動脈硬化の病理(<特集>動脈硬化とアフェレシス)

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  • Pathology of Arteriosclerosis

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Arteriosclerosis is common in patients with chronic kidney disease (CKD), and cardiovascular disease (CVD) represents a major cause of death in these patients, especially those with end-stage renal disease (ESRD). LDL apheresis is used to treat familial hypercholesterolemia (FH), an inherited condition of accelerated atherosclerosis and severe coronary artery disease resulting in premature death. Atherosclerosis, the underlying cause of cardiovascular disease, is classified by morphological features into three groups : 1 intimal atherosclerosis, 2 medial calcific sclerosis, and 3 arteriolosclerosis. Atherogenesis is comprised of four stages, namely diffuse intimal thickening, fatty dots and streaks, fibrous plaque and complicated lesion. Development of intimal thickening is dependent upon aging and is characterized by an increased collagenous matrix. Plaque formation is characterized by an accumulation of intra and extracellular lipids in intima, resulting in advanced lesions with atheroma. The advanced lesions are destabilized by plaque inflammation, and subsequently ruptures, leading to clinical manifestations. The pathological features in ESRD patients are intimal atherosclerosis and medial calcific sclerosis. The important risk factors for CVD in ESRD patients are hypertension, dyslipidemia and CKD bone and mineral disorder (CKD-MBD). In this paper, the pathogenesis of atherosclerosis is described including the current state of research on chronic kidney disease (CKD).

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