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J6 Renal artery stenosis in transplant recipients: Effect on graft survival
190A
AJH-APRIL1997-VOL. 10, NO. 4, PART2
ASH XII ABSTRACTS
J5
J6
RENALARTERY STENOSIS IN TRANSPLANTATION: RENAL ARTERY STENOSIS IN TRANSPLANT LONG-TERM RENAL FUNCTION AND ARTERIAL RECIPIENTS:EFFECT ON GRAFTSURVIVAL. PRESSUREOUTCOMEAIWERANGIOPL4STY. ~i& Jean-Michel Halimi*, Bears-ice Bjrrnel~, .. -, zml Al Na~ Jean-Michel Halimi*, Beatrice Birrrte16, Ma;\as Buchler,YvonL.ebranchu,D.ni@l Al,sm Nephrrrlogyand Transplartrarion,U-NJ Tours, France. MadriaaBuchler,YvonLebrattchu.kkl Ahsm Nephrologyand Transplantation,CHU Tours, France. Renalmafrstenosiscarscause hvoertension and rrmalfailure: Ischemic nephropathy (IN) is defined as a progressive howev&. whether it can also af~;ct lomz-termmafr strrviv~ degradationof renal functionin patients with atherosclerotic aftercor+ecrionof the stenosisis not welideterrkd. renal artery stenosis (RAS) wich carslead to ESRD, despite We assessed the long-term functional outcome in patients correctionof the stenosis.In renal transplantation,long-term with significant graft stenosis (after angioplasty) (S, n=26) renafoutcomeafterdilatationis not well defm.d and in patients who had no stenosis in angiography (NoS, We therefore assessed the long-term functional outcome n=53). Baseline characteristics (age (45 vs 47), sex ratio, (systolic (SAP) and diastolic (DAP) arterial pressure numberof mismatch)were similarin the two groups. (mmHg),serumcreatinine(SCreat, ~mol/1))in patients with At follow-up (57+4 months), no difference in systolic significant graft stenosis (n=26) before and after dilatation (148*4 vs 145& mmHg) and diastolic (8842 vs 84*1 and compared them to patients had no stenosis in mmHg) arterial pressure.and serum creatinine (154K29vs arrgiography(n=53). Baseline characteristics (age (45H vs 14M9 pmol/1)was found in S and NoS grouprespectively. 47*2), sex ratio, number of mismatch (3.3M.2 vs 3.6N.2), Actuarial survival curve durationof marrsplantationat baseline(7 vs 6 months))were 1 similarin both groups.Tireresultsare displayedin the Table: .“. Before 12 24 36 48 0,9 60 mos 0,8 s-ten"osis-------" ---------------------""-----------"-----------------------------"------Stenosis SAP 160+4 147iz4* 147k4” 146k4* 150+4 143*3 0,7 ~ DAP 96*2 87*2 87*2* 86*3* 85*2* 88+2 0,6 No stenosis —“e-SCreat 16!%12 144+9* 142+11* 168+33 140+11 138*I5 0,5 m No stenosis 01234567 148+2 146+2 145*3 143+2 148+3 SAP 150*3 Years DAP 88* I 86* I 86+1 88+1 85+1 86*2 SCreat 156i9
140+8
138+7 146+11
144+8 148* I 1
*"denoies"p-~-;O"5" vs"&-fO&""tieri-O-&aphy; "-"""'""""-"--"-"-"-" ‘---”-”Renal function improvedshortlyafterrevasculatirationand remainedstable in patients with stenosis; however, the longternr outcomewas similarin the two groups,suggestingthat graft RAS does not leadto IN in transplantrecipients. Words: Renal er?tery stenosis ; nephropathy ; renal transplantation
Key
Ischemic
Kay Worda:
nephropathy
Renel ertary stenoaia ; Renel transplantation
; Iachemic
J8
J7 CIRCADIANBLOODPRESSUREVARIATtON IN PATIENTS WITHPRIMARYHYTSRPARATHYROIDISM IS NORMAL. E&JQL&s” D. Elwocd, G.A. Mansoor”, D. Crombie, and W.B. White”, University of Connecticut Health Center and Hartford Hospital, Farrnington, CT. One of the less well understood features of primary hyperparathyroidism (PHPT) is hypertension, which has been reported to occur in 18-730/.of patients with PHPT. Furthermore, the relationship between PHPT and circadian BP is not well studied. It has been suggested that secondary forms of hypertension may lack the normal nocturnal BP decline during sleep. Tfma,we performed a prospective study of smbtdatory BPin patients with primary hyperparathyroidism prior to parathyroidectomy. Controls were matrhed according to age, aex, 24-hour BP and medical therapy. In the PHFT group. 44% were hypertemive baaad on officereadings (>140/90rmnHg) while 27% percent had ambulatory hypertension (24-hour BP > 135/85 ~Hg). The data are su&ra&ed below: PHPT Controts 18(16/2) 18(16/2) Number(F/M) Aze 36+17 56+ 17 1 7/1s A%ihypertensives 7/18 131t 18 132* 15 Awake SBP(rnnrHg) Awake DBP(nunHg) 73* 10 75+ 8 115*21 115* 17 Sleq SBP (rnnrHg) 64*1O Sleep DBP(nunHg) 63*12 Awake-SlespSBP(rnnrHg) 15* 12 17* 10 Awake-SleepDBP(mnrHg) 11* 7 11* 7 16/2 16/2 Nondippers had awake-sleep dectine of c 10% for both systolic and diastolic BP In the PHPT group, there were no correlations between levels of serum caIcimn (mean, 1.4S + 0.2 rnrnol/1), parathyroid hormone and ambutatotw BP or the awake-sleeu BP difference. CmrcZusiorr:
Patients with-primary hyperparat~yroidism preserved circadian variation of BP. Kay Worda:
As depictedin fheFigure,rJreactuwialgraft suMvalrste was comparableitsthe two groups (77% vs 78% 6-year SUMVSI rate in S and NoS respectively). In conclusion,renal graft stenosisafter angioplaatyhas no deleteriouseffecton long-termgraft survival.
hyperparathyroidism,
circadian BP
appear to have ambulatory
BP
PATIENTS WITH PRIMARY HYPERALDOSTERONISMDO NOT HAVE IMPAIRED VARIATION. fbkkhwa”,
DIURNAL BLOOD PRESSURE MDa.d W. S. whit=’, MD. Univ=+ of
CmuwcticutHed thCenrer, Fmnington,CT. Both normotensiveand hypertensivesubjectsexperiencea decline in blood pressure during sleep, The extent of this decline is probably relatedto age, severityof hypertensionatrdthe presrnceor absenceof secondarycauses of hypertension.The possible effects of primary hyperrddmteronism on this diurnalbloodpressurevariationis not well studied,Wethereforeperformedambulatoryblocdpressuremonitoring on 16 patients with primary hyperaldostermtismand 16 control subjectsBothgmupawerematchrrtforage,genderandofficeandawake blocd pressure.There was no differencebetween groups in average awake sleep differences in absoluteterms(mmHg)or when a criterion
of less than 10% decline in hotb systolic and diastolic blood pressure rkfinrdnondiooxa.
Number (f/m)
16(1 1/5)
Age(y.&) OfficeSBP(mmHg) Offkr DBP(rnrrdf~) AwakeSBP(mrrrf&) AwakeDBP(mrrrtfg) Slrep SBP(mmHg) SleepDBP(mmHg) Awakr-slaep(nnnHg) SBP DBP MAP
55 * 3 165+ 5 97* 3 154i 4 S7* 12 139* 6 76+ 3
16 (12/4) 57 i 3 163 + 5 IOQ* 3
15* 3 14* 2 14* 3
14* 3 9*2 10• 3
DippWNrntdi~r*
1Us
Sk?
150* 4 S6* 10 136+ 6 79* 3
I I
BP : mean* SSM in Orehyperaldostemnimr group, there was no relationship between
levelsofaertrrnatdmtemne,urinaryaldmtemneIeveta.rddosteronerenin Thesefindingsindicarrthatthe ratio,andthe awake - sleepditTer&tce, majorityof subjectswithprimmyhypsraldostemnism havepreserved VSdatiOD. diuntatblcmdpISSSIUS
AJH-APRIL1997-VOL. 10, NO. 4, PART2
ASH XII ABSTRACTS
J5
J6
RENALARTERY STENOSIS IN TRANSPLANTATION: RENAL ARTERY STENOSIS IN TRANSPLANT LONG-TERM RENAL FUNCTION AND ARTERIAL RECIPIENTS:EFFECT ON GRAFTSURVIVAL. PRESSUREOUTCOMEAIWERANGIOPL4STY. ~i& Jean-Michel Halimi*, Bears-ice Bjrrnel~, .. -, zml Al Na~ Jean-Michel Halimi*, Beatrice Birrrte16, Ma;\as Buchler,YvonL.ebranchu,D.ni@l Al,sm Nephrrrlogyand Transplartrarion,U-NJ Tours, France. MadriaaBuchler,YvonLebrattchu.kkl Ahsm Nephrologyand Transplantation,CHU Tours, France. Renalmafrstenosiscarscause hvoertension and rrmalfailure: Ischemic nephropathy (IN) is defined as a progressive howev&. whether it can also af~;ct lomz-termmafr strrviv~ degradationof renal functionin patients with atherosclerotic aftercor+ecrionof the stenosisis not welideterrkd. renal artery stenosis (RAS) wich carslead to ESRD, despite We assessed the long-term functional outcome in patients correctionof the stenosis.In renal transplantation,long-term with significant graft stenosis (after angioplasty) (S, n=26) renafoutcomeafterdilatationis not well defm.d and in patients who had no stenosis in angiography (NoS, We therefore assessed the long-term functional outcome n=53). Baseline characteristics (age (45 vs 47), sex ratio, (systolic (SAP) and diastolic (DAP) arterial pressure numberof mismatch)were similarin the two groups. (mmHg),serumcreatinine(SCreat, ~mol/1))in patients with At follow-up (57+4 months), no difference in systolic significant graft stenosis (n=26) before and after dilatation (148*4 vs 145& mmHg) and diastolic (8842 vs 84*1 and compared them to patients had no stenosis in mmHg) arterial pressure.and serum creatinine (154K29vs arrgiography(n=53). Baseline characteristics (age (45H vs 14M9 pmol/1)was found in S and NoS grouprespectively. 47*2), sex ratio, number of mismatch (3.3M.2 vs 3.6N.2), Actuarial survival curve durationof marrsplantationat baseline(7 vs 6 months))were 1 similarin both groups.Tireresultsare displayedin the Table: .“. Before 12 24 36 48 0,9 60 mos 0,8 s-ten"osis-------" ---------------------""-----------"-----------------------------"------Stenosis SAP 160+4 147iz4* 147k4” 146k4* 150+4 143*3 0,7 ~ DAP 96*2 87*2 87*2* 86*3* 85*2* 88+2 0,6 No stenosis —“e-SCreat 16!%12 144+9* 142+11* 168+33 140+11 138*I5 0,5 m No stenosis 01234567 148+2 146+2 145*3 143+2 148+3 SAP 150*3 Years DAP 88* I 86* I 86+1 88+1 85+1 86*2 SCreat 156i9
140+8
138+7 146+11
144+8 148* I 1
*"denoies"p-~-;O"5" vs"&-fO&""tieri-O-&aphy; "-"""'""""-"--"-"-"-" ‘---”-”Renal function improvedshortlyafterrevasculatirationand remainedstable in patients with stenosis; however, the longternr outcomewas similarin the two groups,suggestingthat graft RAS does not leadto IN in transplantrecipients. Words: Renal er?tery stenosis ; nephropathy ; renal transplantation
Key
Ischemic
Kay Worda:
nephropathy
Renel ertary stenoaia ; Renel transplantation
; Iachemic
J8
J7 CIRCADIANBLOODPRESSUREVARIATtON IN PATIENTS WITHPRIMARYHYTSRPARATHYROIDISM IS NORMAL. E&JQL&s” D. Elwocd, G.A. Mansoor”, D. Crombie, and W.B. White”, University of Connecticut Health Center and Hartford Hospital, Farrnington, CT. One of the less well understood features of primary hyperparathyroidism (PHPT) is hypertension, which has been reported to occur in 18-730/.of patients with PHPT. Furthermore, the relationship between PHPT and circadian BP is not well studied. It has been suggested that secondary forms of hypertension may lack the normal nocturnal BP decline during sleep. Tfma,we performed a prospective study of smbtdatory BPin patients with primary hyperparathyroidism prior to parathyroidectomy. Controls were matrhed according to age, aex, 24-hour BP and medical therapy. In the PHFT group. 44% were hypertemive baaad on officereadings (>140/90rmnHg) while 27% percent had ambulatory hypertension (24-hour BP > 135/85 ~Hg). The data are su&ra&ed below: PHPT Controts 18(16/2) 18(16/2) Number(F/M) Aze 36+17 56+ 17 1 7/1s A%ihypertensives 7/18 131t 18 132* 15 Awake SBP(rnnrHg) Awake DBP(nunHg) 73* 10 75+ 8 115*21 115* 17 Sleq SBP (rnnrHg) 64*1O Sleep DBP(nunHg) 63*12 Awake-SlespSBP(rnnrHg) 15* 12 17* 10 Awake-SleepDBP(mnrHg) 11* 7 11* 7 16/2 16/2 Nondippers had awake-sleep dectine of c 10% for both systolic and diastolic BP In the PHPT group, there were no correlations between levels of serum caIcimn (mean, 1.4S + 0.2 rnrnol/1), parathyroid hormone and ambutatotw BP or the awake-sleeu BP difference. CmrcZusiorr:
Patients with-primary hyperparat~yroidism preserved circadian variation of BP. Kay Worda:
As depictedin fheFigure,rJreactuwialgraft suMvalrste was comparableitsthe two groups (77% vs 78% 6-year SUMVSI rate in S and NoS respectively). In conclusion,renal graft stenosisafter angioplaatyhas no deleteriouseffecton long-termgraft survival.
hyperparathyroidism,
circadian BP
appear to have ambulatory
BP
PATIENTS WITH PRIMARY HYPERALDOSTERONISMDO NOT HAVE IMPAIRED VARIATION. fbkkhwa”,
DIURNAL BLOOD PRESSURE MDa.d W. S. whit=’, MD. Univ=+ of
CmuwcticutHed thCenrer, Fmnington,CT. Both normotensiveand hypertensivesubjectsexperiencea decline in blood pressure during sleep, The extent of this decline is probably relatedto age, severityof hypertensionatrdthe presrnceor absenceof secondarycauses of hypertension.The possible effects of primary hyperrddmteronism on this diurnalbloodpressurevariationis not well studied,Wethereforeperformedambulatoryblocdpressuremonitoring on 16 patients with primary hyperaldostermtismand 16 control subjectsBothgmupawerematchrrtforage,genderandofficeandawake blocd pressure.There was no differencebetween groups in average awake sleep differences in absoluteterms(mmHg)or when a criterion
of less than 10% decline in hotb systolic and diastolic blood pressure rkfinrdnondiooxa.
Number (f/m)
16(1 1/5)
Age(y.&) OfficeSBP(mmHg) Offkr DBP(rnrrdf~) AwakeSBP(mrrrf&) AwakeDBP(mrrrtfg) Slrep SBP(mmHg) SleepDBP(mmHg) Awakr-slaep(nnnHg) SBP DBP MAP
55 * 3 165+ 5 97* 3 154i 4 S7* 12 139* 6 76+ 3
16 (12/4) 57 i 3 163 + 5 IOQ* 3
15* 3 14* 2 14* 3
14* 3 9*2 10• 3
DippWNrntdi~r*
1Us
Sk?
150* 4 S6* 10 136+ 6 79* 3
I I
BP : mean* SSM in Orehyperaldostemnimr group, there was no relationship between
levelsofaertrrnatdmtemne,urinaryaldmtemneIeveta.rddosteronerenin Thesefindingsindicarrthatthe ratio,andthe awake - sleepditTer&tce, majorityof subjectswithprimmyhypsraldostemnism havepreserved VSdatiOD. diuntatblcmdpISSSIUS