Korean Journal of Nephrology 1987;6(1):127-132.

신이식후 발생한 고혈압에 대한 임상적 고찰

구완서 , 홍관수 , 김석영 , 최의진 , 장윤식 , 윤영석 , 김영우 , 방병기

Abstract

To evaluate the incidence of hypertenison and the role of renin-angiotensin system in post-transplant hyperten- sion, we studied 156 patients with well functioning renal grafts. The results were summerized as followes: 1) The incidence of hypertenison was 40.4 % in patients with well functioning renal graft. Renal trans- plantation on cyclosporine (44.7%) showed higher inci- dence of hypertension than on azathioprine (38.5%>, but did not reach statistical significance. 2) The baseline plasma renin activity (PRA) in patients with posttransplant hypertension (2.7±1.4 ng/ ml/hr) was higher than that of normal control and essential hypertension (1.6+0.8, 1.4+1.3ng/ml/hr p<. 001, respectively), and stimulated PRA and its percent increase were significantly higher than those of essen- tial hypertension (11.6±5.5ng/ml/hr, 269.0±251.4% vs 2.4± 2.8 ng/ml/hr, 70.3± 85.8%, p <.001, respectively). 3) The baseline plasa aldosterone value was signifi- cantly higher in patients with post-transplant hyperten- sion than that in normal control and essential hyperten- sion (64.1±57.2 vs 26.9±18.5, 30.8±26.1pg/ml p<.05, respectively). 4) There was significant inverse correlation between the baseline PRA and the change of mean arterial pressure 60 minutes after captopril (r= 0.56, p<.05). 5) Among the 4 patients of renovascular hypertension criteria by captopril test, only 1 patient was confirmed to have post-transplant renal artery stenosis detected by digital subtraction angiography. 6) In normotensive transplant patients, baseline PRA and aldosterone tended to be higher in patients on azathioprine than on cyclosporine, but difference in the aldosterone reached statistical significance. From these finding, it is suggested that activation of renin-angiotensin system maybe contribute to the gene- sis of post-transplant hypertension, and angiotensin eonverting enzyme inhibitor may be useful for the con- trol of intractable post-transplant hypertension.