Arterial atherosclerosis in patients with chronic kidney disease and its relationship with serum and tissue

We investigated the correlation between atherosclerosis and tissue and serum levels of endothelin-1 in patients with chronic kidney disease [CKD]. Arterial samples were obtained from 35 patients with CKD during arteriovenous fistula placement. Thirty-one patients with cardiovascular disease who underwent coronary artery bypass graft [CABG] were selected as the atherosclerotic group, and a piece of their aorta punched during CABG was obtained. Also, a small piece of the renal artery was dissected during donation in 24 kidney donors [control group]. Tissue endothelin-1 level was measured and atherosclerosis grading was determined by pathologic examination. Serum levels of endothelin-1 were also measured in the three groups. The mean tissue endothelin-1 levels were 10.73 +/- 7.57 pg/ mL, 12.16 +/- 3.95 pg/mL, and 0.93 +/- 1.06 pg/mL in the patients with CKD, those with CABG, and donors, respectively [P < .001]. The mean serum endothelin-1 level was 25.23 +/- 15.15 pg/mL in the patients with CKD, 21.13 +/- 17.22 pg/mL in the patients with CABG, and 2.66 +/- 1.51 pg/mL in the donors [P < .001]. Atherosclerosis grades correlated with tissue endothelin-1 level [r = 0.823, P < .001] and serum endothelin-1 level [r = 0.608, P < .001] in the patients with CKD. Multiple regression analysis showed tissue endothelin-1 level as the main predicting factor of atherosclerosis [P < .001]. Tissue endothelin-1 concentration is more important than serum endothelin-1 or lipids levels in prediction of atherosclerosis. Thus, blockade of tissue endothelin-1 receptors with its antagonists may prevent atherosclerosis progression

Postnephrectomy changes in doppler indexes of remnant kidney in unrelated kidney donors

We aimed to evaluate the intralobar renal arteries indexes using the Doppler ultrasonography indexes, which have become the established method of kidney monitoring, in living unrelated kidney donors during the postnephrectomy period. In this prospective study, we evaluated and followed up 34 living unrelated kidney donors. The Doppler ultrasonography indexes, including resistive index, pulsatility index, and peak systolic velocity, along with the grey-scale ultrasonographic indexes of cortical thickness, length, and anteroposterior diameter of the kidney were determined before nephrectomy, and then, 1 week and 3 months after nephrectomy. In addition, glomerular filtration rate were assessed simultaneously. The resistive index and pulsatility index did not change 1 week and 3 months after nephrectomy [P = .66 and P = .38, respectively]. The peak systolic velocity at 1 week was significantly higher than its prenephrectomy value [P = .02]. Also, the peak systolic velocity at 3 months was significantly higher than that prior to nephrectomy [P < .00 1]. Indexes of the kidney size all increased during the follow-up period. The estimated glomerular filtration rate increased decreased 1 week after nephrectomy, but it reach to a level comparable with its preoperative values after 3 months. Results of the present study showed an increased peak systolic velocity in association with unaltered resistive index and pulsatility index in the remnant kidney of donors, during the short-term follow-up. This finding indicates the increased blood flow and kidney size in the remnant kidney of donors, following nephrectomy

C-reactive protein level following treatment and withdrawal of lovastatin in diabetic nephropathy

We aimed to evaluate the high-sensitivity C-reactive protein [HS-CRP] level changes at the beginning and after withdrawal of lovastatin therapy in patients with diabetic nephropathy. Thirty male patients with type 2 diabetes mellitus and diabetic nephropathy were enrolled in the study. Lovastatin, 20 mg/d, was administered for 90 days. Afterwards, Lovastatin was withdrawn for the next 30 days. Blood samples were obtained before the intervention, on the 90th day, and days 1, 7, and 30 after withdrawal of Lovastatin. Serum level of HS-CRP was determined by enzyme-linked immunosorbent assay. Alterations in lipid profile was assessed, as well, and compared with that of HS-CRP. Serum level of HS-CRP was significantly reduced after 90 days of lovastatin therapy [P < .001]. Then, the HS-CRP reached the pretreatment baseline level on the 7th day after lovastatin withdrawal and maintained until the 30th day [P < .001]. Serum HS-CRP changes showed no significant association with lipid profile except for serum total cholesterol level [r = 0.9, P = .006] after 3 months of lovastatin therapy. Their association was re-evaluated after 7 days and 1 month of treatment withdrawal and no significant correlations were found. Our findings suggest that lovastatin decreases serum CRP level in patients with diabetic nephropathy, and 7 days after lovastatin cessation, CRP level increases again

Doppler ultrasonographic indeces in kidney transplant recipients its relationship with kidney function

Doppler ultrasonography [DU] is mostly used for assessment of both graft and native kidneys' vascular status. In this study, correlation between the DU indexes and kidney allograft function was evaluated. Hospital records of 273 kidney transplant patients [154 men and 119 women] were reviewed. In all cases, DU had been performed 1 month after kidney transplantation. We evaluated the data on the resistive index [RI] and pulsatility index [PI] in the interlobar arteries and renal artery stenosis [RAS], and renal vessels thrombosis were determined. Concurrent serum creatinine and cyclosporine values were assessed in relation to the DU findings. The RI and PI had significant linear correlations with serum creatinine [P = .03 and P = .002, respectively]. Also, there were direct linear correlations between the age of the patients and the RI and PI values. The frequency of RAS was 10.3%. In patients with RAS, the mean creatinine level [2.08 +/- 1.70 mg/dL] was significantly higher than that in patients without RAS [1.48 +/- 0.97 mg/dL; P = .004]. Despite this finding, RI and PI were significantly lower in patients with RAS than in the patients with patent renovascular tributary [0.59 +/- 0.15 versus 0.65 +/- 0.11; P = .03 and 1.02 +/- 0.40 versus 1.18 +/- 0.46; P = .049, respectively]. There were no associations between serum cyclosporine level or panel reactive antibodies and the RI or PI. The RI and PI are valuable DU markers for determining the kidney allograft function and the related vascular complications