PD01 Effects of ultraviolet radiation on blood pressure in a large chronic haemodialysis patient cohort R. Weller, Y. Wang, J. He, F. Maddux, L. Usvyat, H. Zheng, M. Feelisch and P. Kotanko University of Edinburgh, Edinburgh, U.K., University of California, Santa Barbara, Santa Barbara, U.S.A., Fresenius Medical Care North America, Waltham, U.S.A., Renal Research Institute, New York, U.S.A. and University of Southampton, Southampton, U.K. Ultraviolet (UV) is the major environmental risk factor for skin cancer, but may lower blood pressure (BP), the leading cause of premature death worldwide. Population BP correlates with latitude and is lower in summer than winter. Exposure to sunlight may account for BP variation, but whether the effect is due to variation in temperature or UV radiation is unknown. We test the hypothesis that systolic BP is negatively associated with UV radiation. We tested this hypothesis in a large and diverse cohort of maintenance haemodialysis patients, because in most of them systolic BP (SBP) is measured predialysis thrice weekly as part of routine care. We studied patients at 2178 U.S. dialysis centres over 3 years. Daily UV/temperature data for each location were retrieved from public databases. Linear mixed effects models were fitted to different locations and combined estimates of associations calculated using the DerSimonian and Laird procedure. SBP and environmental data were analysed for 342 457 patients (36.2% black, 63.8% white). SBP showed seasonal variation, and was ~4 mmHg higher in black patients. Temperature, UVA and UVB were linearly and inversely associated with SBP; this was more marked for UVB than UVA and varied with skin colour (in units of 100 9 mmHg SBP change per W m 2 UV): UVA, white 0.75 (95% confidence interval 0.78 to 0.72), black 0.63 ( 0.66 to 0.59); UVB, white 12.73 ( 13.22 to 12.23), black 10.49 ( 11.07 to 9.91). Intriguingly, this relationship remained after correcting for temperature: UVA, white 0.32 ( 0.37 to 0.27), black 0.23 ( 0.29 to 0.16); UVB, white 5.63 ( 6.48 to 4.78), black 4.17 ( 5.26 to 3.08). Solar UV radiation may lower SBP, the leading global risk factor for premature death and disease, independently of temperature. Our results suggest that a careful reassessment of the health benefits of sunshine is warranted. PD02 Isolated actinic lichen planus of the lower lip N. Machnikowski, D. Bilsland, R. Dawe, S. Ibbotson and M. Sivaramakrishnan Ninewells Hospital & Medical School, Dundee, U.K., Department of Dermatology, Queen Elizabeth University Hospital, Glasgow, U.K. and Department of Photobiology & Dermatology, Ninewells Hospital & Medical School, Dundee, U.K. Actinic lichen planus (ALP) affects photoexposed skin sites, with sparing of mucous membranes and predominantly occurs in spring and summer. Only four cases of isolated lichen planus of the lip have been reported and they did not have a seasonal pattern. A 61-year-old woman presented with a history of swelling, crusting and erosions of the lower lip that only occurred after 2 hours of direct sun exposure when abroad or on a sunny summer’s day in Scotland. Resolution occurred within 5 days of sun avoidance. No other body site was affected. High SPF sunscreen, hydroxychloroquine, aciclovir and a potent topical corticosteroid were not effective in preventing or treating episodes. Images from a recent holiday showed oedema, erosions and crusting of the lower lip. Monochromator phototesting to ultraviolet (UV) B, UVA and visible wavebands produced normal immediate and delayed responses on the back at 24 h. Broadband UVA provocation testing on lower lip of normal appearance, at a cumulative dose of 30 J cm 2 over 2 days, induced, erythema, oedema and crusting at the exposed site that resolved over 7 days. Viral swabs for herpes simplex virus PCR taken during an active episode and from the induced provocation site were negative. Lupus serology, porphyria plasma scan, HLA DR4 analysis and patch testing to British standard series were negative. Biopsy taken from the active area on the lip after her recent holiday showed lichenoid inflammation. Biopsy from the abnormal induced provocation site showed acanthosis, parakeratosis, basal layer vacuolar change, Civatte bodies and band-like lymphocytic infiltrate in the dermis consistent with lichen planus. Photoprotection with high SPF sunscreen, and oral prednisolone 20 mg per day commencing the day before and continuing throughout a subsequent 2-week holiday abroad prevented any further episode. A potent topical corticosteroid applied on the lower lip on a very sunny day in Scotland also prevented any active episode. This is the first case of isolated ALP of the lower lip reported. Previous reports of ALP of the skin in two cases were provoked using UVB and a combination of UVA and UVB. As we provoked a severe episode of ALP of the lip by using UVA source, we did not attempt to provoke this with UVB. ALP is a distinct subtype of lichen planus. We wish to raise awareness and highlight this

Acute and chronic complications in patients with IDDM result from insufficiently controlled blood glucose. In order to assist insulin therapy we applied the Universal Process Modeling Algorithm (UPMA) to forecast blood glucose in patients with IDDM. Two diabetic patients (one stable and one unstable) documented blood glucose, therapy, physical activity and diets with an electronic diary (handyDOC™) over 12 months each. That data of the preceeding month were used to predict blood glucose changes in the consecutive month. Predictions of the short-term blood glucose fluctuations were significantly correlated with the observed blood glucose changes, correlation coefficients ranged from 0.45 to 0.73 (p<0.01) in either patient. Extremes of blood glucose changes (i.e. hypo- and hyperglycemias) were identified correctly in the majority (>70%) of the events. In contrast, neither of two diabetologists was able to produce a reliable prediction of future blood glucose changes (0.05 < r < 0.12; p>0.l).

A high salt diet leads to up-regulation of alpha-2 adrenoceptors and down-regulation of beta-2 adrenoceptors in normotensive subjects. Although the increase in blood pressure with a high salt diet is not related to the magnitude of the alpha-2 or beta-2 adrenoceptor changes alone, it is related to the increase in the ratio of the receptor changes (operative alpha/beta adrenoceptor ratio). An increase in the operative alpha/beta adrenoceptor ratio with a high salt intake results in vasoconstriction and reduced vasodilatation at resistance vessels, as well as increased renal proximal tubular sodium reabsorption. An influence of heredity on this relationship is supported by four lines of evidence: 1) salt-sensitivity of blood pressure occurs predominantly in subjects with a family history of hypertension; 2) studies in twin children document the influence of genetic variance on salt-sensitivity of blood pressure; 3) subjects with a family history of hypertension have a significantly lower salivary sodium concentration and an altered urinary sodium excretion after salt loading compared to subjects with no such history; 4) salt-sensitivity of blood pressure may be associated with specific genetic markers. On the basis of these observations, we propose the hypothesis that enhanced inverse alpha-beta-adrenoceptor regulation in response to a high salt intake may be responsible for salt sensitivity in the normal population, and may contribute to the development of essential hypertension in susceptible individuals. This alteration is likely to be genetically mediated.

America & RRI but not in Europe. Lower IDWG was associated with stroke in Europe & Latin America but not in the US. Albumin and nPCR appeared to be lower in the patients with stroke events although not always significant. Conclusions: Higher predialysis SBP variability is associated with stroke on HD populations suggesting a potential role forcerebral perfusion instability. We confirm known associations between age, diabetes, pre-existent cerebrovascular disease and hypertension. In contrast to studies in non-dialysis patients we do not find an association between EPO dose and stroke. Interventional trials of blood pressure management on stroke are recommended. with either Nephrin or CD2AP positive expression was detected in 11 of total 18 hypertension patients (61.11%), while there was no Nephrin and CD2AP expression in normatension subjects. During the urinary podocyte positive subset, Nephrin was detected in 10 patients, CD2AP in 6 patients and both of them in 5 patients. The concentration of U-mALB was significantly higher in urinary podocyte positive subset compared with negative subset (P=0.005), and urinary podocyte was detected even in patients with U-mALB concentration lower than measurable range. Therewas no significant difference in age, blood pressure, sCr, sUA, LDL-C and TG between the two subsets of hypertension patients. According to Pearson correlation analysis of urinary podocyte with otherclinical features, it showed a positive correlation between urinary podocyte and U-mALB (r=0.645, P=0.004). Conclusions: Podocyte can be detected in urine of hypertension patients with negative proteinuria, suggesting that urinary podocyte excretion, as a sensitive marker, may be used in clinical for predicting early phase of hypertension-induced glomerular injury. an increased risk of target organ damage independent of blood pressure. We aimed to evaluate the relation among endothelial functions determined by flow mediated vasodilatation (FMD) with blood pressure levels obtained by OBPM, HBPM, CBP, ABPM and BPV in renal transplant recipients. Methods: OBPM, HBPM, CBP, ABPM were obtained from renal transplant recipients with a diagnosis of hypertension. BPV was calculated using the average real variability index. Patients were divided into two groups as patients with or without endothelial dysfunction according to FMD. Predictive value of different measurement techniques and BPVon endothelial functions were investigated. Results: Seventy-three kidney transplant recipients were enrolled. 68.5% of the patients had endothelial dysfunction. Blood pressure values measured by different techniques in both groups are presented in table.Patients with endothelial dysfunction had significantly higher ambulatory blood pressure values and higher BPV. Therewas no difference in other blood pressure values. There was a negative correlation between FMD with 24-h mean and systolic ARV (r=-0.262; p=0.02 and r=-0.378; p=0.001 respectively). Other blood pressure parameters were not correlated with FMD. Conclusions: ABMP and BPV are the most closely related blood pressure parameters with endothelial functions in renal transplant recipients. used diverse antihypertensive drugs with various effects on MSNA during the recordings. The aim of this current study isto determine the effect of pRDN on MSNA in a standardized fashion: aftercessation of antihypertensive treatment or under the exact same medication. Methods: 13 patients with a systolic BP of ≥ 160mmHg despite the use of ≥ 3 antihypertensive drugs or the inability to followa stable drug regimen due to unacceptable side-effects, in- and exclusion criteria for treatment with pRDN were included in this study. and MSNAwas determined. was changesin MSNA(p=0.336) orheartrate(p=0.521).(fig.1)GFR did not change(p=1.0). Conclusions: Treatment with pRDN did not result in achange in MSNA. Changes in BP did not correlatewith changes in MSNA. More research on the effect of pRDN on MSNA has to be done. mmHg 6 months after pRDN (p<0.001). The mean decrease in systolic BP is not different in the group with solitary arteries(-33mmHg)compared with the group with multiple arteries(-29mmHg, p=0.257). Conclusions: Multiple renal arteries are prevalent among patients referred for treatment with pRDN. There is no relation between presence of multiple arteries and a decrease in BP 6 months after pRDN. Therefore it is questionable whether patients with multiple renal arteries should be excluded from pRDN. atrend forreduction DBP cohort ofpatients renalsympathetic Introduction and Aims: Peritubular capillary (PTC) loss has been proved to be associated with renal function in diabetic nephropathy patients, but has never been studied in malignant hypertension (MHT). This study is aimed to observe the PTC loss as well as clinico-pathological characteristics of essential MHT (EMHT) and IgA nephropathyassociated MHT (IgAN-MHT). Methods: 1.9% (34) IgAN-MHT patients were diagnosed in the 1765 cases of IgA nephropathy in the past 10 years in our hospital. 52 patients with EMHT confirmed by renal biopsy were enrolled asthe EMHT group. The clinical records were reviewed and the lesions of 482 renal small arteries and 818 arterioles were re-evaluated. The peritubular capillary (PTC) was demonstrated by immunohistochemical staining of CD34 (a specific marker for vascular endothelium) and compared with 19 glomerular minimal lesion (GML) patients. Results: Both the IgAN-MHT and EMHT patients were mainly young males (71% vs 92% male, P =0.008) and have very high blood pressures. When compared with EMHT patients, the IgAN-MHT patients showed more severe urinary proteins and glomerular sclerosis lesions, but less severe serum creatinine (Scr) elevation and tubulo-interstitial injuries. The lesions of renal small arteries and arterioles were also less severe among IgAN-MHT patientsthan the EMHT group. Among all the vascular lesions, only the arteriolar occlusion proportion in EMHT group correlated with renal function. The PTC proportion was decreased in both IgAN-MHT (2.98±0.51%, P <0.001) and EMHT (2.24±0.73%, P <0.001) patients compared with the GML control group (3.75±0.79%), and was lowest in the EMHT group. The PTC proportion correlated well with renal function in EMHT group and all MHT patients. Conclusions: Our IgAN-MHT patients had a less prominent PTC loss than the EMHT patients. And the PTC proportion, instead of renal vascular lesions of small arteries and arterioles, correlated well with renal function impairment in malignant hypertension patients. CD4 and CD8 T lymphocytes and macrophages (CD68 + cells) were evaluated in the kidneys. Results: Data at the time ofpressure natriuresis studies: 1) Renal histologic changes and glomerular filtration rate, were not significantly different in the SSHTN and MMF groups. 2) Other data (mean±SE) shown in Table. * optical density to β -actin a=p<0.05 vs. the rest b=p<0.05 vs. C-HSD and C-NSD 3) UNaVand Fractional Na significantly (p<0.05) lowerat 130-150 RAP in SSHTN group Figure. Significant Correlations: Fractional Na excretion vs. Cell infiltration (p=0.004), vs.AII + cells (p=0.0019). Systolic blood pressure vs. Cell infiltration (p<0.0001), vs. AII+ (p<0.0001). Conclusions: Impairment in pressure natriuresis and hypertension correlatewith the severityof renal inflammation in SSHTN. high (>6000 units/week) seemsto higher SBP. This Introduction Blood pressure circadian rhythm variation is rathercommon in patients with existing CKD. Nondippers with renal disease are associated with a subsequent deterioration in renal function than dippers, which is independent of blood pressure level and other risk factors for renal impairment. However, it is still unclear upon the contributing factors for blood pressure rhythm variation in CKD patients. We aimed to determine renal pathological and clinical parameters associated with blood pressure rhythm variation in IgAN patients. Methods: The study involved 341 adult IgAN patients in CKD1 -3 stage, all of whom underwent renal biopsyand ambulatory blood pressure monitoring. Patients were excluded if they were taking antihypertensive drugs, glucocorticoids for treatment. Baseline patient characteristics and clinical data were collected. The pathological scores were performed according to the IgAN Oxford score. Influencing factors of blood pressure rhythm abnormality were determined by Spearman correlation analysis and logistic regression analysis. Results: Theprevalencewas 73.0% (249cases)forIgAN bloodpressurewasgraduallyincreased alongwithhigher IgAN MESTscore inIgAN patients.The prevalence ofnon-dippersbloodpressurewas positively related withage, serum creatinine, uric acid, Up/Cr, 24h urinarysodium, tubularatrophy/interstitialfibrosis, interstitial inflammatory infiltration andarteriolar hyalinosis but negatively correlatedwitheGFR.Resultsoflogistic regression analysis showedthat no matter withorwithouthypertension, Up/Cr, 24h urinarysodium, tubularatrophy/interstitialfibrosis, arteriolar hyalinosis were associated with abnormal blood pressure rhythm. Forthepatientscombinedwithhypertension, eGFR,uric acid and interstitialinflammatory infiltration were correlatedwith abnormal blood pressure rhythm besides ofthefactorsmentionedabove. Conclusions: Excretionofurine protein andsodium, tubulointerstitialinjury including tubularatrophy/fibrosis and arteriolarhyalinosis are associated withabnormalregulation ofblood pressure rhythm. eGFR,uric acid andinterstitialinflammatory infiltration are relatednotonly tohypertensionbut alsotoabnormal rhythmofbloodpressure. (HR), a type therapyand the and coronary heart disease. taken. was Introduction and Aims: The use of ambulatory blood pressure monitoring is recommended by current guidelines because identifies white-coat reactors and correlates with target organ damage better than casual blood pressure measurements. Arterial stiffness is underused in the routine clinical practice although it is a s