ABPM AND END ORGAN DAMAGE IN CHILDREN WITH RENAL TRANSPLANTATION

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。最近的研究表明，通过动态血压监测（ABPM）确定的夜间高血压几乎普遍发生在成人和儿童肾移植后（Tx）。我们假设，在肾Tx后，正常血压的儿童夜间血压升高，将与高血压相关的终末器官损害相关，如左心室质量（LVM）增加、动脉僵硬度增加和肾功能下降。如果夜间血压比办公室血压更能预测靶器官损伤，那么使用ABPM可以发现有风险的患者，并为合理的治疗提供指导。为了验证这一概念，我们将在基线和一年后评估患有肾Tx的儿童心血管结构和功能以及同种异体移植功能。通过测量LVM来评估心脏结构，通过测量颈动脉内膜-中膜厚度（IMT）来评估血管结构和功能，通过测量肾小球滤过率（GFR）来评估同种异体移植功能。这些测量结果将与多个变量相关，其中最重要的是由ABPM测量的白天和夜间血压。高血压是导致成人和儿童肾Tx长期预后不佳的一个强大且独立的危险因素。希望通过24小时ABPM改善高血压的检测，特别是夜间高血压，将导致更有效的治疗，从而预防或减缓心脏病和同种异体移植物功能障碍的进展。因此，长期目标将是降低心血管疾病的发病率和患病率，并延缓患有肾Tx的儿童和年轻人的移植物衰竭。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Recent studies showed that nighttime hypertension as determined by ambulatory BP monitoring (ABPM) occurs almost universally in both adults and children after renal transplantation (Tx). We hypothesize that after renal Tx, increased nighttime BP in children who had normal office BP, will be associated with hypertension-related end-organ damage such as increased left ventricular mass (LVM), increased arterial stiffness and decreased kidney function. If nighttime BP is a better predictor of target organ damage than office BP, the use of ABPM would detect patients at risk and provide the rational guideline for therapy. To test this concept, we will assess in children with renal Tx cardiovascular structure and function and allograft function at baseline and after one year. Cardiac structure will be evaluated by measurement of LVM, vascular structure and function by measurement of carotid artery intima-media thickness (IMT) and allograft function by measurement of glomerular filtration rate (GFR). These measurements will be correlated with multiple variables, the most important of which will be daytime and nighttime BP as measured by ABPM. Hypertension is a strong and independent risk factor for poor long-term outcome in adults and children with renal Tx. It is hoped that improved detection of hypertension by 24-hour ABPM, especially nighttime hypertension, will lead to more effective treatment which will prevent or slow the progression of cardiac disease and allograft dysfunction. Thus, the long-term goal will be to decrease the incidence and prevalence of cardiovascular disease and delay graft failure in children and young adults with renal Tx.