Treatment of patients with IVCS and gross oedema and ascites with diuretic combination and ACE-inhibitors: relation to baseline PRA and PAC.
OBJECTIVE
(1) To assess plasma renin activity (PRA) and plasma aldosterone concentration (PAC) in patients with inferior vena cava syndrome (IVCS). (2) To study in an open fashion the efficacy of loop diuretic treatment, single, or in combination with an ACE-inhibitor or with spironolactone.


METHODS
In 13 patients PRA and PAC were measured and related to urinary sodium excretion (UNa).


RESULTS
Highly elevated PRA and PAC were found in recently developed IVCS. The correlation coefficient between PAC and UNa was -0.61, p < 0.05. In 10 patients the influence of captopril (C)] at maximum tolerable doses with or without furosemide (F) was evaluated. Mean tolerated dose of C amounted to 8.8 mg t.i.d. (range 2-25), achieving a PAC reduction of 26%. Efficacy of F was severely blunted when PAC exceeded the low-normal range. Spironolactone addition at 100 mg/day in non-responders to F or to F and C, induced immediate natriuretic responses except in a patient with 7-70 fold increase in PAC.


CONCLUSIONS
(1) In IVCS loop diuretic efficacy is attenuated by aldosterone activation; (2) complete aldosterone suppression with captopril is difficult to achieve due to dose restriction; (3) spironolactone is favoured for a synergistic response.
Van Vliet
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AA
Department of Internal Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoekziekenhuis, Amsterdam.
Kröger
R
R
Dubbelman
R
R
Ten Bokkel-Huinink
W W
WW
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001201:Ascites / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002216:Captopril / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004487:Edema / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D013148:Spironolactone / Q000627:therapeutic use; D014652:Vascular Diseases / Q000150:complications; D014682:Vena Cava, Inferior
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D013148:Spironolactone; D000450:Aldosterone; D005665:Furosemide; D002216:Captopril; D012083:Renin