Relationship between renal artery stenosis and intrarenal damage in autopsy subjects with stroke

Diuretic response in acute heart failure-an analysis from ASCEND-HF

BACKGROUND

Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF.

METHODS

Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent.

RESULTS

Mean diuretic response was -0.42 kg/40 mg of furosemide (interquartile range -1.0, -0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide.

CONCLUSIONS

Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response.

Kidney function and histological damage in autopsy subjects with myocardial infarction

OBJECTIVES

Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease (CVD). We previously reported renal parenchymal damage in autopsy subjects with stroke or abdominal aortic aneurysm. The aim of this study is to evaluate the relationship between renal histology and clinical characteristics of patients with myocardial infarction (MI).

METHODS

A total of 699 subjects were autopsied at the National Cerebral and Cardiovascular Center Hospital. We retrospectively evaluated all autopsy cases with MI (n = 123). Estimated glomerular filtration rate (eGFR) was calculated using the Japanese formula. Subjects were classified into four groups: 25 subjects with eGFR ≥ 60 mL/min/1.73 m(2) and no proteinuria (no CKD), 10 subjects with eGFR ≥ 60 and proteinuria (CKD1/2), 65 subjects with 60 > eGFR ≥ 30 (CKD3), and 23 subjects with eGFR < 30 (CKD4/5). Renal parenchymal damage was evaluated using a semi-quantitative histological score (score 0-3) for glomerulosclerosis, interstitial fibrosis, tubular atrophy, arteriolar hyalinosis, and arteriosclerosis of medium-sized artery (maximum score = 15).

RESULTS

The mean histological score was significantly higher in patients with CKD3 and CKD4/5 and was associated with age, hypertension, diabetes, kidney function, proteinuria, and other CVD.

CONCLUSIONS

In patients with MI, renal parenchymal damage and deteriorating kidney function are closely associated.

Renal artery revascularization: predictive value of kidney length and volume weighted by resistive index

OBJECTIVE

The purpose of this study was to evaluate the usefulness of renal length, volume, and resistive index measurements at Doppler ultrasound and MR angiography in predicting improvement after renal angioplasty.

MATERIALS AND METHODS

Fifty-one patients underwent Doppler ultrasound examinations and MR angiography before percutaneous transluminal renal angioplasty. Renal length, total and cortical volumes, and resistive index were calculated. Combinations of length, volume, and resistive index measurements were correlated with improvement in blood pressure and renal function after percutaneous transluminal renal angioplasty. Thresholds for improving patient selection were chosen after analysis of receiver operating characteristics curves.

RESULTS

Lower total and cortical volumes on MR angiograms and shorter kidney length on Doppler ultrasound images were found among patients with successful blood pressure control (p = 0.042, p = 0.035, and p = 0.016, respectively). Renal length measured with Doppler ultrasound and cortical volume measured with MR angiography weighted by resistive index were the best predictive factors (p = 0.004, p = 0.006). Using a threshold of renal length-resistive index product less than 7 cm, therapeutic response was predicted with a sensitivity of 87% and specificity of 50%, whereas with a threshold value of 52 mL/m(2) for cortical renal volume-resistive index product divided by body surface area, sensitivity of 86% and specificity of 50% were obtained.

CONCLUSION

Renal length and volume combined with resistive index measurements appear to be predictive of therapeutic response after percutaneous transluminal renal angioplasty.

Effect of early nephrology referral on the initiation of hemodialysis and survival in patients with chronic kidney disease and cardiovascular diseases

BACKGROUND

The timing of referral to nephrologists is highly variable in patients with chronic kidney disease (CKD). The impact of early referral on the timing of hemodialysis (HD) and mortality in the patients with CKD and cardiovascular diseases (CVD) was evaluated in this present study.

METHODS AND RESULTS

A total of 366 patients with CKD and CVD began HD at the National Cardiovascular Center between 1983 and 2003, and survival was followed until 2005. The times between the first evaluation by a nephrologist and the date of the first HD were categorized as late (LR <6 months) or early (ER > or =6 months) referral. Patients were classified into the ER (n=194) and LR (n=172) groups. Clinical data and renal function were not different. In the LR group, the renal function declined more rapidly and the duration between the first visit to the hospital and the first HD was shorter than the ER group. The survival rate after the initiation of HD was better in the ER group. Age, pre end-stage renal disease therapy and cardiac function had a significant impact on survival.

CONCLUSIONS

Early nephrology referral is important and necessary for for patients with CKD and CVD in terms of a better renal prognosis and survival.

Renal Function in Patients with Abdominal Aortic Aneurysm

AIMS

Renal dysfunction occurs occasionally after the repair of abdominal aortic aneurysm (AAA), and preoperative renal function is considered as one of the potential causes. The present study was designed to evaluate and compare renal function and risk factors of AAA patients with those of hypertensive patients.

METHODS

We prospectively examined 95 patients with AAA and 72 patients with essential hypertension (HT) without other cardiovascular diseases (CVD). Renal function, urinary albumin excretion (UAE) and renal scintigraphy were compared. Kidney size was calculated using ultrasonography.

RESULTS

Serum creatinine and creatinine clearance in AAA patients was worse than in HT patients. Smoking status was more apparent in AAA patients. Renal artery stenosis occurred in 8 patients with AAA. Renal scintigraphy showed normal function in 19%, hypofunction in 69% and severe dysfunction in 12% of the AAA patients, and normal function in 42% and hypofunction in 58% of the HT patients (p < 0.0001). Multivariate linear regression analysis showed that renal function was related to age, UAE, CVD, smoking status and kidney size for all patients, UAE, CVD, smoking status and kidney size for AAA patients, and age and kidney size for HT patients.

CONCLUSION

Renal function of AAA patients was worse than HT patients without other CVD. The risk factors for renal dysfunction were different between AAA and HT patients. These preoperative conditions may relate to the postoperative renal dysfunction seen in AAA patients.