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Zhao Q, Shi J, Wu Y, Zhang M, Zheng S, Wang X. Clinical Value of the Combination Detection of Captopril Renal Scintigraphy and Plasma Renin Activity in the Diagnosis of Renal Hypertension. ARCH ESP UROL 2023; 76:532-537. [PMID: 37867339 DOI: 10.56434/j.arch.esp.urol.20237607.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
OBJECTIVE This study aimed to investigate the clinical value of the combination detection of captopril renal scintigraphy (CRS) and plasma renin activity (PRA) in the diagnosis of renal hypertension (RHR). METHODS Retrospective analysis was conducted on the clinical data of 163 patients with suspected RHR admitted to our hospital from March 2019 to March 2021, and all patients underwent blood pressure, CRS and digital subtraction angiography (DSA). The patients were divided into the positive group (n = 100) and the negative group (n = 63) in accordance with the results of DSA examination. PRA, angiotensin II and aldosterone levels of the two groups were detected and compared. The receiver operating characteristic curve was used to analyse the CRS, PRA and combined diagnostic performance. RESULTS The uptake ratio value after captopril intervention in the positive group was 36.71% ± 8.79%, which was significantly lower than that in the negative group (56.79% ± 10.09%, p < 0.05). The serum PRA level of the positive group was 4.70 ± 1.67 ng/mLꞏh, which was distinctly higher than that of the negative group (2.12 ± 1.03 ng/mLꞏh, p < 0.05). The sensitivity and Youden index under the combination detection (area under the curve (AUC) = 0.956, p < 0.001) were all higher than those under single detection. CONCLUSION The combined detection of PRA and CRS can provide considerable evidence for the early diagnosis and treatment of RHR, which has a certain clinical value.
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Affiliation(s)
- Qiannan Zhao
- Department of Clinical Laboratory, Yantaishan Hospital, 264003 Yantai, Shandong, China
| | - Jianfeng Shi
- Department of Clinical Laboratory, Yantai Qishan Hospital, 264001 Yantai, Shandong, China
| | - Yujuan Wu
- Tumor Targeted Therapy Department, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, 266000 Qingdao, Shandong, China
| | - Min Zhang
- Department of Health Management, Jinan Zhangqiu District People's Hospital, 250200 Jinan, Shandong, China
| | - Shuyun Zheng
- Department of Pediatrics, Jinan Zhangqiu District People's Hospital, 250200 Jinan, Shandong, China
| | - Xiaohua Wang
- Department of Clinical Laboratory, Yantaishan Hospital, 264003 Yantai, Shandong, China
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Maritati F, Provenzano M, Lerario S, Corradetti V, Bini C, Busutti M, Grandinetti V, Cuna V, La Manna G, Comai G. Kidney transplantation in systemic sclerosis: Advances in graft, disease, and patient outcome. Front Immunol 2022; 13:878736. [PMID: 35958558 PMCID: PMC9360313 DOI: 10.3389/fimmu.2022.878736] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Systemic sclerosis (SSc) is an immune-mediated rheumatic disease characterized by vascular abnormalities, tissue fibrosis, and inflammation. Renal disease occurring in patients with SSc may have a variable clinicopathological picture. However, the most specific renal condition associated with this disease is the scleroderma renal crisis (SRC), characterized by acute onset of renal failure and severe hypertension. SRC develops in about 20% of cases of SSc, especially in those patients with diffuse cutaneous disease. The prognosis of this condition is often negative, with a rapid progression to end-stage renal disease (ESRD). The advent of the antihypertensive angiotensin-converting enzyme inhibitors in 1980 was associated with a significant improvement in patients’ survival and recovery of renal function. However, the prognosis of these patients can still be improved. The dialytic condition is associated with early death, and mortality is significantly higher than among patients undergoing renal replacement therapy (RRT) due to other conditions. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for kidney transplantation (KT). In this review, we reported the most recent advances in KT in patients with ESRD due to SSc, with a particular overview of the risk of disease recurrence after transplantation and the evolution of other disease manifestations.
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Affiliation(s)
- Adam Min
- St. Michael's Hospital, Toronto, ON, Canada
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Feit L, John D, Delgado Torres N, Sinert R. Flank pain and hematuria is not always a kidney stone. Am J Emerg Med 2020; 40:225.e1-225.e2. [PMID: 32958382 DOI: 10.1016/j.ajem.2020.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with flank pain and hematuria are common emergency department presentations of nephrolithiasis. We may anchor on this etiology and potentially miss other less common differentials. We present a case of a patient with hematuria and flank pain typical of nephrolithiasis who was diagnosed with a Page kidney causing secondary hypertension. A 50 year-old male with no significant past medical history presented to the Emergency Department with severe left-sided flank pain, vomiting, and blood-tinged urine. We pursued a diagnosis of nephrolithiasis and found a left renal subcapsular hematoma on non-contrast CT. A CTA was done with no active hemorrhage found. The patient had no history of recent trauma and was found to be hypertensive on evaluation. Urology was consulted and management for the patient's hypertension was initiated. He was diagnosed with Page Kidney and admitted to medicine for observation and hypertension management with an angiotensin-converting enzyme inhibitor. Page Kidney is a diagnosis that describes compression of the renal parenchyma by a hematoma or mass causing secondary hypertension through the activation of the renin-angiotensin-aldosterone system. Causes may include traumatic subcapsular hematoma, renal cyst rupture, tumor, hemorrhage, arteriovenous malformation, among others. Treatment may involve conservative measures including hypertension management, or more invasive measures like evacuation or nephrectomy. We describe the case of a patient presumed to have nephrolithiasis presenting with typical left-sided flank pain, diagnosed with Page kidney, and treated conservatively.
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Affiliation(s)
- Lisa Feit
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA.
| | - Delna John
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| | - Nayla Delgado Torres
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| | - Richard Sinert
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
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Ali W, Gao G, Bakris GL. Improved Sleep Quality Improves Blood Pressure Control among Patients with Chronic Kidney Disease: A Pilot Study. Am J Nephrol 2020; 51:249-254. [PMID: 31982868 DOI: 10.1159/000505895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the abundance of data documenting the consequences of poor sleep quality on blood pressure (BP), no previous study to our knowledge has addressed the impact of sleep improvement on resistant hypertension among patients with chronic kidney disease (CKD). METHODS The aim of this pilot study was to determine whether improved sleep quality and duration will improve BP control in patients with resistant hypertension and CKD. It was a prospective single-center cohort study that involved 30 hypertensive subjects with CKD presenting with primary resistant hypertension and poor sleep quality or duration <6 h/night. Sleep quality and duration were modified using either sleep hygiene education alone or adding sleep medication. The cohort's BP was followed every 3 months for 6-month duration. The average home and clinic BPs were collected at each follow-up visit. The primary outcome baseline change in systolic BP (SBP) and diastolic BP (DBP; home and clinic) at 3 and 6 months after documented sleep improvement. Secondary outcomes included change from baseline in mean arterial pressure, and delta SBP after sleep improvement. RESULTS African American patients represented 50% of the cohort. All patients had evidence of CKD with GFR ≤60 mL/min and were obese with 40% having type 2 diabetes mellitus. The primary endpoint of change in clinic SBP and DBP was significantly reduced at 3 months, baseline 156 ± 15/88 ± 8 vs. 3 months 125 ± 14/73 ± 7 (p < 0.0001). This difference persisted at 6 months. However, there was no further reduction in-home or clinic BPs between the 3- and 6-month periods. Home and clinic average delta SBP change at 3 months from baseline was -34.4 ± 15 and -30.8 ± 19 mm Hg respectively. Delta SBP change was associated with sleep improvement of >6 h/night, that is, gaining an extra 3-4 h' sleep duration, home; R2 = 0.66, p < 0.0001 and clinic; R2 = 0.49, p < 0.0001. CONCLUSION Optimizing sleep quality and duration to >6 h/night improved BP control and was associated with a significant delta change in SBP within 3 months of follow-up. Physicians should obtain a sleep history in patients with CKD who present with resistant hypertension.
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Affiliation(s)
- Waleed Ali
- Department of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, Illinois, USA
| | - Guimin Gao
- Department of Public Health Science and Biostatistics, University of Chicago Biological Sciences, Chicago, Illinois, USA
| | - George L Bakris
- Department of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, Illinois, USA,
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Vijayvergiya R, Kumar B, Budhakoty S, Savlania A, Lal A. Endovascular Stent-Graft Repair of a Large Renal Artery Pseudoaneurysm With Impending Rupture, Arising From a Solitary Kidney. J Invasive Cardiol 2020; 32:E11-E12. [PMID: 31893505] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This was an unusual case of a large renal artery pseudoaneurysm with impending rupture, which was successfully treated with an endovascular stent-graft in a solitary kidney.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh - 160 012, India.
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Abstract
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
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Affiliation(s)
- Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA.
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
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Courand PY, Dinic M, Lorthioir A, Bobrie G, Grataloup C, Denarié N, Soulat G, Mousseaux E, Sapoval M, Azizi M, Amar L. Resistant Hypertension and Atherosclerotic Renal Artery Stenosis: Effects of Angioplasty on Ambulatory Blood Pressure. A Retrospective Uncontrolled Single-Center Study. Hypertension 2019; 74:1516-1523. [PMID: 31656101 DOI: 10.1161/hypertensionaha.119.13393] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The effect of renal artery angioplasty on blood pressure in patients with true resistant hypertension and atherosclerotic renal artery stenosis has not been fully investigated due to the exclusion of these patients from most trials. In this study, we assessed the benefits of renal angioplasty on daytime ambulatory blood pressure (dABP) in this subgroup of patients. Medical records of our hypertension department were retrospectively analyzed from 2000 to 2016. Seventy-two patients were identified with resistant hypertension (dABP >135 or 85 mm Hg despite at least 3 antihypertensive drugs, including a diuretic) and atherosclerotic renal artery stenosis treated by angioplasty. Atherosclerotic renal artery stenosis was unilateral in 57 patients and bilateral in 15 patients. The mean age of the patients was 67.8±11.2 years; dABP was 157±16/82±10 mm Hg despite 4.0±1.0 antihypertensive treatments; estimated glomerular filtration rate was 52 (41-63) mL/min. After renal angioplasty, dABPM decreased by 14.0±17.3/6.4±8.7 mm Hg (P<0.001 for both), and the number of antihypertensive treatments decreased to 3.6±1.4 (P=0.002) with no significant change in estimated glomerular filtration rate. A high baseline systolic dABP and a low body mass index were independent predictors of systolic dABP changes. The decrease in dABP was confirmed in a subgroup of patients at one and 3 years of follow-up (N=31 and N=18 respectively, P≤0.001 for systolic and diastolic blood pressure at both visits). In this retrospective uncontrolled single-center study, angioplasty in patients with atherosclerotic renal artery stenosis and with true resistant hypertension significantly decreased dABP, reducing the need for antihypertensive treatment with no change in estimated glomerular filtration rate.
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Affiliation(s)
- Pierre-Yves Courand
- From the Université de Paris, INSERM, CIC1418, Hôpital Européen Georges-Pompidou, 75015, Paris, France (P.-Y.C., A.L., M.A.)
- Hôpital de la Croix-Rousse, Cardiology Department, Hospices Civils de Lyon, France and Université de Lyon, CREATIS UMR5220; INSERM U1044; INSA-Lyon; Université Claude Bernard Lyon 1, France (P.-Y.C.)
| | - Miriana Dinic
- Saint-Etienne University Hospital, Department of Nephrology and Renal Transplantation, France (M.D.)
| | - Aurélien Lorthioir
- From the Université de Paris, INSERM, CIC1418, Hôpital Européen Georges-Pompidou, 75015, Paris, France (P.-Y.C., A.L., M.A.)
- Hypertension Unit, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (A.L., G.B., N.D., M.A., L.A.)
| | - Guillaume Bobrie
- Hypertension Unit, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (A.L., G.B., N.D., M.A., L.A.)
| | - Christine Grataloup
- Department of Radiology, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (C.G., G.S., E.M.)
| | - Nicolas Denarié
- Hypertension Unit, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (A.L., G.B., N.D., M.A., L.A.)
| | - Gilles Soulat
- Université de Paris, INSERM UMR-970, Paris-Centre de Recherche Cardiovasculaire, Paris, France (G.S., E.M., M.S., M.A., L.A.)
| | - Elie Mousseaux
- Department of Radiology, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (C.G., G.S., E.M.)
- Université de Paris, INSERM UMR-970, Paris-Centre de Recherche Cardiovasculaire, Paris, France (G.S., E.M., M.S., M.A., L.A.)
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology Department, Vascular and Oncological Interventional Radiology Department, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (M.S.)
- Université de Paris, INSERM UMR-970, Paris-Centre de Recherche Cardiovasculaire, Paris, France (G.S., E.M., M.S., M.A., L.A.)
| | - Michel Azizi
- From the Université de Paris, INSERM, CIC1418, Hôpital Européen Georges-Pompidou, 75015, Paris, France (P.-Y.C., A.L., M.A.)
- Hypertension Unit, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (A.L., G.B., N.D., M.A., L.A.)
- Université de Paris, INSERM UMR-970, Paris-Centre de Recherche Cardiovasculaire, Paris, France (G.S., E.M., M.S., M.A., L.A.)
| | - Laurence Amar
- Hypertension Unit, AP-HP, Hôpital Européen Georges-Pompidou, 75015, Paris, France (A.L., G.B., N.D., M.A., L.A.)
- Université de Paris, INSERM UMR-970, Paris-Centre de Recherche Cardiovasculaire, Paris, France (G.S., E.M., M.S., M.A., L.A.)
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Abstract
The last years have seen substantial progress in primary aldosteronism (PA), which is the most common cause of secondary hypertension. Many programs have been established around the world to meet the needs in healthcare and the management of patients with PA according to published guidelines and clinical protocols. Systematic analysis of emerging data and meticulous scientific work have informed us on the molecular basis of the disease and helped to characterize hereditary forms of PA. Techniques have been developed to better diagnose PA and to establish genotype-phenotype relationships and their impact on hypertension. Studies have been undertaken to stratify patients for risk factors and to ensure quality of best medical treatment. This review focuses on some clinically relevant problems in characterizing autonomous aldosterone secretion and discusses testing and management strategies. Besides, this review puts the emphasis on some colorful studies not to pale soon beside an ever evolving painting background.
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Affiliation(s)
- Holger S Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
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Kaboré J, Metzger M, Helmer C, Berr C, Tzourio C, Massy ZA, Stengel B. Kidney Function Decline and Apparent Treatment-Resistant Hypertension in the Elderly. PLoS One 2016; 11:e0146056. [PMID: 26807712 PMCID: PMC4726557 DOI: 10.1371/journal.pone.0146056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/11/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cross-sectional studies show a strong association between chronic kidney disease and apparent treatment-resistant hypertension, but the longitudinal association of the rate of kidney function decline with the risk of resistant hypertension is unknown. METHODS The population-based Three-City included 8,695 participants older than 65 years, 4265 of them treated for hypertension. We estimated the odds ratios (OR) of new-onset apparent treatment-resistant hypertension, defined as blood pressure ≥ 140/90 mmHg despite use of 3 antihypertensive drug classes or ≥ 4 classes regardless of blood pressure, associated with the mean estimated glomerular filtration rate (eGFR) level and its rate of decline over 4 years, compared with both controlled hypertension and uncontrolled nonresistant hypertension with ≤ 2 drugs. GFR was estimated with three different equations. RESULTS Baseline prevalence of apparent treatment-resistant hypertension and of controlled and uncontrolled nonresistant hypertension, were 6.5%, 62.3% and 31.2%, respectively. During follow-up, 162 participants developed apparent treatment-resistant hypertension. Mean eGFR decline with the MDRD equation was 1.5±2.9 mL/min/1.73 m² per year: 27.7% of the participants had an eGFR ≥3 and 10.1% ≥ 5 mL/min/1.73 m² per year. After adjusting for age, sex, obesity, diabetes, and cardiovascular history, the ORs for new-onset apparent treatment-resistant hypertension associated with a mean eGFR level, per 15 mL/min/1.73 m² drop, were 1.23 [95% confidence interval 0.91-1.64] compared to controlled hypertension and 1.10 [0.83-1.45] compared to uncontrolled nonresistant hypertension; ORs associated with a decline rate ≥ 3 mL/min/1.73 m² per year were 1.89 [1.09-3.29] and 1.99 [1.19-3.35], respectively. Similar results were obtained when we estimated GFR with the CKDEPI and the BIS1 equations. ORs tended to be higher for an eGFR decline rate ≥ 5 mL/min/1.73 m² per year. CONCLUSION The speed of kidney function decline is associated more strongly than kidney function itself with the risk of apparent treatment-resistant hypertension in the elderly.
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Affiliation(s)
- Jean Kaboré
- Inserm U1018, CESP, Villejuif, France
- University Paris-Sud, University Paris-Saclay, Villejuif, France
- IRSS/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Marie Metzger
- Inserm U1018, CESP, Villejuif, France
- University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Catherine Helmer
- Inserm U897-Epidemiology-Biostatistic, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- Clinical Investigation Center – Clinical Epidemiology, Bordeaux, France
| | - Claudine Berr
- Inserm U1061, Montpellier, France, University Montpellier I, Montpellier, France
| | - Christophe Tzourio
- Inserm U897-Epidemiology-Biostatistic, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Ziad A. Massy
- Inserm U1018, CESP, Villejuif, France
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne Billancourt, France
- University Paris-Ouest-UVSQ, Paris, France
| | - Bénédicte Stengel
- Inserm U1018, CESP, Villejuif, France
- University Paris-Sud, University Paris-Saclay, Villejuif, France
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11
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iss, chy. [Hypertension in young obese patients must be investigated]. MMW Fortschr Med 2015; 157:11. [PMID: 26349700 DOI: 10.1007/s15006-015-3446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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12
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Folt DA, Evans KL, Brahmandam S, He W, Brewster PS, Yu S, Murphy TP, Cutlip DE, Dworkin LD, Jamerson K, Henrich W, Kalra PA, Tobe S, Thomson K, Holden A, Rayner BL, Grinfeld L, Haller ST, Cooper CJ. Regional and physician specialty-associated variations in the medical management of atherosclerotic renal-artery stenosis. ACTA ACUST UNITED AC 2015; 9:443-52. [PMID: 26051926 DOI: 10.1016/j.jash.2015.03.007] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/16/2015] [Accepted: 03/21/2015] [Indexed: 11/18/2022]
Abstract
For people enrolled in Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL), we sought to examine whether variation exists in the baseline medical therapy of different geographic regions and if any variations in prescribing patterns were associated with physician specialty. Patients were grouped by location within the United States (US) and outside the US (OUS), which includes Canada, South America, Europe, South Africa, New Zealand, and Australia. When comparing US to OUS, participants in the US took fewer anti-hypertensive medications (1.9 ± 1.5 vs. 2.4 ± 1.4; P < .001) and were less likely to be treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (46% vs. 62%; P < .001), calcium channel antagonist (37% vs. 58%; P < .001), and statin (64% vs. 75%; P < .05). In CORAL, the identification of variations in baseline medical therapy suggests that substantial opportunities exist to improve the medical management of patients with atherosclerotic renal-artery stenosis.
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Affiliation(s)
- David A Folt
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Kaleigh L Evans
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Sravya Brahmandam
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Wencan He
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Pamela S Brewster
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Shipeng Yu
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Timothy P Murphy
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Donald E Cutlip
- Department of Medicine, Harvard Clinical Research Institute, Boston, MA, USA
| | - Lance D Dworkin
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kenneth Jamerson
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - William Henrich
- The University of Texas Health Science Center, San Antonio, TX, USA
| | - Philip A Kalra
- Department of Medicine, Salford Royal Hospital NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Sheldon Tobe
- Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada
| | - Ken Thomson
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - Andrew Holden
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Brian L Rayner
- Department of Medicine, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa
| | - Liliana Grinfeld
- Department of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Steven T Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
| | - Christopher J Cooper
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Halim JM. [Arterial hypertension of renal origin]. Rev Prat 2015; 65:835-837. [PMID: 26298912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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16
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Brod J, Bahlemann J, Cachovan M, Dahlgrün HD, Hundeshagen H, Feldmann U. Haemodynamics of hypertension in chronic renal disease. Contrib Nephrol 2015; 8:100-8. [PMID: 891205 DOI: 10.1159/000400619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Farmelant MH, Burrows BA. Sensitivity and specificity of radioisotope renography in renovascular hypertension. Contrib Nephrol 2015; 11:105-9. [PMID: 699574 DOI: 10.1159/000401786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Effective drug therapy for hypertension modifies the urgency of establishing a diagnosis of renal arterial stenosis. The cost of establishing a diagnosis must be considered with other factors in determining the usefulness of renography in renovascular hypertension. Recently published studies estimate the cost effectiveness of this procedure based on some data from a cooperative study of renal vascular hypertension. The small but costly incidence of false positives contributes significantly to the total cost of patient screening. Careful attention to technical details that are presented here could reduce false positives without sacrificing the true positives. However, even with increased specificity economic considerations would indicate limiting a screening program to younger patients or those in whom a drug regimen is unsuccessful.
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18
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Mansell MA, Jones NF, Ziroyannis PN, Marson WS, Tucker SM. Measurement of urinary NAG and the detection of renovascular hypertension. Contrib Nephrol 2015; 11:202-4. [PMID: 699591 DOI: 10.1159/000401804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Bianchi C, Donadio C, Tramonti G, Calderazzi A, Camerini E, Michelassi PL. Comparison of sequential scintigraphy, rapid sequence pyelography and renography in the screening of renovascular hypertension. Contrib Nephrol 2015; 11:92-4. [PMID: 699601 DOI: 10.1159/000401783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Meurer KA, Tauchert M, Schröder A. Renin activity, renin secretion rate and renal hemodynamics as functional tests renovascular hypertension. Contrib Nephrol 2015; 3:38-44. [PMID: 1026368 DOI: 10.1159/000399379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Rosenthal J, Arlart I, Nadjafi AS, Vollmar J, Franz HE. Relevant diagnostic procedures in renovascular hypertension. Contrib Nephrol 2015; 3:30-7. [PMID: 1026367 DOI: 10.1159/000399378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The validity of invasive preoperative diagnostic procedures in patients with unilateral renovascular hypertension was assessed. A significant lowering of blood pressure following reconstructive surgery can be predicted if following stimulation with Dihydralazine the renal-venous renin ratio of the involved to the noninvolved kidney is at least 2.0. Furthermore, it is of importance to determine the renal perfusion rate in the contralateral non-stenotic kidney which should be within normal limits. If these two criteria are met then in the majority of cases surgical intervention in unilateral hypertension is meaningful.
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22
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Kim HA, Seo YI, Song YW. Four-week effects of allopurinol and febuxostat treatments on blood pressure and serum creatinine level in gouty men. J Korean Med Sci 2014; 29:1077-81. [PMID: 25120316 PMCID: PMC4129198 DOI: 10.3346/jkms.2014.29.8.1077] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to observe the effects of uric acid lowering therapy (UALT), febuxostat and allopurinol, on blood pressure (BP) and serum creatinine level. Post-hoc data were derived from a phase-III, randomised, double-blind, 4-week trial of male gouty patients that compared the safety and efficacy of febuxostat and allopurinol in adults with gout. The subjects were randomly assigned to one of five groups, 35-37 in each group (febuxostat: 40, 80, 120 mg/d; allopurinol: 300 mg/d; control group: placebo). Blood pressure and serum creatinine level were measured at baseline and at weeks 2 and 4. Diastolic BP and creatinine level had decreased significantly in the UALT groups compared to the control group at week 4. Diastolic BP had decreased significantly in the allopurinol group and serum creatinine level had decreased significantly in the febuxostat groups at week 4. After adjusting for confounding variables, serum uric acid changes were found to be significantly correlated with changes in serum creatinine level but were not associated with changes in systolic or diastolic BP. UALT in gouty subjects significantly decreased diastolic BP and serum creatinine level. Changes in uric acid were significantly correlated with those in serum creatinine level, suggesting the feasibility of renal function improvement through UALT in gouty men.
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Affiliation(s)
- Hyun Ah Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute for Skeletal Aging, Hallym University, Chunchun, Korea
| | - Young-Il Seo
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yeong W. Song
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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23
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Bo S, Gruden G, Charbonnier E, Martorana M, Gambino R, Cassader M, Gentile L, Cavallo-Perin P, Durazzo M. High-normal blood pressure and impaired renal function. A prospective study in a population-based cohort. Minerva Med 2014; 105:211-219. [PMID: 24988086] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The association between high-normal blood pressure and the impairment of renal function is highly controversial. We analysed the contribution of high-normal blood pressure on incident impaired renal function. METHODS The study was performed in a population-based cohort of 1307 subjects free of diabetes, cardiovascular and renal disease at baseline, who attended both at baseline and after 6-year follow-up a metabolic screening. The outcome was incident impaired renal function, defined as a glomerular filtration rate <60 mL/min/1.73 m2. RESULTS Incidence of impaired renal function was 2.5%, 4.5%, 8.7% and 10.8% in optimal, normal, high-normal blood pressure and hypertension, respectively. Adjusted relative odds ratio (OR) of impaired renal function were modelled using logistic regression analyses including multiple confounders. The adjusted OR were 1.6 (95% CI 0.5-5.0) for normal blood pressure, 3.4 (1.2-10.3) for high-normal blood pressure and 3.7 (1.3-10.7) for hypertension. Results were similar after excluding overweight or obese patients. CONCLUSION High-normal blood pressure is an independent predictor of impaired renal function. Trials are warranted to test if therapeutic intervention on blood pressure is justified also in subjects with high-normal blood pressure to preserve renal function.
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Affiliation(s)
- S Bo
- Department of Medical Science University of Turin, Turin, Italy -
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24
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Gazymov MM, Shamitov IP, Fillipov DS. [Diagnosis and treatment of patients with secondary arterial hypertension of adrenal and renal genesis]. Urologiia 2014:5-7. [PMID: 25211918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A multidisciplinary approach to the diagnosis and treatment of patients with symptomatic arterial hypertension enabled us to identify 154 patients with adrenal tumors. These patients underwent adrenalectomy for following reasons: pheochromocytoma--73 patients, aldosteronoma-- 43 patients, corticosteroma--22 patients, incidentalomas--16 patients. After surgery, stable normalization of blood pressure (BP) occurred in 84.4% of cases. Requirement of antihypertensive therapy was preserved in 15.6% cases, but blood pressure did not reach the preoperative levels in any of the treated patients. Among 81 patients with renal hypertension, 67 patients underwent balloon angioplasty with stent implantation. Cause of narrowing of renal artery was atherosclerotic lesion in 48 (71.6%) patients, fibromuscular dysplasia--in 18 (26.8 %) patients, and Takayasu's disease--in 12 year-old girl. In the immediate postoperative period, normalization of blood pressure was occurred in all patients who underwent surgery for renovascular hypertension.
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25
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Agarwal R, Sinha AD, Pappas MK, Ammous F. Chlorthalidone for poorly controlled hypertension in chronic kidney disease: an interventional pilot study. Am J Nephrol 2014; 39:171-82. [PMID: 24526255 DOI: 10.1159/000358603] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 11/19/2022]
Abstract
To test the hypothesis that thiazide-type diuretics effectively lower blood pressure (BP) in moderate to advanced chronic kidney disease (CKD; estimated GFR 20-45 ml/min/ 1.73 m(2)), after confirming poorly controlled hypertension with 24-hour ambulatory BP monitoring, chlorthalidone was added to existing medications in a dose of 25 mg/day, and the dose doubled every 4 weeks if the BP remained elevated. The average age of the 14 subjects was 67.5 years, a median of 4 antihypertensive drugs were used and estimated GFR was 26.8 ± 8.8 ml/min/1.73 m(2). Twelve subjects completed the 12-week treatment phase, and the 24-hour BP, which was 143.1/75.1 mm Hg at baseline, was reduced by 10.5/ 3.1 mm Hg (p = 0.01/p = 0.17). Home BP prior to initiating chlorthalidone was 152.4/82.6 mm Hg and fell at 4, 8, and 12 weeks by 10.2/4.8, 13.4/6.0, and 9.4/3.7 mm Hg (all p < 0.05). Maximal reduction in body weight and total body volume (measured by air displacement plethysmography) was seen at 8 weeks, concurrent with the maximal elevation in serum creatinine concentration and plasma renin activity. Albuminuria was significantly reduced by 40-45%. Adverse events were seen following chlorthalidone therapy in 7 subjects who experienced 18 events as follows: hypokalemia (n = 4), hyperuricemia (4), hyponatremia (3), transient creatinine changes (3), dizziness (2), hyperglycemia (1), and constipation (1). One subject had ischemic stroke during the study. In conclusion, among people with moderate to advanced CKD with poorly controlled hypertension, chlorthalidone may significantly reduce BP via volume contraction; a randomized trial is needed to define the risks and benefits. Adverse effects may occur within a few weeks and should be carefully monitored.
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Affiliation(s)
- Rajiv Agarwal
- Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Ind., USA
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26
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Kamide K, Rakugi H, Nagasawa Y, Tamura N, Sone M. [Report from Kinki Chapter Educational Seminar: strategies to diagnose major secondary hypertensions]. Nihon Naika Gakkai Zasshi 2014; 103:188-197. [PMID: 24605508 DOI: 10.2169/naika.103.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Kei Kamide
- Department of Geroatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Japan
| | - Hiromi Rakugi
- Department of Geroatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Japan
| | - Yasuyuki Nagasawa
- Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Japan
| | - Naohisa Tamura
- Department of Endocrinology and Diabetes, Koseikai Takeda Hospital, Japan
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan
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Liu W, Xiong XJ, Wang J. [Progress of diagnosis and treatment of hypertensive renal damage by Chinese medicine]. Zhongguo Zhong Yao Za Zhi 2014; 39:14-19. [PMID: 24754161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypertensive renal damage is based on the extent and duration of hypertension, renal damage caused by varying severity. Hypertensive renal damage due to various causes imbalance of vascular active substances, renal arteriosclerosis, so that the abnormal renal hemodynamic, renal ischemia, low specific gravity of urine, low osmotic pressure and urine. The rapidly increasing incidence of hypertensive renal damage has become one of the most important reasons of end stage renal disease (ESRD). Effective treatment of hypertension is limited by poor compliance and significant adverse reaction of antihypertensive drugs. Therefore, some patients have turned to Chinese medicine (CM), hoping that such treatments might improve the efficiency. The author reviews relevant theory and the latest researches, on the basis of combining diseases and syndrome, discusses state and achievement of hypertensive renal damage with Chinese herbal medicines from fundamental and clinical research and action mechanism from standpoints of Chinese herbal compound and herbal effective chemical composition to take future research for important reference.
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28
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Weis L, Metzger M, Haymann JP, Thervet E, Flamant M, Vrtovsnik F, Gauci C, Houillier P, Froissart M, Letavernier E, Stengel B, Boffa JJ. Renal function can improve at any stage of chronic kidney disease. PLoS One 2013; 8:e81835. [PMID: 24349134 PMCID: PMC3862566 DOI: 10.1371/journal.pone.0081835] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/28/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction Even though renal function decline is considered relentless in chronic kidney disease (CKD), improvement has been shown in patients with hypertensive nephropathy. Whether this can occur in any type of nephropathy and at any stage is unknown as are the features of patients who improve. Methods We identified 406 patients in the NephroTest cohort with glomerular filtration rates (mGFR) measured by 51Cr-EDTA clearance at least 3 times during at least 2 years of follow-up. Individual examination of mGFR trajectories by 4 independent nephrologists classified patients as improvers, defined as those showing a sustained mGFR increase, or nonimprovers. Twelve patients with erratic trajectories were excluded. Baseline data were compared between improvers and nonimprovers, as was the number of recommended therapeutic targets achieved over time (specifically, for systolic and diastolic blood pressure, proteinuria, and use of renin angiotensin system blockers). Results Measured GFR improved over time in 62 patients (15.3%). Their median mGFR slope was +1.88[IQR 1.38, 3.55] ml/min/year; it was −2.23[−3.9, −0.91] for the 332 nonimprovers. Improvers had various nephropathies, but not diabetic glomerulopathy or polycystic kidney disease. They did not differ from nonimprovers for age, sex, cardiovascular history, or CKD stage, but their urinary albumin excretion rate was lower. Improvers achieved significantly more recommended therapeutic targets (2.74±0.87) than nonimprovers (2.44±0.80, p<0.01). They also had fewer CKD-related metabolic complications and a lower prevalence of 25OH-vitamin-D deficiency. Conclusion GFR improvement is possible in CKD patients at any CKD stage through stage 4–5. It is noteworthy that this GFR improvement is associated with a decrease in the number of metabolic complications over time.
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Affiliation(s)
- Lise Weis
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France
| | - Marie Metzger
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, CESP, Villejuif, France
- UMRS 1018, Univ Paris-Sud, Villejuif, France
| | - Jean-Philippe Haymann
- Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
- INSERM UNIT 702, Paris, France
- UMR S 702, Univ Pierre et Marie Curie-Paris 6, Paris, France
| | - Eric Thervet
- Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- UMR S 775, Univ Paris Descartes, Paris, France
| | - Martin Flamant
- Department of Physiology, AP-HP, Hôpital Bichat, Paris, France
| | | | - Cédric Gauci
- Department Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Pascal Houillier
- UMR S 775, Univ Paris Descartes, Paris, France
- Department Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Froissart
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, CESP, Villejuif, France
- UMR S 775, Univ Paris Descartes, Paris, France
- Department Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Emmanuel Letavernier
- Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
- INSERM UNIT 702, Paris, France
- UMR S 702, Univ Pierre et Marie Curie-Paris 6, Paris, France
| | - Bénédicte Stengel
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, CESP, Villejuif, France
- UMRS 1018, Univ Paris-Sud, Villejuif, France
| | - Jean-Jacques Boffa
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France
- INSERM UNIT 702, Paris, France
- UMR S 702, Univ Pierre et Marie Curie-Paris 6, Paris, France
- * E-mail:
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Menown IBA. 2013: The year of renal denervation? Adv Ther 2013; 30:1038-40. [PMID: 24338708 PMCID: PMC3898390 DOI: 10.1007/s12325-013-0082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ian B A Menown
- Interventional Cardiology, Craigavon Cardiac Centre, Southern Trust, Northern Ireland, BT63 5QQ, UK,
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30
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Brothwell S, Dutton M, Ferro C, Stringer S, Cockwell P. Optimising the accuracy of blood pressure monitoring in chronic kidney disease: the utility of BpTRU. BMC Nephrol 2013; 14:218. [PMID: 24112304 PMCID: PMC3852944 DOI: 10.1186/1471-2369-14-218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 10/20/2012] [Accepted: 09/11/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Accurate blood pressure monitoring is critical for the management of chronic kidney disease, but changes in management in secondary care clinics may be based on a single blood pressure reading, with a subsequent lack of accuracy. The aim of this study was to evaluate a fully automated sphygmomanometer for optimising the accuracy of blood pressure measurements in the setting of secondary care renal clinics. METHODS Patients had routine blood pressure measurements with a calibrated DINAMAP PRO400 monitor in a clinical assessment room. Patients then underwent repeat assessment with a DINAMAP PRO400 monitor and BpTRU device and subsequent 24 hour ambulatory blood pressure monitoring (ABPM). RESULTS The BpTRU systolic (± SD) reading (117.3 ± 14.1 mmHg) was significantly lower than the routine clinic mean systolic blood pressure (143.8 ± 15.5 mmHg; P < 0.001) and the repeat blood pressure taken with a DINAMAP PRO400 monitor in a quiet room (129.9 ± 19.9 mmHg; P < 0.001). The routine clinic mean diastolic (82.4 ± 11.2 mmHg) was significantly higher than the BpTRU reading (78.4 ± 10.0 mmHg; P < 0.001). Clinic BpTRU measurements were not significantly different to the daytime mean or overall mean of 24 hour ABPM. CONCLUSIONS In patients with CKD, routine clinic blood pressure measurements were significantly higher than measurements using a BpTRU machine in a quiet room, but there was no significant difference in this setting between BpTRU readings and 24 hour ABPM. Adjusting clinic protocols to utilise the most accurate blood pressure technique available is a simple manoeuvre that could deliver major improvements in clinical practice.
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Affiliation(s)
- Shona Brothwell
- Division of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mary Dutton
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Charles Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Division of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie Stringer
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Division of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Division of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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31
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Mitchell A. [Arterial hypertension and chronic kidney disease]. MMW Fortschr Med 2013; 155:55-57. [PMID: 24340391 DOI: 10.1007/s15006-013-2231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- A Mitchell
- Klinik für Nephrologie, universitätsklinikum Essen.
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32
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Shiraishi N, Tomita K. [Progressive renal diseases: recent advances in diagnosis and treatments. Topics: III. Recent topics; 3. Nephrosclerosis]. Nihon Naika Gakkai Zasshi 2013; 102:1180-1189. [PMID: 23847984 DOI: 10.2169/naika.102.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Naoki Shiraishi
- Department of Nephrology, Kumamoto University Graduate School of Life Sciences, Japan
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Abstract
A young man presented with severe hypertension with evidence of both neurological and cardiovascular end-organ damage. Investigation revealed a small right kidney and a left renal artery aneurysm. Significant hypertension persisted even after right nephrectomy. Despite extensive investigation, no evidence was found to implicate the aneurysm in the causation of his high blood pressure. No alternative cause for hypertension was found, yet blood pressure was high even during hospital admission and observed medication dosing with eight antihypertensive agents. Sustained hypertension resulted in worsening left ventricular hypertrophy and he died suddenly at a tragically young age several years after presentation. This gentleman had truly resistant hypertension, a clinical problem which can be very difficult to manage.
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MESH Headings
- Adult
- Aneurysm/complications
- Aneurysm/diagnosis
- Angiography
- Antihypertensive Agents/adverse effects
- Antihypertensive Agents/therapeutic use
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 2/genetics
- Death, Sudden, Cardiac/etiology
- Diagnosis, Differential
- Drug Resistance
- Drug Therapy, Combination
- Genetic Carrier Screening
- Humans
- Hypertension/drug therapy
- Hypertension/genetics
- Hypertension, Renal/diagnosis
- Hypertension, Renal/drug therapy
- Hypertension, Renovascular/diagnosis
- Hypertension, Renovascular/drug therapy
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/drug therapy
- Kidney/abnormalities
- Male
- Translocation, Genetic/genetics
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Affiliation(s)
- Cate Goodlad
- Department of Nephrology, North Middlesex Hospital, London, UK.
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Malatino L, Stancanelli B, Giannakakis C, Marcantoni C. [Hypertensive nephrosclerosis: an exhaustive diagnosis?]. G Ital Nefrol 2012; 29:650-654. [PMID: 23229662] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hypertensive nephrosclerosis is a much overused clinical diagnosis, largely unsubstantiated by biopsy data. It is in fact a clinical-pathological diagnosis implying a causal role of hypertension in the associated chronic kidney disease. However, such a simple, linear causality is often not obvious or easy to demonstrate. Further factors like age, Afro-American descent, genetic and immunological factors as well as dysmetabolic syndrome may contribute to the development and progression of arterionephrosclerosis independently of hypertension.
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Affiliation(s)
- Lorenzo Malatino
- Dipartimento di Scienze Mediche e Pediatriche, Universita' di Catania, Catania, Italy
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35
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Tenisch E, Uldry E, Meuwly JY, Becce F. Bilateral subcapsular urinomas: an uncommon cause of Page kidney with renal failure. Ultraschall Med 2012; 33:113-116. [PMID: 22639761 DOI: 10.1055/s-0031-1274824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/etiology
- Acute Kidney Injury/therapy
- Adult
- Diagnosis, Differential
- Drainage
- Female
- Humans
- Hypertension, Renal/diagnosis
- Hypertension, Renal/etiology
- Hypertension, Renal/therapy
- Ischemia/complications
- Ischemia/diagnosis
- Ischemia/therapy
- Kidney Cortex/blood supply
- Kidney Diseases/complications
- Kidney Diseases/diagnosis
- Kidney Diseases/therapy
- Renin/blood
- Sensitivity and Specificity
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Pulsed
- Ultrasonography, Interventional
- Urinoma/complications
- Urinoma/diagnosis
- Urinoma/therapy
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Affiliation(s)
- Estelle Tenisch
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne
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36
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37
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Aumiller J. [German Hypertension Society: update on the management of hypertension]. MMW Fortschr Med 2012; 154:69-70. [PMID: 22642011 DOI: 10.1007/s15006-012-0041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Mann WA, Diederich S. [Secondary hypertension: current screening procedures]. MMW Fortschr Med 2011; 153:39-41. [PMID: 22263292 DOI: 10.1007/bf03369260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Okubo R, Tsuruoka S. [Series: Let's think-clinical quiz (question); a 66 year-old man whose blood pressure control worsened recently]. Nihon Naika Gakkai Zasshi 2011; 100:2312-2340. [PMID: 21899168 DOI: 10.2169/naika.100.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Reiko Okubo
- Department of Nephrology, University of Tsukuba, Japan
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Zidek W. [Value of microalbuminuria in diagnostics of hypertension]. MMW Fortschr Med 2011; 153:44-45. [PMID: 21644361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Chaudhary K, Botdorf J, Whaley-Connell A. Atherosclerotic renovascular hypertension: current trends in diagnosis and management. Mo Med 2011; 108:37-41. [PMID: 21462609 PMCID: PMC6188447] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Reno vascular hypertension (RVH) is an important challenge for clinicians managing patients with hypertension. With recent advances in imaging techniques, the diagnosis and recognition of Renal artery stenosis (RAS) has increased resulting in a 3-4 fold increase in endovascular procedures. Recent prospective, randomized trials have demonstrated equivocal results for interventions and a third trial is under way. In managing such patients, clinicians need to consider the risk-benefit of expensive and invasive workup and interventions.
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Affiliation(s)
- Kunal Chaudhary
- Department of Internal Medicine, Division of Nephrology, University of Missouri School of Medicine, USA.
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Dunlap P, Salinas RC, Welborn T. Question: Should patients who have a significant increase in BUN or creatinine (more than 30% above baseline) in response to an ACEI or ARB be tested for renal stenosis? J Okla State Med Assoc 2010; 103:545-546. [PMID: 21319588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Felício JS, de Souza ACCB, Kohlmann N, Kohlmann O, Ribeiro AB, Zanella MT. Nocturnal blood pressure fall as predictor of diabetic nephropathy in hypertensive patients with type 2 diabetes. Cardiovasc Diabetol 2010; 9:36. [PMID: 20704750 PMCID: PMC2928765 DOI: 10.1186/1475-2840-9-36] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/13/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertensive patients with reduced blood pressure fall (BPF) at night are at higher risk of cardiovascular events (CVE). METHODS We evaluated in hypertensive diabetic patients, if a reduced nocturnal BPF can precedes the development of diabetic nephropathy (DN). We followed 70 patients with normal urinary albumin excretion (UAE) for two years. We performed 24-hours ambulatory BP monitoring in baseline and at the end of the study. RESULTS Fourteen (20%) patients (GI) developed DN (N = 11) and/or CVE (n = 4). Compared to the remaining 56 patients (GII) in baseline, GI had similar diurnal systolic (SBP) and diastolic BP (DBP), but higher nocturnal SBP (138 +/- 15 vs 129 +/- 16 mmHg; p < 0.05) and DBP (83 +/- 12 vs 75 +/- 11 mmHg; p < 0,05). Basal nocturnal SBP correlated with occurrence of DN and CVE (R = 0.26; P < 0.05) and with UAE at the end of the study (r = 0.3; p < 0.05). Basal BPF (%) correlated with final UAE (r = -0.31; p < 0.05). In patients who developed DN, reductions occurred in nocturnal systolic BPF (12 +/- 5 vs 3 +/- 6%, p < 0,01) and diastolic BPF (15 +/- 8 vs 4 +/- 10%, p < 0,01) while no changes were observed in diurnal SBP (153 +/- 17 vs 156 +/- 16 mmHg, NS) and DBP (91 +/- 9 vs 90 +/- 7 mmHg, NS). Patients with final UAE < 20 microg/min, had no changes in nocturnal and diurnal BP. CONCLUSIONS Our results suggests that elevations in nocturnal BP precedes DN and increases the risk to develop CVE in hypertensive patients with T2DM.
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Affiliation(s)
- João S Felício
- Endocrinology Division - UFPA - Universidade Federal do Pará, Belém, Brazil
| | | | - Nárcia Kohlmann
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Oswaldo Kohlmann
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arthur B Ribeiro
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria T Zanella
- Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
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Mena C, Robles NR, de Prado JM, Gallego FG, Cidoncha A. Cystatin C and blood pressure: results of 24 h ambulatory blood pressure monitoring. Eur J Intern Med 2010; 21:185-90. [PMID: 20493420 DOI: 10.1016/j.ejim.2010.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 01/25/2010] [Accepted: 01/29/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND The relationship between kidney function and blood pressure (BP) components has been studied in chronic kidney disease patients. Whether cystatin C, a marker of kidney function, is associated in the normal range with systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) obtained using ambulatory blood pressure monitoring has not been previously studied. METHODS The sample subjects were 53 males and 34 females, mean age was 59.3+/-13.5 years. 76% were receiving antihypertensive drug treatment. Kidney function was evaluated by measuring serum cystatin C. Microalbuminuria was measured in a 24h urine collection. Glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease equations. The ambulatory BP was measured non-invasively for 24h by the Spacelab devices programmed to measure BP every 15 min during daytime and every 20 min during nighttime. RESULTS The highest quartile of cystatin C distribution showed an older age and worsel parameters of renal function (cystatin C, serum creatinine and GFR) than the other groups. No differences for gender or diabetes were found. 24h SBP and PP were higher in the fourth quartile compared to the fist one (p<0.01). 24h DBP was lower for the patients in the fourth quartile of cystatin C compared which any one of the other groups (p<0.001). The relationship between cystatin C, as well as GFR, with SBP and PP was statistically significant as renal function comes down. Contrariwise, as cystatin C increases DBP declines; but the correlation with GFR measured through MDRD 4 is not significant. In the same way, no correlation was found for GFR and microalbuminuria, but there was a statistically significant positive relationship between cystatin C and microalbuminuria severity (p<0.01). Multivariate regression analysis confirms these findings. CONCLUSIONS Both SBP and pulse pressure were significantly associated with kidney function. DBP was negatively correlated with cystatin C concentrations but not with GFR. Cystatin C shows a positive relationship with microalbuminura severity. Cystatin C might have cardiovascular effects beyond its use as a marker of the renal function.
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Affiliation(s)
- C Mena
- Centro de Salud de Don Benito, Badajoz, Spain
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Wijaya I, Siregar P. Hypertensive crises in adolescent. Acta Med Indones 2010; 42:108. [PMID: 20513937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Indra Wijaya
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia - dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia
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Nihtyanova SI, Tang EC, Coghlan JG, Wells AU, Black CM, Denton CP. Improved survival in systemic sclerosis is associated with better ascertainment of internal organ disease: a retrospective cohort study. QJM 2010; 103:109-15. [PMID: 19966313 DOI: 10.1093/qjmed/hcp174] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) has high mortality and morbidity. Current management focuses on early detection and treatment of organ-based manifestations. AIM To determine whether the ascertainment of major organ complications of SSc has changed over time and if this is associated with better survival. DESIGN Retrospective cohort analysis. METHODS A total of 520 SSc patients, 234 with disease onset between 1990 and 1993 (historical cohort) and 286 with disease onset between 2000 and 2003 (contemporary cohort), were included. Survival and frequency of internal organ complications were compared between the two cohorts. RESULTS Five-year survival among diffuse cutaneous SSc (dcSSc) patients has improved from 69% in the 1990-93 cohort to 84% in the 2000-03 cohort (P = 0.018), whereas 5-year survival among the limited cutaneous SSc (lcSSc) patients has remained unchanged-93 and 91%, respectively. Sixteen per cent of the lcSSc subjects and 38% of the dcSSc subjects from the contemporary cohort were diagnosed for the clinically significant pulmonary fibrosis compared with 3 and 7%, respectively, of the historical cohort (P < 0.001). Similarly, the diagnosis of pulmonary arterial hypertension was more frequent in the patients from the contemporary cohort (8 and 7% for lcSSc and dcSSc, respectively) compared with [ < 1% (P = 0.002) and 1% (P = 0.148), respectively] the historical cohort. There was no significant difference between the two cohorts in terms of scleroderma renal crisis and cardiac involvement. CONCLUSION Survival has substantially improved for the diffuse cutaneous subset of SSc with better and more complete ascertainment of lung complications as a result of systematic annual screening.
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Affiliation(s)
- S I Nihtyanova
- Centre for Rheumatology, Royal Free Hospital, London NW3 2QG, UK
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Koshlia VI, Klitsunova IO. [Variability of cardiac rhythm in patients with a symptomatic renal hypertension and effect of ramipril on its changes]. Lik Sprava 2010:49-52. [PMID: 20614511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Variability of cardiac rhythm and influence of Ramipril on it have been studied in 31 patients with a secondary renal hypertension of 1 and 2 stages. Obtained data have shown, that treatment with Ramipril normalizes neurohumoral regulation at the expense of decrease of excessive sympathetic stimulation and decrease of peripheral parasympathetic insufficiency rate. All above mentioned changes were accompanied by reduction in frequency and grade of blood pressure increase and improvement in tolerance to physical activity.
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Morović-Vergles J, Culo MI, Kaliterna DM. [Scleroderma renal crisis]. Reumatizam 2010; 57:109-111. [PMID: 21875014] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Systemic sclerosis (SSc) is a multisystem disease whose clinical manifestations result from inflammation, vascular injury and obliteration, and cutaneous and visceral fibrosis. Scleroderma renal crisis (SRC) occurs in 5% of patients with particullary diffuse form of SSc. It is characterized by malignant hypertension and oligo/ anuric acute renal failure. SRC was once a uniformly fatal complication of SSc. The prognosis of SRC has significantly improved with the introduction of angiotensin-converting enzyme inhibitors (ACEi) as treatment. The treatment of SRC relies on tight control of blood pressure and aggressive treatment with ACEi, if needed in combination with other types of antihypertensive drugs.
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Abstract
BP control in diabetic patients is often poor. The contribution of secondary hypertension due to undiagnosed PA in hypertensive type 2 diabetic patients is not well studied. We prospectively screened 100 consecutive Asian type 2 diabetic patients with difficult-to-control or resistant hypertension for PA. PAC (pmol/L) to PRA (ng/mL/h) ratio was measured; those with PAC-to-PRA ratio >550 (corresponding PAC >415) underwent intravenous 0.9% SLT. Patients with PAC >/=140 following SLT had CT adrenals and bilateral AVS. Thirteen patients (13%) were confirmed to have PA, and all had resistant hypertension. Eight had a surgically correctable form of PA. Patients with PA had higher mean (SD) systolic [159.0 (10.6) vs. 146.0 (10.7) mmHg, p=0.001] and diastolic BP [94.6 (6.0) vs. 87.6 (5.9) mmHg, p=0.001], lower serum potassium [3.5 (0.6) vs. 4.3 (0.5) mmol/L, p=0.001], and higher PAC [679.3 (291.0) vs. 239.5 (169.4) pmol/L, p=0.001]. Identification and institution of definitive treatment for PA resulted in better BP control and in a reduction in the use of antihypertensive medications. Our findings demonstrate a high prevalence of PA in type 2 diabetic patients with resistant hypertension. Systematic screening for PA in this select group is recommended, as targeted treatment improves BP control.
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Affiliation(s)
- J J Mukherjee
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
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Agarwal R, Kariyanna SS, Light RP. Circadian blood pressure classification scheme and the health of patients with chronic kidney disease. Am J Nephrol 2009; 30:536-46. [PMID: 19844085 DOI: 10.1159/000252774] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 09/15/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND In health, a sinusoidal rhythm is observed in systolic blood pressure (BP) that peaks (acrophase) during the waking hours (in-phase), but in those with chronic kidney disease (CKD) the acrophase is often observed during sleeping hours (out-of-phase). Yet in others the amplitude of the variation may be so blunted that acrophase may not be definable (phase-less). Circadian rhythms in systolic BP are often described by the dichotomous dipper classification but may not be adequate to fully characterize derangements in cyclical variation in BP. METHODS To compare classification of circadian BP variation by phase-based classification to dipper-status we examined the cross-sectional relationship of these classification patterns to several markers of health such as health-related quality of life (Kidney Disease Quality of Life Survey, KDQOL) and physical activity (actigraphy over 2 weeks). We also assessed the relationship of circadian BP variation with circadian variation in urine electrolyte and albumin excretion rates. RESULTS Among 103 veterans with CKD (97% men, age 69, diabetes mellitus 30%, eGFR 38.8 ml/min/1.73 m(2)) no differences were seen between dippers and non-dippers (n = 77, 75%) in eGFR, urinary Na and Cl excretion rates, or KDQOL. However, non-dippers had lower levels of physical activity and greater albuminuria compared to dippers. The same patients were classified to be in-phase (n = 36, 35%), phase-less (n = 19, 18%) or out-of-phase (n = 48, 47%). Patients in-phase had a higher eGFR and somewhat surprisingly also had the highest Na and Cl excretion rates compared to others. Those with out-of-phase systolic BP had the lowest physical composite score on KDQOL, the lowest level of physical activity, and the greatest amount of albuminuria. CONCLUSIONS Among patients with CKD, circadian BP profile described by either dipper-based or phase-based classification is related to the level of physical activity and the severity of kidney damage. The circadian BP profile is related to overall health and nutritional intake only when using the phase-based classification. The value of these classification schemes to profile circadian BP will require longitudinal studies.
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Affiliation(s)
- Rajiv Agarwal
- Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Ind. 46202, USA.
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