ENDOTHELIN EXCRETION IN HYPERTENSIVE PREGNANCY - RELATIONSHIP TO GLOMERULAR-FILTRATION RATE, BLOOD-PRESSURE, AND SODIUM-EXCRETION

被引:16
作者
WANG, MX [1 ]
BROWN, MA [1 ]
BUDDLE, ML [1 ]
CARLTON, MA [1 ]
CARIO, GM [1 ]
WHITWORTH, JA [1 ]
机构
[1] UNIV NEW S WALES,DEPT MED,SYDNEY,AUSTRALIA
关键词
PREGNANCY; PREECLAMPSIA; HYPERTENSION; ENDOTHELIN; SODIUM;
D O I
10.1093/ajh/7.4.308
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
The objective of this study was to determine whether urinary endothelin (ET) excretion is altered in pregnant women with preeclampsia or essential hypertension compared with normal pregnant and nonpregnant women, and whether urinary ET excretion is significantly related to glomerular filtration rate (GER), blood pressure, or sodium excretion in hypertensive pregnant women. Subjects included 85 hypertensive women in their third trimester (32 with severe preeclampsia, 37 with mild preeclampsia [some of whom may be classified as having ''transient (gestational) hypertension'' by other classifications], and 16 with essential hypertension), 42 normal third-trimester pregnant women, and 26 normal nonpregnant women. Twenty-four-hour urine ET and creatinine excretion were measured in all women. ET was extracted from urine and measured by radioimmunoassay. Plasma creatinine, serum uric acid and albumin concentrations, and urine protein and sodium excretion were also measured. Twenty-four-hour ET excretion was significantly higher (P < .01) in normal pregnant women (14.7 [9.1 to 20.1] pmol/day; median [interquartile range]) than in nonpregnant women (8.4 [6.4 to 15.2] pmol/day) and was reduced significantly (P < .01) in hypertensive pregnant women (severe preeclampsia: 9.0 [5.5 to 12.4] pmol/day; mild preeclampsia: 7.2 [5.7 to 9.9] pmol/day; essential hypertension: 7.5 [6.4 to 9.4] pmol/day) compared to values for normal pregnant women. Twenty-four-hour urine ET excretion in hypertensive pregnant women was correlated positively but weakly with both creatinine clearance (r = 0.31, P < .01) and urine sodium excretion (r = 0.34, P < .01). Urinary ET excretion is increased in normal pregnancy and reduced from these values in pregnancies complicated by preeclampsia or essential hypertension. This may be explained partly by reduced filtered ET but must also reflect impaired renal ET production. There is no evidence for enhanced renal ET production in preeclampsia.
引用
收藏
页码:308 / 313
页数:6
相关论文
共 29 条
[1]  
King A.J., Brenner B.M., Erson S., Endothelin: A potent renal and systemic vsoconstrictor peptide, Am J Physiol, 256, pp. F1051-F1058, (1989)
[2]  
Miller W.L., Redfield M.M., Burnett J.C., Integrated cardiac, renal and endocrine actions of endothelin, J Clin Invest, 83, pp. 317-320, (1989)
[3]  
Saito Y., Nakao K., Mukoyama M., Imura H., Increased plasma endothelin level in patients with essential hypertension, N Engl J Med, 322, (1990)
[4]  
Miyauchi T., Yanagisawa M., Tomizawa T., Et al., Increased plasma concentration of endothelin-1 and big endothelin-1 in acute myocardial infarction, Lancet, 2, pp. 53-54, (1989)
[5]  
Saito Y., Kazuwa N., Shirakami G., Et al., Endothelin in patients with chronic renal failure, J Cardiovasc Pharmacol, 17, pp. S437-S439, (1991)
[6]  
Brown M.A., Pregnancy-induced hypertension: Pathogenesis and management, Aust NZ J Med, 21, pp. 257-273, (1991)
[7]  
Taylor R.N., Varma M., Teng N., Roberts J.M., Women with preeclampsia have higher plasma endothelin levels than women with normal pregnancies, J Clin Endocrinol Metab, 71, pp. 1675-1677, (1990)
[8]  
Mastrogiannis D.S., O'Brien W.F., Krammer J., Benoit R., Potential role of endothelin-1 in normal and hypertensive pregnancies, Am J Obstet Gynecol, 165, pp. 1711-1716, (1991)
[9]  
Nova A., Sibai B.M., Barton J.R., Et al., Maternal plasma level of endothelin is increased in preeclampsia, Am J Obstet Gynecol, 165, pp. 724-727, (1991)
[10]  
Florijn K.W., Derkx F., Visser W., Et al., Plasma immunoreactive endothelin-1 in pregnant women with and without preeclampsia, J Cardiovasc Pharmacol, 17, pp. S446-S448, (1991)