Identifies a novel syndrome of persistent hypotension caused by hypermedullipinemia in the setting of advanced renal insufficiency.
May prompt consideration of hypermedullipinemia in refractory hypotension with renal failure; hypothesis-generating case report requiring validation.
A new syndrome is described in a patient with advanced renal insufficiency. This consists of severe and persistent hypotension causing weakness but associated with a clear mental status. Also present is evidence for decreased vascular reactivity. The hypotension was not orthostatic. The hypotension was associated with a circulating vasodepressor substance having the characteristics of medullipin 1. The medullipin appears to have been derived from the remaining right kidney. Hypotension existed despite the presence of major prohypertensive mechanisms, including an endstage kidney, hyperreninemia and hyperaldosteronemia. It is likely that hypotension due to hypermedullipinemia is an entity occurring in the human being.
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Muirhead et al. (1992) studied this question.
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