Association of serum copeptin and urinary uromodulin with kidney function, blood pressure and albuminuria at 6 weeks post-partum in pre-eclampsia

BackgroundPreeclampsia (PE) is associated with subsequent higher risk of cardiovascular and kidney disease. Serum copeptin, as a proxy for vasopressin, and urinary uromodulin, were associated with PE physiopathology and kidney functional mass respectively. We describe concentrations of these proteins in the post-partum period and characterize their association with persistent hypertension (HTN) or albuminuria.MethodsPatients with PE and healthy controls with uncomplicated pregnancy were prospectively included at two teaching hospitals in Switzerland. Clinical parameters along with serum copeptin and urinary uromodulin were measured at 6 weeks post-partum. PE patients were further characterized based on presence of HTN (defined as either systolic BP (SBP) ≥140 mmHg or diastolic (BP) ≥90 mmHg) or albuminuria [defined as urinary albumin to creatinine ratio (ACR) ≥3 mg/mmol].ResultsWe included 226 patients with 35 controls, 120 (62.8%) PE with persistent HTN/albuminuria and 71 (37.1%) PE without persistent HTN/albuminuria. Median serum copeptin concentration was 4.27 (2.9–6.2) pmol/L without differences between study groups (p > 0.05). Higher copeptin levels were associated with higher SBP in controls (p = 0.039), but not in PE (p > 0.05). Median urinary uromodulin concentration was 17.5 (7.8–28.7) mg/g with lower levels in PE patients as compared to healthy controls (p < 0.001), but comparable levels between PE patients with or without HTN/albuminuria (p > 0.05). Higher uromodulin levels were associated with lower albuminuria in PE as well as control patients (p = 0.040).ConclusionSerum copeptin levels at 6 weeks post-partum are similar between PE patients and healthy controls and cannot distinguish between PE with or without residual kidney damage. This would argue against a significant pathophysiological role of the vasopressin pathway in mediating organ damage in the post-partum period. On the opposite, post-partum urinary uromodulin levels are markedly lower in PE patients as compared to healthy controls, potentially reflecting an increased susceptibility to vascular and kidney damage that could associate with adverse long-term cardiovascular and kidney outcomes

Quelques grilles de lecture pour mieux comprendre son patient hypertendu

L'hypertension artérielle est bien identifiée comme l'un des principaux facteurs de mortalité et d'atteinte cardiovasculaire et rénale dans le monde. Pourtant, la moitié des sujets hypertendus ne sont pas diagnostiqués, et seul le quart des patients a des valeurs normalisées par le traitement. Cet article propose, à l'aide de courtes vignettes cliniques, des grilles de lecture pour mieux comprendre son patient, en se plaçant dans la relation d'un cabinet de consultation, ainsi qu'une lecture de la problématique du patient de son point de vue, afin de déceler les obstacles, outils et ressources disponibles pour améliorer la prise en charge de l'hypertension artérielle

Hyperaldostéronisme primaire

After the age of 45 years more than 50% of the population will suffer from hypertension. The most common etiology is primary hypertension; however, in cases of severe or refractory hypertension, one should always look for secondary causes. Primary hyperaldosteronism will be the most common etiology. We will review the causes of hyperaldosteronism and discuss its diagnosis, algorithms and treatment

Hypertension arterielle résistante

Resistant hypertension (rHTN) is a frequent problem with a high impact on cardiovascular risk. The preferred diagnostic approach is to systematically evaluate risk factors for rHTN and the presence of secondary hypertension. The follow-up of several key elements will often allow an improvement of blood pressure. Four therapeutic classes or even more are often used in these patients. Adding an aldosterone antagonist is often beneficial. Monitoring of patient compliance by electronic medication event monitoring systems can be helpful. Several new therapeutic approaches are currently in development: antagonists of the endothelin receptor and two interventional methods, carotid sinus stimulators and catheter-based renal sympathetic denervation therapy, have shown some promise

Hypertensions gravidiques : considérations pratiques

Hypertension is the most frequent medical disorder of pregnancy. Whether in the form of a chronic hypertension or a pregnancy induced-hypertension, or preeclampsia, it is associated with major maternal and neonatal morbidity and mortality. Improvement of prenatal care allowed a reduction in the number of poor outcomes. However, our partial understanding of the origin of gestational hypertension and preeclampsia limits the establishment of robust prediction models and efficient preventive interventions. This review discusses actual considerations on the clinical approach to hypertension in pregnancy

Sexualité, coeur et chocolat

All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption