Impaired renal functional reserve and albuminuria in essential hypertension

Losito, Attilio; Fortunati, Federico; Zampi, Ivano; Favero, A

doi:10.1136/bmj.296.6636.1562

Cited by 61 publications

(29 citation statements)

References 16 publications

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“…133 Recent cross-sectional reports in non-diabetic populations 51 do, however, suggest a more complicated picture. High-normal albuminuria rather than microalbuminuria may, in fact, represent the initial and easily missed stage associated with hyperfiltration, followed by normalisation of glomerular filtration rate in the presence of microalbuminuria.…”

Section: Renal Dysfunctionmentioning

confidence: 89%

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

et al. 2002

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This paper reviews the existing epidemiological and clinical evidence about the relationships of non-diabetic microalbuminuria with cardiovascular risk factors such as elevated blood pressure (BP), systolic particularly, cardiac hypertrophy, adverse metabolic status, smoking habits, elevated angiotensin II levels, endothelial dysfunction, acute and perhaps subclinical inflammation. Because of that unique property of reflecting the influence of so many clinically relevant parameters, microalbuminuria may legitimately be defined as an integrated marker of cardiovascular risk, an unique profile among the several prognostic predictors available to

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Section: Renal Dysfunctionmentioning

confidence: 89%

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

et al. 2002

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“…13 In a recent study, a similar observation was made in normotensive non-insulin-dependent diabetic patients. 14 The possibility that microalbuminuria is associated with an impaired renal functional reserve assessed by the GFR response to an acute infusion of amino acids was explored by Losito et al 15 It was observed that one third of 34 patients (most of whom were microalbuminuric) with mild to moderate essential hypertension displayed an abolished response of creatinine clearance (a rather unreliable marker of GFR) to this maneuver. In our studies, protein intake (as assessed by urinary excretion of urea) was higher in microalbuminuric when compared with normoalbuminuric patients.…”

Section: Discussionmentioning

confidence: 99%

Is microalbuminuria a marker of early intrarenal vascular dysfunction in essential hypertension?

1994

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The relation between basal intrarenal hemodynamics and the renal response to acute inhibition of angiotensin-converting enzyme by captopril and albuminuria was assessed in 106 lean patients with essential hypertension without detectable proteinuria. It was observed that the microalbuminuric group (24.5% of the total population) was characterized by a higher systemic arterial pressure, a lower level of highdensity lipoprotein cholesterol, and similar mean values of age, duration of hypertension, glomerular filtration rate, renal plasma flow, filtration fraction, and plasma renin activity when compared with normoalbuminuric subjects. In response to captopril, a significant renal vasodilatation without a change in M icroalbuminuria (urinary excretion of albumin lower than 200 /xg/min) was proposed as a reliable predictor of the development of overt (proteinuric) nephropathy in patients with insulin-dependent diabetes 1 and of cardiovascular morbidity and mortality in diabetic 2 -3 and nondiabetic 4 populations. The mechanisms and significance of microalbuminuria observed in some patients with essential hypertension are not clearly elucidated because of the lack of simultaneous assessment of the relation between albuminuria and intrarenal hemodynamics and long-term follow-up studies. In the present studies, an attempt was made to evaluate the systemic and renal determinants of microalbuminuria in a population of never-treated patients with mild to moderate hypertension of rather short duration. In addition, the renal response to acute blockade of angiotensin-converting enzyme was assessed to detect contrasting effects in microalbuminuric (MA+) and normoalbuminuric (MA-) patients. Only lean patients were included to eliminate the possible exacerbating influence of overweight in association with high blood pressure on the urinary excretion of albumin. 5 Methods PatientsOne hundred six lean patients (34 women and 72 men) with mild to moderate essential hypertension were included in this study. Age range was 16 to 64 years, and body mass index was lower than 26 kg/m 2 in women and 27 kg/m 2 in men. All subjects had never received antihypertensive medication before participating in the studies. Women on oral contraceptives as well as patients with albustix-positive proteinuria were

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“…In 1 study, 11 of 34 hypertensive individuals were nonresponders; in 8 of the 11, the UAE was above the normal range. 29 Other studies 30,31 did not found alterations in the increase of GFR induced by an oral protein load in All of the values in the table correspond to samples obtained at baseline of the day of L-arginine infusion. The values from urine samples correspond to the baseline collection periods, before L-arginine administration.…”

Section: Discussionmentioning

confidence: 99%

Impairment of Renal Vasodilation With l -Arginine Is Related to More Severe Disease in Untreated Hypertensive Patients

Bello¹,

Caramelo²,

Martell³

et al. 2001

Hypertension

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Abstract-Data remain insufficient to place the decreased response to L-arginine in hypertensive patients within a consistent pathophysiological sequence. The aim of the present study in patients with essential hypertension was to assess the relationships between the response to L-arginine and a set of relevant clinical and laboratory parameters. In this prospective, interventional study, we administered L-arginine to untreated hypertensive individuals and healthy control subjects and measured the clearance of inulin and of para-aminohippurate and a set of biochemical and clinical variables. L-Arginine infusion revealed major differences between control subjects and 1 subgroup (group B) of hypertensive individuals. Group B hypertensives (nϭ18) had no increase in inulin clearance and no decrease in renal vascular resistance with L-arginine; however, in another subset of hypertensive patients (group A, nϭ27), the insulin clearance increased and renal vascular resistance decreased similar to the control group (group C, nϭ11). The ambulatory blood pressure monitoring in group B showed both an increased mean diastolic pressure and a "nondipper" pattern in the nocturnal regulation of arterial pressure. These findings in group B were accompanied by significant alterations in optic fundus and left ventricle hypertrophy and increased microalbuminuria (all, PϽ0.05). Furthermore, group B individuals had significantly lower values of HDL cholesterol and a higher baseline atherogenic index, plasma insulin level, and glucose/insulin index. We disclose a previously undescribed relationship between end organ repercussion and decreased renal hemodynamic response to L-arginine. Our results may help to understand the mechanisms that lead to target organ damage in hypertension. Key Words: L-arginine Ⅲ hypertension, essential Ⅲ endothelium Ⅲ blood pressure monitoring, ambulatory D espite intense investigative efforts, major basic aspects of the pathophysiology of essential hypertension remain unclear. In recent years, a great deal of attention has been paid to the involvement of endothelium-related mechanisms in the pathogenesis of arterial hypertension. [1][2][3][4][5][6][7][8] In particular, the role of the vascular and renal regulatory mediator NO in hypertension has been extensively studied through the administration of the NO precursor amino acid L-arginine. 9 -12 In these studies, an alteration in the renal vasodilatory response to L-arginine was described, although the findings that have been reported are less than homogeneous. 9 -12 Therefore, even though the information provided in the aforementioned studies is relevant, the data obtained are incomplete and still must be organized to provide a coherent pathophysiological interpretation. First, to homogenize the information and to eliminate undesired variability, strict criteria are necessary to select patients with essential hypertension. Second, and of extreme importance, no relationships have been sought between the response to L-arginine and markers of severity of hypert...

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Impaired renal functional reserve and albuminuria in essential hypertension

Cited by 61 publications

References 16 publications

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

Is microalbuminuria a marker of early intrarenal vascular dysfunction in essential hypertension?

Impairment of Renal Vasodilation With l -Arginine Is Related to More Severe Disease in Untreated Hypertensive Patients

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