Differences in renal hemodynamics and renin secretion between patients with unifocal and multifocal fibromuscular dysplasia

Objective: Fibromuscular dysplasia (FMD) can be classified in a multifocal and a unifocal subtype. As unifocal FMD generally leads to more severe hypertension at younger age, we hypothesized that renal hemodynamics are more disturbed in unifocal renal artery FMD as compared with multifocal FMD, leading to increased renin secretion. Methods: We measured renal blood flow ((133)Xenon washout method), renin secretion, and glomerular filtration rate per kidney in 101 patients with FMD (26 unifocal and 75 multifocal), all off medication and prior to balloon angioplasty. Results: We found that renal blood flow and glomerular filtration were substantially lower in kidneys with unifocal FMD as compared with multifocal FMD. In the affected kidney from patients with unilateral FMD for example, mean renal blood flow was 173 +/- 77 in unifocal vs. 244 +/- 79 ml/100 g kidney/min in multifocal FMD (P=0.013). Moreover, lateralization in renin secretion was only observed in a subset of patients with unifocal FMD, but not in any of the patients with multifocal FMD. Conclusion: These findings suggest that the impact of unifocal FMD lesions on the kidney is more severe, resulting in a classical pattern of renovascular hypertension. In multifocal FMD, however, renal blood flow is more preserved, local renin secretion is not increased, and the association between renin levels and blood pressure is inverse. These differences may explain the often more severe clinical presentation and higher success rate of revascularization in unifocal FMD, but also suggest that the pathophysiological mechanisms leading to hypertension may differ between these two disease entities

Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study

Objective To mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.Design Retrospective analysis.Setting Two EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.Participants The study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.Outcome Primary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).Results Within 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).Conclusion The RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources

Angiotensin-(1-7) as a strategy in the treatment of hypertension?

Purpose of review The renin-angiotensin system plays an important role in cardiovascular disease via the production of angiotensin II. Over the past decades, however, more and more evidence has accumulated suggesting an important role for another angiotensin: Angiotensin-(1-7) [Ang-(1-7)]. In this review, we discuss the recent findings on the effects of Ang-(1-7) and the angiotensin-converting enzyme2/Ang-(1-7)/Mas axis on the cardiovascular system. Recent findings Recent studies demonstrated that Ang-(1-7) exerts a vasodilatory and antiproliferative effect via stimulation of the Mas receptor and inhibition of the effects of angiotensin-type 1 receptor stimulation by angiotensin II. This results in a dynamic equilibrium between Ang-(1-7) and angiotensin II. Various animal studies have demonstrated that Ang-(1-7) has beneficial effects on blood pressure, kidney function, and the prevention of cardiovascular disease. Although targeting the angiotensin-converting enzyme 2/Ang-(1-7)/Mas axis has been difficult so far, several new therapeutic strategies are being developed. Promising results of these new strategies on blood pressure and cardiovascular disease were demonstrated in animal studies. Summary The beneficial effects of the angiotensin-converting enzyme2/Ang-(1-7)/Mas axis have been widely demonstrated in animal studies and provide a promising basis for further development of drugs targeting this axis of the renin-angiotensin system. Further research in humans, however, is necessary to make a serious step forward. Video abstract http://links.lww.com/CONH/A