Chronic kidney damage pathology score for systematic assessment of the non-neoplastic kidney tissue and prediction of post-operative renal function outcomes.

To establish a systematic histological assessment of non-neoplastic kidney (NNK) tissue at the time of nephrectomy to evaluate a patient's risk of developing post-operative renal dysfunction, a combined prospective pathologic assessment of the NNK and a retrospective clinical chart review was conducted. A blinded nephropathologist performed standardized assessment of glomerular sclerosis, tubulointerstitial fibrosis, arteriosclerosis, and hyaline arteriolosclerosis. Combined these formulated the chronic kidney damage pathology score (CKDPS). Multivariate logistic regression models were developed to assess the effect of CKDPS and other clinical factors on renal function up to 24 months following nephrectomy (partial or radical). 156 patients were included in the analysis with a median age of 60 years. 70% patients underwent radical nephrectomy. A history of hypertension and/or diabetes was present in 55.8% and 22.1%, respectively. Higher CKDPS (particularly glomerular global sclerosis and arteriosclerosis scores), radical nephrectomy, and reduced baseline estimated glomerular filtration rate (eGFR) were associated with worsening post-operative renal function outcomes. The systematic assessment of non-neoplastic kidney tissue at the time of renal surgery can help identify patients at risk of post-operative renal dysfunction. CKDPS represents a standardized and prognostically relevant histologic reporting system for non-neoplastic kidney tissue.

Standards for global cardiovascular risk management arteriosclerosis. / Estándares SEA 2019 para el control global del riesgo cardiovascular.

One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation.

Arteriosclerosis and vascular calcification: causes, clinical assessment and therapy.

BACKGROUND: Arteriosclerosis is a pathological, structural (media vascular calcification) and physiological (modified vascular smooth vessel cells; increased arterial stiffness) alteration of the vessel wall. Through improved assessment methods (functional and imaging), it has become a well-known phenomenon in recent decades. However, its clinical importance was underestimated until recently. MATERIALS AND METHODS: Currently available English-speaking data about conditions/diseases associated with arteriosclerosis, its clinical sequels, available diagnostic procedures and therapeutic modalities were reviewed and summarized. RESULTS: In recent decades, emerging data have brought about a better understanding of causes and consequences of arteriosclerosis and highlight its growing clinical impact. CONCLUSION: Although arteriosclerosis showed an independent clinical impact on cardiovascular morbidity and mortality, especially in patients with chronic kidney disease/end-stage renal disease (CKD/ESRD) and diabetes mellitus, convincing clinical therapy concepts are not available until now. The establishment of novel therapeutic strategies derived from basic research is strongly needed.

Assessment of endothelial dysfunction: the role of symmetrical dimethylarginine and proinflammatory markers in chronic kidney disease and renal transplant recipients.

OBJECTIVES: The study was designed to evaluate associations between symmetric dimethylarginine (SDMA), inflammation, and superoxide anion (O2∙-) with endothelial function and to determine their potential for screening of endothelial dysfunction in patients with chronic kidney disease (CKD) and renal transplant (RT) recipients. MATERIALS AND METHODS: We included 64 CKD and 52 RT patients. Patients were stratified according to brachial artery flow-mediated dilation (FMD). RESULTS: Logistic regression analysis showed that high SDMA and high sensitive C-reactive protein (hs-CRP) were associated with impaired FMD in CKD and RT patients, after adjustment for glomerular filtration rate. The ability of inflammation, SDMA, and O2∙- to detect impaired FMD was investigated by receiving operative characteristic analysis. Hs-CRP (area under the curves (AUC) = 0.754, P < 0.001), IL-6 (AUC = 0.699, P = 0.002), and SDMA (AUC = 0.689, P = 0.007) had the highest ability to detect impaired FMD. SDMA in combination with inflammatory parameters and/or O2∙- had better screening performance than SDMA alone. CONCLUSIONS: Our results indicate a strong predictable association between hs-CRP, SDMA, and endothelial dysfunction in CKD patients and RT recipients. The individual marker that showed the strongest discriminative ability for endothelial dysfunction is hs-CRP, but its usefulness as a discriminatory marker for efficient diagnosis of endothelial dysfunction should be examined in prospective studies.

[Why should vascular patients have a dietary assessment?]. / Pourquoi devons-nous évaluer l'alimentation des sujets à risque vasculaire ?

Vascular diseases are a major health problem in Western countries. Coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) share many common risk factors such as age, smoking, dyslipidemia, and diabetes. Although the dietary pattern is considered as a risk factor for CHD, the impact of dietary pattern on stroke and PAD is debated. However, new studies showed that dietary pattern could also be considered as a risk factor in stroke and PAD. Dietary pattern should be evaluated in vascular patients and new tools of dietary assessment must be developed for a better prevention of vascular disease.

Visceral adipose tissue, a potential risk factor for carotid atherosclerosis: results of the Multicultural Community Health Assessment Trial (M-CHAT).

BACKGROUND AND PURPOSE: The association between abdominal obesity and atherosclerosis is believed to be due to excess visceral adipose tissue (VAT), which is associated with traditional risk factors. We hypothesized that VAT is an independent risk factor for atherosclerosis. METHODS: Healthy men and women (N=794) matched for ethnicity (aboriginal, Chinese, European, and South Asian) and body mass index range (<25, 25 to 29.9, or > or =30 kg/m(2)) were assessed for VAT (by computed tomography scan), carotid atherosclerosis (by ultrasound), total body fat, cardiovascular risk factors, lifestyle, and demographics. RESULTS: VAT was associated with carotid intima-media thickness (IMT), plaque area, and total area (IMT area and plaque area combined) after adjusting for demographics, family history, smoking, and percent body fat in men and women. In men, VAT was associated with IMT and total area after adjusting for insulin, glucose, homocysteine, blood pressure, and lipids. This association remained significant with IMT after further adjustment for either waist circumference or the waist-to-hip ratio. In women, VAT was no longer associated with IMT or total area after adjusting for risk factors. CONCLUSIONS: VAT is the primary region of adiposity associated with atherosclerosis and likely represents an additional risk factor for carotid atherosclerosis in men. Most but not all of this risk can be reflected clinically by either the waist circumference or waist-hip ratio measures.

[Predictive significance of insulin resistance and metabolic syndrome for assessment of the degree of endothelium disfunction and early signs of atherosclerotic lesion].

The contribution of the clinical or laboratory risk factors associated with the metabolic syndrome to the changes in peripheral vascular reactions and to the natural history of atherosclerosis has not been established until now. The aim of the work was to study interrelations between the risk factors entering the symptom complex of the metabolic syndrome, to assess their impact on endothelium-dependent vasodilatation and constrictor component of vascular reactivity as well as on the change in the thickness of the intima-media complex (TIMC) of the common carotid artery (CCA). The study accrued 122 practically normal men aged 35 to 50 years. Stepwise multiple regression analysis has established interrelations between the disorder of vasoregulating endothelium function and the intensity of atherosclerotic lesion according to the maximal value of the TIMC of the CCA, glucose concentration 120 min after glucose load, IMT, the signs of arterial hypertension. The data have been obtained that confirmed the hypothesis of the role played by endothelium dysfunction manifesting by the disturbance of vasoregulating function, as an early marker of atherosclerosis. Carbohydrate metabolism, tissue sensitivity to insulin and the presence of arterial hypertension were most significant predictive factors of the TIMC of the CCA and disorder of arterial wall function.

Effects of subchronic exposures to concentrated ambient particles in mice. IX. Integral assessment and human health implications of subchronic exposures of mice to CAPs.

In order to examine the biologic plausibility of adverse chronic cardiopulmonary effects in humans associated with ambient particulate matter (PM) exposure, we exposed groups of normal mice (C57) and knockout mice that develop atherosclerotic plaque (ApoE-/- and ApoE-/- LDLr-/-) for 6 h/day, 5 days/wk for 5 or 6 mo during the spring/summer of 2003 to either filtered air or 10-fold concentrated ambient particles (CAPs) in Tuxedo, NY (average PM2.5 concentration during exposure = 110 microg/m3). Some of the mice had implanted electrocardiographic monitors. We demonstrated that: (1) this complex interdisciplinary study was technically feasible in terms of daily exposure, collection of air quality monitoring data, the collection, analysis, and interpretation of continuous data on cardiac function, and the collection and analyses of tissues of the animals sacrificed at the end of the study; (2) the daily variations in CAPs were significantly associated, in ApoE-/- mice, with daily variations in cardiac functions; (3) there were significant differences between CAPs and sham-exposed ApoE-/- mice in terms of cardiac function after the end of exposure period, as well as small differences in atherosclerotic plaque density, coronary artery disease, and cell density in the substantia nigra in the brain in the ApoE-/- mice; (4) there are suggestive indications of gene expression changes for genes associated with the control of circadian rhythm in the ApoE-/- LDLr-/- double knockout (DK) mice. These various CAPs-related effects on cardiac function and the development of histological evidence of increased risk of clinically significant disease at the end of exposures in animal models of atherosclerosis provide biological plausibility for the premature mortality associated with PM2.5 exposure in human subjects and provide suggestive evidence for neurogenic disease as well.

Biological ageing: a fundamental, biological link between socio-economic status and health?

Socio-economic differences in health appear to be universal but the precise pathways that link socio-economic status and health remain unclear. Differential exposure to specific risk and protective factors are often cited as, at least, partial explanations of socio-economic differences in health. However, risk factors are culturally specific and risk factor-specific models of socio-economic differences in health may be inadequate: as soon as prevailing risk factors change, so too must associated explanations of socio-economic differences in health. An alternative, risk factor-independent, model of socio-economic differences in health proposes that fundamental pathways to health and disease exist and that risk and protective factors act by feeding into these pathways. We propose that biological ageing is one such fundamental pathway to health, disease and, thus, socio-economic differences in health. Biological ageing is the progressive decline in physiological ability to meet demands, that occurs over time. It is due to the accumulation of damage at the cellular level and the rate of biological ageing is determined by both environmental and genetic factors. There is increasing evidence that many known disease risk and protective factors influence the rate of cellular damage accumulation and hence biological ageing and that the pathogenesis of some important diseases is related to biological ageing. We discuss these issues and hypothesize that socio-economic differences in health are partly a result of poor people ageing faster than rich people due to the unhealthy environments to which they are exposed.

Tratamento clínico para pacientes hipercolesterolêmicos com doença arterial dos membros inferiores com base na qualidade de vida / Assessment of clinical treatment for hypercholesterolemic patients with lower extremity arterial disease based on their quality of life

Objetivo: Proceder a avaliação clínica de pacientes hipercolesterolêmicos e arteriopatas após tratamento médico com base na qualidade de vida. Método: No período de maio a dezembro de 1999, foram acompanhados 30 pacientes, divididos em três grupos distintos de maneira aleatória, sendo 19 homens(63,3 por cento) e 11 mulheres (33,6,6 por cento) com idade média de 59,9 anos, todos arteriopatase claudicantes. Cada grupo recebeu um tipo de tratamento distinto. O grupo I recebeu dieta hipocolesterolêmica e fisioterapia programada. O grupo II recebeu dieta hipercolesterolêmica, fisioterapia programada e sinvastatina na dose diária de 10 mg. O grupo III recebeu dieta livre, fisioterapia programada e sinvastatina na dose diária de 10 mg. Cada paciente respondeu um questionário relacionado à qualidade de vida. Resultados: Em todos os grupos avaliados, foi possível observar melhora nos níveis de colesterol total e suas frações, assim como na qualidade de vida dos pacientes. Conclusão: O grupo II foi o que melhor respondeu e o que teve melhor qualidade de vida ao final do tratamento.

Clinical review 168: What vascular ultrasound testing has revealed about pediatric atherogenesis, and a potential clinical role for ultrasound in pediatric risk assessment.

Coronary vascular disease is one facet of a generalized disturbance of vascular function present throughout the vascular tree. Dysfunction of the endothelium leads to thickening of the intima and media of the vessel wall of large and medium-sized muscular arteries and large elastic arteries, such as the aorta, carotid, and iliac arteries. Flow-mediated dilatation of the brachial artery is one of several tests used to assess dysfunction of the endothelium using high resolution ultrasound. Endothelial dysfunction has been demonstrated in children with heterozygous familial hypercholesterolemia, type 1 diabetes, morbid obesity, and homozygous homocystinuria and in the offspring of a parent with early coronary disease. High resolution ultrasound has also confirmed postmortem findings that atherogenesis has its beginnings in childhood and adolescence, with the demonstration of increased carotid artery intima-medial thickening in children with familial hypercholesterolemia, familial combined hyperlipidemia, and type 1 diabetes and in the offspring of a parent with early coronary disease. In combination with family history and traditional risk factors, ultrasound evaluation of brachial artery flow-mediated vasodilation and carotid artery intima-medial thickening could be used in a clinical setting to assess coronary risk in high risk pediatric patients.

Assessment of atherosclerotic risk factors and endothelial function in children and young adults with pediatric-onset systemic lupus erythematosus.

OBJECTIVE: To characterize atherosclerotic risk factors and endothelial function in pediatric-onset systemic lupus erythematosus (SLE). METHODS: Lipoproteins, oxidized state, and autoantibodies to oxidized low-density lipoprotein (Ox-LDL) were assessed. Endothelial function was evaluated using brachial artery reactivity. RESULTS: Thirty-three SLE patients and 30 controls were studied. SLE subjects had significantly decreased mean high-density lipoprotein (HDL) cholesterol (41 mg/dl versus 51 mg/dl; P = 0.002) and apolipoprotein A-I (97 mg/dl versus 199 mg/dl; P = 0.0004). There was no difference between groups in markers of oxidized state (including nitric oxide metabolites, isoprostanes, and Ox-LDL) or in endothelial function. However, SLE subjects had increased median anti-Ox-LDL IgG (2,480 relative light units [RLU] versus 1,567 RLU; P = 0.0007) and IgG immune complexes with LDL (4,222 RLU versus 2,868 RLU; P = 0.002). CONCLUSION: Pediatric SLE patients had significantly decreased levels of HDL cholesterol and apolipoprotein A-I and elevated titers of autoantibodies to Ox-LDL. Despite these atherosclerotic risk factors, SLE patients had normal measures of oxidized state and endothelial function.