Effect of prostaglandin A1 infusion in hypertensive patients with renal artery stenosis

Clinical data, arteriographic findings, peripheral and renal vein plasma renin activity (PRA) studies and responses to prostaglandin A1 infusion are presented from observations in seven hypertensive patients with renal artery stenosis. PGA1 infusion caused an increase in PRA and urine sodium excretion but no significant change in blood pressure. Exaggerated increases in PRA were observed in five patients. With cessation of PGA1 infusion PRA returned toward pre-infusion levels. In two patients bilateral renal and peripheral vein PRA's were determined before and during PGA1 infusion. PGA1 caused a greater increase in renal vein PRA than in peripheral vein PRA indicating a direct enhancement of renin secretion. These studies indicate possible relationships between the vasoactive prostaglandins and the renin-angiotensin system in the pathogenesis of hypertension due to renal artery stenosis.     

Induction of renin release by exogenous prostaglandins in hyporeninemic hypoaldosteronism

A deficiency in renal prostaglandin synthesis has been proposed as the cause of the syndrome of hyporeninemic hypoaldosteronism. To determine if renin release could be stimulated by pharmacologic infusions of PGA₁, we infused PGA₁ 0.075 to 0.60 μg/kg/min to nine patients with the syndrome. Total renal PGE production as measured by urinary PGE excretion was normal (650 ± 169 vs 400 ± 55 ng/24hr in normal subjects). Renin (PRA) was markedly depressed in all patients despite stimulation with upright posture and furosemide (1.0 ± 0.4 vs 9.3 ± 0.7 ng/ml/hr, p<0.001). But in two patients PGA₁ induced an increase in renin similar to that of normal subjects. PRA increased to a lesser degree in two other patients and plasma aldosterone slightly increased. Five showed no response. Infusions of nitroprusside in doses and duration that mimicked the hypotensive effects of PGA₁ failed to increase PRA or aldosterone. The data suggest that total renal PGE production is normal in patients with the syndrome of hyporeninemic hypoaldosteronism. Although orthostasis, furosemide and nitroprusside do not increase renin, prostaglandin A₁ infusion appears to be a potent stimulus to renin release in some of the patients.     

Prostaglandin and renal artery stenosis

This study in dogs demonstrated that the prostaglandin PGA₁ could alter the renal excretory pattern and renal renin secretion produced by partial renal artery occlusion. It gives support to the hypothesis that a prostaglandin (s) has to be considered in the biological reponse to partial renal artery occlusion.     

Effect of somatostatin on plasma renin activity.

Intravenous infusion of somatostatin in mongrel dogs caused a significant decrease in the peripheral plasma renin activity (PRA) enhanced by pentobarbital sodium anesthesia or furosemide treatment. However, the inhibitory activity vanished within 10 min after termination of somatostatin infusion. Intrarenal arterial infusion of somatostatin decreased furosemide-enhanced PRA in renal vein by 24.0%, 16.6% and 8.6% in dose of 0.1, 0.5 and 1.0 microgram, respectively. On the other hand, high doses of the peptide (50-200 microgram) failed to decrease. The changes in PRA occurred in the absence of any alteration in blood pressure during the intravenous infusion under furosemide treatment. In an in vitro study, the addition of somatostatin in doses of 0.01 and 0.05 microgram suppressed the renin release in dog renal cortical cell suspension by 74.3% and 53.6%, respectively. Therefore, in both intrarenal arterial infusion and the cell suspension system, somatostatin was increasingly effective in decreasing renin release towards the lower end of the dose range tested. These results suggest that the effect of somatostatin on hyperreninemia may involve an inhibition of renin release at the cell level in the kidney.     

Renal vein plasma adenosine 3',5'-cyclic monophosphate in renovascular hypertension.

The concentration of plasma adenosine 3'',5''-cyclic monophosphate (cyclic AMP) and plasma renin activity (PRA) were measured concomitantly in blood from both renal veins and in arterial blood in 22 hypertensive patients. In the nine patients with true renovascular hypertension the concentration of plasma cyclic AMP was greater in the venous effluent of the kidney affected by the renal artery stenosis than in that of the unaffected or less affected kidney. The arteriovenous difference in cyclic AMP concentration was less on the affected side in all but one patient. The arteriovenous differences in PRA identified the affected kidney as the source of hyper-reninemia and showed that renin release from the other kidney was suppressed. In the 13 patients with hypertension associated with but unrelated to renal artery stenosis there were no consistent patterns of cyclic AMP concentration or PRA in the venous effluent of the kidneys or of their arteriovenous differences. In renovascular hypertension the venous effluent of the kidney affected by renal artery stenosis contains not only more renin but also more cyclic AMP, owing to either increased cyclic AMP production or decreased excretion or extraction of cyclic AMP by the affected kidney. This unilateral increase in cyclic AMP concentration may become a complementary diagnostic feature of true renovascular hypertension.     

Role of prostaglandis in the control of renin secretion in the dog (II)

Infusion of prostaglandin E₁ (PGE₁) into the renal artery of anesthetized dogs (1.03 μg/min) caused increases in urine flow rate (V), renal plasma flow (RPF) and renin secretion rate without any change in mean arterial blood pressure (MABP), whereas infusion of prostaglandin F₂α (PGF_2α), (1.03 μg/min) caused no consistent change in V, RPF, or renin secretion rate. Infusion of prostaglandin E₂ (PGE₂) (1.03 μg/min) into the renal artery of “non-filtering” kidneys caused renin secretion rate to rise from 567.7 ± 152.0 U/min(M ± SEM) during control periods to 1373.6 ± 358.5 U/min after 60 minutes of infusion of PGE₂ (P < 0.01), without significant change in MABP (P > 0.1). The data suggest that PGE₁ and PGE₂ play a role in the control of renin secretion. The data further suggest that PGE may control renin secretion through a direct effect on renin-secreting granular cells.     

The Angiotensin Infusion Test and Peripheral Venous Renin Activity

Forty hypertensive patients were studied to examine the assumption that the angiotensin pressor dose reflects endogenous renin activity. Peripheral renin activity was assayed by the method of Boucher et al.⁴ Sensitivity to the infusion of synthetic angiotensin II was determined as suggested by Kaplan and Silah.¹Sixteen patients with essential hypertension with normal renal angiography required 3.8 ng. angiotensin/kg./min. to raise the diastolic pressure 20 mm. Hg. All but one were sensitive to angiotensin infusion of less than 5 ng./kg./min. Renin activity was normal in all except in one sensitive subject. Angiotensin infusion response and mean renin activity in 13 patients with essential hypertension with abnormal renal angiography were similar to that of the first group. The pressor dose in 11 renovascular hypertensives was 9.8 ng./kg./min. All but three had elevated plasma renin activity.Our results suggest that: (1) the angiotensin infusion test is suitable for differentiating patients with true renovascular hypertension from those with essential hypertension with or without associated renal artery disease; (2) the angiotensin pressor dose correlates with the level of peripheral venous renin activity (p < 0.01).     

Metabolism of prostaglandin A. I. The kidney cortex as a major site of PGA2 degradation

The antihypertensive and natriuretic prostaglandin A₂ (medullin) has been isolated and identified in rabbit renal papilla. Since PGA₂, unlike prostaglandin F₂ (PGE₂) and prostaglandin F_2α (PGF_2α), is not metabolized by the lung, studies were undertaken to determine if the site of PGA₂ metabolism is in the renal cortex where its primary vasodilatory and natriuretic effects occur. In $\text{in vitro}$ experiments, homogenates of renal cortex and outer medulla were incubated with ³H-PGA₂ (0.2 μc, 20 μg) at 37°C for 30 minutes. A metabolite(s) less polar than ³H-PGA₂ was observed following silicic acid chromatography of acidic lipid extracts of cortical, but not outer medullary homogenates. In $\text{in vivo}$ studies, ³H-PGA₂ (2 μc, 50 μg) was injected into the renal artery of the rabbit and blood withdrawn from the ipsilateral renal vein. At least three less polar major metabolites of PGA₂ were observed in the plasma within 15 seconds following injection. No appreciable ³H-PGA₂ was observed in venous plasma 30 seconds following injection of ³H-PGA₂. In contrast to plasma, the major urinary metabolites were more polar than PGA₂. The present study reveals that PGA₂ is almost completely metabolized in a single passage through the rabbit kidney suggesting this organ is a major site of PGA₂ metabolism.     

Synergic effects of kallikrein-kinin and prostaglandins on renin release on infusion of isolated hog kidney with aldosterone

The effects of infusion of a large amount of aldosterone into the renal artery of isolated perfused hog kidney on the release of renin, prostaglandins (PG) and kinin and the excretion of urinary kallikrein were investigated. Infusion of aldosterone at a rate of 100 ng/min (100 to 800 ng/ml of perfusate) resulted in significant releases of renin, PG (PGE₂, 6-0-PGF_1α), and kinin and increase in urinary kallikrein. Infusion of aldosterone and an inhibitor of kallikrein, aprotinin, decreased the releases of renin, PG and kinin and infusion of aldosterone with indomethacin decreased the release of PG but increased that of kinin and urinary kallikrein without significant change in renin releases. These findings suggest that the release of renin by aldosterone may result from synergic effects of renal PG and the kallkrein-kinin system.     

A comparison of the diuretic effects of prostaglandin A1, sodium ethacrynate,and placebo

The comparative diuretic activity of prostaglandin A₁ (PGA₁), sodium ethacrynate, and placebo was assessed in healthy volunteers. Known active dosages of the various agents were administered as intravenous infusions. In the first four hours after the start of the infusion, the ratio of urine output to liquid intake was higher for sodium ethacrynate than either PGA₁ or placebo. Sodium ethacrynate was the only treatment which significantly changed urinary electrolyte excretion. At the doses administered in this study, sodium ethacrynate was more effective as a diuretic than either PGA₁ or placebo. PGA₁ and placebo exerted nearly identical effects upon the variables studied. This study suggests that PGA₁ may be effective only in the presence of altered distribution of blood flow in renal disturbances where tubular functions are involved in maintaining electrolyte excretion.     

Effect of intravenous epinephrine infusion on plasma renin activity in adrenalectomized dogs

Previous experiments have shown that circulating epinephrine stimulates renin secretin and increases plasma renin activity (PRA) when it is infused intravenously, but not when it is infused directly into the renal artery at similar infusion rates. The present experiments were designed to test the hypothesis that the adrenal glands mediate the PRA response to intravenous epinephrine infusion. Accordingly, anesthetized dogs were prepared with either an acute bilateral adrenalectomy or a sham-adrenalectomy procedure. Epinephrine was then infused intravenously into each animal for 45 minutes at a rate of 25 ng X kg-1 X min-1. Time control experiments in which epinephrine was not infused were also conducted. In sham-adrenalectomized dogs, PRA (in nanograms per ml h-1) rose from 4.1 +/- 1.4 in the control period to 13.0 +/- 3.0 during intravenous epinephrine infusion (means +/- SE; p less than 0.01). In adrenalectomized dogs, PRA rose from 2.1 +/- 0.4 during the control period to 5.5 +/- 0.9 during intravenous epinephrine infusion (p less than 0.01). Neither the absolute increments in PRA nor the percent increases in PRA were significantly different between the two groups receiving epinephrine. PRA remained unchanged in time control experiments. These data demonstrate that the adrenal glands need not be present in order for intravenous epinephrine infusion to elicit an increase in PRA. The data do not support the hypothesis, therefore, that epinephrine-induced increases in PRA are initiated by receptors located within the adrenal glands.     

Comparison of the effects of prostaglandins E1 and A1 on coronary occlusion induced arrhythmia

The present study compares the effects of PGE₁ and PGA₁ on ventricular arrhythmias following coronary artery occlusion. The left anterior descending coronary artery (LAD) was occluded abruptly in 55 cats anesthetized with α-chloralose. Lead II of the ECG along with arterial blood pressure were monitored for one hour after occlusion. Either vehicle or prostaglandin was infused into the left atrium (LA) or femoral vein (IV) 15 min prior to and for 1 hour after LAD occlusion at a rate of 0.15 ml/min. Prostaglandin was infused at either a high dose (1.0 μg/kg/min) or a low dose (0.1 μg/kg/min). Infusion of either PGE₁ or PGA₁ produced a marked fall in blood pressure and heart rate which returned toward control before occlusion. Abrupt occlusion of the LAD produced ventricular arrhythmia in all cats ranging from ventricular premature beats to ventricular fibrillation (VF). The control animals had a 38% incidence of VF. VF occurred in 75% of the animals in which PGE₁ was administered into the LA at either the high or low dose while the occurrence in those administered PGA₁ was 67% and 50%, respectively. Intravenous administration of the high dose of PGE₁ or PGA₁ resulted in VF in 13% and 67% of the animals after LAD occlusion, respectively. These data indicate that the IV administration of PGE₁ may protect the heart from VF while the infusion of PGE₁ or PGA₁ into the LA may enhance VF after LAD occlusion.     

Metabolism of prostaglndin A. II. Isolation, characterization, and synthesis of PGA1 renal.

Since the renal cortex has recently been shown to be a major site of prostaglandin A₁ (PGA₁) metabolism, studies were undertaken to isolate and characterize the major metabolites. Homogenates of rabbit cortex (500g) were incubated with ³H-PGA₁ (50mg) in the presence of NAD⁺ (50mg). Acidic lipid extracts were subjected to linear gradient silicic acid chromatography. Six radioactive peaks were recovered, of which peak 4 was unconverted PGA₁. The major metabolites (1,3) were further subjected to reversed phase partition chromatography and TLC with and without silver nitrate. Three PGA₁ analogs were then synthesized via oxidation of the secondary alcohol group at C-15 by manganese dioxide (15-keto-PGA₁). The second compound was synthesized by hydrogenation of 15-keto-PGA₁ (15-keto 13, 14-dihydro PGA₁). The third compound (13, 14-dihydro PGA₁) was obtained by direct catalytic hydrogenation of PGA₁. Purification of these substances were achieved by a combination of silicic acid and thin layer chromatography. It was found that metabolite 1 cochromatographed on TLC (AgNO3) with synthesized 15-keto 13, 14-dihydro PGA₁. Both compounds were 100 times less potent than PGA₁ in lowering rat blood pressure. Metabolite 3 cochromatographed on TLC (AgNO3) with synthesized 13, 14-dihydro PGA₁. Both were as potent as PGA₁ in lowering rat blood pressure. Metabolites 1 and 3 absorbed UV at 221 nm but not at 280 nm following alkali treatment. These studies suggest that rabbit renal cortex metabolizes PGA₁ to what appears to be biologically active 13, 14-dihydro PGA₁ and biologically inactive 15-keto 13, 14-dihydro PGA₁. It remains possible that the hypotensive effect of PGA₁ is the result of its conversion to its biologically active 13, 14-dihydro derivative.     

Effect of precursors of the 1,2, and 3 series prostaglandins on renin release and renal blood flow in the dog

The precursors of the monoene, diene, and triene series of prostaglandins, eicosatrienoic acid, arachidonic acid, and eicosapentaenoic acid, respectively, were infused at 3×10^?6, 10^?5, and 3×10^?5 g/kg/min directly into the renal artery of non-filtering, denervated kidneys of conscious propranolol-treated dogs. Renal blood flow was measured with an electromagnetic flow probe around the renal artery and renal renin secretion rate from blood samples taken from catheters in the aorta and renal vein. The highest dose of arachidonic acid increased renal blood flow by 54 ± 19% and increased renin secretion rate seven-fold. Eicosatrienoic acid produced a smaller increased in renal blood flow but did not significantly increase renin secretion rate. Eicosapentaenoic did not change either blood flow or renin secretion rate. We conclude that compared with arachidonic acid the precursors of the 1 and 3 series of prostaglandins are not significantly involved in the regulation of renal blood flow or renin secretion.     

The treatment of the hepatorenal syndrome with intra-renal administration of prostaglandin E1

Three patients with the hepatorenal syndrome were treated with prostaglandin E₁ administered through a selective renal arterial catheter. Prostaglandin E₁ was given in progressively increasing doses (2 to 100 ng/kg/min) over a 60-minute period. Control plasma prostaglandin E levels were elevated in all three patients, 0.98, 0.91, and 0.83 ng/ml, respectively. At the end of the infusion, plasma prostaglandin E levels had risen to 10.4, 2.63, and 10.3 ng/ml in the three patients respectively. Plasma renin activity increased during the course of the infusion in two of the patients. The plasma aldosterone concentration did not change during the prostaglandin E₁ infusion. Intrarenal prostaglandin E₁ failed to increase urine volume or urinary sodium concentration in three patients with the hepatorenal syndrome.     

Reversible hypertension caused by calcium overloading in a patient with postoperative hypoparathyroidism

A 37-year-old woman with postoperative hypoparathyroidism had hypertension, and elevated plasma renin activity (PRA) and subsequent hyperaldosteronism during a two-month hypercalcemic period caused by vitamin D and excessive calcium supplements. The hypertension with elevated PRA, however, was resistant to the angiotensin II (AII) analog [Sar1, Ile8] ALL. PRA further increased and plasma aldosterone decreased in response to the [Sar1, Ile8] ALL. When the patient became normocalcemic, normotensive and normoreninemic, calcium gluconate (5 mg calcium/kg/h) was infused for one hour. The calcium infusion reproduced hypercalcemic hypertension mediated by an increase in total peripheral resistance. These observations suggest that the hypertension observed while taking vitamin D and excessive calcium supplements may be caused by a direct effect of calcium on peripheral blood vessels and the renin-angiotensin system may play a negligible role.     

Active and inactive renin in human forearm of hypertensive patients.

Although many in vitro and animal studies indicate the existence of a local renin--angiotensin system, data regarding its physiological role are quite controversial, and moreover, evidence suggesting inactive and active renin release from vascular tissue in vivo is lacking both in animal and humans. The aim of our study was to evaluate whether beta-adrenoceptor stimulation, a well-known stimulus to renin production, through isoproterenol might cause local renin production from vessels of the forearm of hypertensive patients. Drugs were infused into the brachial artery at systemically ineffective rates, while forearm blood flow (FBF, venous plethysmography), mean intra-arterial pressure, and heart rate were monitored throughout. Active and inactive vessel renin production was measured by calculating venous-arterial (V-A) differences by simultaneous sampling from brachial artery and an ipsilateral deep vein. Active renin (PRA) and total renin (Sepharose bound trypsin activation) were measured by radioimmunoassay while inactive renin was calculated as the difference between total and active renin. V-A differences were corrected for FBF to calculate renin extraction or production. In a group of 10 patients, isoproterenol, which was infused at increasing cumulative rates (0.03, 0.1, 0.3 micrograms.100 mL-1 forearm tissue.min-1 for 5 min each), caused a dose-dependent increment in FBF that was blunted by intra-arterial propranolol (n = 5) pretreatment (10 micrograms.100 mL-1 forearm tissue.min-1 for 10 min). beta-Adrenoceptor stimulation caused a dose-dependent outflow of both active and inactive renin, an effect antagonized by propranolol. In conclusion, our data represent the first evidence in humans of tissue active and inactive renin production in the forearm vascular bed.     

Biological activity of des-(Asp1, Arg2, Val3)-angiotensin II in man

When des-(Asp¹, Arg², Val³)-angiotensin II was infused iv at rates of 308–5,550 pmol/kg·min for 10–120 min into 5 normal men and 2 patients with Bartter's syndrome, no significant change was observed in blood pressure (BP), plasma renin activity (PRA) or plasma aldosterone (PA), and the lowest dose did not inhibit a captopril-induced increase in PRA in the normal men, although des-(Asp¹, Arg²)-angiotensin II was reported in the same 5 normal men to cause a decrease in PRA and an increase in PA in this dose range and a rise in BP at 2,220 and 5,550 pmol/kg·min. However, an iv infusion of the pentapeptide at 9,000 pmol/kg·min for 15 min significantly raised BP in the 5 normal men but not in patients with Bartter's syndrome. BP returned to the pretreatment level 60 min after the cessation of the infusion, although the duration of the pressor actions of angiotensin II, angiotensin III and des-(Asp¹, Arg²)-angiotensin II were reported to be within 5 min in man. At the same dose level none of the 7 examined subjects showed any significant change in PRA or PA. Des-(Asp¹, Arg², Val³, Tyr⁴)-angiotensin II was infused iv at a rate of 41,480 pmol/kg·min into one of the normal men, but it caused no significant change in BP, PRA or PA. These results suggest that the pentapeptide and probably the tetrapeptide do not possess renin-suppressing and steroidogenic actions in man but the pentapeptide does elecit a minimal pressor action with a prolonged duration.     

Testing the “redirection hypothesis” of prostaglandin metabolism in the kidney

Furosemide increases the synthesis of two major renal eicosanoids, prostacylin (PGI₂) and thromboxane A₂ (TXA₂), by stimulating the release of arachidonic acid which in turn is metabolized to PGG₂/PGH₂, then to PGI₂ and TXA₂. PGI₂ may mediate, in part, the early increment in plasma renin activity (PRA) after furosemide. We hypothesized that thromboxane synthetase inhibition should direct prostaglandin endoperoxide metabolism toward PGI₂, thereby enhancing the effects of furosemide on renin release. Furosemide (2.0 mg.kg⁻¹ i.v.) was injected into Sprague-Dawley rats pretreated either with vehicle or with U-63, 557A (a thromboxane synthetase inhibitor, 2 mg/kg⁻¹ followed by 2 mg/kg⁻¹.hr⁻¹). Urinary 6ketoPGF₁ α and thromboxane B₂ (TXB₂), reflecting renal synthesis of PGI₂ and TXA₂, as well as PRA and serum TXB₂, were measured. Serum TXB₂ was reduced by 96% after U-63, 557A. U-63, 557A did not affect the basal PRA. Furosemide increased PRA in both vehicle and U63, 557A treated rats. However, the PRA-increment at 10, 20 and 40 min following furosemide administration was greater in U-63, 557A-treated rats than in vehicle-treated rats and urine 6ketoPGF₁ α excretion rates were increased. These effects of thromboxane synthesis inhibition are consistent with a redirection of renal PG synthesis toward PGI₂ and further suggest that such redirection can be physiologically relevant.     

Prostaglandin synthesis in rabbit renal medulla.

Prostaglandin (PG) synthesis in rabbit renal medullary homogenates was investigated by gas chromatography-mass spectrometry utilizing two internal standards. The internal standards were added immediately after homogenization to an aliquot of the fresh homogenate. Another aliquot of the homogenate was incubated and subsequently the internal standards were added. The internal standards were 3,3,4,4 tetradeutero PGE₂(d₄-PGE₂) for quantification of PGE₂, the PGA₁ for quantification of PGA₂ and 3,3,4,4 tetradeutero PGA₂, the latter representing an $\text{in}$$\text{vitro}$ dehydration product of d₄-PGE₂ generated during work up of the samples. In 6 experiments on 6 rabbits levels of PGE₂ were 4.4 ± 1.6 μg/g (mean ± SD) renal medulla increasing during incubation to 14.95 ± 6.5 μg/g (p < 0.01) PGA₂ levels were 0.03 ± 0.02 μg/g in the non-incubated samples and did not increase during incubation. When PGA₂ levels were corrected for the amount of PGA₂ formed by $\text{in virto}$ dehydration from PGE₂ as measured by the amount of d₄-PGE₂ dehydrated to d₄-PGA₂ during workup, PGA₂ levels were indistinguishable from zero.