Chronic Hypovolemia Associated with Accelerated Hypertension and Orthostatic Hypotension in a Patient on Continuous Ambulatory Peritoneal Dialysis
作者:
Takashi Touma,
Hiromi Muratani,
Kunitoshi Iseki,
Nobuyuki Kawazoe,
Shichi Takishita,
Koshiro Fukiyama,
期刊:
American Journal of Nephrology
(Karger Available online 1992)
卷期:
Volume 12,
issue 6
页码: 461-465
ISSN:0250-8095
年代: 1992
DOI:10.1159/000168499
出版商: S. Karger AG
关键词: End-Stage renal disease;Plasma renin activity;Baroreflex;Sympathetic nerve activity;Continuous ambulatory peritoneal dialysis
数据来源: Karger
摘要:
We report a patient with nondiabetic end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD) associated with chronic hypovolemia. Despite the administration of nilvadipine, the patient showed accelerated hypertension and concomitantly orthostatic hypotension. Plasma renin activity was markedly high, and blockade of angiotensin II action by captopril or an angiotension II antagonist decreased the supine blood pressure. This indicated that the enhanced activity of the renin-angiotensin system was the principal cause of the supine hypertension. The plasma concentration of norepinephrine was also very high. After correction of hypovolemia by blood transfusion, the enhancement of the renin-angiotensin system and high plasma norepinephrine level were reduced, and symptomatic orthostatic hypotension disappeared. The accelerated hypertension was easily controlled by the administration of low-dose captopril and nilvadipine. These findings suggest that chronic hypovolemia related to the intractable supine hypertension as well as orthostatic hypotension. Hypovolemia-induced enhancement of the renin-angiotensin system and sympathetic nerve activity may cause vasoconstrictive hypertension in patients on CAPD.
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