bluuebunny/crossref_metadata_2025_split huggingface dataset:
BILATERAL RENAL ARTERY EMBOLIZATION IN END-STAGE RENAL DISEASE AND RESISTANT HYPERTENSION
Authors: Vaclavik Jan , Kvapil Tomas , Cerna Marie , Prasil Vojtech , Kocianova Eva , Jelinek Libor , Kamasova Monika 
Published: April 2021

Objective:
Some patients with end-stage renal disease present with resistant or refractory arterial hypertension despite dialysis and use of multiple antihypertensive drugs. Renal artery embolization is a rarely used minimally invasive interventional procedure which may provide improved blood pressure (BP) control in chronic renal parenchymal disease by eliminating renal function while avoiding the morbidity and mortality of a nephrectomy.

Design and method:
A 44-year old white male with chronic glomerulonephritis and stage 5 chronic kidney disease undergoing regular dialysis treatment was referred for refractory arterial hypertension. Despite treatment by 7 antihypertensive drugs and good therapeutic adherence his office and ambulatory BP remained very high. Plasma renin was markedly elevated and CT angiography found diffuse atherosclerotic changes of renal arteries. Sequential catheter-based renal artery embolization with application of a tissue glue was indicated.

Results:
In September 2019, catheter based embolization of right renal artery was performed in analgosedation, followed by the embolization of the left renal artery two weeks later. Because of the rapid antihypertensive effect of the procedure, antihypertensive medications were reduced at the time of the left-sided procedure (from 9 to 6 defined daily doses). One month after the renal artery embolization, despite reduced medication, office BP decreased from baseline 170/106 mmHg by 57/22 mmHg. Mean 24-hour, day-time and night-time ambulatory BP was reduced by 15/11 mmHg, 14/11 and 34/15 mmHg, respectively. The patient reported prolonged flank pain lasting approximately one week after the embolization, which responded well to conventional analgesics.

Conclusions:
Renal artery embolization lead to a marked improvement of BP control in a patient with end-stage renal disease, refractory arterial hypertension and high plasma renin. Further studies are warranted to assess the efficacy and safety of renal artery embolization in such patients.
HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS AND PROTEINURIC PHENOTYPE OF CHRONIC KIDNEY DISEASE ARE CHARACTERIZED BY WORSE PARAMETERS OF 24-H CENTRAL AORTIC BLOOD PRESSURE
Authors: Chernomorets V. , Troitskaya E. , Kobalava Z. 
Published: April 2021

Objective:
The aim of the study was to evaluate the 24-h profile of peripheral and central blood pressure (BP) in hypertensive patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) according to the presence of proteinuria.

Design and method:
The study included 90 patients with HTN, T2DM and CKD with eGFR 30-<60 ml/min/1.73 m2 and urine albumin–creatinine ratio (UACR) <300 mg/g (66% females, median age 60 years, median duration of DM–7.5 years, median duration of HTN 18 years). All received antihypertensive therapy and antidiabetic drugs (insulin in 58%). The analysis was performed according to CKD phenotype: proteinuric (UACR 30-<300 mg/g) and non-proteinuric (UACR < 30 mg/g). Office BP was measured with a validated oscillometric device. Clinical central BP and 24-hour ABPM of brachial and central aortic BP were performed with BPLab Vasotens. All results are presented as median values. p < 0.05 was considered significant.

Results:
Office brachial BP was 156/83 mmHg, aortic – 139/90 mmHg, median UACR was 26.5 mg/g. Proteinuric phenotype was found in 78% and compared to non-proteinuric phenotype was characterized by higher rate of dyslipidemia (85% vs 45%, p = 0.0004), more frequent history of coronary artery disease (53% vs 10%, p = 0.001), longer duration of HTN and DM (19.5 vs 7.5 years and 8 vs 3 years respectively, p < 0.01), lower HDL-C (1.2 vs 1.9, p = 0.02) and higher office brachial DBP (83 vs 80 mmHg, p = 0.04) and central SBP (147 vs 137 mmHg, p = 0.007). Proteinuric phenotype compared to non-proteinuric was associated with worse 24-h profile of central SBP (daytime 147 vs 138 mmHg, p = 0.008; night-time 143 vs 130 mmHg, p = 0.04). HTN phenotypes according to diurnal index for proteinuric and non-proteinuric CKD were as follows: dippers 0 vs 10%, non-dippers 6 vs 5%, night-peakers 82 vs 70% over-dippers 12 vs 15% (all differences were non-significant). Presence of proteinuric phenotype positively correlated with daytime and night-time aortic SBP (r = 0.28 and 0.21 respectively, p < 0.05).

Conclusions:
Proteinuric phenotype of CKD in patients with HTN and T2DM is associated with worse 24-h profile of central BP.
The publication was prepared with the of the RUDN University Program 5-100
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.