Exercise Activates Renal Dysfunction in Hypertension

• Published in: American journal of hypertension Vol. 9; no. 7; pp. 653 - 661
• Main Authors: Clorius, John H, Mandelbaum, Alexander, Hupp, Thomas, Reinbold, Fritz, Zuna, Ivan, Denk, Stefan, Fellhauer, Constanze, van Kaick, Gerhard
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1996; Oxford University Press; Elsevier Science
• Subjects: Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; exercise; Exercise - physiology; Female; Gamma Cameras; Heart Rate - physiology; Hippurates; Humans; Hypertension; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; kidney; Kidney - diagnostic imaging; Kidney Diseases - diagnostic imaging; Kidney Diseases - etiology; Kidney Function Tests; Male; Medical sciences; Middle Aged; Radioisotope Renography; radioisotopes; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - physiopathology; Renal Circulation - physiology; renal dysfunction; renography; Hypertension; kidney; exercise; renal dysfunction; radioisotopes; renography; Radionuclide study; Physical exercise; Human; Urinary system; Renal artery; Stenosis; Unilateral; Cardiovascular disease; Exploration; Scintigraphy; Kidney
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/0895-7061(96)00036-2

A bilateral, exercise-mediated 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 bilateral-abnormal exercise renogram identifies the disturbance. Hypertensives with unilateral renovascular disease were studied in the continuing evaluation of the bilateral function disturbance. We 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 131I-hippurate and 111In-diethylenetriamine pentaacetic acid to determine glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) at rest, and during 25 W ergometric exercise. Eighteen of 31 hypertensives with unilateral renovascular disease were found to have a bilateral-abnormal 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 changes. We conclude that an exercise-mediated bilaterally occuring functional disturbance exists in certain hypertensives, who then have a bilateral-abnormal exercise renogram. Associated with this is a distinctly abnormal clearance during exercise which is characterized by a low filtration fraction. Am J Hypertens 1996;9:653–661