A GIANT ANEURYSM OF PROPER HEPATIC ARTERY IN A CRYOGLOBULINEMIC PATIENT ON HEMODIALYSIS: A CASE REPORT.

Introductrion. Hepatic artery aneurysms (HAAs) are unusual vascular lesions often associated with many different pathological conditions. Most of reported cases are described in association with connective tissue diseases, such as polyarteritis nodosa and systemic lupus erythematosus. Case report. We observed a 52-year-old man with hypertension and HCV-related cryoglobulinemia complicated by end stage renal disease on replacement therapy by hemodialysis. He was admitted to our hospital because of the worsening of blood pressure values (170/110 mmHg) associated to new onset abdominal pain. After an initial physical examination, that showed a periumbelical bruit associated to a pulsatile mass…

Polymorphonuclear leukocyte membrane fluidity and cytosolic Ca2+ content at baseline and after activation in essential hypertension

Carotid plaque detection improves the predictve value of CHA2DS2-VASc score in patients with non-valvular atrial fibrilation: The ARAPACIS Study

Abstract Background and aims Vascular disease (VD), as assessed by history of myocardial infarction or peripheral artery disease or aortic plaque, increases stroke risk in atrial fibrillation (AF), and is a component of risk assessment using the CHA 2 DS 2 -VASc score. We investigated if systemic atherosclerosis as detected by ultrasound carotid plaque (CP) could improve the predictive value of the CHA 2 DS 2 -VASc score. Methods We analysed data from the ARAPACIS study, an observational study including 2027 Italian patients with non-valvular AF, in whom CP was detected using Doppler Ultrasonography. Results VD was reported in 351 (17.3%) patients while CP was detected in 16.6% patients. Ad…

LIPID PARAMETERS AND LEFT VENTRICULAR MASS IN ESSENTIAL HYPERTENSIVE PATIENTS

ASSOCIAZIONE TRA INDICE DI RESISTENZA INTRARENALE E STIFFNESS AORTICA IN SOGGETTI CON MALATTIA RENALE CRONICA

RAZIONALE. L’indice di resistenza intraparenchimale renale (IR), valutato mediante eco-color-Doppler, è stato classicamente utilizzato quale valido strumento di valutazione diagnostica e prognostica delle patologie renali. Studi recenti suggeriscono che i parametri emodinamici intrarenali, e l’IR in particolare, possano essere anche associati ad alterazioni vascolari sistemiche, nonché ad un incremento del rischio cardiovascolare. Tuttavia, dati contrastanti esistono in letteratura circa l'associazione indipendente tra IR e pulse wave velocity aortica (PWVa), indice di stiffness arteriosa, nonché espressione di danno d'organo subclinico. Scopo di questo studio è stato dunque quello di valut…

Relazione tra indice di resistenza renale e severità dell’aterosclerosi carotidea in soggetti con ipertensione arteriosa.

RAZIONALE. L’indice di resistenza intraparenchimale renale (IR), valutato mediante eco-color-Doppler, è stato classicamente considerato mera espressione di resistenza vascolare distrettuale renale. Studi più recenti, tuttavia, hanno mostrato come tale indice sia anche influenzato da fattori a tergo, compliance vasale in primis, a prova di un suo possibile ruolo quale marker di alterazioni vascolari sistemiche. Diversi studi hanno dimostrato, inoltre, come lo spessore intimale (IMTc) e la placca a livello carotideo, valutati mediante ultrasonografia, siano documentati marcatori di danno d'organo subclinico nonché espressioni progressive di malattia aterosclerotica. Scopo del nostro studio è …

RELATIONSHIPS BETWEEN SHORT-TERM BLOOD PRESSURE VARIABILITY AND EARLY RENAL DYSFUNCTION IN ESSENTIAL HYPERTENSIVE PATIENTS

Management of secondary hyperparathyroidism in uremic patients : the role of the new vitamin D analogs

Secondary hyperparathyroidism - a common comorbid condition in patients with chronic renal insufficiency - is considered a consequence of critical determinants such as hypocalcemia, phosphate retention and reduced levels of calcitriol production. In this complex mechanism, the skeletal apparatus and the nonskeletal targets such as vascular and heart valves are often involved, thus explaining the increased risk of cardiovascular morbidity and mortality of uremic patients. In this review we will focus on the major role played by Calcitriol deficiency as a trigger of secondary hyperparathyroidism and the crucial need for obiquitous vitamin D receptor activation in order to have an optimal PTH …

INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Introduction: Dilatation of aortic root is associated with presence and severity of aortic regurgitation and risk for aortic dissection. Recent studies performed in general population suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Aim: To assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. Methods: We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63 %) consecutively attending our outpatient nephrology and hypertension unit. Patients on dialysis treatment, with valvulopathy more than mil…

Relationship of fetuin-A with glomerular filtration rate and endothelial dysfunction in moderate-severe chronic kidney disease

Background: In end-stage renal disease, fetuin-A has been demonstrated to be reduced and inversely related to cardiovascular mortality. This study had 2 distinct aims. The first was to verify if circulating concentration of fetuin-A may depend on renal function in patients with chronic kidney disease (CKD). Furthermore, we analyzed the correlation of fetuin-A with the biomarker of endothelial dysfunction endothelin-1 (ET-1), and with the inflammatory cytokine interleukin-6 (IL-6). Methods: In 108 subjects with stage 3-5 CKD, plasma levels of fetuin-A, ET-1 and IL-6 were assayed. Patients were studied first as a whole group and then were divided according to stages of CKD and fetuin-A tertil…

Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study

Chronic obstructive pulmonary disease (COPD) increases the risk of mortality in non-valvular atrial fibrillation (NVAF) patients. Data on the relationship of COPD to major cardiovascular events (MACE) in AF have not been defined. The aim of the study is to assess the predictive value of COPD on incident MACE in NVAF patients over a 3-year follow-up. In the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) cohort, we evaluate the impact of COPD on the following clinical endpoints: MACE (including vascular death, fatal/non-fatal MI and stroke/TIA), cardiovascular (CV) death and all-cause mortality. Among 2027 NVAF patients, pati…

Ventrolateral Compression of the Brain Stem in Essential Hypertension: MR Angiography Study

Our purpose was to evaluate neurovascular compression at the level of ventrolateral medulla and NVC with the IXth and the Xth cranial nerves in patients with essential hypertension and in healthy volunteers using high resoluted Spoiled Recalled Gradient Echo (SPGR) sequences, allowing the detection of stationary tissues and moving spins. Thirty patients (19 men and 11 women) with essential hypertension were examined. Patient's ages ranged from 24 to 64 years-old (mean age was 48 y.o.). Patients older than 65 were excluded. The average of systolic blood-pressure of hypertensive patients was 183 ± 10 mmHg, while the diastolic pressure was 98 ± 10.5 mmHg. In conclusion, we consider axial sing…

Aberrant origin of the superior thyroid artery and ascending pharyngeal artery from a common trunk arising from the common carotid artery in a hypertensive patient with dizziness.

Oxidative stress, inflammation and cardiovascular disease in chronic renal failure

Traditional risk factors such as hypertension, diabetes, dyslipidemia, obesity and metabolic syndrome, as well as additional nontraditional risk factors, can damage the kidney directly and by promoting intrarenal atherogenesis. Evidence indicates that increased oxidative stress and inflammation may mediate most of the effects of risk factors on the kidney. Clinical studies have demonstrated a relationship between oxidative stress and inflammatory biomarkers, and a few studies indicate an inverse correlation of oxidative stress biomarkers with estimated glomerular filtration rate (eGFR). Further, surrogate indexes of atherosclerosis such as intima-media thickness and aortic pulse wave veloci…

Short and middle term effects of hypocaloric low carbohydrate diet vs hypocaloric Mediterranean diet on endothelial function in obese subjects

Adequate nutritional treatment is required to address the problem of increasing prevalence of obesity in Western countries. The Mediterranean diet style is now acknowledged to have large scientific evidences in terms of cardiovascular prevention. However, many popular diets are diffusing also as self-prescribed treatments. Among those, the efficacy of low-carbohydrate diets (also known as Atkins’ diet in its most popular variety) has been addressed by some investigations. It is generally concluded that the low-carbohydrate diet is able to induce a greater weight loss, at least in the middle term, and a better serum lipid profile than the conventional diet. In this longitudinal, randomised, …

SHORT-TERM VARIABILITY OF 24H SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH MICROALBUMINURIA IN PATIENTS WITH PRIMARY HYPERTENSION

Objective: Limited and conflicting data are available about the association between shortterm blood pressure (BP) variability and urinary albumin excretion rate (uAER). The objective of our study was to analyze the relationships between microalbuminuria, defined as an uAER between 20 and 200mg/ min, and shortterm BP variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24h BP, and as SD of daytime and nighttime BP. Design and method: The study population consisted of 315 untreated essential hypertensives with normal estimated glomerular filtration rate (> 60ml/min/1.73 m2), which underwent 24h ambulatory BP monitoring and 24h uAER determination. Result…

Influence of chronic renal insufficiency on left ventricular diastolic function in hypertensives without left ventricular hypertrophy

Relazioni tra stiffness aortica ed indice di resistenza intrarenale nell’ipertensione arteriosa

Per molti anni lo studio mediante eco-color-doppler dei parametri semiquantitativi emodinamici renali è stato utilizzato per rilevare le alterazioni della perfusione del rene trapiantato, per la diagnosi della stenosi dell’arteria renale o per valutare la progressione di alcune nefropatie. Più recentemente è stato osservato che tali parametri, ed in particolare l’indice di resistenza intrarenale (IR), non sono soltanto espressione della perfusione parenchimale, ma sono associati anche ad alterazioni morfo-funzionali sistemiche dell’albero vascolare. Vari studi hanno dimostrato come la stiffness aortica vada aumentando con il progressivo deterioramento della funzione renale. Tuttavia, dati c…

Metabolic syndrome in subjects with essential hypertension: Relationships with subclinical cardiovascular and renal damage

It has long been recognized that arterial hypertension is often a part of a larger constellation of anthropometric and metabolic abnormalities that includes abdominal (or visceral) obesity, a characteristic dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides), glucose intolerance, insulin-resistance and hyperuricemia. These traits occur simultaneously to a greater degree than would be expected by chance alone, supporting the existence of a discrete disorder that, over the years, has been defined by a variety of terms, including plurimetabolic syndrome, the deadly quartet, dysmetabolic syndrome, insulin resistance syndrome, cardiometabolic syndrome and more recently…

Pericardial thickening in chronic kidney disease: what meaning?

A theft renal arteriovenous fistula

RELAZIONI TRA PARAMETRI LIPIDICI E MASSA VENTRICOLARE SINISTRA IN SOGGETTI CON IPERTENSIONE ARTERIOSA ESSENZIALE

Dati non univoci sono riportati in letteratura sul ruolo della dislipidemia nello sviluppo dell’ipertrofia ventricolare sinistra. Scopo del nostro studio, è stato quello di valutare le potenziali associazioni dei principali parametri lipidici con la massa ventricolare sinistra (LVM) in pazienti con ipertensione essenziale (EHs). Abbiamo arruolato 724 soggetti con EH (età media 45±12 anni; 63% maschi), senza complicanze cardiovascolari e non trattati con farmaci ipolipemizzanti. In tutti i soggetti dono stati dosati la colesterolemia totale (Tchol), la trigliceridemia (TG) e il colesterolo HDL (HDLc). Il colesterolo LDL (LDLc) è stato stimato con la formula di Friedewald ed è stato calcolato…