Exercise Activates Renal Dysfunction in Hypertension
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 e...
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Published in | American journal of hypertension Vol. 9; no. 7; pp. 653 - 661 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Elsevier Inc
01.07.1996
Oxford University Press Elsevier Science |
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Abstract | 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 |
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AbstractList | 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 occurring 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. 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 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 |
Author | Reinbold, Fritz Denk, Stefan van Kaick, Gerhard Clorius, John H Mandelbaum, Alexander Hupp, Thomas Fellhauer, Constanze Zuna, Ivan |
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Keywords | Hypertension kidney exercise renal dysfunction radioisotopes renography Radionuclide study Physical exercise Human Urinary system Renal artery Stenosis Unilateral Cardiovascular disease Exploration Scintigraphy Kidney |
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Notes | istex:2FEAE90AAE4636B2BFF8382B733E926269FD79C2 href:9_7_653.pdf Address correspondence and reprint requests to John H. Clorius, MD, German Cancer Research Center, Department of Oncologic Diagnosis and Therapy, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. ark:/67375/HXZ-RNC90VFQ-K ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
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References | Clorius, Ostertag, Raptou (BIB10) 1979; 20 Burckhardt, Ullrich (BIB14) 1989; 36 Pemsel, Mahlstedt, Lange (BIB21) 1979; 131 Hupp, Clorius, Allenberg (BIB22) 1991; 14 Clorius, Allenberg, Hupp (BIB23) 1987; 10 Hünermann, Weiβbach, Zwicker (BIB19) 1975; 3 Documenta Geigy, 7th ed. Stuttgart, Georg Thieme, 1975, p 527. Fine, Blaufox, Blumenfeld (BIB2) 1996; 37 Maher, Strong, Elveback (BIB6) 1971; 46 Nally, Clarke, Windham (BIB20) 1985; 26 Clorius, Schmidlin (BIB1) 1983; 24 Mackay, Eadil, Cumming (BIB7) 1981; 19 He, Tanigawara, Kamiya (BIB15) 1991; 19 Cohen (BIB9) 1974; 4 Geyskes, Oei, Puylaert (BIB17) 1987; 9 Stadalnik, Vogel, Jansholt (BIB8) 1980; 21 Clorius, Mann, Schmidlin (BIB3) 1987; 10 Mann, Pickering, Sos (BIB16) 1991; 90 Farmelant, Dukstein, Burrows (BIB18) 1970; 14 Hollenberg, Borucki, Adams (BIB12) 1978; 57 Esler, Julius, Zweifler (BIB13) 1977; 296 Clorius, Hupp, Mandelbaum (BIB24) 1995; 13 Clorius, Reinbold, Hupp (BIB4) 1993; 34 Clorius, Schmidlin, Raptou (BIB11) 1981; 140 Diem K, Lentner C: Wissenschaftliche Tabellen Burckhardt, G., Ullrich, K. J. 1989; 36 Esler, M., Julius, S., Zweifler, A. 1977; 296 Clorius, J. H., Hupp, T., Mandelbaum, A. 1995; 13 Hünermann, B., Weiβbach, L., Zwicker, H. 1975; 3 Hupp, T., Clorius, J. H., Allenberg, J. R. 1991; 14 Nally, J. V., Clarke, H. S., Windham, J. P. 1985; 26 Mackay, A., Eadil, A., Cumming, A. M. M. 1981; 19 Stadalnik, R. C., Vogel, J. M., Jansholt, A-L 1980; 21 Pemsel, H. K., Mahlstedt, J., Lange, H. 1979; 131 Clorius, J. H., Mann, J., Schmidlin, P. 1987; 10 Fine, E. J., Blaufox, M. D., Blumenfeld, J. D. 1996; 37 Farmelant, M. H., Dukstein, W., Burrows, B. A. 1970; 14 Cohen, M. L. 1974; 4 Hollenberg, N. K., Borucki, L. J., Adams, D. F. 1978; 57 Clorius, J. H., Schmidlin, P. 1983; 24 Clorius, J. H., Allenberg, J., Hupp, T. 1987; 10 Maher, F. T., Strong, C. G., Elveback, L. R. 1971; 46 Clorius, J. H., Ostertag, H., Raptou, E. 1979; 20 He, Yan-Ling, Tanigawara, Y., Kamiya, A. 1991; 19 Clorius, J. H., Reinbold, F., Hupp, T. 1993; 34 Geyskes, G. G., Oei, H. Y., Puylaert, C. B. A. J. 1987; 9 Clorius, J. H., Schmidlin, P., Raptou, E. 1981; 140 Mann, S. J., Pickering, T. G., Sos, T. A. 1991; 90 |
References_xml | – volume: 140 start-page: 231 year: 1981 end-page: 235 ident: BIB11 article-title: Hypertension associated with massive, bilateral, posture-dependent renal dysfunction publication-title: Radiology contributor: fullname: Raptou – volume: 296 start-page: 405 year: 1977 end-page: 411 ident: BIB13 article-title: Mild high-renin essential hypertension. Neurogenic human hypertension? publication-title: N Engl J Med contributor: fullname: Zweifler – volume: 26 start-page: 917 year: 1985 end-page: 924 ident: BIB20 article-title: Technetium-99m DTPA renal flow studies in Goldblatt hypertension publication-title: J Nucl Med contributor: fullname: Windham – volume: 46 start-page: 189 year: 1971 end-page: 192 ident: BIB6 article-title: Renal extraction ratios and plasma binding studies or radioiodinated orthoiodohippurate and iodopyracet and of publication-title: Mayo Clin Proc contributor: fullname: Elveback – volume: 131 start-page: 275 year: 1979 end-page: 280 ident: BIB21 article-title: Nierendurchblutung, Diurese und Isotopennephrogramm bei experimenteller Stenosierung der Nierenarterie (in German). publication-title: Rofo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr contributor: fullname: Lange – volume: 36 start-page: 370 year: 1989 end-page: 377 ident: BIB14 article-title: Organic anion transport across the contraluminal membrane-dependence on sodium publication-title: Kidney Int contributor: fullname: Ullrich – volume: 21 start-page: 168 year: 1980 end-page: 170 ident: BIB8 article-title: Renal clearance and extraction parameters of ortho-iodo-hippurate (I-123) compared with OIH (I-131) and PAH publication-title: J Nucl Med contributor: fullname: Jansholt – volume: 34 start-page: 48 year: 1993 end-page: 56 ident: BIB4 article-title: Renovascular hypertension: a perfusion disturbance that escaped recognition publication-title: J Nucl Med contributor: fullname: Hupp – volume: 24 start-page: 104 year: 1983 end-page: 109 ident: BIB1 article-title: The exercise renogram. A new approach documents renal involvement in systemic hypertension publication-title: J Nucl Med contributor: fullname: Schmidlin – volume: 19 start-page: 49 year: 1981 end-page: 57 ident: BIB7 article-title: Assessment of total and divided renal plasma flow by publication-title: Kidney Int contributor: fullname: Cumming – volume: 57 start-page: 167 year: 1978 end-page: 178 ident: BIB12 article-title: The renal vasculature in early essential hypertension: evidence for a pathogenic role publication-title: Medicine contributor: fullname: Adams – volume: 9 start-page: 451 year: 1987 end-page: 458 ident: BIB17 article-title: Renovascular hypertension identified by captopril-induced changes in the renogram publication-title: Hypertension contributor: fullname: Puylaert – volume: 10 start-page: 287 year: 1987 end-page: 293 ident: BIB3 article-title: Clinical evaluation of patients with hypertension and exercise-induced renal dysfunction publication-title: Hypertension contributor: fullname: Schmidlin – volume: 14 start-page: 200 year: 1991 end-page: 207 ident: BIB22 article-title: Renovascular hypertension: predicting surgical cure with exercise renography publication-title: J Vasc Surg contributor: fullname: Allenberg – volume: 90 start-page: 30 year: 1991 end-page: 40 ident: BIB16 article-title: Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations publication-title: Am J Med contributor: fullname: Sos – volume: 37 start-page: 838 year: 1996 end-page: 842 ident: BIB2 article-title: Exercise renography in untreated subjects with essential hypertension publication-title: J Nucl Med contributor: fullname: Blumenfeld – volume: 20 start-page: 462 year: 1979 ident: BIB10 article-title: ( publication-title: J Nucl Med contributor: fullname: Raptou – volume: 13 start-page: 33 year: 1995 end-page: 39 ident: BIB24 article-title: Repeat exercise renograms in hypertension identify persistant renal dysfunction publication-title: J Hypertens contributor: fullname: Mandelbaum – volume: 4 start-page: 23 year: 1974 end-page: 38 ident: BIB9 article-title: Radionuclide clearance techniques publication-title: Semin Nucl Med contributor: fullname: Cohen – volume: 14 start-page: 186 year: 1970 end-page: 189 ident: BIB18 article-title: Influence of water and manitol loads on radio-hippuran renal function curves publication-title: J Nucl Med contributor: fullname: Burrows – volume: 3 start-page: 81 year: 1975 end-page: 85 ident: BIB19 article-title: The renogram and individual publication-title: Urol Res contributor: fullname: Zwicker – volume: 19 start-page: 667 year: 1991 end-page: 690 ident: BIB15 article-title: Moment analysis of drug disposition in kidney. 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A. – volume: 140 start-page: 231 year: 1981 end-page: 235 article-title: Hypertension associated with massive, bilateral, posture-dependent renal dysfunction publication-title: Radiology contributor: fullname: Raptou, E. – volume: 10 start-page: 280 year: 1987 end-page: 286 article-title: Predictive value of exercise renography for presurgical evaluation of nephrogenic hypertension publication-title: Hypertension contributor: fullname: Hupp, T. – volume: 10 start-page: 287 year: 1987 end-page: 293 article-title: Clinical evaluation of patients with hypertension and exercise-induced renal dysfunction publication-title: Hypertension contributor: fullname: Schmidlin, P. – volume: 24 start-page: 104 year: 1983 end-page: 109 article-title: The exercise renogram. 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Neurogenic human hypertension? publication-title: N Engl J Med contributor: fullname: Zweifler, A. – volume: 131 start-page: 275 year: 1979 end-page: 280 article-title: Nierendurchblutung, Diurese und Isotopennephrogramm bei experimenteller Stenosierung der Nierenarterie (in German). publication-title: Rofo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr contributor: fullname: Lange, H. – volume: 19 start-page: 667 year: 1991 end-page: 690 article-title: Moment analysis of drug disposition in kidney. VI. Assessment of in vivo transmembrane transport of -aminohippurate in tubular epithelium publication-title: J Pharmacokinet Biopharm contributor: fullname: Kamiya, A. – volume: 9 start-page: 451 year: 1987 end-page: 458 article-title: Renovascular hypertension identified by captopril-induced changes in the renogram publication-title: Hypertension contributor: fullname: Puylaert, C. B. A. J. – volume: 26 start-page: 917 year: 1985 end-page: 924 article-title: Technetium-99m DTPA renal flow studies in Goldblatt hypertension publication-title: J Nucl Med contributor: fullname: Windham, J. P. – volume: 19 start-page: 49 year: 1981 end-page: 57 article-title: Assessment of total and divided renal plasma flow by I-hippuran renography publication-title: Kidney Int contributor: fullname: Cumming, A. M. 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Snippet | A bilateral, exercise-mediated renal functional abnormality was first described more than a decade ago. The disturbance is specific for hypertension, is seen... |
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SubjectTerms | 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 |
Title | Exercise Activates Renal Dysfunction in Hypertension |
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