saralasin and Postoperative-Complications

In a multicentric prospective study should be tested clinically the effectiveness and the tolerance of an angiotensin-II-antagonist (Saralasin-IWF) developed by the Institut für Wirkstofforschung der Akademie der Wissenschaften, its position in the differential-diagnostic step programme of the arterial hypertension should be analysed and with it should be performed pathogenetic investigations for hypertension after kidney transplantation. Taking into consideration international studies our results confirm that the Saralasin test, taking into account strongly standardized methodical prerequisites, is suited to objectify a participation of the RAAS in the hypertension pathogenesis, without, however, thus making an absolutely reliable evidence concerning the etiology of hypertension. The Saralasin test may represent an important diagnostic criterion for an optimization of the therapy of "volume-resistant" hypertension under the conditions of haemodialysis and in connection with selective renin determinations it possesses a high value in the screening diagnostics of the arterial stenosis after allogenic kidney transplantation.

Topics: Blood Pressure; Diagnosis, Differential; Humans; Hypertension; Hypertension, Renal; Hypertension, Renovascular; Kidney Transplantation; Postoperative Complications; Renal Dialysis; Saralasin

Cadaver kidney donors were treated with Angiotensin II-Analogon-Saralasin before nephrectomy in order to reduce the rate of acute renal failure. Eighteen (64.3%) of the recipients of the 30 donor kidneys pretreated with Saralasin were primarily free from dialysis. Six recipients showed acute renal failure. Two donor kidneys never resumed their function and no reports could be obtained on two organs. In the control-group with no pre-treatment, acute renal failure appeared significantly more often (67.3%). Thus only 32.7% of the recipients needed no further dialysis. This difference is statistically significant.

Topics: Acute Kidney Injury; Adolescent; Adult; Cadaver; Humans; Kidney Function Tests; Kidney Transplantation; Nephrectomy; Postoperative Complications; Premedication; Renin-Angiotensin System; Saralasin

The saralasin acetate test was performed in 17 hypertensive patients with renal transplants. These results were compared with 39 previously published reports of transplant patients who had been tested in the same manner. Eighty-two percent of our patients had a positive saralasin acetate test, suggesting renin-dependent hypertension. Baseline plasma renin activity (PRA) was significantly higher in patients with positive tests (6.96 +/- 1.75 v 2.88 +/- 0.53 ng/mL/hr). However, positive tests were obtained in several patients who had normoreninemia, and PRA levels did not correlate with the magnitude of vasodepressor BP response to saralasin. Transplant artery stenosis, acute rejection, and chronic rejection were the most common posttransplant complications associated with a positive test, but several patients had hypertension alone. While highly sensitive for renin-dependent hypertension posttransplantation, the test had poor specificity for identification of any one cause of posttransplant hypertension.

Topics: Blood Pressure; Follow-Up Studies; Graft Rejection; Humans; Hypertension, Renal; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Renal Artery Obstruction; Renin; Saralasin

Saralasin was used as a functional test of the renin-angiotensin axis in 4 renal transplant patients with hypertension. Blood pressure was recorded by an automatic recording device and plasma renin activity was measured by radioimmunoassay of angiotensin I. A positive saralasin test suggested renin-mediated hypertension despite normal peripheral renin levels in a 40-year-old man whose original kidney disease was nephrosclerosis. Since the blood pressure was refractory to intravenous sodium nitroprusside saralasin was used for 14 hours to control blood pressure before and after arteriography in the patient. Removal of the native kidneys markedly ameliorated the hypertension. A 35-year-old woman with transplant hypertension was responsive to angiotensin blockade only during a period of abrupt worsening of blood pressure associated with an acute rejection episode. Finally, 2 patients with advanced chronic rejection responded to saralasin administration. These studies confirm that 1) angiotensin blockade is a useful tool in the diagnosis of renin-dependent hypertension even when plasma renin levels are not elevated, 2) saralasin can be used to control renin-dependent forms of hypertension that are refractory to intravenous sodium nitroprusside therapy and 3) transplant hypertension associated with acute and chronic rejection appears to be renin-dependent.

Topics: Adult; Angiotensin II; Blood Pressure; Female; Graft Rejection; Humans; Hypertension; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Renin; Saralasin; Transplantation, Homologous

Many potential cadaveric kidney donors have been exposed to shock or hypotension before or during organ donation. Renin-mediated vasoconstriction has been implied in the pathogenesis of acute renal failure. High renin levels have been associated with poor graft survival under hypothermic pulsatile perfusion. An attempt was made to block renin effect with Saralasin (1-Sar-8-ala-angiotensin II), a competitive blocker. Eight conditioned mongrel dogs had their renal arteries exposed, and Saralasin, 100 microgram, was injected intra-arterially. Warm ischemia was then induced for 30 min. Thereafter, the kidney was removed and placed under hypothermic pulsatile perfusion for 24 hours, during which time Saralasin was given continuously at a rate of 1 microgram/min. The kidneys were reimplanted in the same animal on the contralateral iliac fossa, Saralasin, 100 microgram, was given intraarterially after implantation, and a contralateral nephrectomy was performed. Four control animals were given saline solution instead of Saralasin. No significant differences were noted in perfusion characteristics and postoperative creatinine values between treated and control groups. This apparent lack of protective effect of angiotensin II competitive blocker suggests that in the pathophysiology of acute renal failure other factors could be involved besides renin release.

Topics: Acute Kidney Injury; Angiotensin II; Animals; Blood Pressure; Creatinine; Dogs; Female; Ischemia; Kidney; Kidney Transplantation; Postoperative Complications; Saralasin; Transplantation, Autologous; Vascular Resistance

Renin, aldosterone and exchangeable sodium were measured in 38 hypertensive and 56 normotensive renal transplant recipients with good renal function and without renal artery stenosis. Response to competitive blockade of angiotensin II using saralasin was studied in 20 of the hypertensive group. Hypertension was uncommon when bilateral nephrectomy had been performed. When diseased kidneys remained in situ, blood pressure after transplantation correlated well with blood pressure on dialysis. Plasma renin activity was higher in hypertensive patients despite higher exchangeable sodium levels. Urinary aldosterone was also higher and correlated well with blood pressure and plasma renin activity. Angiotensin II blockade produced a fall in blood pressure proportional to plasma renin activity. These observations suggest that hypersecretion of renin is an aetiological factor in the hypertension of renal transplant recipients. It appears to act both through the stimulation of aldosterone secretion, with resultant salt retention, and through the direct vasoconstrictor action of angiotensin II. Since renin levels were lower in patients subjected to bilateral nephrectomy the source of the excess renin is probably the host's kidneys.

Topics: Adult; Aldosterone; Blood Pressure; Humans; Hypertension; Kidney; Kidney Transplantation; Middle Aged; Postoperative Complications; Renin; Saralasin; Sodium; Transplantation, Homologous

Topics: Adolescent; Angiotensin II; Aortic Coarctation; Blood Pressure; Child; Child, Preschool; Humans; Hypertension; Postoperative Complications; Renin; Saralasin

To define the role of the renin-angiotensin system in post-transplantation hypertension we studied 12 hypertensive recipients of renal transplants. The patients received saralasin acetate, an angiotensin II antagonist, while on a normal sodium diet and again after seven days of sodium restriction. In six patients with only one kidney, saralasin did not lower blood pressure on either diet; salt depletion did not lower systolic or diastolic blood pressures. In six patients with more than one kidney, salt depletion also did not lower blood pressure; however, salt depletion plus saralasin lowered their systolic pressures from a mean (+/- S.E.M.) of 146 +/- 9 to 128 +/- 8 mm Hg, and mean diastolic pressures fell from 103 +/- 5 to 89 +/- 5 (P less than 0.001). In four of five patients renal-vein renin activity was greater in one or more host kidneys than in the transplant kidney (or kidneys). Although pre-transplant blood pressure was the same in both groups, post-transplantation hypertension is more likely to be angiotensin II-dependent in patients with more than one kidney.

Topics: Adolescent; Adult; Aldosterone; Angiotensin II; Blood Pressure; Diet; Female; Humans; Hypertension; Infusions, Parenteral; Kidney; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Renal Veins; Renin; Saralasin; Sodium; Transplantation, Homologous