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e250 Journal of Hypertension Vol 36, e-Supplement 1, June 2018
(r = –0.36, p = 0.027) and alphacalcidol dose [ug/24 h] (r = 0.41, p = 0.02). In the
study group we found correlations of renalase with GFR (r = –0.69, p = 0.00001),
hemoglobin (r = –0.48, p = 0.002), phosphate (r = 0.35, p = 0.03), Calcium-phos-
phorus product (r = 0.35, p = 0.03), parathormone (r = 0.58, p = 0.0001), total
cholesterol (r = 0.35, p = 0.03), LDL-cholesterol (r = 0.36, p = 0.03) and triglyc-
erides (r = 0.52, p = 0.01). We found no correlations between renalase and pe-
ripheral and central blood pressure and IMT; renalase correlated only with PWV
Z-score (r = 0.42, p = 0.043). In control group renalase was dependent only on
age (r = –0.37, p = 0.022); such relation was not found in the study group. No
other correlations between renalase and analyzed clinical, vascular and biochemi-
cal parameters were found in the control group.
Conclusions: 1. In children with chronic kidney disease renalase level is higher
compared to healthy peers and is highly dependent on glomerular fi ltration.
2. In children with chronic kidney disease renalase seems to be related neither to
central nor to peripheral blood pressure but may be a marker of arterial stiffness.
INFLUENCE OF THE CARDIOPROTECTION ON HEMODYNAMIC IN
PERIOPERATIVE PERIOD IN ELDERLY
Y. Ploshchenko, O. Klygunenko. SE Dnipropetrovsk medical academy MOH of
Ukraine, Dnipro, UKRAINE
Objective: The issue of prevention of cardiac complications during non-cardiac
elective surgery is an actual problem of anesthesiology. Decompensation of cardi-
ac function is characteristic for the elderly, which may be the cause of postopera-
tive lethality. Cardioprotective therapy may contributes to survival of cardiomyo-
cytes under ischemia – hypoxia. In our real clinical practice only a few drugs with
cardioprotective properties are introduced, in particular which include the amino
acids L-arginine and L-carnitine. Affecting endothelial dysfunction, it energizes
the cardiomyocyte. For the anesthesiologist also there is an important absence of
negative hemodynamic action.The purpose of the study was to detect the presence
of cardioprotective effect of the solution of L-arginine and L-carnitine by assess-
ing the central hemodynamic effects in elderly patients in the perioperative period.
Design and method: We examined 20 patients aged 60 to 81 years with car-
diovascular comorbidities, which was performed by abdominal surgery in an-
esthesiology department of the Dnipropetrovsk City Multidisciplinary Clinical
Hospital N 4. All patients in the preoperative period, as preparation for anesthesia
and surgical intervention, received the solution of L-arginine and L-carnitine 100
ml intravenous, there was continued for the next three days at a daily dose in the
postoperative period. To control the cardioprotective effect before surgery and
after infusion, we used echocardiography and central hemodynamics by thoracic
rheography (modifi ed Kubichek technique, electrodes on the back).
Results: In the study of echocardiography in patients receiving the solution of
L-arginine and L-carnitine, during the entire period of the perioperative period, no
signifi cant variability of the main parameters (ejection fraction, volume of cham-
bers of the heart) was observed. In the analysis of rheograms preoperatively in
patients there was a hypokinetic type of hemodynamics with high vascular pres-
sure. From 2 days there was a tendency to normal circulation, with simultane-
ous decrease of vascular resistance to normal indexes, the index of work of left
ventricle decreased.
Conclusions: the use of the the solution of L-arginine and L-carnitine in the
perioperative period reduces the hemodynamic load on the myocardium and is ap-
propriate in order to prevent cardiac complications of non-cardiac elective surgery
in elderly patients.
A PREGNANT WOMAN WITH PSEUDOHYPERALDOSTERONISM
DUE TO MUMIJO CONSUMPTION: A LICORICE-LIKE SYNDROME
K. Imprialos, K. Stavropoulos, D. Patoulias, S. Bouloukou, G. Kerpiniotis,
G. Lales, A. Manafi s, C. Mitas, K. Petidis, V. Athyros, A. Karagiannis, M. Dou-
mas. 2nd Propedeutic Department of Internal Medicine, Aristotle University of
Thessaloniki, Thessaloniki, GREECE
Objective: To report the fi rst case of pseudohyperaldosteronism due to mumijo
consumption and provide the pathophysiologic background.
Design and method: A 37-year-old woman on the 32nd-week of gestation was
referred to our Department due to persistent hypokalemia, hypomagnesaemia and
high blood pressure (BP). After meticulous investigation of her medical history,
we found that the patient received without prescription mumijo over the last six-
months. Physical examination was unremarkable. A thorough diagnostic work-up
was then initiated to evaluate the persistent hypokalemia along with hypertension.
Results: Serum potassium at admission was 2.7mmol/L, while serum magne-
sium was 1.72 mg/dl. The rest serum electrolytes values were within normal
values. Offi ce BP was 152/97mmHg. Air blood gases examination revealed the
presence of metabolic alkalosis. Twenty-four-hour urine sample revealed high
urinary excretion of potassium, magnesium and calcium. The 24 h ambulatory
BP monitoring confi rmed the increased BP levels (146/104mmHg) with non-
dipping pattern. Consequently, patient had a high clinical suspicious for primary
aldosteronism, thus underwent the diagnostic procedure of the disease. Interest-
ingly, both plasma renin activity and aldosterone were found at remarkably low
levels (0.08ng/ml, and > 0.16ng/100 ml, respectively). Normal early cortisol lev-
el (8.9mcg/100 ml) and 1 mg dexamethasone suppression test (2.3mcg/100 ml)
excluded Cushing’s syndrome. Moreover, dehydroepiandrosterone level mea-
sured in normal values (1.494,9ng/ml). These fi ndings excluded the diagnosis
of primary aldosteronism and emerged the probability of a pseudohyperaldoste-
ronism-syndrome. Biochemical and hormonal normalization was observed with
mumijo withdrawal.
Conclusions: Our patient was fi nally diagnosed with pseudohyperaldosteronism-
syndrome due to mumijo consumption, a ‘’licorice-like syndrome’’, via inhibition
of 11-hydroxysteroid dehydrogenase type 2, leading to impaired inactivation of
cortisol to cortisone and fi nally to excessive mineralocorticoid activity, mainly in
the distal- and cumulative-tubule. Clinicians should be aware of this side effect
when prescribing mumijo, and a detailed medical history is always needed.
VITAMIN D AND BLOOD PRESSURE PARAMETERS IN CHILDREN
AND ADOLESCENTS WITH ARTERIAL HYPERTENSION
P. Skrzypczyk1, K. Dziedzic-Jankowska1, A. Ofi ara2, M. Szyszka2, M. Panczyk-
Tomaszewska1. 1Medical University of Warsaw - Department of Pediatrics and
Nephrology, Warsaw, POLAND, 2Medical University of Warsaw - Student Scien-
tifi c Group at the Department of Pediatrics and Nephrology, Warsaw, POLAND
Objective: Observational studies suggest that low vitamin D levels may promote
hypertension. Aim was to assess vitamin D status in children and adolescents with
arterial hypertension and to fi nd relation between vitamin D and clinical, bio-
chemical and ABPM parameters.
Design and method: Study group included 49 pediatric patients aged
14.29 ± 3.17 years with arterial hypertension; 24 children received antihyperten-
sive medications. In all patients we evaluated vitamin D status, serum calcium,
phosphorus, parathormone, alkaline phosphatase, urinary calcium and phospho-
rus loss, offi ce blood pressure, ABPM, height, weight and BMI, GFR, uric acid,
lipids and albuminuria. Children were not supplemented with vitamin D. Accord-
ing to Central European Guidelines vitamin D status was defi ned as: defi ciency
(<20 ng/mL), suboptimal status (20–30 ng/ml), adequate status (>30 to 50 ng/
mL), high supply (> 50 to 100 ng/mL).
Results: Vitamin D level was from 6.1 to 55.3, mean 19.74 ± 9.68 ng/mL. Vi-
tamin D defi ciency was found in 29 (59.2%), suboptimal status in 17 (34.7%),
adequate status in 1 (2.0%), high supply in 2 (4.1%) children. Vitamin D lev-
el was higher in Spring-Summer months compared to Autumn-Winter months
(21.79 ± 10.19 vs. 15.53 ± 7.08 ng/mL, p = 0.031), did not differ between boys
and girls (20.14 ± 11.13 vs. 18.83 ± 5.25 ng/mL, p = 0.974) and between treated
and untreated children (20.72 ± 12.71 vs. 18.80 ± 5.53 ng/mL, p = 0.031). Other
parameters of calcium-phosphorus metabolism were within normal limits in all
children. Vitamin D level correlated with height Z-score (R = 0.39, p = 0.003),
BMI Z-score (r = –0.34, p = 0.016), uric acid (r = –0.31, p = 0.044) and triglyc-
erides (r = –0.37, p = 0.014). Vitamin D level correlated negatively with mean
24-hour heart rate (r = –0.38, p = 0.007); whereas no relation was found between
vitamin D and age. In the subgroup of 24 children treated with antihypertensive
medications (mean duration of hypertension 23.54 ± 21.64 months) vitamin D
correlated with ambulatory arterial stiffness index (r = 0.50, p = 0.036).
Conclusions: 1. Inadequate supply (defi ciency or suboptimal status) is ubiqui-
tous in children with arterial hypertension.
2. Vitamin D defi ciency should be suspected especially in Autumn-Winter period
and among obese and short children.
3. The relation between vitamin D status and ambulatory arterial stiffness index
suggests negative infl uence of vitamin D on arterial wall but requires further ex-
aminations.
RED BLOOD CELLS COUNT AND HEMOGLOBIN LEVEL ARE
ASSOCIATED WITH ARTERIAL STIFFNESS IN HEALTHY SUBJECTS
I. Strazhesko, A. Staroverova, E. Borisov, Y. Orlova. Lomonosov Moscow State
University, department of age-associated diseases, Moscow, RUSSIA
Objective: Increased arterial stiffness (AS), measured as increased pulse wave
velocity (PWV), has been considered as important aspect of vascular aging and
independent risk factor for both cardiovascular events and overall mortality.
Chronic infl ammation due to the aging of immune system and disturbances in the
functional state of endothelial progenitor cells is one of the key mechanisms of