Association of urinary angiotensinogen with renal arteriolar remodeling in chronic kidney disease

Kanamitsu, Takafumi; Kohagura, Kentaro; Zamami, Ryo; Nakamura, Takuto; Oshiro, Nanako; Miyagi, Tsuyoshi; Nakamura, Koshi; Ohya, Yusuke

doi:10.1097/hjh.0000000000003031

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…Combining SMK and HU might have a significant influence on arteriolar wall thickening associated with hypertension and RAS activation because renal RAS has been demonstrated to be associated with renal arteriolar wall thickening [30].…”

Section: Discussionmentioning

confidence: 99%

The Association of Smoking and Hyperuricemia with Renal Arteriolosclerosis in IgA Nephropathy

et al. 2023

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The combination effects of smoking (SMK) and hyperuricemia (HU) on renal arteriolosclerosis in patients with IgA nephropathy remain unknown. We examined the cross-sectional association between smoking (current or former) and renal arteriolar hyalinosis and wall thickening with or without HU [uric acid (UA) level ≥ 7 and ≥5 mg/dL in men and women] in 87 patients with IgA nephropathy who underwent renal biopsy. Arteriolar hyalinosis and wall thickening were assessed by the semiquantitative grading of arterioles. The SMK/HU subgroup showed the highest indices for hyalinosis and wall thickening, followed by the non-SMK/HU, SMK/non-HU, and non-SMK/non-HU subgroups. Multiple logistic analysis showed that SMK/HU, but not SMK/non-HU, was significantly associated with an increased risk of higher-grade renal arteriolar wall thickening. However, this did not occur with hyalinosis compared to non-SMK/non-HU. The adjusted odds ratio (95% confidence interval, p value) for SMK/HU was 12.8 (1.36–119, p < 0.05) for wall thickening. An association between SMK and renal arteriolar wall thickening might be prevalent only among patients with HU and in patients with IgA nephropathy. Further prospective studies are needed to determine whether patients with HU and SMK history exhibit rapid eGFR deterioration.

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Section: Discussionmentioning

confidence: 99%

The Association of Smoking and Hyperuricemia with Renal Arteriolosclerosis in IgA Nephropathy

et al. 2023

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Heterogeneous afferent arteriolopathy: a key concept for understanding blood pressure–dependent renal damage

Kohagura,

Zamami,

Oshiro

et al. 2024

Hypertens Res

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Hypertension, aging, and other factors are associated with arteriosclerosis and arteriolosclerosis, primary morphological features of nephrosclerosis. Although such pathological changes are not invariably linked with renal decline but are prevalent across chronic kidney disease (CKD), understanding kidney damage progression is more pragmatic than precisely diagnosing nephrosclerosis itself. Hyalinosis and medial thickening of the afferent arteriole, along with intimal thickening of small arteries, can disrupt the autoregulatory system, jeopardizing glomerular perfusion pressure given systemic blood pressure (BP) fluctuations. Consequently, such vascular lesions cause glomerular damage by inducing glomerular hypertension and ischemia at the single nephron level. Thus, the interaction between systemic BP and afferent arteriolopathy markedly influences BP-dependent renal damage progression in nephrosclerosis. Both dilated and narrowed types of afferent arteriolopathy coexist throughout the kidney, with varying proportions among patients. Therefore, optimizing antihypertensive therapy to target either glomerular hypertension or ischemia is imperative. In recent years, clinical trials have indicated that combining renin–angiotensin system inhibitors (RASis) and sodium–glucose transporter 2 inhibitors (SGLT2is) is superior to using RASis alone in slowing renal function decline, despite comparable reductions in albuminuria. The superior efficacy of SGLT2is may arise from their beneficial effects on both glomerular hypertension and renal ischemia. A comprehensive understanding of the interaction between systemic BP and heterogeneous afferent arteriolopathy is pivotal for optimizing therapy and mitigating renal decline in patients with CKD of any etiology. Therefore, in this comprehensive review, we explore the role of afferent arteriolopathy in BP-dependent renal damage.

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Association of urinary angiotensinogen with renal arteriolar remodeling in chronic kidney disease

Cited by 2 publications

References 36 publications

The Association of Smoking and Hyperuricemia with Renal Arteriolosclerosis in IgA Nephropathy

The Association of Smoking and Hyperuricemia with Renal Arteriolosclerosis in IgA Nephropathy

Heterogeneous afferent arteriolopathy: a key concept for understanding blood pressure–dependent renal damage

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