The association between renal function and structural parameters: a pig study

<p>Abstract</p> <p>Background</p> <p>The objective was to investigate the association between renal structural parameters and renal function. The structural parameters were renal cortical volume, total renal volume, number of glomeruli, and total glomerular volume, and renal function was expressed by the single kidney GFR (skGFR). Investigations were performed using both healthy and chronically diseased kidneys. We investigated which of the structural parameters showed the best correlation to renal function and evaluated the possibility of predicting the renal function from structural parameters.</p> <p>Methods</p> <p>Twenty-four pigs, twelve with healthy kidneys and twelve with diseased kidneys, underwent skGFR measurements. Nephrectomies were performed and structural parameters were estimated using stereological procedures. The correlation between the structural parameters and skGFR was analysed by Pearson's correlation test. The prediction of skGFR from structural parameters was analysed by a linear regression test.</p> <p>Results</p> <p>In general, we demonstrated a good correlation between structural parameters and skGFR. When all kidneys were evaluated together Pearson's correlation coefficient between skGFR and any stereological parameter was above 0.60 and highly significant (p < 0.001), and with r-values ranging from 0.62 regarding number of glomeruli, to 0.78 regarding cortical volume. The best correlation was found between cortical volume and skGFR. Prediction of single kidney GFR from any structural parameter showed to be quite imprecise.</p> <p>Conclusion</p> <p>The observed correlations between structural parameters and renal function suggest that these parameters may potentially be useful as surrogate markers of the renal function. At present, however, precise prediction of renal function based on a single structural parameter seems hard to obtain.</p

Normal kidney size and its influencing factors - a 64-slice MDCT study of 1.040 asymptomatic patients

<p>Abstract</p> <p>Background</p> <p>Normal ultrasound values for pole-to-pole kidney length (LPP) are well established for children, but very little is known about normal kidney size and its influencing factors in adults. The objectives of this study were thus to establish normal CT values for kidney dimensions from a group of unselected patients, identify potential influencing factors, and to estimate their significance.</p> <p>Methods</p> <p>In multiphase thin-slice MDCTs of 2.068 kidneys in 1.040 adults, the kidney length pole to pole (LPP), parenchymal (PW) and cortical width (CW), position and rotation status of the kidneys, number of renal arteries, pyelon width and possible influencing factors that can be visualized, were recorded from a volume data set. For length measurements, axes were adjusted individually in double oblique planes using a 3D-software. Analyses of distribution, T-tests, ANOVA, correlation and multivariate regression analyses were performed.</p> <p>Results</p> <p>LPP was 108.5 ± 12.2 mm for the right, and 111.3 ± 12.6 mm for the left kidney (p < 0.0001 each). PW on the right side was 15.4 ± 2.8 mm, slightly less than 15.9 ± 2.7 mm on the left side (p < 0.0001), the CW was the same (6.6 ± 1.9 mm). The most significant independent predictors for LPP, CW, and PW were body size, BMI, age, and gender (p < 0.001 each). In men, the LPP increases up to the fifth decade of life (p < 0.01). It is also influenced by the position of the kidneys, stenoses and number of renal arteries (SRA/NRA), infarctions suffered, parapelvic cysts, and absence of the contralateral kidney; CW is influenced by age, position, parapelvic cysts, NRA and SRA, and the PW is influenced in addition by rotation status (p < 0.05 each). Depending on the most important factors, gender-specific normal values were indicated for these dimensions, the length and width in cross section, width of the renal pelvis, and parenchyma-renal pyelon ratio.</p> <p>Conclusions</p> <p>Due to the complex influences on kidney size, assessment should be made individually. The most important influencing factors are BMI, height, gender, age, position of the kidneys, stenoses and number of renal arteries.</p

HTA et traitement hormonal de la menopause

International audienceCan menopausal hormone therapy (HT) be used in hypertensive women? The group of experts of the French Society of Hypertension has carried out a review of the recent literature in order to answer this question, based on the most recent scientific publications. If use of oral HT is associated with a discreet increase in blood pressure, the transdermal route seems to be safer. The first results of major randomized trials of HT had alerted to an increase in cardiovascular events and breast cancer with the use of oral HT, generally, tipping the benefit-risk balance of the deleterious side. Complementary analyzes have shown the importance of the window of intervention (less than 10 years after the menopause) and the age of the woman to start the HT. On the contrary, they have shown a significant decrease of the coronary events. For woman suffering from hypertension and important climacteric symptoms, it is important to evaluate the whole cardiovascular risk in order to decide the possibility of prescribing a HT. Thus, the group of experts proposes a prescription assistance algorithm based on the stratification of cardiovascular risk, always favoring, when it is authorized, HT by transdermal route of administration

Predictors of poor blood pressure control assessed by 24 hour monitoring in patients with type B acute aortic dissection

Pascal Delsart1, Marco Midulla2, Jonathan Sobocinski3, Charles Achere4, Stephan Haulon3, Gonzague Claisse1, Claire Mounier-Vehier11Vascular Medicine and Hypertension Department, Cardiology Hospital, CHRU Lille, 2Radiology and Cardiovascular Imaging Department, Cardiology Hospital, CHRU Lille, 3Vascular Surgery Department, Cardiology Hospital, CHRU Lille, 4Cardiology Department, Cardiology Hospital, CHRU Lille, FranceAbstract: The chronic management of post-acute aortic dissection (AD) of the descending aorta (Type B) is based on optimal control of blood pressure (BP), with a target BP &amp;lt; 135/80 mmHg. The aim of our study was to determine and verify effective blood pressure control with an objective measurement method and to identify predicting factors.Methods: We collected data from 26 patients hospitalized in the acute phase of a Type B AD between 2006 and 2009. Two groups were defined according to 24 hour BP monitoring results at follow-up. Group 1 consisted of patients with a controlled BP (&amp;lt; 130/80 mmHg), and Group 2 consisted of patients with an uncontrolled BP.Results: Thirty four percent of patients showed an uncontrolled BP at checkup. Vascular history before AD (P = 0.06), high baseline BP trend (P = 0.01 for systolic and P = 0.08 for diastolic), and greater diameter of the descending aorta (P = 0.02) were associated with poor BP control.Conclusion: Prognosis after AD is associated with BP control. Therefore, 24 hour BP monitoring can be made.Keywords: acute aortic syndrome, blood pressure monitoring, hypertensio

Menopausal hormone therapy and risk of incident hypertension: role of the route of estrogen administration and progestogens in the E3N cohort.

International audienceObjectives: Although menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms of menopause, its association with the development of arterial hypertension remains unclear. We sought to explore associations between different formulations of MHT and incident hypertension among menopausal women in a prospective cohort study.Methods: We used the Etude Epidémiologique de femmes de la Mutuelle Générale de l’Education (E3N) cohort, a French prospective population-based study initiated in 1990 on 98,995 women. Out of these, 49,905 menopausal women with complete information on the use of MHT, and without prevalent hypertension at inclusion were included.Results: The mean age of the population at baseline was 54.2 ± 4.3 years, and 32,183 (64.5%) reported ever using MHT. Among these women, 10,173 cases of incident hypertension were identified over an average follow-up time of 10.6 years. Compared with women who never used MHT, those who ever used it had an increased risk of incident hypertension (adjusted HR 1.07, 95% CI 1.02-1.12) after adjustment for body mass index and other potential confounders. Oral but not transdermal estrogen use was associated with an increased risk of hypertension (adjusted HR = 1.09; 95% CI: 1.04-1.14 and HR = 1.03; 95% CI: 0.99-1.07, respectively). However, the HRs associated with oral and transdermal estrogens did not differ significantly (P-homogeneity = 0.09). Regarding the role of concomitant progestogens, pregnane and norpregnane derivatives were significantly associated with hypertension risk (HR = 1.12; 95% CI: 1.06-1.19 and HR = 1.06; 95% CI: 1.01-1.13, respectively).Conclusions: MHT was associated with a modest but significant increased risk of incident hypertension, especially when using oral estrogen in combination with a progestogen such as pregnane and norpregnane derivatives. Surveillance of blood pressure should be added to the medical surveillance of MHT users

Exercise training at the crossover point improves bodily and cardiorespiratory data but not quality of life in women with metabolic syndrome.

International audienceThis study investigated the effects of an exercise program at the intensity corresponding to the crossover point of substrate utilization (COP) on anthropometric measures, health-related quality of life (HRQoL) and cardiorespiratory fitness (i.e., peak oxygen uptake: VO2peak and peak power output: Ppeak) in women with metabolic syndrome (MetS). Nineteen obese and post-menopausal women with MetS (age: 54.8 ± 8.1 y, body mass: 89.0 ± 12.2 kg, body mass index: 34.5 ± 4.0 kg.m-2) followed a 12-week program consisting of three 45-min sessions per week of cycle ergometer exercise. The imposed exercise intensity corresponded to COP. Before and after the program, HRQoL, VO2peak and Ppeak were measured and then compared. Body mass (89.0 ± 12.2 vs 86.2 ± 11.0 kg), body mass index (34.5 ± 4.0 vs 33.4 ± 3.6 kg.m-2), waist (106 ± 10 vs 100 ± 9 cm) and hip (117 ± 11 vs 114 ± 11 cm) circumferences, waist-to-hip ratio (0.91 ± 0.07 vs 0.88 ± 0.07), fat mass (43.3 ± 4.6 vs 41.9 ± 4.6%), fat-free mass (56.7 ± 4.6 vs 58.2 ± 4.6%), VO2peak (16.6 ± 3.4 vs 18.1 ± 4.1 mL.min-1.kg-1) and Ppeak (102 ± 22 vs 125 ± 27 W) were significantly improved after the exercise program (P 0.05). Although a 12-week exercise program at COP improved anthropometric measures and cardiorespiratory fitness in women with MetS, self-perceived HRQoL did not significantly improve. This finding may be linked to a significant but nevertheless insufficient reduction in body mass, probably because COP is too weak exercise intensity to induce important energy expenditure

Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period

OBJECTIVES: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome. METHODS: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan–Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models. RESULTS: The mean follow up was 51 months (1–132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events. CONCLUSIONS: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting