Guideline PA. Renin. Renin From a Laboratory Perspective. Use of renin and aldosteron measurements. UMCG Dept. Laboratory Medicine
|
|
|
- Avice Ray
- 5 years ago
- Views:
Transcription
1 UMCG Dept. Laboratory Medicine SKML symposium Endocriene hypertensie Renin From a Laboratory Perspective Anneke Muller Kobold Clinical Chemist Endocrinology Laboratory of Binding Analysis University Medical Center Groningen The Netherlands Utrecht Renin Proteolytic enzyme, 4kD MW Synthesized as preprorenin Stored in granules as prorenin or renin Juxtaglomerular cells of the kidney Blood: prorenin to renin ratio: 1 to 1 Prorenin is inactive Activation by enzymatic cleavage of prosegment Renin secretion tightly controlled 2/27 Use of renin and aldosteron measurements Guideline PA JCEM, 216, 11(5): Disorder Expected findings Renin Aldosterone Correct hypokalemia Antihypertensive medication? PA Salt loading (oral, infusion) Renal artery stenosis Bartter s syndrome Renin secreting tumours Pseudohypoaldosteronism Primary aldosteron deficiency Secondary aldosteron deficiency Congenital adrenal hyperplasia Renin to monitor fludrocortisone treatment 3/27 4/27 1
2 Effect of medication on renin levels PRA vs PRC Interpretation of lab results & antihypertensive treatment DRC PRA + DRC PRA BP 6/27 5/27 Preanalytical conditions effecting renin levels Renin assays Time of day, diurnal rhythm early morning evening effect on renin level Posture standing (FN) Effect on ARR supine (FP) Age old age (FP) Pregnancy, lutheal phase (FN) Ethnicity black subjects (FP) Male/female Female (follicular) (FP) Potassium status hypokalemia (FN) Dietary salt intake loading (FP) Chronic kidney disease (FP) Activity or Mass? 7/27 8/27 2
3 Plasma Renin Activity PRA assay ANGIOTENSINOGEN 9 min 37 C ph Ang I RIA ANGIOTENSIN I Enzyme inhibitor: PMSF ANGIOTENSIN II *ANGIOTENSIN I* ANGIOTENSIN I Correct for blanc: 9 min 4 C 9/27 1/27 PRA: remarks Renin mass assay Direct Renin concentration (DRC) Endogeneous angiotensinogen as substrate Low renin concentrations difficult? Prolongation incubation time (37 C) may increase sensitivity Lack of standardization Preanalytical conditions Incubation time ph Differences in assay sensitivity Precision/accuracy/reproducability 11/27 12/27 3
4 Direct Renin assay Direct Renin assay Solid phase Capture antibody Recognizes renin (and prorenin)* Label Detection antibody Recognizes renin (and open prorenin) Independent of plasma angiotensinogen levels Sample processing at RT Assay can be automated Relatively large sample volume required Calibrated against WHO IR 68/356 Interlaboratory CVs are lower than for PRA Analytical sensitivity? 13/27 * Some kit-inserts: Active and inactive renin 14/27 EQAS (DRV) results EQAS (DRV) results All Labs Other assays Immunotech Beckman 2 CisBio In house assays DiaSorin PRA DRC All Labs Other assays Immunotech Beckman 2 CisBio In house assays DiaSorin 15/27 16/27 4
5 Preanalytical concerns II activation of prorenin 17/27 Proteolytic enzyme, 4kD MW Juxtaglomerular cells of the kidney Synthesized as preprorenin Stored in granules as prorenin or renin Blood: prorenin to renin ratio: 1 to 1 Prorenin is inactive.?? Activation by enzymatic cleavage of prosegment Renin secretion tightly controlled 18/27 Proteolytic activation of prorenin Irreversible Proteolytic (serine proteases) removal of the prosegment secretory granules of the juxtaglomerular cells Neutral or low ph (depending on proteases) At low (4ºC) temperature and neutral ph (cryoactivation) Nonproteolytic activation of prorenin Reversible conformational changes (closed to open conformation) At low (4ºC) temperature (cryoactivation) Schalekamp et al. Effect of low temperature on PRA and DRC Craven & Symonds
6 Low renin - high prorenin! Effect of Prorenin Blood: prorenin to renin: 1 to 1 The lower the renin concentration the higher the proportion of plasma prorenin concentration Patients with low-renin hypertension or diabethic nephropathy have 1 fold more prorenin than renin levels Cryoactivation: falsly elevated renin values! 4 C or lower, not at 37 C, serum > EDTA plasma mainly due to conformational change of epitope Both PRA and DRC may be influenced Effect of incubation temperature (22 C, left and 37 C, right) on assay (IRMA) performance 2/27 21/27 Activity or Mass? Which assay is more elegant? Which assay is the fastest? Which assay is the most solid one? Which assay gives the best information? 1 normotensive individuals 5 /5 m/f, age 2-7 1/1 per age decade PRA vs DRC (Cisbio) Aldosterone (Siemens RIA) Aldosterone-renin ratios Before & after 3 day oral salt loading test (additional 9 g NaCl/day) 22/27 23/27 6
7 Precision profile, functional sensitivity and LOD Pl.ren.conc. CV (%) CV (%) Cobas Immulite25 Passing & Bablok (III) fit ( x) 95% CI bands Precision profile, functional sensitivity and LOD CV (%) CV (%) PRA vs DRC precision precision profile PRA profile (as DRC PRA values) Passing Bablok: DRC ~ 1 x PRA 35 Scatter Plot with Fit Linear fit ( x) Passing Bablok: DRC ~ 1 x PRA LOD = 5,36.45 ng/l nmol/l/h FS = 7,9.7 ng/l nmol/l/h 3 95% CI Scatter Plot with Passing & Bablok Fit 95% Prediction interval level level PRA (ng/l) (nmol/l/h) 15 precision profile DRC LOD =,7 ng/l FS = 1, ng/l PRA /27 25/27 level (ng/l) precision profile PRA LOD =.45 nmol/l/h FS =.7 nmol/l/h level PRA (nmol/l/h) precision profile DRC After SLT: nmol/l/h LOD =.7 ng/l FS = 1. ng/l After SLT: ng/l Reference values Before SLT After SLT units DRC plasma 3,4-29,6 1,8-2, ng/l PRA plasma,1-2,35,9-1,84 nmol/l/hr Aldosterone plasma pmol/l ARRdrc plasma 4,1-81,3 3,9-74,8 pmol/ng ARRpra plasma,7-1,45,6-1,84 /hr Aldosterone urine 6,7-84,3 6,4-37,6 nmol/24 hr Screeningstest Confirmation test 26/ level (ng/l) 27/27 7
8 UMCG Dept. Laboratory medicine In conclusion Standardize preanalytical conditions Stop, if possible, antihypertensives Both PRA and DRC measure renin But PRA and DRC measure different things Prevent cryoactivation of prorenin PRA and DRC can both be influenced by cryoactivation Take caution when interpreting PRA or DRC results under antihypertensive medication (especially renin inhibitors) Reference values for DRC, Aldosterone, ARRdrc Renin and units: pmol/l/min, ng/ml/h, mu/l, ng/l???? Activity assays Mass assays 8
9 serum Liason Serum vs EDTA plasma effect of prorenin activation? DiaSorin vs CisBio Scatter Plot with Passing & Bablok Fit 18 Scatter Plot with Passing & Bablok Fit Identity Identity 1 8 Passing & Bablok (I) fit ( x) 8 Passing & Bablok (I) fit ( x) plasma DRC LHBI Renin assay confusion? Enzyme kinetic (indirect) assay Production Ang I Plasma renin activity assay PRA Endogenous substrate (angiotensinogen) Plasma renin concentration assay PRC Exogenous substrate (angiotensinogen) Total renin concentration (activity of prorenin & renin) actrc Immunosorbent (direct assays) DRC ELISA s & IRMA s Immunoreactive renin Schalekamp et al. Total renin concentration (concentration of prorenin & renin) irtrc Campbell et al. 9
10 Renin assay confusion? Enzyme kinetic (indirect) assay Production Ang I Plasma renin activity assay PRA Endogenous substrate (angiotensinogen) Plasma renin concentration assay PRC Exogenous substrate (angiotensinogen) Total renin concentration (activity of prorenin & renin) actrc Immunosorbent (direct assays) DRC ELISA s & IRMA s Immunoreactive renin assay Total renin concentration (concentration of prorenin & renin) irtrc Campbell et al. Schalekamp et al. 1
Primary Aldosteronism: screening, diagnosis and therapy
Primary Aldosteronism: screening, diagnosis and therapy Jacques W.M. Lenders, internist DEPT. OF INTERNAL MEDICINE, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTER, NIJMEGEN,THE NETHERLANDS DEPT. OF INTERNAL
Upon completion, participants should be able to:
Learning Objectives Upon completion, participants should be able to: Describe the causes of secondary hypertension and the prevalence of primary aldosteronism Discuss the diagnostic approach to primary
Primary aldosteronism clinical practice guidelines: a re-appraisal The Management of Primary Aldosteronism
Primary aldosteronism clinical practice guidelines: a re-appraisal The Management of Primary Aldosteronism Prof. FRANCO MANTERO Division of Endocrinology University of Padua Italy Case Detection, Diagnosis
Methodologic Issues in the Measurement of Urinary Renin
Article Methodologic Issues in the Measurement of Urinary Renin Lodi C.W. Roksnoer, Koen Verdonk, Ingrid M. Garrelds, Jeanette M.G. van Gool, Robert Zietse, Ewout J. Hoorn, and A.H. Jan Danser Abstract
Measurement of Renin Activity using Tandem Mass Spectrometry Ravinder J Singh, PhD, DABCC Mayo Clinic, Rochester, MN
Measurement of Renin Activity using Tandem Mass Spectrometry Ravinder J Singh, PhD, DABCC Mayo Clinic, Rochester, MN Renin Angiotension System Weber, et al. NEJM 2001; 345:1690. Renin Angiotension System
Updates in primary hyperaldosteronism and the rule
Updates in primary hyperaldosteronism and the 20-50 rule I. David Weiner, M.D. Professor of Medicine and Physiology and Functional Genomics University of Florida College of Medicine and NF/SGVHS The 20-50
Aldosterone on Liaison XL In use date: June 6, 2017
Aldosterone on Liaison XL In use date: June 6, 2017 I. PRINCIPLE Aldosterone is a steroid hormone of molecular weight 360.4 daltons, the major mineralcorticoid secreted by the adrenal cortex. The role
BODY FLUID. Outline. Functions of body fluid Water distribution in the body Maintenance of body fluid. Regulation of fluid homeostasis
BODY FLUID Nutritional Biochemistry Yue-Hwa Chen Dec 13, 2007 Chen 1 Outline Functions of body fluid Water distribution in the body Maintenance of body fluid Intake vs output Regulation of body fluid Fluid
Urinary Kallikrein Excretion in Hypertensive Man
Urinary Kallikrein Excretion in Hypertensive Man RELATIONSHIPS TO SODIUM INTAKE AND SODIUM-RETAINING STEROIDS By Harry S. Margolius, David Horwttz, John J. Pisano, and Harry R. Kelser ABSTRACT Urinary
Improve the Hypertension Management
Improve the Hypertension Management Ask for LIAISON Aldosterone and Direct Renin Assays FOR OUTSIDE THE US ONLY Improve the Hypertension Management DiaSorin The Solution Hypertension worldwide estimation
Is there a need of new RAAS blockers in diabetic hypertension?
Is there a need of new RAAS blockers in diabetic hypertension? Dr. Dominik N. Müller First World Congress on Controversies in Obesity, Diabetes and Hypertension Berlin October 2006 Renin-Angiotensin System
Updates in primary hyperaldosteronism and the rule
Updates in primary hyperaldosteronism and the 20-50 rule I. David Weiner, M.D. C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University of
The endocrine system is made up of a complex group of glands that secrete hormones.
1 10. Endocrinology I MEDCHEM 535 Diagnostic Medicinal Chemistry Endocrinology The endocrine system is made up of a complex group of glands that secrete hormones. These hormones control reproduction, metabolism,
CHOLESTEROL IS THE PRECURSOR OF STERIOD HORMONES
HORMONES OF ADRENAL CORTEX R. Mohammadi Biochemist (Ph.D.) Faculty member of Medical Faculty CHOLESTEROL IS THE PRECURSOR OF STERIOD HORMONES CONVERSION OF CHOLESTROL TO PREGNENOLONE MINERALOCORTICOCOIDES
Plasma Renin Activity and Renin-Substrate Concentration in Patients with Liver Disease
Plasma Renin Activity and Renin-Substrate Concentration in Patients with Liver Disease By Carlos R. Ayers, M.D. ABSTRACT Peripheral venous renin activity was determined by the method of Boucher in 15 patients
Clarification of hypertension Diagnosis of primary hyperaldosteronism
Nr. 1/2010 Clarification of hypertension Diagnosis of primary hyperaldosteronism Marc Beineke The significance of the /renin ratio (ARR) in the diagnosis of normoalaemic and hypokalaemic primary hyperaldosteronism,
Systemic Hypertension Dr ahmed almutairi Assistant professor Internal medicine dept
Systemic Hypertension Dr ahmed almutairi Assistant professor Internal medicine dept Continents 1- introduction 2- classification/definition 3- classification/etiology 4-etiology in both categories 5- complications
Special Lecture 11/08/2013. Hypertension Dr. HN Mayrovitz
Special Lecture 11/08/2013 Hypertension Dr. HN Mayrovitz Arterial Blood Pressure (ABP) Major Factors Summarized Sympathetic Hormones Arteriole MAP ~ Q x TPR + f (V / C) SV x HR Renal SBP Hypertension =
HYPERTENSION IN CKD. LEENA ONGAJYOOTH, M.D., Dr.med RENAL UNIT SIRIRAJ HOSPITAL
HYPERTENSION IN CKD LEENA ONGAJYOOTH, M.D., Dr.med RENAL UNIT SIRIRAJ HOSPITAL Stages in Progression of Chronic Kidney Disease and Therapeutic Strategies Complications Normal Increased risk Damage GFR
COMPOSITION. A film coated tablet contains. Active ingredient: irbesartan 75 mg, 150 mg or 300 mg. Rotazar (Film coated tablets) Irbesartan
Rotazar (Film coated tablets) Irbesartan Rotazar 75 mg, 150 mg, 300 mg COMPOSITION A film coated tablet contains Active ingredient: irbesartan 75 mg, 150 mg or 300 mg. Rotazar 75 mg, 150 mg, 300 mg PHARMACOLOGICAL
About 20% of the Canadian population
Mineralocorticoid Hypertension: Common and Treatable Hypertension is the most common chronic disease treated by the primary-care physician. It is now evident that mineralocorticoid hypertension, which
Blood Pressure Regulation 2. Faisal I. Mohammed, MD,PhD
Blood Pressure Regulation 2 Faisal I. Mohammed, MD,PhD 1 Objectives Outline the intermediate term and long term regulators of ABP. Describe the role of Epinephrine, Antidiuretic hormone (ADH), Renin-Angiotensin-Aldosterone
Blood Pressure Regulation 2. Faisal I. Mohammed, MD,PhD
Blood Pressure Regulation 2 Faisal I. Mohammed, MD,PhD 1 Objectives Outline the intermediate term and long term regulators of ABP. Describe the role of Epinephrine, Antidiuretic hormone (ADH), Renin-Angiotensin-Aldosterone
(Pro)renin Revisited: New Insights from Studies in Mast Cells
(Pro)renin Revisited: New Insights from Studies in Mast Cells (Pro)renine: Nieuwe inzichten uit studies met mestcellen Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam
Endocrine hypertensionmolecules. Marie Freel Caledonian Endocrine Society Meeting 29 th November 2015
Endocrine hypertensionmolecules and genes Marie Freel Caledonian Endocrine Society Meeting 29 th November 2015 Plan Mineralocorticoid hypertension Myths surrounding Primary Aldosteronism (PA) New developments
Renal Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross
Renal Physiology Part II Bio 219 Napa Valley College Dr. Adam Ross Fluid and Electrolyte balance As we know from our previous studies: Water and ions need to be balanced in order to maintain proper homeostatic
1. How did occlusion of Mr. Hanna's left renal artery lead to an increase in plasma renin activity?
76 I'HYSIOLOGY CASES AND PROBLEMS Case 14 Renovascular Hypertension: The Renin-Angiotensin-Aldosterone System Stewart Hanna is a 58-year-old partner in a real estate firm. Over the years, the pressures
014 Chapter 14 Created: 9:25:14 PM CST
014 Chapter 14 Created: 9:25:14 PM CST Student: 1. Functions of the kidneys include A. the regulation of body salt and water balance. B. hydrogen ion homeostasis. C. the regulation of blood glucose concentration.
Adrenal gland consist of: Outer Cortex and Inner Medulla Hormones secreted by Adrenal Cortex are: Glucocorticoid, Mineralocorticoid and Sex Steroids
1 UNIVERSITY OF PAPUA NEW GUINEA SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY PBL MBBS Year III; BMLS & BDS Year 3 ADRENAL
신장환자의혈압조절 나기영. Factors involved in the regulation of blood pressure
신장환자의혈압조절 K/DOQI Clinical practice guidelines on Hypertension and Antihypertensive agents in CKD 나기영 Factors involved in the regulation of blood pressure Renal function curve MAP (mmhg) Central role of
Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital
Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment
Overview. Fluid & Electrolyte Disorders. Water distribution. Introduction 5/10/2014
Overview Fluid & Electrolyte Disorders Dr Nicola Barlow Clinical Biochemistry Department, City Hospital Introduction Fluid and electrolyte homeostasis Electrolyte disturbances Analytical parameters Methods
ADRENAL GLANDS. G M Kellerman. Hunter Area Pathology Service
ADRENAL GLANDS G M Kellerman Hunter Area Pathology Service ADRENAL FUNCTIONS THE ADRENAL GLANDS ACTUALLY HAVE 4 QUITE SEPARATE FUNCTIONS 1. MINERALOCORTICOID SECRETION BY THE ZONA GLOMERULOSA OF THE CORTEX
Renal Regulation of Sodium and Volume. Dr. Dave Johnson Associate Professor Dept. Physiology UNECOM
Renal Regulation of Sodium and Volume Dr. Dave Johnson Associate Professor Dept. Physiology UNECOM Maintaining Volume Plasma water and sodium (Na + ) are regulated independently - you are already familiar
Renin Activity ELISA
Renin Activity ELISA For the quantitative determination of Plasma Renin Activity (PRA) in human plasma For Research use Only. Not For Use In Diagnostic Procedures. Catalog Number: 11RENHUE02 Size: 2 x
Regulation of Arterial Blood Pressure 2 George D. Ford, Ph.D.
Regulation of Arterial Blood Pressure 2 George D. Ford, Ph.D. OBJECTIVES: 1. Describe the Central Nervous System Ischemic Response. 2. Describe chemical sensitivities of arterial and cardiopulmonary chemoreceptors,
Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass
European Journal of Endocrinology (2004) 150 517 523 ISSN 0804-4643 CLINICAL STUDY Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in
Inactive Renin of High Molecular Weight (Big Renin) in Normal Human Plasma. Activation by Pepsin, Trypsin, or Dialysis to ph 3.3 and 7.
Inactive Renin of High Molecular Weight (Big Renin) in Normal Human Plasma Activation by Pepsin, Trypsin, or Dialysis to ph 3.3 and 7.5 W. A. HSUEH, M.D., JOHN A. LUETSCHER, M.D., E. J. CARLSON, B.S.,
CALCINEURIN INHIBITORS AND HYPERKALEMIA. Sheena Surindran, MD 3/22/2011
CALCINEURIN INHIBITORS AND HYPERKALEMIA Sheena Surindran, MD 3/22/2011 DISTAL TUBULE K SECRETION EFFECTS OF CYCLOSPORINE ON RAS AND POTASSIUM EXCRETION 10 pts on CsA and prednisone / 10 on AZT and prednisone
4/23/2015. Objectives DISCLOSURES
2015 PENS Conference Savannah, GA Novel Cases of Congenital Hyperreninemic Hypaldosteronism Jan M. Foote DISCLOSURES I have no actual or potential conflicts of interest in relation to this presentation.
Hormonal Control of Osmoregulatory Functions *
OpenStax-CNX module: m44828 1 Hormonal Control of Osmoregulatory Functions * OpenStax This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0 By the end of
Tiny Jaarsma Linköping University No conflict of interest
Detrimental effects of sodium in heart failure - Tiny Jaarsma Linköping University No conflict of interest Sodium restriction in Heart Failure Why? Prevention of heart failure Blood pressure treatment
Managing Addison s Disease
Managing Addison s Disease Dr Charles R Buchanan Consultant Paediatric Endocrinologist Kings College Hospital, London Thomas Addison 1793-1860 Guy s Hospial Described Symptoms 1855 My experience 25 years
Serology and International units
Serology and International units L. Grangeot-Keros, National Reference Laboratory for Rubella, Virology Department, A. Béclère Hospital, Clamart, France Detection of rubella-specific IgG antibody Assays
Circulating renin is synthesized in the renal juxtaglomerular
Appropriate Regulation of Renin and Blood Pressure in 45-kb Human Renin/Human Angiotensinogen Transgenic Mice Daniel F. Catanzaro, Rong Chen, Yan Yan, Lufei Hu, Jean E. Sealey, John H. Laragh Abstract
Aldosterone synthase inhibitors. John McMurray BHF Cardiovascular Research Centre University of Glasgow
Aldosterone synthase inhibitors John McMurray BHF Cardiovascular Research Centre University of Glasgow Inhibition of aldosterone synthesis is hypothesized to be of benefit to patients with cardiovascular
DKK-1 ELISA, Cat.No. BI For the quantitative determination of DKK-1 in human serum
DKK-1 ELISA, Cat.No. BI-20413 For the quantitative determination of DKK-1 in human serum ASSAY CHARACTERISTICS Method Standard range Conversion factor Sample volume / well Incubation time, temp. Sensitivity
Amlodipine plus Lisinopril Tablets AMLOPRES-L
Amlodipine plus Lisinopril Tablets AMLOPRES-L COMPOSITION AMLOPRES-L Each uncoated tablet contains: Amlodipine besylate equivalent to Amlodipine 5 mg and Lisinopril USP equivalent to Lisinopril (anhydrous)
In the name of GOD. Animal models of cardiovascular diseases: myocardial infarction & hypertension
In the name of GOD Animal models of cardiovascular diseases: myocardial infarction & hypertension 44 Presentation outline: Cardiovascular diseases Acute myocardial infarction Animal models for myocardial
Clinical Chemistry. Your article (tracking # ) from Clinical Chemistry is available for download
Clinical Chemistry Copy of e-mail notification Your article (tracking # 242990 ) from Clinical Chemistry is available for download zcy1635 Dear Author, The proof for your article to be published in "Clinical
The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline
SPECIAL FEATURE Clinical Practice Guideline The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline John W. Funder, Robert M.
Endocrine Hypertension
Endocrine Hypertension 1 No Disclosures Endocrine Hypertension Objectives: 1. Understand Endocrine disorders causing hypertension 2. Understand clinical presentation of Pheochromocytoma and Hyperaldosteronism
Year 2004 Paper two: Questions supplied by Megan 1
Year 2004 Paper two: Questions supplied by Megan 1 QUESTION 96 A 32yo woman if found to have high blood pressure (180/105mmHg) at an insurance medical examination. She is asymptomatic. Clinical examination
Hypertension Update. Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy
Hypertension Update Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy Introduction 1/3 of US adults have HTN More prevalent in non-hispanic
- Dr Alia Shatnawi. 1 P a g e
- 1 مها أبو عجمية - - - Dr Alia Shatnawi 1 P a g e A Skippable Intr0 Blood pressure normally decreases during the night. Absence of this phenomenon is called (nondipping) Wikipedia: Circadian rhythm....
Chapter 27: WATER, ELECTROLYTES, AND ACID-BASE BALANCE
Chapter 27: WATER, ELECTROLYTES, AND ACID-BASE BALANCE I. RELATED TOPICS Integumentary system Cerebrospinal fluid Aqueous humor Digestive juices Feces Capillary dynamics Lymph circulation Edema Osmosis
PERIOSTIN ELISA CONTENTS
PERIOSTIN ELISA for the quantitative determination of Periostin in human serum, EDTA plasma, heparin plasma, and citrate plasma Cat. No. BI-20433. 12 x 8 tests CONTENTS ASSAY CHARACTERISTICS Summary...
Patterns of Sodium Excretion During Sympathetic Nervous System Arousal. Gregory A. Harshfield, Derrick A. Pulliam, and Bruce S.
1156 Patterns of Sodium Excretion During Sympathetic Nervous System Arousal Gregory A. Harshfield, Derrick A. Pulliam, and Bruce S. Alpert The purpose of this study was to examine Na + handling and regulation
Veins. VENOUS RETURN = PRELOAD = End Diastolic Volume= Blood returning to heart per cardiac cycle (EDV) or per minute (Venous Return)
Veins Venous system transports blood back to heart (VENOUS RETURN) Capillaries drain into venules Venules converge to form small veins that exit organs Smaller veins merge to form larger vessels Veins
Harmonisation of Growth Hormone Assays: why, issues. MJ Ellis, Endolab, Canterbury Health Labs, May 2015
Harmonisation of Growth Hormone Assays: why, issues MJ Ellis, Endolab, Canterbury Health Labs, May 2015 Why measure Growth Hormone? diagnose and monitor disorders of growth usually in conjunction with
BASELINE CHARACTERISTICS OF THE STUDY POPULATION
COMPARISON OF TREATING METABOLIC ACIDOSIS IN CKD STAGE 4 HYPERTENSIVE KIDNEY DISEASE WITH FRUITS & VEGETABLES OR SODIUM BICARBONATE This was a 1-year, single-center, prospective, randomized, interventional
How do I investigate suspected secondary hypertension? Marie Freel RCP Update in Medicine 23 rd November 2016
How do I investigate suspected secondary hypertension? Marie Freel RCP Update in Medicine 23 rd November 2016 World beaters..! Michel Joffres et al. BMJ Open 2013;3:e003423 Hypertension often poorly controlled
Blood Pressure Regulation Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.
Blood Pressure Regulation Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com) Page 1. Introduction There are two basic mechanisms for regulating
DBC 25-Hydroxyvitamin D
D I A G N O S T I C S B I O C H E M C A N A D A DBC 25-Hydroxyvitamin D ELISA OVERVIEW The worldwide aging and chronically ill population is increasing rapidly. It is forecasted that the Global Vitamin
HYPERTENSIVE VASCULAR DISEASE
HYPERTENSIVE VASCULAR DISEASE Cutoffs in diagnosing hypertension in clinical practice sustained diastolic pressures >90 mm Hg, or sustained systolic pressures >140 mm Hg Malignant hypertension A small
CASE 13. What neural and humoral pathways regulate arterial pressure? What are two effects of angiotensin II?
CASE 13 A 57-year-old man with long-standing diabetes mellitus and newly diagnosed hypertension presents to his primary care physician for follow-up. The patient has been trying to alter his dietary habits
Questions? Homework due in lab 6. PreLab #6 HW 15 & 16 (follow directions, 6 points!)
Questions? Homework due in lab 6 PreLab #6 HW 15 & 16 (follow directions, 6 points!) Part 3 Variations in Urine Formation Composition varies Fluid volume Solute concentration Variations in Urine Formation
Annual Review Contents. Page 1. Introduction, scheme-wide trends, future developments Insulin C-Peptide 8-10
UK NEQAS Guildford Peptide Hormones Annual Review 212 Contents Page 1. Introduction, scheme-wide trends, future developments 1-3 2. Insulin 3-7 3. C-Peptide 8-1 4. Insulin interpretative exercise 1-12
Melatonin and Growth Hormone Deficiency: A Contribution to the Evaluation of Neuroendocrine Disorders
Melatonin and Growth Hormone Deficiency: A Contribution to the Evaluation of Neuroendocrine Disorders Fideleff G., Suárez M., Boquete HR, Azaretzky M., Sobrado P., Brunetto O*, Fideleff HL Endocrinology
Sample Submission Form Hypertension in childhood and adolescence
Sample Submission Form Hypertension in childhood and adolescence Physician Name: Specialty: Clinic / Practice: Street Address: Postal Code: City: Country: Phone: Fax: Email: Patient Information Surname,
Blood Pressure Regulation -1
CVS Physiology Lecture 18 Blood Pressure Regulation -1 Please study the previous sheet before studying this one, even if the first part in this sheet is revision. In the previous lecture we were talking
Byvalson. (nebivolol, valsartan) New Product Slideshow
Byvalson (nebivolol, valsartan) New Product Slideshow Introduction Brand name: Byvalson Generic name: Nebivolol, valsartan Pharmacological class: Beta-blocker + angiotensin II receptor blocker (ARB) Strength
DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE
ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE DISCLOSURES Editor-in-Chief- Nephrology- UpToDate- (Wolters Klewer) Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA 1 st Annual Internal
Papers in Press. First published July 9, 2004 as doi: /clinchem Nonstandard abbreviations: PHA, primary hyperaldosteronism; PAC,
Papers in Press. First published July 9, 2004 as doi:10.1373/clinchem.2004.033159 Clinical Chemistry 50:9 000 000 (2004) Endocrinology and Metabolism Rapid Screening Test for Primary Hyperaldosteronism:
A case of DYSELECTROLYTEMIA. Dr. Prathyusha Dr. Lalitha janakiraman s unit
A case of DYSELECTROLYTEMIA Dr. Prathyusha Dr. Lalitha janakiraman s unit CASE SUMMARY 4 month old, female infant 1 st born to NC parents, term, b.wt: 3.25kg No neonatal hospitalization Attained head control
5.2 Key priorities for implementation
5.2 Key priorities for implementation From the full set of recommendations, the GDG selected ten key priorities for implementation. The criteria used for selecting these recommendations are listed in detail
PHARMACEUTICAL INFORMATION AZILSARTAN
AZEARLY Tablets Each Tablet Contains Azilsartan 20/40/80 mg PHARMACEUTICAL INFORMATION AZILSARTAN Generic name: Azilsartan Chemical name: 2-Ethoxy-1-{[2'-(5-oxo-2,5-dihydro-1,2,4-oxadiazol-3-yl)-4-biphenylyl]methyl}-
Regulation of Body Fluids: Na + and Water Linda Costanzo, Ph.D.
Regulation of Body Fluids: Na + and Water Linda Costanzo, Ph.D. OBJECTIVES: After studying this lecture, the student should understand: 1. Why body sodium content determines ECF volume and the relationships
AVS and IPSS: The Basics and the Pearls
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2018 Mayo Foundation for Medical Education and Research.
LONG-TERM EFFECTS OF SURGICAL MENAGEMENT OF PRIMARY ALDOSTERONISM ON THE CARDIOVASCULAR SISTEM
LONG-TERM EFFECTS OF SURGICAL MENAGEMENT OF PRIMARY ALDOSTERONISM ON THE CARDIOVASCULAR SISTEM Riccardo Marsili, Pietro Iacconi, Massimo Chiarugi, Giampaolo Bernini*, Alessandra Bacca*, Paolo Miccoli Department
USING THE ACCESS AMH ASSAY IN YOUR LABORATORY
INFORMATION BULLETIN USING THE ACCESS AMH ASSAY IN YOUR LABORATORY ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
CPY 605 ADVANCED ENDOCRINOLOGY
CPY 605 ADVANCED ENDOCRINOLOGY THE ADRENAL CORTEX PRESENTED BY WAINDIM NYIAMBAM YVONNE HS09A187 INTRODUCTION Two adrenal glands lie on top of each kidney. Each gland between 6 and 8g in weight is composed
Hormones. Introduction to Endocrine Disorders. Hormone actions. Modulation of hormone levels. Modulation of hormone levels
Introduction to Endocrine Disorders Hormones Self-regulating system (homeostasis) Affect: Growth Metabolism Reproduction Fluid and electrolyte balance Hormone actions Endocrine gland Hormone synthesis
Renal Quiz - June 22, 21001
Renal Quiz - June 22, 21001 1. The molecular weight of calcium is 40 and chloride is 36. How many milligrams of CaCl 2 is required to give 2 meq of calcium? a) 40 b) 72 c) 112 d) 224 2. The extracellular
Lab Activity 31. Anatomy of the Urinary System. Portland Community College BI 233
Lab Activity 31 Anatomy of the Urinary System Portland Community College BI 233 Urinary System Organs Kidneys Urinary bladder: provides a temporary storage reservoir for urine Paired ureters: transport
Adrenal Insufficiency During Pregnancy
Disclosures Adrenal Insufficiency During Pregnancy Research funding from Diurnal Limited via NIH CRADA mechanism Deborah P. Merke, M.D., M.S. Bethesda, MD Outline Primary Adrenal Insufficiency Physiological
How to Recognize Adrenal Disease
How to Recognize Adrenal Disease CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi
Parathyroid hormone (serum, plasma)
Parathyroid hormone (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Parathyroid hormone (PTH) 1.2 Alternative names Parathormone 1.3 NMLC code 1.4 Description of analyte PTH is an
Renin inhibition with aliskiren in hypertension: focus on aliskiren/hydrochlorothiazide combination therapy
REVIEW Renin inhibition with aliskiren in hypertension: focus on aliskiren/hydrochlorothiazide combination therapy Kalathil K Sureshkumar Division of Nephrology and Hypertension, Allegheny General Hospital,
Potassium, Aldosterone, and Hypertension: How Physiology Determines Treatment. Jamie Johnston, MD University of Pittsburgh School of Medicine
Potassium, Aldosterone, and Hypertension: How Physiology Determines Treatment Jamie Johnston, MD University of Pittsburgh School of Medicine No Disclosures Acknowledgements: Evan Ray, MD, PhD Objectives
renoprotection therapy goals 208, 209
Subject Index Aldosterone, plasminogen activator inhibitor-1 induction 163, 164, 168 Aminopeptidases angiotensin II processing 64 66, 214 diabetic expression 214, 215 Angiotensin I intrarenal compartmentalization
Endogenous antibody interference in immunoassays. Ellen Anckaert, M.D., Ph.D. Dienst Klinische Chemie en Radio-immunologie UZ Brussel
Endogenous antibody interference in immunoassays Ellen Anckaert, M.D., Ph.D. Dienst Klinische Chemie en Radio-immunologie UZ Brussel To help protect your privacy, PowerPoint has blocked automatic download
BIPN100 F15 Human Physiology (Kristan) Lecture 18: Endocrine control of renal function. p. 1
BIPN100 F15 Human Physiology (Kristan) Lecture 18: Endocrine control of renal function. p. 1 Terms you should understand by the end of this section: diuresis, antidiuresis, osmoreceptors, atrial stretch
Mechanism: 1- waterretention from the last part of the nephron which increases blood volume, venous return EDV, stroke volume and cardiac output.
Blood pressure regulators: 1- Short term regulation:nervous system Occurs Within secondsof the change in BP (they are short term because after a while (2-3 days) they adapt/reset the new blood pressure
Difficult to Control HTN: It is not all the same. Structured approach to evaluation and treatment
Difficult to Control HTN: It is not all the same. Structured approach to evaluation and treatment Dmitri Vasin M.D. Nephrologist and ASH certified clinical hypertension specialist Bremerton, WA, USA Johnson
Southern Derbyshire Shared Care Pathology Guidelines. Secondary Hypertension
Southern Derbyshire Shared Care Pathology Guidelines Secondary Hypertension Purpose of Guideline This guideline covers the investigation and referral criteria of patients with suspected secondary causes
Chapter 19 The Urinary System Fluid and Electrolyte Balance
Chapter 19 The Urinary System Fluid and Electrolyte Balance Chapter Outline The Concept of Balance Water Balance Sodium Balance Potassium Balance Calcium Balance Interactions between Fluid and Electrolyte
had no effect on the production of aldosterone, corticosterone, or cortisol after
INHIBITION OF THE EFFECTS OF ANGIOTENSIN II ON ADRENAL STEROID PRODUCTION BY DIETARY SODIUM BY WARREN W. DAVIS,* LAWRENCE R. BURWELL,t AND FREDERIC C. BARTTERt ENDOCRINOLOGY BRANCH, NATIONAL HEART INSTITUTE,
Assistant Professor of Endocrinology
Pathophysiology Of Adrenal Disorder Dr.Rezvan Salehidoost Assistant Professor of Endocrinology Pathophysiology Of Adrenal Disorder The adrenal glands lie at the superior pole of each kidney and are composed