Severe hypertension after bilateral nephrectomy normalized by successful renal transplantation

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ASH XV ABSTRACTS

(Group I, n ⫽ 60), hypertensive (Group II, n ⫽ 32) and those undergoing hemodialysis (Group III, n ⫽ 38). Results. There was a progressive increase in left ventricular mass (LVM) index (88.6 ⫾ 19.7, 127.6 ⫾ 40.4 and 150.5 ⫾ 56.5 g/m2, p ⬍ 0.0001) and in the prevalence of left ventricular hypertrophy (LVH) (3%, 43% and 62%, p ⬍ 0.0001) in groups I, II and III respectively. Univariate analysis revealed that the LVM index was correlated with age, body mass index, systolic and diastolic blood pressure (BP), creatinine and hemoglobin. Age, sex, systolic BP and hemoglobin were independent predictors of LVM index in the entire population, systolic BP and creatinine in non-dialytic patients and systolic BP in dialytics. Doppler parameters were different in the three groups: E wave and E/A ratio were lower and A wave was higher in group II and III than in group I. E wave deceleration time and isovolumic relaxation time were significantly longer in group III than in group I or II. Abnormal diastolic function (E/A ratio ⬍1) was more prevalent in group III than in groups I and II (62% vs 2% vs 46% respectively, p ⬍ 0.0001). E/A ratio was correlated with age, systolic and diastolic BP, creatinine, hemoglobin, urinary albumin excretion, LVM index and heart rate. Age, heart rate and diastolic BP in the entire group, and age, heart rate and LVM index in non-dialytic patients remained as independent predictors of abnormal diastolic function. Overall prevalence of mitral valve prolapse was 6%. Prevalence of aortic and mitral regurgitation in non-dialytic patients was 4%. The majority of valvular abnormalities affected dialytic patients and were related to annular mitral calcification (28%) or aortic valve calcification (38%). Conclusions. Cardiac involvement in ADPKD patients is a continuous process that evolves during the course of this disease. It is characterized by a low incidence of specific valvular abnormalities, a progressive increase in LVM, LVH and diastolic dysfunction, which are greatest in the latter stages of the disease. Systolic BP is the most important determinant of LVM in this population. Key Words: Left ventricular mass; left ventricular hypertrophy; diastolic function; Doppler echocardiography; autosomal dominant polycystic kidney disease M004 SEVERE HYPERTENSION AFTER BILATERAL NEPHRECTOMY NORMALIZED BY SUCCESSFUL RENAL TRANSPLANTATION K.E. Kim*, and C. Swartz. MCP Hahnemann University, Philadelphia, PA We have shown that bilateral nephrectomy of hypertensive patients with end-stage renal disease (ESRD) reduced both blood pressure (BP) and total peripheral resistance (TPR). Most anephric patients therefore have a normal blood pressure at dry weight. Severe hypertension is occasionally seen in end-stage renal disease despite bilateral nephrectomy and dry weight with adequate dialysis. We reviewed 25 years of experience and found only 4 patients out of 86 who underwent bilateral nephrectomy had persistent severe and uncontrollable hypertension in the anephric state. All four became normotensive after successful renal transplantation

AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2

(RT). Two patients underwent hemodynamic study before and after RT. BP was measured by intra-arterial cannula, cardiac output by dye-dilution technique and blood volume by radioactive labelled I131 albumin. After successful RT, mean arterial pressure decreased from 137 to 93 mmHg, TPR index decreased from 2748 to 2020. Cardiac index and blood volume did not change. In 5% of patients with ESRD, BP is not decreased by bilateral nephrectomy. We postulate this represents a select group whose hypertension is sustained by lack of a renal vasodepressor substance. The postulate is substantiated by the correction of hypertension and reduction of TPR by renal transplantation. Key Words: Severe hypertension; anephric patients; bilateral nephrectomy; renal vasodepressor substance

M005 PREVALENCE OF CARDIAC DAMAGE IN PATIENTS WITH RENOVASCULAR HYPERTENSION D. Melina*, G. Guerrera, G. Filice, F. Travaglino, G. Melina. Istituto di Patologia Speciale Medica, Universita` Cattolica del Sacro Cuore, Roma, Italia Aim of the present study was to investigate factors for cardiac dysfunction in patients with renovascular hypertension (RVH). We have studied three groups of 20 patients each. Group 1 was composed by patients with renovascular hypertension, Group 2 was composed by patients with essential hypertension, Group 3 was composed by normotensive patients. The three groups were similar for age, sex distribution, body mass index and cardiovascular risk factors. Group 1 and 2 were similar for hypertension duration and drugs administration. All patients, after ten days of pharmacological wash-out, underwent: 1) simultaneous 24 h ambulatory blood pressure and ECG monitoring; 2) echocardiographic study; 3) bycicle exercise stress test; 4) PRA and aldosteronemia. Cardiac damage was defined by class 1 to 3 of score including LVH, silent or symptomatic myocardial ischemia, ventricular arrhythmias. The following results were noted:

A) a significantly higher incidence of cardiac damage score in Group 1 (p ⬍ 0.001); B) the cardiac damage score in Group 1 was significantly related to: - 24 h SBP and/or DBP variability (p ⬍ 0.05); - 24 h HR variability (p ⬍ 0.01); - nocturnal BP incrase (p ⬍ 0.001); - PRA values (p ⬍ 0.01). Our data suggest that hemodynamic and metabolic factors play a relevant role in the incidence and evolution of cardiac damage in patients with RVH. Key Words: Renovascular hypertension; cardiac damage; BP/HR variability