Renin and Control of Arterial Blood Pressure during Terminal Renal Failure Treated by Haemodialysis and by Transplantation

Abstract

1. Plasma renin concentrations were determined in 1068 samples obtained in 113 patients in the end stage of chronic renal failure treated by repeated haemodialyses or by renal transplantation. 2. Patients with malignant nephroangiosclerosis have a very high concentration of plasma renin; this differentiates them from other disease groups, where renin concentration is sometimes normal and sometimes elevated; there is no significant difference between the glomerulonephritis and pyelonephritis groups. 3. There is a weak but significant correlation between plasma renin concentration and arterial blood pressure. In the terminal stage of chronic renal insufficiency, blood pressure appears to be controlled by other quantitatively more important factors. However, the hypertension of some cases, characterized by high concentrations of plasma renin, can be controlled only by bilateral nephrectomy. 4. There is an inverse and highly significant correlation between plasma renin and sodium concentrations. This is also the case in transplanted patients where an inverse correlation also exists between plasma renin concentration and daily urinary output of sodium. 5. The juxtaglomerular granulation index correlates positively with the plasma renin concentration. 6. In terminal renal failure the kidney retains its capacity to secrete renin as a response to acute haemorrhage or other stimuli. 7. Renin is present in the blood of anephric patients and its concentration is not correlated either with the patient's sex or with the time elapsed after binephrectomy. 8. During rejection episodes in transplanted patients a rise of plasma renin concentration is frequently but not invariably observed. Elevation of plasma renin concentration is evident in very acute rejection crises.

Blood Pressure in Terminal Renal Failure

“…Whereas Wilkinson et al [45] found a close correlation of blood pressure and renin in their pa tients, this could not be demonstrated by others [39,44]. Furthermore, we did not find a significant inverse relation of PRA to fluid spaces [11,44] or plasma sodium [39].…”

“…Whereas Wilkinson et al [45] found a close correlation of blood pressure and renin in their pa tients, this could not be demonstrated by others [39,44]. Furthermore, we did not find a significant inverse relation of PRA to fluid spaces [11,44] or plasma sodium [39]. Thus, alternative mechanisms of blood pressure regulation in patients on maintenance dialysis have to be considered: (I) autonomic vascular factors [16]; (2) dysfunction of baroceptors [22,30]; (3) disturbance of the hypotensive prostaglandin-kinin system [19], and (4) disturbance of the sympathetic system [3,22].…”

“…However, it has to be taken into account that the mean age of our control group was lower and PRA is expected to be lower in older people [32], In addition, several patients were studied in the afternoon, a time at which PRA tends to be lower [28]. Thus, we sug gest that PRA tends to be elevated in terminal renal failure, preferably in patients with nephrosclerosis [4,6,39,43]. In our patients, AT II was lower in chronic renal failure as compared to a control group.…”

Effects of Hemodialysis and Saline Loading on Body Fluid Compartments, Plasma Renin Activity and Blood Pressure in Patients on Chronic Hemodialysis

“…In 21 patients the increase in PRA after dialysis, correlated negatively with the change in systolic blood pressure [9], In 16 patients the change in PRA due to dialysis was nega tively correlated with the variation in body weight [3]. In 21 patients dialysis resulted in a mean increase in PRA by a factor of 1.4 [8].…”

“…Most of the reported studies dealt with long-term blood pressure regulation and as sessed the influence of chronic hemodialysis on blood pressure, plasma renin activity (PRA) and body fluid compartments, but contain only scattered information regarding the influence of acute volume changes [2][3][4]6,8,9,11], In the present study, the effects of one dialysis session and of subsequent loading by 1.5-2 liters saline on body fluid compartments. PRA and blood pressure were studied in patients, attending a chronic hemodialysis program.…”