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Eun Y, Kim JH, Lim SH, Ahn YH, Kang HG, Ha IS. Two cases of children presenting with polydipsia, polyuria, and malignant hypertension: Answers. Pediatr Nephrol 2022; 37:559-561. [PMID: 34727244 DOI: 10.1007/s00467-021-05236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yong Eun
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seon Hee Lim
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Uijeongbu-si, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hinokuma N, Sakurai S, Shiratori A, Nagahara K, Abe Y, Shimizu T, Fujii T, Mizuno K, Tomita H. A pediatric patient with hyponatremic hypertensive syndrome without persistent hypertension in acute phase: A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20969559. [PMID: 33294189 PMCID: PMC7705808 DOI: 10.1177/2050313x20969559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Hyponatremic hypertensive syndrome is characterized by hypertension, hyponatremia, and hypokalemia due to unilateral renal artery stenosis. We herein report a 1-year-old hyponatremic hypertensive syndrome infant without persistent hypertension in the acute phase. On the ninth hospital day, his systolic and diastolic blood pressure increased up to 154-160 and 70-84 mmHg, respectively. Acute gastroenteritis and dehydration might transiently mask his hypertension. By percutaneous transluminal balloon angioplasty for right renal artery, his blood pressure finally normalized without antihypertensive drugs. We reviewed 23 previously reported pediatric patients with hyponatremic hypertensive syndrome under the age of 15 years. Including our patient, there are only three reports on hyponatremic hypertensive syndrome without persistent hypertension in the acute phase. Hyponatremic hypertensive syndrome is curable with proper diagnosis and timely intervention. Therefore, pediatricians should pay attention to the signs and symptoms associated with hyponatremic hypertensive syndrome, even if persistent hypertension was absent in the acute phase.
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Affiliation(s)
- Nodoka Hinokuma
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Shunsuke Sakurai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | | | - Keiko Nagahara
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yoshifusa Abe
- Children's Medical Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takeshi Shimizu
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Katsumi Mizuno
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Hideshi Tomita
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
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3
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Ardabili S, Uerlings V, Kaelin Agten A, Hodel M. Fetal congenital midaortic syndrome with unilateral renal artery stenosis prenatally presenting with polyhydramnios and postpartum as hyponatremic hypertensive syndrome. BMJ Case Rep 2020; 13:13/5/e234459. [PMID: 32444441 DOI: 10.1136/bcr-2020-234459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The midaortic syndrome (MAS) is a rare anomaly, characterised by narrowing of the distal aorta and its major branches. The most common symptom is severe arterial hypertension. The combination of hyponatremia, polyuria and renovascular hypertension caused by a unilateral renal artery stenosis is described as hyponatremic hypertensive syndrome. We report a case of MAS with unilateral renal artery stenosis in a preterm female neonate. A pregnant woman at 34 weeks of gestation was referred with fast growing abdominal circumference and pain. The ultrasound revealed severe polyhydramnios and fetal myocardial hypertrophy. Within the first 48 hours of the neonatal period, the diagnosis of MAS was made. We conclude that symptomatic MAS, caused by unilateral renal artery stenosis, resulting in increased renin-angiotensin-aldosterone system activity and subsequent polyuria of the non-stenotic kidney, lead to clinically significant polyhydramnios.
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Affiliation(s)
- Sara Ardabili
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Vincent Uerlings
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Markus Hodel
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Pandey M, Sharma R, Kanwal SK, Chhapola V, Awasthy N, Mathur A, Kumar V. Hyponatremic-hypertensive syndrome: think of unilateral renal artery stenosis. Indian J Pediatr 2013; 80:872-4. [PMID: 23152163 DOI: 10.1007/s12098-012-0908-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 10/08/2012] [Indexed: 11/25/2022]
Abstract
Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder, in which hypertension is associated with profound hyponatremia. It is mostly encountered in adults with unilateral renal artery stenosis. Although renovascular hypertension is one of the commonest causes for severe hypertension in children, HHS is rarely reported in childhood. The authors report a 9-y old boy with hypertensive emergency and severe hyponatremia due to unilateral renal artery stenosis who was successfully managed by vascular stenting of the affected vessel. Prompt recognition of this disorder can be life-saving and can subsequently lead to appropriate referral and treatment as in the present case.
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Affiliation(s)
- Meenu Pandey
- Department of Pediatrics, Division of Pediatric Intensive Care, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, Bangla Sahib Road, New Delhi, 110001, India
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5
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Kovalski Y, Cleper R, Krause I, Dekel B, Belenky A, Davidovits M. Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare? Pediatr Nephrol 2012; 27:1037-40. [PMID: 22366877 DOI: 10.1007/s00467-012-2123-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 12/23/2011] [Accepted: 01/23/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyponatremic hypertensive syndrome (HHS) is characterized by unilateral renal artery stenosis with secondary hypertension and glomerular and tubular dysfunction due to hyperfiltration and activation of the renin-angiotensin system (RAS). CASE-DIAGNOSIS/TREATMENT We describe four children with HHS. All presented with polyuria and polydipsia, electrolyte disturbances, metabolic alkalosis, variable tubular dysfunction, and nephrotic range proteinuria along with hypertension. Interestingly, in one patient, glomerular and tubular abnormalities preceded the development of hypertension. All symptoms resolved after the underlying renal ischemia was corrected by percutaneous angioplasty. CONCLUSION Hyponatremic hypertensive syndrome may be more common in children than previously thought. Clinicians should be alert of the signs and symptoms because cure is possible with timely diagnosis and treatment.
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Affiliation(s)
- Yael Kovalski
- Institute of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, 49202, Israel
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6
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Pillai U, Mandakapala C, Mehta K. Resistant hyponatremia and hypokalemia treated successfully with nephrectomy. Clin Kidney J 2012; 5:68-9. [PMID: 26069754 PMCID: PMC4400453 DOI: 10.1093/ndtplus/sfr138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 09/02/2011] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Kalyani Mehta
- Department of Nephrology, Wayne State University, Detroit, MI, USA
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van Tellingen V, Lilien M, Bruinenberg J, de Vries WB. The hyponatremic hypertensive syndrome in a preterm infant: a case of severe hyponatremia with neurological sequels. Int J Nephrol 2011; 2011:406515. [PMID: 21876801 PMCID: PMC3161200 DOI: 10.4061/2011/406515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/23/2011] [Indexed: 11/20/2022] Open
Abstract
Objective. To report the irreversible severe neurological symptoms following the hyponatremic hypertensive syndrome (HHS) in an infant after umbilical arterial catheterization. Design. Case report with review of the literature. Setting. Neonatal intensive care unit at a tertiary care children's hospital. Patient. A three-week-old preterm infant. Conclusions. In evaluating a neonate with hyponatremia and hypertension, HHS should be considered, especially in case of umbilical arterial catheterization. In case of diagnostic delay, there is a risk of severe irreversible neurological damage.
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Affiliation(s)
- Vera van Tellingen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
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D'Angelo P, Catania S, Zirilli G, Collini P, Tropia S, Perotti D, Terenziani M, Spreafico F. Severe polyuria and polydipsia in hyponatremic-hypertensive syndrome associated with Wilms tumor. Pediatr Blood Cancer 2010; 55:566-9. [PMID: 20658633 DOI: 10.1002/pbc.22610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The combination of hyponatremia and renovascular hypertension is known as hyponatremic-hypertensive syndrome (HHS) and so rarely described in children but associated with various kinds of occlusions of the renal artery. We describe two children who presented HHS with severe hypokalemia, polyuria, and polydipsia associated with Wilms tumor, which required treatment with an angiotensin-converting enzyme inhibitor before nephrectomy. All HHS signs and symptoms resolved only following surgical resection of the tumor, allowing chemotherapy to be given.
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Affiliation(s)
- Paolo D'Angelo
- Unit of Pediatric Hematology and Oncology, G. Di Cristina Children's Hospital, A.R.N.A.S., Palermo, Italy.
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Lundgren G, Bozovic L, Castenfors J. Plasma Renin Activity before and after Allogeneic Kidney Transplantation in Man. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/00365596709133538] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van Brummelen P, Schalekamp MA. Body fluid volumes and the response of renin and aldosterone to short- and long-term thiazide therapy of essential hypertension. ACTA MEDICA SCANDINAVICA 2009; 207:259-64. [PMID: 6992515 DOI: 10.1111/j.0954-6820.1980.tb09718.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Plasma volume (PV), extracellular fluid volume (ECV) serum electrolytes, renin and aldosterone were measured before and after 1 week and 4 months of hydrochlorothiazide (HCT) treatment, 50 mg twice daily, in nine male patients with uncomplicated essential hypertension. All studies were carried out under strictly standardized conditions in a metabolic ward. After 1 week of HCT treatment, significant reductions were found in PV and ECV, but after 4 months only ECV was significantly reduced. During HCT therapy, renin and aldosterone were permanently elevated whereas serum sodium and potassium were lowered. After 1 week, renin was inversely correlated with PV and ECV and directly correlated with heart rate. After 4 months, renin was inversely correlated with serum sodium. These results indicate a permanent decrease in ECV during long-term HCT therapy. It is further suggested that the mechanisms responsible for the renin response during short- and long-term HCT treatment are different, changes in body fluid volumes and increased neural activity being responsible for the initial rise in renin, and serum sodium being the predominant factor during chronic treatment.
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Nicholls MG. Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children--more common than we think? Pediatr Nephrol 2006; 21:887-90. [PMID: 16773397 DOI: 10.1007/s00467-006-0107-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 01/23/2006] [Indexed: 01/07/2023]
Abstract
A case report in the journal Pediatric Nephrology describes a 15-month-old girl with the syndrome of hypertension and hyponatremia (HH syndrome) due to underlying unilateral renal artery stenosis. This syndrome is typically associated with hypokalemia and severe volume depletion and sometimes proteinuria, all of which, along with hypertension and hyponatremia, are usually corrected by resolution of the underlying renal ischemia. Gross and probably sudden activation of the renin-angiotensin system in response to renal ischemia is central to the pathophysiology although the cardiac atrial and B-type natriuretic peptides probably contribute also. Initial control of the severe hypertension may, in some cases, require careful volume repletion prior to introduction of blockade of the renin-angiotensin system in order to avoid first-dose hypotension, after which correction of the underlying renal ischemia is required. Whereas the syndrome has rarely been reported in children, it is possible that, as in adults, this reflects its lack of recognition by clinicians. The HH syndrome due to unilateral renal ischemia in children may be much more common than we think.
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Seracini D, Pela I, Favilli S, Bini RM. Hyponatraemic-hypertensive syndrome in a 15-month-old child with renal artery stenosis. Pediatr Nephrol 2006; 21:1027-30. [PMID: 16773417 DOI: 10.1007/s00467-006-0121-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Revised: 02/07/2006] [Accepted: 02/07/2006] [Indexed: 12/30/2022]
Abstract
In this report we present the case of a 15-month-old girl with hyponatraemic-hypertensive syndrome (HHS) caused by stenosis of the left renal artery. On sonographic examination the contralateral non-stenotic kidney appeared enlarged and with cortical hyperechogenicity mimicking a parenchymal lesion. After successful percutaneous transluminal angioplasty, when the girl became normotensive, her serum electrolyte and acid-base balance became normal within a few days. The contralateral non-stenotic kidney hyperechogenicity also disappeared, but only after a period of 6 months, suggesting parenchymal damage due to tubulointerstitial injury, even though reversible. Our case confirms that renovascular hypertension may rarely also be present with HHS in children and that metabolic and morphological alterations are reversible after the resolution of arterial stenosis.
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Affiliation(s)
- Daniela Seracini
- Paediatric Nephrology, Meyer Hospital, Via Luca Giordano 13, Florence, 50135, Italy.
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Ashida A, Matsumura H, Inoue N, Katayama H, Kiyohara Y, Yamamoto T, Nakakura H, Hattori M, Tamai H. Two cases of hyponatremic-hypertensive syndrome in childhood with renovascular hypertension. Eur J Pediatr 2006; 165:336-9. [PMID: 16411091 DOI: 10.1007/s00431-005-0048-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 11/09/2005] [Indexed: 11/28/2022]
Abstract
UNLABELLED We report two children with renovascular hypertension and fibromuscular dysplasia. They initially presented with severe hyponatremia, hypokalemia, polyuria, and transient proteinuria. This combination of symptoms is known to occur in patients with renovascular and malignant hypertension, and is known as hyponatremic-hypertensive syndrome (HHS), although it is considered rare in children. Since in both of our patients, the renal arterial stenosis was very severely or almost totally occlusive, we could not perform percutaneous transluminal renal artery angioplasty, and therefore nephrectomy was the only option. A histological study showed partial or complete occlusion with intimal hyperplasia and medial fibroplasia of intrarenal arteries such as the interlobular arteries. CONCLUSION Both patients showed rapidly progressive renovascular hypertension and loss of function of the affected kidney. In order to preserve renal function in such cases, early invasive intervention appears to be necessary.
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Affiliation(s)
- Akira Ashida
- Department of Pediatrics, Osaka Medical College, 2-7, Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
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Modlinger P, Chabrashvili T, Gill PS, Mendonca M, Harrison DG, Griendling KK, Li M, Raggio J, Wellstein A, Chen Y, Welch WJ, Wilcox CS. RNA silencing in vivo reveals role of p22phox in rat angiotensin slow pressor response. Hypertension 2006; 47:238-44. [PMID: 16391171 DOI: 10.1161/01.hyp.0000200023.02195.73] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The angiotensin II (Ang II) slow-pressor response entails an increase in mean arterial pressure and reactive oxygen species. We used double-stranded interfering RNAs (siRNAs) in Sprague Dawley rats in vivo to test the hypothesis that an increase in the p22phox component of NADPH oxidase is required for this response. Reactive oxygen species were assessed from excretion of 8-isoprostane prostaglandin F2alpha and blood pressure by telemetry. Two siRNA sequences to p22phox (sip22phox) reduced mRNA >85% in cultured vascular smooth muscle cells. Rats received rapid (10 second) IV injections (50 to 100 microg) of 1 of 2 different sip22phox, control siRNA, or vehicle (TransIt in saline) during 14 day SC infusions of Ang II (200 ng.kg(-1).min(-1)) or sham infusions. In both groups, sip22phox, relative to control siRNA, led to significant (P<0.001; approximately 50%) reductions in expression of p22phox mRNA and protein and of NADPH oxidase activity in the kidney cortex. In Ang II-infused rats, sip22phox decreased protein expression for Nox-1, -2, and -4 but increased p47phox. Three days after sip22phox, conscious rats infused with Ang II had a reduced excretion of 8-isoprostane (10+/-1 versus 19+/-2 pg.24 h(-1); P<0.01) and a reduced mean arterial pressure (142+/-5 versus 168+/-4 mm Hg; P<0.005). An increase in p22phox is required for increased renal NADPH oxidase activity, expression of Nox proteins and oxidative stress, and contributes < or =50% to hypertension during an Ang II slow-pressor response.
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Affiliation(s)
- Paul Modlinger
- Division of Nephrology and Hypertension, Georgetown University, Washington, DC, USA
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Sadjadi J, Kramer GL, Yu CH, Welborn MB, Modrall JG. Angiotensin II Exerts Positive Feedback on the Intrarenal Renin-Angiotensin System by an Angiotensin Converting Enzyme-Dependent Mechanism1. J Surg Res 2005; 129:272-7. [PMID: 15992826 DOI: 10.1016/j.jss.2005.04.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 04/25/2005] [Accepted: 04/26/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Plasma angiotensin II (ANG II) is not increased significantly in renovascular hypertension (RVH), but tissue ANG II levels are elevated in both kidneys of renovascular rats. Because the contralateral, non-ischemic kidney is critical for maintenance of hypertension in RVH, this study sought to understand the mechanism by which intrarenal ANG II levels are augmented in the non-ischemic kidney. This study tested the hypothesis that an incremental increase in plasma ANG II induces the intrarenal renin-angiotensin system (RAS) in the non-ischemic kidney by an angiotensin converting enzyme (ACE) dependent mechanism. METHODS To simulate the incremental increase in plasma ANG II induced by the ischemic kidney in RVH, an ANG II infusion model was used. This model used a chronic infusion of ANG II (40 ng/min) or vehicle by osmotic minipump into uninephrectomized rats. Parallel groups were treated with the ACE inhibitor Enalaprilat (200 mg/kg/day). Intrarenal ACE activity was measured by radioenzymatic assay. ANG II levels were quantified by radioimmunoassay. RESULTS Hypertension was evident in ANG II-infused rats, compared to control rats (155 +/- 4 versus 112 +/- 1 mmHg; P < 0.001). Concurrent treatment with Enalaprilat reversed the hypertension induced by ANG II infusion (98 +/- 3 versus 155 +/- 4 mmHg; P < 0.001). ANG II up-regulated intrarenal ACE activity in the non-ischemic kidney (59.2 +/- 11.9 versus 25.2 +/- 6.8 units/mg protein; P < 0.01). Enalaprilat significantly decreased renal ACE activity in ANG II-treated rats, compared to ANG II alone (11.4 +/- 1.0 versus 59.2 +/- 11.9 units/mg protein; P < 0.001). Intrarenal ANG II was increased in ANG II-infused rats, compared to control animals (52.9 +/- 7.1 versus 23.0 +/- 3.2 fmol/mg tissue; P < 0.001), and Enalaprilat prevented ANG II-induced increases in intrarenal ANG II (29.9 +/- 2.6 versus 52.9 +/- 7.1 fmol/mg tissue; P < 0.05). CONCLUSION Incremental changes in plasma ANG II induce de novo production of ANG II in the non-ischemic kidney to augment intrarenal ANG II content. ACE inhibition blocks this positive feedback loop, suggesting that ANG II activates the intrarenal RAS by an ACE-dependent mechanism. The impact of ACE inhibition on blood pressure suggests that this feedback loop may be an important mechanism for maintenance of hypertension in RVH.
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Affiliation(s)
- Javid Sadjadi
- Department of Surgery, Division of Vascular Surgery, Dallas Veterans Affairs Medical Center and the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390, USA
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Abstract
Two cases of hyponatraemic hypertensive syndrome occurring in extremely low birthweight infants are presented. Both infants experienced unilateral renal ischaemia resulting in hyponatraemia and hypertension. A proposed pathophysiological mechanism, namely unilateral renal ischaemia leading to a pressure-natriuresis in the contralateral kidney, is presented. This is associated with an increase in plasma renin and aldosterone, with a paradoxical increase in urinary sodium loss. Immature renal tubular function and relative aldosterone resistance could place the extremely low birthweight infant at increased risk for the condition. The paucity of reports suggests that the condition might be under-recognized.
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Affiliation(s)
- D Bourchier
- Neonatal Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand.
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Tetsuou YT, Miyatake YY, Tanaka K, Suzuki T, Ohtsu F, Nagasawa K, Fuji-i M, Tanaka S, Iino Y, Tamura K. Hyponatremic-hypertensive syndrome associated with renovascular hypertension: a case report. Circ J 2002; 66:297-301. [PMID: 11922282 DOI: 10.1253/circj.66.297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Renovascular hypertension occasionally manifests clinically as electrolyte disorders and albuminuria in addition to elevated blood pressure. A 49-year-old man who had renovascular hypertension also had severe hypokalemia, hyponatremia, polyuria and polydipsia that were treated by an angiotensin-converting enzyme inhibitor and resection of an atrophic kidney with a compromised blood supply. This is a case of hyponatremic-hypertensive syndrome related to renovascular hypertension and occurring as an additional abnormality.
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Affiliation(s)
- Yayoi Tsukada Tetsuou
- Department of Internal Medicine Tama-Nagayama Hospital, Nippon Medical School, Tama-city, Japan.
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Affiliation(s)
- J Menard
- Faculté de Médecine, Université Paris, 75270 Paris, France
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Abstract
Renovascular hypertension has its experimental counterpart in the two-kidney, one clip model (Goldblatt hypertension). From the study of this model, a general pathophysiological scheme has evolved suggesting that temporal stages in the development and maintenance of hypertension are regulated by complicated hormonal and neural interrelations. The central roles played by the renin-angiotensin system and the renal nerves is discussed as they relate to other hormones. In addition, the possible contribution of converting enzyme inhibitors to understanding the pathophysiology of this condition is discussed.
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Abstract
Recent research indicates that neurohormonal responses after myocardial infarction may predict patient outcome, and alteration of this process may change etiologic factors and strengthen positive prognosticators. Because there are clinical similarities between acute myocardial infarction and heart failure, there appears to be justification for a unified treatment approach (i.e., therapies that have proved beneficial in the treatment of myocardial infarction have also showed promise in the treatment of heart failure). Conversely, some therapies that have benefited the patient with heart failure may benefit the patient who has had a myocardial infarction. For example, angiotensin-converting enzyme inhibitors have been proven to blunt detrimental neurohormonal activity seen after myocardial infarction. These therapies promise to reduce complications and improve survival.
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Affiliation(s)
- T B Levine
- Heart Failure and Cardiac Transplant Program, Henry Ford Hospital, Detroit, Michigan 48202
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Abstract
Evidence from animal studies demonstrates that the renin-angiotensin (ANG II) system and sodium retention play major roles in experimental renovascular hypertension (RVH). Two basic models have been described. In the first, one-clip two-kidney Goldblatt hypertension, the ischemic kidney secretes renin, which leads to increased ANG II formation and hence elevation of blood pressure (BP). As BP rises, sodium excretion by the intact contralateral kidney increases (pressure natriuresis); therefore, there is no sodium retention. In the second, one-clip one-kidney Goldblatt hypertension, the contralateral kidney is removed. In this case the pressure natriuresis can no longer occur, and sodium retention occurs. The ensuing expansion of plasma volume inhibits renin secretion, so that in this model the renin level is normal or low. Following the clipping of the renal artery, renal blood flow and pressure are maintained distal to the stenosis by an ANG II-mediated vasoconstriction. This acts preferentially on the efferent glomerular arterioles, so that the ratio of preglomerular to postglomerular resistance is reduced, which helps to maintain glomerular filtration despite the reduced renal perfusion pressure. In the contralateral kidney the afferent arteriolar resistance is increased, probably as a direct result of exposure to the higher intrarenal arterial pressure. ANG II constricts the efferent arterioles in the same way as in the ischemic kidney, so that the ratio of preglomerular to postglomerular resistance is unchanged. When an angiotensin converting enzyme (ACE) inhibitor is given, the efferent arterioles vasodilate. In the ischemic kidney this may produce a reduction of glomerular filtration rate (GFR), which is not seen in the contralateral kidney. Unilateral RVH in humans corresponds closely to the animal model of one-clip two-kidney hypertension. Plasma renin activity is usually high, and converting enzyme inhibitors lower BP effectively. The increased renin is due exclusively to increased secretion of renin by the ischemic kidney, and is completely suppressed in the contralateral kidney. It is not clear whether bilateral RVH corresponds to the one-clip one-kidney model, but there is circumstantial evidence to suggest that both renin and volume factors may be involved. The majority of cases of human RVH are caused by atheroma, which is commonly bilateral, or by fibromuscular dysplasia. The former tends to be associated with atheroma elsewhere in the arterial tree, and often progresses to complete occlusion and renal failure. The latter occurs in younger patients, and almost never progresses to complete occlusion.
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Affiliation(s)
- T G Pickering
- Cardiovascular Center, New York Hospital-Cornell University Medical Center, NY 10021
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Kholeif M, Isles C. Profound hypotension after atenolol in severe hypertension. BMJ (CLINICAL RESEARCH ED.) 1989; 298:161-2. [PMID: 2493837 PMCID: PMC1835458 DOI: 10.1136/bmj.298.6667.161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M Kholeif
- MRC Blood Pressure Unit, Western Infirmary, Glasgow
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Streeten DH, Anderson GH. Hypertension: relating drug therapy to pathogenetic mechanisms. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1988; 32:175-94. [PMID: 3064182 DOI: 10.1007/978-3-0348-9154-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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26
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Kawazoe N, Eto T, Abe I, Takishita S, Ueno M, Kobayashi K, Uezono K, Muratani H, Kimura Y, Tomita Y. Pathophysiology in malignant hypertension: with special reference to the renin-angiotensin system. Clin Cardiol 1987; 10:513-8. [PMID: 3621700 DOI: 10.1002/clc.4960100911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pathophysiology of malignant hypertension, of which underlying disease was essential hypertension (EHT) in 33 cases and chronic glomerulonephritis (CGN) in 26 cases, was studied with reference to the renin-angiotensin system. Plasma renin activity (PRA) was significantly higher in the EHT than in the CGN group, and angiotensin II antagonist [Sar1, Ile8]angiotensin II (AIIA) induced a significant lowering of blood pressure only in the former group. PRA was linearly correlated with both pretreatment mean blood pressure (MBP, r = 0.474, n = 29, p less than 0.01) and serum creatinine (r = 0.540, n = 29, p less than 0.01) in the EHT group but not in CGN patients, although there was an inverse correlation between PRA and serum sodium in both groups. Multiple regression analysis revealed that PRA was independently related to MBP, serum creatinine, and serum sodium in the EHT group, but not in the CGN group. These results suggest that the renin-angiotensin system plays a significant role in elevating blood pressure and deteriorating renal function in malignant hypertension derived from EHT, but it is less important in CGN related hypertension.
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Fujishima M, Nakatomi Y, Tamaki K, Ishitsuka T, Kawasaki T, Omae T. Cerebrospinal fluid lactate and pyruvate concentrations in patients with malignant hypertension. J Neurol 1984; 231:71-4. [PMID: 6737011 DOI: 10.1007/bf00313719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Lactate and pyruvate concentrations and acid-base parameters in cerebrospinal fluid (CSF) and arterial blood were measured in 21 patients with malignant hypertension ( MHT ), 19 with benign hypertension (BHT) and 21 normotensive subjects (NT). Average values for CSF lactate and lactate/pyruvate (L/P) ratio were significantly higher in MHT (1.90 +/- 10 mM/1, 19.2 +/- 1.0) than in either BHT (1.50 +/- 0.05 mM/l, 15.7 +/- 0.7) or NT (1.44 +/- 0.04 mM/1, 15.7 +/- 0.4). There was a linear correlation between CSF lactate and CSF pressure (r = 0.565, P less than 0.01), and the latter was also related to mean arterial pressure exceeding 150 mm Hg (r = 0.553, P less than 0.01). Such increases in the acid metabolites in CSF indicate that brain metabolism becomes anaerobic in MHT , probably due to increased intracranial pressure. Increased cerebrovascular permeability is also discussed as participating in causal mechanisms.
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28
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Stephens GA, Creekmore JS. Response of plasma renin activity to hypotension and angiotensin converting enzyme inhibitor in the turtle. J Comp Physiol B 1984. [DOI: 10.1007/bf02464409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hodsman GP, Isles CG, Murray GD, Usherwood TP, Webb DJ, Robertson JI. Factors related to first dose hypotensive effect of captopril: prediction and treatment. BRITISH MEDICAL JOURNAL 1983; 286:832-4. [PMID: 6403103 PMCID: PMC1547159 DOI: 10.1136/bmj.286.6368.832] [Citation(s) in RCA: 103] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The blood pressure response to the first dose of captopril (6.25 mg, 12.5 mg, or 25 mg) was measured in 65 treated, severely hypertensive patients. Mean supine blood pressure was 187/108 mm Hg immediately before captopril was given. Twenty one patients experienced a fall in supine systolic pressure greater than 50 mm Hg, including five whose pressure fell more than 100 mm Hg and two whose pressure fell more than 150 mm Hg. Six patients developed symptoms of acute hypotension, including dizziness, stupor, dysphasia, and hemiparesis. Percentage reductions in blood pressure were greatest in those with secondary hypertension (p less than 0.05), high pretreatment blood pressure (p less than 0.05), and high concentrations of plasma renin and angiotensin II (p less than 0.01). No significant correlation was found between fall in blood pressure and serum sodium concentration, age, renal function, and the dose of captopril given. A severe first dose effect cannot be consistently predicted in individual patients who have received other antihypertensive drugs for severe hypertension. Such patients should have close medical supervision for at least three hours after the first dose of captopril.
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Saragoça MA, Homsi E, Ribeiro AB, Ferreira Filho SR, Ramos OL. Hemodynamic mechanism of blood pressure response to captopril in human malignant hypertension. Hypertension 1983; 5:I53-8. [PMID: 6337961 DOI: 10.1161/01.hyp.5.2_pt_2.i53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The hemodynamic mechanism of blood pressure response to angiotensin blockade is well established in "benign" but not in human malignant hypertension. We studied the changes in mean arterial pressure (MAP), cardiac index (CI), pulmonary wedge pressure (PWP), and in plasma volume (PV) induced by a single oral dose of captopril (150 mg) in 11 patients with malignant hypertension. Two hours after captopril, MAP fell from 178.5 +/- 5.8 to 151.8 +/- 7.8 mm Hg (p less than 0.001) (means +/- SEM) due to a fall in total peripheral resistance (TPR) (from 54.8 +/- 6.8 to 46.4 +/- 1.6 arbitrary units, p less than 0.001). However, there was a simultaneous increase in CI (from 3.29 +/- 0.13 to 3.70 +/- 0.15 liter/min/m2, p less than 0.001), and a decrease in PWP (from 15.3 +/- 3.5 to 11.0 +/- 2.5 mm Hg, p less than 0.001), while PV remained unchanged (from 4.02 +/- 0.26 to 4.12 +/- 0.12 liters, n.s.). Our data show that, in human malignant hypertension, blood pressure response to captopril is due to a decrease in TPR, but in contrast to benign hypertension, there is also a simultaneous increase in CI. Our results suggest that, in malignant hypertension, potentially high CI levels are artificially normalized by the increased TPR and may be fully disclosed by vasodilation.
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Abstract
Plasma renin activity frequently is increased in patients with congestive heart failure. This increase in inversely related to serum sodium concentration, but is not correlated with hemodynamic measurements. Nonetheless, inhibition of converting enzyme activity by administration of teprotide or captopril results in a decrease in systemic vascular resistance that is directly related to the control plasma renin activity. These data suggest that angiotensin II contributes to the systemic vasoconstriction of heart failure and that chronic inhibition of the renin-angiotensin system may have a salutary effect on left ventricular performance in patients with heart failure.
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Abstract
The factors that might activate the renin-angiotensin system in treated heart failure were explored. Serum Na+ correlated inversely with plasma renin activity. The degree of congestive heart failure measured by right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance did not correlate with plasma renin activity. Similarly, renal function as measured by blood urea nitrogen, creatinine, and urinary Na+ excretion did not correlate with plasma renin activity. In a prospectively screened group, seven patients with congestive heart failure who were found to be hyponatraemic had plasma renin activities greater than 15 ng/ml per h. Serial determinations in one patient showed plasma renin activity to vary inversely with the serum Na+. It is concluded that serum sodium can be used to identify those patients with congestive heart failure who have a high plasma renin activity. The value of identifying these high renin heart failure patients was seen in their response in four cases to specific therapy with a converting enzyme inhibitor.
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Tuck ML, Sambhi MP, Kramer SB, Eggena P, Barrett J. Enhanced renin levels after discontinuation of furosemide: additional effects of loop diuretics on renin release. CLINICAL AND EXPERIMENTAL HYPERTENSION. PART A, THEORY AND PRACTICE 1982; 4:1359-75. [PMID: 6749346 DOI: 10.3109/10641968209060795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The rate of recovery of the renin-angiotensin-aldosterone axis after stopping diuretic administration was examined in 18 male patients with essential hypertension. Upright plasma renin activity (PRA) and plasma aldosterone (PA) were measured during sodium restriction (10 mEq sodium intake), after three days of furosemide administration (40 mg BID po) and for five days following cessation of the diuretic. After diuretic administration, the mean PRA level (8.2 +/- 1.7 ng/ml/hr) was significantly elevated compared to the level on low sodium diet (4.2 +/- 0.5 ng/ml/hr). However, the major finding was that PRA levels continued to increase significantly compared to levels during diuresis on days 1 (11.3 +/- 1.7 ng/ml/hr) and 2 (10.8 +/- 1.5 ng/ml/hr) of the postdiuretic period. Mean PA values paralleled PRA responses in the study. Infusion of normal saline on postdiuretic day 1 failed to suppress PRA to levels seen in subjects not receiving diuretics. The postdiuretic period was accompanied by increased urinary sodium reabsorption and decreased urinary potassium excretion and by significant decreases in creatinine, PAH and free water clearance. The mechanism of this sustained renin response several days after cessation of diuretic therapy may be best explained by a prolonged action of furosemide or by partial ongoing volume depletion with reduced sodium load to the distal nephron. Since all patients demonstrated a marked and consistent PRA response after diuretic withdrawal, this time period represents a potent stimulatory challenge for monitering renin responses.
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Ferriss JB, Brown JJ, Fraser R, Lever AF, Robertson JI. Primary hyperaldosteronism. CLINICS IN ENDOCRINOLOGY AND METABOLISM 1981; 10:419-52. [PMID: 7047018 DOI: 10.1016/s0300-595x(81)80006-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Case DB, Atlas SA, Sullivan PA, Laragh JH. Acute and chronic treatment of severe and malignant hypertension with the oral angiotensin-converting enzyme inhibitor captopril. Circulation 1981; 64:765-71. [PMID: 6168412 DOI: 10.1161/01.cir.64.4.765] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The patients with severe and 10 with accelerated or malignant hypertension were treated with the angiotensin-converting enzyme inhibitor captopril. Captopril acutely reduced blood pressure in all patients except two who had suppressed plasma renin activity. Four patients with encephalopathy showed immediate improvement after the first dose. Two patients could be withdrawn from nitroprusside infusion upon administration of captopril. Nineteen of 20 patients have remained on captopril for 12-32 months. Blood pressure is controlled in 18 and improved in two. Eleven required addition of diuretic and one addition of clonidine. The maximal antihypertensive effect of captopril with or without diuretics was evident after 3 months of continuous therapy and was associated with elevated plasma renin levels, normal aldosterone excretion and preservation of renal function. Captopril was well-tolerated, but produced occasional rash, loss of taste and proteinuria. We conclude that captopril, alone or in combination with other drugs, is effective in both the acute and long-term management of severe and malignant hypertension.
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36
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Dzau VJ, Colucci WS, Hollenberg NK, Williams GH. Relation of the renin-angiotensin-aldosterone system to clinical state in congestive heart failure. Circulation 1981; 63:645-51. [PMID: 7006851 DOI: 10.1161/01.cir.63.3.645] [Citation(s) in RCA: 388] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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37
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Peart WS. Concepts in hypertension. The Croonian Lecture 1979. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1980; 14:141-52. [PMID: 7009848 PMCID: PMC5373238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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38
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Atkinson AB, Brown JJ, Fraser R, Lever AF, Morton JJ, Riegger AJ, Robertson JI. Angiotensin II and renal hypertension in dog, rat and man: effect of converting enzyme inhibition. Clin Exp Hypertens 1980; 2:499-524. [PMID: 6253241 DOI: 10.3109/10641968009037127] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The role of the renin-angiotensin system in the pathogenesis of one-clip, two-kidney hypertension has been studied in man, dog and rat. Particular attention has been paid to peripheral plasma concentrations of angiotensin II in different circumstances; angiotensin II infusion has been combined with radioimmunoassay to construct angiotensin II/blood pressure dose-response curves. The effect of converting enzyme inhibitors has been studied, precautions being taken to avoid obtaining falsely high values for plasma angiotensin II because of cross-reaction with angiotensin I in these circumstances. The initial phase of one-clip, two-kidney hypertension is attributable to the direct pressor effect of the immediate rise in plasma angiotensin II. Subsequently, plasma angiotensin II is relatively lower, although blood pressure remains high. This upward resetting of the plasma angiotensin II/blood pressure relationship can be mimicked by infusing angiotensin II chronically at low dose. After reconstruction of a stenosed renal artery, or excision of a post-stenotic kidney, the angiotensin II/blood pressure relationship returns slowly to normal. In this second phase of one-clip, two-kidney hypertension, the long-term administration of saralasin, or of converting enzyme inhibitor, can also return arterial pressure to normal; brief administration of these drugs is less effective or ineffective. The results are compatible with, although they do not conclusively establish, an important slow pressor action of the renin-angiotensin system in the second phase of one-clip, two-kidney hypertension. This provides a rational basis for the use of captopril clinically in this condition.
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Atkinson AB, Davies DL, Leckie B, Morton JJ, Brown JJ, Fraser R, Lever AF, Robertson JI. Hyponatraemic hypertensive syndrome with renal-artery occlusion corrected by captopril. Lancet 1979; 2:606-9. [PMID: 90271 DOI: 10.1016/s0140-6736(79)91666-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Malignant hypertension with severe hyponatraemia, hypokalaemia, depletion of sodium and potassium, and elevated blood levels of renin, angiotensin I, angiotensin II, aldosterone, and arginine vasopressin developed in a woman with renal-artery occlusion. Plasma angiotensin II was disproportionately high in relation to exchangeable sodium. Captopril, by inhibiting conversion of angiotensin I to angiotensin II, further elevated the blood levels of renin and angiotensin I but corrected all other abnormalities. Unilateral nephrectomy was subsequently curative.
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41
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Brereton RJ. Ryle's tube for rapid intravenous transfusion. Lancet 1979; 1:557. [PMID: 85143 DOI: 10.1016/s0140-6736(79)90982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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42
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Atkinson AB, Brown JJ, Morton JJ, Leckie B, Fraser R, Lever AF, Robertson JI. Captopril in a hyponatraemic hypertensive: need for caution in initiating therapy. Lancet 1979; 1:557-8. [PMID: 85145 DOI: 10.1016/s0140-6736(79)90983-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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43
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Ferriss JB, Beevers DG, Brown JJ, Fraser R, Lever AF, Padfield PL, Robertson JI. Low-renin ("primary") hyperaldosteronism. Differential diagnosis and distinction of sub-groups within the syndrome. Am Heart J 1978; 95:641-58. [PMID: 345789 DOI: 10.1016/0002-8703(78)90307-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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44
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Engquist A, Blichert-Toft M, Olgaard K, Brandt MR, Kehlet H. Inhibition of aldosterone response to surgery by saline administration. Br J Surg 1978; 65:224-7. [PMID: 638442 DOI: 10.1002/bjs.1800650403] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The renin-angiotensin system, ACTH and hyperkalaemia are known to induce increased plasma levels of aldosterone. In order to assess the relative significance of these mechanisms during surgical stress, aldosterone, cortisol and electrolytes in plasma were measured in 12 otherwise healthy women during and after cholecystectomy. The patients received either isotonic sodium chloride or 5 per cent glucose in water during the experimental period of 22 h. The results showed that the pronounced increase of aldosterone and the concomitant decrease of sodium in plasma found in patients given glucose in water could almost be inhibited by the administration of saline. Cortisol and potassium concentrations were identical in the two groups of subjects. It is concluded that the aldosterone response to surgery is mainly mediated via the renin-angiotensin system. This response is probably due to a reduced sodium content or volume of extracellular fluid, since it could almost be inhibited by administration of sodium chloride. The rationale of saline restriction during and after surgery is questioned.
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Blair-West JR, Brook AH, Simpson PA. On the question of body fluid volume or sodium status influencing renin release. J Physiol 1977; 267:321-38. [PMID: 874867 PMCID: PMC1283617 DOI: 10.1113/jphysiol.1977.sp011815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
1. The extent to which renin release is affected by simultaneous changes in body Na and body fluid volume was studied in six sheep. 2. The animals' water intake was restricted for 10-17 days after which they were offered solutions containing varying amounts of NaCl. 3. Plasma renin concentration (PRC) of water restricted sheep was 2-3 times normal. 4. The changes in PRC following drinking were inversely related to the amount of sodium consumed, Na excretion and plasma Na concentration. There was no correlation between the changes of PRC and of plasma volume in so far as the latter is reflected by alterations in plasma protein concentration. 5. We conclude that changes in renin release were related to the animals' handling of NA, and not to alterations in body fluid volume. 6. These findings are compatible with the proposition that renin release was mediated by a macula densa mechanism.
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Galvez OG, Roberts BW, Mishkind MH, Bay WH, Ferris TF. Studies of the mechanism of contralateral polyuria after renal artery stenosis. J Clin Invest 1977; 59:609-15. [PMID: 845253 PMCID: PMC372264 DOI: 10.1172/jci108678] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Acute renal artery stenosis in hydropenic dogs caused a contralateral increase in urine volume and free water clearance without change in glomerular filtration, renal blood flow, or osmolar clearance. The increase in urine volume was not dependent on the development of hypertension since it occurred in animals pretreated with trimethaphan but was dependent upon angiotensin since it was presented with angiotensin blockade with Saralasin. The effect was not caused by angiotensin inhibiting antidiuretic hormone release since the polyuria occurred in hypophysectomized animals receiving a constant infusion of 10 muU/kg per min of aqueous Pitressin. Since the rise in urine volume was associated with an increase in renal vein prostaglandin E concentration and was prevented by pretreatment with indomethacin (5 mg/kg) the results suggest that the rise in plasma angiotensin after renal artery stenosis causes an increase in contralateral prostaglandin E synthesis with resultant antagonism to antidiuretic hormone at the collecting tubule.
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Sullivan JM, Adams DF, Hollenberg NK. beta-adrenergic blockade in essential hypertension: reduced renin release despite renal vasoconstriction. Circ Res 1976; 39:532-6. [PMID: 963837 DOI: 10.1161/01.res.39.4.532] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The acute effects of small doses of intravenous propranolol on renin release and on circulatory dynamics were studied at the time of renal arteriography in 12 persons with essential hypertension. All of the subjects had a normal peripheral renin response to chronic sodium depletion and all had normal renal function. Seven subjects received a 10-mEq sodium diet. At the time of arteriography, arterial blood pressure, pulse rate, cardiac output, renal blood flow, and arterial and renal venous renin activity were measured before and 6-20 minutes after the intravenous administration of propranolol (9-18 mjg/kg). Average renin secretion rate in the salt-depleted subjects fell from 367 +/- 80 (SEM) U/ml per 100 g/min to 122 +/- 51 U/ml per 100 g (P=0.03) and renal plasma flow fell from 189 to 155 ml/min per 100 g (P = 0.018). We also found that in the salt-loaded subjects, renal plasma flow fell from 213 to 184 ml/min per 100 g (P = 0.025), whereas renin secretion did not change significantly in either group. We conclude that propranolol rapidly blocks renin release despite circulatory changes which ordinarily constitute a stimulus for renin secretion, i.e., renal vasoconstriction and reduced renal blood flow.
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Graham RM, Muir MR, Hayes JM. Differing effects of the vasodilator drugs, prazosin and diazoxide on plasma renin activity in the dog. Clin Exp Pharmacol Physiol 1976; 3:173-7. [PMID: 975613 DOI: 10.1111/j.1440-1681.1976.tb00602.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
1. The effects of intravenous (i.v.) administration of the vasodilator drugs prazosin or diazoxide on blood pressure and plasma renin activity were evaluated in the anaesthetized dog. 2. Prazosin and diazoxide both induced a rapid reduction in the mean arterial pressure to 73% and 75% of control values respectively. 3. Prazosin lowered plasma renin activity to 62% (P less than 0-025) of the control value whereas diazoxide raised plasma renin activity to 178% (P less than 0.05) of the control value. 4. The combination of vasodilatation and low renin activity observed following the administration of prazosin is unique, and may have clinical significance if these factors reduce the vascular complications of hypertension.
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Gavras H, Brunner HR, Laragh JH, Vaughan ED, Koss M, Cote LJ, Gavras I. Malignant hypertension resulting from deoxycorticosterone acetate and salt excess: role of renin and sodium in vascular changes. Circ Res 1975; 36:300-9. [PMID: 234807 DOI: 10.1161/01.res.36.2.300] [Citation(s) in RCA: 140] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The evolution of malignant hypertension was studied under metabolic balance conditions in 11 uninephrectomized rats given deoxycorticosterone acetate and 1% NaCl as drinking water. Changes in sodium and potassium balance were related to changes in blood pressure, plasma renin activity, hematocrit, and kidney histology. After 3-4 weeks of steadily positive sodium balance accompanied by continuously increasing blood pressure up to 185 plus or minus 19 (SE) mm Hg, periods of sodium loss accompanied by evidence of hemoconcentration were observed marking the onset of the malignant phase as defined by the development of fibrinoid necrosis in the kidney. Plasma renin activity remained markedly suppressed both at the fourth week (0.33 plus or minus 0.02 ng/ml hour-1) when the sodium balance was positive and the kidney biopsy negative and at the end of the experiment (0.35 plus or minus 0.36 ng/ml hour-1) when the sodium balance was negative and the kidney histology revealed malignant vasculitis. Infusion of the angiotensin II inhibitor 1-Sar-8-Ala-angiotensin II consistently failed to affect blood pressure, and the kidney tissue norepinephrine level was reduced (0.054 plus or minus 0.01 mug/g) compared with the control level (0.132 plus or minus 0.02 mug/g). We conclude that malignant vasculitis in this model is preceded by hypertension associated with sodium and water retention and is accompanied by negative sodium balance, decreases in body weight, falling blood pressure, and hemoconcentration without demonstrable participation of the renin-angiotensin system or the renal catecholamines.
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