Exercise Activates Renal Dysfunction in Hypertensi

Authors: Clorius John H Mandelbaum Alexander Hupp Thomas Reinbold Fritz Zuna Ivan Denk Stefan Fellhauer Constanze van Kaick Gerhard

Publish Date: 1996/07/01

Volume: 9, Issue: 7, Pages: 653-661

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Abstract

John H Clorius Alexander Mandelbaum Thomas Hupp Fritz Reinbold Ivan Zuna Stefan Denk Constanze Fellhauer Gerhard van Kaick Exercise Activates Renal Dysfunction in Hypertension American Journal of Hypertension Volume 9 Issue 7 July 1996 Pages 653–661 https//doiorg/101016/0895706196000362A bilateral exercisemediated renal functional abnormality was first described more than a decade ago The disturbance is specific for hypertension is seen in different forms of hypertension and has been studied most extensively in hypertensives with renovascular disease The bilateralabnormal exercise renogram identifies the disturbance Hypertensives with unilateral renovascular disease were studied in the continuing evaluation of the bilateral function disturbanceWe examined 31 hypertensives with documented unilateral renovascular disease all of whom had renography at rest and during 60 to 80 W ergometric exercise An additional seven normotensives and 17 essential hypertensives served as controls and had the same sequence of studies All patients reported upon continued on to an infusion clearance with 131Ihippurate and 111Indiethylenetriamine pentaacetic acid to determine glomerular filtration rate GFR and effective renal plasma flow ERPF at rest and during 25 W ergometric exerciseEighteen of 31 hypertensives with unilateral renovascular disease were found to have a bilateralabnormal exercise renogram Clearance examinations in these identified a prominent reduction of the GFR and a lesser decrease in the ERPF during exercise Hypertensives with normal exercise renograms did not have the exercise mediated abnormal clearance pattern Similar results were observed in the control population of essential hypertensives 65 of whom developed the functional disturbance The seven normotensives controls did not exhibit the exercise mediated function changesWe conclude that an exercisemediated bilaterally occuring functional disturbance exists in certain hypertensives who then have a bilateralabnormal exercise renogram Associated with this is a distinctly abnormal clearance during exercise which is characterized by a low filtration fractionAn exercise mediated tissue transport disturbance of the radiolabeled paraaminohippurate PAH analog hippurate was reported a decade ago in a population of unselected hypertensives1 The examined population had a normal transrenal 131Ihippurate transport when examined at rest Repeat examinations during ergometric exercise caused bilateral tissue entrapment of the labeled hippurate Slow tracer washout from the tissue resulted in delayed excretion of hippurate into the bladder and thereby caused an elevation of the excretory segment of the renogram The renographic pattern had not been described The known kinetics of hippurate however suggested that the exercise mediated change in tracer transport might well be an expression of an exerciseinduced disturbance of perfusion Evidence to date indicate that the disturbance is specific for hypertension12 and that it can not be recognized with the commonly used clinical tests employed in the evaluation of hypertension3 The disturbance was seen in nearly 60 of unselected hypertensives1 It was shown that bilateralabnormal exercise renograms occur in patients classified as having essential hypertension malignant and renoparenchymal hypertension as well as in hypertension associated with renovascular disease3 This last group has been used as a model to evaluate the disturbanceThis study continues to use hypertensives with renovascular disease to investigate exercisemediated renal dysfunction An earlier study had assessed global and unilateral glomerular filtration rate GFR and effective renal plasma flow ERPF in hypertensives with bilateralabnormal exercise renograms4 It was based on a much smaller patient population which did not permit the selective study of those with unilateral renovascular disease since one third of the patients had bilateral renovascular lesions Consequently we estimated GFR and ERPF for the “better” kidney This study estimates global and nonstenosed single kidney clearance values for a homogenous population of hypertensives with unilateral renovascular lesions The potential influence of largevessel disease on GFR and ERPF was thus eliminated for the nonstenosed kidneyIt was the goal of this study to define the investigated disturbance relative to clearance parameters and show that the disturbance while studied in hypertensives with renovascular disease is not specific to this population or caused by the vascular lesion

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