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논문분류	춘계학술대회 초록집
제목	Loss of Renal Peritubular Capillaries in Hypertensive Patients is Detectable by Urinary Endothelial Microparticle Levels
저자	In O Sun
출판정보	2019; 2019(1):
키워드	urine \| exosomes \| hypertension \| chronic kidney disease \| microvascular rarefaction
초록	Hypertension, an important cause of chronic kidney disease, is characterized by peritubular capillary (PTC) loss. Circulating levels of endothelial microparticles (EMPs) reflect systemic endothelial injury. We hypothesized that systemic and urinary PTC-EMPs levels would reflect renal microvascular injury in hypertensive patients. We prospectively measured by flow-cytometry renal vein, inferior vena cava, and urinary levels of EMPs in essential (EH, n=14) and renovascular (RVH, n=24) hypertensive patients, and compared them with peripheral blood and urinary levels in healthy volunteers (HVs, n=14). PTC-EMPs were identified as urinary exosomes positive for the PTC marker plasmalemmal-vesicle-associated protein. In 7 RVH patients, PTC and fibrosis were also quantified in renal biopsy, and in 18 RVH patients, PTC-EMPs were measured again 3 months after continued medical therapy with or without stenting (n=9 each). Renal vein and systemic PTC-EMPs levels were not different among the groups, whereas their urinary levels were elevated in both RVH and EH vs. HVs (56.8±12.7 and 62.8±10.7 vs. 34.0±17.8%, both p≤0.001). Urinary PTC-EMPs levels correlated directly with blood pressure and inversely with estimated glomerular filtration rate. Furthermore, in RVH, urinary PTC-EMPs levels correlated directly with stenotic-kidney hypoxia, histological PTC count, and fibrosis, and inversely with cortical perfusion. Three months after treatment, the change in urinary PTC-EMPs levels correlated inversely with a change in renal function (r=-0.582, p=0.011). Therefore, urinary PTC-EMPs levels are increased in hypertensive patients, and may reflect renal microcirculation injury, whereas systemic PTC-EMPs levels are unchanged. Urinary PTC-EMPs may be useful as novel biomarkers of intrarenal capillary loss.
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