Increased Intrarenal Arterial Stiffness May Predict the Occurrence of New Digital Ulcers in Systemic Sclerosis

Rosato, Edoardo; Barbano, Biagio; Gigante, Antonietta; Molinaro, Ilenia; Quarta, Silvia; Pisarri, Simonetta; Amoroso, Antonio; Cianci, Rosario; Salsano, Felice

doi:10.1002/acr.22309

Cited by 24 publications

(30 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, we found that patients with ulcers had a significantly greater LVM compared to patients without skin lesions. Moreover, it is well known that a clinically silent kidney injury in the course of SSc can be detected by Doppler renal ultrasound [21] and that RI correlates with systemic autonomic dysfunction [3], digital ulcers [9] and erectile dysfunction [22]. After analyzing our results, we can postulate that LVM/BSA correlates with intrarenal arterial stiffness as demonstrated by elevated RI, PI and S/D.…”

Section: Discussionmentioning

confidence: 85%

“…Increased intrarenal arterial stiffness can be considered the first manifestation of vascular renal scleroderma impairment, and it correlates with the eGFR trend [21]. Following the relationship between intrarenal arterial stiffness and capillaroscopic damage, Rosato et al [9] demonstrated that scleroderma renal damage starts with an injury of the microvascular vessels. In addition, it has been demonstrated that response to vasodilator drugs correlates with intrarenal arterial Doppler indices [23].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, these results suggest that a structural damage of vasculature occurs in many vascular districts and contributes to cardiac and renal dysfunction. RP is the hallmark of SSc and represents the clinical expression of a blood vessel spasm in the fingers, heart, kidney and other internal organs [25,26,9]. Therefore, a diffuse RP could be considered as the trigger for chronic CRS-5.…”

Section: Discussionmentioning

confidence: 99%

“…Our group already demonstrated that left ventricular mass (LVM), measured by echocardiography and normalized by body surface area (BSA), can be used as a marker of nutritional status and fibrosis in SSc patients [8]. Moreover, increased renal arterial stiffness is known to be associated with sclerodermic kidney dysfunction [4], and we also demonstrated that Doppler indices of intrarenal stiffness are reliable predictors of new digital ulcer occurrence [9]. Considering the strong relationship between the kidney and heart, and the frequency of simultaneous involvement of these two organs in the course of SSc, it would be clinically relevant to assess whether LVM can be related to intrarenal arterial stiffness, thus predicting a cardiorenal dysfunction before it becomes clinically evident.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Left Ventricular Mass and Intrarenal Arterial Stiffness as Early Diagnostic Markers in Cardiorenal Syndrome Type 5 due to Systemic Sclerosis

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background: Cardiorenal syndrome type 5 (CRS-5) includes a group of conditions characterized by a simultaneous involvement of the heart and kidney in the course of a systemic disease. Systemic sclerosis (SSc) is frequently involved in the etiology of acute and chronic CRS-5 among connective tissue diseases. In SSc patients, left ventricular mass (LVM) can be used as a marker of nutritional status and fibrosis, while altered intrarenal hemodynamic parameters are suggestive of early kidney involvement. Methods: Forty-two consecutive patients with a diagnosis of SSc without cardiac and/or renal impairment were enrolled to assess whether cardiac muscle mass can be related to arterial stiffness. Thirty subjects matched for age and sex were also enrolled as healthy controls (HC). All patients performed echocardiography and renal ultrasound. Results: Doppler indices of intrarenal stiffness and echocardiographic indices of LVM were significantly increased in SSc patients compared to HC. A positive correlation exists between LVM/body surface area and pulsatile index (p < 0.05, r = 0.36), resistive index (p < 0.05, r = 0.33) and systolic/diastolic ratio (p < 0.05, r = 0.38). Doppler indices of intrarenal stiffness and LVM indices were significantly higher in SSc patients with digital ulcers than in SSc patients without a digital ulcer history. Conclusions: SSc is characterized by the presence of microvascular and multiorgan injury. An early cardiac and renal impairment is very common. LVM and intrarenal arterial stiffness can be considered as early markers of CRS onset. The clinical use of these markers permits a prompt identification of organ damage. An early diagnosis allows the appropriate setting of pharmacological management, by slowing disease progression.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Left Ventricular Mass and Intrarenal Arterial Stiffness as Early Diagnostic Markers in Cardiorenal Syndrome Type 5 due to Systemic Sclerosis

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Its use has been proposed in the differential diagnosis of several nephropathies, including the therapeutic management of renal artery stenosis, 1 kidney transplantation, 2 in long-term outcome chronic nephropathies, 3 lupus nephritis evaluation, 4 monitoring in renal scleroderma crisis, and systemic sclerosis. [5][6][7] Moreover, some studies report a correlation between RI and renal function in patients with renal diseases. 8 The aim of this study is to evaluate the relationship between renal parenchymal resistance and histopathologic parameters of renal damage, particularly vascular features.…”

Section: Introductionmentioning

confidence: 99%

Renal parenchymal resistance in patients with biopsy proven glomerulonephritis: Correlation with histological findings

Gigante

Barbano

Mario

et al. 2016

Int J Immunopathol Pharmacol

Self Cite

View full text Add to dashboard Cite

Renal Doppler ultrasound is increasingly used in nephrology for the evaluation of renovascular disease, allograft dysfunction, and chronic nephropathies. We compared intrarenal hemodynamic parameters to biopsy findings of glomerular sclerosis, tubular atrophy, interstitial fibrosis, crescents, arteriolosclerosis, and clinical variables in 100 patients. A positive correlation exists between renal function and percentage of glomerular sclerosis (P <0.01, r = 0.26), conversely a negative correlation exists between glomerular filtrate rate and percentage of glomerular sclerosis (P <0.0001, r = −0.35). The percentage of glomerular sclerosis correlate positively with pulsatile index (PI) (P <0.05, r = 0.21) and renal resistive index (RI) (P <0.05, r = 0.20). The percentage of crescents correlates positively with PI (P <0.05, r = 0.21) and RI (P <0.05, r = 0.20). Classifying arteriolosclerosis in four groups according to a severity scale, from absence to severe, PI (P <0.05) and RI (P <0.01) were significantly different. In the post hoc analysis, the median values of PI and RI are significantly different in patients with severe arteriolosclerosis than others. Ultrasound examination is a non-invasive diagnostic technique used on patients with suspected or established renal disease. Our study shows a close correlation between kidney function, ultrasound parameters, and histological findings. Measurement of renal parenchymal resistance by ultrasound could be used in association with biopsy and glomerular function for the evaluation of renal damage in patients with glomerulonephritis.

show abstract

Reduction of fat free mass index and phase angle is a risk factor for development digital ulcers in systemic sclerosis patients

et al. 2020

View full text Add to dashboard Cite

Increased Intrarenal Arterial Stiffness May Predict the Occurrence of New Digital Ulcers in Systemic Sclerosis

Cited by 24 publications

References 24 publications

Left Ventricular Mass and Intrarenal Arterial Stiffness as Early Diagnostic Markers in Cardiorenal Syndrome Type 5 due to Systemic Sclerosis

Left Ventricular Mass and Intrarenal Arterial Stiffness as Early Diagnostic Markers in Cardiorenal Syndrome Type 5 due to Systemic Sclerosis

Renal parenchymal resistance in patients with biopsy proven glomerulonephritis: Correlation with histological findings

Reduction of fat free mass index and phase angle is a risk factor for development digital ulcers in systemic sclerosis patients

Contact Info

Product

Resources

About