ComplicationInfectionAltered metabolism: LipidsEndothelial Dysfunction in Renal Transplant Recipients
Section snippets
Endothelial dysfunction: definitions, mechanisms, and measurement
Under normal circumstances, the main role of the endothelium is to facilitate vasodilatation and inhibit platelet adhesion through the production of nitric oxide (NO). Reduced production of NO is the predominant component of endothelial dysfunction, leading to enhanced vasoconstriction and platelet adhesion (and activation). The loss of vasodilatation contributes to development of hypertension. However, there are additional factors that contribute to the measurement of endothelial dysfunction.
Underlying mechanisms and interventions
Two main factors contribute to endothelial dysfunction and the impaired release of NO in response to agonists like carbachol. The first is the production of superoxide that reacts with NO to produce peroxynitrite. Superoxide and other free radicals are a result of oxidative stress and are dependent on factors such as cigarette smoking, vasoactive compounds (eg, angiotensin II and endothelin), and lipids (eg, oxidised low density lipoprotein). This pathway may explain some of the benefits of,
Intervention
If endothelial dysfunction is central to the development of atherosclerotic CVD, the question arises of how to reverse this abnormality. There are no interventions that independently reverse ED, although interventions that reduce CV risk in other populations are associated with improved endothelial function. These include lifestyle measures, such as weight loss, exercise, and smoking cessation. The reduction of homocysteine levels by the use of folic acid is associated with improved ED in the
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Cited by (16)
Caffeine and kidney diseases
2019, Caffeinated and Cocoa Based Beverages: Volume 8. The Science of BeveragesCarotid intima-media thickness in kidney transplant recipients
2016, Hong Kong Journal of NephrologyCitation Excerpt :On multiple linear stepwise regression we used age and hemoglobin on the prediction model with two steps (Table 4). Endothelial dysfunction and ongoing chronic inflammation due to multiple risk factors including immunosuppressive therapy play an important role in premature subclinical atherosclerosis in KTx recipients.4,11,15 We found that the prevalence of increased CIMT was significantly higher in our KTx recipients compared to controls.
Low pre-transplant adiponectin multimers are associated with adverse allograft outcomes in kidney transplant recipients a 3-year prospective study
2012, Regulatory PeptidesCitation Excerpt :Adiponectin exerts anti-inflammatory effects on the vascular wall by suppressing the expression of pro-inflammatory adhesion molecules and by inhibiting endothelial NF-κB signaling [24,25]. Adiponectin reverses the deleterious endothelial effects of TNF-α and other cytokines which trigger an inflammatory signaling cascade and enhance leukocytes–endothelial interactions [19,26]. In turn, it has been demonstrated that adiponectin deficient mice show an accelerated endothelial expression of the vascular cell adhesion molecule-1 (VCAM-1).
Renal Transplantation Does Not Improve Erectile Function in Hemodialysed Patients
2009, European UrologyCitation Excerpt :Hypertension, diabetes mellitus, hyperlipidaemia, smoking habit, and uraemic toxins are well-recognised causative agents of this disorder [25]. Although it may be improved, endothelial dysfunction persists after RT [26,27]. Cyclosporin exerts a well-recognised negative effect on endothelial function.
Endothelial Dysfunction in Peritoneal Dialysis Patients With and Without Failed Renal Transplants
2009, Transplantation ProceedingsSubclinical impairment of coronary flow velocity reserve assessed by transthoracic echocardiography in young renal transplant recipients
2009, AtherosclerosisCitation Excerpt :Nearly 50% of their population had coronary calcifications confirming the necessity to monitor these patients to prevent premature cardiac morbidity and mortality. Recent studies furthermore demonstrated an increased common carotid IMT or abnormal carotid artery compliance in adults who developed ESRD during the childhood [7,17,22,27] and it is well known that endothelial dysfunction of ESRD persists after renal transplantation [28,29]. Mitsnefes et al. [7] described an increased IMT in children and adolescents with successful renal transplantation associated with cardiac abnormalities such as increased wall thickness and LV contractility.