Öz
Amaç: Sol ventrikül hipertrofisi, ekokardiyografinin yaygın kullanımı nedeniyle hipertansiyona bağlı hedef organ hasarı için en sık çalışılan indekstir. Renalaz, esas olarak böbrekler tarafından üretilen, katekolaminleri azaltarak kan basıncını düzenleyen ve kardiyovasküler fonksiyonlara etki eden bir monoamin oksidazdır. Bu çalışmada esansiyel hipertansiyonlu çocuklarda serum renalaz düzeyi ile hipertansif kardiyak değişiklikler arasındaki ilişki sağlıklı kontrol grubu ile karşılaştırıldı.
Gereç ve Yöntemler: Çalışmaya 4-18 yaş (ortalama 15.1 ± 1.9 yıl) arasında 60 hipertansif çocuk (kız/erkek 20/40) dahil edildi. Vücut kitle indeksi normal (4-18, ortalama 14,2 ± 1,3 yıl) ve benzer cinsiyete sahip (kadın/erkek 10/10) 20 sağlıklı çocuk kontrol grubunu oluşturdu. Hipertansif çocukların 30'unda (kadın/erkek: 9/21) ekokardiyografide sol ventrikül hipertrofisi görüldü. Geriye kalan 30 hipertansif hastanın (kadın/erkek: 11/19) ekokardiyografik bulguları normaldi. Hipertansif gruplardan biyokimyasal incelemeler ve renalaz düzeyi için venöz kan örneği alındı. İdrar örnekleri ve 24 saatlik idrar örnekleri toplandı. Hipertansif grupların kan basıncını ölçmek için 24 saatlik ambulatuar kan basıncı izleme (ABPM) kullanıldı. Hipertansif grupların kardiyak değerlendirmesi M-mod ekokardiyografi kullanılarak yapıldı.
Bulgular: Hipertansif gruplarda vücut kitle indeksi normal kan basıncı olan gruba göre anlamlı olarak daha yüksekti (p<0.05). Hipertansif gruplar karşılaştırıldığında beden kitle indeksi açısından anlamlı fark bulunmadı. Tüm gün sistolik, diyastolik; gece sistolik, diyastolik ve gündüz sistolik kan basıncı yükleri, hipertansif sol ventrikül hipertrofik grupta hipertansif hipertrofik olmayan gruba göre anlamlı olarak daha yüksekti (p <0.05). M-mod ekokardiyografide sol ventrikül kitle indeksi, sol ventrikül hipertrofik grupta 39.7 g/m2 ve hipertansif hipertrofik olmayan grupta 27.9 g/m2 olarak bulundu (p <0.05). Kan basıncı yükleri ile sol ventrikül kitle indeksi arasındaki ilişki gruplar arasında karşılaştırıldığında, gündüz sistolik kan basıncı yükü ile artmış sol ventrikül kitle indeksi arasında anlamlı bir ilişki bulundu (p<0.05). Renalaz düzeyi, hipertansif gruplarda normotansif gruba göre anlamlı derecede düşüktü (p <0.05).
Sonuç: Renalaz eksikliği ile artmış sol ventrikül kitle indeksi arasında bir ilişki vardır. Düşük renalaz düzeylerinin erken belirteç olarak kullanılmasının, sol ventrikül hipertrofisi ve uzun dönem hipertansiyon komplikasyonları açısından risk altındaki hastaları belirlemede yararlı ve değerli bir parametre olabileceğine inanıyoruz.
Anahtar Kelimeler
Destekleyen Kurum
Sağlık Bakanlığı Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji EAH
Proje Numarası
01.06.2017/14
Kaynakça
- 1. Marc B. Lande. Hypertension in Children: In Nelson Textbook of Pediatrics (eds: Richard B, Kliegman RM, Jenson H, Stanton B), Elsevier, Philadelphia 2017;19:1988-91.
- 2. Awazu M. Epidemiology of hypertension. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, editors. Pediatric Nephrology. Berlin Heidelberg: Springer Verlag 2009;1460–84.
- 3. Daniels SR, Loggie JMH, Khoury P, Kimball TR. Left Ventricular Geometry and Severe Left Ventricular Hypertrophy in Children and Adolescents With Essential Hypertension. Circulation 1998;97:1907-11.
- 4. Taranta-Janusz K, Roszkowska R, Wasilewska A. Renalase levels in children with solitary functioning kidney. Indian Pediatr 2015;52:1047-50.
- 5. Lee HT, Kim JY, Kim M, Wang P, Tang L, Baroni S, ve ark. Renalase protects against ischemic AKI. J Am Soc Nephrol 2013;24:445-55.
- 6. Wu Y, Xu J, Velazquez H, Wang P, Li G, Liu D, ve ark. Renalase deficiency aggravates ischemic myocardial damage. Kidney Int 2011;79:853-60.
- 7. Foster BJ, MacKie AS, Mitsnefes M. A novel method of expressing left ventricular mass relative to body size in children. Circulation 2008;117:2769-75.
- 8. Bilge I. Hipertansiyon. in Pediatri (eds:Neyzi O, Ertuğrul E). Nobel Tıp Kitabevi Istanbul. 2010;4:1453-62.
- 9. Blood A, Devices P. Medical progress clinical and research aspects of ambulatory blood pressure monitoring in children. Pediatrics 2004;144:7-16.
- 10. Foppa M, Duncan BB, Rohde L. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 2005;3:1-17.
- 11. Alving BM. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Natl Institutes Health 2004;114:555-76.
- 12. Bucher BS, Ferrarini A, Weber N, Bullo M, Bianchetti MG, Simonetti GD. Primary hypertension in childhood. Curr Hypertens Rep 2013;15:444-52.
- 13. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007;116:1488-96.
- 14. Akiş N, Pala K, İrgil E, Aydın N, Aksu H, Bursa ili Orhangazi ilçesi 6 merkez ilköğretim okulunda 6- 14 yaş grubu öğrencilerde kilo fazlalığı ve obezite. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2003;29:17-20.
- 15. Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 2002;39:903-8.
- 16. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, ve ark. Management of high blood pressure in children and adolescents: recommendations of the european society of hypertension. J Hypertension 2009;27:1719-42.
- 17. He Q, Ding ZY, Fong DY T, Karlberg J. Blood pressure Is associated with body mass index in both normal and obese children. Hypertension 2000;36:165-70.
- 18. Killeen JD, Vanderburg D, Harlan WR. Application of weight-height ratios and body indices to juvenile populations - the National Health Examination Survey Data. J Chronic Dis 1978;31:529-37.
- 19. Flynn JT, Alderman MH. Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 2005;20:961-6.
- 20. Xu J, Desir GV. Renalase, a new renal hormone: Its role in health and disease. Curr Opin Nephrol Hypertension 2007;16:373-8.
Öz
Objective: Left ventricular hypertrophy is the most commonly studied index for hypertension related target organ damage due to the wide usage of echocardiography. Renalase is a monoamine oxidase, mainly produced by the kidneys, regulating blood pressure by reducing catecholamines and acting on cardiovascular functions. In this study, the relationship between serum renalase level and hypertensive cardiac changes in children with essential hypertension was compared with the healthy control group.
Materials and Methods: A total of 60 hypertensive children (female/male 20/40) aged between 4-18 years (mean 15.1 ± 1.9 years) were included in the study. Twenty healthy children with normal body mass index (4-18, mean14.2 ± 1.3 years) and similar gender (female/male 10/10) formed the control group. In 30 of hypertensive children (female/male: 9/21), echocardiography showed left ventricular hypertrophy. Echocardiographic findings of 30 remaining hypertensive patients (female/male: 11/19) were normal. A venous blood sample was collected from the hypertensive groups for biochemical examinations and renalase level. Urine samples and 24-hour urine samples were collected. 24-hour ambulatory blood pressure monitoring (ABPM) was used to measure blood pressure of hypertensive groups. The cardiac evaluation of hypertensive groups was performed using M-mode echocardiography.
Results: The body mass index was significantly higher in hypertensive groups than the group with normal blood pressure (p <0.05). In comparison of hypertensive groups, no significant difference was found in terms of body mass index. All day systolic, diastolic; night systolic, diastolic, and daytime systolic blood pressure loads were significantly higher in hypertensive left-ventricular hypertrophic group than hypertensive non-hypertrophic group (p <0.05). Left ventricular mass index in M-mode echocardiography, revealed 39.7 g/m2 in the left ventricular hypertrophic group and 27.9 g/m2 in the hypertensive non-hypertrophic group (p <0.05). When the relationship between blood pressure loads and left ventricular mass index was compared between the groups, a significant correlation was found between daytime systolic blood pressure load and increased left ventricular mass index (p <0.05). Renalase level was significantly lower in hypertensive groups compared to normotensive group (p <0.05). There is a relationship between renalase deficiency and increased left ventricular mass index.
Conclusion: There is a correlation between renalase deficiency and increased left ventricular mass index. We believe that utilization of low renalase levels as an early marker may be a useful and valuable parameter for determining the patients at risk for left ventricular hypertrophy and long-term complications of hypertension
Anahtar Kelimeler
Proje Numarası
01.06.2017/14
Kaynakça
- 1. Marc B. Lande. Hypertension in Children: In Nelson Textbook of Pediatrics (eds: Richard B, Kliegman RM, Jenson H, Stanton B), Elsevier, Philadelphia 2017;19:1988-91.
- 2. Awazu M. Epidemiology of hypertension. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, editors. Pediatric Nephrology. Berlin Heidelberg: Springer Verlag 2009;1460–84.
- 3. Daniels SR, Loggie JMH, Khoury P, Kimball TR. Left Ventricular Geometry and Severe Left Ventricular Hypertrophy in Children and Adolescents With Essential Hypertension. Circulation 1998;97:1907-11.
- 4. Taranta-Janusz K, Roszkowska R, Wasilewska A. Renalase levels in children with solitary functioning kidney. Indian Pediatr 2015;52:1047-50.
- 5. Lee HT, Kim JY, Kim M, Wang P, Tang L, Baroni S, ve ark. Renalase protects against ischemic AKI. J Am Soc Nephrol 2013;24:445-55.
- 6. Wu Y, Xu J, Velazquez H, Wang P, Li G, Liu D, ve ark. Renalase deficiency aggravates ischemic myocardial damage. Kidney Int 2011;79:853-60.
- 7. Foster BJ, MacKie AS, Mitsnefes M. A novel method of expressing left ventricular mass relative to body size in children. Circulation 2008;117:2769-75.
- 8. Bilge I. Hipertansiyon. in Pediatri (eds:Neyzi O, Ertuğrul E). Nobel Tıp Kitabevi Istanbul. 2010;4:1453-62.
- 9. Blood A, Devices P. Medical progress clinical and research aspects of ambulatory blood pressure monitoring in children. Pediatrics 2004;144:7-16.
- 10. Foppa M, Duncan BB, Rohde L. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 2005;3:1-17.
- 11. Alving BM. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Natl Institutes Health 2004;114:555-76.
- 12. Bucher BS, Ferrarini A, Weber N, Bullo M, Bianchetti MG, Simonetti GD. Primary hypertension in childhood. Curr Hypertens Rep 2013;15:444-52.
- 13. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007;116:1488-96.
- 14. Akiş N, Pala K, İrgil E, Aydın N, Aksu H, Bursa ili Orhangazi ilçesi 6 merkez ilköğretim okulunda 6- 14 yaş grubu öğrencilerde kilo fazlalığı ve obezite. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2003;29:17-20.
- 15. Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension 2002;39:903-8.
- 16. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, ve ark. Management of high blood pressure in children and adolescents: recommendations of the european society of hypertension. J Hypertension 2009;27:1719-42.
- 17. He Q, Ding ZY, Fong DY T, Karlberg J. Blood pressure Is associated with body mass index in both normal and obese children. Hypertension 2000;36:165-70.
- 18. Killeen JD, Vanderburg D, Harlan WR. Application of weight-height ratios and body indices to juvenile populations - the National Health Examination Survey Data. J Chronic Dis 1978;31:529-37.
- 19. Flynn JT, Alderman MH. Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 2005;20:961-6.
- 20. Xu J, Desir GV. Renalase, a new renal hormone: Its role in health and disease. Curr Opin Nephrol Hypertension 2007;16:373-8.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | ORIGINAL ARTICLES |
| Yazarlar | |
| Proje Numarası | 01.06.2017/14 |
| Yayımlanma Tarihi | 30 Kasım 2022 |
| Gönderilme Tarihi | 19 Ekim 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 16 Sayı: 6 |