Chankova, P.

Nenov, D.

Ruseva, T.

Yankova, T.

English

Varna Medical University Press: Journals

ANGIOTENSIN-CONVERTING ENZYME IN PATIENTS W I T H CHRONIC R E N A L F A I L U R E ON HEMODIALYSIS P. Chankova, D. Nenov, T. Yankova, T. Ruseva Key-words: angiotensin-converting enzyme — chronic renal failure — haemodialysis — renin The serum angiotensin-converting enzyme ( A C E ) plays an important role in regulation of circulat ing vasoactive peptides. A C E realizes the interre-lation between k in in and renin-angiotensin system ( R A S ) by means of con-verting angiotensin — I into angiotensin — I I and of simultaneous inact ivat ion of the hypotensive bradykin in (1,4) . A number of authors confirmed its importance for the diagnostics and treat-ment of sarcoidosis (11). A C E diagnostic significance in various kinds of pulmo-nary , sk in , heart, and liver diseases was also discussed (7, 8, 10, 13). Recently, treatment of severe hypertension which is hard to be we l l in hand was directed towards A C E - i n h i b i t i n g drugs (1) . A C E intrarenal secretion, its high tubu-lar epitheloid cells ' concentration, its impossibil i ty to pass through the intact glomerule as wel l as the attempt to find a manner of treating severe, even dia-lysis-resistent hypertension asks a question of its diagnostical importance in chronic renal failure ( C R F ) patients (12). H a v i n g in mind the possibilities for altering the lung epitheloid cells during hemodialysis ( H D ) and the related disturbances of k in in , f ibrinolytic , complement, and renin-angiotensin sys-tems (2, 3, 4, 5, 9, 12), we had the a im to study A C E changes in C R F patients on chronic H D . Material and methods A C E level was studied in a total of 84 individuals divided into 3 groups: \ s t — 24 C R F patients (19 males and 5 females) aged between 20 and 54 years on maintenance H D for 3 t i l l 94 months long twice-thrice weekly wi th total du-ration of 12—15 hours by using the dialysator capi l la ry type " C O R D I S " ( U S A ) . Blood pressure 26,6—15,3/15,93—7,98 k P a , at the average 19,42 (11,17 k P a ; I I n d — 6 C R F patients (3 males and 3 females) aged between 30 and 56 years on conservative therapy; I I I r d — 54 c l in ica l ly healthy blood donors (30 males and 24 females) aged between 20 and 50 years. The serum A C E was determined spectrophotometrically according to Cushmas et Cheung's method (6) by using as substrate hippuri l , h i s t idy l , leucine — S E R V A ( G F R ) . I t was estimated in nmol/ml/min. Blood samples were taken in the morn-ing before meal at 0 °C. I t was done in H D patients before and after H D by using venous puncture of the arteriovenous fistula. H D patients' renin ac t iv i ty was determined in ng/ml/h by means of a radioimmunological method wi th test pack-age from the firm "Rotop" ( G D R ) . The results obtained were processed s ta t is t ica l ly according to the method of var ia t ion analysis and presented on tables. Angiotensin-converting enzyme in. Results and discussion A C E level didn't change s tat is t ical ly significantly in C R F patients both on H D (20,16=7,16) and without H D (18,37=8,55) as compared wi th that of the controls (19,57=6,88) (p>0,05) (see table 1). The dialysis procedure didn't cause T a b l e 1 ACE in CRF patients on HD and concervative treatment in nmol/ml/min C R F Patients Healthy without on hemodialysis dialysis before HD after HD x 19,57 18,73 20,16 23,26 S 6,88 8,55 7,16 12,05 Sx 0,93 3,82 1,46 2,40 any stat is t ical ly reliable changes of A C E values (from 20,16=7,16 before H D t i l l 23,28=12,05 after H D ) (p>0,05) (table 1). Th i s tendency towards A C E in-crease immediately after H D (table 1) is clarified after separation of certain H D patients wi th A C E values exceeding x + 2 S (table 2 and 3) at the end of H D . F r o m T a b l e 2 ACE in a group of 6 males with CRF on chronic HD according to x and 2S rates in nmol/ml/min after HD 19,63 6,17 1,12 28,26 4,10 1,82 39,98 4,79 2,13 this point of v iew it is to be noted that these patients show significant A C E chan-ges (p<0,05) at the end of H D and even before it as compared wi th the controls and C R F patients. A comparison is made wi th a collected control group (both males and fema-les) as we l l as wi th a control group of 30 healthy blood donors (males). There is no relation between A C E changes, on the one hand, and age, blood pressure, and H D duration, on the other. The assessment of renin did not reveal any significant changes at the end of H D both in the collected group of dialysed patients (2,52 = =±=0,36 before H D ; 2,18=0,48 after H D ) (p>0,05) and in the separated one (wi th higher A C E level (3 ,84=1,30 before H D and 1,98=0,55 after H D ) (p>0 ,05 ) . A C E level in H D patients was studied in a generalized group of C R F patients (on H D and conservative treatment) by R . Patel et a l . (12) who could not estab-l i sh any significant A C E changes in these patients as compared wi th those of the controls. However, they found out a s ta t is t ical ly reliable A C E difference in H D 70 P. Chankova, D. Nenov, T. Yankova, T. Ruseva T a b l e 3 Age, blood pressure and HD duration differences in 6 males with ACE levels overx + 2S after HD Systolic blood Patient Age (years) pressure к Pa Dialysis Diagnosis beginning ending duration (months) N . I . 40 21,71 13,30 7 glomerulo­nephritis P . D. 50 21,23 13,30 22 pyelonephritis Y . U . 37 17,29 15,96 19 polycystic disease G . B . 51 17,29 17,29 94 gout neph­ritis E . P . 37 17,29 17,29 75 glomerulo­I . G . nephritis 39 21,28 18,02 14 patients correlating wi th H D duration. Our results do not demonstrate such a correlation (table 3). I n contrast to R . Patel ' s et a l . data we establish a distinct A C E increase in 25 per cent of the patients at the end of H D (p<0 ,05 — table 2) and after repeated H D as compared wi th that of the healthy controls. According to some recent results (3, 5), lung endothelial cells are damaged during H D procedure. Hav ing in mind the enzyme localization in them (7, 8) A C E increase after H D could be due to these changes in 25 per cent of the patients. The reaction of some patients as proved by R . Patel et a l . can ' t exclude patients' indiv idual response against HD-induced hemostatic disturbances and the diffe­rent degree of complement act ivat ion followed by leukocyte microembolism (3) . HD-induced disbalance in R A S , k in in -ka l l ik re in , and f ibr inolyt ic systems con­firms our previous investigations (2). HD-induced A C E increase can be directly related to the increase of the total proteolytic ac t iv i ty following the decrease of some inhibitors of these systems (2) . Our results support the lack of correlation between renin and blood pressure in H D patients reported by D . Koev et a l . (4) on the one hand, and, between A C E , blood pressure, hematocrit, and age accord­ing to R . Patel et a l . (12), on the other. I t is obvious that the problem is very complicated and requires further inves­tigations. We can conclude that A C E changes in C R F patients on H D and conserva­tive treatment are insignificant in comparison wi th these of healthy controls (p>0 ,05) . I n 25 per cent of H D patients there is, however, a s ta t i s t ica l ly re l iable A C E increase after H D (p<0 ,05) . There is not any correlation between A C E changes, H D duration, patients' age, blood pressure and renin. R E F E R E N C E S 1. Б е л о в е ж д о в , H . Вътр. болести, 1981, № 6, 30—34. 2. Я н к о в а , Т . , П. Ч а н к о в а, Д . Н е н о в . В: Нац. K O H F P . вътр. болести, V I I . Плевен, 1982, с. 63 . З. В i s с h е 1, М. D. , F . L . О г г е 1 1 е, et a l . Trans., 19, 1973, 492—497. 4. С a 1 d -w e l l , M . D . , H . J . W i g g e r, et a l . Атег . J . Pathol., 105, 1981, 54 63. 5. С г a d d о с k , P . R . , F . F e n r, et a l . N . Engl. J . Med., 296, 1977, 769—774. 6. С u s h m a s, D. W . , Angiotensin-converting enzyme in. 7 i АНГИОТЕНЗИН-КОНВЕРТИНГ ЭНЗИМ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ, ЛЕЧИВШИХСЯ МЕТОДОМ ГЕМОДИАЛИЗА П. Чанкова, Д . Ненов, Т. Янкова, Т. Русева Р Е З Ю М Е Уровень ангиотензин-конвертинг энзима исследовался спектрофотометрическим мето­дом Cushmas u Cheung. Проведено исследование 84 больных, которые были распределены в три подгруппы: I группа — больных хронической почечной недостаточностью, лечившихся гемодиализом; I I группа — больных хронической почечной недостаточностью, лечившихся консервативно; I I I группа (контрольная) — клинически здоровых лиц. Не было установлено статистически значимых различий уровня ангиотензинконвертинг энзима у больных хронической почеч­ной недостатачностью на гемодиализе и у тех, которые лечились консервативно, по сравне­нию с контрольной группой клинически здоровых лиц. Статистически значимое повышение количества ангиотензин-конвертинг энзима после проведенного гемодиализа наблюдалось у 25 % больных, лечившихся этим методом. Полученные результаты не дают оснований уста­новить регулярную связь между изменениями ангиотензин-конвертинг энзима, продолжи­тельностью хронического диализа, возрастом больных, уровнем кровяного давления и ко ­личеством ренина. I H . S. C h e u n g . Biochem. Pharmacol., 20, 1971, 1637—1648. 7. F о u r r i е r, M . D . , et a l . Chest, 1983, 493—496. 8. H o l l i n g e r , A . M . , P. A . D a v i s. Chest, 1983, No. 4, 589— 590. 9. К о е v , D . , D . N е n о v , G . T a u s с h a n о v a. Sc, Sc i . Med., 16, 1979,73— 78. 10. L i e b e r m a n , J . Amer. J . Med., 59, 1975, 365—372. 11. L i е b е r m a n, J . , et a l . Ann. Intern. Med., 93, 1980, No. 6, 825—826. 12. P a t е 1, R . , A . A n s a r i , et a l . Dia lys . Transplant., 10, 1981, No. 12, 1001—1005. 13. R a f f, M . , H . B a r d a c h , M. M u l l e r . Arch. Dermatol. Res., 270, 1981, 341—345. 

ANGIOTENSIN-CONVERTING ENZYME IN PATIENTS WITH CHRONIC RENAL FAILURE ON HEMODIALYSIS

https://journals.mu-varna.bg/index.php/ssm/article/download/3162/2626

ANGIOTENSIN-CONVERTING ENZYME IN PATIENTS WITH CHRONIC RENAL FAILURE ON HEMODIALYSIS

Abstract

Similar works

Full text

Available Versions

Varna Medical University Press: Journals