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Renal Function and Hemodynamic Studies in Low- and Normal-Renin Essential Hypertension

Renal Function and Hemodynamic Studies in Low- and Normal-Renin Essential Hypertension Abstract • Reduced renal blood flow has been suggested to be both a cause and a consequence of essential hypertension. To test these hypotheses, techniques for the clearance of inulin (Cin) and p-aminohippurate (Cpah) were used to assess renal function and hemodynamic measurements in patients with mild and moderate normal-renin and low-renin essential hypertension and in age-matched normotensive subjects. In our study, compared with age-matched control subjects, normal-renin hypertensive subjects younger than 42 years with basal diastolic BPs less than 100 mm Hg had normal glomerular filtration (Cin) and effective renal plasma flow (Cpah), filtration fraction (Cin/Cpah), and renal blood flow (Cpah/1 — hematocrit value). The mean arterial pressure (MAP) and renal vascular resistance (MAP/renal blood flow) were increased. In contrast, compared with age-matched control subjects, normal-renin hypertensive subjects older than 42 years with basal diastolic BPs less than 100 mm Hg and greater than 100 mm Hg had a decreased Cpah and an increased filtration fraction. The MAP was increased, the renal blood flow decreased, and the renal vascular resistance notably increased. Subjects with low-renin essential hypertension had renal function and hemodynamic patterns indistinguishable from those of age-matched normal-renin hypertensive subjects with similar basal diastolic BPs. These data suggest that in early normal-renin essential hypertension, the increase in systemic BP is not caused by renal circulatory disturbances. Increased renal vascular resistance, however, may lead to subsequent vascular functional or structural changes, ultimately decreasing effective renal plasma flow but at a rate disproportionate to the glomerular filtration rate. (Arch Intern Med 1982;142:1317-1323) References 1. Shannon JA, Smith HW: The excretion of inulin, xylose and urea by normal and phlorizinized man. J Clin Invest 1935;14:393-401.Crossref 2. Smith HW: Note on the interpretation of clearance method in the diseased kidney. J Clin Invest 1941;20:631-635.Crossref 3. Smith HW, Finkelstein N, Aliminosa L, et al: The renal clearances of substituted hippuric acid derivatives and other aromatic acids in dog and man. J Clin Invest 1945;24:388-404.Crossref 4. Chesley LC, Chesley ER: Renal blood flow in women with hypertension and renal impairment. J Clin Invest 1940;19:475-482.Crossref 5. Friedman M, Selzer A, Rosenblum H: The renal blood flow in hypertension. JAMA 1941;117:92-95.Crossref 6. Goldring W, Chasis H, Ranges HA, et al: Effective renal blood flow in subjects with essential hypertension. J Clin Invest 1941;20:637-653.Crossref 7. Chasis H, Redish J: Effective renal blood flow in the separate kidneys of subjects with essential hypertension. J Clin Invest 1941;20:655-661.Crossref 8. Foa PP, Woods WW, Peet MM, et al: Effective renal blood flow, glomerular filtration rate, and tubular excretory mass in arterial hypertension. Arch Intern Med 1941;69:822-835.Crossref 9. Hageman O: Clearance tests in renal disease and hypertension. Acta Med Scand 1948;132( (suppl) ):166-197. 10. Corcoran AC, Taylor RD, Page IH: Functional patterns in renal disease. Ann Intern Med 1948;28:560-582.Crossref 11. Cargill WH: The measurement of glomerular and tubular plasma flow in the normal and diseased human kidney. J Clin Invest 1949;28:533-538.Crossref 12. Lowenstein J, Steinmetz PR, Effros RM, et al: The distribution of intrarenal blood flow in normal and hypertensive man. Circulation 1967;35:250-259.Crossref 13. Logan AG, Velasquez MT, Cohn JN: Renal cortical blood flow, cortical fraction, and cortical blood volume in hypertensive subjects. Circulation 1973;47:1306-1312.Crossref 14. Hollenberg HK, Epstein M, Basch RI, et al: 'No man's land' of the renal vasculature: An arteriographic and hemodynamic assessment of the interlobar and arcuate arteries in essential and accelerated hypertension. Am J Med 1969;47:845-854.Crossref 15. Hollenberg NK, Adams DF, Solomon H, et al: Renal vascular tone in essential and secondary hypertension. Medicine 1975;54:29-44.Crossref 16. Hollenberg NK, Borucki LJ, Adams DF: The renal vasculature in early essential hypertension: Evidence for a pathogenetic role. Medicine 1978;57:167-178.Crossref 17. Willassen Y, Ofstad J: Renal sodium excretion and the peritubular capillary physical factors in essential hypertension. Hypertension 1980;2:771-779.Crossref 18. Walser M, Davidson DG, Orloff J: The renal clearance of alkali-stable inulin. J Clin Invest 1955;34:1520-1523.Crossref 19. Kolsters G, Schalekamp MADH, Birkenhager WH, et al: Renin and renal function in benign essential hypertension: Evidence for a renal abnormality , in Berglund G, Hanssen L, Werke L (eds): Pathophysiology and Management of Arterial Hypertension . Sweden, Astra Pharmaceuticals AB, 1975, pp 54-65. 20. Owen JA, Iggo B, Scandrett FF, et al: The determination of creatinine in plasma or serum and in urine: A critical examination. Biochem J 1954;58:426-437. 21. Grim CE, Weinberger MH, Higgins JT, et al: Diagnosis of secondary forms of hypertension. JAMA 1977;237:1331-1335.Crossref 22. Cohen EL, Grim CE, Conn JW, et al: Accurate and rapid measurement of plasma renin activity by radioimmunoassay. J Lab Clin Med 1971;77:1025-1038. 23. Ito I, Woo J, Haning R, et al: A radioimmunoassay for aldosterone in human peripheral plasma including a comparison of alternate techniques. J Clin Endocrinol 1972;34:106-112.Crossref 24. McLachlan MSF: The aging kidney. Lancet 1978;2:143-146.Crossref 25. Crane MG, Harris JJ: Effect of aging on renin activity and aldosterone excretion. J Lab Clin Med 1976;87:947-959. 26. Reubi FC, Weidmann P, Hodler J, et al: Changes in renal function in essential hypertension. Am J Med 1978;64:556-563.Crossref 27. Pedersen EB, Kornerup JH: Renal haemodynamics and plasma renin in patients with essential hypertension. Clin Sci Mol Med 1976;50:409-414. 28. Schalekamp MADH, Birkenhager WH, Zaal GA, et al: Hemodynamic characteristics of low renin hypertension. Clin Sci Mol Med 1977;52:405-412. 29. De Leeuw PW, Kho TL, Falke HE: Haemodynamic and endocrinological profile of essential hypertension. Acta Med Scand 1978;622( (suppl) ):586. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Renal Function and Hemodynamic Studies in Low- and Normal-Renin Essential Hypertension

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340200077018
Publisher site
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Abstract

Abstract • Reduced renal blood flow has been suggested to be both a cause and a consequence of essential hypertension. To test these hypotheses, techniques for the clearance of inulin (Cin) and p-aminohippurate (Cpah) were used to assess renal function and hemodynamic measurements in patients with mild and moderate normal-renin and low-renin essential hypertension and in age-matched normotensive subjects. In our study, compared with age-matched control subjects, normal-renin hypertensive subjects younger than 42 years with basal diastolic BPs less than 100 mm Hg had normal glomerular filtration (Cin) and effective renal plasma flow (Cpah), filtration fraction (Cin/Cpah), and renal blood flow (Cpah/1 — hematocrit value). The mean arterial pressure (MAP) and renal vascular resistance (MAP/renal blood flow) were increased. In contrast, compared with age-matched control subjects, normal-renin hypertensive subjects older than 42 years with basal diastolic BPs less than 100 mm Hg and greater than 100 mm Hg had a decreased Cpah and an increased filtration fraction. The MAP was increased, the renal blood flow decreased, and the renal vascular resistance notably increased. Subjects with low-renin essential hypertension had renal function and hemodynamic patterns indistinguishable from those of age-matched normal-renin hypertensive subjects with similar basal diastolic BPs. These data suggest that in early normal-renin essential hypertension, the increase in systemic BP is not caused by renal circulatory disturbances. Increased renal vascular resistance, however, may lead to subsequent vascular functional or structural changes, ultimately decreasing effective renal plasma flow but at a rate disproportionate to the glomerular filtration rate. (Arch Intern Med 1982;142:1317-1323) References 1. Shannon JA, Smith HW: The excretion of inulin, xylose and urea by normal and phlorizinized man. J Clin Invest 1935;14:393-401.Crossref 2. Smith HW: Note on the interpretation of clearance method in the diseased kidney. J Clin Invest 1941;20:631-635.Crossref 3. Smith HW, Finkelstein N, Aliminosa L, et al: The renal clearances of substituted hippuric acid derivatives and other aromatic acids in dog and man. J Clin Invest 1945;24:388-404.Crossref 4. Chesley LC, Chesley ER: Renal blood flow in women with hypertension and renal impairment. J Clin Invest 1940;19:475-482.Crossref 5. Friedman M, Selzer A, Rosenblum H: The renal blood flow in hypertension. JAMA 1941;117:92-95.Crossref 6. Goldring W, Chasis H, Ranges HA, et al: Effective renal blood flow in subjects with essential hypertension. J Clin Invest 1941;20:637-653.Crossref 7. Chasis H, Redish J: Effective renal blood flow in the separate kidneys of subjects with essential hypertension. J Clin Invest 1941;20:655-661.Crossref 8. Foa PP, Woods WW, Peet MM, et al: Effective renal blood flow, glomerular filtration rate, and tubular excretory mass in arterial hypertension. Arch Intern Med 1941;69:822-835.Crossref 9. Hageman O: Clearance tests in renal disease and hypertension. Acta Med Scand 1948;132( (suppl) ):166-197. 10. Corcoran AC, Taylor RD, Page IH: Functional patterns in renal disease. Ann Intern Med 1948;28:560-582.Crossref 11. Cargill WH: The measurement of glomerular and tubular plasma flow in the normal and diseased human kidney. J Clin Invest 1949;28:533-538.Crossref 12. Lowenstein J, Steinmetz PR, Effros RM, et al: The distribution of intrarenal blood flow in normal and hypertensive man. Circulation 1967;35:250-259.Crossref 13. Logan AG, Velasquez MT, Cohn JN: Renal cortical blood flow, cortical fraction, and cortical blood volume in hypertensive subjects. Circulation 1973;47:1306-1312.Crossref 14. Hollenberg HK, Epstein M, Basch RI, et al: 'No man's land' of the renal vasculature: An arteriographic and hemodynamic assessment of the interlobar and arcuate arteries in essential and accelerated hypertension. Am J Med 1969;47:845-854.Crossref 15. Hollenberg NK, Adams DF, Solomon H, et al: Renal vascular tone in essential and secondary hypertension. Medicine 1975;54:29-44.Crossref 16. Hollenberg NK, Borucki LJ, Adams DF: The renal vasculature in early essential hypertension: Evidence for a pathogenetic role. Medicine 1978;57:167-178.Crossref 17. Willassen Y, Ofstad J: Renal sodium excretion and the peritubular capillary physical factors in essential hypertension. Hypertension 1980;2:771-779.Crossref 18. Walser M, Davidson DG, Orloff J: The renal clearance of alkali-stable inulin. J Clin Invest 1955;34:1520-1523.Crossref 19. Kolsters G, Schalekamp MADH, Birkenhager WH, et al: Renin and renal function in benign essential hypertension: Evidence for a renal abnormality , in Berglund G, Hanssen L, Werke L (eds): Pathophysiology and Management of Arterial Hypertension . Sweden, Astra Pharmaceuticals AB, 1975, pp 54-65. 20. Owen JA, Iggo B, Scandrett FF, et al: The determination of creatinine in plasma or serum and in urine: A critical examination. Biochem J 1954;58:426-437. 21. Grim CE, Weinberger MH, Higgins JT, et al: Diagnosis of secondary forms of hypertension. JAMA 1977;237:1331-1335.Crossref 22. Cohen EL, Grim CE, Conn JW, et al: Accurate and rapid measurement of plasma renin activity by radioimmunoassay. J Lab Clin Med 1971;77:1025-1038. 23. Ito I, Woo J, Haning R, et al: A radioimmunoassay for aldosterone in human peripheral plasma including a comparison of alternate techniques. J Clin Endocrinol 1972;34:106-112.Crossref 24. McLachlan MSF: The aging kidney. Lancet 1978;2:143-146.Crossref 25. Crane MG, Harris JJ: Effect of aging on renin activity and aldosterone excretion. J Lab Clin Med 1976;87:947-959. 26. Reubi FC, Weidmann P, Hodler J, et al: Changes in renal function in essential hypertension. Am J Med 1978;64:556-563.Crossref 27. Pedersen EB, Kornerup JH: Renal haemodynamics and plasma renin in patients with essential hypertension. Clin Sci Mol Med 1976;50:409-414. 28. Schalekamp MADH, Birkenhager WH, Zaal GA, et al: Hemodynamic characteristics of low renin hypertension. Clin Sci Mol Med 1977;52:405-412. 29. De Leeuw PW, Kho TL, Falke HE: Haemodynamic and endocrinological profile of essential hypertension. Acta Med Scand 1978;622( (suppl) ):586.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1982

References