Nocturnal blood pressure is elevated with natriuresis and proteinuria as renal function deteriorates in nephropathy
| Autor: | Takeshi Usami, Atsuhiro Yoshida, Michio Fukuda, Genjiro Kimura, Naoyuki Nakao, Yoshinobu Kamiya, Miwa Munemura, O Takeuchi |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male circadian rhythm medicine.medical_specialty Hypertension Renal Ambulatory blood pressure Urinary system natriuresis Hemodynamics Renal function Natriuresis chemistry.chemical_compound Internal medicine medicine Humans Creatinine business.industry Sodium renal function blood pressure Middle Aged Endocrinology Blood pressure chemistry Nephrology Renal physiology Female proteinuria business Glomerular Filtration Rate |
| Zdroj: | Kidney International. 65:621-625 |
| ISSN: | 0085-2538 |
| DOI: | 10.1111/j.1523-1755.2004.00419.x |
| Popis: | Nocturnal blood pressure is elevated with natriuresis and proteinuria as renal function deteriorates in nephropathy. Background We reported that patients with sodium sensitive type of hypertension exhibited the lack of nocturnal fall in blood pressure with enhanced natriuresis during night. Sodium sensitivity is caused by diminished glomerular filtration capability and/or augmented tubular reabsorption of sodium, and seems tightly linked with glomerular capillary hypertension. In the present study, we investigated the relationship between glomerular filtration rate and circadian rhythms of these parameters in patients with glomerulopathy. Methods Twenty six patients (15 men and 11 women; aged 17 to 72 years; mean age 47 ± 3 years), whose diagnosis was confirmed as glomerulopathy with renal biopsy, were studied during hospitalization. Ambulatory blood pressure for 24 hours was monitored, while urinary samples were collected for both daytime (6:00 a.m. to 9:00 p.m.) and nighttime (9:00 p.m. to 6:00 a.m.) to estimate circadian rhythms of urinary sodium and protein excretion rates (U Na V, U pro V). Then night/day ratios of mean arterial blood pressure (MAP), U Na V, and U pro V were analyzed in relation to 24-hour creatinine clearance as a marker of glomerular filtration rate. Results Serum creatinine and creatinine clearance were 1.1 ± 0.1 mg/dL and 89 ± 7 mL/min/1.73m2. There were significant day-night differences in MAP (96 ± 2 mm Hg vs. 92 ± 2 mm Hg; P = 0.006), U Na V (6.7 ± 0.9 mmol/hour vs. 3.6 ± 0.3mmol/hour; P = 0.003), and U pro V (161 ± 27 mg/hour vs. 128 ± 28 mg/hour; P = 0.02). Creatinine clearance had significantly negative relationships with night/day ratios of MAP ( r =-0.49; P = 0.01), U Na V ( r =-0.43; P = 0.03,) and U pro V ( r =-0.41; P = 0.04). In addition, night/day ratio of MAP had significantly positive relationships with night/day ratios of U Na V ( r = 0.49; P = 0.01) and U pro V ( r = 0.45; P = 0.02). Conclusion Our results show that as renal function deteriorates in glomerulopathy the nocturnal dip in blood pressure is lost, resulting in enhanced urinary sodium and protein excretions during night. These findings are compatible with our proposal that impaired natriuresis during daytime makes nocturnal blood pressure elevated to compensate for diminished natriuresis by pressure natriuresis. We speculate that nocturnal glomerular capillary hypertension contributes, at least in part, to enhanced urinary sodium and protein excretions during night. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|