Aldosterone in uremia - beyond blood pressure.
Aldosterone was in the past considered only as a prohypertensinogenic agent. It has recently become clear that apart from the classical endocrine action, i.e. causing blood pressure elevation as a result of salt retention, aldosterone has numerous blood-pressure-independent actions on nonepithelial tissue. Under conditions of high salt concentration, aldosterone is injurious to the kidney, heart and vasculature. Of particular interest are recent observations that aldosterone is a permissive factor for the effect of minor increases in plasma sodium concentration on endothelial cell dysfunction. Despite surprising effects of aldosterone blockade on blood pressure of anuric dialysis patients, the potential role of mineralocorticoid receptor blockade in dialysis patients is currently unclear and requires controlled investigation to define the risk of potential hazards, specifically hyperkalemia.
Ritz
Eberhard
E
Nierenzentrum, Ruperto Carola University Heidelberg, Heidelberg, Germany. prof.e.ritz@t-online.de
Koleganova
Nadezda
N
D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000502:physiology; D000450:Aldosterone / Q000502:physiology*; D042783:Endothelial Cells / Q000187:drug effects; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000502:physiology; D006929:Hyperaldosteronism / Q000150:complications* / Q000188:drug therapy; D006947:Hyperkalemia / Q000139:chemically induced; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D024821:Metabolic Syndrome / Q000503:physiopathology; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D018161:Receptors, Mineralocorticoid / Q000737:chemistry / Q000502:physiology; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D012964:Sodium / Q000097:blood; D012982:Sodium, Dietary / Q000009:adverse effects* / Q000493:pharmacokinetics; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use; D014511:Uremia / Q000097:blood / Q000503:physiopathology*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid; D012982:Sodium, Dietary; D013148:Spironolactone; D000450:Aldosterone; D012964:Sodium; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D006854:Hydrocortisone