The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons.

Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel-derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT's deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health

Plasma Pro-Endothelin-1 Peptide Concentrations Rise in Chronic Kidney Disease and Following Selective Endothelin A Receptor Antagonism

The new analyses described in this article were funded by the Medical Research Council (Grant G0801509). Additional funding was from the British Heart Foundation (Project Grant PG/05/91), Encysive Pharmaceuticals, and Pfizer. Dr Dhaun is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/13/30/29994)

Forgotten signs of chronic kidney disease-associated mineral bone disease

This text presents the natural and cultural heritage of Malinalco (State of Mexico), as well as the te-rritorial identity of its inhabitants. It focuses on the perceptions, opinions, ratings and attitudes of the population around their village. Two are the objectives being pursued, the view of its inhabitants on the site: what they like and dislike, people, what has unique or special, their characterization and the feeling of living there. Secondly, an assessment of its heritage: festivities, the chinelos and the concheros, neighborhoods and Center, the ex-convent and the archaeological, the hills and the nature of the environment.Therefore applied a survey on the issue among the population, in order to obtain, as stated, the percep-tions and opinions of the inhabitants of the village. Often question them identity and heritage are defined from political or academic authorities on this occasion this is done through the eyes and voice of the people of the place. Almost all the issues requested throughout the survey, the population of the place shows very positive and favourable with regard to their place of residence. The identity is considered important and the feelings are positive, as well as the assessment of their heritage is also satisfactory. It is possible to say that there is a grounded emotional attachment and appreciation of their identity and heritage, and within some diversity of opinion on some issues, emphasizes the taste of living in the place, the appreciation for its people, feel good, happy and calm.Este texto presenta el patrimonio natural y cultural de Malinalco (Estado de México), así como la identidad territorial de sus habitantes. Se centra en percepciones, opiniones, valoraciones y actitudes de la población en torno a su pueblo.Los objetivos que se persiguen son dos: obtener la visión de sus habitantes sobre el lugar (lo que gusta y disgusta), la gente (lo que posee de único o especial), su caracterización y el sentimiento de vivir ahí. Y, en segundo lugar, la valoración de su patrimonio: las fiestas patronales (los chinelos y los concheros), los barrios y el centro, el exconvento y la zona arqueológica, los cerros y la naturaleza del entorno. Para ello, se aplicó una encuesta sobre el tema entre la población con objeto de recabar, como se dijo, las percepciones y opiniones de los habitantes del pueblo. Muchas veces las cuestionas identitarias y patrimoniales se definen desde autoridades políticas o académicas.En esta ocasión esto se hace a través de la mirada y voz de la gente del lugar. En casi todas las cuestiones solicitadas a lo largo de la encuesta, la población se muestra muy positiva y favorable con relación a su residencia. Se considera importante la identidad y los sentimientos positivos, así como, la valoración de su patrimonio. Es posible afirmar que existe un apego afectivo a la tierra y valoración de su identidad y patrimonio; sin embargo, dentro de cierta diversidad de opinión respecto a algunas cuestiones destaca el gusto de vivir ahí, el aprecio por su gente, el sentirse bien

Risk factors for severe outcomes in patients with systemic vasculitis & COVID‐19: a bi‐national registry‐based cohort study

OBJECTIVE: COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and so may be at risk of severe outcomes following COVID-19. It is important to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies. METHODS: A multi-centre cohort was developed through the participation of centres affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes were described. Logistic regression was used to evaluate associations between potential risk factors and severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, invasive ventilation, or death. RESULTS: Sixty-five cases of patients with systemic vasculitis who developed COVID-19 were reported (median age 70 years, 49% female) of whom 25 (38%) experienced a severe outcome. Most cases (55/65, 85%) had ANCA-associated vasculitis (AAV). Almost all patients required hospitalization (59/65, 91%), 7 patients (11%) were admitted to intensive care and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcome (adjusted odds ratio [aOR] 3.7 (1.1-14.9, p=0.047)) as was comorbid respiratory disease (aOR 7.5 (1.9-38.2, p=0.006)). Vasculitis disease activity and non-glucocorticoid immunosuppression were not associated with severe outcome. CONCLUSION: In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision making relating to risk of severe COVID-19 in this vulnerable patient group

Resolution of Hypoglycemia and Cardiovascular Dysfunction After Rituximab Treatment of Insulin Autoimmune Syndrome

D.C. is funded by a Diabetes Research & Wellness Foundation Sutherland-Earl Clinical Fellowship (RG68554). R.W.H. is supported by the Wellcome Trust–University of Edinburgh Institutional Strategic Support Fund. N.D. is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/13/30/29994). R.S. is funded by the Wellcome Trust (grant WT098498)

Rituximab for maintenance of remission in ANCA-associated vasculitis: expert consensus guidelines—Executive summary

[This is the executive summary of Rituximab for maintenance of remission in ANCA-associated vasculitis: expert consensus guidelines: full guideline, doi: 10.1093/rheumatology/kez640