Ischemic Nephropaty: The Role of the Renal Artery Stenosis Revascularization on Renal Stem Cells

Cianci, Rosario; Perrotta, Adolfo; Gigante, Antonietta; Errigo, Federica; Ferri, Claudio; Cianci, Eleonora; Simeoni, Mariadelina; Mazzaferro, Sandro; Lai, Silvia

doi:10.3390/medicina57090944

Cited by 4 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, further studies are needed to investigate role of novel biomarkers for assessment of the renal and cardiovascular outcomes after revascularization of ARAS. One of the promising directions is assessment of the activation of mesenchymal stem cells and their role in the renal tissue regeneration after kidney reperfusion leading to repair organ damage [43].…”

Section: Discussionmentioning

confidence: 99%

The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease

Badacz

Kabłak‐Ziembicka

Rosławiecka

et al. 2022

JPM

View full text Add to dashboard Cite

Patients with type 2 diabetes mellitus (T2DM) constitute a large proportion of patients with atherosclerotic renal artery stenosis (ARAS). However, the mechanism of impaired renal function and hypertension in this subset of patients is multifactorial. We aimed to investigate whether, in diabetic patients, renal function (RF), systolic (SBP) and diastolic blood pressure (DBP) values following stent-supported angioplasty (PTA) for ARAS have an impact on cardiovascular and renal outcomes. Methods: The study group included 93 patients with T2DM and resistant hypertension who underwent PTA for ARAS. The pre- and post-procedure (6 to 12, and 24 months) values of SBP, DBP, eGFR and glycaemia were obtained. The prospective follow-up of median 44 months was performed for combined outcome: major cardiac and cerebral events (MACCE) and progression to renal replacement therapy (RRT). Results: MACCE-RRT occurred in 46 (49.5%) patients, with higher incidence in patients with higher values of SBP (147.8 ± 25.8 vs. 136.7 ± 15.8 mmHg, p = 0.006), DBP (80.8 ± 13.3 vs. 74.4 ± 12.3 mmHg, p = 0.009), chronic kidney disease in stages 3B to 5 (p = 0.029) and those who have not obtained target glycemic goals compared to well-maintained T2DM (p = 0.007) at 24-months. On multivariate Cox analysis, well-maintained T2DM targets [Hazard Ratio (HR):0.27; 95% Confidence Interval (CI):0.13–0.57; p < 0.001], eGFR below 45 mL/min/m2 (HR: 2.20; 95%CI: 1.20–4.04; p = 0.011), previous stroke (HR:2.52; 95%CI:1.19–5.34; p = 0.015) retained their associations with MACCE-RRT, while BP values were not associated with the outcome. Conclusions: The post-procedural RF, maintained glycemic target goal and previous stroke are vital for the outcome in patients undergoing PTA for renovascular disease in diabetic patients.

show abstract

Section: Discussionmentioning

confidence: 99%

The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease

Badacz

Kabłak‐Ziembicka

Rosławiecka

et al. 2022

JPM

View full text Add to dashboard Cite

show abstract

“…As the reduction in Renal Blood Flow (RBF) increases, the transition from a purely hemodynamic phase to an inflammatory one begins, since the reduction in renal oxygenation will activate the proinflammatory and fibrotic pathways, which could be reversed if renal ischemia is promptly treated [18,19].…”

Section: The Role Of Mesenchymal Stem Cells In Renal Hypoperfusionmentioning

confidence: 99%

“…Once migrated or activated in the damaged kidney, MSCs produce and release, through extracellular vesicles and exosomes, a variety of cytokines and chemokines able to reduce inflammation and increase different reparative pathways. Paracrine and/or endocrine mechanisms are involved, with effects on both immune response modulation and cellular replacement [15,18].…”

Section: The Role Of Mesenchymal Stem Cells In Renal Hypoperfusionmentioning

confidence: 99%

Mesenchymal Stem Cells Infusion and Renal Revascularization in Atherosclerotic Renal Artery Stenosis - New Modalities in Therapeutic Approach

2024

Curr Trends Intern Med

View full text Add to dashboard Cite

Recent studies indicate increased Renal Blood Flow (RBF) and cortical perfusion after Mesenchymal Stem Cells (MSCs) infusion in Atherosclerotic Renovascular Disease (ARVD) patients.They underscores the importance of exploring the new therapeutic modalities alongside endovascular stenting. Delivery of MSCs into the stenotic kidney at the time of revascularization preserves oxygen-dependent tubular function and microvascular architecture, and decreases inflammation and fibrosis. Recovery of cortical perfusion and eGFR has been observed in the contralateral kidney according to recent studies.MSC therapy plays a crucial role in promoting cell proliferation and migration, enhancing angiogenesis while inhibiting apoptosis and inflammation. Furthermore, they preserve endothelial function and provide protection against the progression of fibrosis. To emphasize the potential of MSCs in treating ARVD patients, the aim of this study is to highlight the need for a longer follow-up period. Continuing with a larger patient sample and an extended follow-up period of over 6 months, future research should explore the efficacy of MSCs in restoring endothelial function and microvascular rarefarction in ARVD after stenting. Additionally, there is a need to evaluate treatment guidelines for these patients, which were based on studies conducted almost a decade ago, such as CORAL and ASTRAL.

show abstract

Renal Stem Cells, Renal Resistive Index, and Neutrophil Gelatinase Associated Lipocalin Changes After Revascularization in Patients With Renovascular Hypertension and Ischemic Nephropathy

Cianci

Simeoni

Gigante

et al. 2023

CPD

View full text Add to dashboard Cite

Background: Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the gold standard therapy in patients with atherosclerotic renal artery stenosis (aRAS). However, therapeutic success depends on the correct timing of revascularization and the reversibility of the renal damage. Materials and Methods: We report a case series of patients treated with PTRA for renovascular hypertension and ischemic nephropathy. We measured bilateral renal resistive index (RRI), circulating renal stem cells (RSC), and Neutrophil Gelatinase Associated Lipocalin (NGAL) at baseline and after PTRA at different time points to understand their changes in post-revascularization. Results: At baseline, the studied patients (n=5) had different RSC levels. After PTRAs, all patients showed an improvement in blood pressure, while renal function varied differently within the studied subjects. RRI >0.75 at baseline and the absence of NGAL decrease after PTRAs were associated with post-PTRA renal function worsening, despite an increase of RSC in all patients. Conclusions: Although limited to a few patients, our observation allowed the exploration of the behaviour of the studied parameters in different degrees of renal ischemia. This revealed different disease models suggesting the importance of further investigations in larger and homogeneous cohorts to confirm that a greater basal RSC percentage, low RRI values before PTRA, and a post-revascularization NGAL reduction could be related to better renal outcomes in aRAS patients.

show abstract

Ischemic Nephropaty: The Role of the Renal Artery Stenosis Revascularization on Renal Stem Cells

Cited by 4 publications

References 12 publications

The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease

The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease

Mesenchymal Stem Cells Infusion and Renal Revascularization in Atherosclerotic Renal Artery Stenosis - New Modalities in Therapeutic Approach

Renal Stem Cells, Renal Resistive Index, and Neutrophil Gelatinase Associated Lipocalin Changes After Revascularization in Patients With Renovascular Hypertension and Ischemic Nephropathy

Contact Info

Product

Resources

About