“…Even though acute neurovisceral attacks are the most dramatic, and potentially life-threatening, clinical manifestations of acute porphyrias, patients affected by this group of diseases do suffer from chronic complications, which may be debilitating and have a considerable impact on their quality of life. In particular, patients with symptomatic AHPs are prone to develop long-term complications of vascular nature, such as arterial hypertension, chronic kidney disease (often termed porphyria-associated kidney disease-PAKD) [ 11 , 13 , 17 , 38 , 39 ], and thrombotic events [ 40 , 41 ]. Therefore, it could be reasonably conjectured a direct involvement of the endothelium, which could be a primary site of organ damage, in the pathogenesis of AHPs.…”