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Weir RJ, Paintin DB, Robertson JIS, Tree M, Fraser R, Young J. Renin, Angiotensin and Aldosterone Relationships in Normal Pregnancy. Proc R Soc Med 2016. [DOI: 10.1177/003591577006311p110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- R J Weir
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - D B Paintin
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - J I S Robertson
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - M Tree
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - R Fraser
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
| | - J Young
- MRC Blood Pressure Unit, Western Infirmary, Glasgow; and Departments of Obstetrics, St Mary's Hospital, London and the Queen Mother's Hospital, Glasgow
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Kumar D, Plagov A, Yadav I, Torri DD, Sayeneni S, Sagar A, Rai P, Adabala M, Lederman R, Chandel N, Ding G, Malhotra A, Singhal PC. Inhibition of renin activity slows down the progression of HIV-associated nephropathy. Am J Physiol Renal Physiol 2012; 303:F711-20. [PMID: 22718888 DOI: 10.1152/ajprenal.00643.2011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the present study, we evaluated the effect of inhibition of renin activity (aliskiren) on the progression of renal lesions in two different mouse models (Vpr and Tg26) of human immunodeficiency virus (HIV)-associated nephropathy (HIVAN). In protocol A, Vpr mice were fed either water (C-VprA) or doxycycline [Doxy (D-VprA)] in their drinking water for 6 wk. In protocols B and C, Vpr mice received either normal saline (C-VprB/C), Doxy + normal saline (D-VprB/C), or Doxy + aliskiren (AD-VprB/C) for 6 wk (protocol B) or 12 wk (protocol C). In protocols D and E, Vpr mice were fed Doxy for 6 wk followed by kidney biopsy. Subsequently, half of the mice were administered either normal saline (D-VprD/E) or aliskiren (AD-VprD/E) for 4 wk (protocol D) or 8 (protocol E) wk. All D-VprA mice showed renal lesions in the form of focal segmental glomerular sclerosis and dilatation of tubules. In protocols B and C, aliskiren diminished both progression of renal lesions and proteinuria. In protocol C, aliskiren also diminished (P < 0.01) the rise in blood urea. In all groups, Doxy-treated mice displayed increased serum ANG I levels (the product of plasma renin activity); on the other hand, all aliskiren-treated mice displayed diminished serum ANG I levels. Renal tissues of D-VprC displayed increased ANG II content; however, aliskiren attenuated renal tissue ANG II production in AD-VprC. In protocol D, AD-VprD showed a 24.2% increase in the number of sclerosed glomeruli compared with 139.2% increase in sclerosed glomeruli in D-VprD (P < 0.01) from their baseline. The attenuating effect of aliskiren on the progression of renal lesions continued in AD-VprE. Aliskiren also diminished blood pressure, proteinuria, and progression of renal lesions in Tg26 mice. These findings indicate that inhibition of renin activity has a potential to slow down the progression of HIVAN.
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Affiliation(s)
- Dileep Kumar
- Division of Kidney Diseases and Hypertension, North Shore Long Island Jewish Medical Center, New Hyde Park, NY, USA
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Abstract
Many of the electrolyte derangements seen in chronic heart failure are related to activation of the renin-angiotensin system. Activation of the system may cause the retention of both sodium and water; the former is primarily related to the release of aldosterone and the latter is related to an angiotensin-mediated increase in thirst and decrease in the excretion of free water. The interaction of these mechanisms may explain why patients with chronic heart failure have higher values for total body sodium but lower values for serum sodium concentration than hypertensive patients or normal subjects. Activation of the renin-angiotensin system may also cause potassium depletion, which is manifest clinically by a decrease in both total body potassium and serum potassium concentration. These electrolyte disturbances may play a role in the development of ventricular arrhythmias. The renin-angiotensin system may also contribute to the development of magnesium deficits. These hormone-electrolyte interactions have important implications in the treatment of patients with heart failure, especially those in whom the renin-angiotensin system is pharmacologically inhibited.
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Affiliation(s)
- H J Dargie
- Department of Cardiology, Western Infirmary, Glasgow, Scotland
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4
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Abstract
We have studied retrospectively 18 infants who have received captopril for treatment of severe heart failure due to left-to-right shunts with pulmonary hypertension. Captopril has been administered in doses of up to 3.5 mg/kg/day (mean 2.47 mg/kg/day). Maintenance treatment with digoxin and frusemide was continued but potassium-sparing diuretics were stopped in most patients. The mean period of assessment was 19 days before and 27 days after commencing captopril. The mean daily weight gain before captopril was -7 g and after its introduction was + 13 g (P less than 0.001). There were statistically significant (P less than 0.05) falls in mean heart rate and respiratory rate and rises in plasma sodium concentration and feeding score. Plasma urea concentration fell but this did not reach statistical significance. Two patients suffered hypotension after increments in captopril dosage and subsequently had a rise in plasma urea and creatinine values. This adverse reaction may be linked to the presence of hyponatraemia. This preliminary report shows captopril may be useful in the control of severe heart failure in infancy.
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Affiliation(s)
- A M Scammell
- Institute of Child Health, University of Liverpool, Royal Liverpool Children's Hospital, U.K
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Atkinson AB, Brown JJ, Cumming AM, Fraser R, Lever AF, Leckie BJ, Morton JJ, Robertson JI, Davies DL. Captopril in the management of hypertension with renal artery stenosis: its long-term effect as a predictor of surgical outcome. Am J Cardiol 1982; 49:1460-6. [PMID: 7041585 DOI: 10.1016/0002-9149(82)90361-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Fifteen patients with hypertension and unilateral renal artery disease were treated with captopril alone; 10 came to operation and were later assessed postoperatively with no drug treatment. Captopril caused both immediate and sustained decreases in plasma angiotensin II and aldosterone, with increases in plasma active renin and blood angiotensin I concentrations. Decrements in systolic and diastolic pressure 2 hours after the first dose of captopril were closely correlated with the initial decreases in plasma angiotensin II. Blood pressure was decreased by long-term captopril therapy irrespective of whether plasma angiotensin II was abnormally high before treatment. The long-term response of both systolic and diastolic pressure correlated well with the response to surgery. By contrast, the blood pressure decrease 2 hours after the initial dose of captopril variously underestimated and overestimated the decrease during prolonged use of the drug and did not relate to surgical outcome. In patients who, before treatment, had secondary aldosteronism, hyponatremia, hypokalemia and sodium and potassium deficiency, captopril corrected these abnormalities. In the remaining patients, long-term captopril therapy did not alter exchangeable sodium, plasma sodium or total body potassium, although plasma potassium levels increased.
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Atkinson AB, Brown JJ, Cumming AM, Fraser R, Lever AF, Leckie BJ, Morton JJ, Robertson JI. Captopril in renovascular hypertension: long-term use in predicting surgical outcome. BRITISH MEDICAL JOURNAL 1982; 284:689-93. [PMID: 6802290 PMCID: PMC1496684 DOI: 10.1136/bmj.284.6317.689] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The angiotensin converting-enzyme inhibitor captopril was used as long-term preoperative treatment in a series of hypertensive patients with unilateral renal arterial disease. There were immediate and sustained falls in plasma angiotensin II and aldosterone concentrations, with converse increases in circulating renin and angiotensin I. In patients with sodium and potassium deficiency and secondary aldosterone excess before treatment captopril corrected the sodium and potassium deficits; in these cases the initial hypotensive response was profound but the later effect was less pronounced. When sodium and potassium state was initially normal it remained unchanged during captopril treatment, while the full hypotensive effect took up to three weeks to be attained. The immediate, but not long-term, falls in arterial pressure with captopril were proportional to the immediate decrements of plasma angiotensin II. Nevertheless, while the immediate blood-pressure reduction with captopril variously overestimated and underestimated the eventual surgical response, the absolute blood-pressure values during long-term captopril related well with those after operation. Pretreatment plasma renin and angiotensin II concentrations, while closely predicting the immediate captopril response, are fallible guides to surgical prognosis. In contrast, long-term treatment with converting-enzyme inhibitors may provide an accurate indication of surgical outcome.
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7
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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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Nicholls MG, Espiner EA, Ikram H, Maslowski AH. Hyponatraemia in congestive heart failure during treatment with captopril. BRITISH MEDICAL JOURNAL 1980; 281:909. [PMID: 7000281 PMCID: PMC1714174 DOI: 10.1136/bmj.281.6245.909] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Atkinson AB, Morton JJ, Brown JJ, Davies DL, Fraser R, Kelly P, Leckie B, Lever AF, Robertson JI. Captopril in clinical hypertension. Changes in components of renin-angiotensin system and in body composition in relation to fall in blood pressure with a note on measurement of angiotensin II during converting enzyme inhibition. Heart 1980; 44:290-6. [PMID: 7000102 PMCID: PMC482400 DOI: 10.1136/hrt.44.3.290] [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: 02/06/2023] Open
Abstract
The effect of the converting enzyme inhibitor captopril on arterial pressure, the components of the renin-angiotensin-aldosterone system, and body sodium and potassium content was studied in eight hypertensive patients with renal artery stenosis and, in conjunction with diuretics, in seven patients with hypertension unresponsive to previous treatment. Two hours after the first dose, captopril caused significant falls in systolic and diastolic pressures, plasma angiotensin II, and aldosterone, with converse increases in angiotensin I and both active and total renin; the initial fall in diastolic pressure was significantly related to the drop in plasma angiotensin II. The biochemical changes were sustained during prolonged treatment, even when diuretics were added. One untreated patient with renal artery occlusion had severe secondary aldosterone excess, was sodium and potassium depleted, and severely hyponatraemic and hypokalaemic; captopril restored blood pressure, plasma electrolyte concentrations, and exchangeable sodium and total body potassium to normal. In one man with renal artery stenosis and overall renal impairment captopril led to sodium retention, and blood pressure did not fall until a diuretic was added. In the remaining patients with renal artery stenosis, pretreatment renin, angio tensin II, and aldosterone concentrations were either normal or only modestly raised, and plasma electrolyte concentrations and body content of sodium and potassium were normal. Captopril alone controlled arterial pressure in all, three cases showing a gradual fall of pressure over the first six weeks of treatment; no significant changes in exchangeable sodium or total body potassium were seen. The group of patients with previously intractable hypertension were all controlled with a combination of captopril and diuretic.
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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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Brown JJ, Casals-Stenzel J, Cumming AM, Davies DL, Fraser R, Lever AF, Morton JJ, Semple PF, Tree M, Robertson JI. Angiotensin II, aldosterone and arterial pressure: a quantitative approach. Arthur C. Corcoran Memorial Lecture. Hypertension 1979; 1:159-79. [PMID: 399234 DOI: 10.1161/01.hyp.1.3.159] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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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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15
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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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16
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Roulston JE, Macgregor GA, Adam T, Markandu ND. Measurement of plasma renin activity as a valid estimation of plasma angiotensin status. Ann Clin Biochem 1978; 15:250-2. [PMID: 718108 DOI: 10.1177/000456327801500160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Measurement of plasma renin activity is widely used as an indirect assessment of plasma angiotensin II concentration. There has been some controversy over the validity of this assay as an estimate of circulating angiotensin II levels because, during the in vitro generation of angiotensin I by renin, over a period of time, substrate concentration may diminish to such an extent that it becomes rate-limiting, giving an artificially low reflection of angiotensin II levels. In this paper the initial angiotensin I concentration, that is the concentration before in vitro angiotensin I generation, has been compared with the corresponding plasma renin activity for 2752 individual plasma samples. A linear relationship was found between the initial angiotensin I concentration and the plasma renin activity below 60 ng ml-1 h-1. This indicates that, under the conditions of this assay, substrate does not appear to become rate-limiting except at exceedingly high levels of plasma renin activity. These results appear to provide further validation for the use of plasma renin activity measurement as a reflection of the concentration of circulating angiotensin II levels.
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Deheneffe J, Cuesta V, Briggs JD, Brown JJ, Fraser R, Lever AF, Morton JJ, Robertson IS, Tree M. Response of aldosterone and blood pressure to angiotensin II infusion in anephric man. Effect of sodium deprivation. Circ Res 1976; 39:183-90. [PMID: 939003 DOI: 10.1161/01.res.39.2.183] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Angiotensin II, infused intravenously, increased plasma aldosterone concentration in two of six anephric subjects taking their usual dietary quantities of sodium. After 3 days of dietary sodium restriction and weight-reducing hemodialysis, the aldosterone response to infused angiotensin II in the two previously reactive subjects was enhanced, while the four previously unreactive subjects also showed a rise in plasma aldosterone. Before and after sodium depletion the anephric subjects were less responsive than normal subjects. Even when sodium-depleted, the anephrics showed no further rise in plasma aldosterone when arterial plasma angiotensin II was increased by infusion to concentrations greater than 50-199pg/ml, in contrast to sodium-depleted normals who show progressive aldosterone responses with plasma angiotensin II concentrations up to at least 370pg/ml. Before the infusion of angiotensin II, arterial plasma renin, angiotensin II, and aldosterone were detectable in the anephrics, but were unchanged by dietary sodium restriction or weight-reducting hemodialysis. Sodium depletion caused significant falls in weight, plasma sodium, and blood pressure, but no changes in plasma potassium or cortisol. Increases in blood pressure in relation to increments of arterial plasma angiotensin II were unaffected by sodium depletion, as might be expected in the absence of a rise in endogenous angiotensin II.
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Walker WG, Horvath JS, Moore MA, Whelton P, Russell RP. Relation between plasma renin activity, angiotensin, and aldosterone and blood pressure in mild untreated hypertension. Circ Res 1976; 38:470-6. [PMID: 1269097 DOI: 10.1161/01.res.38.6.470] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Plasma renin activity, arterial and venous angiotensin II (A II), plasma aldosterone, and sodium excretion were measured in a group of 101 patients with mild essential hypertension. For the total hour; arterial A II was 5.2 +/- 1.0 pg/ml; venous A II was 4.2 +/- 0.6 pg/ml; and plasma aldosterone was 5.0 +/- 0.45 ng/100 ml. All values were lower corresponding values for normal subjects on a high salt intake despite the fact that salt intake in the normal subjects exceeded that for the hypertensive group more than 3-fold. Moreover, when the range of diastolic blood pressure up to 114 mm Hg was divided into three successive class intervals of increasing severity, there was a negative correlation between diastolic blood pressure and both PRA and plasma aldosterone. Arterial A II showed an anomalous increase in the class interval 105-114 mm Hg, despite the fact that this group exhibited the lowest level of PRA. At diastolic blood pressures above 114 mm Hg, the PRA appears to rise again. The anomalous increase in arterial A II in the presence of marked suppression of PRA is consistent with the presence of a renin activator or accelerator factor in hypertensive plasma as postulated by others. It also identifies a possible mechanism whereby even small increases in PRA could exert an adverse effect on the hypertensive state.
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Levine D, Ramsay L, Auty R, Branch R, Tidd M. Antagonism of endogenous mineralocorticoids in normal subjects by prorenoate potassium and spironolactone. Eur J Clin Pharmacol 1976; 09:381-6. [PMID: 786663 DOI: 10.1007/bf00606552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The pharmacological activity of single oral doses of a new aldosterone antagonist, prorenoate potassium, has been compared with spironolactone and placebo in a balanced double-blind crossover study in six healthy subject. Endogenous mineralocorticoids were stimulated by administration of frusemide followed by dietary sodium restriction, and the urinary excretion of electrolytes in response to prorenoate potassium, spironolactone and placebo was measured over a 24 hour period. Significant activity of prorenoate potassium and spironolactone was observed between 2 - 24 hours after medication, with peak activity at 6 - 8 hours. The active drugs significantly increased sodium excretion and the sodium : potassium (Na/K) ratio, but changes in potassium excretion were not significant. The total urine Na/K response to prorenoate potassium 45 mg was significantly greater than to spironolactone 100 mg.
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Abstract
Renin release from the kidneys is controlled by four major mechanisms - renal baroreceptors, the macula densa, the sympathetic nervous system and other humoral and ionic influences. Recently, the importance of the sympathetic nervous system in modulating renin release for a variety of stimuli has become apparent. The sympathetic adrenergic nerves act on a specific beta-receptor to stimulate renin release from the kidney. Those antihypertensive drugs that inhibit adrenergic nerve transmission tend therefore to lower plasma renin. beta-Adrenoreceptor blocking drugs also generally lower plasma renin by specific inhibition of renal renin release both in animals and humans. Diuretics and vasodilators in contrast elevate plasma renin levels. Plasma renin levels in hypertensive patients are the net result of many diverse influences, and similarly in patients treated with antihypertensive drugs the plasma renin level often is the result of opposing influences. Plasma renin levels tend to return towards normal levels after treatment in hypertensive patients. Plasma renin levels may offer a guide to a more rational basis for antihypertensive therapy in the future. However, the primary aim in treatment of the hypertensive patient should be to lower his blood pressure, independent of the effect of plasma renin levels.
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Chrysant SG, Kastagir BK, Stevens LE, Klinkmann H, Kolff WJ. Plasma renin activity in hypertension after renal homotransplantation. Angiology 1974; 25:172-85. [PMID: 4593218 DOI: 10.1177/000331977402500302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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OELKERS WOLFGANG, BROWN JEHOIDAJ, FRASER ROBERT, LEVER ANTHONYF, MORTON JAMESJ, ROBERTSON JIANS. Sensitization of the Adrenal Cortex to Angiotensin II in Sodium-Deplete Man. Circ Res 1974. [DOI: 10.1161/01.res.34.1.69] [Citation(s) in RCA: 128] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of sodium depletion on the dose-response relationships of angiotensin II to aldosterone and blood pressure was studied. Arterial plasma angiotensin II and aldosterone and arterial blood pressure were measured before and during the incremental infusion of angiotensin II into sodium-replete and sodium-deplete subjects. Sodium depletion caused a distinct steepening of the angiotensin Il-aldosterone dose-response curves in four of five subjects and a concurrent diminution in the pressor effect of angiotensin II. Administration of angiotensin II did not demonstrably alter the half-life of aldosterone. Sodium depletion did not change the plasma concentrations of sodium or potassium, but it was accompanied by a significant increase in plasma levels of 11-hydroxycorticosteroids and magnesium. The contrasting effects of sodium depletion on the aldosterone and the pressor dose-response curves favored sodium retention. These results are consistent with an important role for the renin-angiotensin system in the control of aldosterone secretion in man.
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Affiliation(s)
- WOLFGANG OELKERS
- Medical Research Council Blood Pressure Unit, Western Infirmary, Glasgow C11 6NT, Scotland
- Klinikum Steglitz der Freien Universität, Berlin
| | - JEHOIDA J. BROWN
- Medical Research Council Blood Pressure Unit, Western Infirmary, Glasgow C11 6NT, Scotland
| | - ROBERT FRASER
- Medical Research Council Blood Pressure Unit, Western Infirmary, Glasgow C11 6NT, Scotland
| | - ANTHONY F. LEVER
- Medical Research Council Blood Pressure Unit, Western Infirmary, Glasgow C11 6NT, Scotland
| | - JAMES J. MORTON
- Medical Research Council Blood Pressure Unit, Western Infirmary, Glasgow C11 6NT, Scotland
| | - J. IAN S. ROBERTSON
- Medical Research Council Blood Pressure Unit, Western Infirmary, Glasgow C11 6NT, Scotland
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Klaus D, Rössler R. [Renin secretion in analbuminaemia (author's transl)]. KLINISCHE WOCHENSCHRIFT 1973; 51:969-72. [PMID: 4762585 DOI: 10.1007/bf01468252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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25
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Schalekamp MA, Beevers DG, Briggs JD, Brown JJ, Davies DL, Fraser R, Lebel M, Lever AF, Medina A, Morton JJ, Robertson JI, Tree M. Hypertension in chronic renal failure. An abnormal relation between sodium and the renin-angiotensin system. Am J Med 1973; 55:379-90. [PMID: 4355704 DOI: 10.1016/0002-9343(73)90137-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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26
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Capelli JP, Wesson LG, Housel EL. Renovascular hypertension: incidence, diagnosis, mechanism and treatment. JOURNAL OF CHRONIC DISEASES 1973; 26:503-27. [PMID: 4355659 DOI: 10.1016/0021-9681(73)90003-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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27
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28
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Brown JJ, Fraser R, Lever AF, Robertson JI. Hypertension with aldosterone excess. BRITISH MEDICAL JOURNAL 1972; 2:391-6. [PMID: 4554158 PMCID: PMC1788241 DOI: 10.1136/bmj.2.5810.391] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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29
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Acute Circulatory Renal Failure: A Probable Manifestation of Excess Renin Release. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1972. [DOI: 10.1007/978-1-4684-0940-6_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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30
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Meurer KA. [Importance of the sympathico-adrenal system in renin release]. KLINISCHE WOCHENSCHRIFT 1971; 49:1001-14. [PMID: 4328546 DOI: 10.1007/bf01487731] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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31
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Judson WE, Helmer OM. Relationship of cardiorenal function to renin-aldosterone system in patients with valvular heart disease. Circulation 1971; 44:245-53. [PMID: 5562560 DOI: 10.1161/01.cir.44.2.245] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Metabolic data obtained during sodium (Na) loading, restriction, and depletion with thiazide were compared in 23 patients with valvular heart disease who had cardiac indices (CI) > and < 2.5 liters/min/m
2
. During Na loading (80 mEq Na for 4 days, followed by 150 mEq for 4 days) patients with CI > 2.5 excreted –3.4% Na load than those with the lowest normal values, whereas those with CI < 2.5 excreted –20.8% (
P
< 0.02). All 12 patients with CI > 2.5 responded to Na loss with elevation of plasma renin activity (PRA). In contrast, of the ill patients with CI < 2.5, none of the six on the 10 mEq diet, and only two of five on thiazide, responded with an increase in PRA; the urinary aldosterone values paralleled the PRA responses. The renin-angiotensin-aldosterone system responded to changes in Na balance. The magnitude and direction of the responses were influenced by cardiohemodynamic abnormalities. Aldosterone plays an important role in the Na retention in patients with valvular heart disease by stimulating Na-K exchange in the distal tubules of the kidney.
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32
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Weir RJ, Paintin DB, Brown JJ, Fraser R, Lever AF, Robertson JI, Young J. A serial study in pregnancy of the plasma concentrations of renin, corticosteroids, electrolytes and proteins and of haematocrit and plasma volume. THE JOURNAL OF OBSTETRICS AND GYNAECOLOGY OF THE BRITISH COMMONWEALTH 1971; 78:590-602. [PMID: 5558849 DOI: 10.1111/j.1471-0528.1971.tb00321.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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33
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Coghlan JP, Blair-West JR, Denton DA, Scoggins BA, Wright RD. Perspectives in aldosterone and renin control. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1971; 1:178-97. [PMID: 4327827 DOI: 10.1111/j.1445-5994.1971.tb02287.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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34
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Love DR, Brown JJ, Fraser R, Lever AF, Robertson JI, Timbury GC, Thomson S, Tree M. An unusual case of self-induced electrolyte depletion. Gut 1971; 12:284-90. [PMID: 5574799 PMCID: PMC1411623 DOI: 10.1136/gut.12.4.284] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A case of anorexia nervosa, presenting with unexplained hypokalaemia, is described. The patient was also secretly addicted to purgatives and diuretics. During an attempted metabolic balance study she secretly disposed of food and excreta, which were smuggled from the hospital by her sister. The patient induced her husband to bring his own stools into the ward, these then being substituted for her own. The interrelationships of the electrolyte disturbances, elevation of plasma renin, renin substrate, and hyperaldosteronism are discussed, particularly in connexion with the pathogenesis of peripheral oedema in anorexia nervosa.
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35
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Chan MY, Holmes WN. Studies on a "renin-angiotensin" system in the normal and hypophysectomized pigeon (Columba livia). Gen Comp Endocrinol 1971; 16:304-11. [PMID: 4323879 DOI: 10.1016/0016-6480(71)90042-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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36
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Robertson JI, Weir RJ, Düsterdieck GO, Fraser R, Tree M. Renin, angiotensin and aldosterone in human pregnancy and the menstrual cycle. Scott Med J 1971; 16:183-96. [PMID: 4326683 DOI: 10.1177/003693307101600303] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aldosterone secretion is frequently, although not invariably, increased above the normal non-pregnant range in normal pregnancy. Substantial increases in plasma aldosterone concentration have also been demonstrated as early as the sixteenth week. In pregnancy, aldosterone secretion rate responds in the usual way to changes in sodium intake. Plasma renin concentration is frequently, but not invariably, raised above the normal non-pregnant range. Plasma renin-substrate is consistently raised in pregnancy. Plasma angiotensin II has also been shown usually to be raised in a series of pregnant women. A significant positive correlation has been shown between the maternal plasma aldosterone concentration and the product of the concurrent plasma renin and renin-substrate concentrations. This suggests that the increased plasma aldosterone in pregnancy is the consequence of an increase in circulating angiotensin II, which in turn is related to the level of both renin and its substrate in maternal blood. For these reasons, estimations of renin activity in pregnancy are of dubious value. The increased renin, angiotensin and aldosterone concentrations may represent a tendency to maternal sodium depletion, probably mainly a consequence of the increased glomerular filtration rate. It is possible that the nausea and other symptoms of early pregnancy may be a consequence of this tendency to sodium depletion, with its attendant hormonal changes. In ‘pre-eclampsia’, renin and aldosterone values are generally slightly lower than in normal pregnancy. Human chorion can apparently synthesize renin independently of the kidney. The physiological significance of this remains at present obscure, but it seems unlikely that this source contributes much, if at all, to the often elevated maternal plasma renin. Plasma renin, renin-activity and angiotensin II concentrations, and aldosterone secretion are increased in the luteal phase of the menstrual cycle.
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37
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Lubash GD, Muiesan GE, Alicandri CL, Garfinkel DJ, Siekierski EC, McConnaughey CK. Plasma angiotensin, serum 'angiotensinase activity', and blood pressure response during angiotensin II amide infusions in normal volunteers. EXPERIENTIA 1971; 27:68-9. [PMID: 4323541 DOI: 10.1007/bf02137747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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38
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Siemensen HC, Augustin HJ, Bauditz W. [Behavior of plasma-renin-activity during hemodialysis and orthostasis in chronic nephropathies]. KLINISCHE WOCHENSCHRIFT 1970; 48:1380-5. [PMID: 5521260 DOI: 10.1007/bf01488807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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39
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Weir RJ, Paintin DB, Robertson JI, Tree M, Fraser R, Young J. Renin, angiotensin and aldosterone relationships in normal pregnancy. Proc R Soc Med 1970; 63:1101-2. [PMID: 4098611 PMCID: PMC1811712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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40
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41
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Klaus D, Bocskor A, Fleischer K, Simsch A. [The possibility of stimulation and suppression of renin secretion by sodium deprivation and sodium loading in primary and renal hypertension]. KLINISCHE WOCHENSCHRIFT 1970; 48:1024-33. [PMID: 5523457 DOI: 10.1007/bf01497207] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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42
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Brown JJ, Davies DL, Johnson VW, Lever AF, Robertson JI. Renin relationships in congestive cardiac failure, treated and untreated. Am Heart J 1970; 80:329-42. [PMID: 5452310 DOI: 10.1016/0002-8703(70)90098-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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43
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Abstract
1. Tubular size and lissamine green transit times were measured in rat kidneys undergoing a diuretic response to angiotensin II (0.5 mug/kg per min), and compared with the changes observed during diuresis induced by osmotic diuretics, noradrenaline and chlorothiazide.2. Angiotensin always caused a marked prolongation in proximal and distal tubular transit times; individual distal convolutions were coloured for prolonged periods, and lissamine green appeared in high concentration in distal tubules.3. Marked changes were observed in superficial tubular calibre during a stable diuretic response to angiotensin. Where distal tubular diameter was normal for the rate of urine flow, proximal tubular volume was generally reduced. In a number of experiments, however, distal tubules were markedly dilated, and in these cases proximal tubular volume was also often increased. Angiotensin may therefore be capable of causing a degree of internal hydronephrosis in the rat kidney.4. Prolongation of dye transit times, and the appearance of a concentrated lissamine green bolus in distal tubules, was suggestive of a decreased superficial nephron flow rate, indicating that the diuretic effect of angiotensin may take place only through deeper nephrons.
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44
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Tarazi RC, Dustan HP, Frohlich ED. Long-term thiazide therapy in essential hypertension. Evidence for persistent alteration in plasma volume and renin activity. Circulation 1970; 41:709-17. [PMID: 5437415 DOI: 10.1161/01.cir.41.4.709] [Citation(s) in RCA: 162] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Plasma volume (RIHSA) and peripheral plasma renin activity (Pickens' method) were measured in eight essential hypertensive patients treated with thiazide diuretics alone for periods ranging from 6 to 24 months. Treatment was then stopped and measurements repeated at weekly intervals for a month. During the first week of discontinuance, body weight and plasma volume rose in all (
P
< 0.001 for both), while peripheral plasma renin activity fell from 3.66 to 1.04 ng/ml (
P
< 0.005), and serum sodium concentration was practically unchanged. Over the next 3 weeks, both plasma volume and body weight gradually fell from the high first week "rebound" values to plateau at levels higher than those obtained during treatment (2741 vs. 2567 ml,
P
< 0.001 and 76.1 vs. 74.7 kg,
P
< 0.001, respectively). At the same time, peripheral plasma renin activity remained stable and markedly lower than during treatment (
P
< 0.001), while blood pressure gradually rose. Extracellular water (ECW) was measured serially (radiobromine) in five patients; in all, body weight variations were completely accounted for by changes in ECW, and ratio of plasma to interstitial fluid volume remained stable. These data indicate that blood pressure reduction by longterm thiazide therapy was associated with persistent plasma volume contraction and occurred despite increased peripheral renin activity. There was no evidence for chronic intracellular dehydration, and variations in peripheral renin activity were related to changes in plasma volume and not to serum sodium concentration.
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45
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Meurer KA, Scheck KD, Kaufmann W. [Plasma renin activity in hypertensions under stimulatory and suppressive conditions]. KLINISCHE WOCHENSCHRIFT 1970; 48:275-84. [PMID: 5523220 DOI: 10.1007/bf01486436] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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46
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47
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48
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Brown JJ, Gleadle RI, Lawson DH, Lever AF, Linton AL, Macadam RF, Prentice E, Tree M, Robertson JI. Renin and acute renal failure: studies in man. BRITISH MEDICAL JOURNAL 1970; 1:253-8. [PMID: 4313590 PMCID: PMC1699373 DOI: 10.1136/bmj.1.5691.253] [Citation(s) in RCA: 93] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Plasma renin concentration was increased, usually appreciably, in 22 out of 25 patients with acute renal failure, the average value being 226 units/litre (mean for normal subjects 8.2 units/1.). The highest renin values were found in the first 10 days of the disease; lower and sometimes normal values were found subsequently. Unequivocal acute tubular necrosis was present in only two of the eight cases examined post mortem.These findings are compatible with Goormaghtigh's proposal that an excess of renin and angiotensin may act within the kidney to produce acute renal failure.
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49
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Fraser R, Brown JJ, Chinn R, Lever AF, Robertson JI. The control of aldosterone secretion and its relationship to the diagnosis of hyperaldosteronism. Scott Med J 1969; 14:420-40. [PMID: 5364793 DOI: 10.1177/003693306901401204] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Current concepts of the control of aldosterone secretion in man have been reviewed with particular reference to the role of the kidney. On the basis of these concepts, it is concluded that hyperaldosteronism is most conveniently diagnosed by repeated estimation of plasma potassium, which is usually persistently or intermittently reduced in this disease. Occasional cases fail to show hypokalaemia. Distinction between primary and secondary hyperaldosteronism is made by means of measurement of plasma renin concentration. Subnormal values are usually obtained in the first instance and supranormal values in the second.
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50
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Goldberg A. Recent advances in clinical medicine. Scott Med J 1969; 14:395-400. [PMID: 4901941 DOI: 10.1177/003693306901401106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We had the problem of the five-year-old boy in the candy store—just too many interesting things to do! Neil Armstrong, recalling his impressions on landing on the moon.
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