[Does obesity influence gestational hypertension?]. / Czy otylosc wplywa na rozwój nadcisnienia tetniczego u kobiet ciezarnych?

EPH gestosis is one from most serious complications stepping out in pregnancy. Reason of occurrence gestosis to this times did not become explained in spite of existences of many theories on theme etiopathogenesis. Stoutness weighty pregnant women in opinion many authors is factor predestinating to occurrences gestosis. Material investigative determined 2 groups: one group--43 healthy weighty pregnant women, and second group--18 pregnant women with gestosis. In each groups investigated one qualified average age of women, MAP, and body mass index (BMI). Our investigations had to answer on following questions: 1. has stoutness influence on course of pregnancy and of childbirth state of new-born child? 2. has stoutness influence on height of arterial pressure in pregnancy? The results shown one ascertained correlation between MAP and BMI in group of weighty pregnant women with EPH gestosis.

[Do leptin and neuropeptide Y influence blood pressure regulation in healthy pregnant women and women with preeclampsia?]. / Czy leptyna oraz neuropeptyd Y uczestnicza w regulacji cisnienia tetniczego u zdrowych kobiet ciezarnych oraz u ciezarnych z EPH-gestoza?

UNLABELLED: Leptin (LP) and neuropeptide Y (NPY) are involved in the regulation of appetite and energy expenditure. As was shown in our previous studies healthy non pregnant and pregnant women are characterized by a significant positive correlation between maternal body mass index (BMI) and plasma leptin concentration. On the other side participation of both leptin and obesity in the pathogenesis of essential hypertension is presumed. The present study aimed to answer the following question: to what extend LP and NPY are involved in the pathogenesis of arterial hypertension in pregnant women with EPH gestosis. One to 2 days before delivery plasma LP and NPY concentration were estimated in 43 healthy pregnant women, in 18 pregnant women with EPH gestosis and in 26 healthy non pregnant women. In pregnant women with EPH gestosis, mean arterial blood pressure (MAP) (114.6 +/- 1.3 mm Hg) and mean leptinaemia (21.9 +/- 8.5 ng/ml) were significantly higher than in healthy pregnant women (89.1 +/- 0.9 mm Hg and 15.0 +/- 1.3 ng/ml respectively) and in non pregnant women (MAP--91.56 +/- 1.4 mm HG i LP--10.9 +/- 1.7 ng/ml). In healthy pregnant women, in women with EPH gestosis and in healthy nonpregnant women plasma NPY concentrations were of similar magnitude (42.3 +/- 4.1 vs 43.7 +/- 8.5 vs 50.7 +/- 6.1 pg/ml respectively). In pregnant women with EPH gestosis a significant positive correlation was found between diastolic blood pressure or MAP and plasma NPY concentration. Leptinaemia was significantly correlated with systolic, diastolic and MAP respectively only when results obtained in both groups of pregnant women were analyzed together. CONCLUSIONS: 1) leptin seems to be involved in the regulation of blood pressure both in healthy and preeclamptic pregnant women, 2) participation of NPY in the pathogenesis of hypertension in preeclamptic women is likely.

[Response of vasoactive substance to blood pressure changes during hemodialysis in uremic patients]. / Profil czynników regulujacych napiecie naczyn w zaleznosci od zmian cisnienia tetniczego w czasie hemodializy u chorych na przewlekla mocznice.

UNLABELLED: Ultrafiltration during haemodialysis (HD) may be the cause of blood pressure (BP) decline due to reduction of blood volume. In some patients, however, BP does not decrease or even rises during HD. The aim of the study was to answer the question: do uraemic hypertensive patients, showing a decline of mean blood pressure (MAP) during HD session (group A) differ from those showing a stable MAP during HD session (group B) with respect to hormonal profile of aldosterone (ALD), vasopressin (AVP), atrial natriuretic peptide (ANP), endothelin-1,2 (ET-1,2), blood nitric oxide (NO) and plasma renin activity (PRA). A total of 39 haemodialysed, hypertensive patients (17 female, 22 men) were studied. 24 patients (group A) showed a MAP decline of 10 mm Hg or more, while 15 patients (group B) showed MAP changes of less than +/- 10 mm Hg during HD session. PRA, ALD, AVP, ANP, ET-1,2, NO concentration were assessed in blood samples withdrawn from the arterial blood line before HD and after 60, 120, 180 and 240 minutes of HD session. Plasma ET-1,2 and blood NO concentration were also assessed after 30 minutes of HD. BV was continuously monitored with a Crit-Line equipment, BP was measured before and every 30 minutes on HD. Before HD session both examined groups showed similar baseline plasma levels of ALD, AVP, ANP, ET-1,2, NO, PRA and MAP. A 4-hours HD induced a significant increase in plasma ALD and AVP concentrations and a significant decline in ANP level in both groups of patients. In group A, PRA and blood NO concentration increased significantly, while plasma ET-1,2, level did not change during HD. In group B, no significant changes in PRA and blood NO level were noticed, while plasma ET-1,2 rose markedly. In addition in group B, a significant positive correlation was found between MAP and plasma ET-1,2 level changes, but a significant negative correlation between MAP and blood NO level changes. CONCLUSION: Patients with a decline of MAP over 10 mm Hg during HD differ from those with a stable MAP by a different response of plasma ET and blood NO to HD induced volume changes.

Concentrations of leptin and neuropeptide Y in maternal plasma, umbilical cord blood and in amniotic fluid in pregnant women with EPH-gestosis.

Leptin is presumed to be related to body mass index (BMI) and body fat stores and is involved together with neuropeptid Y (NPY) in the regulation of appetite. As pregnancy is accompanied both by changes of BMI and appetite, performance of studies presented in this paper were fully justified. In 43 healthy pregnant women and in 18 pregnant women with mild or moderate EPH-gestosis, concentrations of leptin and NPY were estimated in maternal venous blood, umbilical cord blood and in amniotic fluid. The control group consisted of 26 healthy nonpregnant women. Healthy nonpregnant women showed a BMI of 23.08+/-0.65 kg/m2 which was significantly lower than in healthy pregnant women (26.9+/-0.4 kg/m2, p < 0.001) and in women with EPH-gestosis (29.7+/-0.9, p < 0.0001). Also in healthy pregnant women the BMI was significantly lower than in EPH-gestosis subjects (p < 0.001). In healthy nonpregnant women plasma leptin levels were significantly lower than in healthy pregnant and EPH-gestosis women (10.9+/-1.68 vs 14.99+/-1.28 vs 21.89+/-2.58 ng/ml, respectively). In umbilical cord blood plasma leptin levels were significantly lower than in maternal blood only in healthy pregnant women (7.37+/-0.69 vs 14.99+/-1.28 ng/ml) but not in EPH-gestosis subjects (18.06+/-3.38 vs 21.89+/-2.58 ng/ml). Leptin levels in amniotic fluid were significantly lower than in umbilical cord blood both in healthy pregnant women (2.25+/-0.20 vs 7.37+/-0.69 ng/ml) and EPH-gestosis women (6.58+/-2.62 vs 18.06+/-3.38 ng/ml). In EPH-gestosis women leptin levels were significantly higher than in healthy pregnant women in maternal blood (21.89+/-2.58 vs 14.99+/-1.28 ng/ml), umbilical cord blood (18.06+/-3.38 vs 7.37+/-0.69 ng/ml) and amniotic fluid (6.58+/-2.62 vs 2.25+/-0.2 ng/ml). In both examined pregnant groups plasma NPY levels were nonsignificantly lower in healthy pregnant and EPH-gestosis women (42.28+/-4.09 and 43.68+/-8.45 pg/ml, respectively) than in nonpregnant women 50.65+/-6.13 pg/ml). In normal pregnancy a significantly higher NPY level was found in umbilical cord blood as compared with respective values in EPH-gestosis women (116.28+/-17.0 vs 49.65+/-7.01 pg/ml). Finally in both examined groups of pregnant women the amniotic fluid NPY level was of similar magnitude (13.85+/-1.52 and 13.89+/-2.46 pg/ml in healthy pregnant and EPH-gestosis women respectively). No significant correlation was found between fetal birth weight and cord-serum leptin and NPY levels respectively.

[Nephrologic analysis of 94 women with diagnosed "primary" gestosis]. / Oddalna ocena nefrologiczna 94 kobiet z rozpznana gestoza "pierwotna".

Among 94 women with diagnosed "primary" gestosis during pregnancy, 67 patients demonstrated (3-6 months after delivery) chronic glomerulonephritis (25 women) or chronic pyelonephritis (28 women) or hypertension caused by others than nephrologic reasons. "Primary" gestosis was diagnosed correctly only in 29% cases. The most often reason of "secondary" gestosis was undiagnosed chronic nephropathy before and during pregnancy. Obtained results confirm other data informing that "primary" gestosis is a rare phenomenon.

Changes of vascular architecture independent of blood pressure in experimental uremia.

Striking alterations of the structure of arterial vessels of different caliber are a well-known feature of renal failure, but it is currently unknown to what extent they are a reflection of hypertension or of uremia per se. To address this issue further we studied subtotally nephrectomized rats, sham-operated and pair-fed with matched controls. After uremia of 14 days' duration, stereologic measurements were carried out on perfusion-fixed tissue. To eliminate a potential influence of hypertension, subgroups of animals received furosemide and hydralazine in the drinking fluid to yield daily doses of 15 mg/kg and 20 mg/kg, respectively. At the end of the experiment, systolic blood pressure (tail plethysmography) was 110 +/- 13.3 (mean +/- SD) mm Hg and 99.4 +/- 8.1 mm Hg in untreated and treated controls, respectively, and 132 +/- 20.7 mm Hg and 103 +/- 13.0 mm Hg in untreated and treated uremic animals, respectively (n = 5 to 10 animals per group). The wall:lumen ratio of intramyocardial small arteries was 0.056 +/- 0.011 and 0.052 +/- 0.006 in untreated and treated controls, respectively. In untreated and treated uremic animals, the corresponding values were 0.077 +/- 0.011 and 0.066 +/- 0.007 (P < .01; control v uremia, ANOVA). A similar increase, unaffected by blood pressure treatment, was found for wall thickness of intramyocardial arteries. Analogous changes were also noted in mesenteric arterioles and veins. Finally, aorta media thickness was significantly (P < .005) higher in uremic animals than in controls (138 +/- 29 micrometers v 103 +/- micrometers).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of elevated blood pressure and proteinuria on progression of mesangioproliferative glomerulonephritis]. / Wplyw nadcisnienia tetniczego oraz bialkomoczu na przebieg klebuszkowego rozplemowego mezangialnego zapalenia nerek (glomerulonephritis proliferativa mesangialis).

UNLABELLED: Mesangioproliferative glomerulonephritis (GNpm) is one of the most frequent histopathological forms in patients with proteinuria and erythrocyturia. The aim of this study was to assess the rate of deterioration of renal function in 39 patients with mesangioproliferative glomerulonephritis. All patients (25 M and 14 F, age from 19 do 55 year) were diagnosed in the Department of Nephrology Silesian University School of Medicine in Katowice two times: before and at least 12 month after renal biopsy respectively. 21 patients with mesangioproliferative glomerulonephritis was oligosymptomatic. In 6 patients the leading sign of GNpm was moderate arterial hypertension while in the other 22 nephrotic syndrome. 17 patients with mesangioproliferative glomerulonephritis received immunosuppressive medication while in the other 22 patients these drugs were not used. Deterioration of renal function was assessed using a progression index (PI) which is calculated by dividing delta of serum creatinine (mumol/l) by the observation period (months). Deterioration of renal function was faster in nephrotic patients (PI = 0.27 +/- 0.11 mumol creat./month) and in patients with the hypertensive form of mesangioproliferative glomerulonephritis (PI = 0.69 +/- 0.29 umol creat./month) than in patients with oligosymptomatic mesangioproliferative glomerulonephritis (PI = 0.06 +/- 0.04 mumol creat./month). Significantly slower deterioration of renal function was noticed in patients treated with immunosuppressive drugs than medicated only symptomatically (PI = 0.05 +/- 0.007 mumol creat./month vs 0.70 +/- 0.06 mumol creat./month). CONCLUSIONS: 1) Presence of hypertension and of a nephrotic syndrome does influence adversely the progression of mesangioproliferative glomerulonephritis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relationship between renal biopsy histopathology and profile of changes in serum protein, lipids and proteinuria in patients with nephrotic syndrome due to chronic glomerulonephritis]. / Zaleznosc pomiedzy obrazem histopatologicznym bioptatu nerki, a profilem zmian proteinogramu i lipidogramu surowicy oraz proteinuria u chorych z zespolem nerczycowym spowodowanym przewleklym klebuszkowym zapaleniem nerek.

UNLABELLED: Relationship was assessed between the type of renal pathology and the degree of plasma protein and lipid abnormalities in 59 patients with nephrotic syndrome due to chronic glomerulonephritis (GN). All patients were divided into 5 subgroups according to the type of renal pathology (extracapillary proliferative GN--23, mesangioproliferative GN--18, membranous GN--5, minimal changes--5, other--8 patients) and according to the presence (22 patients) or absence (37 patients) of altered interstitium (inflammation and/or fibrosis). In all patients the following parameters were analyzed: plasma levels of creatinine, total cholesterol and lipids, triglycerides, total protein, electrophoretic fractions of plasma proteins and urinary protein excretion. Type of renal pathology as well as presence of interstitial lesion did not influence the degree of protein and lipid abnormalities in nephrotic patients. Significantly more marked (p < 0.05) abnormalities in the serum and lipid profile were found in patients in whom 76-100% of all glomeruli were abnormal than in patients with a lower percentage of damaged glomeruli. CONCLUSION: Percentage of damaged glomeruli but not the type of renal pathology (glomerular or/and interstitial) are the main factors influencing the magnitude of abnormal serum protein and lipid profiles in nephrotic patients.

The effect of enalapril on glomerular growth and glomerular lesions after subtotal nephrectomy in the rat: a stereological analysis.

INTRODUCTION: Angiotensin converting enzyme (ACE) inhibitors have a beneficial effect on glomerular injury in different models of renal damage. Their presumed nephroprotective action has been related partly to actions on glomerular growth. We examined the effect of prophylactic administration of a moderate dose of enalapril (50 mg/l in drinking water) in male Sprague-Dawley rats on a diet containing 40% protein and moderate NaCl. METHODS: The rats were followed for 8 weeks after subtotal nephrectomy and compared with sham-operated matched controls. RESULTS: The number of glomeruli per kidney was reduced significantly in both the enalapril-treated and control groups. The median glomerulosclerosis index was significantly lower in the enalapril-treated than in the untreated subtotally nephrectomized rats. The mean absolute glomerular volume was significantly higher after subtotal nephrectomy, but was significantly lower in the enalapril-treated than in the untreated subtotally nephrectomized rats. The total numbers of cells per glomerulus and of mesangial or endothelial cells, as well as nuclear volumes of mesangial cells and the total capillary length per glomerulus, were all significantly higher after subtotal nephrectomy. These parameters were significantly lower in the enalapril-treated than in the untreated nephrectomized rats. The rise in systemic blood pressure was modest in the nephrectomized rats and the arteriolar volume: length ratio was unchanged by treatment with enalapril. CONCLUSIONS: In subtotally nephrectomized rats enalapril inhibits (but fails to reverse completely) the compensatory glomerular enlargement and the increase in mesangial cell number and activation, with a concomitant reduction in the development of glomerulosclerosis. The results is compatible with antiproliferative, and possibly antiangiogenic, actions of ACE inhibitors.

[Function of the renin-angiotensin-aldosterone system and atrial natriuretic peptide secretion in patients with acute non-inflammatory renal insufficiency]. / Czynnosc ukladu renina-angiotensyna-aldosteron oraz wydzielanie przedsionkowego peptydu sodopednego (ANP) u chorych na ostra niezapalna niewydolnosc nerek.

Plasma renin activity, blood aldosterone levels and ANP secretion have been studied in 15 patients with the acute non-inflammatory renal insufficiency prior to and after ACE blockade with captopril. The above parameters were investigated at rest and in water immersion. Captopril significantly enhanced plasma renin activity in both examined groups, and decreased blood serum aldosterone levels but only in healthy subjects. Captopril had no effect on serum ANP levels. Results did not reveal close correlation between ANP release and renin-angiotensin-aldosterone system activity in both healthy subjects and patients with the acute non-inflammatory renal insufficiency.

Beneficial effect of nifedipine and moxonidine on glomerulosclerosis in spontaneously hypertensive rats. A micromorphometric study.

The effect of calcium channel blockers on the development of glomerulosclerosis and progression of renal failure in different models of renal injury is still controversial. We compared the effects of blood pressure lowering with high doses of nifedipine (27 mg/kg body weight/day) and with the sympatholytic agent moxonidine (8 mg/kg body weight/day) in 6-month-old male spontaneously hypertensive rats (SHRsp). As controls we studied untreated hypertensive SHRsp and normotensive Wisfar-Kyoto rats (WKY). After 3 months of treatment, left ventricular (LV) weight and systolic blood pressure (tail plethysmography) were lower in both treated groups (144 +/- 21.4 mm Hg and 144 +/- 13.5 mm Hg v 193 +/- 38.6 mm Hg in untreated SHRsp), but remained higher than in WKY (116 +/- 16.0 mm Hg). Stereological analysis of perfusion fixed kidneys showed an unchanged total volume of cortex and medulla, but a higher mean glomerular volume in nifedipine treated SHRsp. The glomerulosclerosis index was similarly reduced by both antihypertensive agents (92.8 +/- 68.1 in untreated SHRsp v 27.2 +/- 12.9 and 18.2 +/- 9.8 in the two treatment groups, respectively). This was accompanied by a similar reduction of total cortical arterial wall volume (from 36.3 +/- 16.5 mm3 to 18.9 +/- 2.53 and 15.3 +/- 2.53 mm3, respectively) and by reduction of tubular atrophy or interstitial fibrosis, respectively. In this model nifedipine lowered blood pressure and inhibited development of glomerulosclerosis to the same extent as a sympatholytic agent. This was accompanied by increased glomerular volume and filtration area in nifedipine treated animals.

[Effect of thermal dehydration on blood levels of volume- regulating hormones and sweat electrolytes in patients with essential hypertension treated with propranolol]. / Wplyw odwodnienia termicznego na stezenie we krwi hormonów regulujacych wolemie oraz sklad elektrolitowy potu u chorych na nadcisnienie tetnicze samoistne leczonych propranololem.

The present study aims to answer the following questions: 1. do secretion of volume related hormones in patients with EH pre- and post treatment with propranolol differ from normotensive subjects if examined in thermal dehydration conditions; 2. is the electrolyte composition of thermal sweat related to the plasma profile of volume related hormones? and 3. does treatment by propranolol influence sweat electrolytes in EH patients. In 15 patients with EH and in 20 healthy subjects a thermal dehydration test was performed. In patients with EH this test was done twice: before treatment and after 6 weeks of propranolol therapy. In all subjects the plasma renin activity (PRA), aldosterone (Ald), AVP and ANP were measured before and after thermal dehydration. In sweat samples collected after 15' and 45' of thermal dehydration (the concentration of Na, K and Cl was assessed). In hypertensive patients before propranolol treatment significantly higher values of PRA, Ald and ANP were found, while sweat concentrations of Na and Cl were significantly lower than in controls. After propranolol treatment sweat electrolytes concentrations showed a tendency to normalize. No significant correlation was found between the plasma hormonal profile and sweat Na, K and Cl concentrations respectively both in controls and patients with EH pretreatment. A significant positive correlation was noticed only in hypertensive patients posttreatment between ANP and sweat potassium concentration respectively, and significant negative correlation between PRA and sweat sodium and chloride concentration. From results obtained in this paper it seemed, that volume related hormones (Ald, AVP, ANP) do not seem to influence markedly the electrolyte composition of thermal sweat both in healthy subjects and in hypertensive patients.

[Renin-angiotensin-aldosterone system (RAA) and vasopressin secretion in patients with chronic renal failure]. / Czynnosc ukladu renina-angiotensyna-aldosteron (RAA) oraz sekrecja wazopresyny u chorych na przewlekla niewydolnosc nerek.

Influence of blockade converting enzyme on plasma renin activity (PRA), aldosterone and vasopressin secretion in 12 hemodialyzed patients with chronic renal failure and in 21 healthy subjects was observed. Our observation were provided during bed rest and water immersion tests. We didn't observe statistically significant influence PRA (increase after converting enzyme blockade) on vasopressin secretion in patients with chronic renal failure and in healthy subjects. Correlation between PRA and vasopressin secretion was absent.

The activity of the renin-angiotensin-aldosterone (RAA) system and vasopressin secretion in patients with acute non-inflammatory renal failure.

In 12 patients with acute non-inflammatory renal failure (ANRF) and in 21 healthy persons the relationship was studied between the activity of the renin-angiotensin-aldosterone (RAA) system and vasopressin secretion. The study was carried out during the so called bed rest test and during water immersion (WI) after captopril-induced blockade of the angiotensin-converting enzyme. The results of these experiments suggest the absence of a close functional relationship between the activity of the RAA system and vasopressin secretion in patients with ANRF and in healthy controls.

Activity of the renin-angiotensin-aldosterone (RAA) and secretion of the atrial natriuretic peptide (ANP) in patients with chronic renal failure.

In 12 patients with chronic renal failure (CRF) treated with haemodialyses and in 21 healthy controls plasma renin activity (PRA) and the concentrations of aldosterone and atrial natriuretic peptide (ANP) were determined in serum before and after blockade of the angiotensin converting enzyme with captopril. The study was carried out under conditions of the so called bed rest test (BR) and water immersion test (WI). After captopril administration a significant rise of PRA was noted in both groups with a drop of aldosterone level which was significant only in the control group. Captopril administration had no effect on serum ANP level. The results of the study are not suggesting the presence of a close relationship between ANP secretion and the activity of the RAA system in healthy controls and in CRF patients.

[Study of vibration sensation in the aspect of disorders of calcium-phosphate metabolism in patients with chronic renal failure]. / Badanie czucia wibracji w aspekcie zaburzen gospodarki wapniowo-fosforanowej u chorych na przewlekla niewydolnosc nerek.

A group of 72 patients with chronic renal failure (22 non-dialysed and 50 hemodialysed) were studied for the behaviour of the threshold of vibratory sensibility in upper and lower limbs at frequencies of 125 and 250 Hz. The patients dialysed were examined just before hemodialysis. All the patients were studied for the following parameters: concentration of calcium, inorganic phosphates, PTH, creatinine, uric acid in the blood serum and the activity of general alkaline phosphatase and its thermolabile fraction (osseous). The patients dialysed differed from the patients non-dialysed in higher creatinine, uricemia and the activity of alkaline phosphatase, both general and its "osseous" fraction. But they did not differ significantly in the concentration of phosphates, PTH and calcemia . Two thirds of patients with chronic renal failure, both dialysed and non-dialysed, revealed a significant increase in the threshold of vibratory sensibility, better marked in lower limbs then in upper limbs. As opposed to patients non-dialysed, patients dialysed did not show a significant correlation between the level of PTH in blood serum and the threshold of vibratory sensibility. Dialysotherapy did not influence significantly the frequency of disorders in vibratory sensibility. Considering the fact of almost identical frequency of disorders in vibratory sensibility both in patients dialysed and non-dialysed and also the lack of correlation between the level of lesion of vibratory sensibility and the concentration of PTH in blood serum, the participation of parathormone in the pathogenesis of uremic neuropathy seems to be doubtful.

[Selected indicators of calcium-phosphate metabolism in patients with diabetes mellitus]. / Wybrane wskazniki gospodarki wapniowo-fosforanowej u chorych na cukrzyce.

The changes in blood serum concentrations of calcium, magnesium, inorganic phosphate, total activity of alkaline phosphatase and the activity of its bone fraction, as well as urinary excretion of calcium, phosphate, hydroxyproline and oxalate have been measured in 31 patients with insulin-dependent (type I) diabetes, in 31 patients with non-insulin-dependent (type II) diabetes and in 29 healthy subjects in the condition of low-calcium diet. The elevated urinary excretion of calcium, phosphate, hydroxyproline and oxalate, lowered blood serum level of magnesium, and increased total and bone fraction activities of alkaline phosphatase were found in diabetic patients. The urinary excretion of calcium and hydroxyproline, and the activity of bone fraction alkaline phosphatase were significantly higher in patients with type II diabetes than in those with type I diabetes. It was concluded that there is a significant relation between the state of metabolic normalization of diabetes and the degree of biochemical aberrations concerning calcium-phosphate metabolism.