Vasoactive mediators and renal haemodynamics in exertional heat stroke complicated by acute renal failure.
BACKGROUND
Although vasoactive substances may be important in the pathogenesis of some types of acute renal failure (ARF), their potential role in exertional heat stroke (ExHS) with ARF has not been explored.


OBJECTIVE
To evaluate whether changes in concentration of individual vasoactive mediators correlated with alterations in renal function and haemodynamics in patients with ExHS and ARF.


METHODS
Prospective case-control study.


METHODS
Systemic and renal haemodynamics, circulating vasoactive hormones and urinary vasodilator metabolites were determined in 12 military recruits who developed ExHS with ARF but without other organ failure during a three-year period. The control group consisted of 12 recruits who performed similar exercise under the same conditions without developing ExHS.


RESULTS
There were significant elevations in circulating pressor hormones (catecholamines, renin, aldosterone and endothelin-1 (ET-1)) and significant decreases in the vasodilatory hormone prostaglandin E(2) (PGE(2)) in the acute phase of ExHS with ARF when compared to ExC. There was also a significant rise in nitric oxide metabolites (NOx) in the acute phase of ExHS. All of these abnormalities in circulating hormones returned to normal range during the recovery phase of ExHS. The ERPF correlated positively with GFR and urinary PGE(2) and negatively with plasma catecholamines, renin, ET-1 and NOx.


CONCLUSIONS
The changes in the plasma levels of these hormones, together with enhanced NO production, may both contribute to the pathophysiology of ARF in ExHS.
Lin
Y-F
YF
Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. linyf@ndmctsgh.edu.tw
Wang
J-Y
JY
Chou
T-C
TC
Lin
S-H
SH
D058186:Acute Kidney Injury / Q000150:complications / Q000503:physiopathology*; D000328:Adult; D016022:Case-Control Studies; D015232:Dinoprostone / Q000652:urine; D018883:Heat Stroke / Q000150:complications / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D009569:Nitric Oxide / Q000652:urine; D011446:Prospective Studies; D012079:Renal Circulation / Q000502:physiology*; D014662:Vasoconstrictor Agents / Q000097:blood; D014665:Vasodilator Agents / Q000097:blood
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide; D015232:Dinoprostone