Textor S C, Gavras H, Tifft C P, Bernard D B, Idelson B, Brunner H R
Hypertension. 1981 May-Jun;3(3):294-9. doi: 10.1161/01.hyp.3.3.294.
To assess the interaction between adrenergic activity and blood pressure regulation in patients with chronic renal failure, plasma norepinephrine (NE) and plasma renin activity (PRA) were measured before and after vigorous ultrafiltration. The significance of PRA was further assessed by angiotensin blockade with saralasin. Two patterns of response were defined: nine patients had low levels of PRA before and after hemodialysis. These patients showed a net fall in norepinephrine and no angiotensin dependence of any time. Failure to stimulate either PRA or norepinephrine was also observed during periods of marked hypotension. Seven other patients had higher PRA, which rose during hemodialysis. This was associated with an increase in NE and postdialysis angiotensin dependence. Patients experiencing hypotension in this group showed a sharp rise in NE, suggesting baroceptor-mediated adrenergic stimulation. In all patients sustaining hypotension during therapy, postdialysis PRA was closely correlated with NE. These results indicate that hemodialysis mobilizes the renin-angiotensin system to maintain hypertension in a greater proportion of dialysis patients than previously supposed and that impaired renin release following hypotension may represent uremic autonomic dysfunction.
为评估慢性肾衰竭患者肾上腺素能活性与血压调节之间的相互作用，在强力超滤前后测量了血浆去甲肾上腺素（NE）和血浆肾素活性（PRA）。通过用沙拉新进行血管紧张素阻断进一步评估PRA的意义。定义了两种反应模式：9例患者在血液透析前后PRA水平较低。这些患者去甲肾上腺素出现净下降，且在任何时候都不依赖血管紧张素。在明显低血压期间也观察到PRA或去甲肾上腺素未受刺激。另外7例患者PRA较高，在血液透析期间升高。这与NE增加和透析后血管紧张素依赖性增加有关。该组中出现低血压的患者NE急剧上升，提示压力感受器介导的肾上腺素能刺激。在治疗期间所有出现低血压的患者中，透析后PRA与NE密切相关。这些结果表明，血液透析比先前认为的能使更多比例的透析患者动员肾素-血管紧张素系统以维持高血压，且低血压后肾素释放受损可能代表尿毒症自主神经功能障碍。
