Progressive Resetting of Sodium-Renin-Aldosterone Relationships in Human Pregnancy

Brown, Mark; Nicholson, Ellen; Ross, M.; Norton, Helen E.; Gallery, Eileen D.M.

doi:10.3109/10641958609031667

Cited by 11 publications

(12 citation statements)

References 35 publications

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“…The presence of mid‐trimester hyperaldosteronism in TTTS, previously reported by Van Peborgh et al , 6 was confirmed by the present study. The aldosterone levels in our 60 women were approximately ten‐fold higher than that of normal nonpregnant individuals, 3 three‐fold higher than normal mid‐trimester singleton pregnancy levels 9 and two‐fold higher than normal mid‐trimester twin pregnancy range 5,6 …”

Section: Discussionmentioning

confidence: 61%

“…At diagnosis and prior to treatment for TTTS, maternal hyperaldosteronism reached a median of 685 pg/ml (interquartile range 430–1008), with normal nonpregnant levels being below 300 pg/ml (68–300), 3 normal mid‐trimester singleton pregnancy levels below 400 pg/ml 9 and normal mid‐trimester twin pregnancy levels below 500 pg/ml 5 (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…These changes in maternal physiology are balanced by early supra‐physiological renin–angiotensin–aldosterone system (RAS) activation, which increases throughout gestation 2 . Both aldosterone and renin receptors are reset to activate at a lower threshold of sodium levels during gestation 3 . However, increase in the levels of aldosterone in plasma appears earlier in pregnancy than that of renin, and the interaction with renin is weakened, 4 thus mimicking primary hyperaldosteronism 1 …”

Section: Introductionmentioning

confidence: 99%

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Maternal pseudo primary hyperaldosteronism in twin‐to‐twin transfusion syndrome

Gussi

Nizard

Yamamoto

et al. 2006

BJOG

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Objective To monitor changes in the maternal renin-angiotensinaldosterone system following laser therapy and amnioreduction in severe twin-to-twin transfusion syndrome (TTTS).Design Observational prospective study.Setting Single university hospital in Poissy, France.Population Sixty cases of TTTS at 16-26 weeks of gestation.Method Maternal blood sampling before, 6 and 24 hours following the procedure.Main outcome measures Plasma levels of aldosterone, renin, angiotensin II (AII), atrial natriuretic peptide (ANP), vasopressin, sodium, potassium and plasma proteins together with full blood count were measured before, 6 and 24 hours following the procedure.Results TTTS is associated with maternal hyperaldosteronism dissociated from renin-angiotensin changes. Correcting TTTS by placental surgery and amnioreduction triggers incomplete correction of hyperaldosteronism, as early as 6 hours following the procedure, without changes in AII but an increase in the levels of ANP in plasma. Electrolyte concentrations remained stable despite haemodilution, while vasoactive hormone levels such as that of vasopressin remained unchanged.Conclusion Mechanisms involved in marked fluid retention in TTTS are rapidly corrected by laser therapy followed by amnioreduction while maintaining electrolyte homeostasis.

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Section: Discussionmentioning

confidence: 61%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal pseudo primary hyperaldosteronism in twin‐to‐twin transfusion syndrome

Gussi

Nizard

Yamamoto

et al. 2006

BJOG

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“…Normal pregnancy is characterized by increased activity of the renin-angiotensinaldosterone system [RAAS; (1)(2)(3)(4)]. Prior-studies demonstrated that, not only are levels of the RAAS hormones increased, but that these hormones maintain responsiveness to changes in posture (5-7), oral sodium intake (8,9), and saline infusion (7,(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

The Renin-Aldosterone Response to Stimulation and Suppression During Normal Pregnancy

Bentley‐Lewis

Graves

Seely

2005

Hypertension in Pregnancy

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Objective-During normal pregnancy, studies have shown increased activity of the reninangiotensin-aldosterone system (RAAS) and a dissociation of plasma renin activity (PRA) and aldosterone (Aldo) evidenced by a greater increase in Aldo relative to PRA. The aims of this study were to examine the RAAS response to stimulation by upright posture and suppression by saline infusion and to investigate the PRA-Aldo dissociation under these two conditions. Methods-We studied 24 healthy normotensive women (mean ± standard error of mean, ages 29 ± 1 yrs) in sodium (Na) balance in the second and third trimesters and postpartum. Subjects underwent a 24-hour urine collection which was analyzed for Na, norepinephrine (NE), epinephrine (Epi), and dopamine (DA); a posture study with analysis of blood pressure (BP), PRA, Aldo, NE, Epi, DA, and cortisol; and a 0.9% NaCl infusion study (500 mL/hr for 3 hrs) with analysis of BP, PRA, Aldo, cortisol, and digitalis-like factor (DLF). Analyses included paired t tests to compare posture and saline responses, repeated measures to compare across periods, and percent change to evaluate the PRA-Aldo dissociation.Results-During pregnancy, PRA, Aldo, BP, catecholamines, and cortisol levels were significantly greater in upright than left lateral decubitus (LLD) posture, and the percent change in Aldo was significantly greater than the percent change in PRA. During pregnancy in response to saline infusion, BP did not change; the PRA and Aldo significantly decreased; the percent change in Aldo was significantly greater than the percent change in PRA in the second trimester; and serum DLF and cortisol levels significantly decreased.Conclusions-In longitudinally studied normal pregnancy, PRA and Aldo levels were dissociated at baseline, with stimulation and, to a lesser degree, with suppression. Norepinephrine, adrenocorticotrophic hormone, and DLF may contribute to this dissociation, and clarification of these interactions may provide insight into the regulation of aldosterone during normal and hypertensive pregnancy.

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“…63 There is a positive correlation between PRA and plasma aldosterone concentration during these manoeuvres.…”

Section: Stimuli and Restraintsmentioning

confidence: 96%

The renin angiotensin aldosterone system and pregnancy

Pipkin

1992

Fet. Matern. Med. Rev.

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Given the phylogenic antiquity of the renin angiotensin system (RAS) and the high degree of renin gene sequence conservation between species, it is perhaps not surprising that the RAS should be central to cardiovascular homeostasis. Nor, given the common embryological origin of the kidneys and reproductive tracts, is it especially surprising that the system should be influenced by, and may itself influence, the state of pregnancy. In this review I shall attempt to give an outline of the workings of the system in normal and in hypertensive pregnancy. The RAS is now known to be involved in spheres far beyond the ‘simple’ control of sodium and water homeostasis, and hence of blood pressure. Its roles in reproduction and in fetal life in animals have been very recently reviewed; this review will therefore confine itself to human studies unless otherwise stated.

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Progressive Resetting of Sodium-Renin-Aldosterone Relationships in Human Pregnancy

Cited by 11 publications

References 35 publications

Maternal pseudo primary hyperaldosteronism in twin‐to‐twin transfusion syndrome

Maternal pseudo primary hyperaldosteronism in twin‐to‐twin transfusion syndrome

The Renin-Aldosterone Response to Stimulation and Suppression During Normal Pregnancy

The renin angiotensin aldosterone system and pregnancy

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