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Biomedical subjects

G Du Cailar

Publications and source records attributed to G Du Cailar.

12 recordsLinked to original sources
PubMed2000

Nephrotic-range proteinuria in patients with renovascular disease.

PURPOSE: Proteinuria is usually considered a manifestation of glomerular disease. We sought to describe the characteristics of patients with nephrotic-range proteinuria resulting from renovascular disease and to compare them with those of patients who had glomerulonephritis. SUBJECTS AND METHODS: We identified 14 patients with nephrotic-range proteinuria and renovascular disease and compared them with 14 patients who had nephrotic-range proteinuria and biopsy-proven glomerulonephritis, matched for sex, age, and glomerular filtration rate. RESULTS: Patients with renovascular disease were more likely to have known atherosclerotic vascular disease [13 of 14 (93%) vs 3 of 14 (21%), P < 0.0001) and were usually smokers [12 of 14 (85%) vs 3 of 14 (21%), P < 0.0001]. They also had a greater mean (+/- SD) difference between the lengths of their kidneys (29 +/- 10 vs 5 +/- 5 mm, P < 0.001); greater systolic blood pressure (203 +/- 22 vs 174 +/- 25 mm Hg, P < 0.005), plasma renin activity (17 +/- 19 vs 2 +/- 2 ng/mL/h, P = 0.005), and plasma aldosterone concentration (40 +/- 23 vs 11 +/- 10 ng/dL, P = 0.0001); and lower serum potassium levels (3.3 +/- 0.5 vs 3.8 +/- 0.5, P <0.05). Effective renal plasma flow was lower (139 +/- 68 vs 307 +/- 185 mL/min/1.73 m3) and filtration fraction was markedly greater (0.28 +/- 0.04 vs 0.15 +/- 0.07, P = 0.0001) in the patients with renovascular disease. After the oral administration of captopril, blood pressure, effective renal plasma flow, and glomerular filtration rate decreased only among patients with renovascular disease. Of the 14 patients with renovascular disease, 13 had evidence of renal artery thrombosis seen at angiography; 2 patients required dialysis, and 3 others died during follow-up. CONCLUSION: Our findings suggest that the patients with nephrotic-range proteinuria resulting from renovascular disease have distinct characteristics and a poor prognosis.

Aged↗
PubMed1999

[Primary dysautonomia in the elderly: the diagnostic value of the inversion of the circadian rhythm of arterial blood pressure].

PURPOSE: Ambulatory blood pressure monitoring allows characterization of the circadian variations in blood pressure. METHODS: In order to investigate the diagnostic value of circadian variations in blood pressure in the elderly, 11 patients with autonomic failure and 11 control subjects paired on age, blood pressure level and daily life activity range were studied. RESULTS: Periodic postural disorders, positive response to passive tilt-test and alpha denervation supersensitivity to noradrenaline were found in all patients with autonomic failure. In control subjects, blood pressure levels assessed by ambulatory monitoring were lower at night. Conversely, circadian variations in blood pressure were higher at night and lower in the morning in patients with autonomic failure. The nadir of blood pressure measurement was related with the reported time of peak incidence of orthostatic symptoms. CONCLUSION: Ambulatory 24-hour blood pressure monitoring may therefore be of value in the diagnosis and management of patients with autonomic failure.

Activities of Daily Living↗
PubMed1999

Microalbuminuria in essential hypertension.

Urinary excretion of albumin exceeds normal values in 10 to 25% of patients with essential hypertension. The level of albuminuria is highly correlated with arterial pressure, and more closely with ambulatory arterial pressure. The interaction between albuminuria and arterial pressure is enhanced by overweight, smoking, protein intake, insulin resistance, lipid abnormalities, and possibly genotypes of the components of the renin-angiotensin system. The renal mechanisms of microalbuminuria are not well elucidated. Notably, an increase in filtration fraction suggestive of intraglomerular hypertension was observed in patients with hyperfiltration. Microalbuminuria may be a marker of diffuse vascular abnormalities predisposing to cardiovascular disease and/or hypertensive renal disease heralding future renal failure, but its predictive value needs to be tested in more long-term follow-up studies. Antihypertensive treatment has a varied influence on albuminuria; angiotensin-converting enzyme inhibitors may correct this abnormality (at least partially) better than other agents.

Albuminuria↗
PubMed1998

[Aging and regression of cardiac hypertrophy in the hypertensive patient].

OBJECTIVE: This study was aimed at determining factors acting on the regression of left ventricular hypertrophy due to essential hypertension. METHODS: It was a non-randomized, echocardiographic study of 60 previously untreated hypertensive subjects (20 to 75 years of age). RESULTS: Following a 5-year therapy, the decrease in the left ventricular mass was 14%. Normalization of blood pressure and reversal of left ventricular hypertrophy were obtained in 50% and 58% of patients, respectively. Patients of the non-responder group (non-response being defined as a less than 10% decrease in the left ventricular mass) were older and had a longer history of high blood pressure. A positive correlation was observed between age and decrease in the left ventricular mass, the latter being less marked in older patients. Antihypertensive drugs classes had no influence on reversal of left ventricular hypertrophy. CONCLUSION: Ageing may be a factor of resistance to the decrease in left ventricular mass with therapy. These results suggest that early screening and management of hypertension are essential.

Adult↗
PubMed1995

Albuminuria predicts renal functional outcome after intervention in atheromatous renovascular disease.

BACKGROUND: Atheromatous renovascular disease is increasingly recognized as a cause of renal failure; however, the benefit of intervention on renal function outcome cannot be clearly anticipated. OBJECTIVE: To identify reliable predictor(s) of renal functional outcome after revascularization in patients with atheromatous renovascular disease. DESIGN: The effect of percutaneous transluminal renal angioplasty (n = 5) or surgery (n = 18) on glomerular filtration rate ([99mTc]-diethylene triaminopenta-acetic acid clearance) and renal haemodynamics was prospectively assessed in 23 patients with atheromatous renovascular disease (unilateral occlusion in five, unilateral stenosis in four, stenosis of a single kidney in five, unilateral occlusion associated with contralateral stenosis in six, bilateral stenosis in three). Renal function was altered in 18 patients. RESULTS: At early follow-up study (5 +/- 1 months) after intervention, glomerular filtration rate improved (i.e. increased by more than 15%) in six patients, deteriorated in five and remained unchanged in 12 patients. The change in glomerular filtration rate associated with intervention was inversely correlated with the pre-intervention level of urinary albumin excretion and positively with the change in effective renal plasma flow after intervention. Stepwise regression analysis showed that pre-intervention urinary albumin excretion was the only predictor of the glomerular filtration rate response to intervention. At late follow-up study (32 +/- 6 months, n = 13), glomerular filtration rate was stable compared with early follow-up determination in non-proteinuric patients whereas it had deteriorated further in proteinuric patients. CONCLUSION: In patients with atheromatous renovascular disease, albuminuria may be considered as a marker of pre-existing intra-renal vascular and glomerular damage and a reliable predictor of renal functional outcome after intervention.

Adult↗
PubMed1993

Comparative renal and cardiac effects of tertatolol and enalapril in essential hypertension.

The influence of a 3-month antihypertensive treatment on cardiac structure and renal function was assessed in patients with uncomplicated essential hypertension randomly allocated to treatment by the nonselective beta-blocker tertatolol or the angiotensin-converting enzyme inhibitor enalapril. Both tertatolol and enalapril treatments were associated with a similar decrease in mean arterial pressure (-26 +/- 6 and -15 +/- 2 mm Hg, respectively, both p < 0.05 in comparison with baseline values) and left ventricular mass (echocardiography: -48 +/- 17 vs. -18 +/- 6 g) but no change in glomerular filtration rate (DTPA clearance). Renal vascular resistance decreased similarly in both groups. Urinary albumin excretion was not significantly modified in either group. These results indicate that a consistent reduction in arterial pressure by either treatment was associated with a proportional change in left ventricular geometry and no alteration in renal function.

Adrenergic beta-Antagonists↗
PubMed1992

Sodium and left ventricular mass in untreated hypertensive and normotensive subjects.

To determine whether urinary sodium excretion (a rather rough estimate of sodium intake) can influence left ventricular mass independently of arterial pressure, 91 untreated subjects with essential hypertension and 50 normotensive subjects of similar age were studied. Left ventricular mass index (M-mode echocardiography) was positively correlated with urinary sodium excretion in hypertensive (r = 0.22, P less than 0.01) as well as normotensive subjects (r = 0.22, P less than 0.05), and systolic arterial pressure was correlated only in hypertensive subjects (r = 0.23, P less than 0.01). When hypertensive subjects were divided into groups with appropriate or inappropriate left ventricular mass by reference to a theoretical optimal left ventricular mass for each subject's level of systolic arterial pressure, left ventricular mass was appropriate in 68% and inappropriate in 32% of subjects. Urinary sodium excretion was higher in subjects with inappropriate left ventricular mass compared with those with appropriate left ventricular mass. In conclusion, sodium excretion may be an important modulator of the influence of arterial pressure on the left ventricle in normotensive subjects and subjects with essential hypertension.

Adolescent↗
PubMed1992

[Left systolic ventricular function and metabolic disorders in untreated hypertensive patients].

Previous studies have shown that essential hypertension is frequently associated with insulin resistance and hyperinsulinism. Because insulin may exert a direct positive inotropic as well as chronotropic effect and controlled the initiation of peptide chains in the heart, we tested the hypothesis that insulin may be a determinant of myocardial hypertrophy and contractility. The relation between glucose metabolism (assessed by the oral glucose tolerance test) and left ventricular (LV) mass and function (assessed by echocardiography) was explored in 47 never-treated lean essential hypertensive patients (EH) of short duration and 19 normotensive subjects (NT). A greater number of EH versus NT (23 vs 5%) had an abnormal glucose tolerance. The fasting insulin-to-glucose ratio was significantly higher in EH as compared to NT. Fasting as well as integrated serum insulin to glucose values ratio were positively correlated with heart rate (r = 0.35, p < 0.05, r = 0.38, p < 0.05) and the LV end-systolic stress to volume ratio (r = 0.48, p < 0.001, r = 0.54, p < 0.001) but not with LV mass (r = 0.02, r = 0.02) in EH. When EH were divided into those with normal (n = 36) and supernormal (n = 11) LV contractility based on the relationship between LV fractional shortening and LV end-systolic stress, integrated insulin level and fasting insulin to glucose ratio were markedly higher in patients with supernormal LV contractility, whereas arterial pressure, heart rate, urinary sodium excretion, and plasma renin activity were similar in the two groups. We concluded that hyperinsulinemia and LV hypercontractility are associated in patients with hypertension of short duration. If chronic hyperinsulinemia is to be causally related to hypertension, one would have to postulate that the effects (inotropism and chronotropism) of insulin on the heart can be dissociated from the resistance to the glucose-lowering action of insulin.

Blood Glucose↗