Renal response to an acute protein challenge in pregnant women with borderline hypertension.

BACKGROUND: The renal reserve (RR), assessed after an oral protein challenge or the intravenous administration of amino acids, is still present in healthy pregnant women (NP), although resting glomerular filtration rate (GFR) and renal plasma flow (RPF) increase progressively throughout normal gestation. No studies have addressed this issue in hypertensive gravidas; the aim of this trial was to evaluate renal response to an acute protein load (PL) in NP and pregnant women with borderline hypertension (HP). METHODS: Five NP, eight HP and eight healthy non-pregnant women (CG) were evaluated. After fasting overnight, all subjects received an oral water load (20 mL/kg of body weight), the urinary output was then replaced orally with equal volumes of water. After two 30 min periods, an 80 g PL was provided. Creatinine clearance (CCr) was measured every 30 min from 1 h before and for 4 h following PL. Participants remained recumbent during the study, bladder emptiness was assessed by ultrasound immediately after each micturition. Baseline CCr was taken as the average of two 30 min periods before PL and peak Ccr as the maximal CCr recorded thereafter. RESULTS: The groups were similar with regard to age, weight or gestation age. Baseline CCr (NP: 118.5+/-6.0, HP: 127.4+/-6.7 and CG: 99.8+/-2.9 mL/min, P=0.004 (CG vs NP and HP), increased after PL to NP: 223.5+/-9.8 to HP: 178.5+/-13 and to CG: 149.1+/-4.0 mL/min, P<0.0004 (CG vs HP, CG vs NP and NP vs HP)). Peak minus baseline CCr was 97.3+/-10.1; 46.3+/-12.7 and 48.3+/-4.8 for NP, HP and CG, respectively (P<0.006 HP vs CG and NP). The peak CCr was obtained significantly earlier in both pregnant groups (Period 3) compared with the healthy non-pregnant women (Period 5) (P=0.02). The fractional proximal reabsorption of sodium (FPRNa+) at peak CCr was similar in the groups (NP: 0.74+/-0.01 HP: 0.78+/-0.02 and CG: 0.74+/-0.03, P=not significant (NS)) as was the distal delivery of sodium (DDNa+) (NP: 5.8+/-0.5; HP: 4.1+/-0.5 and CG: 4.3+/-0.4 meq/min, P=NS). Fractional excretion of urea (%) increased from 91.4+/-5.5 to 105.5+/-9.8%; 80.7+/-8.0 to 97.3+/-9.8; and 44.4+/-7.8 to 86.0+/-7.1 in NP, HP and CG, respectively (P=NS). There was a trend towards a poorer maternal and fetal outcome in the HP group. CONCLUSION: Mid-term borderline HP failed to increase CCr as much as NP did after a protein challenge, suggesting altered functional response of the nephron or lessened sensitivity of renal vasculature to additional vasodilator stimuli. These results support the interest of additional prospective studies with a larger number of patients to confirm these findings and evaluate the value of RR tests as predictors of outcome of pregnancies at risk.

[Hormonal replacement therapy. Benefits and risks]. / Terapética hormonal de reemplazo. Beneficios y riesgos.

UNLABELLED: A woman lives an average of between 25 to 30 years since the beginning of menopause. This period of life is characterized for the appearance of chronic diseases. Estrogens are effective in controlling vasomotor symptoms and also over the loss of bone mineral density, therefore lowering the risk of fractures in about 25-30%. The use of unopposed estrogens (without progesterone) raises 8 to 10 times the risk of endometrial and 2 to 3 times the risk of deep venous thrombosis as well. Until now, no raise was seen in breast cancer in short treatments (less than 5 years) especially if they are not opposed with progesterone. The recent publication of the surprising data of the trial Women's Health Initiative demonstrates a significative but small increase in the risk of breast cancer associated with the use of combined estrogen/progestin therapy proportional to the duration of the treatment. The reduction of the plasmatic levels of low density lipoproteins associated with the use of Hormonal Replacement Therapy (HRT), has not been linked to evident cardiovascular protection. There is a higher cardiovascular risk with the use of HRT in the first year of the treatment. No clear benefit of HRT has been associated to treatment of Alzheimer disease, and is still under investigation its role in the prevention of the disease. CONCLUSIONS: 1) A careful analysis of advantages and risks of HRT must be done before its use. 2) The treatment must be instituted on an individual basis and should be discussed with each patient.

Terapética hormonal de reemplazo. Beneficios y riesgos / [Hormonal replacement therapy. Benefits and risks]

A woman lives an average of between 25 to 30 years since the beginning of menopause. This period of life is characterized for the appearance of chronic diseases. Estrogens are effective in controlling vasomotor symptoms and also over the loss of bone mineral density, therefore lowering the risk of fractures in about 25-30

. The use of unopposed estrogens (without progesterone) raises 8 to 10 times the risk of endometrial and 2 to 3 times the risk of deep venous thrombosis as well. Until now, no raise was seen in breast cancer in short treatments (less than 5 years) especially if they are not opposed with progesterone. The recent publication of the surprising data of the trial Women’s Health Initiative demonstrates a significative but small increase in the risk of breast cancer associated with the use of combined estrogen/progestin therapy proportional to the duration of the treatment. The reduction of the plasmatic levels of low density lipoproteins associated with the use of Hormonal Replacement Therapy (HRT), has not been linked to evident cardiovascular protection. There is a higher cardiovascular risk with the use of HRT in the first year of the treatment. No clear benefit of HRT has been associated to treatment of Alzheimer disease, and is still under investigation its role in the prevention of the disease. Conclusions: 1) A careful analysis of advantages and risks of HRT must be done before its use. 2) The treatment must be instituted on an individual basis and should be discussed with each patient.

Terapética hormonal de reemplazo. Beneficios y riesgos. / [Hormonal replacement therapy. Benefits and risks]

A woman lives an average of between 25 to 30 years since the beginning of menopause. This period of life is characterized for the appearance of chronic diseases. Estrogens are effective in controlling vasomotor symptoms and also over the loss of bone mineral density, therefore lowering the risk of fractures in about 25-30

. The use of unopposed estrogens (without progesterone) raises 8 to 10 times the risk of endometrial and 2 to 3 times the risk of deep venous thrombosis as well. Until now, no raise was seen in breast cancer in short treatments (less than 5 years) especially if they are not opposed with progesterone. The recent publication of the surprising data of the trial Womens Health Initiative demonstrates a significative but small increase in the risk of breast cancer associated with the use of combined estrogen/progestin therapy proportional to the duration of the treatment. The reduction of the plasmatic levels of low density lipoproteins associated with the use of Hormonal Replacement Therapy (HRT), has not been linked to evident cardiovascular protection. There is a higher cardiovascular risk with the use of HRT in the first year of the treatment. No clear benefit of HRT has been associated to treatment of Alzheimer disease, and is still under investigation its role in the prevention of the disease. Conclusions: 1) A careful analysis of advantages and risks of HRT must be done before its use. 2) The treatment must be instituted on an individual basis and should be discussed with each patient.