Abstract: SA-PO974

Long-Term Clinical Spectrum and Circulating RAS Evaluation of Anephric Patients on Hemodialysis: A Series of 4 Cases and Literature Review

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Liu, Lin, China-Japan Friendship Hospital, Beijing, China
  • Zhang, Yumei, China-Japan Friendship Hospital, Beijing, China
  • Fu, Fangting, China-Japan Friendship Hospital, Beijing, China
  • Li, Wenge, China-Japan Friendship Hospital, Beijing, China
Background

Blood pressure decline is one of the short-term complications of bilateral nephrectomy mainly due to sharp change of circulating renin-angiotensin system (RAS), but data about long-term outcome of clinical status and the development of circulating RAS of these patients is limited.

Methods

We enrolled 4 Chinese cases with both their kidneys removed for 2, 6, 8 and 8 years, respectively, from 304 patients on maintenance hemodialysis in December 2016 in our center. The blood samples for RAS tests were drawn after the subjects seated for 30 minutes immediately before hemodialysis was started. Radioimmunoassay was performed to assess their circulating RAS. Their ages ranged from 49 to 80, and 3 out of 4 were female. The reasons of nephrectomy included polycystic kidney disease (n=1), cancer (n=2), and hydronephrosis (n=1). Hypotension after surgery occurred in 2 patients, and mostly happened during dialysis. They suffered embolism of arteriovenous fistula, but not any life-threatening complications happened. At present, the SBPs in 24 hours of the 4 subjects were all above 90mmHg,and the lowest SBP of 90mmHg and DBP of 46mmHg occurred during dialysis and at midnight, respectively. Only one patient developed severe hypertension again since 4 years after surgery, whose BP now was not well-controlled despite 6 kinds of antihypertensive drugs including ACEI and ARB. The average hemoglobin level was 103.3±12.3g/L. Two of them complicated with hemorrhage of digestive tract, resulting in the need of high erythropoietin (EPO) dosages. The other two patients without hemorrhage received intravenous EPO of only 4500-8000iu/week. The 3 patients receiving blood tests all presented with extremely low plasma renin activity (PRA) of 0.08±0.03ng/ml, compared with normal range of 0.93-6.56ng/ml. Surprisingly, plasma Ang‖ concentration of 71.37±8.28 pg/ml and aldosterone level of 0.17±0.02 ng/ml were within normal limits.

Conclusion

In conclusion, in 2 to 8 years after surgery, the 4 anephric cases did not suffer life-threatening complications with their hypotension gradually recovered and EPO dosage relatively small. Although their PRA was extremely low, they produced normal Ang‖ and aldosterone in plasma, indicating the kidney-independent mechanism of Ang‖ production compensated well in 2 years after removement of kidneys.

Funding

  • Government Support - Non-U.S.