Plasma Renin Activity and Blood Pressure in 89 Patients Receiving Maintenance Haemodialysis Therapy

Craswell, Peter W.; Hird, V. M.; Judd, Patricia A.; Baillod, R. A.; Varghese, Z.; Moorheàd, J. F.

doi:10.1136/bmj.4.5843.749

Cited by 34 publications

(21 citation statements)

References 28 publications

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“…In previous studies on haemodialysis patients, IPRC has not been measured but APRC or indices of APRC have been extensively examined. Thus, Craswellet al [2] did not find a significant relationship between plasma renin activity (PRA) and blood pressure, but reported significant nega tive correlations between PRA and plasma sodium con centration, and between PRA and dietary sodium intake. Brown et al [1] observed that changes in active PRC de pended on the magnitude of body weight loss during dia lysis; losses greater than 2 kg usually led to increased PRC.…”

Section: Discussionmentioning

confidence: 99%

“…Studies of plasma renin and its relationship to sodium balance and blood pressure in patients receiving mainten ance haemodialysis therapy have been performed by several workers [1][2][3]. Renin has been known to exist in multiple forms since 1953, when three types were differentiated by their ultra-violet absorption spectra [4], It was later shown that an inactive renin form exists in body fluids which can be activated by various pre-treatments.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Active and Inactive Renin with Haemodialysis

Thatcher¹,

Whitworth

Skinner

1982

Nephron

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Active (A) and inactive (I) plasma renin concentrations (PRC) were examined during haemodialysis in relation to blood pressure and body weight changes. Patients had either one (n = 15) or two (n = 51) remnant kidneys in situ, or were anephric (n = 4). 6 of the two remnant kidney patients had non-functioning renal allografts. Inactive renin was activated by acidification. Renin assay was by enzyme kinetic technique using sheep substrate and angiotensin I radioimmunoassay. Cryoactivation during handling was excluded. For the whole patient group the proportion of IPRC was inversely related to APRC in pre-dialysis plasma (p < 0.001). APRC and IPRC did not change with heparinisation nor did activation of renin occur across the dialyser. Dialysis with up to 3 kg reduction in body weight did not consistently raise APRC or IPRC. Blood pressure was not significantly correlated with IPRC or APRC during dialysis. In all situations a high APRC was associated with a low IPRC: APRC ratio consistent with preferential secretion of the active form and/or consumption of the inactive renin zymogen.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in Active and Inactive Renin with Haemodialysis

Thatcher¹,

Whitworth

Skinner

1982

Nephron

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“…The greater response occurred in the four patients ( 1,4,5,8) with inulin clearances of more than 60 ml/min. Urinary excretion of potassium rose in four patients and fell in the others: the difference between pre-treatment and treatment urinary potassium excretion was not significant.…”

Section: Part / Intravenous Metolazonementioning

confidence: 99%

“…Electrolytes were measured using a flame photometer. Urinary excretion rates of WBC, red blood cells (RBC), and renal epithelial cells (REC) were measured by the method of Prescott and Brodie [16] using the dye 2:7 diaminofluorene and were expressed as mean excretion in 1,000, h. Plasma renin activity was assessed using a modification of the method of Haber et al [7] as described previously [4].…”

Section: Partmentioning

confidence: 99%

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Use of Metolazone, a New Diuretic, in Patients with Renal Disease

Craswell¹,

Ezzat²,

Kopstein³

et al. 1974

Nephron

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Metolazone, a new diuretic/saluretic/anti-hypertensive agent related to quinethazone, was used to treat 20 patients with impaired renal function. Among eight water loaded hospitalized patients given metolazone 5 mg intra venously, glomerular filtration rate rose in four and diminished slightly in four while urine flow and sodium excretion in creased significantly. In 12 out-patients given long-term oral metolazone (usually 5–10 mg in single daily doses) treatment effectively removed oedema and induced weight loss; in the seven initially hypertensive patients blood pressure decreased also. Plasma renin activity was measured in seven patients before and after several weeks’ metolazone therapy. Activity fell in two patients and rose in five, but the upper limit of normal was exceeded in one only. Renal epithelial cell excretion rates indicated that drug nephrotoxicity was absent. Mean creatinine clearances rose, serum potassium levels fell, and ten patients received oral potassium supplements. Small transient increases in liver enzymes were seen in three patients. Metolazone tended to maintain glomerular filtration rate and renal plasma flow while increasing salt and water losses. A proximal as well as a distal site of action was suggested for the drug, and its anti-hypertensive effect was confirmed.

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