Treino de Força Reduz Stress Oxidativo Cardíaco e Renal em Ratos com Hipertensão Renovascular / Strength Training Reduces Cardiac and Renal Oxidative Stress in Rats with Renovascular Hypertension

Resumo Fundamento O treino de força tem efeitos benéficos em doenças renais, além de ajudar a melhorar a defesa antioxidante em animais saudáveis. Objetivo Verificar se o treino de força reduz o dano oxidativo ao coração e rim contralateral para cirurgia de indução de hipertensão renovascular, bem como avaliar as alterações na atividade das enzimas antioxidantes endógenas superóxido dismutase (SOD), catalase (CAT) e glutationa peroxidase (GPx). Métodos Dezoito ratos machos foram divididos em três grupos (n=6/grupo): placebo, hipertenso e hipertenso treinado. Os animais foram induzidos a hipertensão renovascular através da ligação da artéria renal esquerda. O treino de força foi iniciado quatro semanas após a indução da hipertensão renovascular, teve 12 semanas de duração e foi realizada a 70% de 1RM. Depois do período de treino, os animais foram submetidos a eutanásia e o rim esquerdo e o coração foram retirados para realizar a quantificação de peróxidos de hidrogênio, malondialdeído e grupos sulfidrílicos, que são marcadores de danos oxidativos. Além disso, foram medidas as atividades das enzimas antioxidantes superóxido dismutase, catalase e glutationa peroxidase. O nível de significância adotado foi de 5% (p < 0,05). Resultados Depois do treino de força, houve redução de danos oxidativos a lipídios e proteínas, como pode-se observar pela redução de peróxidos de hidrogênio e níveis sulfidrílicos totais, respectivamente. Além disso, houve um aumento nas atividades das enzimas antioxidantes superóxido dismutase, catalase e glutationa peroxidase. Conclusão O treino de força tem o potencial de reduzir danos oxidativos, aumentando a atividades de enzimas antioxidantes. (Arq Bras Cardiol. 2021; 116(1):4-11)

Abstract Background Strength training has beneficial effects on kidney disease, in addition to helping improve antioxidant defenses in healthy animals. Objective To verify if strength training reduces oxidative damage to the heart and contralateral kidney caused by the renovascular hypertension induction surgery, as well as to evaluate alterations in the activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) endogenous antioxidant enzymes. Methods Eighteen male rats were divided into three groups (n=6/group): sham, hypertensive, and trained hypertensive. The animals were induced to renovascular hypertension through left renal artery ligation. Strength training was initiated four weeks after the induction of renovascular hypertension, continued for a 12-weeks period, and was performed at 70% of 1RM. After the training period, the animals were euthanized and the right kidney and heart were removed for quantitation of hydroperoxides, malondialdehyde and sulfhydryl groups, which are markers of oxidative damage. In addition, the activity of SOD, CAT, and GPx antioxidant enzymes was also measured. The adopted significance level was 5% (p < 0.05). Results After strength training, a reduction in oxidative damage to lipids and proteins was observed, as could be seen by reducing hydroperoxides and total sulfhydryl levels, respectively. Furthermore, an increased activity of superoxide dismutase, catalase, and glutathione peroxidase antioxidant enzymes was observed. Conclusion Strength training is able to potentially reduce oxidative damage by increasing the activity of antioxidant enzymes. (Arq Bras Cardiol. 2021; 116(1):4-11)

Hipertensão renovascular / Renovascular hypertension

Estenoses da artéria renal (EAS) é um estreitamento ou bloqueio de uma artéria para os rins. Pode causar insuficiência renal e pressão alta. Fumantes e ex-fumantes têm maior risco de contrair RAS. Os homens são afetados com essa condição duas vezes mais que as mulheres. É mais comum nas idades de 50 e 70. Colesterol alto, diabetes, excesso de peso e histórico familiar de doenças cardíacas também são fatores de risco para RAS. A pressão alta é uma causa e resultado do RAS. A causa mais comum de bloqueio da artéria renal é a arteriosclerose (espessamento e endurecimento das paredes da artéria) com acúmulo de colesterol e placa. Isso é semelhante ao que é visto nas artérias coronárias do coração, nas artérias carótidas, no cérebro e nos vasos das pernas. Apresentamos um caso de doença vascular renal em um homem diabético e ex-fumante e é apresentada uma atualização sobre a doença.

Renal artery stenoses (RAS) is a narrowing or blockage of an artery to the kidneys. It may cause kidney failure and high blood pressure. Smokers and ex-smokers have a greater risk of getting RAS. Men are affected with this condition twice as often as women. It>s most common in the ages of 50 and 70. High cholesterol, diabetes, being overweight, and having a family history of heart disease are also risk factors for RAS. High blood pressure is both a cause and a result of RAS. The most common cause of renal artery blockages is arteriosclerosis (the thickening and hardening of artery walls) with cholesterol and plaque build-up. This is similar to what is seen in the coronary arteries of the heart, the carotid arteries to the brain and the leg vessels.We presente a case of renal vascular disease in a diabetic and ex-smoker man and an up to date about the disease is presented.

Value of non-contrast-enhanced MR angiography combined with captopril renal scintigraphy in the diagnosis of renovascular hypertension / 中华核医学与分子影像杂志

Objective@#To evaluate the clinical value of non-contrast-enhanced MR angiography (NCE-MRA) combined with captopril renal scintigraphy (CRS) in the diagnosis of renovascular hypertension (RVH).@*Methods@#A total of 52 patients (33 males, 19 females; age: (54.5±16.3) years) with highly suspected RVH between January 2018 and October 2018 from Henan Provincial People′s Hospital were retrospectively analyzed. The examination data of NCE-MRA, basic renal dynamic imaging, CRS and digital subtraction angiography (DSA) were collected and reviewed. The renal artery stenosis (RAS) rate≥70% was the criterion for RVH diagnosed by DSA, which was considered as the gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of NCE-MRA, CRS and NCE-MRA+ CRS were determined. The consistency between NCE-MRA and DSA was analyzed by Kappa test. The differences of diagnostic efficiencies between CRS and NCE-MRA + CRS were compared by χ2 test or Fisher exact test.@*Results@#There was a high consistency between NCE-MRA and DSA in the diagnosis of RVH (Kappa=0.81, 95% CI: 0.62-0.96; P<0.01). The diagnostic sensitivity, specificity, accuracy, PPV and NPV of NCE-MRA were 88.89%(24/27), 92.00%(23/25), 90.38%(47/52), 92.31%(24/26), and 88.46%(23/26) respectively, those of CRS were 81.48%(22/27), 72.00%(18/25), 76.92%(40/52), 75.86%(22/29) and 78.26%(18/23) respectively, and those of NCE-MRA+ CRS were 74.07%(20/27), 100%(25/25), 86.54%(45/52), 100%(20/20) and 78.12%(25/32) respectively. Compared with CRS, the specificity (P=0.01) and PPV (P=0.03) of NCE-MRA+ CRS in the diagnosis of RVH were increased.@*Conclusion@#NCE-MRA and CRS are effective in the diagnosis of RVH, and the combination of two methods can significantly improve the diagnostic specificity and PPV than CRS alone.

Value of non-contrast-enhanced MR angiography combined with captopril renal scintigraphy in the diagnosis of renovascular hypertension / 中华核医学与分子影像杂志

Objective To evaluate the clinical value of non-contrast-enhanced MR angiography (NCE-MRA) combined with captopril renal scintigraphy (CRS) in the diagnosis of renovascular hypertension (RVH).Methods A total of 52 patients (33 males,19 females;age:(54.5±16.3) years) with highly suspected RVH between January 2018 and October 2018 from Henan Provincial People's Hospital were retrospectively analyzed.The examination data of NCE-MRA,basic renal dynamic imaging,CRS and digital subtraction angiography (DSA) were collected and reviewed.The renal artery stenosis (RAS) rate ≥70％ was the criterion for RVH diagnosed by DSA,which was considered as the gold standard.The diagnostic sensitivity,specificity,accuracy,positive predictive value (PPV) and negative predictive value (NPV) of NCE-MRA,CRS and NCE-MRA+CRS were determined.The consistency between NCE-MRA and DSA was analyzed by Kappa test.The differences of diagnostic efficiencies between CRS and NCE-MRA + CRS were compared by x2 test or Fisher exact test.Results There was a high consistency between NCE-MRA and DSA in the diagnosis of RVH (Kappa=0.81,95％ CI:0.62-0.96;P＜0.01).The diagnostic sensitivity,specificity,accuracy,PPV and NPV of NCE-MRA were 88.89％(24/27),92.00％(23/25),90.38％ (47/52),92.31％(24/26),and 88.46％(23/26) respectively,those of CRS were 81.48％(22/27),72.00％ (18/25),76.92％ (40/52),75.86％ (22/29) and 78.26％ (18/23) respectively,and those of NCE-MRA+CRS were 74.07％(20/27),100％(25/25),86.54％(45/52),100％(20/20) and 78.12％ (25/32) respectively.Compared with CRS,the specificity (P =0.01) and PPV (P =0.03) of NCE-MRA+CRS in the diagnosis of RVH were increased.Conclusion NCE-MRA and CRS are effective in the diagnosis of RVH,and the combination of two methods can significantly improve the diagnostic specificity and PPV than CRS alone.

Hipertensão arterial resistente (HAR) / Resistant arterial hypertension (RAH)

A hipertensão arterial resistente (HAR) é definida quando a pressão arterial (PA) permanece acima das metas recomendadas com o uso de três anti-hipertensivos de diferentes classes, incluindo um bloqueador do sistema renina- angiotensina (inibidor da enzima conversora da angiotensina [IECA] ou bloqueador do receptor de angiotensina [BRA]), um bloqueador dos canais de cálcio (BCC) de ação prolongada e um diurético tiazídico (DT) de longa ação em doses máximas preconizadas e toleradas, administradas com frequência, dosagem apropriada e comprovada adesão. Nesta definição está incluído o subgrupo de pacientes hipertensos resistentes, cuja PA é controlada com quatro ou mais medicamentos anti-hipertensivos, chamada de HAR controlada (HAR-C). A classificação da doença em HAR-C e HAR não controlada (HAR-NC), incluindo a HAR refratária (HAR-Ref), um fenótipo extremo de HAR-NC em uso de cinco ou mais anti-hipertensivos, é uma proposta que ganha espaço na literatura. Diante da suspeita clínica de HAR, é necessário verificar a confirmação diagnóstica, e a primeira etapa na investigação é a exclusão das causas de pseudorresistência, tais como falta de adesão ao tratamento (farmacológico e não farmacológico), posologia inadequada, técnica imprópria de aferição da PA e efeito do avental branco. O MAPA e o monitoramento residencial da pressão arterial (MRPA) são os exames para confirmação do controle inadequado da PA. Uma vez afastada a pseudorresistência, confirma-se a existência da HAR e inicia-se uma investigação diagnóstica com exames específicos, conforme a orientação das Diretrizes de Hipertensão em relação ao comprometimento de lesões em órgãos-alvo e hipertensão secundária. A ocorrência de comorbidades associadas deve ser detectada com exames especializados de acordo com a suspeita clínica. O objetivo do tratamento medicamentoso na HAR é detectar as causas do não controle e encontrar a melhor combinação de fármacos, visando o alcance das metas pressóricas com menor ocorrência de efeitos adversos e maior adesão. Em geral, busca-se otimizar o tratamento tríplice com os fármacos preferenciais, que são: IECA ou BRA, BCC di-hidropiridínico e DT.

Resistant hypertension (RHTN) is defined as blood pressure (BP) persistently above the recommended target values despite the use of three antihypertensive agents of different classes, including one blocker of the renin- angiotensin system (angiotensin-converting enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB]), one long- acting calcium channel blocker (CCB), and one long-acting thiazide diuretic (TD) at maximum recommended and tolerated doses, administered with appropriate frequency and doses and with proven adherence. The definition above includes a subgroup of patients with RHTN whose BP is controlled with four or more antihypertensive medications, known as controlled RHTN (C-RHTN). On clinical suspicion of RHTN, diagnostic confirmation is required, and the first step in the investigation is the exclusion of causes of pseudoresistance, such as lack of treatment adherence (pharmacological and non-pharmacological), inadequate dosing, improper BP measurement technique, and white-coat effect. Lack of BP control should be confirmed by ABPM and home blood pressure monitoring (HBPM). Secondary hypertension (SecH) is defined as increased BP due to an identifiable cause. Patients with RH should be investigated for the most prevalent causes of "non-endocrine" and "endocrine" SecH after exclusion of use of medications that may interfere with BP values: antiinflammatory drugs, glucocorticoids, nasal decongestants, appetite suppressants, antidepressants, immunosuppressants, erythropoietin, contraceptives, and illicit drugs. The objective of pharmacological treatment in RHTN is to identify the causes of lack of control and find the best combination of drugs, aiming at achieving the target BP with few adverse effects and greater adherence. In general, triple treatment optimization is attempted with preferred drugs, namely, ACEIs or ARBs, dihydropyridine CCBs, and TDs

Effect of Telmisartan on Myocardial Remodeling in Rats with Renovascular Hypertention / 医药导报

Objective To investigate the the molecular mechanism of telmisartan for myocardial remodeling in rats with renovascular hypertention. Methods The renovascular hypertensive myocardial hypertrophy model of rats were established by narrowing the left renal artery.The total of 45 mature male SD rats were divided into sham-operated group(n= 15),model control (n = 15 ) and telmisartan group ( n = 15 ) randomly. The rats in telmisartan group were treated with telmisartan (10 mg?kg-1?d-1 ) while those in the sham-operated and model control were reated with the same amounts of distilled water by intragastrical administration . At 8th week of administration, the myocardial structure and function were detected by ultrasonography.The blood pressure was measured by arterial catheterization and calculating the left ventricular mass index (LVMI) .The level of serum calcium and nerve phosphatase ( CaN) and the expression of β-myosin heavy chain ( β-MHC) mRNA were detected. Results The thickness of left ventricular,ejection fraction[(69.23± 1.09)% vs(73.77± 3.00)%], fractional shortening [(30.21±2.02)% vs(35.29±0.90)%],LVMI[(2.83±0.14) mg?g-1 vs(2.32±0.11) mg?g-1 ] were decreased,and the differences were statistically significant (P<0.05).The level of serum calcium and nerve phosphatase (CaN) and the expression of β-myosin heavy chain (β-MHC) mRNA were decreased in telmisartan treated rats,and the differences were statistically significant (P< 0.05) when compared with the model control group. Conclusion Telmisartan can improve the myocardial hypertrophy of renovascular hypertensive rats,and it may downregulate the expression of β-MHC by inactivating of the start signal CaN and its downstream signal pathway.

Estudo da superposição de mecanismos fisiopatológicos como modelo de hipertensão arterial com repercussões cardíacas graves / Study of overlap of pathophysiologicalmechanisms as a model of hypertensionwith severe cardiac effects

Fundamento: Acredita-se que o rato espontaneamente hipertenso (SHR) mimetize a hipertensão arterial (HA) essencial em humanos. Lesões em órgãos-alvo nesses animais não são devidas unicamente ao aumento da pressão arterial. Outros mecanismos fisiopatológicos superajuntados talvez representem melhor o complexo dano cardiovascular observado também em humanos. Objetivo: avaliar, comparativamente, as alterações cardíacas em ratos SHR nos quais mecanismos outros de HA (renovascular, hipervolemia, disfunção endotelial) sejam superpostos. Materiais e Métodos: cinco grupos foram estudados: Controle (C,n=11); SHR (n=11); SHR + L-NAME (SHR + L-NAME, n=11); SHR com estenose cirúrgica de artéria renal (SHR + 2R-1C, n=11); SHR+ deoxicorticosterona e cloreto de sódio 0,9% (SHR+DOCA-SALT, n = 11). Foram avaliados pressão arterial caudal (PAC), hipertrofia do ventrículo esquerdo (VE) e alterações histológicas miocárdicas. Resultados: Após oito semanas, os grupos SHR + L-NAME, SHR + 2R-1C e SHR + DOCA-SALT mantiveram PAC semelhante e mais elevada que os animais SHR (159,9 ± 8,3; 162,7± 16,7 e 166,3 ± 6,7 versus 138±7,8, respectivamente), bem como a espessura relativa da parede do VE (SHR + L-NAME = 0,64 ± 0,06; SHR+DOCA-SALT=0,63 ± 0,07 versus SHR=0,57±0,03) (p < 0,05). Amassa relativa do VE dogrupo SHR+ L-NAME (4,2±1,15) foi maior que nos demais grupos (SHR=2,8±0,5; SHR + 2R-1C=3,2±0,5; SHR + DOCA-SALT = 3,1 ± 0,2) (p <0,05). O desarranjo de fibras, fibrose intersticial, espessura médio-intimal aumentada foram mais frequentes nos ratos SHR + L-NAME. Conclusão: O modelo SHR + L-NAME mostrou repercussões cardíacas mais evidentes que os demais modelos de HA, fato não explicado apenas pelos níveis de PA elevados. Tal modelo pode ser utilizado em estudos futuros como representativo de maior comprometimento cardíaco na HA grave ou em estados avançados da doença.

Background: Spontaneously hypertensive rats (SHR) are believed to mimic arterial hypertension (HA) essential in humans. The injuries on targeted organs on these animals are not due only to increased blood pressure. Other pathophysiological mechanisms may represent better the superimposed complex cardiovascular damage observed on humans as well. Objective: comparatively evaluate the cardiac abnormalities in SHR in which other mechanisms of hypertension (renovascular, fluid overload and endothelial dysfunction) are superimposed. Materials and Methods: 5 groups were studied: Control (C, n=11); SHR (n = 11); SHR + L-NAME (SHR + L-NAME, n= 11), SHR with surgical stenosis of renal artery (SHR+ 2K-1C, n = 11), SHR + deoxycorticosterone and sodium chloride 0.9% (SHR + DOCA-SALT, n = 11). The blood pressure flow (PAC), left ventricular hypertrophy (VE) (echocardiography) and myocardial histological changes were evaluated. Results:After 8 weeks, the SHR + L-NAME, SHR + 2K-1C and SHR + DOCA-SALT groups maintained similar and higher PAC than SHR (159.9 ± 8.3, 162.7 ± 16.7 and 166.3 ± 6.7 versus 138± 7.8, respectively) as well as the relative thickness of the VE wall (SHR + L-NAME = 0.64 ± 0.06, SHR + DOCA-SALT= 0, 63 ± 0.07 versus SHR = 0.57 ±0.03;) (p < 0.05). The relative LV mass (MRVE, mg/g) of the group SHR + L-NAME (4.2 ± 1.15) was higher than in other groups (SHR = 2.8 ± 0.5, SHR + 2K-1C = 3.2±0.5, SHR + DOCA-SALT = 3.1 ± 0.2) (p < 0.05). Fiber disarray, interstitial fibrosis and the increased of intima-media thickness were more frequent in SHR + L-NAME. Conclusion: SHR + L-NAME showed cardiac effects more evident than the other models of hypertension, which was not explained only by high levels of PA. This model can be used in future studies as representative of greater cardiac involvement in hypertension or severe stages of the disease.

Hipertensión arterial secundaria a displasia fibromuscular de la arteria renal. A propósito de un caso / Hypertension secondary to fibromuscular dysplasia of the renal artery. Report of a case

Se presenta el caso clínico de una paciente que debutó con hipertensión arterial (HTA) grado II realizándose los estudios sistematizados correspondientes para descartar patologías secundarias. Dentro de los estudios de primera línea en la valoración merece destacarse la ecografía Doppler renal por la información que ella aporta, orientado al diagnóstico de estenosis de la arteria renal. La identificación de una HTA de origen renovascular supone el hallazgo de una de las causas reversibles de hipertensión. Dentro de esta etiología la más frecuente es la displasia fibromuscular (DFM) que mejora con la corrección de la estenosis mediante técnicas quirúrgicas o percutáneas con angioplastia con balón o stent. El objetivo es presentar un caso clínico para mostrar la complejidad del proceso diagnóstico y la importancia que tiene la sospecha clínica para la corrección oportuna de este tipo de HTA reversible...

Avaliação da sensibilidade e especificidade dos exames não invasivos no diagnóstico da estenose de artéria renal / Analysis of the sensitivity and specificity of noninvasive imaging tests for the diagnosis of renal artery stenosis

FUNDAMENTO: O envelhecimento e a aterosclerose estão relacionados à hipertensão renovascular em indivíduos idosos. Independentemente das comorbidades, a estenose de artéria renal é, por si só, importante causa de morbidade e mortalidade cardiovascular. OBJETIVO: Definir a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo dos exames não invasivos utilizados no diagnóstico de estenose da artéria renal. MÉTODOS: Um grupo de 61 pacientes recrutados permitiram a análise de 122 artérias e a definição de sensibilidade, especificidade e da contribuição relativa de cada exame realizado (Doppler, cintilografia e angiotomografia, comparados a arteriografia renal). RESULTADOS: A média das idades foi de 65,43 (desvio padrão: 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas estiveram correlacionadas à estenose da artéria renal, à disfunção renal e aos triglicerídeos. A mediana do ritmo de filtração glomerular foi de 52,8 mL/min/m². O Doppler identificou sensibilidade de 82,90%, especificidade de 70%, valor preditivo positivo de 85% e valor preditivo negativo de 66,70%. Para a tomografia, encontraram-se sensibilidade de 66,70%, especificidade de 80%, valor preditivo positivo de 87,50% e valor preditivo negativo de 55,20%. Esses achados permitiram identificar os exames que melhor detectavam a estenose. CONCLUSÃO: A tomografia e o Doppler mostraram qualidade e grande possibilidade no diagnóstico de estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, ocorre em diabéticos e associa-se à disfunção renal e à disfunção ventricular esquerda grave.

BACKGROUND: Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. OBJECTIVE: To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. METHODS: In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). RESULTS: The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m². Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. CONCLUSION: Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction.

Diagnostic value of urinary light chain detection in essential hypertension renal injury / 中华检验医学杂志

Objective To investigate the diagnostic value of urinary light chain detection in essential hypertension renal injury. Methods According to "National Prevention and Treatment Guide of Hypertension" (2005 Edition) and the diagnostic criteria of essential hypertension renal injury, patients'medical history and damage of target organs, we selected 60 patients with essential hypertension and divided them into two groups: 28 patients without renal injury and 32 patients with renal injury. Meanwhile, Thirty healthy individuals were included in a control group. Urinary proteins and light chains were detected by immuonephelometry and the activity of NAG was determined by liquid kinetic rate assay with MNP as substrate. The urinary light chains concentration of each group were compared and analyzed with those of Alb and α1-MG. Results The results of lamU in renal injury group [8. 89(3.84-33. 30) mg] were higher than those of non renal injury group [3. 84(3. 84-10. 4) mg] and control group [3.84(0. 00-3.84) mg]. There was statistically significant difference ( H = 37.97, P ＜ 0. 01 ). The levels of kapU in renal injury group [26. 65 (6. 97-62. 5 ) mg] were higher than those of non renal injury group [6. 97 (6. 97-23.7 )mg] and control group [6. 97(6. 97-7. 20) mg], which also had statistical significance (H =40. 09,P ＜0. 01 ). All the other results in renal injury group ( Alb, α1-MG, IgG, TRF and NAG) were higher than those of non renal injury group and control group ( H =21.02, 32. 65, 25.50, 30. 45 and 30. 57, P ＜0. 01 ). Correlation analysis showed that Alb levels were highly correlated with urinary IgG and TRF levels [Correlation coefficient (r) =0. 911, 0. 965, P ＜ 0. 01]. The levels of urinary light chain lamU and kapU were also highly correlated with α1-MG ( r = 0. 804, 0. 827, P ＜ 0. 01 ). However, There was no correlationship between NAG and α1MG levels (r=0. 398,P＞0. 05). Conclusion The urinary light chain lamU and kapU can be used as indicators for evaluation of renal injury in essential hypertension, especially renal tubular injury.

Manejo intervencionista en estenosis de arterias renales y su impacto sobre el control de la presión arterial / Percutaneal interventional management for renal artery stenosis and its impact in the control of arterial hypertension

Introducción: la hipertensión renovascular es la segunda causa más frecuente de hipertensión arterial secundaria, después de la parenquimatosa (o enfermedad renal crónica) y, hasta el momento, no se cuenta con evidencia suficiente que respalde alguna intervención terapéutica que impacte de manera positiva sobre el control de las cifras tensionales, así como para evitar el deterioro renal. El objetivo del estudio es describir el comportamiento de las cifras de presión arterial en los pacientes que han sido intervenidos mediante angioplastia y/o stent en las arterias renales con estenosis ateroesclerótica. Metodología: estudio retrospectivo observacional de pacientes intervenidos con angioplastia y/o stent para manejo de estenosis renal angiográficamente significativa. Se evaluó indirectamente el efecto de la intervención en la presión arterial mediante la diferencia entre el consumo de tabletas ingeridas diariamente antes y después del procedimiento. Resultados: en total se incluyeron 34 pacientes donde se observó que la mediana del consumo de medicamentos antihipertensivos previo al procedimiento fue de 5.5 tabletas (RIQ 3 – 8) y posterior al procedimiento fue de 5 tabletas (RIQ 2.75 – 7.25), Z = -1.042 para un valor p = 0.16. Conclusión: no existe diferencia en cuanto al control de las cifras tensionales, medido por la reducción en el número de tabletas de antihipertensivos que los pacientes consumen a diario.

Introduction: Renovascular hypertension is the second most frequent cause of secondary arterial hypertension, after parenchymal damage (or chronic kidney disease) which stands first. Nowadays, there is a lack of evidence to support therapeuticinterventions that impact arterial pressure control in a positive way, or that help avoiding renal disease. Methods: Observational retrospective studiy performed on patients undergoing angioplasty / stent management for angiographically significant renal stenosis. The effect of the intervention was indirectly evaluated by means of the change in the number of pills taken every day before and after the procedure. Results: A total of 34 patients were included in this research, as it was observed that themedian of the take of prior antihypertensive medicines to the procedure was 5,5 pills (IQR 3 - 18) and after the procedure was 5 pills (IQR 2.75 – 7.25), Z = -1.042 for p-value = 0,16. Conclusion: No difference was found in the control of arterial pressure, measured by the reduction in the number of antihypertensives pills that patients take on a daily basis.

Tratamento percutâneo da hipertensão renovascular: relato de caso / Percutaneous treatment of renovascular hypertension: case record

A doença renovascular decorre da estenose uni ou bilateral da artéria renal ou um de seus ramos. Causa hipertensão arterial secundária em crianças e adultos. Será relatado caso de mulher jovem com doença fibrodisplásica e hipertensão renovascular submetida a angioplastia com cateter balão que, treze anos depois, retorna com níveis pressóricos elevados. Angiograficamente constatou-se lesão arterial renal contra-lateral e realizou-se nova intervenção percutânea com stent. Após o procedimento, evoluiu com redução e estabilização das cifras tensionais na fase hospitalar sem uso de medicamentos. O presente artigo relata o caso e revisa etiologia, incidência, manifestações clínicas, diagnóstico e tratamento.

The renovascular disease results of a unit or bilateral renal stenosis or arterial ramification. It's one of the causes of secondary hypertension in both children and adults. It reports a case of renovascular hypertension due to fibromuscular dysplasia in a young female patient treated with angioplasty, who, thirteen years later, returns with high blood levels. Then,she was submitted to percutaneous intervention with stent in treatment of opponent renal artery. The patient has evolved with normal blood pressure, while in the hospital without pharmacological therapy. This article describes a case of renovascular hypertension and its etiology, incidence, clinical presentation, diagnosis and treatment are reviewed.

Use of intravascular ultrasound to determine relationship between renal artery remodeling and renovascular hypertension / 中华超声影像学杂志

50%) were divided into two groups,including 10 hypertensive (Group I) and 11 normotensive patients (Group II).Renal artery intravascular ultrasound was performed in all cases to obtain the ultrasound image of renal artery lesion.Renal venous blood of both stenotic and contra lateral sides was collected to measure the levels of renin and renal vein renin rate(RVRR).The results were compared respectively.Results There were no differences in the numbers of adaptive remolding (5 vs 7) and coarctation (5 vs 4) between the two groups.The cross sectional area of external elastic membrane [( 128.3 ? 29.5 )mm 2 vs ( 111.8 ? 30.4 )mm 2],the plaque area [( 94.4 ? 26.2 )mm 2 vs ( 79.6 ? 28.5 )mm 2] and the luminal stenosis ( 73.3 ? 6.7 )% vs ( 67.9% ? 11.2 )% were higher in Group I than those in Group II,but did not achieve statistical significance.The RVRR( 2.79 ? 0.57 vs 1.09 ? 0.28 ) in Group I,however,was significantly higher than that in Group II (P

Effects of atorvastatin on cardiovascular remodeling in renovascular hypertensive rats / 中华老年医学杂志

Objective To investigate the effects of atorvastatin on cardiovascular remodeling in renovascular hypertensive rats. Methods The 2-kindey,1-clip hypertensive rats(2K1C,Goldblatt) were prepared with Sprague-Dawley rat.SD rats were randomly divided into three groups: normal control rats,hypertensive rats and hypertensive rats treated with atorvastatin(2 mg?kg~(-1)?d~(-1)).After 6 weeks treatment,systolic blood pressure(SBP) was measured using the tail-cuff method.The plasma concentration of angiotensin Ⅱ and renin activity were determined by radioimmunoassay.The heart weight,the ratio of left ventricular weight to body weight were calculated.Results The plasma concentration of angiotensin Ⅱ((106.4?7.8)ng/L) and renin activity((20.6?2.4) ng/L)were significantly increaed in hypertensive rats compared with normal rats((72.3?5.4) ng/L and(12.5?3.7) ng/L)(P

Relationships between ouabain of plasma and tissues and blood pressure in lklc hypertensive rats / 中国病理生理杂志

AIM: To explore the role of endogenous ouabain (EO) in the development of hypertension and its secretion character in 1k1c hypertensive rats(HR). METHODS: EO contents of plasma and tissues in 1k1c HR were detected by ELISA. The relationships between plasma and tissues ouabain and blood pressure were analyzed. RESULTS: EO contents of plasma, heart, kidney, adrenal gland, pituitary and hypothalamus in lklc HR were significantly higher than those of normal rats, especially in the adrenal gland and hypothalamus. EO contents of serum, kidney and hypothalamus were correlated with blood pressure. CONCLUSIONS: EO might play an important role in the development of hypertension in 1k1c hypertensive rats. Adrenal gland might be the major source of EO.

Effects of Bushen Yixin Tablet on Plasma Lipid Peroxide and Sexual Hormone in Renal Hypertension Rats / 中药新药与临床药理

To investigate the effects of Bushen Yixin Tablet (BYT) on plasma lipid peroxide (LPO) and sexual hormone in renal hypertension rats. Goldblatt's renal hypertension rat models were established. All rats were allocated to six groups: BYT groups (with high, moderate and low dosage of BYT respectively), captopril group, normal saline (NS) group and mimic-operation group. The treatment course lasted 4 weeks. Blood pressure was lowered in BYT groups (P

Effect of L-Arg on plasma content of endothelin and expression of c-fos mRNA in the left ventricle of rats with renovascular hypertensive hypertrophy / 中国病理生理杂志

AIM: To study the effect of L-Arg on plasma content of endothelin (ET) and the expression of proto-oncogene c-fos mRNA in the left ventricle of rats with renovascular hypertensive hypertrophy. METHODS: The level of c-fos mRNA were measured by in situ hybridization. The ET in plasma were measured by radioimmunoassay. RESULTS: After eight weeks of treatment with L-Arg, the expression of c-fos decreased markedly ( P

The changes of beta-adrenergic receptor on circulating intact lymphocytes in hypertensive-diabetic rats / 中国病理生理杂志

Some kinetic characteristics of beta-adrenoceptor on circulating intact lymphocytes (CIL) in the combined renovasoeular hypertensive and diabetic (HD) rats were studied and the relation of betareceptos between CIL and cardium as well as the morphologic changes in the processe of dilated cardiomypathy (DCM) were observed. The results show that: the density of beta-adrenoceptor on CIL (Bmax) was going up 41.28%(P0.05), but the Kd was still 50.01%(P

Observation of astrocyte proliferation and glial fibrillary acid protein expression for evaluating cerebral infarction / 中国病理生理杂志

AIM: To observe the activity and distribution of astrocytes and glial fibrillary acid protein(GFAP) after middle cerebral artery occlusion (MCAO). METHODS: The rat MCAO model was made by two-kidney, tow clip renovascular hypertensive rat stroke prone(RHRSP). Rats were killed and brain samples were collected at the end of 1,3,6 and 9 weeks after MCAO, respectively. The ultrastructure of astrocytes was determined at broder of infarct (A area); distant of infarct (B area) and opposite of hemisphere (C area) by electron microscope. The number and optical density of GFAP-positive cells were also observed. RESULTS: The astrocyte proliferation distributed in the whole brain after MCAO. The highest numbers of GFAP-positive cells were observed at A area, then B area. The lowest numbers of GFAP positive cells were found in C area. The time course of GFAP-positive cell change was that the highest number was observed at 1 week after MCAO, then decreased by time from 3, 6 weeks to 9 weeks. The optical density of GFAP-positive cells showed the same patterns. CONCLUSION: The correlation between astrocyte proliferation and tissue damage after MCAO can be estimated by GFAP expression. The astrocyte proliferation plays an important role in healing process after MCAO.