The relationship between renal resistive index, arterial stiffness, and atherosclerotic burden: the link between macrocirculation and microcirculation.

The renal resistive index (RRI) measured by Doppler sonography is a marker of microvascular status that can be generalized to the whole of the arterial tree. Its association with large-vessel dysfunction, such as arterial stiffness or the atherosclerotic burden, can help to establish physiopathological associations between macrocirculation and microcirculation. The authors conducted a cross-sectional study of hypertensive patients (n=202) and a healthy control group (n=16). Stiffness parameters, atherosclerotic burden, and determination of the RRI in both kidneys were performed. The average RRI was 0.69±0.08 and was significantly greater in patients with diabetes and chronic kidney disease. Renal resistive index positively correlated with age, creatinine, and albuminuria. Positive correlations were found with arterial stiffness parameters (pulse wave velocity, ambulatory arterial stiffness index, and 24-hour pulse pressure), as well as atherosclerotic burden and endothelial dysfunction measured as asymmetric dimethylarginine in serum. In the multivariate analysis, independent factors for increased RRI were age, renal function, 24-hour diastolic blood pressure, and arterial stiffness. The authors concluded that there is an independent association between renal hemodynamics and arterial stiffness. This, together with the atherosclerotic burden and endothelial dysfunction, suggests that there is a physiopathologic relationship between macrovascular and microvascular impairment.

Síndrome de Pickering – estenosis de arteria renal y flash edema pulmonar. Nueva denominación de un concepto antiguo / Pickering Syndrome – renal artery stenosis and flash pulmonary edema. A new name for an old concept

El «flash» edema pulmonar es un tipo de edema pulmonar recurrente que normalmente se presenta en pacientes con estenosis crítica de arteria renal bilateral o unilateral enmonorrenos. Una recomendación reciente de la 20.aReunión Europea de Hipertensión propone denominar a esta entidad clínica síndrome de Pickering. En la actualidad representa una de las pocas indicaciones claras de tratamiento endovascular en la enfermedad renovascular ateroesclerótica. Presentamos el caso de un varón de 61 años con síndrome de Pickering y buena evolución tras revascularización (AU)

Flash pulmonary edema is a type of recurrent pulmonary edema that usually develops in patients with critical bilateral renal artery stenosis or renal artery stenosis to a solitary kidney. A recent recommendation from the 20thEuropean Meeting on Hypertension proposes naming this clinical entity Pickering Syndrome. Currently, it is one of the few clear indications for endovascular procedures in atherosclerotic renovascular disease. We present a case of a61-year old man with Pickering syndrome and good outcome after revascularization (AU)

Doppler ultrasound in the measurement of pulse wave velocity: agreement with the Complior method.

Aortic stiffness is an independent predictor factor for cardiovascular risk. Different methods for determining pulse wave velocity (PWV) are used, among which the most common are mechanical methods such as SphygmoCor or Complior, which require specific devices and are limited by technical difficulty in obtaining measurements. Doppler guided by 2D ultrasound is a good alternative to these methods. We studied 40 patients (29 male, aged 21 to 82 years) comparing the Complior method with Doppler. Agreement of both devices was high (R = 0.91, 0.84-0.95, 95% CI). The reproducibility analysis revealed no intra-nor interobserver differences. Based on these results, we conclude that Doppler ultrasound is a reliable and reproducible alternative to other established methods for the measurement of aortic PWV.

La excreción urinaria de interleucina 6 refleja la presión arterial sistólica media durante 24 h en pacientes con diabetes mellitus tipo 2 / Urinary interleukin-6 excretion reflects mean 24-hour systolic blood pressure in type 2 diabetes

Objetivo: Debido a la necesidad de investigar nuevos marcadores de riesgo de nefropatía diabética, en este estudio se decidió evaluar la excreción en orina de 24 h de interleucina 6 (uIL-6) en pacientes con diabetes mellitus tipo 2 (DM2) y su relación con el daño tisular inducido por el aumento de presión arterial. Métodos: La uIL-6, la excreción de albúmina y la presión arterial medida durante 24 h fueron evaluadas en 49 pacientes con DM2 y función renal normal. Comparamos a los sujetos con presión arterial sistólica (PAS)media de 24 h correcta, definida por PAS 130 mmHg, con los pacientes con PAS no controlada (PAS > 130 mmHg). Se calculó mediante estudio de regresión múltiple qué factores contribuían de manera significativa ala uIL-6.Resultados: La tasa de excreción de albúmina (AER) y la uIL-6 se asociaron de manera significativa (r = 0,63; p < 0,0001). Los pacientes con una PAS media de 24 h > 130 mmHg (n = 27) tenían una media de uIL-6superior a la de los pacientes con PAS media de 24 h 130 mmHg (n =22) (p = 0,009). La fuerza de la asociación de la uIL-6 con la presión diastólica diurna y con la media (PAD) fue superior a la que presentaba con la AER. La PAS media (p < 0,0001) contribuyó al 25% de la variancia de la AER tras ajustar por el índice de masa corporal, el sexo, la edad, la PAS media, la PAD media, la HbA1c y el tabaquismo. La PAS media de 24h (p = 0,005) y el tabaquismo (p = 0,03) contribuyeron al 15 y el 9% de la variancia de la uIL-6, respectivamente. Conclusiones: El aumento de uIL-6, quizá reflejando el daño y el remodelado tisular, podría ser un marcador de la elevación de la PAS en sujetos con DM2 (AU)

Aims: Research into new risk markers for diabetic kidney disease is required. We aimed to study 24-hour urinary interleukin-6 excretion (uIL-6) in type 2 diabetic patients in relation to organ damage induced by increased blood pressure. Methods: 24-hour uIL-6 and albumin excretion and 24-hour blood pressure recording were evaluated in 49 patients with type 2 diabetes and normal renal function. Patients with optimized mean 24-hour systolic blood pressure (SBP), defined as SBP 130 mmHg, and those with uncontrolled SBP (SBP > 130 mmHg) were compared. Multiple linear regression analysis was performed to study significant contributors to variance in the24-hour uIL-6 excretion rate. Results: Albumin excretion rate (AER) anduIL-6 were significantly correlated (r = 0.63;p < 0.0001). Patients with mean 24-hourSBP above 130 mmHg (n = 27) had significantly higher mean uIL-6 excretion than those with a mean 24-hour SBP equal to or below 130 mmHg (n = 22) (p = 0.009).The strength of the association of uIL-6with diurnal and mean diastolic blood pressure (DBP) was significantly greater than that with AER. Mean SBP (p < 0.0001)contributed to 25% of AER variance after body mass index, age, sex, mean SBP, mean DBP, HbA1c and smoking status were accounted for. Mean 24-hour SBP (p =0.005) and smoking (p = 0.03) contributed to 15% and 9%, respectively, of uIL-6variance.Conclusions: Increased uIL-6, perhaps by reflecting significant tissue damage and remodeling, could be a marker for increased mean SBP in type 2 diabetes (AU)

Urinary interleukin-6 excretion reflects mean 24-hour systolic blood pressure in type 2 diabetes.

AIMS: Research into new risk markers for diabetic kidney disease is required. We aimed to study 24-hour urinary interleukin- 6 excretion (uIL-6) in type 2 diabetic patients in relation to organ damage induced by increased blood pressure. METHODS: 24-hour uIL-6 and albumin excretion and 24-hour blood pressure recording were evaluated in 49 patients with type 2 diabetes and normal renal function. Patients with optimized mean 24-hour systolic blood pressure (SBP), defined as SBP ≤ 130 mmHg, and those with uncontrolled SBP (SBP > 130 mmHg) were compared. Multiple linear regression analysis was performed to study significant contributors to variance in the 24-hour uIL-6 excretion rate. RESULTS: Albumin excretion rate (AER) and uIL-6 were significantly correlated (r=0.63; p<0.0001). Patients with mean 24-hour SBP above 130 mmHg (n=27) had significantly higher mean uIL-6 excretion than those with a mean 24-hour SBP equal to or below 130 mmHg (n=22) (p=0.009). The strength of the association of uIL-6 with diurnal and mean diastolic blood pressure (DBP) was significantly greater than that with AER. Mean SBP (p<0.0001) contributed to 25% of AER variance after body mass index, age, sex, mean SBP, mean DBP, HbA1c and smoking status were accounted for. Mean 24-hour SBP (p=0.005) and smoking (p=0.03) contributed to 15% and 9%, respectively, of uIL-6 variance. CONCLUSIONS: Increased uIL-6, perhaps by reflecting significant tissue damage and remodelling, could be a marker for increased mean SBP in type 2 diabetes.

Nefropatía, ritmo nictemeral y presión de pulso en la diabetes mellitus tipo 2 / Nephropathy, nycthemeral variability and pulse pressure in patients with type 2 diabetes mellitus

FUNDAMENTO: La pérdida del ritmo nictemeral de la presión arterial y la presión de pulso elevada se consideran factores de riesgo cardiovascular independientes que pueden relacionarse con la afección microvascular de los pacientes con diabetes mellitus tipo 2. PACIENTES Y MÉTODO: Estudio observacional, transversal, de una población de pacientes con diabetes mellitus tipo 2. Las variables se estudian mediante registro ambulatorio de la presión arterial. Los resultados se comparan con los diversos grados de nefropatía. RESULTADOS: Se estudia a un total de 61 pacientes, 31 de los cuales tienen un comportamiento no dipper. La proporción de no dipper aumenta con la excreción urinaria de albúmina (p = 0,024). La presión de pulso es superior en los pacientes con macroalbuminuria (p = 0,004). CONCLUSIONES: Existe una pérdida del ritmo nictemeral más frecuente, así como presiones del pulso más elevadas, entre los pacientes con diabetes mellitus tipo 2 que presentan nefropatía (AU)