ABSTRACT
OBJECTIVE: Renal sympathetic denervation (RSD) is an emerging device based treatment for patients with resistant hypertension. Nocturnal dipping (ND) is defined as a decrease in BP of 10-20 % during sleep, and has been shown to be protective against cardiovascular disease. This study examined the effect of RSD on the 24 h BP profile of patients with resistant hypertension. METHODS AND RESULTS: The first 23 consecutive patients with resistant hypertension scheduled for renal denervation in a single centre were included. 24 h ambulatory blood pressure monitors (ABPM) were given to patients pre-procedure and 9 months post-procedure. RSD led to a statistically non-significant reduction in overall 24 h ABPM BP (150/85 ± 12/9 vs. 143/84 ± 15/11 mmHg; P > 0.05) despite a reduction in the number of antihypertensive medications (4.9 ± 1.2 vs. 4.3 ± 1.2; P = 0.001). There were improvements in systolic ND 1.7 ± 8 vs. 5.2 ± 8 %; P < 0.05), diastolic ND (5.2 ± 8 vs. 10.2 ± 9 %; P < 0.05) and mean arterial pressure (MAP) ND (4.2 ± 8 vs. 8.0 ± 8 %; P < 0.05). Non-significant changes in ND status were observed in systolic (17 vs. 43 % of participants; P > 0.05), diastolic (30 vs. 43 % of participants; P > 0.05) and MAP (22 vs. 39 % of participants; P > 0.05) measurements. CONCLUSIONS: These data suggest that RSD may lead to an improvement in nocturnal dipping in selected patients with resistant hypertension. This may have cardiovascular benefits even if reduction in BP is not achieved with RSD.
Subject(s)
Hypertension/physiopathology , Kidney/pathology , Sympathectomy/methods , Antihypertensive Agents/therapeutic use , Blood Pressure , Blood Pressure Monitoring, Ambulatory/methods , Circadian Rhythm , Female , Humans , Ireland , Male , Middle Aged , Tertiary Care CentersABSTRACT
Micro-vascular and renal complications in diabetic patients are a considerable clinical challenge. In a previous study, we found a significant decrease in vascular endothelial growth factor A (VEGF-A) mRNA levels in glomeruli from patients with diabetic nephropathy (DN). We now set out to investigate the relationship between reduced VEGF-A and connective tissue growth factor (CTGF) expression levels, the number of podocytes, and the extent of interstitial fibrosis. Laser capture microdissection was applied to obtain glomerular RNA from 28 patients with DN and 22 controls. mRNA levels of VEGF-A, CTGF, nephrin, podocin, and Wilms tumor1 (WT1) were measured using real-time polymerase chain reaction. Protein expression was evaluated using immuno-stainings for VEGF-A and CTGF, as well as markers for podocytes (WT1) and endothelial cells (CD31). We found a significant decrease in glomerular mRNA levels for VEGF-A (2.5 times), CTGF (1.6), nephrin (2.8), podocin (3.3), and WT1 (1.7) in patients with DN. There was a significant correlation between expression of podocyte markers and VEGF-A mRNA levels, and an inverse correlation between podocin message and the extent of interstitial fibrosis. CD31-positive area was significantly decreased (3.2 times) in patients with DN. Reduction of angiogenic factors correlated with the extent of interstitial fibrosis. This downregulation was related to a reduction of podocytes in DN. The results may suggest that downregulation of VEGF-A and CTGF in DN is a result of podocyte loss.
Subject(s)
Diabetic Nephropathies/immunology , Immediate-Early Proteins/biosynthesis , Intercellular Signaling Peptides and Proteins/biosynthesis , Podocytes , Vascular Endothelial Growth Factor A/biosynthesis , Adult , Aged , Connective Tissue Growth Factor , Female , Humans , Male , Middle AgedABSTRACT
There have been major advances in our understanding of the pathogenetic mechanisms of diabetic nephropathy in recent years. Of particular interest is the emerging paradigm of the role that developmentally important genes may play in this process, representing recapitulation of the ontogenic process. This review examines the potential pathophysiological involvement of one such developmental gene gremlin in diabetic nephropathy.
Subject(s)
Diabetic Neuropathies/genetics , Intercellular Signaling Peptides and Proteins , Proteins/genetics , Bone Morphogenetic Proteins/genetics , Bone Morphogenetic Proteins/metabolism , Diabetic Neuropathies/metabolism , Humans , Kidney Glomerulus , Proteins/metabolismSubject(s)
Angiomyolipoma/pathology , Kidney Neoplasms/pathology , Kidney Transplantation/adverse effects , Aged , Female , Humans , Male , Middle Aged , Tissue DonorsSubject(s)
Antitubercular Agents/therapeutic use , Glomerulonephritis, Membranoproliferative/chemically induced , Methylprednisolone/therapeutic use , Rifampin/adverse effects , Tuberculosis, Pulmonary/drug therapy , Aged , Antitubercular Agents/adverse effects , Clarithromycin/therapeutic use , Female , Glomerulonephritis, Membranoproliferative/pathology , Humans , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Pyrazinamide/therapeutic use , Sputum/microbiology , Tuberculosis, Pulmonary/complicationsABSTRACT
Aminoglycoside-containing topical preparations are commonly used in the treatment of chronic suppurative otitis media and otitis externa. We report a case where systemic absorption of topical Gentisone HC occurred producing a serum gentamicin level of 6.2 micrograms/ml.