Plasma metanephrines in renal failure
Plasma metanephrines in renal failure
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DOI：
10.1111/j.1523-1755.2005.67123.x
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发表时间：
2005-02-01
影响因子：
19.6
通讯作者：
Lenders, JWM
中科院分区：
文献类型：
--
作者：
Eisenhofer, G;Huysmans, F;Lenders, JWM
背景。由于缺乏常规尿液儿茶酚胺过量测量的可靠性，肾衰患者嗜铬细胞瘤的诊断面临着一个困境。血浆肾上腺素、去甲肾上腺素和肾上腺素（去甲肾上腺素和肾上腺素的o -甲基化代谢物）的测量提供了另一种诊断测试。肾上腺素可以作为游离代谢物或在解偶联步骤后测量，其中测量主要反映硫酸盐偶联代谢物。肾功能不全对这些指标的影响尚不清楚。对17例终末期肾病透析患者和19例肾功能不全患者（肌酐清除率5 ~ 78 mL/min）血浆游离肾上腺素和儿茶酚胺水平与89例高血压患者、68例健康血压正常者和51例von Hippel-Lindau综合征患者进行比较。肾功能衰竭患者血浆儿茶酚胺和游离肾上腺素浓度比对照组高2倍，血浆去钠化肾上腺素浓度比对照组高12倍以上。75%和42%的透析患者血浆游离肾上腺素和儿茶酚胺在参照组的95%置信区间内，74%和68%的肾功能不全患者血浆游离肾上腺素和儿茶酚胺在参照组的95%置信区间内。相比之下，没有透析患者和只有一半肾功能不全患者的血浆去钠化肾上腺素水平在参考区间内。血浆去钠化肾上腺素水平与肌酐清除率呈明显的负相关，而游离肾上腺素水平与肌酐清除率无明显的负相关。血浆游离肾上腺素浓度相对独立于肾功能，因此，相对于去钠化肾上腺素的测定，血浆游离肾上腺素浓度更适合于肾衰竭患者嗜铬细胞瘤的诊断。
Background. Diagnosis of pheochromocytoma in renal failure poses a diagnostic dilemma due to lack of reliability of conventional urinary measurements of catecholamine excess. Measurements of the plasma metanephrines, normetanephrine and metanephrine (the O-methylated metabolites of norepinephrine and epinephrine), provide an alternative diagnostic test. The metanephrines may be measured as free metabolites or after a deconjugation step where measurements reflect mainly sulfate-conjugated metabolites. The influence of renal insufficiency states on these various measurements is unclear.Methods. Plasma free and deconjugated metanephrines and catecholamines in 17 patients on dialysis with end-stage renal disease and 19 patients with renal insufficiency (creatinine clearance, 5-78 mL/min) were compared with levels in 89 hypertensives, 68 healthy normotensives, and 51 patients with von Hippel-Lindau syndrome.Results. Patients with renal failure had up to two-fold higher plasma concentrations of catecholamines and free metanephrines, and more than 12-fold higher plasma concentrations of deconjugated metanephrines than comparison groups. Plasma free metanephrines and catecholamines were, respectively, within the 95% confidence intervals of reference groups in 75% and 42% of the dialysis patients, and in 74% and 68% of patients with renal insufficiency. In contrast, no dialysis patient and only half the renal insufficiency patients had plasma levels of deconjugated metanephrines within the reference intervals. Plasma levels of deconjugated metanephrines, but not free metanephrines, showed strong inverse relationships with creatinine clearance.Conclusion. Plasma concentrations of free metanephrines are relatively independent of renal function and are, therefore, more suitable for diagnosis of pheochromocytoma among patients with renal failure than measurements of deconjugated metanephrines.