Endothelial dysfunction and inflammation in asymptomatic proteinuria

Paisley, K.E., Beaman, M., Tooke, J.E., Mohamed-Ali, V., Lowe, G.D.O. and Shore, A.C. (2003) Endothelial dysfunction and inflammation in asymptomatic proteinuria. Kidney International, 63(2), pp. 624-633. (doi: 10.1046/j.1523-1755.2003.00768.x)

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Publisher's URL: http://dx.doi.org/10.1046/j.1523-1755.2003.00768.x

Abstract

Background. Proteinuria is associated with vascular risk and a systemic increase in vascular permeability. Endothelial dysfunction occurs early in atherosclerosis and modulates vascular permeability. Vascular risk and chronic inflammation are associated. This study investigates whether the increased vascular permeability in proteinuria reflects systemic endothelial dysfunction and chronic inflammation. Methods. Twenty-one patients with asymptomatic proteinuria (1.29 g/24 h; range 0.18 to 3.17) and 21 matched controls were studied. Microvascular endothelial function was assessed using acetylcholine iontophoresis. Maximum microvascular hyperemia (MMH) was assessed by flux response to local skin heating. Macrovascular endothelial function was assessed by flow- associated dilation (FAD) in the brachial artery using ultrasound. von Willebrand factor (vWF) was measured as a marker of endothelial activation. Low-grade inflammation was assessed by measurement of circulating C-reactive protein (CRP) values using a high sensitivity assay. Results. FAD was impaired in proteinuric subjects (AP) compared to controls [1.8 (0.2 to 5.3) AP vs. 3.8 (1.5 to 6.2) C %; P = 0.014]. There was no significant difference between groups in MMH or in the response to acetylcholine iontophoresis. The AP group had a higher CRP [4.0 (0.5 to 39.0) AP vs. 0.2 (0.1 to 21.3) C mg/L; P lt 0.001] and tendency to higher vWF [101.5 (67.0 to 197.0) AP vs. 77.5 (45.0 to 185.0) C IU/dL; P = 0.046] compared to controls. In the AP, but not control, group there was an inverse correlation between CRP and microvascular function as determined by acetylcholine iontophoresis (r = -0.509; P = 0.018). Conclusions. In AP subjects there is evidence of macrovascular endothelial dysfunction remote from the kidney and of low-grade inflammation that is associated with microvascular endothelial dysfunction.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lowe, Professor Gordon
Authors: Paisley, K.E., Beaman, M., Tooke, J.E., Mohamed-Ali, V., Lowe, G.D.O., and Shore, A.C.
Subjects:R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Kidney International
Publisher:Nature Publishing Group
ISSN:0085-2538
ISSN (Online):1523-1755
Copyright Holders:© Blackwell Publishing
First Published:First published in Kidney International 63(2):624-633
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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