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Angiotensin-II and endothelin-1 levels in children with renoprival hypertension
L Seguias1, G Zilleruelo, J Strauss
1University of Miami, Jackson Memorial Hospital, Department of Pediatrics, Division of Nephrology, PO Box 016960, Miami, FL 33101, USA.
Insights
Hypertension in anephric children on hemodialysis is not linked to angiotensin-II (AT-II) or endothelin-1 (ET-1) vascular production. This pilot study found no correlation between these factors and blood pressure in these patients.
Area of Science:
- Nephrology
- Pediatric Hypertension
- Renal Disease Research
Background:
- Children with end-stage renal disease (ESRD) frequently experience hypertension even after kidney removal and dialysis.
- Hypertension in anephric patients may involve extrarenal renin contributing to angiotensin-II (AT-II) production.
- Experimental data suggest endothelin-1 (ET-1) mediates AT-II's vasoconstrictive effects.
Purpose of the Study:
- To investigate the potential role of vascular-mediated angiotensin-II (AT-II) and endothelin-1 (ET-1) in hypertension among anephric children undergoing hemodialysis.
- To determine if serum levels of AT-II and ET-1 correlate with blood pressure in this patient population.
Main Methods:
- A pilot study involving 12 anephric children on hemodialysis.
- Measurement of predialysis systolic and diastolic blood pressures (SBP and DBP).
- Quantification of predialysis serum levels of AT-II and ET-1.
Main Results:
- Predialysis serum levels of AT-II and ET-1 were consistent across all patients.
- No significant correlation was observed between AT-II or ET-1 levels and mean SBP or DBP.
- In patients with postdialysis hypertension, predialysis AT-II and ET-1 plasma levels did not correlate.
Conclusions:
- The study found no evidence supporting a significant contribution of vascular-mediated AT-II and/or ET-1 to hypertension in anephric children on hemodialysis.
- These findings suggest that other mechanisms may be responsible for persistent hypertension in this specific pediatric population.
Abstract:
Children with end-stage renal disease (ESRD) often remain hypertensive despite bilateral nephrectomy and aggressive fluid removal on hemodialysis. We speculated that an extrarenal source of renin might contribute to the release of "tissular" angiotensin-II (AT-II) generating hypertension in anephric patients. At the same time, experimental evidence supports that peripheral AT-II vasoconstrictive effect is likely mediated by endothelin-1 (ET-1). Thus, it is conceivable that hypertension in ESRD patients may be due, in part, to a cascade involving vascular production and secretion of AT-II and ET-1. In order to establish the relationship between AT-II, ET-1, and blood pressure we performed a pilot study to measure predialysis systolic and diastolic blood pressures (SBP and DBP, respectively) and serum AT-II and ET-1 levels in 12 anephric children receiving hemodialysis. Predialysis AT-II and ET-1 levels were similar in all patients, and neither value correlated with their mean SBP or DBP. In patients with postdialysis hypertension, there was no correlation between predialysis AT-II and ET-1 plasma levels. We therefore find no evidence to suggest that vascular-mediated AT-II and/or ET-1 contributes significantly to hypertension in anephric patients.