BACKGROUND. A high incidence of hypertension (50 to 75 percent) occurs early in the course of autosomal dominant polycystic kidney disease. Cyst enlargement, causing bilateral renal ischemia and subsequent release of renin, is proposed as the cause of this form of hypertension. METHODS. To investigate this hypothesis, we measured plasma renin activity and aldosterone concentrations during short-term and long-term converting-enzyme inhibition in 14 patients with hypertension due to polycystic kidney disease, 9 patients with essential hypertension, 11 normotensive patients with polycystic kidney disease, and 13 normal subjects. The groups were comparable with respect to age, sex, body-surface area, degree of hypertension, sodium excretion, and renal function. RESULTS. During the short-term study, the mean (+/- SE) plasma renin activity was significantly higher in the hypertensive patients with polycystic kidney disease than in the patients with essential hypertension, in the supine (0.36 +/- 0.06 vs. 0.22 +/- 0.06 ng per liter.second, P = 0.05) and upright positions (1.03 +/- 0.14 vs. 0.61 +/- 0.08 ng per liter.second, P less than 0.03) and after converting-enzyme inhibition (1.97 +/- 0.28 vs. 0.67 +/- 0.17 ng per liter.second, P less than 0.0006). The mean arterial pressures measured in the supine and upright positions and the plasma aldosterone concentrations measured in the upright position were significantly higher in the normotensive patients with polycystic kidney disease than in the normal subjects. After six weeks of converting-enzyme inhibition, renal plasma flow increased (P less than 0.005), and both renal vascular resistance (P less than 0.007) and the filtration fraction (P less than 0.02) decreased significantly in the hypertensive patients with polycystic kidney disease but not in the patients with essential hypertension. CONCLUSIONS. The renin-angiotensin-aldosterone system is stimulated significantly more in hypertensive patients with polycystic kidney disease than in comparable patients with essential hypertension. The increased renin release, perhaps due to renal ischemia caused by cyst expansion, probably contributes to the early development of hypertension in polycystic kidney disease.
Source Information
Department of Medicine, University of Colorado School of Medicine, Denver 80262.
This article has been cited by other articles:
Gattone, V. H. II, Siqueira, T. M. Jr, Powell, C. R., Trambaugh, C. M., Lingeman, J. E., Shalhav, A. L.
(2008). Contribution of Renal Innervation to Hypertension in Rat Autosomal Dominant Polycystic Kidney Disease. Exp. Biol. Med.
233: 952-957
[Abstract][Full Text]
Turkmen, K., Oflaz, H., Uslu, B., Cimen, A. O., Elitok, A., Kasikcioglu, E., Alisir, S., Tufan, F., Namli, S., Uysal, M., Ecder, T.
(2008). Coronary Flow Velocity Reserve and Carotid Intima Media Thickness in Patients with Autosomal Dominant Polycystic Kidney Disease: From Impaired Tubules to Impaired Carotid and Coronary Arteries. CJASN
3: 986-991
[Abstract][Full Text]
Chapman, A. B.
(2008). Approaches to Testing New Treatments in Autosomal Dominant Polycystic Kidney Disease: Insights from the CRISP and HALT-PKD Studies. CJASN
3: 1197-1204
[Abstract][Full Text]
Zeltner, R., Poliak, R., Stiasny, B., Schmieder, R. E., Schulze, B. D.
(2008). Renal and cardiac effects of antihypertensive treatment with ramipril vs metoprolol in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant
23: 573-579
[Abstract][Full Text]
Steinman, T. I.
(2008). Renal and cardiac effects of antihypertensive treatment with ramipril versus metoprolol in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant
23: 431-433
[Full Text]
Zafar, I., Tao, Y., Falk, S., McFann, K., Schrier, R. W., Edelstein, C. L.
(2007). Effect of statin and angiotensin-converting enzyme inhibition on structural and hemodynamic alterations in autosomal dominant polycystic kidney disease model. Am. J. Physiol. Renal Physiol.
293: F854-F859
[Abstract][Full Text]
Chapman, A. B.
(2007). Autosomal Dominant Polycystic Kidney Disease: Time for a Change?. J. Am. Soc. Nephrol.
18: 1399-1407
[Abstract][Full Text]
Torres, V. E., King, B. F., Chapman, A. B., Brummer, M. E., Bae, K. T., Glockner, J. F., Arya, K., Risk, D., Felmlee, J. P., Grantham, J. J., Guay-Woodford, L. M., Bennett, W. M., Klahr, S., Meyers, C. M., Zhang, X., Thompson, P. A., Miller, J. P., and the Consortium for Radiologic Imaging Studies,
(2007). Magnetic Resonance Measurements of Renal Blood Flow and Disease Progression in Autosomal Dominant Polycystic Kidney Disease. CJASN
2: 112-120
[Abstract][Full Text]
Pereira, T. V., Nunes, A. C. F., Rudnicki, M., Magistroni, R., Albertazzi, A., Pereira, A. C., Krieger, J. E.
(2006). Influence of ACE I/D gene polymorphism in the progression of renal failure in autosomal dominant polycystic kidney disease: a meta-analysis. Nephrol Dial Transplant
21: 3155-3163
[Abstract][Full Text]
Lawson, C. R, Doulton, T. W, MacGregor, G. A
(2006). Review: Autosomal Dominant Polycystic Kidney Disease: Role of the Renin-Angiotensin System in Raised Blood Pressure in Progression of Renal and Cardiovascular Disease. Journal of Renin-Angiotensin-Aldosterone System
7: 139-145
[Abstract]
Loghman-Adham, M., Soto, C. E., Inagami, T., Sotelo-Avila, C.
(2005). Expression of Components of the Renin-angiotensin System in Autosomal Recessive Polycystic Kidney Disease. J. Histochem. Cytochem.
53: 979-988
[Abstract][Full Text]
Paterson, A. D., Magistroni, R., He, N., Wang, K., Johnson, A., Fain, P. R., Dicks, E., Parfrey, P., St. George-Hyslop, P., Pei, Y.
(2005). Progressive Loss of Renal Function Is an Age-Dependent Heritable Trait in Type 1 Autosomal Dominant Polycystic Kidney Disease. J. Am. Soc. Nephrol.
16: 755-762
[Abstract][Full Text]
Loghman-Adham, M., Soto, C. E., Inagami, T., Cassis, L.
(2004). The intrarenal renin-angiotensin system in autosomal dominant polycystic kidney disease. Am. J. Physiol. Renal Physiol.
287: F775-F788
[Abstract][Full Text]
Le, T. H., Oliverio, M. I., Kim, H.-S., Salzler, H., Dash, R. C., Howell, D. N., Smithies, O., Bronson, S., Coffman, T. M.
(2004). A {gamma}GT-AT1A receptor transgene protects renal cortical structure in AT1 receptor-deficient mice. Physiol. Genomics
18: 290-298
[Abstract][Full Text]
McPherson, E. A., Luo, Z., Brown, R. A., LeBard, L. S., Corless, C. C., Speth, R. C., Bagby, S. P.
(2004). Chymase-like Angiotensin II-Generating Activity in End-Stage Human Autosomal Dominant Polycystic Kidney Disease. J. Am. Soc. Nephrol.
15: 493-500
[Abstract][Full Text]
Persu, A., El-Khattabi, O., Messiaen, T., Pirson, Y., Chauveau, D., Devuyst, O.
(2003). Influence of ACE (I/D) and G460W polymorphism of {alpha}-adducin in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant
18: 2032-2038
[Abstract][Full Text]
Kim, S. H., Moon, M. W., Lee, H. J., Sim, J. S., Kim, S. H., Ahn, C.
(2003). Renal Cyst Ablation with n-Butyl Cyanoacrylate and Iodized Oil in Symptomatic Patients with Autosomal Dominant Polycystic Kidney Disease: Preliminary Report. Radiology
226: 573-576
[Abstract][Full Text]
Kuehn, E. W., Park, K. M., Somlo, S., Bonventre, J. V.
(2002). Kidney injury molecule-1 expression in murine polycystic kidney disease. Am. J. Physiol. Renal Physiol.
283: F1326-F1336
[Abstract][Full Text]
Schrier, R., McFann, K., Johnson, A., Chapman, A., Edelstein, C., Brosnahan, G., Ecder, T., Tison, L.
(2002). Cardiac and Renal Effects of Standard Versus Rigorous Blood Pressure Control in Autosomal-Dominant Polycystic Kidney Disease: Results of a Seven-Year Prospective Randomized Study. J. Am. Soc. Nephrol.
13: 1733-1739
[Abstract][Full Text]
Schiavello, T., Burke, V., Bogdanova, N., Jasik, P., Melsom, S., Boudville, N., Robertson, K., Angelicheva, D., Dworniczak, B., Lemmens, M., Horst, J., Todorov, V., Dimitrakov, D., Sulowicz, W., Krasniak, A., Stompor, T., Beilin, L., Hallmayer, J., Kalaydjieva, L., Thomas, M.
(2001). Angiotensin-converting enzyme activity and the ACE Alu polymorphism in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant
16: 2323-2327
[Abstract][Full Text]
ECDER, T., SCHRIER, R. W.
(2001). Hypertension in Autosomal-Dominant Polycystic Kidney Disease: Early Occurrence and Unique Aspects. J. Am. Soc. Nephrol.
12: 194-200
[Full Text]
VAN DIJK, M. A., PETERS, D. J.M., BREUNING, M. H., CHANG, P. C.
(1999). The Angiotensin-Converting Enzyme Genotype and Microalbuminuria in Autosomal Dominant Polycystic Kidney Disease. J. Am. Soc. Nephrol.
10: 1916-1920
[Abstract][Full Text]
VALERO, F. A., MARTINEZ-VEA, A., BARDAJÍ, A., GUTIERREZ, C., GARCIA, C., RICHART, C., OLIVER, J. A.
(1999). Ambulatory Blood Pressure and Left Ventricular Mass in Normotensive Patients with Autosomal Dominant Polycystic Kidney Disease. J. Am. Soc. Nephrol.
10: 1020-1026
[Abstract][Full Text]
Remuzzi, G.
(1999). Sympathetic Overactivity in Hypertensive Patients with Chronic Renal Disease. NEJM
340: 1359-1361
[Full Text]
Ihnat, D. M., Berman, S. S., Marek, J. M., James, S., Mills, J. L.
(1998). Renal Artery Stenosis Complicating Polycystic Kidney Disease. VASC ENDOVASCULAR SURG
32: 647-650
[Abstract]
SULLIVAN, L. P., WALLACE, D. P., GRANTHAM, J. J.
(1998). Epithelial Transport in Polycystic Kidney Disease. Physiol. Rev.
78: 1165-1191
[Abstract][Full Text]
Litchfield, W. R., Anderson, B. F., Weiss, R. J., Lifton, R. P., Dluhy, R. G.
(1998). Intracranial Aneurysm and Hemorrhagic Stroke in Glucocorticoid-remediable Aldosteronism. Hypertension
31: 445-450
[Abstract][Full Text]
Chapman, A. B., Zamudio, S., Woodmansee, W., Merouani, A., Osorio, F., Johnson, A., Moore, L. G., Dahms, T., Coffin, C., Abraham, W. T., Schrier, R. W.
(1997). Systemic and renal hemodynamic changes in the luteal phase of the menstrual cycle mimic early pregnancy. Am. J. Physiol. Renal Physiol.
273: F777-F782
[Abstract][Full Text]
Gabow, P. A.
(1993). Autosomal Dominant Polycystic Kidney Disease. NEJM
329: 332-342
[Full Text]
Previous
