Endocrine alteration in the adrenal gland in kidney transplant patients

Introduction: Endocrine alterations associated with chronic renal failure h ave been reviewed recently. Some of these alterations are of clinical relev ance. The aim of this study was to investigate the effect of renal transpla ntation on the endocrine system of the adrenal gland of the transplant reci pients. Methods: The serum angiotensin-converting enzyme (SACE), plasma ren in (PR) and plasma aldosterone (PA) were examined in 30 patients before and after renal allotransplantation. Additionally measured parameters were blo od pressure, serum creatinine, potassium, sodium, the duration of dialysis and immunosuppressive medication. Results: Six weeks after renal transplant ation, serum creatinine decreased from 820.07 +/- 172.01 to 138.12 +/- 67.5 4 mu mol/l. In the same periode, serum potassium decreased from 5.42 +/- 0. 89 to 4.17 +/- 0.42 mmol/l. PA and PR decreased from 1,150.84 +/- 976.06 to 233.52 +/- 217.07 mu mol/l, and from 121.07 +/- 100.12 to 26.16 +/- 10.86 muU/ml, respectively. SACE decreased from 0.21 +/- 0.21 to 0.13 +/- 0.11 mu mol/l. No significant correlation was seen with blood pressure, serum sodi um, the duration of dialysis and immunosuppressive drugs. Additionally, 2 p atients with acute renal graft dysfunction showed significant increases in PR and PA. After successful treatment both levels declined very quickly to prerejection levels. Patients after binephrectomy show no elevation in PR ( 5-47 muU/ml) or PA (21-16 mu mol/l) neither before nor after renal transpla ntation. Conclusions: We conclude that renal transplantation has profound e ffects on the recipient's renin-angiotensin-aldosterone system. Because of the rapid depression after renal transplantation, it does not appear to be involved in the pathogenesis of post transplantation hypertension but may r eflect a role for repair processes after renal allotransplantation. Copyrig ht (C) 2001 S. Karger AG, Basel.