scholarly journals Pediatric renal allograft transplantation does not normalize the increased cortisol/cortisone ratios of chronic renal failure

2006 ◽  
Vol 154 (4) ◽  
pp. 555-561 ◽  
Author(s):  
Michael Schroth ◽  
Christian Plank ◽  
Manfred Rauh ◽  
Helmuth-Günther Dörr ◽  
Wolfgang Rascher ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Blood Pressure ◽  
Renal Failure ◽  
Renal Transplantation ◽  
Chronic Renal Failure ◽  
Tandem Mass Spectrometry ◽  
Renal Allograft ◽  
Tandem Mass ◽  
Allograft Transplantation ◽  
Arterial Blood

Objective: The conversion of cortisol (F) to cortisone (E) is catalyzed by 11beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2). Children suffering from chronic renal failure (CRF) have a decreased activity of 11β-HSD2 contributing to increased arterial blood pressure. The objective was to investigate whether a normal conversion of F to E is achieved after renal transplantation (TX) in children. Methods: Fifteen children with CRF, 17 children with steroid-free immunosuppression after TX, and 18 healthy controls (CO) were enrolled. The activity of 11β-HSD2 in plasma was calculated using the ratio of F/E determined by tandem mass spectrometry, the ratio of tetrahydrocortisol (THF) +5α-tetrahydrocortisol (5αTHF) in urine determined by gas chromatography/mass spectrometry, and the ratio of (THF +5αTHF)/tetrahydrocortisone (THE) in urine determined by tandem mass spectrometry. Results: The F/E ratio (mean ± s.d./s.e.m.) was significantly higher in CRF and TX (5.6 ± 1.9/0.6, 7.12 ± 3.1/0.9) than in CO (1.18 ± 0.2/0.03, P < 0.0001) groups. The (THF + 5αTHF)/THE ratio in CRF (1.19 ± 1.1/0.5) and TX (1.19 ± 0.1/0.5) groups was significantly higher than in controls (0.21 ± 0.05/0.18, P < 0.0001). Positive correlations between plasma and urinary ratios (P = 0.0004. R2 = 0.73 in CRF, P = 0.0013, R2 = 0.56 in TX, P < 0.0001, R2 = 0.66 in CO) were found, whereas significant correlations between F/E or (THF + 5αTHF)/THE ratios and blood pressure, the number of antihypertensive drugs taken or creatinine clearance could not be found. Conclusions: In all children with chronic renal failure plasma and urinary cortisol/cortisone ratios are elevated and do not return to normal levels after renal allograft transplantation. This suggests that renal transplantation does not normalize 11β-HSD2 activity.

Blood Pressure Elevation during the Night in Chronic Renal Failure, Hemodialysis and after Renal Transplantation

Nephron ◽  
1991 ◽  
Vol 57 (3) ◽  
pp. 293-298 ◽  
Author(s):  
Peter Baumgart ◽  
Peter Walger ◽  
Stefan Gemen ◽  
Michael von Eiff ◽  
Holger Raidt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Renal Transplantation ◽  
Chronic Renal Failure ◽  
Blood Pressure Elevation ◽  
Pressure Elevation

scholarly journals Influence of Enalapril on the progression of chronic renal failure in diabetic nephropathy and nephropathies of and other aethiology: A two-year study

2002 ◽  
Vol 130 (3-4) ◽  
pp. 87-90
Author(s):  
Jasna Trbojevic ◽  
Biljana Stojimirovic
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Diabetic Nephropathy ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Regression Line ◽  
Diabetic Patients ◽  
Protein Levels ◽  
Arterial Blood ◽  
The Difference

Chronic renal failure (CRF) is almost always associated with high arterial blood pressure. Adequate control of hypertension slows down the progression of the disease, Inhibitors of angiotenzin-converting enzyme (ACE inhibitors) have proved to be very efficacious in decreasing high blood pressure. The aim of this study was to assess the influence of ACE inhibitor enalapril on the progression of CRF in patients with diabetic nephropathy and nephropathies of other origin. During 1998 and 1999 thirty patients (20 males and 10 females, aged 525+1.3) have been followed-up at the Department of Nephrology, Clinical Centre of Serbia. On regular monthly controls serum creatinine, urea, calcium and protein levels, creatinine clearance, and blood pressure, were measured. All patients were suggested a low protein diet. Progression of the disease was expressed by the slope of the regression line showing reciprocal serum creatinine values. Proteinaemia was significantly higher in diabetic patients after 12 months (p<0.35) but in the next 12 months the difference between groups disappeared. The same patients had significantly lower serum urea (p<0.05) after 24 months and creatinine values (p<0.05) dur ing the whole study. Other variables changed in the same manner and with similar progression in both groups. The direction of slope lines suggested recovery of kidney function in both examined groups. However, a smaller slope in patients with diabetic nephropathy together with other results showed that enalapril had better influence on slowing down the progression of CRF in this group of patients.

scholarly journals Seasonal variation of blood pressure in maintenance hemodialysis

1998 ◽  
Vol 116 (4) ◽  
pp. 1774-1777 ◽  
Author(s):  
Manuel Carlos Martins de Castro ◽  
Décio Mion Jr. ◽  
Marcello Marcondes ◽  
Emil Sabbaga
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Seasonal Variation ◽  
Chronic Renal Failure ◽  
Ambient Temperature ◽  
Sao Paulo ◽  
São Paulo ◽  
Dialysis Unit ◽  
Arterial Blood ◽  
The Impact

CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 ± 8 vs 107 ± 10 and 101 ± 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 ± 8 vs 130 ± 11 and 124 ± 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 ± 1.6 vs 19.5 ± 3.0 and 15.8 ± 1.9 ºC, respectively; p < 0.01). CONCLUSIONS: We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.

Effect of Isoosmolar volume Reduction during Hemofiltration on Plasma Antidiuretic Hormone in Patients with Chronic Renal Failure

1980 ◽  
Vol 3 (6) ◽  
pp. 322-325 ◽  
Author(s):  
N.D. Vaziri ◽  
R. Skowsky ◽  
A. Warner
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Volume Reduction ◽  
Fluid Loss ◽  
Fluid Removal ◽  
Arterial Blood ◽  
Clear Explanation ◽  
Stage Renal Disease ◽  
End Stage

The effect of isoosmolar volume reduction on plasma ADH level was studied in 8 patients with chronic renal failure utilizing hemofiltration technique. Plasma ADH fell significantly (P < 0.001) after one hour of hemofiltration despite volume reduction which was expected to elevate the ADH level. After two hours of hemofiltration, ADH remained low in 5 patients and increased in 3. Posthemofiltration mean blood pressure was generally lower in patients whose ADH rose than those whose ADH remained low. The two groups were otherwise comparable with respect to total fluid loss, hemofiltration rate, and fluid removed expressed as percent body weight. It can thus be suggested that in these patients a rise in plasma ADH in response to fluid reduction may require a fall in the arterial blood pressure below a critical level. While the rise in plasma ADH observed with continued fluid removal in some patients can be readily explained, we have no clear explanation for the paradoxical initial fall of ADH in all patients and subsequent maintenance of low levels observed in the majority of patients. This unusual ADH response to isoosmolar volume reduction may represent some unidentified mechanism of ADH regulation in patients with end-stage renal disease.

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