Objective: Renin-angiotensin system (RAS) might be associated with arteriolar remodeling. The present study aimed to explore the hitherto unknown relationship between renal RAS and renal arteriolar remodeling and to elucidate whether altered renal RAS subsequently affects renal function in patients with chronic kidney disease (CKD).Methods: In this retrospective study, patients with various CKDs not using RAS inhibitors who underwent renal biopsy were included in cross-sectional and longitudinal analyses. Urinary angiotensinogen (UAGT) levels and wall/ lumen ratio (WLR) were determined to evaluate renal RAS and renal arteriolar remodeling, respectively. The association between ln(UAGT) and ln(WLR) was crosssectionally examined using a liner regression model. Furthermore, the association of ln(UAGT) with subsequent changes in estimated glomerular filtration rate (eGFR) per year were longitudinally examined in the largest subgroup of patients who were diagnosed with IgA nephropathy.Results: In the overall cohort (n ¼ 54), the median age, blood pressures, eGFR, and WLR were 37 years, 120/ 73 mmHg, 85 ml/min per 1.73 m 2 , and 0.93, respectively. Ln(UAGT) was significantly and positively associated with ln(WLR) even after adjusting for classical and nonclassical clinical renal risk factors. In patients with IgA nephropathy, higher ln(UAGT) was associated with higher ln(WLR). Ln(UAGT) also tended to be associated with a greater decline in eGFR per year over a median period of 8.7 years, even after adjusting for potential confounding factors. Conclusion:In patients with CKD, renal RAS might be associated with renal arteriolar remodeling and future decline in eGFR, independent of potential risk factors.
Background: Hypertensive emergencies are poor prognosis conditions associated with rapid blood pressure (BP) elevation and various organ damage. The frequency of dialysis induction due to nephrosclerosis is high and early detection and appropriate therapeutic intervention are important. Methods:We selected 15 patients diagnosed as hypertensive emergencies with severe renal dysfunction (serum creatinine level > 2.5 mg/dL) admitted to our hospital between 2005 and 2019. These were divided into two groups: those who received a renal replacement therapy (RRT) after 3 years and those who were not received (non-RRT). The clinical features and laboratory data between the two groups were reviewed and compared retrospectively. Results:The median age was 48 years old and the male to female ratio was 3:1. All the patients lacked medical examination and regular checkups after diagnosis of hypertension. 33% of them were obese with body mass index > 25. Six patients resulted in end-stage renal disease and received RRT. On admission, about 80% had elevated plasma renin activity and serum aldosterone levels, while there were no cases of renal artery stenosis. Between two groups, there was no significant difference in serum creatinine levels. Serum LDH levels in the non-RRT group were higher than those in the RRT group. Serum potassium levels and platelet counts were lower, respectively. These data at post-antihypertensive treatment was improved significantly in the non-RRT group. Serum values of LDH, potassium, and platelet in the comparison of pre-and post-treatment data of the two groups showed significantly improved by two-way analysis of variance.
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