Renal Arteries Remodelling — The Initiator and Target of Cardiorenal Continuum

Gulchenko³

et al. 2020

Cardiovasc Ther Prev

Aim. To assess the effect of electrolyte changes on the prognosis of long-term cardiovascular events after acute coronary syndrome (ACS).Material and methods. The study included 105 patients with ACS who underwent coronary angiography (CA) with coronary stenting. At the study inclusion (before CA with coronary stenting), we collected data on traditional risk factors, analyzed levels of urinary sodium and potassium, kaliuresis and natriuresis. Free water clearance (FWC) and electrolyte free water clearance (EFWC), as well as fluid balance using bioelectrical impedance analysis were determined. Study endpoints (fatal and nonfatal cardiovascular events) were determined 6,2±0,2 months after CA with coronary stenting.Results. It was found that a decrease in urinary sodium (χ2=5,64, p=0,02, Constanta B0 =-0,62, Estimate =-16,5) and natriuresis (χ2=4,1, р=0,044, Constanta B0 =-1,38, Estimate =-5,2) increase the death risk. Urinary sodium of 0,2 mol/L and natriuresis of 0,5 mol are threshold levels of increased risk of death. Urinary potassium decrease was associated with an increase in death risk (threshold level — 0,5 mol/L, χ2=4,99, р=0,025, Constanta B0 =-0,63, Estimate =-70,4) and acute myocardial infarction (threshold level — 0,06 mol/L, χ2=3,93, р=0,04, Constanta B0 =-0,99, Estimate =-58,0) in the long-term period. Increase in EFWC increased the likelihood of long-term transient ischemic attack after ACS (χ2=4,61, р=0,03, Constanta B0 =-2,95, Estimate =-1,0). There were no significant relationships in the matter of FWC (p>0,05). However, with a decrease in intracellular fluid volume compared to normal values and a decrease in FWC or an increase in EFWC, the likelihood of longterm composite endpoints after ACS increases.Conclusion. As a result of the study, risk markers for long-term fatal and non-fatal cardiovascular events after ACS were established: decrease in urinary sodium <0,2 mol/l and potassium <0,5 mol/l; decrease in FWC and increase in EFWC with or without cellular dehydration. The established markers can complement the current cardiovascular risk score methods in patients with ACS.

Section: Introductionunclassified

Influence of electrolyte balance on the prognosis of long-term cardiovascular events after acute coronary syndrome

Левицкая

Gulchenko³

et al. 2020

Cardiovasc Ther Prev

“…Возникает феномен "разряжения" почечной ткани, характеризующийся уменьшением функционально эффективного тубулоинтерстиция на одну единицу сосуда. Замыкание "порочного круга" является необратимым процессом и одним из главных факторов более быстрого развития ХПН [4].…”

Section: Introductionunclassified

Role of remodeling of small diameter kidney arteries in the prognosis of progression of tubulointerstitial fibrosis in patients with chronic glomerulonephritis

Левицкая

Чистяков

et al. 2019

Cardiovasc Ther Prev

Aim. To assess the role of remodeling of small diameter kidney arteries in the prognosis of progression of tubulointerstitial fibrosis in patients with chronic glomerulonephritis.Material and methods. The study involved 97 patients with primary glomerulonephritis. The average age of patients was 37,27±1,2 years. The inclusion criterion was the presence of indications for renal biopsy. Renal biopsy was used to analyze renal tissue, in particular, for determining of tubulointerstitial fibrosis (TIF). Based on TIF sign, the patients were divided in 2 groups. The first group includes patients with TIF, the second — without TIF. Vasometry, a measurement of the renal arteries structures, was performed as part of renal biopsy. Parameters of internal and external diameters, wall thickness, intima, media, intima-media complex, vascular mass were analyzed.Results. The influence of the size of the inner and outer diameters of the interlobular artery (MA) on the studied risk was established. Probability of TIF developing increases with decreasing of MA inner diameter (χ2-criterion =5,34, p=0,02) and increasing of MA outer diameter (χ2-criterion =7,77, p=0,005). Intimal thickness does not have a statistically significant effect on the risk of TIF developing (p=0,29), whereas media thickness has a high statistical significance in renal tissue remodeling (χ2-criterion =13,71, p=0,0002). A statistically significant effect of an increase in the vascular mass on the risk of TIF was determined (χ2-criterion =6,55, p=0,01).Conclusion. We established that changes in the structure of small diameter kidney arteries in chronic glomerulonephritis occurs according to a hypertrophic type. Remodeling of small diameter kidney arteries plays significant role on the risk of TIF.

“…ССР связано с широким спектром метаболических и гемодинамических нарушений, наибольший вклад среди которых вносят уремическая интоксикация, электролитные расстройства, системный воспалительный процесс, артериальная гипертензия, сосудистая кальцификация, гиперфосфатемия, протеинурия, анемия. Перечисленные факторы и их высокая распространенность у пациентов с ХБП составляют основу кардиоренального континуума [7,8].…”

unclassified

The Role of Uremic Intoxication in the Development of Cardiovascular Remodeling in Patients with Chronic Kidney Disease Stages 3a-5d

Гасанов

Kolomyitseva

Arhivʺ vnutrennej mediciny

2021

In recent decades, the prevalence of chronic kidney disease (CKD) in the population has a clear upward trend. This is due, first of all, to an increase in the frequency of occurrence of the main factors leading to its development: diabetes mellitus and arterial hypertension. The progression of CKD against the background of the action of these factors leads to a steady loss of the kidneys of their filtration capacity and the development of complications associated with this process. These include, first of all, metabolic and acid-base disorders, electrolyte abnormalities, uremic intoxication, overhydration, protein-energy wasting, sarcopenia and others. Most of them are involved in the development of endothelial dysfunction and the formation of cardiovascular remodeling (CVR), as a key component of the cardiorenal continuum. At the same time, there is a mutual negative influence of pathology of the cardiovascular system on renal function and manifestations of CKD on cardiovascular hemodynamics. This “vicious circle” leads to the development of end-stage renal disease and an increase in cardiovascular risk and mortality from diseases of the circulatory system in patients with advanced stages of CKD. In this connection, this work is devoted to the study of the role of uremic intoxication and, in particular, indoxyl sulfate, in the development of CVR in patients with CKD at different stages of the disease.