, respectively. The male population (53.9%) had significantly higher FLI levels (p < 0.05). Subjects with FLI > 60 had higher cfPWV than those with FLI < 30 (p = 0.006). cfPWV was positively correlated with FLI (r = 0.143, p = 0.004). After adjusting for age, sex, body mass index, PDP, glucose, triacylglycerol, total cholesterol and LDL, FLI remained positively associated with cfPWV (p = 0.011).

Conclusions:

cfPWV, as a measure of arterial stiffness, is higher in the NAFLD group when compared to that in normal groups. Fatty liver index is positively associated with arterial stiffness in a Chinese population.
THE INTERPLAY OF ANTICOAGULATION AND THORACIC AORTA CALCIFICATION IN PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME
Authors: Gkini Konstantia-Para , Terentes-Printzios Dimitrios , Vlachopoulos Charalambos , Aznaouridis Konstantinos , Ioakeimidis Nikolaos , Gardikioti Vasiliki , Sigala Evangelia , Dima Ioanna , Kallikazaros Ioannis , Tousoulis Dimitrios
Published: April 2021

Objective:

Patients under haemodialysis have increased vascular calcification burden especially that is seems to be upregulated when treated with Vitamin K antagonists (VKA). We sought to investigate the association of anticoagulation and thoracic aorta calcification (TAC) in patients with ACS.

Design and method:

Two hundred patients admitted with ACS were included in the study. Type of anticoagulant therapy and the extent of TAC were recorded for every patient. Anticoagulants were divided into two groups, VKA and non-VKA anticoagulants. The extent of TAC on a postero-anterior plain chest X-ray was divided into four grades 0 to 3. Lower and higher TAC were categorized as grade 0 to 1 and 2 to 3 respectively.

Results:

Twenty-nine (15%) patients at admission were on anticoagulants. Seventeen patients (9%) were treated with VKA and 12 patients (6%) with non-VKA anticoagulants. Patients with higher grade of TAC more often had history of heart failure (p < 0.001), chronic kidney disease (p < 0.001) and atrial fibrillation (p = 0.006). Age and history of chronic kidney disease predicted higher TAC burden (Odds ratio [OR] = 1.07, 95% Confidence intervals [CI] 1.03 to 1.10, p < 0.001 and OR = 6.07, 95% CI 2.35 to 15.67, p < 0.001, respectively). Patients treated with VKA had higher TAC grade after adjustment for age, gender and chronic kidney disease. (OR = 3.64, 95% CI 1.08 to 12.20, p = 0.037). On the other hand, there was a non-statistically significant trend for reduced TAC burden in patients treated with non-VKA anticoagulants (OR = 0.24, 95% CI 0.04 to 1.47, p = 0.12).

Conclusions:

Our study shows that patients with ACS treated with VKA have higher grade TAC, while patients treated with non-VKA anticoagulants seem to have lower grade TAC.