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The Renal Resistive Index in systemic sclerosis: Determinants, prognostic implication and proposal for specific age-adjusted cut-offs

  • Cosimo Bruni
    Correspondence
    Corresponding author at: University of Firenze, Department of Experimental and Clinical Medicine, Division of Rheumatology, Via delle Oblate 4, 50141 Firenze, Italy.
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy

    Department Cardio-Thorax-Vascular Medicine, Division of General Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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  • Edoardo Rosato
    Affiliations
    Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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  • Vanessa Maestripieri
    Affiliations
    Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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  • Antonietta Gigante
    Affiliations
    Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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  • Giulia Tesei
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy
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  • Silvia Bellando-Randone
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy

    Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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  • Serena Guiducci
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy

    Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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  • Marco Chiostri
    Affiliations
    Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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  • Khadija El Aoufy
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy
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  • Jelena Blagojevic
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy

    Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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  • Alberto Moggi-Pignone
    Affiliations
    Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Department of Internal Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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  • Amato De Paulis
    Affiliations
    Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University Federico II, Naples, Italy
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  • Daniel E. Furst
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy

    Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

    Department of Medicine, Division of Rheumatology, University of California at Los Angeles, USA

    University of Washington, Seattle, WA, USA
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  • Author Footnotes
    1 Equal senior authorship.
    Maria Boddi
    Footnotes
    1 Equal senior authorship.
    Affiliations
    Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    University of Washington, Seattle, WA, USA
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  • Author Footnotes
    1 Equal senior authorship.
    Marco Matucci-Cerinic
    Footnotes
    1 Equal senior authorship.
    Affiliations
    Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via Delle Oblate 4, 50134 Florence, Italy

    Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
    Search for articles by this author
  • Author Footnotes
    1 Equal senior authorship.
Published:September 17, 2019DOI:https://doi.org/10.1016/j.ejim.2019.09.001

      Highlights

      • Renal Resistive Index (RRI) is applicable in systemic sclerosis.
      • RRI reflex renal and extra-renal involvement in scleroderma.
      • RRI has prognostic impact on mortality.
      • Age-SSc adjusted cut offs should be used when measuring RRI in scleroderma patients.

      Abstract

      Background

      Renal Resistive Index (RRI), reflects changes in both renal vascular and tubular-interstitial compartments and in systemic vascular compliance related to age and comorbidities.

      Objectives

      a) To investigate determinants of RRI in SSc population, b) its association with SSc-related features and c) to test its prognostic impact on organ specific worsening or death.

      Methods

      380 SSc patients ≥18 years were enrolled after giving informed consent. Baseline data on RRI, laboratory, instrumental and therapeutic features were retrospectively collected. Age-SSc adjusted cut-offs were created by dividing the population in age quartiles and considering RRI values >75th percentile as pathologic. Clinical follow-up was performed until last available visit or the development/worsening of specific internal organ involvement or death.

      Results

      RRI was independently predicted by age and systolic pulmonary arterial pressure on Echo. Therefore, we created Age-SSc adjusted pathologic RRI cut-offs, which were significantly associated with various disease related skin and lung fibrotic manifestations, as well as vasculopathic complications. After a mean follow-up of 3.6 ± 2.6 years, RRI was one of the independent predictors (together with modified Rodnan skin score, interstitial lung disease, presence of dyspnoea and late nailfold-videocapillaroscopy pattern) for mortality, with 0.68 as best cut-off (sensitivity 88.5%, specificity 50.9%).

      Conclusion

      If corroborated, Renal Resistive Index cut-offs might be used to evaluate renal and extrarenal involvement in SSc and could serve as predictors of mortality.

      Keywords

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