Dataset Information

The renal resistive index is associated with microvascular remodeling in patients with severe obesity.

ABSTRACT:

Background

Renal hemodynamics is impaired since the early stage of cardiometabolic disease. However, in obesity, its noninvasive ultrasound assessment still fails to provide pathophysiologic and clinical meaningfulness. We aimed to explore the relationship between peripheral microcirculation and renal hemodynamics in severe obesity.

Methods

We enrolled fifty severely obese patients with an indication for bariatric referring to our outpatient clinic. Patients underwent an extensive reno-metabolic examination, paired with Doppler ultrasound and measurement of the renal resistive index (RRI). On the day of the surgery, visceral fat biopsies were collected to perform an ex-vivo complete microcirculatory assessment. Media-to-lumen ratio (M/L) and vascular response to acetylcholine (ACh), alone or co-incubated with N G -nitro arginine methyl ester (L-NAME), were measured.

Results

Patients were stratified according to their normotensive (NT) or hypertensive (HT) status. HT had lower estimated glomerular filtration rate and higher RRI compared to NT, while the presence and extent of albuminuria were similar between the two groups. Concerning microcirculatory assessment, there were no differences between groups as regards the microvascular structure, while the vasorelaxation to ACh was lower in HT ( P = 0.042). Multivariable analysis showed a relationship between M/L and RRI ( P = 0.016, St. β 0.37) and between albuminuria and the inhibitory response of L-NAME to Ach vasodilation ( P = 0.036, St. β = -0.34). Notably, all these correlations were consistent also after adjustment for confounding factors.

Conclusions

The RRI and albuminuria relationship with microvascular remodeling in patients affected by severe obesity supports the clinical implementation of RRI to improve risk stratification in obesity and suggests a tight pathophysiologic connection between renal haemodynamics and microcirculatory disruption.

SUBMITTER: Moriconi D

PROVIDER: S-EPMC10242520 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The renal resistive index is associated with microvascular remodeling in patients with severe obesity.

Moriconi Diego D Mengozzi Alessandro A Duranti Emiliano E Cappelli Federica F Taddei Stefano S Nannipieri Monica M Bruno Rosa Maria RM Virdis Agostino A

Journal of hypertension 20230406 7

<h4>Background</h4>Renal hemodynamics is impaired since the early stage of cardiometabolic disease. However, in obesity, its noninvasive ultrasound assessment still fails to provide pathophysiologic and clinical meaningfulness. We aimed to explore the relationship between peripheral microcirculation and renal hemodynamics in severe obesity.<h4>Methods</h4>We enrolled fifty severely obese patients with an indication for bariatric referring to our outpatient clinic. Patients underwent an extensive ...[more]

PMID: 37071436

Similar Datasets

Project description:BackgroundHigh ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians.MethodsConsecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 and/or proteinuria>0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of p<0.10, was used to assess the independent correlates of RI as continuous variable.ResultsWe studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m2. From low (<0.65) to intermediate (0.65-0.70) to high (>0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels (p<0.001), diabetes (p = 0.042), CVD (p = 0.009), smoking habit (p = 0.021) and higher serum phosphorus levels (p = 0.001) were associated with higher continuous RI. Serum phosphorus showed Area Under the Curves (AUC) values of 0.714 and 0.664 for discriminating RI cut-offs of 0.70 and 0.65.ConclusionsThis analysis suggests that RI is higher in CKD patients with CVD, diabetes, smoking habit and higher serum phosphorus, regardless of eGFR. Further studies are needed to verify whether higher RI indicates more complex pathway of intrarenal damage, besides and beyond kidney function.

Project description:ObjectivesThe performance of renal resistance index (RRI) in predicting persistent sepsis-associated acute kidney injury (S-AKI) remains debatable, and the value of urinary C-C motif chemokine ligand 14 (CCL14) in predicting persistent S-AKI has not been validated yet. Therefore, we aimed to determine the applicability of a urinary biomarker CCL14 for the early detection of persistent S-AKI. Furthermore, the use of RRI obtained from renal Doppler ultrasonography was applied to differentiate transient from persistent S-AKI. Finally, we aimed to evaluate the use of these techniques in predicting different subtypes of S-AKI.MethodsThis prospective observational study was conducted at the internal medicine intensive care unit (ICU) of a university hospital. The RRI was determined within 12 h of ICU admission and the urinary CCL14 was evaluated at T0, T6, T12, and T24. The reversibility of renal dysfunction was assessed within 48 h. The receiver operating characteristic curves were then plotted to assess the diagnostic efficacy of the RRI and urinary CCL14 in predicting persistent S-AKI.ResultsOut of 48 patients, 23 developed persistent S-AKI upon admission. The RRI was higher in the persistent S-AKI group (P = 0.02) and the RRI ≥ 0.679 could predict persistent S-AKI with an area under the receiver operating characteristic curve of 0.79 (95% CI 0.65-0.93), a sensitivity of 91.30% (95% CI 70-98%), and a specificity of 65.20% (95% CI 43-83%). Urinary CCL14 was not significantly different between the two groups at the tested period, showing poor diagnostic performance at T0, T6, T12, and T24, with areas under the receiver operating characteristic curves of 0.56 (95% CI 0.38-0.73), 0.62 (95% CI 0.46-0.79), 0.52 (95% CI 0.35-0.68), and 0.60 (95% CI 0.43-0.77), respectively.ConclusionsThe RRI obtained from renal Doppler ultrasound is extremely effective in predicting persistent S-AKI in critically ill patients, and urinary CCL14 could not distinguish between transient and persistent S-AKIs.

Project description:BackgroundIn recent years, the triglyceride-glucose (TyG) index has emerged as a reliable surrogate marker of insulin resistance (IR). This study aimed to investigate the association between the TyG index and severe proteinuria or decreased renal function in patients with primary membranous nephropathy (PMN).MethodsWe consecutively enrolled 536 patients with PMN hospitalized at Peking University Third Hospital from January, 2014 to December, 2023. The TyG index was calculated as Ln[fasting triglyceride (mg/dL)×fasting blood glucose (mg/dL)/2]. All participants were categorized into quantiles according to the TyG index. Severe proteinuria was defined as 24 h urine protein > 3.5 g/d, and decreased renal function was defined as the estimated glomerular filtration rate < 90 mL/min/1.73m2. Multivariable logistic regression, restricted cubic spline (RCS) curves, and receiver operating characteristic (ROC) curves were used for analysis.ResultsAmong 536 patients with PMN, 355 patients had severe proteinuria and 149 patients had decreased renal function. The levels of TyG index was significantly elevated in PMN patients with severe proteinuria or decreased renal function. The RCS analysis revealed a positive linear relationship of the TyG index with the risk of severe proteinuria (P for non-linear = 0.317) or decreased renal function (P for non-linear = 0.199) in patients with PMN. Using the lowest quantile as the reference, multivariate-adjusted logistic regression indicated that patients in the highest quantile of the TyG index had a significantly increased risk of severe proteinuria [odds ratio (OR) = 2.08, 95% confidence interval (CI): 1.44-3.01, P < 0.001] and decreased renal function (OR = 1.57, 95% CI: 1.04-2.36, P = 0.032). The area under the ROC curve (AUC) of the TyG index is 0.613 (95% CI: 0.564-0.662) for severe proteinuria and 0.590 (95% CI: 0.536-0.643) for decreased renal function.ConclusionOur findings indicated that the TyG index has a positive linear correlation with severe proteinuria or decreased renal function in patients with PMN.

Dataset Information

The renal resistive index is associated with microvascular remodeling in patients with severe obesity.

Background

Methods

Results

Conclusions

Publications

The renal resistive index is associated with microvascular remodeling in patients with severe obesity.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets