STRUCTURAL ALTERATIONS IN SUBCUTANEOUS SMALL RESISTANCE ARTERIES PREDICT CHANGES IN THE RENAL FUNCTION OF HYPERTENSIVE PATIENTS

Background We have previously demonstrated that
structural alterations in subcutaneous small resistance
arteries of hypertensive patients, as indicated by an
increased media to lumen ratio (M/L), are a potent predictor
of cardiovascular events, and that a close correlation exists
between serum creatinine and M/L. The aim of the present
study was to assess whether M/L of subcutaneous small
resistance arteries may predict subsequent changes in
renal function in hypertensive patients.
Method Sixty participants (13 normotensive participants
and 47 hypertensive patients) underwent a biopsy of
subcutaneous fat. Resistance-sized arteries were dissected
and mounted on a wire myograph, and M/L was measured.
Patients were re-evaluated after a mean follow-up period of
8.6 years. Serum creatinine, blood urea nitrogen, and uric
acid were measured; glomerular filtration rate (eGFR) was
estimated according to Modification of Diet in Renal Disease
formula.
Results At baseline, we observed significant correlations
between M/L and serum creatinine, eGFR, blood urea
nitrogen, systolic, diastolic, mean, and pulse pressure.
In addition, we observed significant correlations
between M/L and serum creatinine at follow-up (rU0.57;
P< 0.001), percentage changes in serum creatinine (rU0.46;
P< 0.001), eGFR at follow-up (rU S0.43; P< 0.001);
percentage changes in eGFR, yearly changes in eGFR, blood
urea nitrogen at follow-up, and uric acid at follow-up.
A multivariate analysis in which all common cardiovascular
risk factors were included showed that M/L ratio is the most
potent predictor of changes in renal function.
Conclusion Our data suggest that structural alterations in
subcutaneous small arteries may predict the time course of
changes in renal function during a follow-up period of about
9 years