Response to letter regarding article, "Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage".
Response to letter regarding article, "Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage".
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对有关文章“慢性肾脏病与原发性脑出血患者脑微出血的关联”的信件的回复。
DOI：
10.1161/strokeaha.113.003354
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发表时间：
2013
期刊：
影响因子：
8.3
通讯作者：
Kidwell,ChelseaS
中科院分区：
文献类型：
--
作者：
Ovbiagele,Bruce;Kidwell,ChelseaS
我们感谢Tsuda博士对我们最近发表的文章的兴趣。正如他在信中提到的，一氧化二氮对肾小球滤过率（GFR）的调节产生了强大的影响，1越来越多的证据表明，最初的肾内皮损伤可能导致一氧化氮的超氧化物清除，最终导致弥漫性严重内皮功能障碍，包括脑血管床内。2然而，必须指出的是，来自内源性一氧化氮的各种研究的结果相互矛盾，一些研究表明慢性肾病（CKD）患者缺乏一氧化氮，3而其他研究则报告了一氧化二氮的产生上调。4关于CKD、一氧化氮产生和种族之间可能的相互作用，血管壁中一氧化氮生物利用度的降低可能确实是观察到的黑人与白人之间阻力动脉功能和机械特性差异的重要原因，5，但我们没有收集关于内皮功能或血浆NO-DECIPHER队列中的代谢物水平，因此无法在当前数据集中直接具体解决该问题。我们分享Tsuda博士对未来研究的热情，这些研究旨在探索一氧化氮产生不足，作为慢性肾脏疾病对血管性脑损伤（包括脑微出血）影响的种族差异的潜在解释。
We thank Dr. Tsuda for his interest in our recently published article. As he alluded to in his letter, nitrous oxide exerts a powerful influence on the regulation of glomerular filtration rate (GFR), 1 and mounting evidence suggests that initial renal endothelial damage may lead to superoxide scavenging of nitric oxide, ultimately leading to diffuse severe endothelial dysfunction, including within the cerebrovascular bed. 2 However, it must be noted that results from various studies on endogenous nitric oxide conflict, with some studies suggesting a deficiency in nitric oxide with chronic kidney disease (CKD), 3 and others reporting upregulated nitrous oxide production. 4Regarding the possible interplay of CKD, nitric oxide production, and race, reduced nitric oxide bioavailability in the vascular wall may indeed be an important contributor to the observed differences in function and mechanical properties of resistance arteries between Blacks vs. Whites, 5 but we did not collect data on endothelial function or plasma NO-metabolite levels in the DECIPHER cohort and therefore cannot specifically address this issue directly in the current dataset. We share Dr. Tsuda’s enthusiasm for future studies aimed at exploring inadequate nitric oxide production as a potential explanation for racial disparities in the influence of chronic kidney disease on vascular brain injury (including cerebral microbleeds).