Kidney Week

Abstract: SA-PO999

Hyperreactivity of Aldosterone to Renin Contributes to Pathogenesis of Malignant Hypertension and Renovascular Hypertension

Session Information

• Hypertension and CVD: Mechanisms - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1403 Hypertension and CVD: Mechanisms

Authors

• Watanabe, Shun, Toranomon Hospital Kajigaya, Kawasaki, kanagawa, Japan

Shun Watanabe,

• Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan

Keiichi Sumida,

• Yamanouchi, Masayuki, Toranomon Hospital Kajigaya, Kawasaki, kanagawa, Japan

Masayuki Yamanouchi,

• Suwabe, Tatsuya, Toranomon Hospital Kajigaya, Kawasaki, kanagawa, Japan

Tatsuya Suwabe,

• Hoshino, Junichi, Toranomon Hospital, Tokyo, Japan

Junichi Hoshino,

• Ubara, Yoshifumi, Toranomon Hospital Kajigaya, Kawasaki, kanagawa, Japan

Yoshifumi Ubara,

Background

Malignant hypertension (MH) and renovascular hypertension (RVH) are known as diseases exhibiting high renin hypertension. By comparing the two groups, we examine how renin-angiotensin aldosterone system (RAAS) participates not only in the onset of hypertension but also in the onset of nephropathy.

Methods

A total of 33 patients who were diagnosed as MH(n=19) and RVH (n=14) at Toranomon Hospital from 1986 to 2017 were evaluated retrospectively.

Results

There was no significant difference in plasma renin concentration (PRC) between MH group and RVH group. While, age was younger in MH group than in RVH group with median [interquartile range]; 40 years [32-48 years] vs. 65 years [62-76 years], P =0.0001). Blood pressure (median; 230/130 vs 164/98 mmHg), UN (median;53.0 vs 28.8 mg/dl), Cre (median; 6.0 vs 2.0 mg/dl), plasma aldosterone concentration (PAC) （mrdian;49.7 vs 32.0 ng/dl）and aldosterone -renin-ratio (ARR)（1.10 VS 0.64）were significantly higher in MH group than in RVH group. Serum K (median; 3.7 vs 4.3 mEq/L) was significantly lower in MH group than in RVH group. The majority of MH group showed intimal edematous thickening (onion skin lesion) of small arteries including arteriole by renal biopsy. While four patients out of patients with RVH showed focal glomerular sclerosis on non-narrowed kidney by renal biopsy, but did not show onion skin lesion of small arteries.

Conclusion

Hyperreninemia was similar on both groups, but aldosterone value and APR were significantly higher in MH group. This indicates that hyperreactivity of aldosterone to renin might contribute not only to the formation of MH with onion-skin lesion via higher blood pressure, and result in also to hypokalemia, though renal function was higher on MH group. Whenever hyperreactivity of aldosterone to renin exists on MH group remains unknown.

These results suggest that the mechanism by which renin stimulation leads to overproduction of aldosterone may be thought to be involved in MH and the progression of nephropathy.