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Kokko E, Choudhary MK, Mutanen A, Honkonen M, Tikkakoski A, Koskela JK, Hämäläinen M, Moilanen E, Viukari M, Matikainen N, Nevalainen PI, Pörsti I. Volume overload is a major characteristic in primary aldosteronism: a 3-year follow-up study. J Hypertens 2024:00004872-990000000-00416. [PMID: 38406920 DOI: 10.1097/hjh.0000000000003696] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES We examined haemodynamics, focusing on volume balance and forward and backward wave amplitudes, before and after 2.8 years of targeted treatment of primary aldosteronism. Patients with essential hypertension and normotensive individuals were examined for comparison (n = 40 in each group). METHODS Recordings were performed using radial artery pulse wave analysis and whole-body impedance cardiography. Unilateral aldosteronism was treated with adrenalectomy (n = 20), bilateral aldosteronism with spironolactone-based medication (n = 20), and essential hypertension with standard antihypertensive agents. RESULTS Aortic SBP and DBP, forward and backward wave amplitudes, and systemic vascular resistance were equally elevated in primary aldosteronism and essential hypertension. All these haemodynamic variables were similarly reduced by the treatments. Primary aldosteronism presented with 1 litre (∼10%) extracellular water excess (P < 0.001) versus the other groups, and this excess was normalized by treatment. Initial pulse wave velocity (PWV) was similarly increased in primary aldosteronism and essential hypertension, but final values remained higher in primary aldosteronism (P < 0.001). In regression analyses, significant explanatory factors for treatment-induced forward wave amplitude reduction were decreased systemic vascular resistance (β = 0.380) and reduced extracellular water volume (β = 0.183). Explanatory factors for backward wave amplitude reduction were changes in forward wave amplitude (β = 0.599), heart rate (β = -0.427), and PWV (β = 0.252). CONCLUSION Compared with essential hypertension, the principal haemodynamic difference in primary aldosteronism was higher volume load. Volume excess elevated forward wave amplitude, which was subsequently reduced by targeted treatment of primary aldosteronism, along with normalization of volume load. We propose that incorporating extracellular water evaluation alongside routine diagnostics could enhance the identification and diagnosis of primary aldosteronism.
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Affiliation(s)
- Eeva Kokko
- Faculty of Medicine and Health Technology, Tampere University
| | | | - Aapo Mutanen
- Faculty of Medicine and Health Technology, Tampere University
| | - Milja Honkonen
- Faculty of Medicine and Health Technology, Tampere University
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University
- Department of Clinical Physiology and Nuclear Medicine
| | - Jenni K Koskela
- Faculty of Medicine and Health Technology, Tampere University
- Department of Internal Medicine, Tampere University Hospital
| | - Mari Hämäläinen
- Faculty of Medicine and Health Technology, Tampere University
- Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere
| | - Eeva Moilanen
- Faculty of Medicine and Health Technology, Tampere University
- Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere
| | - Marianna Viukari
- Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Niina Matikainen
- Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
| | | | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University
- Department of Internal Medicine, Tampere University Hospital
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Viukari M, Leijon H, Vesterinen T, Söderlund S, Hämäläinen P, Yliaska I, Rautiainen P, Rintamäki R, Soinio M, Pörsti I, Nevalainen PI, Matikainen N. Clinical significance of CYP11B2 immunostaining in unilateral primary aldosteronism. Endocr Connect 2024; 13:e230344. [PMID: 38051154 PMCID: PMC10831582 DOI: 10.1530/ec-23-0344] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/05/2023] [Indexed: 12/07/2023]
Abstract
Objective The associations between adrenal histopathology, lateralization studies, and surgical outcomes in primary aldosteronism remain poorly characterized. We examined the value of immunohistochemical analysis of CYP11B2 for evaluation of adrenalectomy outcomes after anatomical versus functional subtyping. Design A retrospective multicenter study of 277 patients operated for primary aldosteronism who had an adrenalectomy sample available in the Finnish biobanks from 1 January 2000 to 31 December 2019. Adrenal slides from biobanks were analyzed centrally after CYP11B2 and CYP11B1 staining. Clinical data were obtained from patient registries. Histopathological diagnosis and cure after surgery were assessed as outcome measures. Results Re-evaluation with CYP11B2 staining changed the histopathological diagnosis in 91 patients (33%). The presence of a CYP11B2-positive adenoma and the use of functional subtyping independently predicted clinical cure of primary aldosteronism. CYP11B2-positive <7 mm nodules were more frequent in patients without clinical cure, whereas CYP11B2-positive micronodules were common in all patients and had no impact on adrenalectomy outcomes. Small CYP11B2-positive nodules and micronodules were equally prevalent regardless of the subtyping method applied. Clinical cure rates were lower and CYP11B2-negative adenomas more common after adrenalectomy based on anatomical imaging than functional studies. Conclusions Incorporating CYP11B2 staining in histopathological diagnosis enhances the prediction of surgical outcomes in primary aldosteronism. A finding of CYP11B2-positive adenoma is indicative of cure of primary aldosteronism, whereas smaller CYP11B2-positive nodules associate with poorer results at postoperative evaluation. Functional subtyping methods decrease the operations of CYP11B2-negative adenomas and are superior to anatomical imaging in identifying unilateral primary aldosteronism.
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Affiliation(s)
- Marianna Viukari
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helena Leijon
- Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Vesterinen
- Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Sanni Söderlund
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi Hämäläinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Iina Yliaska
- Medical Research Center Oulu, Oulu University Hospital and Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Reeta Rintamäki
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Minna Soinio
- Department of Endocrinology, Turku University Hospital, Turku, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pasi I Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Niina Matikainen
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Choudhary MK, Bouquin H, Hytönen J, Koskela JK, Niemelä O, Nevalainen PI, Mustonen J, Pörsti I. Blood Haemoglobin Concentration Is Directly and Independently Related with Pulse Wave Velocity, a Measure of Large Artery Stiffness. J Clin Med 2023; 12:7623. [PMID: 38137695 PMCID: PMC10743951 DOI: 10.3390/jcm12247623] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
High haemoglobin level has been associated with metabolic syndrome, elevated blood pressure (BP), and increased mortality risk. In this cross-sectional study, we investigated the association of blood haemoglobin with haemodynamics in 743 subjects, using whole-body impedance cardiography and pulse wave analysis. The participants were allocated to sex-stratified haemoglobin tertiles with mean values 135, 144, and 154 g/L, respectively. The mean age was similar in all tertiles, while body mass index was higher in the highest versus the lowest haemoglobin tertile. The highest haemoglobin tertile had the highest erythrocyte and leukocyte counts, plasma C-reactive protein, uric acid, renin activity, and aldosterone. The lipid profile was less favourable and insulin sensitivity lower in the highest versus the lowest haemoglobin tertile. Aortic BP, cardiac output, and systemic vascular resistance were similar in all tertiles, while the pulse wave velocity (PWV) was higher in the highest versus the lowest haemoglobin tertile. In linear regression analysis, age (Beta 0.478), mean aortic BP (Beta 0.178), uric acid (Beta 0.150), heart rate (Beta 0.148), and aldosterone-to-renin ratio (Beta 0.123) had the strongest associations with PWV (p < 0.001 for all). Additionally, haemoglobin concentration was an explanatory factory for PWV (Beta 0.070, p = 0.028). To conclude, blood haemoglobin concentration had a small direct and independent association with a measure of large artery stiffness.
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Affiliation(s)
- Manoj Kumar Choudhary
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Heidi Bouquin
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Jere Hytönen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Jenni K. Koskela
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
| | - Pasi I. Nevalainen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
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Taurio J, Koskela J, Sinisalo M, Tikkakoski A, Niemelä O, Hämäläinen M, Moilanen E, Choudhary MK, Mustonen J, Nevalainen P, Pörsti I. Urine sodium excretion is related to extracellular water volume but not to blood pressure in 510 normotensive and never-treated hypertensive subjects. Blood Press 2023; 32:2170869. [PMID: 36708156 DOI: 10.1080/08037051.2023.2170869] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE High sodium intake is an accepted risk factor for hypertension, while low Na+ intake has also been associated with increased risk of cardiovascular events. In this cross-sectional study, we examined the association of 24-h urinary Na+ excretion with haemodynamics and volume status. MATERIALS AND METHODS Haemodynamics were recorded in 510 normotensive and never-treated hypertensive subjects using whole-body impedance cardiography and tonometric radial artery pulse wave analysis. The results were examined in sex-specific tertiles of 24-h Na+ excretion, and comparisons between normotensive and hypertensive participants were also performed. Regression analysis was used to investigate factors associated with volume status. The findings were additionally compared to 28 patients with primary aldosteronism. RESULTS The mean values of 24-h urinary Na+ excretion in tertiles of the 510 participants were 94, 148 and 218 mmol, respectively. Average tertile age (43.4-44.7 years), office blood pressure and pulse wave velocity were corresponding in the tertiles. Plasma electrolytes, lipids, vitamin D metabolites, parathyroid hormone, renin activity, aldosterone, creatinine and insulin sensitivity did not differ in the tertiles. In supine laboratory recordings, there were no differences in aortic systolic and diastolic blood pressure, heart rate, cardiac output and systemic vascular resistance. Extracellular water volume was higher in the highest versus lowest tertile of Na+ excretion. In regression analysis, body surface area and 24-h Na+ excretion were independent explanatory variables for extracellular water volume. No differences in urine Na+ excretion and extracellular water volume were found between normotensive and hypertensive participants. When compared with the 510 participants, patients with primary aldosteronism had 6.0% excess in extracellular water (p = .003), and 24-h Na+ excretion was not related with extracellular water volume. CONCLUSION In the absence of mineralocorticoid excess, Na+ intake, as evaluated from 24-h Na+ excretion, predominantly influences extracellular water volume without a clear effect on blood pressure.
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Affiliation(s)
- Jyrki Taurio
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mari Hämäläinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Eeva Moilanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Pasi Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Värri E, Suojanen L, Koskela JK, Choudhary MK, Tikkakoski A, Kähönen M, Nevalainen PI, Mustonen J, Pörsti I. Ambulatory daytime blood pressure versus tonometric blood pressure measurements in the laboratory: effect of posture. Blood Press Monit 2023; 28:199-207. [PMID: 37318783 PMCID: PMC10309093 DOI: 10.1097/mbp.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 11/21/2022] [Accepted: 02/23/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To compare blood pressure (BP) in tonometric radial artery recordings during passive head-up tilt with ambulatory recordings and evaluate possible laboratory cutoff values for hypertension. METHODS Laboratory BP and ambulatory BP were recorded in normotensive (n = 69), unmedicated hypertensive (n = 190), and medicated hypertensive (n = 151) subjects. RESULTS Mean age was 50.2 years, BMI 27.7 kg/m 2 , ambulatory daytime BP 139/87 mmHg, and 276 were male (65%). As supine-to-upright changes in SBP ranged from -52 to +30 mmHg, and in DBP from -21 to +32 mmHg, the mean values of BP supine and upright measurements were compared with ambulatory BP. The mean(supine+upright) systolic laboratory BP was corresponding to ambulatory level (difference +1 mmHg), while mean(supine+upright) DBP was 4 mmHg lower ( P < 0.05) than ambulatory value. Correlograms indicated that laboratory 136/82 mmHg corresponded to ambulatory 135/85 mmHg. When compared with ambulatory 135/85 mmHg, the sensitivity and specificity of laboratory 136/82 mmHg to define hypertension were 71.5% and 77.3% for SBP, and 71.7% and 72.8%, for DBP, respectively. The laboratory cutoff 136/82 mmHg classified 311/410 subjects similarly to ambulatory BP as normotensive or hypertensive, 68 were hypertensive only in ambulatory, while 31 were hypertensive only in laboratory measurements. CONCLUSION BP responses to upright posture were variable. When compared with ambulatory BP, mean(supine+upright) laboratory cutoff 136/82 mmHg classified 76% of subjects similarly as normotensive or hypertensive. In the remaining 24% the discordant results may be attributed to white-coat or masked hypertension, or higher physical activity during out-of-office recordings.
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Affiliation(s)
- Emmi Värri
- Faculty of Medicine and Health Technology, Tampere University, Departments of
| | - Lauri Suojanen
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
| | - Jenni K. Koskela
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
| | - Manoj K. Choudhary
- Faculty of Medicine and Health Technology, Tampere University, Departments of
| | - Antti Tikkakoski
- Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | | | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Departments of
- Internal Medicine
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6
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Ylänen A, Pörsti I, Nevalainen R, Hinkka T, Huhtala H, Matikainen N, Hämäläinen E, Niemelä O, Nevalainen PI. Non-suppression of renin by renal cysts in a subset of patients with primary aldosteronism - a prospective observational single centre study. Eur J Endocrinol 2023:lvad072. [PMID: 37431563 DOI: 10.1093/ejendo/lvad072] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/24/2023] [Accepted: 05/24/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Screening for primary aldosteronism is based on measuring aldosterone-to-renin ratio. Non-suppressed renin may cause false negative screening results, and such patients may miss focused, potentially curable treatment. We investigated the association between renal cysts and non-suppressed plasma renin. METHODS Altogether 114 consecutive patients with confirmed primary aldosteronism undergoing adrenal vein sampling were prospectively recruited between 7.10.2020 and 30.12.2021. During the procedure, plasma samples for renin analyses were collected from the right and left renal veins and the inferior vena cava. Renal cysts were identified using contrast-enhanced computed tomography. RESULTS Renal cysts were found in 58.2% of the 114 patients. Neither screening nor renal vein renin concentrations were significantly different in patients with and without cysts, or when the kidneys with and without cysts were evaluated. However, cysts were significantly more prevalent in the 'high-normal renin' group (cut point 23.0 mU/L) than in the 'low to low-normal renin' group (90.9%, n=11, vs. 56.0%, n=102, P=0.027, respectively). All patients ≤50 years of age in the 'high-normal renin' group had renal cysts. Strong correlations were found between renin concentrations in the right and left renal vein (r=0.984), and between renin concentration and renin activity in the inferior vena cava (r=0.817). CONCLUSION Renal cysts are found in the majority of patients with primary aldosteronism, and they may interfere with diagnostics, especially in patients aged 50 years or less. In patients with non-suppressed renin due to renal cysts, aldosterone-to-renin ratio below the diagnostic threshold does not always exclude the diagnosis of primary aldosteronism.
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Affiliation(s)
- Antero Ylänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Riikka Nevalainen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Tero Hinkka
- Department of Radiology, Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Niina Matikainen
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pasi I Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Penninkangas RM, Choudhary MK, Mangani C, Maleta K, Teivaanmäki T, Niemelä O, Ashorn P, Ashorn U, Pörsti I. Low length-for-age Z-score within 1 month after birth predicts hyperdynamic circulation at the age of 21 years in rural Malawi. Sci Rep 2023; 13:10283. [PMID: 37355681 PMCID: PMC10290681 DOI: 10.1038/s41598-023-37269-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
Low birth weight predisposes to the development of hypertension in middle- and high-income countries. We examined the relation of early life length-for-age score (Z-score) on cardiovascular function in young adults in Malawi, a low-income country. Capture of supine, seated, and standing brachial pulse waveforms (Mobil-O-Graph) were performed in 223 females and 152 males (mean age 21 years), and analyzed according to the length-for-age Z-score tertiles during the first month of life. Plasma LDL cholesterol in young adulthood was slightly lower in the lowest versus highest tertile. Otherwise, blood hemoglobin and plasma chemistry were similar in all tertiles. Irrespective of posture, blood pressure, forward and backward wave amplitudes, and pulse wave velocity were corresponding in all tertiles. In the three postures, the lowest tertile presented with 4.5% lower systemic vascular resistance than the highest tertile (p = 0.005), and 4.4% and 5.5% higher cardiac output than the middle and highest tertiles, respectively (p < 0.01). Left cardiac work was 6.8% and 6.9% higher in the lowest tertile than in the middle and highest tertiles, respectively (p < 0.01). To conclude, in a low-income environment, low length-for-age Z-score after birth predicted hyperdynamic circulation at 21 years of age without changes in blood pressure and metabolic variables.
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Affiliation(s)
| | - Manoj Kumar Choudhary
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Chichiri Blantyre, Malawi
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Chichiri Blantyre, Malawi
| | - Tiina Teivaanmäki
- Department of Pediatrics, Helsinki University Hospital, Helsinki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland.
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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Taurio J, Hautaniemi EJ, Koskela JK, Eräranta A, Hämäläinen M, Tikkakoski A, Kettunen JA, Kähönen M, Niemelä O, Moilanen E, Mustonen J, Pörsti I. The characteristics of elevated blood pressure in abdominal obesity correspond to primary hypertension: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:161. [PMID: 36973671 PMCID: PMC10045516 DOI: 10.1186/s12872-023-03150-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Obesity-related hypertension and the associated metabolic abnormalities are considered as a distinct hypertensive phenotype. Here we examined how abdominal fat content, as judged by waist:height ratio, influenced blood pressure and hemodynamic profile in normotensive subjects and never-treated hypertensive patients. METHODS The 541 participants (20-72 years) underwent physical examination and laboratory analyses and were divided into age and sex-adjusted quartiles of waist:height ratio. Supine hemodynamics were recorded using whole-body impedance cardiography, combined with analyses of radial tonometric pulse wave form and heart rate variability. RESULTS Mean waist:height ratios in the quartiles were 0.46, 0.51, 0.55 and 0.62. Radial and aortic blood pressure, systemic vascular resistance, pulse wave velocity, markers of glucose and lipid metabolism, leptin levels and C-reactive protein were higher in quartile 4 when compared with quartiles 1 and 2 (p < 0.05 for all). Cardiac index was lower in quartile 4 versus quartile 1, while no differences were seen in heart rate variability, augmentation index, plasma renin activity, and aldosterone concentration between the quartiles. Linear regression analyses showed independent associations of abdominal obesity with higher aortic systolic and diastolic blood pressure, systemic vascular resistance, and pulse wave velocity (p < 0.05 for waist:height ratio in all regression models). CONCLUSION Higher waist:height ratio was associated with elevated blood pressure, systemic vascular resistance, and arterial stiffness, but not with alterations in cardiac sympathovagal modulation or activation of the circulating renin-angiotensin-aldosterone system. Although obesity-related elevation of blood pressure has distinct phenotypic features, these results suggest that its main characteristics correspond those of primary hypertension. TRIAL REGISTRATION ClinicalTrails.gov NCT01742702 (date of registration 5th December 2012).
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Affiliation(s)
- Jyrki Taurio
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Elina J Hautaniemi
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Jenni K Koskela
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Mari Hämäläinen
- The Immunopharmacology Research group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jarkko A Kettunen
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Laboratory and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Eeva Moilanen
- The Immunopharmacology Research group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland.
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9
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Vaheri A, Smura T, Vauhkonen H, Hepojoki J, Sironen T, Strandin T, Tietäväinen J, Outinen T, Mäkelä S, Pörsti I, Mustonen J. Puumala Hantavirus Infections Show Extensive Variation in Clinical Outcome. Viruses 2023; 15:v15030805. [PMID: 36992513 PMCID: PMC10054505 DOI: 10.3390/v15030805] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
The clinical outcome of Puumala hantavirus (PUUV) infection shows extensive variation, ranging from inapparent subclinical infection (70-80%) to severe hemorrhagic fever with renal syndrome (HFRS), with about 0.1% of cases being fatal. Most hospitalized patients experience acute kidney injury (AKI), histologically known as acute hemorrhagic tubulointerstitial nephritis. Why this variation? There is no evidence that there would be more virulent and less virulent variants infecting humans, although this has not been extensively studied. Individuals with the human leukocyte antigen (HLA) alleles B*08 and DRB1*0301 are likely to have a severe form of the PUUV infection, and those with B*27 are likely to have a benign clinical course. Other genetic factors, related to the tumor necrosis factor (TNF) gene and the C4A component of the complement system, may be involved. Various autoimmune phenomena and Epstein-Barr virus infection are associated with PUUV infection, but hantavirus-neutralizing antibodies are not associated with lower disease severity in PUUV HFRS. Wide individual differences occur in ocular and central nervous system (CNS) manifestations and in the long-term consequences of nephropathia epidemica (NE). Numerous biomarkers have been detected, and some are clinically used to assess and predict the severity of PUUV infection. A new addition is the plasma glucose concentration associated with the severity of both capillary leakage, thrombocytopenia, inflammation, and AKI in PUUV infection. Our question, "Why this variation?" remains largely unanswered.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Teemu Smura
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Hanna Vauhkonen
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Jussi Hepojoki
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Tomas Strandin
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Johanna Tietäväinen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Tuula Outinen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
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10
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Tervo L, Outinen T, Kiekara T, Tietäväinen J, Paakkala A, Pörsti I, Huhtala H, Mäkelä S, Mustonen J. The presence of intraperitoneal, retroperitoneal and pleural fluid in acute Puumala hantavirus infection. Infect Dis (Lond) 2023; 55:207-215. [PMID: 36562294 DOI: 10.1080/23744235.2022.2160010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes most cases of haemorrhagic fever with renal syndrome (HFRS) in Europe. PUUV infection is characterised by acute kidney injury, thrombocytopenia and increased capillary leakage. Typical symptoms are fever, headache, nausea, abdominal and back pain. This study aimed to evaluate the amount and distribution of intraperitoneal, retroperitoneal and pleural fluid and the association of fluid collections to the symptoms and clinical findings in patients with acute PUUV infection. METHODS Abdominal magnetic resonance imaging (MRI) was performed on 27 hospitalised patients with acute PUUV infection. The clinical and laboratory findings and patients' symptoms were analysed in relation to the imaging findings. The thickness of the fluid collections was measured in millimetres (mm) from axial images. RESULTS Fluid collections were found in all patients. The amount of intraperitoneal fluid correlated positively with plasma C-reactive protein (CRP) level (r = 0.586, p = .001), while it had an inverse correlation with serum creatinine concentration (r = -0.418, p = .030). Retroperitoneal fluid also correlated inversely with serum creatinine and cystatin C concentrations (r = -0.501, p = .008 and r = -0.383, p = .048, respectively). The amount of fluid was not greater in patients with abdominal or back pain. Patients with back pain had higher serum creatinine compared with patients without back pain, 452 µmol/L (range 88-1071) vs. 83 µmol/L (range 60-679), p = .004. CONCLUSIONS Fluid collections were found in all patients. A greater amount of intraperitoneal fluid associates with higher CRP concentrations but not with higher serum creatinine levels. Back pain associates with higher creatinine level but not with the presence of fluids.
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Affiliation(s)
- L Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - T Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - T Kiekara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - J Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - A Paakkala
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - I Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - S Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - J Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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11
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Kurra V, Eräranta A, Paavonen T, Honkanen T, Myllymäki J, Riutta A, Tikkanen I, Lakkisto P, Mustonen J, Pörsti I. Moderate hyperuricaemia ameliorated kidney damage in a low-renin model of experimental renal insufficiency. Basic Clin Pharmacol Toxicol 2023; 132:21-32. [PMID: 36220802 PMCID: PMC10091954 DOI: 10.1111/bcpt.13806] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/06/2022] [Accepted: 10/06/2022] [Indexed: 01/06/2023]
Abstract
Uric acid has promoted renal fibrosis and inflammation in experimental studies, but some studies have shown nephroprotective effects due to alleviated oxidative stress. We studied the influence of experimental hyperuricaemia in surgically 5/6 nephrectomized rats. Three weeks after subtotal nephrectomy or sham operation, the rats were allocated to control diet or 2.0% oxonic acid (uricase inhibitor) diet for 9 weeks. Then blood, urine and tissue samples were taken, and renal morphology and oxidative stress were examined. Inflammation and fibrosis were evaluated using immunohistochemistry and real-time PCR (RT-PCR). Remnant kidney rats ingesting normal or oxonic acid diet presented with ~60% reduction of creatinine clearance and suppressed plasma renin activity. Oxonic acid diet increased plasma uric acid levels by >80 μmol/L. In remnant kidney rats, moderate hyperuricaemia decreased glomerulosclerosis, tubulointerstitial damage and kidney mast cell count, without influencing the fibrosis marker collagen I messenger RNA (mRNA) content. In both sham-operated and 5/6 nephrectomized rats, the mast cell product 11-epi-prostaglandin-F2α excretion to the urine and kidney tissue cyclooxygenase-2 (COX-2) levels were decreased. To conclude, hyperuricaemic remnant kidney rats displayed improved kidney morphology and reduced markers of oxidative stress and inflammation. Thus, moderately elevated plasma uric acid had beneficial effects on the kidney in this low-renin model of experimental renal insufficiency.
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Affiliation(s)
- Venla Kurra
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Timo Paavonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teemu Honkanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Myllymäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Asko Riutta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ilkka Tikkanen
- Minerva Institute for Medical Research, Biomedicum Helsinki 2U, Helsinki, Finland.,Abdominal Center, Nephrology, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Lakkisto
- Minerva Institute for Medical Research, Biomedicum Helsinki 2U, Helsinki, Finland.,Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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12
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Viukari M, Kokko E, Pörsti I, Leijon H, Vesterinen T, Hinkka T, Soinio M, Schalin‐Jäntti C, Matikainen N, Nevalainen PI. Adrenal androgens versus cortisol for primary aldosteronism subtype determination in adrenal venous sampling. Clin Endocrinol (Oxf) 2022; 97:241-249. [PMID: 35167715 PMCID: PMC9544970 DOI: 10.1111/cen.14691] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined if measurement of adrenal androgens adds to subtype diagnostics of primary aldosteronism (PA) under cosyntropin-stimulated adrenal venous sampling (AVS). DESIGN A prospective pre-specified secondary endpoint analysis of 49 patients with confirmed PA, of whom 29 underwent unilateral adrenalectomy with long-term follow-up. METHODS Concentrations of androstenedione, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEAS) were measured during AVS in addition to aldosterone and cortisol. Subjects with lateralisation index (LI) of ≥4 were treated with unilateral adrenalectomy, and the immunohistochemical subtype was determined with CYP11B2 and CYP11B1 stains. The performance of adrenal androgens was evaluated by receiver operating characteristics (ROC) curve analyses in adrenalectomy and medical therapy groups. RESULTS During AVS, the correlations between cortisol and androstenedione, DHEA and DHEAS for LI and selectivity index (SI) were highly significant. The right and left side SIs for androstenedione and DHEA were higher (p < .001) than for cortisol. In ROC analysis, the optimal LI cut-off values for androstenedione, DHEA and DHEAS were 4.2, 4.5 and 4.6, respectively. The performance of these LIs for adrenal androgens did not differ from that of cortisol. CONCLUSIONS Under cosyntropin-stimulated AVS, the measurement of androstenedione and DHEA did not improve the cannulation selectivity. The performance of cortisol and adrenal androgens are confirmatory but not superior to cortisol-based results in lateralisation diagnostics of PA.
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Affiliation(s)
- Marianna Viukari
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Eeva Kokko
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Ilkka Pörsti
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of Internal MedicineTampere University HospitalTampereFinland
| | - Helena Leijon
- Department of Pathology, University of Helsinki and HUSLABHelsinki University HospitalHelsinkiFinland
| | - Tiina Vesterinen
- Department of Pathology, University of Helsinki and HUSLABHelsinki University HospitalHelsinkiFinland
| | - Tero Hinkka
- Department of Radiology, Centre for Vascular Surgery and Interventional RadiologyTampere University HospitalTampereFinland
| | - Minna Soinio
- Department of EndocrinologyTurku University HospitalTurkuFinland
| | | | - Niina Matikainen
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Pasi I. Nevalainen
- Department of Internal MedicineTampere University HospitalTampereFinland
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13
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Isojärvi J, Viukari M, Pörsti I, Leijon H, Vesterinen T, Seppänen M, Nevalainen PI, Matikainen N. Lateralization in 11 C-Metomidate PET and outcome of adrenalectomy in primary aldosteronism. Endocrinol Diabetes Metab 2022; 5:e368. [PMID: 36039035 PMCID: PMC9659653 DOI: 10.1002/edm2.368] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Subtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone 11 C-metomidate positron emission tomography (11 C-MTO-PET) for subtype classification. METHODS Postoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative 11 C-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on 11 C-MTO-PET alone and those with concordant or discordant lateralization in 11 C-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure. RESULTS Adrenalectomy side was based on 11 C-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after 11 C-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant 11 C-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with 11 C-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery. CONCLUSIONS Outcomes of adrenalectomy based on clinically significant lateralization in 11 C-MTO-PET alone correspond to those based on 11 C-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with 11 C-MTO-PET in case of discordant lateralization studies.
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Affiliation(s)
- Juhani Isojärvi
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Marianna Viukari
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ilkka Pörsti
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland,Department of Internal MedicineTampere University HospitalTampereFinland
| | - Helena Leijon
- Department of PathologyUniversity of Helsinki and HUSLAB, Helsinki University HospitalHelsinkiFinland
| | - Tiina Vesterinen
- Department of PathologyUniversity of Helsinki and HUSLAB, Helsinki University HospitalHelsinkiFinland
| | - Marko Seppänen
- Turku PET CentreUniversity of TurkuTurkuFinland,Department of clinical Physiology and Nuclear MedicineTurku University HospitalTurkuFinland
| | - Pasi I. Nevalainen
- Department of Internal MedicineTampere University HospitalTampereFinland
| | - Niina Matikainen
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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14
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Koskela JK, Tahvanainen A, Tikkakoski AJ, Kangas P, Uitto M, Viik J, Kähönen M, Mustonen J, Pörsti I. Resting heart rate predicts cardiac autonomic modulation during passive head-up tilt in subjects without cardiovascular diseases. SCAND CARDIOVASC J 2022; 56:138-147. [PMID: 35652524 DOI: 10.1080/14017431.2022.2079713] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Resting heart rate (HR) and its variability (HRV) reflects the cardiac sympathovagal balance that is stimulated by head-up tilting. HRV is influenced by the level of HR, but how much HRV offers additional information about cardiac autonomic tone than HR alone remains unresolved. We examined the relation of resting HR with HRV during head-up tilt. Methods. Hemodynamics of 569 subjects without known cardiovascular diseases and medications with direct cardiovascular effects were recorded using whole-body impedance cardiography, radial pulse wave analysis, and electrocardiography-based HRV analysis during passive head-up tilt. Results. Higher low frequency to the high-frequency ratio (LF/HF) of HRV (reflecting sympathovagal balance) was associated with higher HR in supine (p < .05, both linear regression analysis and variance analysis comparing HR tertiles) and upright postures (p < .001, linear regression analysis). The association of HR with HRV during tilt-testing remained significant when the HR dependence of HRV was mathematically weakened by dividing the HRV power spectra with the fourth power of the average RR-interval. Conclusion. Higher resting HR is related to higher LF/HF both supine and upright, reflecting elevated sympathetic influence on cardiac autonomic modulation. Lower resting HR is associated with lower resting LF/HF, while the differences in LF/HF between the HR tertiles were minor during head-up tilt, suggesting a greater change in cardiac sympathovagal balance in response to upright posture in those with lowest resting HR. Altogether, resting HR well predicts HRV levels during head-up tilt.Trial registration: Clinicaltrialsregister.eu 2006-002065-39, first registered 5 May 2006. ClinicalTrials.gov NCT01742702, first registered 5 December 2012.
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Affiliation(s)
- Jenni K Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Anna Tahvanainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Antti J Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Pauliina Kangas
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marko Uitto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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15
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Pelttari S, Väärämäki S, Vanakker O, Verschuere S, Uusitalo H, Huhtala H, Hinkka T, Pörsti I, Nevalainen PI. Various vascular malformations are prevalent in Finnish pseudoxanthoma elasticum (PXE) patients: a national registry study. Orphanet J Rare Dis 2022; 17:185. [PMID: 35525997 PMCID: PMC9077871 DOI: 10.1186/s13023-022-02341-6] [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: 12/06/2021] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Pseudoxanthoma elasticum (PXE, OMIM# 264800) is an inborn error of metabolism causing ectopic soft tissue calcification due to low plasma pyrophosphate concentration. We aimed to assess the prevalence of PXE in Finland and to characterize the Finnish PXE population. A nationwide registry search was performed to identify patients with ICD-10 code Q82.84. Information was gathered from available medical records which were requisitioned from hospitals and health centers. Misdiagnosed patients and patients with insufficient records were excluded. Results The prevalence of PXE in Finland was 1:260,000 with equal sex distribution. Patients with high conventional cardiovascular risk had more visual and vascular complications than patients with low risk. Four patients (19%) had at least one vascular malformation. A high proportion (33%) of ABCC6 genotypes were of the common homozygous c.3421C > T, p.Arg1141Ter variant. Nine other homozygous or compound heterozygous allelic variants were found. Conclusions The prevalence of diagnosed PXE appears to be lower in Finland than in estimates from other countries. Decreased visual acuity is the most prevalent complication. We suggest that various vascular malformations may be an unrecognized feature of PXE.
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Affiliation(s)
- Saku Pelttari
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Suvi Väärämäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Olivier Vanakker
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Shana Verschuere
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Hannu Uusitalo
- SILK, Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tero Hinkka
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland
| | - Pasi I Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland.
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16
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Mustonen J, Vaheri A, Pörsti I, Mäkelä S. Long-Term Consequences of Puumala Hantavirus Infection. Viruses 2022; 14:v14030598. [PMID: 35337005 PMCID: PMC8953343 DOI: 10.3390/v14030598] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023] Open
Abstract
Several viral infections are associated with acute and long-term complications. During the past two years, there have been many reports on post-infectious symptoms of the patients suffering from COVID-19 disease. Serious complications occasionally occur during the acute phase of Puumala orthohantavirus caused nephropathia epidemica. Severe long-term consequences are rare. Fatigue for several weeks is quite common. Hormonal insufficiencies should be excluded if the patient does not recover normally.
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Affiliation(s)
- Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland;
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
- Correspondence:
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland;
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland;
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
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17
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Choudhary MK, Penninkangas RM, Eräranta A, Niemelä O, Mangani C, Maleta K, Ashorn P, Ashorn U, Pörsti I. Posture-Related Differences in Cardiovascular Function Between Young Men and Women: Study of Noninvasive Hemodynamics in Rural Malawi. J Am Heart Assoc 2022; 11:e022979. [PMID: 35195013 PMCID: PMC9075090 DOI: 10.1161/jaha.121.022979] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Cardiovascular risk is higher in men than in women, but little information exists about sex‐related differences in cardiovascular function from low‐income countries. We compared hemodynamics between sexes in rural Malawi in a cohort followed up since their birth. Methods and Results Supine, seated, and standing hemodynamics were recorded from 251 women and 168 men (mean age, 21 years; body mass index, 21 kg/m2) using oscillometric brachial waveform analyses (Mobil‐O‐Graph). The results were adjusted for estimated glomerular filtration rate, and plasma potassium, lipids, and glucose. Men had higher brachial and aortic systolic blood pressure and stroke index regardless of posture (P<0.001), and higher upright but similar supine diastolic blood pressure than women. Regardless of posture, heart rate was lower in men (P<0.001), whereas cardiac index did not differ between sexes. Women presented with lower supine and standing systemic vascular resistance index (P<0.001), whereas supine‐to‐standing increase in vascular resistance (P=0.012) and decrease in cardiac index (P=0.010) were higher in women. Supine left cardiac work index was similar in both sexes, whereas standing and seated left cardiac work index was higher in men than in women (P<0.001). Conclusions In young Malawian adults, men had higher systolic blood pressure, systemic vascular resistance, and upright cardiac workload, whereas women presented with higher posture‐related changes in systemic vascular resistance and cardiac output. These findings show systematic sex‐related differences in cardiovascular function in a cohort from a low‐income country with high exposure to prenatal and postnatal malnutrition and infectious diseases.
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Affiliation(s)
| | | | - Arttu Eräranta
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology Tampere University Tampere Finland.,Department of Laboratory Medicine and Medical Research Unit Seinäjoki Central Hospital Seinäjoki Finland
| | - Charles Mangani
- School of Public Health and Family Medicine College of Medicine University of Malawi Blantyre Malawi
| | - Kenneth Maleta
- School of Public Health and Family Medicine College of Medicine University of Malawi Blantyre Malawi
| | - Per Ashorn
- Faculty of Medicine and Health Technology Tampere University Tampere Finland.,Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology Tampere University Tampere Finland.,Department of Internal Medicine Tampere University Hospital Tampere Finland
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18
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Tietäväinen J, Laine O, Mäkelä S, Huhtala H, Pörsti I, Vaheri A, Mustonen J. ABO and Rhesus Blood Groups in Acute Puumala Hantavirus Infection. Viruses 2021; 13:v13112271. [PMID: 34835077 PMCID: PMC8621274 DOI: 10.3390/v13112271] [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] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022] Open
Abstract
Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. We aimed to evaluate whether ABO and rhesus blood groups associate with the susceptibility or the severity of PUUV infection. We analyzed blood groups in 289 adult patients treated in Tampere University hospital due to PUUV infection during the years 1982–2017. Patients’ blood group distribution was compared to that of healthy, voluntary blood donors living in the Tampere University Hospital responsibility area (n = 21,833). The severity of PUUV infection, as judged by the severity of acute kidney injury (AKI), thrombocytopenia, inflammation, capillary leakage, and the length of hospital care, was analyzed across the groups. The ABO and rhesus blood group distributions did not differ between the patients and blood donors. Patients with non-O blood groups had lower systolic blood pressure compared to patients with blood group O, but there was no difference in other markers of capillary leakage or in the severity of AKI. Minor deviations in the number of platelets and leukocytes were detected between the O and non-O blood groups. To conclude, patients with blood group O may be less susceptible to hypotension, but otherwise blood groups have no major influences on disease susceptibility or severity during acute PUUV infection.
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Affiliation(s)
- Johanna Tietäväinen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (O.L.); (S.M.); (I.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
- Correspondence:
| | - Outi Laine
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (O.L.); (S.M.); (I.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Satu Mäkelä
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (O.L.); (S.M.); (I.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, 33250 Tampere, Finland;
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (O.L.); (S.M.); (I.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland;
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (O.L.); (S.M.); (I.P.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
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19
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Tarvainen M, Mäkelä S, Laine O, Pörsti I, Risku S, Niemelä O, Mustonen J, Jaatinen P. Hormonal Defects Are Common during Puumala Hantavirus Infection and Associate with Disease Severity and Biomarkers of Altered Haemostasis. Viruses 2021; 13:v13091818. [PMID: 34578397 PMCID: PMC8472102 DOI: 10.3390/v13091818] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Central and peripheral hormone deficiencies have been documented during and after acute hantavirus infection. Thrombocytopenia and coagulation abnormalities are common findings in haemorrhagic fever with renal syndrome (HFRS). The associations between coagulation and hormonal abnormalities in HFRS have not been studied yet. Forty-two patients diagnosed with Puumala virus (PUUV) infection were examined during the acute phase and on a follow-up visit approximately one month later. Hormonal defects were common during acute PUUV infection. Overt (clinical) hypogonadism was identified in 80% of the men and approximately 20% of the patients had overt hypothyroidism. At the one-month follow-up visit, six patients had central hormone deficits. Acute peripheral hormone deficits associated with a more severe acute kidney injury (AKI), longer hospital stay and more severe thrombocytopenia. Half of the patients with bleeding symptoms had also peripheral hormonal deficiencies. Patients with free thyroxine levels below the reference range had higher D-dimer level than patients with normal thyroid function, but no thromboembolic events occurred. Acute phase hormonal abnormalities associate with severe disease and altered haemostasis in PUUV infection.
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Affiliation(s)
- Marlene Tarvainen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland; (S.M.); (O.L.); (I.P.); (J.M.); (P.J.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
- Correspondence:
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland; (S.M.); (O.L.); (I.P.); (J.M.); (P.J.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Outi Laine
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland; (S.M.); (O.L.); (I.P.); (J.M.); (P.J.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland; (S.M.); (O.L.); (I.P.); (J.M.); (P.J.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Sari Risku
- Division of Internal Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
| | - Onni Niemelä
- Laboratory and Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland; (S.M.); (O.L.); (I.P.); (J.M.); (P.J.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Pia Jaatinen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland; (S.M.); (O.L.); (I.P.); (J.M.); (P.J.)
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
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20
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Koskela JK, Vääräniemi K, Tahvanainen AMH, Mustonen J, Mäkelä S, Tikkakoski AJ, Pörsti I. Disparate Information Provided by Pulse Wave Velocity versus Other Measures of Aortic Compliance in End-Stage Renal Disease. Nephron Clin Pract 2021; 146:11-21. [PMID: 34515178 DOI: 10.1159/000518174] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Unfavorable changes in cardiac and arterial function are related to poor prognosis in chronic kidney disease (CKD). We compared hemodynamic profiles between subjects with end-stage renal disease and 2 control groups with corresponding pulse wave velocities (PWVs). METHODS Noninvasive hemodynamics were recorded during passive head-up tilt in CKD stage 5 patients (n = 35), patients with primary hypertension (n = 35, n = 30 with antihypertensive medications), and subjects without cardiovascular or renal diseases and cardiovascular medications (n = 70). The groups were selected to have corresponding age, sex, body mass index, and PWV. Hemodynamic data were captured using whole-body impedance cardiography and radial tonometric pulse wave analysis. RESULTS Supine blood pressure did not differ between the groups, but upright diastolic blood pressure was lower in CKD patients than in the 2 control groups (p ≤ 0.001 for both, RANOVA). Despite similar PWV, supine aortic pulse pressure was higher in CKD patients versus nonmedicated subjects (p = 0.029). Two additional measures indicated reduced aortic compliance in CKD patients versus both control groups: lower ratio of stroke index to aortic pulse pressure (p ≤ 0.023) and higher aortic characteristic impedance (p ≤ 0.003). The subendocardial viability ratio was lower in the CKD group than in both control groups (p ≤ 0.039). CONCLUSION In the absence of differences in PWV, higher aortic pulse pressure and characteristic impedance, and lower ratio of stroke index to aortic pulse pressure, suggest reduced aortic compliance and impaired left ventricular function in CKD patients. A lower subendocardial viability ratio predisposes the CKD patients to impaired cardiac oxygen supply versus hypertensive patients and nonmedicated controls.
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Affiliation(s)
- Jenni Kaarina Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Kati Vääräniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Anna Mari Helena Tahvanainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Johannes Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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21
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Soinio M, Luukkonen AK, Seppänen M, Kemppainen J, Seppänen J, Pienimäki JP, Leijon H, Vesterinen T, Arola J, Lantto E, Helin S, Tikkanen I, Metso S, Mirtti T, Heiskanen I, Norvio L, Tiikkainen M, Tikkanen T, Sane T, Välimäki M, Gomez-Sanchez CE, Pörsti I, Nuutila P, Nevalainen PI, Matikainen N. Response to Letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping. Eur J Endocrinol 2021; 184:L11-L12. [PMID: 33555271 PMCID: PMC8045446 DOI: 10.1530/eje-21-0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Minna Soinio
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Anna-Kaarina Luukkonen
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Marko Seppänen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Janne Seppänen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Juha-Pekka Pienimäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Helena Leijon
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Vesterinen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Johanna Arola
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Eila Lantto
- Medical Imaging Center, Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Semi Helin
- Turku PET Centre, University of Turku, Turku, Finland
| | - Ilkka Tikkanen
- Abdominal Center, Nephrology, University of Helsinki, and Helsinki University Hospital, and Minerva Institute for Medical Research, Helsinki, Finland
| | - Saara Metso
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology (ONCOSYS), University of Helsinki, Helsinki, Finland
| | - Ilkka Heiskanen
- Endocrine Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leena Norvio
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirja Tiikkainen
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Timo Sane
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Välimäki
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Celso E Gomez-Sanchez
- G.V. (Sonny) Montgomery VA Medical Center and Department of Pharmacology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ilkka Pörsti
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Pirjo Nuutila
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Pasi I Nevalainen
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Niina Matikainen
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
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22
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Uotila T, Pörsti I. Unusual hand nodules. Assoc Med J 2021. [DOI: 10.1136/bmj.m4969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Oinonen L, Tikkakoski A, Koskela J, Eräranta A, Kähönen M, Niemelä O, Mustonen J, Pörsti I. Parathyroid hormone may play a role in the pathophysiology of primary hypertension. Endocr Connect 2021; 10:54-65. [PMID: 33289696 PMCID: PMC7923049 DOI: 10.1530/ec-20-0446] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Parathyroid hormone has been related with the risk of hypertension, but the matter remains controversial. We examined the association of parathyroid hormone with central blood pressure and its determinants in 622 normotensive or never-treated hypertensive subjects aged 19-72 years without diabetes, cardiovascular or renal disease, or cardiovascular medications. The methods were whole-body impedance cardiography and analyses of pulse wave and heart rate variability. Cardiovascular function was examined in sex-specific tertiles of plasma parathyroid hormone (mean concentrations 3.0, 4.3 and 6.5 pmol/L, respectively) during head-up tilt. Explanatory factors for haemodynamics were further investigated using linear regression analyses. Mean age was 45.0 (s.d. 11.7) years, BMI 26.8 (4.4) kg/m2, seated office blood pressure 141/90 (21/12) mmHg, and 309 subjects (49.7%) were male. Only five participants had elevated plasma parathyroid hormone and calcium concentrations. Highest tertile of parathyroid hormone presented with higher supine and upright aortic diastolic blood pressure (P < 0.01) and augmentation index (P < 0.01), and higher upright systemic vascular resistance (P < 0.05) than the lowest tertile. The tertiles did not present with differences in pulse wave velocity, cardiac output, or measures of heart rate variability. In linear regression analyses, parathyroid hormone was an independent explanatory factor for aortic systolic (P = 0.005) and diastolic (P = 0.002) blood pressure, augmentation index (P = 0.002), and systemic vascular resistance (P = 0.031). To conclude, parathyroid hormone was directly related to central blood pressure, wave reflection, and systemic vascular resistance in subjects without cardiovascular comorbidities and medications. Thus, parathyroid hormone may play a role in the pathophysiology of primary hypertension.
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Affiliation(s)
- Lasse Oinonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Correspondence should be addressed to L Oinonen:
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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24
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Choudhary MK, Värri E, Matikainen N, Koskela J, Tikkakoski AJ, Kähönen M, Niemelä O, Mustonen J, Nevalainen PI, Pörsti I. Primary aldosteronism: Higher volume load, cardiac output and arterial stiffness than in essential hypertension. J Intern Med 2021; 289:29-41. [PMID: 32463949 DOI: 10.1111/joim.13115] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The diagnostics of primary aldosteronism (PA) are usually carried out in patients taking antihypertensive medications. We compared haemodynamics between medicated PA, medicated essential hypertension (EH), never-medicated EH and normotensive controls (n = 130 in all groups). METHODS The hypertensive groups were matched for age (53 years), sex (84 male/46 female) and body mass index (BMI) (30 kg m-2 ); normotensive controls had similar sex distribution (age 48 years, BMI 27 kg m-2 ). Haemodynamics were recorded using whole-body impedance cardiography and radial pulse wave analysis, and the results were adjusted as appropriate. Radial blood pressure recordings were calibrated by brachial blood pressure measurements from the contralateral arm. RESULTS Radial and aortic systolic and diastolic blood pressure was similar in PA and never-medicated EH, and higher than in medicated EH and normotensive controls (P ≤ 0.001 for all comparisons). Extracellular water balance was ~ 4% higher in PA than in all other groups (P < 0.05 for all), whilst cardiac output was ~ 8% higher in PA than in medicated EH (P = 0.012). Systemic vascular resistance and augmentation index were similarly increased in PA and both EH groups when compared with controls. Pulse wave velocity was higher in PA and never-medicated EH than in medicated EH and normotensive controls (P ≤ 0.033 for all comparisons). CONCLUSIONS Medicated PA patients presented with corresponding systemic vascular resistance and wave reflection, but higher extracellular water volume, cardiac output and arterial stiffness than medicated EH patients. Whether the systematic evaluation of these features would benefit the clinical diagnostics of PA remains to be studied in future.
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Affiliation(s)
- M K Choudhary
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - E Värri
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - N Matikainen
- Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - J Koskela
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - A J Tikkakoski
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - M Kähönen
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - O Niemelä
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Laboratory and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - J Mustonen
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - P I Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - I Pörsti
- From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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25
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Nurmi R, Pohjonen J, Metso M, Pörsti I, Niemelä O, Huhtala H, Mustonen J, Kaukinen K, Mäkelä S. Prevalence of Inflammatory Bowel Disease and Celiac Disease in Patients with IgA Nephropathy over Time. Nephron Clin Pract 2020; 145:78-84. [PMID: 33271538 DOI: 10.1159/000511555] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION IgA nephropathy (IgAN) has been connected with increased intestinal permeability and subclinical intestinal mucosal inflammation as well as with inflammatory bowel disease (IBD) and celiac disease - nevertheless, the results are controversial. The prevalence of bowel diseases has increased over time in Western populations. Whether similar trend is seen among IgAN patients remains obscure. Our aim was to study the prevalence of IBD and celiac disease in IgAN patients over time. METHODS The study cohort consisted of altogether 629 patients with newly diagnosed IgAN during years 1976-2012. Data on diagnosis of IBD and celiac disease were retrospectively collected from medical records. Further, to detect unrecognized celiac disease, IgA-class tissue transglutaminase antibodies (tTGA) were measured from serum samples taken at the time of kidney biopsy during years 1980-2012 (defined as screen-detected celiac disease autoimmunity). RESULTS The prevalence of IBD among IgAN patients increased over time from 0 to 4.4%, while the prevalence of clinically diagnosed celiac disease decreased from 2.6 to 0.6%. Moreover, the number of screen-detected tTGA-positive cases decreased from the 1980s to the 21st century (2.8-0.7%). CONCLUSION The prevalence of IBD increased over time in IgAN patients, which exceeds the prevalence of 0.6% in Finnish general population. In parallel, the prevalence of celiac disease and screen-detected celiac disease autoimmunity decreased over time. The coexistence of IBD and IgAN is not negligible. Whether this finding is caused by the increase in the prevalence of IBD in the population or shared pathophysiology between IgAN and IBD remains a matter of further studies.
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Affiliation(s)
- Rakel Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,
| | - Jussi Pohjonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Martti Metso
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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26
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Soinio M, Luukkonen AK, Seppänen M, Kemppainen J, Seppänen J, Pienimäki JP, Leijon H, Vesterinen T, Arola J, Lantto E, Helin S, Tikkanen I, Metso S, Mirtti T, Heiskanen I, Norvio L, Tiikkainen M, Tikkanen T, Sane T, Välimäki M, Gomez-Sanchez CE, Pörsti I, Nuutila P, Nevalainen PI, Matikainen N. Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism. Eur J Endocrinol 2020; 183:539-550. [PMID: 33055298 PMCID: PMC8045447 DOI: 10.1530/eje-20-0532] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/02/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA. DESIGN We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery. METHODS Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2. RESULTS In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma. CONCLUSIONS The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.
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Affiliation(s)
- Minna Soinio
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Anna-Kaarina Luukkonen
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Marko Seppänen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Janne Seppänen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Juha-Pekka Pienimäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Helena Leijon
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Vesterinen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Johanna Arola
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Eila Lantto
- Medical Imaging Center, Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Semi Helin
- Turku PET Centre, University of Turku, Turku, Finland
| | - Ilkka Tikkanen
- Abdominal Center, Nephrology, University of Helsinki, and Helsinki University Hospital, and Minerva Institute for Medical Research, Helsinki, Finland
| | - Saara Metso
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology (ONCOSYS), University of Helsinki, Helsinki, Finland
| | - Ilkka Heiskanen
- Endocrine Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leena Norvio
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirja Tiikkainen
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Timo Sane
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Välimäki
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Celso E Gomez-Sanchez
- Department of Pharmacology, G.V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ilkka Pörsti
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Pirjo Nuutila
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Pasi I Nevalainen
- Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Niina Matikainen
- Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
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27
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Kokko E, Nevalainen PI, Choudhary MK, Koskela J, Tikkakoski A, Huhtala H, Niemelä O, Viukari M, Mustonen J, Matikainen N, Pörsti I. Aldosterone-to-renin ratio is related to arterial stiffness when the screening criteria of primary aldosteronism are not met. Sci Rep 2020; 10:19804. [PMID: 33188272 PMCID: PMC7666146 DOI: 10.1038/s41598-020-76718-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022] Open
Abstract
Aldosterone-to-renin ratio (ARR) is a screening tool for primary aldosteronism (PA), but the significance of ARR when the PA criteria are not met remains largely unknown. In this cross-sectional study we investigated the association of ARR with haemodynamic variables in 545 normotensive and never-medicated hypertensive subjects (267 men, 278 women, age range 19-72 years) without suspicion of PA. Supine haemodynamic data was recorded using whole-body impedance cardiography and radial tonometric pulse wave analysis. In sex-adjusted quartiles of ARR, determined as serum aldosterone to plasma renin activity ratio, the mean values were 282, 504, 744 and 1467 pmol/µg of angiotensin I/h, respectively. The only difference in haemodynamic variables between the ARR quartiles was higher pulse wave velocity (PWV) in the highest quartile versus other quartiles (p = 0.004), while no differences in blood pressure (BP), heart rate, wave reflections, cardiac output or systemic vascular resistance were observed between the quartiles. In linear regression analysis with stepwise elimination, ARR was an independent explanatory factor for PWV (β = 0.146, p < 0.001, R2 of the model 0.634). In conclusion, ARR was directly and independently associated with large arterial stiffness in individuals without clinical suspicion of PA. Therefore, ARR could serve as a clinical marker of cardiovascular risk.Trial registration: ClinicalTrails.gov: NCT01742702.
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Affiliation(s)
- Eeva Kokko
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pasi I Nevalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | | | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Clinical Laboratory and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Marianna Viukari
- Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Niina Matikainen
- Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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28
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Mantula P, Tietäväinen J, Clement J, Niemelä O, Pörsti I, Vaheri A, Mustonen J, Mäkelä S, Outinen T. Flash-Like Albuminuria in Acute Kidney Injury Caused by Puumala Hantavirus Infection. Pathogens 2020; 9:E615. [PMID: 32731475 PMCID: PMC7459820 DOI: 10.3390/pathogens9080615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/12/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
Transient proteinuria and acute kidney injury (AKI) are characteristics of Puumala virus (PUUV) infection. Albuminuria peaks around the fifth day and associates with AKI severity. To evaluate albuminuria disappearance rate, we quantified albumin excretion at different time points after the fever onset. The study included 141 consecutive patients hospitalized due to acute PUUV infection in Tampere University Hospital, Finland. Timed overnight albumin excretion (cU-Alb) was measured during the acute phase in 133 patients, once or twice during the convalescent phase within three months in 94 patients, and at six months in 36 patients. During hospitalization, 30% of the patients had moderately increased albuminuria (cU-Alb 20-200 μg/min), while 57% presented with severely increased albuminuria (cU-Alb >200 μg/min). Median cU-Alb was 311 μg/min (range 2.2-6460) ≤7 days after fever onset, 235 μg/min (range 6.8-5479) at 8-13 days and 2.8 μg/min (range 0.5-18.2) at 14-20 days. After that, only one of the measurements showed albuminuria (35.4 μg/min at day 44). At six months, the median cU-Alb was 2.0 μg/min (range 0.6-14.5). Albuminuria makes a flash-like appearance in PUUV infection and returns rapidly to normal levels within 2-3 weeks after fever onset. In the case of AKI, this is a unique phenomenon.
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Affiliation(s)
- Paula Mantula
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
| | - Johanna Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Jan Clement
- Department of Microbiology, Immunology and Transplantation, Rega Institute, National Reference Center for Hantaviruses, Laboratory of Clinical and Epidemiological Virology, KU Leuven, 3000 Leuven, Belgium;
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
- Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00100 Helsinki, Finland;
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
- Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
| | - Tuula Outinen
- Department of Internal Medicine, Tampere University Hospital, 33521 Tampere, Finland; (J.T.); (I.P.); (J.M.); (S.M.); (T.O.)
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29
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Honkonen M, Vääräniemi K, Saijonmaa O, Nyman A, Tikkakoski AJ, Koskela J, Lehtimäki T, Kähönen M, Mustonen J, Fyhrquist F, Pörsti I. Leukocyte telomere length is inversely associated with arterial wave reflection in 566 normotensive and never-treated hypertensive subjects. Aging (Albany NY) 2020; 12:12376-12392. [PMID: 32575070 PMCID: PMC7343461 DOI: 10.18632/aging.103459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 02/17/2020] [Accepted: 05/27/2020] [Indexed: 04/19/2023]
Abstract
Telomeres are short segments in chromosome ends, the length of which is reduced during cell lifecycles. We examined the association of mean leukocyte telomere length (LTL) and short telomere proportion (STP) with hemodynamic variables in normotensive and never-treated hypertensive volunteers (n=566, 19-72 years). STP and mean LTL were determined using Southern blotting, and supine hemodynamics recorded using continuous tonometric pulse wave analysis and whole-body impedance cardiography. The analyses were adjusted for age, body mass index (BMI), alcohol use, smoking, plasma chemistry, and estimated glomerular filtration rate (eGFR). In univariate analyses, mean LTL and STP both correlated with age, BMI, eGFR, aortic blood pressure, augmentation index, and pulse wave velocity (p<0.05 for all). Mean LTL also correlated with systemic vascular resistance (p<0.05). In linear regression analyses of all hemodynamic variables, mean LTL was only an independent explanatory factor for augmentation index (Beta -0.006, p=0.032), while STP was not an explanatory factor for any of the hemodynamic variables, in contrast to age, BMI and several cardiovascular risk factors. To conclude, augmentation index was predominantly related with chronological aging, but also with mean LTL, suggesting that this variable of central wave reflection is a modest marker of vascular biological aging.
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Affiliation(s)
- Milja Honkonen
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Kati Vääräniemi
- Department of Internal Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Outi Saijonmaa
- Minerva Institute for Medical Research, Biomedicum U2 Helsinki, Helsinki, Finland
| | - Anna Nyman
- Minerva Institute for Medical Research, Biomedicum U2 Helsinki, Helsinki, Finland
| | - Antti J. Tikkakoski
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories Ltd, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Frej Fyhrquist
- Minerva Institute for Medical Research, Biomedicum U2 Helsinki, Helsinki, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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30
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Törmänen S, Lakkisto P, Eräranta A, Kööbi P, Tikkanen I, Niemelä O, Mustonen J, Pörsti I. Unfavorable Reduction in the Ratio of Endothelin B to A Receptors in Experimental 5/6 Nephrectomy and Adenine Models of Chronic Renal Insufficiency. Int J Mol Sci 2020; 21:ijms21030936. [PMID: 32023824 PMCID: PMC7037353 DOI: 10.3390/ijms21030936] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic renal insufficiency (CRI) is characterized by increased endothelin 1 (ET-1) synthesis. We studied rat kidney endothelin receptor A (ETA) and receptor B (ETB) expressions after 12 and 27 weeks of 5/6 nephrectomy, and after 12 weeks of 0.3% adenine diet, representing proteinuric and interstitial inflammation models of CRI, respectively. Uric acid and calcium-phosphate metabolism were modulated after 5/6 nephrectomy, while ETA blocker and calcimimetic were given with adenine. Endothelin receptor mRNA levels were measured using RT-qPCR and protein levels using autoradiography (5/6 nephrectomy) or ELISA (adenine model). Both 12 and 27 weeks after 5/6 nephrectomy, kidney cortex ETA protein was increased by ~60% without changes in ETB protein, and the ETB:ETA ratio was reduced. However, the ETB:ETA mRNA ratio did not change. In the adenine model, kidney ETA protein was reduced by ~70%, while ETB protein was suppressed by ~95%, and the ETB:ETA ratio was reduced by ~85%, both at the protein and mRNA levels. The additional interventions did not influence the observed reductions in the ETB:ETA ratio. To conclude, unfavorable reduction in the ETB:ETA protein ratio was observed in two different models of CRI. Therefore, ETA blockade may be beneficial in a range of diseases that cause impaired kidney function.
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Affiliation(s)
- Suvi Törmänen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Päivi Lakkisto
- Minerva Institute for Medical Research, 00290 Helsinki, Finland
- Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Peeter Kööbi
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Eye Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Ilkka Tikkanen
- Minerva Institute for Medical Research, 00290 Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Department of Clinical Chemistry and Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
- Correspondence: ; Tel.: +358-331-166-010
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31
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Pörsti I, Honkonen M, Vääräniemi K, Saijonmaa O, Tikkakoski A, Koskela J, Eräranta A, Kähönen M, Mustonen J, Fyhrquist F. P36 Leukocyte Telomere Length is Inversely Associated with Wave Reflection in 566 Normotensive and Never-treated Hypertensive Subjects. Artery Res 2020. [DOI: 10.2991/artres.k.191224.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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32
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Oinonen L, Koskela J, Eräranta A, Tikkakoski A, Kähönen M, Niemelä O, Mustonen J, Pörsti I. Plasma total calcium concentration is associated with blood pressure and systemic vascular resistance in normotensive and never-treated hypertensive subjects. Blood Press 2019; 29:137-148. [PMID: 31790289 DOI: 10.1080/08037051.2019.1696180] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The underlying causes of primary hypertension are not fully understood. Evidence on the relation of plasma calcium concentration with blood pressure (BP) is inconsistent and relies largely on studies utilizing office BP measurements in populations using cardiovascular drugs. In many studies adjustment for confounders was not optimal. In this cross-sectional study we examined the association of plasma total calcium concentration with the haemodynamic determinants of blood pressure.Subjects and methods: Supine haemodynamics were recorded using pulse wave analysis, whole-body impedance cardiography, and heart rate variability analysis in 618 normotensive or never-treated hypertensive subjects (aged 19-72 years) without diabetes, cardiovascular or renal disease, or cardiovascular medications. Linear regression analysis was used to investigate factors associated with haemodynamic variables.Results: Mean age was 45.0 years, body mass index 26.8 kg/m2, seated office BP 141/89 mmHg, and 307 subjects (49.7%) were male. Mean values of routine blood and plasma chemistry analyses were within the reference limits of the tests except for low-density lipoprotein cholesterol (3.05 mmol/l). In the laboratory, mean supine radial BP was 131/75 mmHg, and both systolic and diastolic BP correlated directly with plasma total calcium concentration (r = 0.25 and r = 0.22, respectively, p < 0.001 for both). In regression analysis plasma total calcium concentration was an independent explanatory variable for radial and aortic systolic and diastolic BP, and systemic vascular resistance, but not for cardiac output, pulse wave velocity, or any of the heart rate variability parameters.Conclusion: Plasma total calcium concentration was directly associated with systolic and diastolic BP and systemic vascular resistance in normotensive or never-treated hypertensive subjects without comorbidities and cardiovascular medications. Higher plasma calcium concentration potentially plays a role in primary hypertension via an effect on vascular resistance.
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Affiliation(s)
- Lasse Oinonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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33
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Pohjonen J, Nurmi R, Metso M, Oksanen P, Huhtala H, Pörsti I, Mustonen J, Kaukinen K, Mäkelä S. Inflammatory bowel disease in patients undergoing renal biopsies. Clin Kidney J 2019; 12:645-651. [PMID: 31583091 PMCID: PMC6768292 DOI: 10.1093/ckj/sfz004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There are no good data in the literature on the prevalence of inflammatory bowel disease (IBD) in patients with kidney disease and we do not know whether IBD affects the course of kidney disease or if the type of IBD is an influential factor. The aim of this study was to evaluate the prevalence of IBD among patients who have undergone renal biopsies due to clinical indications and to elucidate whether the presence of IBD influences renal and patient outcomes. METHODS We collected retrospective data on concomitant diseases, especially IBD, from adult patients undergoing renal biopsy for any clinical indication between 2000 and 2012 at Tampere University Hospital, Tampere, Finland. Information was systematically collected on the activity of IBD, medication for IBD, surgery performed for IBD and markers of kidney function. RESULTS Of the 819 patients biopsied, 35 (4.3%) had IBD. The prevalence of IBD was 13.3 and 4.6% in patients with tubulointerstitial nephritis (TIN) and immunoglobulin A nephropathy (IgAN), respectively. In comparison, the prevalence of IBD in the Finnish population is 0.6%. Ulcerative colitis and Crohn's disease were equally represented. The presence of IBD showed no impact on renal and patient outcomes. CONCLUSIONS IBD should not be overlooked in patients undergoing renal biopsies, especially those diagnosed with TIN or IgAN. The renal findings did not associate with the activity of intestinal inflammation. Whether a concomitant IBD truly affects the course of chronic kidney disease should be examined in further studies.
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Affiliation(s)
- Jussi Pohjonen
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Rakel Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Martti Metso
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
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34
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Nurmi R, Metso M, Pörsti I, Niemelä O, Huhtala H, Mustonen J, Kaukinen K, Mäkelä S. Corrigendum to "Celiac disease or positive tissue transglutaminase antibodies in patients undergoing renal biopsies" [Dig Liver Dis (2018);50:27-31]. Dig Liver Dis 2019; 51:1207-1208. [PMID: 31253487 DOI: 10.1016/j.dld.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 12/11/2022]
Affiliation(s)
- R Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Finland.
| | - M Metso
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - I Pörsti
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - O Niemelä
- Medical Research Unit, Seinäjoki Central Hospital, Finland; University of Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, University of Tampere, Finland
| | - J Mustonen
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - K Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Finland; Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - S Mäkelä
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland
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35
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Choudhary MK, Eräranta A, Koskela J, Tikkakoski AJ, Nevalainen PI, Kähönen M, Mustonen J, Pörsti I. Atherogenic index of plasma is related to arterial stiffness but not to blood pressure in normotensive and never-treated hypertensive subjects. Blood Press 2019; 28:157-167. [PMID: 30821503 DOI: 10.1080/08037051.2019.1583060] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Atherogenic index of plasma (AIP), defined as the logarithm of triglycerides to high-density lipoprotein cholesterol (HDL-C) ratio, is a strong predictor of future cardiovascular disease. Our aim was to examine the association of AIP with haemodynamic variables in normotensive and never-treated hypertensive subjects in a cross-sectional study. METHODS Supine haemodynamics in 615 subjects without antihypertensive and lipid-lowering medications were examined using whole-body impedance cardiography and radial pulse wave analysis. Linear regression analysis was applied to investigate the association of AIP with haemodynamic variables and age, sex, body mass index (BMI), smoking status, alcohol consumption, plasma C-reactive protein, electrolytes, uric acid, low density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate, and quantitative insulin sensitivity check index. RESULTS The demographics and laboratory values of the study population were (mean ± 95% confidence interval): age 44.9 ± 1.0 years, BMI 26.8 ± 0.4 kg/m2, office blood pressure 140.6 ± 1.6/89.4 ± 1.0 mmHg, total cholesterol 5.2 ± 0.08, LDL-C 3.1 ± 0.08, triglycerides 1.2 ± 0.08, HDL-C 1.6 ± 0.04 mmol/l, and AIP -0.15 ± 0.02. Age (standardized coefficient Beta 0.508, p < .001) and aortic systolic blood pressure (Beta 0.239, p < .001) presented with the strongest associations with pulse wave velocity. However, AIP was also associated with pulse wave velocity (Beta 0.145, p < .001). AIP was not related with aortic or radial blood pressure, cardiac output, systemic vascular resistance, or augmentation index. CONCLUSIONS AIP is directly and independently associated with arterial stiffness, a variable strongly related to cardiovascular risk. This supports more widespread use of AIP in standard clinical cardiovascular disease risk evaluation.
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Affiliation(s)
- Manoj Kumar Choudhary
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland
| | - Arttu Eräranta
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland
| | - Jenni Koskela
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Antti J Tikkakoski
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland.,c Department of Clinical Physiology , Tampere University Hospital , Tampere , Finland
| | - Pasi I Nevalainen
- b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Mika Kähönen
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland.,c Department of Clinical Physiology , Tampere University Hospital , Tampere , Finland
| | - Jukka Mustonen
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Ilkka Pörsti
- a Faculty of Medicine and Health Technology , Tampere University , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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Choudhary MK, Eräranta A, Tikkakoski AJ, Koskela J, Hautaniemi EJ, Kähönen M, Mustonen J, Pörsti I. LDL cholesterol is associated with systemic vascular resistance and wave reflection in subjects naive to cardiovascular drugs. Blood Press 2018; 28:4-14. [PMID: 30369274 DOI: 10.1080/08037051.2018.1521263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Low density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerosis, but it is also associated with elevated blood pressure (BP) and future development of hypertension. We examined the relationship between LDL-C and haemodynamic variables in normotensive and never-treated hypertensive subjects. METHODS We recruited 615 volunteers (19-72 years) without lipid-lowering and BP-lowering medication. Supine haemodynamics were recorded using continuous radial pulse wave analysis, whole-body impedance cardiography, and single channel electrocardiogram. The haemodynamic relations of LDL-C were examined using linear regression analyses with age, sex, body mass index (BMI) (or height and weight as appropriate), smoking status, alcohol use, and plasma C-reactive protein, sodium, uric acid, high density lipoprotein cholesterol (HDL-C), triglycerides, estimated glomerular filtration rate, and quantitative insulin sensitivity check index as the other included variables. RESULTS The mean (SD) characteristics of the subjects were: age 45 (12) years, BMI 27 (4) kg/m2, office BP 141/89 (21/13) mmHg, creatinine 74 (14) µmol/l, total cholesterol 5.2 (1.0), LDL-C 3.1 (0.6), triglycerides 1.2 (0.8), and HDL-C 1.6 (0.4) mmol/l. LDL-C was an independent explanatory factor for aortic systolic and diastolic BP, augmentation index, pulse wave velocity (PWV), and systemic vascular resistance index (p < 0.05 for all). When central BP was included in the model for PWV, LDL-C was no longer an explanatory factor for PWV. CONCLUSIONS LDL-C is independently associated with BP via systemic vascular resistance and wave reflection. These results suggest that LDL-C may play a role in the pathogenesis of primary hypertension.
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Affiliation(s)
| | - Arttu Eräranta
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Antti J Tikkakoski
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Clinical Physiology , Tampere University Hospital , Tampere , Finland
| | - Jenni Koskela
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Elina J Hautaniemi
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Mika Kähönen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Clinical Physiology , Tampere University Hospital , Tampere , Finland
| | - Jukka Mustonen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,c Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Ilkka Pörsti
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,c Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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37
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Kangas P, Tikkakoski A, Uitto M, Viik J, Bouquin H, Niemelä O, Mustonen J, Pörsti I. Metabolic syndrome is associated with decreased heart rate variability in a sex-dependent manner: a comparison between 252 men and 249 women. Clin Physiol Funct Imaging 2018; 39:160-167. [PMID: 30307694 DOI: 10.1111/cpf.12551] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Abstract
Impaired heart rate variability (HRV) is associated with increased risk of cardiovascular disease, but evidence regarding alterations of HRV in metabolic syndrome (MetS) remains elusive. In order to examine HRV in MetS, we subjected 501 volunteers without atherosclerosis, diabetes or antihypertensive medication, mean age 48 years, to passive head-up tilt. The subjects were divided to control men (n = 131), men with MetS (n = 121), control women (n = 191) and women with MetS (n = 58) according to the criteria by Alberti et al. (Circulation, 2009, 120, 1640). In unadjusted analyses (i) men and women with MetS had lower total power and high-frequency (HF) power of HRV than controls whether supine or upright (P<0·05 for all). (ii) Supine low-frequency (LF) power of HRV was lower in men (P = 0·012) but not in women (P = 0·064) with MetS than in controls, while men and women with MetS had lower upright LF power of HRV than controls (P <0·01 for both). (iii) The LF:HF ratio did not differ between subjects with and without MetS. After adjustment for age, smoking habits, alcohol intake, height, heart rate and breathing frequency, only the differences in upright total power and HF power of HRV between women with MetS and control women remained significant (P<0·05). In conclusion, reduced total and HF power of HRV in the upright position may partially explain why the relative increase in cardiovascular risk associated with MetS is greater in women than in men. Additionally, the present results emphasize that the confounding factors must be carefully taken into consideration when evaluating HRV.
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Affiliation(s)
- Pauliina Kangas
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Heidi Bouquin
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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38
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Choudhary MK, Eräranta A, Tikkakoski AJ, Koskela J, Hautaniemi E, Kähönen M, Mustonen J, Pörsti I. P119 LDL CHOLESTEROL IS ASSOCIATED WITH SYSTEMIC VASCULAR RESISTANCE AND WAVE REFLECTION IN SUBJECTS NOT USING MEDICATIONS WITH HAEMODYNAMIC INFLUENCES. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nurmi R, Metso M, Pörsti I, Niemelä O, Huhtala H, Mustonen J, Kaukinen K, Mäkelä S. Celiac disease or positive tissue transglutaminase antibodies in patients undergoing renal biopsies. Dig Liver Dis 2018; 50:27-31. [PMID: 29050994 DOI: 10.1016/j.dld.2017.09.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/02/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND An association between celiac disease and renal diseases has been suggested, but the results are controversial. AIMS To investigate the prevalence of celiac disease autoimmunity among individuals undergoing renal biopsies and to evaluate whether co-existent celiac autoimmunity influences the clinical outcome of the renal disease. METHODS The prevalence of celiac autoimmunity (previous diagnosis of celiac disease or positive tissue transglutaminase antibodies) was determined in 827 consecutive patients undergoing kidney biopsies due to clinical indications. Up to 15 years' follow-up data on kidney function and co-morbidities were obtained. RESULTS Celiac autoimmunity was found in 45 (5.4%) patients. Among the IgA nephropathy patients, 8.2% of had celiac autoimmunity. At the time of kidney biopsy and after a median follow-up of 5 to 6 years, renal function measured by estimated glomerular filtration rate (eGFR) was inferior in IgA nephropathy patients with celiac autoimmunity compared to those without it (P=0.048 and P=0.022, respectively). CONCLUSION The prevalence of celiac autoimmunity seems to be high in patients undergoing renal biopsies, especially in patients with IgA nephropathy. Such autoimmunity may be associated with worse renal function in IgA nephropathy. Hence the co-existence of celiac disease should be taken into consideration when treating patients with renal diseases.
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Affiliation(s)
- Rakel Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Finland.
| | - Martti Metso
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Ilkka Pörsti
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Onni Niemelä
- Medical Research Unit, Seinäjoki Central Hospital, Finland; University of Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Finland
| | - Jukka Mustonen
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Finland; Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Satu Mäkelä
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland
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40
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Törmänen S, Pörsti I, Lakkisto P, Tikkanen I, Niemelä O, Paavonen T, Mustonen J, Eräranta A. Endothelin A receptor blocker and calcimimetic in the adenine rat model of chronic renal insufficiency. BMC Nephrol 2017; 18:323. [PMID: 29078759 PMCID: PMC5659028 DOI: 10.1186/s12882-017-0742-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/17/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We studied whether endothelin receptor antagonist and calcimimetic treatments influence renal damage and kidney renin-angiotensin (RA) components in adenine-induced chronic renal insufficiency (CRI). METHODS Male Wistar rats (n = 80) were divided into 5 groups for 12 weeks: control (n = 12), 0.3% adenine (Ade; n = 20), Ade + 50 mg/kg/day sitaxentan (n = 16), Ade + 20 mg/kg/day cinacalcet (n = 16), and Ade + sitaxentan + cinacalcet (n = 16). Blood pressure (BP) was measured using tail-cuff, kidney histology was examined, and RA components measured using RT-qPCR. RESULTS Adenine caused tubulointerstitial damage with severe CRI, anemia, hyperphosphatemia, 1.8-fold increase in urinary calcium excretion, and 3.5-fold and 18-fold increases in plasma creatinine and PTH, respectively. Sitaxentan alleviated tubular atrophy, while sitaxentan + cinacalcet combination reduced interstitial inflammation, tubular dilatation and atrophy in adenine-rats. Adenine diet did not influence kidney angiotensin converting enzyme (ACE) and AT4 receptor mRNA, but reduced mRNA of renin, AT1a, AT2, (pro)renin receptor and Mas to 40-60%, and suppressed ACE2 to 6% of that in controls. Sitaxentan reduced BP by 8 mmHg, creatinine, urea, and phosphate concentrations by 16-24%, and PTH by 42%. Cinacalcet did not influence BP or creatinine, but reduced PTH by 84%, and increased hemoglobin by 28% in adenine-rats. The treatments further reduced renin mRNA by 40%, while combined treatment normalized plasma PTH, urinary calcium, and increased ACE2 mRNA 2.5-fold versus the Ade group (p < 0.001). CONCLUSIONS In adenine-induced interstitial nephritis, sitaxentan improved renal function and tubular atrophy. Sitaxentan and cinacalcet reduced kidney renin mRNA by 40%, while their combination alleviated tubulointerstitial damage and urinary calcium loss, and increased kidney tissue ACE2 mRNA.
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Affiliation(s)
- Suvi Törmänen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. .,School of Medicine / Internal Medicine, FIN-33014 University of Tampere, Tampere, Finland.
| | - Päivi Lakkisto
- Minerva Institute for Medical Research, Helsinki, Finland.,Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Tikkanen
- Minerva Institute for Medical Research, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Onni Niemelä
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Timo Paavonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Fimlab Laboratories, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Outinen TK, Mantula P, Laine OK, Pörsti I, Vaheri A, Mäkelä SM, Mustonen J. Haematuria is a marker for the severity of acute kidney injury but does not associate with thrombocytopenia in acute Puumala hantavirus infection. Infect Dis (Lond) 2017; 49:840-846. [PMID: 28762841 DOI: 10.1080/23744235.2017.1358461] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome characterized by thrombocytopenia, capillary leakage and acute kidney injury (AKI) with proteinuria and haematuria. Although the typical histologic lesion is acute tubulointerstitial nephritis, the amount of glomerular proteinuria predicts the severity of upcoming AKI. Here, we studied the associations of haematuria and proteinuria with the severity of emerging AKI, thrombocytopenia and markers of coagulation and fibrinolysis in PUUV infection. METHODS We examined 205 consecutive patients treated for serologically confirmed acute PUUV infection at Tampere University Hospital during 1997-2014. The patients were divided into three groups according to the combined positive result in urine haemoglobin and albumin dipstick tests: 0-2 + (n = 58), 3-4 + (n = 100) and 5-6 + (n = 47). RESULTS The medians of maximum creatinine concentrations in the three groups were: 0-2 + 100 μmol/L (range 52-1499), 3-4 + 204 μmol/L (range 65-1071) and 5-6 + 361 μmol/l (range 51-1285) (p < .001). The number of blood platelets (p = .069), and the levels of fibrinogen, prothrombin fragments F1 + 2 and d-dimer (p = .602, p = .113, p = .289, respectively) were not significantly different between the groups. When the amount of haematuria in the dipstick test was examined separately, no association with thrombocytopenia was detected (p = .307 between groups 0, 1+ and 2-3+). CONCLUSIONS Combined positive result of haematuria and proteinuria in the dipstick test at hospital admission predicted the severity of upcoming AKI in acute PUUV infection. As haematuria was not associated with the severity of thrombocytopenia, it did not indicate increased bleeding tendency, but was rather a marker of acute kidney injury.
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Affiliation(s)
- Tuula K Outinen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Paula Mantula
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Outi K Laine
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Ilkka Pörsti
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Antti Vaheri
- c Department of Virology , Medicum, University of Helsinki , Helsinki , Finland
| | - Satu M Mäkelä
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Jukka Mustonen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland.,b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
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Abstract
Acute kidney injury (AKI) remains a predominant clinical expression of nephropathia epidemica (NE). Its pathogenesis is not yet fully understood. Here, we describe the tissue injury comprehensively and present new data aimed to characterize the injury and explain its pathophysiology. When compared to tubulointerstitial nephritis of a wide variety of other aetiologies, a high degree of proteinuria is a distinguished trait of NE, a finding that is also helpful in the clinical suspicion of the disease. Recently, novel biomarkers for the prediction of severe AKI, including neutrophil gelatinase-associated lipocalin (NGAL), have been identified and ultrastructural tissue changes have been more accurately described. A role for soluble urokinase-type plasminogen activator (suPAR) in the pathogenesis of NE has been suggested, and data on gene polymorphisms, in relation to the severity of AKI have been presented. Smoking is a risk factor for NE and smoking is also associated with aggravated AKI in NE. Although no specific treatment is in sight, recent case reports concerning therapy directed against vascular permeability and vasodilation are of interest. In fact, future work trying to explain the pathophysiology of AKI might need concentrated efforts towards the mechanisms of increased vascular permeability and vasodilatation, which irrespective of organ manifestation, are two major determinants of NE.
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Affiliation(s)
- Jukka Mustonen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Tuula Outinen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Outi Laine
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Ilkka Pörsti
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Antti Vaheri
- c Department of Virology, Medicum , University of Helsinki , Helsinki , Finland
| | - Satu Mäkelä
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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Säynävälammi P, Pörsti I, Nurmi AK, Seppälä E, Laitinen LA, Manninen V, Ylitalo P, Vapaatalo H. Differing Effects of Two Angiotensin Converting Enzyme Inhibitors, Captopril and CI-906, on Diuresis and the Urinary Excretion of Kallikrein and Prostaglandins in Spontaneously Hypertensive Rats. ACTA ACUST UNITED AC 2016; 18:23-27. [DOI: 10.1080/00365599.1984.11783710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pekka Säynävälammi
- From the Department of Biomedical Sciences, University of Tampere, Tampere, Finland
| | - Ilkka Pörsti
- From the Department of Biomedical Sciences, University of Tampere, Tampere, Finland
| | - Anna-Kaisa Nurmi
- From the Department of Biomedical Sciences, University of Tampere, Tampere, Finland
| | - Erkki Seppälä
- From the Department of Biomedical Sciences, University of Tampere, Tampere, Finland
| | - Lauri A. Laitinen
- Research Institute of Military Medicine, Central Military Hospital, Helsinki, Finland
| | - Vesa Manninen
- First Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Pauli Ylitalo
- From the Department of Biomedical Sciences, University of Tampere, Tampere, Finland
| | - Heikki Vapaatalo
- From the Department of Biomedical Sciences, University of Tampere, Tampere, Finland
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Kangas P, Tahvanainen A, Tikkakoski A, Koskela J, Uitto M, Viik J, Kähönen M, Kööbi T, Mustonen J, Pörsti I. Increased Cardiac Workload in the Upright Posture in Men: Noninvasive Hemodynamics in Men Versus Women. J Am Heart Assoc 2016; 5:JAHA.115.002883. [PMID: 27329447 PMCID: PMC4937251 DOI: 10.1161/jaha.115.002883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Men and women differ in the risk of cardiovascular disease, but the underlying mechanisms are not completely understood. We examined possible sex‐related differences in supine and upright cardiovascular regulation. Methods and Results Hemodynamics were recorded from 167 men and 167 women of matching age (≈45 years) and body mass index (≈26.5) during passive head‐up tilt. None had diabetes mellitus or cardiovascular disease other than hypertension or used antihypertensive medication. Whole‐body impedance cardiography, tonometric radial blood pressure, and heart rate variability were analyzed. Results were adjusted for height, smoking, alcohol intake, mean arterial pressure, plasma lipids, and glucose. Supine hemodynamic differences were minor: Men had lower heart rate (−4%) and higher stroke index (+7.5%) than women (P<0.05 for both). Upright systemic vascular resistance was lower (−10%), but stroke index (+15%), cardiac index (+16%), and left cardiac work were clearly higher (+20%) in men than in women (P<0.001 for all). Corresponding results were observed in a subgroup of men and postmenopausal women (n=76, aged >55 years). Heart rate variability analyses showed higher low:high frequency ratios in supine (P<0.001) and upright (P=0.003) positions in men. Conclusions The foremost difference in cardiovascular regulation between sexes was higher upright hemodynamic workload for the heart in men, a finding not explained by known cardiovascular risk factors or hormonal differences before menopause. Heart rate variability analyses indicated higher sympathovagal balance in men regardless of body position. The deviations in upright hemodynamics could play a role in the differences in cardiovascular risk between men and women. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01742702.
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Affiliation(s)
| | - Anna Tahvanainen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- Department of Electronics and Communication Engineering, Tampere University of Technology, Tampere, Finland
| | - Mika Kähönen
- School of Medicine, University of Tampere, Finland Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- School of Medicine, University of Tampere, Finland Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Outinen TK, Laine OK, Mäkelä S, Pörsti I, Huhtala H, Vaheri A, Mustonen J. Thrombocytopenia associates with the severity of inflammation and variables reflecting capillary leakage in Puumala Hantavirus infection, an analysis of 546 Finnish patients. Infect Dis (Lond) 2016; 48:682-7. [PMID: 27299174 DOI: 10.1080/23744235.2016.1192719] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Hantaviruses cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) in humans. Hantavirus infections are characterized by thrombocytopenia. Our objective was to assess the association of thrombocytopenia with disease severity in HFRS induced by Puumala hantavirus (PUUV). METHODS Altogether 546 patients treated for acute serologically confirmed PUUV infection during 1982-2013 at Tampere University Hospital, Finland, were examined. Blood platelet count was determined daily and analysed in relation to different variables reflecting disease severity. The patients were divided into two groups according to the minimum platelet count: severe thrombocytopenia (<69 × 10(9)/L, i.e. below median) and no severe thrombocytopenia (≥69 × 10(9)/L). RESULTS Thrombocytopenia (platelet count <150 × 10(9)/L) was detected in 90% of patients, and in 28% of patients platelet count was <50 × 10(9)/L. Patients with severe thrombocytopenia had longer stay (8 versus 7 days, p = 0.002) and greater weight gain (2.8 versus 2.0 kg, p < 0.001) at the hospital, higher blood leukocyte count (11.2 × 10(9)/L versus 9.6 × 10(9)/L, p < 0.001), plasma C-reactive protein (81 versus 59 mg/L, p < 0.001), maximum hematocrit (0.44 versus 0.42, p < 0.001), urinary protein excretion (1.7 versus 1.1 g/24 h, p = 0.002), and lower plasma albumin concentration (27 versus 32 g/L, p < 0.001) than patients without severe thrombocytopenia (comparisons between medians). Maximum creatinine concentration did not differ between patients with or without severe thrombocytopenia (median 235 versus 214 μmol/L, p = 0.217). CONCLUSIONS The severity of thrombocytopenia associates with the degree of inflammation and variables reflecting capillary leakage, but not with the severity of acute kidney injury in PUUV infected Finnish patients.
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Affiliation(s)
- Tuula K Outinen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Outi K Laine
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
| | - Satu Mäkelä
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
| | - Ilkka Pörsti
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
| | - Heini Huhtala
- c School of Health Sciences , University of Tampere , Tampere , Finland
| | - Antti Vaheri
- d Department of Virology, Medicum, Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - Jukka Mustonen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland ;,b School of Medicine , University of Tampere , Tampere , Finland
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Mantula P, Outinen T, Clement J, Huhtala H, Pörsti I, Mäkelä S, Mustonen J. SP198PROTEINURIA DETECTED BY ALBUMIN DIPSTICK TEST PREDICTS THE SEVERITY OF ACUTE KIDNEY INJURY IN PUUMALA HANTAVIRUS-INDUCED NEPHROPATHIA EPIDEMICA. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw162.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Koskela S, Laine O, Mäkelä S, Pessi T, Tuomisto S, Huhtala H, Karhunen PJ, Pörsti I, Mustonen J. Endothelial Nitric Oxide Synthase G894T Polymorphism Associates with Disease Severity in Puumala Hantavirus Infection. PLoS One 2015; 10:e0142872. [PMID: 26561052 PMCID: PMC4641644 DOI: 10.1371/journal.pone.0142872] [Citation(s) in RCA: 8] [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: 08/30/2015] [Accepted: 10/27/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Hantavirus infections are characterized by both activation and dysfunction of the endothelial cells. The underlying mechanisms of the disease pathogenesis are not fully understood. Here we tested the hypothesis whether the polymorphisms of endothelial nitric oxide synthase, eNOS G894T, and inducible nitric oxide synthase, iNOS G2087A, are associated with the severity of acute Puumala hantavirus (PUUV) infection. Patients and Methods Hospitalized patients (n = 172) with serologically verified PUUV infection were examined. Clinical and laboratory variables reflecting disease severity were determined. The polymorphisms of eNOS G894T (Glu298Asp, rs1799983) and iNOS G2087A (Ser608Leu, rs2297518) were genotyped. Results The rare eNOS G894T genotype was associated with the severity of acute kidney injury (AKI). The non-carriers of G-allele (TT-homozygotes) had higher maximum level of serum creatinine than the carriers of G-allele (GT-heterozygotes and GG-homozygotes; median 326, range 102–1041 vs. median 175, range 51–1499 μmol/l; p = 0.018, respectively). The length of hospital stay was longer in the non-carriers of G-allele than in G-allele carriers (median 8, range 3–14 vs. median 6, range 2–15 days; p = 0.032). The rare A-allele carriers (i.e. AA-homozygotes and GA-heterozygotes) of iNOS G2087A had lower minimum systolic and diastolic blood pressure than the non-carriers of A-allele (median 110, range 74–170 vs.116, range 86–162 mmHg, p = 0.019, and median 68, range 40–90 vs. 72, range 48–100 mmHg; p = 0.003, respectively). Conclusions Patients with the TT-homozygous genotype of eNOS G894T had more severe PUUV-induced AKI than the other genotypes. The eNOS G894T polymorphism may play role in the endothelial dysfunction observed during acute PUUV infection.
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Affiliation(s)
- Sirpa Koskela
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- * E-mail:
| | - Outi Laine
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Tanja Pessi
- School of Medicine, University of Tampere, Tampere, Finland
- Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Sari Tuomisto
- School of Medicine, University of Tampere, Tampere, Finland
- Fimlab Laboratories Ltd, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Pekka J. Karhunen
- School of Medicine, University of Tampere, Tampere, Finland
- Fimlab Laboratories Ltd, Tampere, Finland
| | - Ilkka Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
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Haltia O, Törmänen S, Eräranta A, Jokihaara J, Nordhausen K, Rysä J, Ruskoaho H, Tikkanen I, Mustonen J, Pörsti I. Vasopeptidase Inhibition Corrects the Structure and Function of the Small Arteries in Experimental Renal Insufficiency. J Vasc Res 2015; 52:94-102. [PMID: 26184548 DOI: 10.1159/000431368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We studied whether vasopeptidase inhibition corrects the structure and function of the small arteries in experimental chronic renal insufficiency (CRI). METHODS After 5/6 nephrectomy (NX) surgery was performed on rats, there was a 14-week follow-up, allowing CRI to become established. Omapatrilat (40 mg/kg/day in chow) was then given for 8 weeks, and the small mesenteric arterial rings were investigated in vitro using wire and pressure myographs. RESULTS Plasma and ventricular B-type natriuretic peptide (BNP) concentrations were increased 2- to 2.7-fold, while systolic blood pressure (BP) increased by 32 mm Hg after NX. Omapatrilat treatment normalized the BNP and reduced the BP by 45 mm Hg in the NX rats. Endothelium-dependent vasorelaxation was impaired but the response to acetylcholine was normalized after omapatrilat treatment. Vasorelaxations induced by nitroprusside, isoprenaline and levcromakalim were enhanced after omapatrilat, and the responses were even more pronounced than in untreated sham-operated rats. Arterial wall thickness and wall-to-lumen ratio were increased after NX, whereas omapatrilat normalized these structural features and improved the strain-stress relationship in the small arteries; this suggests improved arterial elastic properties. CONCLUSION Omapatrilat treatment reduced BP, normalized volume overload, improved vasorelaxation and corrected the dimensions and passive elastic properties of the small arteries in the NX rats. Therefore, we consider vasopeptidase inhibition to be an effective treatment for CRI-induced changes in the small arteries.
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Affiliation(s)
- Olli Haltia
- Schools of Medicine, University of Tampere, Tampere, Finland
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Outinen TK, Mäkelä S, Clement J, Paakkala A, Pörsti I, Mustonen J. Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome. Nephron Clin Pract 2015; 130:182-90. [PMID: 26139246 DOI: 10.1159/000433563] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) induces an acute tubulointerstitial nephritis and acute kidney injury (AKI). Our aim was to evaluate the prognosis of severe AKI associated with PUUV infection. METHODS We examined 556 patients who were treated at Tampere University Hospital during 1982-2013 for acute, serologically confirmed PUUV infection. Plasma creatinine was measured during hospitalization, convalescence, and 1, 2, and 5 years after the acute infection. RESULTS Plasma creatinine concentration was elevated (>100 μmol/l) in 459 (83%) patients, while altogether 189 patients (34%) had severe AKI defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, that is, plasma creatinine ≥353.6 μmol/l (4.0 mg/dl) or need of dialysis. There were no fatal cases during the hospitalization or the following 3 months. Fatality rate during the years following PUUV infection did not differ between patients who had suffered from severe AKI versus those without severe AKI. Post-hospitalization plasma creatinine values were available for 188 (34%) patients. One month after the acute infection, patients with prior severe AKI had higher median plasma creatinine concentration (82 µmol/l, range 54-184) than patients without severe AKI (74 µmol/l, range 55-109, p = 0.005). After 1 year, no significant difference existed in median plasma creatinine concentrations between patients with (71 µmol/l, range 36-123) and without prior severe AKI (72 µmol/l, range 34-116, p = 0.711). After 5 years all but 1 patient had normal creatinine levels. CONCLUSIONS In contrast to the worldwide well-accepted KDIGO criteria, severe AKI associated with PUUV infection is not associated with excess fatality but has a very good prognosis, both in the short and long terms.
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Affiliation(s)
- Tuula K Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Kurra V, Vehmas T, Eräranta A, Jokihaara J, Pirttiniemi P, Ruskoaho H, Tokola H, Niemelä O, Mustonen J, Pörsti I. Effects of oxonic acid-induced hyperuricemia on mesenteric artery tone and cardiac load in experimental renal insufficiency. BMC Nephrol 2015; 16:35. [PMID: 25886588 PMCID: PMC4377065 DOI: 10.1186/s12882-015-0033-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/17/2015] [Indexed: 02/07/2023] Open
Abstract
Background Recent studies suggest a causal role for increased plasma uric acid in the progression of chronic renal insufficiency (CRI). However, uric acid also functions as an antioxidant with possible beneficial effects. Methods We investigated the influence of hyperuricemia on mesenteric arterial tone (main and second order branch) and morphology in experimental CRI. Forty-four Sprague–Dawley rats were 5/6 nephrectomized (NX) or Sham-operated and fed 2.0% oxonic acid or control diet for 9 weeks. Results Oxonic acid feeding elevated plasma uric acid levels 2.4 and 3.6-fold in the NX and Sham groups, respectively. Plasma creatinine and urea were elevated 2-fold and blood pressure increased by 10 mmHg in NX rats, while hyperuricemia did not significantly influence these variables. Right and left ventricular weight, and atrial and B-type natriuretic peptide mRNA content were increased in NX rats, but were not affected by hyperuricemia. In the mesenteric artery, hyperuricemia did not influence vasoconstrictor responses in vitro to norepinephrine or potassium chloride. The small arteries of NX rats featured hypertrophic remodeling independent of uric acid levels: wall to lumen ratio, wall thickness and cross-sectional area were increased without changes in lumen diameter. In the main branch, vasorelaxations to acetylcholine were impaired in NX rats, but were not affected by hyperuricemia. In contrast, relaxations to the large-conductance Ca2+-activated K+-channel (BKCa) opener NS-1619 were reduced by oxonic acid feeding, whereas responses to nitroprusside were not affected. Conclusions Experimental hyperuricemia did not influence cardiac load or vascular remodeling, but impaired BKCa -mediated vasorelaxation in experimental CRI.
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Affiliation(s)
- Venla Kurra
- Department of Internal Medicine, School of Medicine, University of Tampere, FIN-33014, Tampere, Finland.
| | - Tuija Vehmas
- Department of Internal Medicine, School of Medicine, University of Tampere, FIN-33014, Tampere, Finland.
| | - Arttu Eräranta
- Department of Internal Medicine, School of Medicine, University of Tampere, FIN-33014, Tampere, Finland.
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, Tampere, Finland.
| | - Päivi Pirttiniemi
- Department of Internal Medicine, School of Medicine, University of Tampere, FIN-33014, Tampere, Finland.
| | - Heikki Ruskoaho
- Department of Pharmacology and Toxicology, Institute of Biomedicine, University of Oulu, Oulu, Finland. .,Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
| | - Heikki Tokola
- Department of Pharmacology and Toxicology, Institute of Biomedicine, University of Oulu, Oulu, Finland. .,Department of Pathology, Oulu University Hospital, Oulu, Finland.
| | - Onni Niemelä
- Department of Clinical Chemistry, Seinäjoki Central Hospital Laboratory, Seinäjoki, Finland.
| | - Jukka Mustonen
- Department of Internal Medicine, School of Medicine, University of Tampere, FIN-33014, Tampere, Finland. .,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
| | - Ilkka Pörsti
- Department of Internal Medicine, School of Medicine, University of Tampere, FIN-33014, Tampere, Finland. .,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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