ABSTRACT
The renal resistive index (RRI) measured by Doppler sonography is a marker of microvascular status that can be generalized to the whole of the arterial tree. Its association with large-vessel dysfunction, such as arterial stiffness or the atherosclerotic burden, can help to establish physiopathological associations between macrocirculation and microcirculation. The authors conducted a cross-sectional study of hypertensive patients (n=202) and a healthy control group (n=16). Stiffness parameters, atherosclerotic burden, and determination of the RRI in both kidneys were performed. The average RRI was 0.69±0.08 and was significantly greater in patients with diabetes and chronic kidney disease. Renal resistive index positively correlated with age, creatinine, and albuminuria. Positive correlations were found with arterial stiffness parameters (pulse wave velocity, ambulatory arterial stiffness index, and 24-hour pulse pressure), as well as atherosclerotic burden and endothelial dysfunction measured as asymmetric dimethylarginine in serum. In the multivariate analysis, independent factors for increased RRI were age, renal function, 24-hour diastolic blood pressure, and arterial stiffness. The authors concluded that there is an independent association between renal hemodynamics and arterial stiffness. This, together with the atherosclerotic burden and endothelial dysfunction, suggests that there is a physiopathologic relationship between macrovascular and microvascular impairment.
Subject(s)
Atherosclerosis/physiopathology , Blood Circulation/physiology , Kidney/blood supply , Microcirculation/physiology , Renal Artery/physiology , Vascular Resistance/physiology , Vascular Stiffness/physiology , Adult , Age Factors , Aged , Atherosclerosis/epidemiology , Blood Pressure/physiology , Case-Control Studies , Cross-Sectional Studies , Diabetes Mellitus/physiopathology , Endothelium, Vascular/physiopathology , Female , Humans , Hypertension/physiopathology , Incidence , Kidney/physiology , Kidney/physiopathology , Male , Middle Aged , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Renal Insufficiency, Chronic/physiopathology , Ultrasonography, DopplerABSTRACT
FUNDAMENTO: La pérdida del ritmo nictemeral de la presión arterial y la presión de pulso elevada se consideran factores de riesgo cardiovascular independientes que pueden relacionarse con la afección microvascular de los pacientes con diabetes mellitus tipo 2. PACIENTES Y MÉTODO: Estudio observacional, transversal, de una población de pacientes con diabetes mellitus tipo 2. Las variables se estudian mediante registro ambulatorio de la presión arterial. Los resultados se comparan con los diversos grados de nefropatía. RESULTADOS: Se estudia a un total de 61 pacientes, 31 de los cuales tienen un comportamiento no dipper. La proporción de no dipper aumenta con la excreción urinaria de albúmina (p = 0,024). La presión de pulso es superior en los pacientes con macroalbuminuria (p = 0,004). CONCLUSIONES: Existe una pérdida del ritmo nictemeral más frecuente, así como presiones del pulso más elevadas, entre los pacientes con diabetes mellitus tipo 2 que presentan nefropatía (AU)
