Renal involvement in psychological eating disorders

Psychological eating disorders--anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder--are an increasing public health problem with severe clinical manifestations: hypothermia, hypotension, electrolyte imbalance, endocrine disorders and kidney failure; they are of interest to nephrologists, but pathophysiological mechanisms in determining the renal involvement are still unclear. We describe pathophysiology, histological features and clinical manifestations of the most frequent psychological eating disorders: AN and BN. Regarding AN, we analyze the recent literature, and identify 3 principal pathways towards renal involvement: chronic dehydration-hypokalemia, nephrocalcinosis and chronic rhabdomyolysis. Regarding BN, we describe the correlation between obesity and many proinflammatory cytokines, chemokines, growth factors and adipokines, having potential metabolic and hemodynamic effects on the kidney and an important role in the pathogenesis of obesity-related renal injury, independently of hypertension and diabetes

INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects

[OP.2D.05] RELATIONSHIP OF OXIDATIVE STRESS WITH CARDIAC HYPERTROPHY IN HYPERTENSIVE PATIENTS

OBJECTIVE: Left ventricular hypertrophy is common in hypertensive patients. In these subjects increased oxidative stress has been observed. Our aim was to evaluate the association of biomarkers of both oxidative stress and inflammation with markers of cardiovascular damage in a large group of hypertensives with different stages of renal function. DESIGN AND METHOD: In 517 hypertensives we analyzed left ventricular mass indexed for body surface area, and we assayed plasma levels of 8-isoprostaglandin F2alpha and high sensitivity C reactive protein. RESULTS: Multivariate analysis carried out considering left ventricular mass as dependent variable, and including 8-isoprostaglandin F2alpha, high sensitivity C reactive protein, age, sex, body mass index, estimated glomerular filtration rate, serum glucose, (log)triglycerides, hemoglobin, pulse pressure or systolic blood pressure, mean or diastolic blood pressure, and antihypertensive treatment showed that in hypertensives plasma levels of 8-isoprostaglandin F2alpha were correlated with left ventricular mass (beta=0.269, p\u200a<\u200a0.0001).The bivariate relationship of left ventricular mass with 8-isoprostaglandin F2alpha in hypertensives with estimated glomerular filtration rate higher and lower than 60\u200aml/min/1.73m2 was also calculated separately, demonstrating no significant differences in both correlations coefficients and slopes of the regression lines (r\u200a=\u200a0.254, p\u200a<\u200a0.001 and r\u200a=\u200a0.226, p\u200a<\u200a0.002; respectively).In the overall group, receiver operating characteristic curves showed that 8-isoprostaglandin F2alpha and high sensitivity C reactive protein were predictors of left ventricular hypertrophy, p\u200a<\u200a0.0001. CONCLUSIONS: To the best of our knowledge, this is the first demonstration that in hypertensives oxidative stress is correlated to left ventricular hypertrophy independently of other confounding factors. Oxidative stress might participate in the development of hypertensive cardiac hypertrophy

Influence of metabolic syndrome on hypertension-related target organ damage

OBJECTIVES: The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage. DESIGN: Cross-sectional study. SETTING: Outpatient hypertension clinic. SUBJECTS AND METHODS: A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography. RESULTS: When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P = 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components. CONCLUSIONS: MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS

A GIANT ANEURYSM OF PROPER HEPATIC ARTERY IN A CRYOGLOBULINEMIC PATIENT ON HEMODIALYSIS: A CASE REPORT.

Introductrion. Hepatic artery aneurysms (HAAs) are unusual vascular lesions often associated with many different pathological conditions. Most of reported cases are described in association with connective tissue diseases, such as polyarteritis nodosa and systemic lupus erythematosus. Case report. We observed a 52-year-old man with hypertension and HCV-related cryoglobulinemia complicated by end stage renal disease on replacement therapy by hemodialysis. He was admitted to our hospital because of the worsening of blood pressure values (170/110 mmHg) associated to new onset abdominal pain. After an initial physical examination, that showed a periumbelical bruit associated to a pulsatile mass in right hypocondrium, an abdominal ultrasound was performed with evidence of aneurysms of both the right branch (diameter max 4,5 cm) and the left branch (diameter max 1.5 cm) of the hepatic artery. An abdominal CT study was also performed and it confirmed the diagnosis of right intrahepatic artery aneurysm with partially thrombosed area in its peripheral distal portion. Discussion. Many different factors can contribute to the aneurysm formation in this patient. Vasculitic involvement due to cryoglobulinemic disease, therapy with steroid drugs, inflammatory state associated to HCV-related hepatitis, chronic kidney disease and replacement therapy by hemodialysis may all be involved in the development of the aneurysmatic hepatic lesion

BILATERAL RENAL ARTERY STENOSIS IN A HYPERTENSIVE LUPUS PATIENT WITHOUT RENAL DYSFUNCTION: A CASE REPORT

Systemic lupus erythematosus (SLE) is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction. We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg), despite drug therapy. No signs of renal impairment were evident. After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral renal artery stenosis. An angio-MR study also confirmed the diagnosis and showed a double renal artery on the right side. Many different factors can contribute to the bilateral renal artery stenosis in this patient. Chronic inflammatory state associated to SLE, metabolic alterations with dyslipidemia and steroid therapy may all be involved in the development of the renal atherosclerotic le-sions

Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients

OBJECTIVES: To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness. DESIGN: Cross-sectional study. SETTING: Outpatient hypertension clinic. SUBJECTS: Seventy patients with mild-to-moderate essential hypertension, aged 42 +/- 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotid-femoral PWV, by means of a computerized method, and AER. RESULTS: Microalbuminuric patients (AER > or = 20 microg min(-1); n = 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 +/- 10/10 vs. 128/83 +/- 7/6 mmHg; P < 0.001 and P = 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 +/- 2 m s(-1) vs. 9.2 +/- 1.3; P = 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P = 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r = 0.42; P = 0.0003). This association was confirmed in a multiple regression model (beta = 0.35; P = 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added. CONCLUSIONS: Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk

Enniatin and Beauvericin Biosynthesis in Fusarium Species: Production Profiles and Structural Determinant Prediction

Citation: Liuzzi, V. C., Mirabelli, V., Cimmarusti, M. T., Haidukowski, M., Leslie, J. F., Logrieco, A. F., . . . Mule, G. (2017). Enniatin and Beauvericin Biosynthesis in Fusarium Species: Production Profiles and Structural Determinant Prediction. Toxins, 9(2), 17. doi:10.3390/toxins9020045Members of the fungal genus Fusarium can produce numerous secondary metabolites, including the nonribosomal mycotoxins beauvericin (BEA) and enniatins (ENNs). Both mycotoxins are synthesized by the multifunctional enzyme enniatin synthetase (ESYN1) that contains both peptide synthetase and S-adenosyl-L-methionine-dependent N-methyltransferase activities. Several Fusarium species can produce ENNs, BEA or both, but the mechanism(s) enabling these differential metabolic profiles is unknown. In this study, we analyzed the primary structure of ESYN1 by sequencing esyn1 transcripts from different Fusarium species. We measured ENNs and BEA production by ultra-performance liquid chromatography coupled with photodiode array and Acquity QDa mass detector (UPLC-PDA-QDa) analyses. We predicted protein structures, compared the predictions by multivariate analysis methods and found a striking correlation between BEA/ENN-producing profiles and ESYN1 three-dimensional structures. Structural differences in the beta strand's Asn789-Ala793 and His797-Asp802 portions of the amino acid adenylation domain can be used to distinguish BEA/ENN-producing Fusarium isolates from those that produce only ENN