Document Detail


Renal impairment of pure autonomic failure.
MedLine Citation:
PMID:  19738158     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Supine hypertension is difficult to manage in patients with pure autonomic failure (PAF), because treatment can worsen orthostatic hypotension. Supine hypertension in PAF has been associated with left ventricular hypertrophy, but end organ damage in the kidney has not been assessed. We reviewed hemodynamic and laboratory data of 64 male patients with PAF who were 69+/-11 (mean+/-SD) years old. Systolic blood pressure fell by 67+/-40 mm Hg within 10 minutes of standing, with an inappropriately low 13+/-11-bpm increase in heart rate. Plasma norepinephrine levels were below normal (0.62+/-0.32 nmol/L supine and 1.28+/-1.25 nmol/L standing). A control data set of 75 men (67+/-12 years) was obtained from a deidentified version of the Vanderbilt University Medical Center electronic medical chart database. Compared with controls, PAF patients had lower hemoglobin (8.3+/-0.9 versus 9.3+/-0.8 mmol/L; P<0.001), packed cell volume (0.40+/-0.04 versus 0.45+/-0.04; P<0.001), and red blood cell count (4.4+/-0.5 x 10(12) versus 5.0+/-0.5 x 10(12) cells/L; P<0.001). Serum creatinine and blood urea nitrogen levels were elevated in patients. Forty-eight percent of patients with PAF had supine hypertension (supine systolic blood pressure: > or = 150 mm Hg). Serum creatinine was higher in patients with supine hypertension (133+/-44 versus 106+/-27 micromol/L; P=0.021) and estimated glomerular filtration rate was lower (57+/-22 versus 70+/-20 mL/min per 1.73 m2; P=0.022) compared with patients who did not have supine hypertension. These findings may indicate that renal function is diminished in PAF in association with supine hypertension.
Authors:
Emily M Garland; Alfredo Gamboa; Luis Okamoto; Satish R Raj; Bonnie K Black; Thomas L Davis; Italo Biaggioni; David Robertson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-09-08
Journal Detail:
Title:  Hypertension     Volume:  54     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-22     Completed Date:  2009-11-12     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1057-61     Citation Subset:  IM    
Affiliation:
Autonomic Dysfunction Center, Vanderbilt University, Nashville, TN 37232-2195, USA. emily.garland@vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
Age Distribution
Aged
Aged, 80 and over
Case-Control Studies
Creatinine / blood
Glomerular Filtration Rate
Heart Rate / physiology
Hemodynamics / physiology
Humans
Hypertension / complications*,  diagnosis
Hypotension, Orthostatic / complications*,  diagnosis
Incidence
Male
Middle Aged
Norepinephrine / blood
Prognosis
Pure Autonomic Failure / complications*,  diagnosis
Reference Values
Renal Insufficiency / epidemiology,  etiology*,  physiopathology
Risk Assessment
Severity of Illness Index
Supine Position
Grant Support
ID/Acronym/Agency:
K23 RR020783-04/RR/NCRR NIH HHS; KL2 RR024977/RR/NCRR NIH HHS; KL2 TR000446/TR/NCATS NIH HHS; P01 HL056693/HL/NHLBI NIH HHS; P01 HL056693-13/HL/NHLBI NIH HHS; R01 HL071784/HL/NHLBI NIH HHS; R01 HL071784-06/HL/NHLBI NIH HHS; TL1 RR024978/RR/NCRR NIH HHS; TL1 TR000447/TR/NCATS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975-03/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
51-41-2/Norepinephrine; 60-27-5/Creatinine
Comments/Corrections
Comment In:
Kidney Int. 2010 Jan;77(2):81-2   [PMID:  20050379 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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