title: Structural alterations in subcutaneous small resistance arteries predict changes in the renal function of hypertensive patients.
abstract: 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.
  
  
  METHODS
  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 (r = 0.57; P < 0.001), percentage changes in serum creatinine (r = 0.46; P < 0.001), eGFR at follow-up (r = -0.43; 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
authors.forename: Gianluca E M
authors.initials: GE
authors.lastname: Boari
authors.forename: Damiano
authors.initials: D
authors.lastname: Rizzoni
authors.forename: Carolina
authors.initials: C
authors.lastname: De Ciuceis
authors.forename: Enzo
authors.initials: E
authors.lastname: Porteri
authors.forename: Daniele
authors.initials: D
authors.lastname: Avanzi
authors.forename: Caterina
authors.initials: C
authors.lastname: Platto
authors.forename: Monica
authors.initials: M
authors.lastname: Mazza
authors.forename: Alida
authors.initials: A
authors.lastname: Brignani
authors.forename: Claudia Agabiti
authors.initials: CA
authors.lastname: Rosei
authors.forename: Doris
authors.initials: D
authors.lastname: Ricotta
authors.forename: Luigi
authors.initials: L
authors.lastname: Caimi
authors.forename: Enrico Agabiti
authors.initials: EA
authors.lastname: Rosei
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000473:pathology* / Q000503:physiopathology*; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D050151:Subcutaneous Fat / Q000098:blood supply*; D017540:Tunica Media / Q000473:pathology; D014655:Vascular Resistance
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine