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Kronik Böbrek Hastalarında Endotel İşlev Bozukluğu ve Serum Pentraxin-3 Düzeyleri

The Relationship between Endothelial Dysfunction and Pentraxin-3 Concentration in Chronic Kidney Disease

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DOI: 
DOI 10.5262/tndt.2010.1003.07
Abstract (2. Language): 
AIM : Cardiovascular diseases are the leading cause of morbidity and mortality in chronic kidney disease (CKD). Inflammation and endothelial dysfunction contribute to the development of cardiovascular disease in CKD. Pentraxin-3 (PTX-3), a new candidate marker for inflammation is expressed in a variety of cell types. We aimed to investigate the relation between plasma PTX-3, serum hs-CRP levels and endothelial dysfunction in CKD. MA TERIAL and M ETHODS: One hundred and twenty-five patients with CKD were studied. Patients were divided into 5 groups according to their glomerular filtration rate (GFR) as assessed by K/DOQI guidelines. Twenty-five healthy subjects were studied as controls. Venous samples were obtained from all subjects for PTX-3 and hs-CRP levels in addition to detailed metabolic panel. Endothelial dysfunction was assessed from all subjects by flow-mediated dilatation (FMD). RESUL TS: FMD levels were significantly decreased in all stages with the higher the stage of CKD, the lower the levels of FMD. Plasma PTX-3 levels of the stage 1-2-3 CKD group were similar to those of the controls, while other groups had significantly higher values (p<0.001). Additionally, hs-CRP levels were significantly increased in all stages of CKD. There was a significant positive correlation between FMD and GFR(r=0.762, p<0.001). There was also a significant negative correlation between FMD and PTX-3 (r=-0.414, p<0.001) as well as between FMD and hs-CRP (r=-0.546, p<0.001). CONCLU SION: The results suggest that both plasma PTX-3 and hs-CRP levels are associated with endothelial dysfunction in CKD patients.
Abstract (Original Language): 
AMA Ç: Kronik böbrek hastalığında (KBH) morbidite ve mortalitenin en önemli nedenini kardiyovasküler hastalıklar oluşturmaktadır. Endotel işlev bozukluğu ve enflamasyon KBH’da kardiyovasküler hastalık gelişimine katkıda bulunur. Enflamasyon belirteci olmaya aday yeni bir belirteç olan Pentraxin-3 (PTX- 3) birçok farklı hücreden salınmaktadır. Amacımız KBH olanlarda endotel işlev bozukluğu ile plazma PTX-3, serum hs-CRP düzeyleri arasındaki ilişkiyi araştırmaktır. GEREÇ ve YÖN TEML ER: KBH olan 125 hasta çalışmaya alındı. Hastalar K/DQOI kılavuzunda belirlenen glomerüler filtrasyon hızına (GFH) göre 5 gruba ayrıldı. Kontrol olarak 25 sağlıklı kişi çalışıldı. Çalışmaya alınan tüm kişilerden venöz kan örneği alındı, detaylı metabolik panele ek olarak plazma PTX-3 ve serum hs-CRP düzeyleri ölçüldü. Endotel işlev bozukluğu çalışmaya katılan tüm kişilerden elde edilen endotel bağımlı vazodilatasyon (EBVD) değeri ile değerlendirildi. BUL GULA R: EBVD düzeyleri bütün evrelerde belirgin olarak azalmaktaydı. KBH evresi ilerledikçe EBVD değeri de paralel olarak o kadar azalmaktaydı. Plazma PTX-3 düzeyi evre 1-2-3 hastalarda kontrollerden farksız iken diğer gruplarda belirgin olarak daha yüksek saptandı. Ek olarak hsCRP düzeyleri KBH’nın tüm evrelerinde belirgin olarak artmaktaydı. EBVD ve GFH arasında belirgin pozitif bir korelasyon saptandı (r=0,762, p<0,001). EBVD ve PTX-3 arasında da negatif bir korelasyon (r=- 0,414, p<0,001) kadar EBVD ve hs-CRP arasında da belirgin negatif korelasyon (r=-0,546, p<0.001) saptandı. SONU Ç: Sonuçlar KBH’da endotel işlev bozukluğu ile hem PTX-3 hem de hs-CRP düzeyleri arasında ilişki olduğunu göstermektedir.
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REFERENCES

References: 

1. Foley RN, Murray AM, Li S, Herzog CA, McBean AM, Eggers PW,
Collins AJ: Chronic kidney disease and the risk for cardiovascular
disease, renal replacement, and death in the United States States
Medicare population, 1998 to 1999. J Am Soc Nephrol 2005; 16(2):
489-495
2. Foley RN, Parfrey PS, Sarnak MJ: Clinical epidemiology of
cardiovascular disease in chronic renal disease. Am J Kidney Dis
1998; 32(5 Suppl 3): 112-119
3. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM: The elephant
in uremia: Oxidant stress as a unifying concept of cardiovascular
disease in uremia. Kidney Int 2002; 62(5): 1524-1538
4. Cases A, Vera M, Lopez Gomez JM: Cardiovascular risk in patients
with chronic renal failure. Patients in renal replacement therapy.
Nefrologia 2002; 22 Suppl 1: 68-74
5. Stenvinkel P: Interactions between inflammation, oxidative stress,
and endothelial dysfunction in end-stage renal disease. J Ren Nutr
2003; 13(2):144-148
6. Panichi V, Migliori M, De Pietro S, Taccola D, Bianchi AM,
Norpoth M, Giovannini L, Palla R, Tetta C: C-reactive protein as
a marker of chronic inflammation in uremic patients. Blood Purif
2000;18(3):183-190
7. O’Riordan E, Chen J, Brodsky SV, Smirnova I, Li H, Goligorsky
MS: Endothelial cell dysfunction: The syndrome in making. Kidney
Int 2005; 67: 1654-1658
8. Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR
Jr, Lerman A: Long-term follow-up of patients with mild coronary
artery disease and endothelial dysfunction. Circulation 2000; 101:
948-954
9. Muntner P, Hamm LL, Kusek JW, Chen J, Whelton PK, He J: The
prevalence of nontraditional risk factors for coronary heart disease
in patients with chronic kidney disease. Ann lntern Med 2004; 140:
9-17
10. lkizler TA, Wingard RL, Harvell J, Shyr Y, Hakim RM: Association
of morbidity with markers of nutrition and inflammation in chronic
hemodialysis patients: A prospective study. Kidney Int 1999; 55:
1945-1951
11. Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C:
Inflammation enhances cardiovascular risk and mortality in
hemodialysis patients. Kidney Int 1999; 55: 648-658
12. Mantovani A, Garlanda C, Doni A, Bottazzi B: Pentraxins in innate
immunity: From C-reactive protein to the long pentraxin PTX3. J
Clin Immunol 2008; 28: 1-13
13. Mantovani A, Garlanda C, Bottazzi B, Peri G, Doni A, Martinez
de la Torre Y & Latini R: The long pentraxin PTX3 in vascular
pathology. Vascul Pharmacol 2006; 45: 326-330
14. Fazzini F, Peri G, Doni A, Dell’Antonio G, Dal Cin E, Bozzolo
E, D’Auria F, Praderio L, Ciboddo G, Sabbadini MG, Manfredi
AA, Mantovani A, Querini PR: PTX3 in small-vessel vasculitides:
an independent indicator of disease activity produced at sites of
inflammation. Arthritis Rheum 2001; 44(12): 2841-2850
15. Eknoyan G, Lameire N, Barsoum R, Eckardt KU, Levin A, Levin
N, Locatelli F, MacLeod A, Vanholder R, Walker R, Wang H: The
burden of kidney disease: Improving global outcomes. Kidney Int
2004; 66(4): 1310-1314
16. Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R,
Tuttle K, Douglas J, Hsueh W, Sowers J: Preserving renal function
in adults with hypertension and diabetes: A consensus approach.
National Kidney Foundation Hypertension and Diabetes Executive
Committees Working Group. Am J Kidney Dis 2000; 36(3):
646-661
17. Amann K, Ritz E: Microvascular disease-the cinderella of uraemic
heart disease. Nephrol Dial Transplant 2000; 15:1493-1503
18. Ghiadoni L, Cupisti A, Huang Y, Mattei P, Cardinal H, Favilla S,
Rindi P, Barsotti G, Taddei S, Savletti A: Endothelial dysfunction
and oxidative stress in chronic renal failure. J Nephrol 2004; 17(4):
512-519
Şahin E ve ark: Kronik Böbrek Hastalarında
Endotel İşlev Bozukluğu ve Serum Pentraxin-3 Düzeyleri
Cilt/Vol: 19, No: 3, 2010, Sayfa/Page: 192-198 198
Türk N efroloji D iyaliz ve Transplantasyon D ergisi
Turkish Nephrology, Dialysis and Transplantation Journal
19. Yılmaz MI, Saglam M, Caglar K, Cakir E, Sonmez A, Ozgurtas T,
Aydin A, Eyileten T, Ozcan O, Acikel C, Tasar M, Genctoy G, Erbil
K, Vural A, Zoccali C: The determinants of endothelial dysfunction
in CKD: Oxidative stress and asymmetric dimethylarginine. Am J
Kidney Dis 2006; 47(1): 4250
20. Yılmaz MI, Saglam M, Caglar K, Çakir E, Ozgurtas T, Sonmez
A, Eyileten T, Yenicesu M, Acikel C, Oguz Y, Ozcan O, Bozlar
U, Erbil K, Aslan I, Vural A: Endothelial functions improve with
decrease in asymmetric dimethylarginine (ADMA) levels after
renal transplantation. Transplantation 2005; 80(12): 1660-1666
21. Bottazzi B, Bastone A, Doni A, Garlanda C, Valentino S, Deban
L, Maina V, Cotena A, Moalli F, Vago L, Salustri A, Romani L,
Mantovani A: The long pentraxin PTX3 as a link among innate
immunity, inflammation, and female fertility. J Leukoc Biol 2006;
79(5): 909-912
22. Rovere P, Peri G, Fazzini F, Bottazzi B, Doni A, Bondanza A,
Zimmermann VS, Garlanda C, Fascio U, Sabbadini MG, Rugarli
C, Mantovani A, Manfredi AA: The long pentraxin PTX3 binds to
apoptotic cells and regulates their clearance by antigen-presenting
dendritic cells. Blood 2000; 96(13): 4300-4306
23. Tong M, Carrero JJ, Qureshi AR, Anderstam B, Heimbürger O,
Bárány P, Axelsson J, Alvestrand A, Stenvinkel P, Lindholm B,
Suliman ME: Plasma pentraxin 3 in patients with chronic kidney
disease: associations with renal function, protein-energy wasting,
cardiovascular disease and mortality. Clin J Am Soc Nephrol 2007;
2(5): 889-897
24. Suliman ME, Qureshi AR, Carrero JJ, Bárány P, Yilmaz MI,
Snaedal-Jonsdottir S, Alvestrand A, Heimbürger O, Lindholm B,
Stenvinkel P: The long pentraxin PTX-3 in prevalent hemodialysis
patients: Associations with co-morbidities and mortality. QJM
2008; 101(5): 397-405
25. Peri G, Introna M, Corradi D, Iacuitti G, Signorini S, Avanzini F,
Pizzetti F, Maggioni AP, Moccetti T, Metra M, Cas LD, Ghezzi
P, Sipe JD, Re G, Olivetti G, Mantovani A, Latini R: PTX3, A
prototypical long pentraxin, is an early indicator of acute myocardial
infarction in humans. Circulation 2000; 102(6): 636-641
26. Muller B, Peri G, Doni A, Torri V, Landmann R, Bottazzi B,
Mantovani A: Circulating levels of the long pentraxin PTX3
correlate with severity of infection in critically ill patients. Crit
Care Med 2001; 29(7): 1404-1407
27. Luchetti MM, Piccinini G, Mantovani A, Peri G, Matteucci C,
Pomponio G, Fratini M, Fraticelli P, Sambo P, Di Loreto C, Doni
A, Introna M, Gabrielli A: Expression and production of the long
pentraxin PTX3 in rheumatoid arthritis (RA). Clin Exp Immunol
2000; 119: 196–202
28. Muller B, Peri G, Doni A, Torri V, Landmann R, Bottazzi B,
Mantovani A: Circulating levels of the long pentraxin PTX3
correlate with severity of infection in critically ill patients. Crit
Care Med 2001; 29(7): 1404-1407
29. Boehme M, Kaehne F, Kuehne A, Bernhardt W, Schröder M,
Pommer W, Fischer C, Becker H, Müller C, Schindler R: Pentraxin
3 is elevated in haemodialysis patients and is associated with
cardiovascular disease. Nephrol Dial Transplant 2007; 22(8):
2224-2229
30. Suliman ME, Yilmaz MI, Carrero JJ, Quershi AR, Saglam M,
Ipcioglu OM, Yenicesu M, Tong M, Heimbürger O, Barany P,
Alvestrand A, Lindholm B, Stenvinkel P: Novel links between the
long pentraxin, endothelial dysfunction and albuminuria in early
and advanced chronic kidney disease. Clin J Am Soc Nephrol 2008;
3(4): 976-985
31. Danielski M, Ikizler TA, McMonagle E, Kane JC, Pupirn L, Morrow
J, Himmelfarb J: Linkage of hypoalbuminemia, inflammation, and
oxidative stress in patients receiving maintenance hemodialysis
therapy. Am J Kidney Dis 2003; 42: 286-294
32. Alles VV, Bottazzi B, Peri G, Golay J, Introna M, Mantovani A:
Inducible expression of PTX3, a new member of the pentraxin
family, in human mononuclear phagocytes. Blood 1994; 84:
3483–3493
33. Nauta AJ, de Haij S, Bottazzi B, Mantovani A, Borrias MC, Aten
J, Rastaldi MP, Daha MR, van Kooten C, Roos A: Human renal
epithelial cells produce the long pentraxin PTX3. Kidney Int 2005;
67: 543–553
34. Bussolati B, Peri G, Salvidio G, Verzola D, Mantovani A, Camussi G:
The long pentraxin PTX3 is synthesized in IgA glomerulonephritis
and activates mesangial cells. J Immunol 2003; 170: 1466–1472

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