Hypertension and crescentic glomerulonephritis in the elderly: Results of 334 renal biopsies in patients 65 years of age or older

POSTERS: Secondary Hypertension

A]H 1996; 9:88A-92A

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CIRCADIAN PLASMA ENDOTHELIN-l RHYTHM IS ALTERED IN PREECLAMPTIC PREGNANCY B Hemlz. W Heyl. K Wille. HG S,eberlh and B Lemmer. Dept. oClntemal Medtcme. University Aachen,

HYPERTENSION AND CRESCENTIC GLOMERULONEPHRITIS IN THE ELDERLY: RESULTS OF 334 RENAL BIOPSIES IN PATIENTS 65 YEARS OF AGE OR OLDER RA Preston', BJ Materson', MA Yoham, M Healy-Smith, V Pardo. Dept Medicine and Pathology, Univ. Miami and VA Medical Center, Miami, FL. Renal dysfunction in the elderly often may be asaibed to worsening of hypertensive nephrosclerosis a ctvonic interstitial disease. Therefore, serious renal disease may often be overlooked in elderly patients. We studied clinical and pathologic data from 334 consecutive renal biopsies done in patients 65 years of age or more. Of these 334 biopsies, 53 (15.9%) were found to have crescentic glomerulonephritis (CGN). The mean age of the patients was 70.5 :t 3.93 (SO) with a range 65-a1 years old. There were 24 (45.3%) women and 29 (54.7%) men. Frenquent clinical indications for renal biopsy were: unexplained subacute renal failure (19 patients), acute renal failure (12), chronic renal failure (6) and unexplained hematuria (6). Thirty-two percent (17/53) were hypertensive (>140190) at presentation. Hematuria was present in 45/53 (84.9%), but red blood cell (RBC) casts were identified in only 4/53 (7.5%). Proteinuria was present in 43/43 (100%): mean 2~ excretion in 24 patients was 3.06 :t 3.14 grams/24 hours but in 13/24 (54.2%) was under 2.0 grams/24 hours. The mean serum creatinine concentration (Scr) was 7.21 :t 4.1 (SO) mgldl, range 1.4-12.0 mgldl. CONCLUSIONS: Nephritic rapidly manifestations of CGN (hypertension, progressive renal failure, RBC casts) may be absent in elderly patients and a degree of clinical suspicion for underlying glomerular disease is warranted. Key Words'

Germany.

It has been reported that maternal endothehn-I (ET-I) levels increase in preeclampsia Additionally. the syndrome is associated with hypertension showing a diminished or abohshed decrease in arterial blood pressure at nighttime. As the endothelial interface may be directly involved in the regulation of blood pressure. we looked for an altered CIrcadian plasma endothelin-I rhythm 10 preeclamptic pregnancies. Ten normolenslve pregnant women (-0-) and ten preeclampuc pauents (-,-) were investigated in this study Over a period of one day. 16 venous blood was drawn from each patient hourly to deterrrnne plasma endothelin-I samples by radioimmunoassay. At the same ~ 12 , I 10 I ~0 I occasions ambulalory blood g I '" pressure measurements were • I0I II.' performed (20 min intervals.

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ET:I levels 10 preeclamptIC ' 'paUents. Apparently. 10 preeclamptic patients a marked change in the Circadian profile of maternal ET-I levels L....J..----'_.J-...L........L~'__.J--'-' occured. However. this is the 6 10 14 IS 22 2 6 10 first time a circadian pattern of Tunc of Day (b) ET-I plasma levels has been reported. As described previously. also in our patients the circadian blood pressure rhythm shows a diminished fall of elevated systolic and diastolic values at rughttime. One may hypothesize that both, altered circadian blood pressure rhythm and circadian endothelial function are involved in the preeclamptic disorder as acausative relationslup. Further studies have to clarify the pathophysiological relevance of an altered ET-I rhythm. 0

KeyWords: Eclampsia, endothelins. hypertension, chronobiology

Hypertension. elderly, glomerulonephritis

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HYPERTENSION RESULTING FROM PRIMARY HYPERALDOSTERONISM: COMPARISON OF CT AND MAl SCA/'l'olING IN DIAGNOSJs. ~ DR Singer, GA MacGregor. Sl Georgr's Hospital Medical School, London, UK Primary hyperaldosteronism Is a common underlying cause of severe hypertension. Recognition of this disease Is Important as adrenalectomy usually cures the hypertension when it Is caused by an adrenal adenoma. There has recently been controversy regarding Imaging techniques to Identify adrenal adenomas. We assessed the clinicallmplicalions of improvements In both CT and MRI scanning techniques In 20 subjects (12 men, mean age 48 years) with primary hyperaldosteronism. An adrenal adenoma was Identified in 10 of the patients by CT scanning. Eight of these patients also had an MRI scan In 7 of which the adenoma was confirmed, In I of which the MRI scan was reported as showing bilateral adrenal hyperplasia. Of the remaining 10 patients, 9 had both CT and MRI scans. In 7 patients there was agreement between the two Imaging methods (normal findings, 3; bilateral adrenal hyperplasia, 4). In one case, bilateral hyperplasia was noted on CT scan but not on MRI; In a further patient bilateral hyperplasia was reported on MRI scanning, but not on CT scanning. Based on these findings, our policy remains to use CT scanning for Initial Imaging In patients wllh clinical evidence 01 primary hyperaldosteronism. Our results suggest that subsequent MRI scanning could scaned for patients In whom luther adrenal scans are clinically Indicated.

ROUTINE DETERMINATION OF TSH FOR THE DETECTION OF HYPO- AND HYPER-TINROlDISM IN HYPERTENSIVE WOMEN REFERRING TO A SPECIALIZED CENTRE. A Fort.OI. C Cappelletti. A. Leopardi. R Laureano H) pertenslon UOII, Intemal Med1cIDe, san GIovanni di 010 HOSPItal, Flren~e. Italv. H) po- and h)per-thyroidism are well-known causes of h)"pcrtension, parllCularl) IR females. that are affected by thyrOId dIsease stales 10 times more frequently than males. The aim of tlus study was 10 evaluate the uso:fulness of IDcludlng the determination of Thyroid StlmulallRg Hormone (TSH), a very SCRSIUve lest for hypothyroidism (lRcreased TSH) and hyperthyroidism (reduced TSH). in the roullne work-up of the hypertensive women referring to our HypertensIon VOlt We retrospecUvely evaluated the results obtalRed over 2 yean wllh the roullRe determination of TSH (I RM.A.) ID the hypenensive women refemng to our Uml.TSH was available ID 156 of the 203 (77%) pallenlS observed dunng the study penod and was abnormal ID 20 pts ( 12 8%) as shown ID the followin table Abnormal TSH: 20 12.8% Increa
Key Words: computed tomography, hypertension, magnetic resonance Imaging, primary hyperaldosteronism.

Key Words.

Secondary hypertensiOn.

HypothyroIdiSm, TSH.

HyperthyroidIsm.