Plasma metanephrines in renal failure

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Plasma metanephrines in renal failure Graeme Eisenhofer, Frans Huysmans, Karel Pacak, Macclellan M. Walther, Fred C.G.J. Sweep, Jacques W.M. Lenders Kidney International Volume 67, Issue 2, Pages 668-677 (February 2005) DOI: 10.1111/j.1523-1755.2005.67123.x Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 1 Diagram showing the main pathways for metabolism of the norepinephrine and epinephrine derived from sympathoneuronal or adrenalmedullary sources. Deamination in sympathetic nerves (white) is the major pathway of catecholamine metabolism and involves intraneuronal deamination of norepinephrine leaking from storage granules, or of norepinephrine recaptured after release by sympathetic nerves. Metabolism in adrenal chromaffin cells (black) involves O-methylation of catecholamines leaking from storage granules into the cytoplasm of adrenalmedullary cells. The extraneuronal pathway (gray) is a relatively minor pathway of metabolism of catecholamines released from sympathetic nerves or the adrenal medulla, but is important for further processing of metabolites produced in sympathetic nerves and adrenal chromaffin cells. The free metanephrines produced in extraneuronal tissues or adrenal chromaffin cells are either further metabolized by deamination or sulfate conjugation. Abbreviations: NE, norepinephrine; E, epinephrine; DHPG, 3,4-dihydroxyphenylglycol; MN, metanephrine; NMN, normetanephrine; MHPG, 3-methoxy-4-hydroxyphenylglycol; VMA, vanillylmandelic acid; MHPG-SO4, 3-methoxy-4-hydroxyphenylglycol sulfate; NMN-SO4, normetanephrine-sulfate; MN-SO4, metanephrine-sulfate; MAO, monoamine oxidase; COMT, catechol-O-methyltransferase; ADH, alcohol dehydrogenase; SULT1A3, phenolsulfotransferase type 1A3. Kidney International 2005 67, 668-677DOI: (10.1111/j.1523-1755.2005.67123.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 2 Plasma concentrations of catecholamines, free metanephrines, and deconjugated metanephrines in individual patients with ESRD on dialysis (▴) and patients with milder renal insufficiency (Δ) compared to individual values in the three reference groups. Horizontal dashed lines represent the upper limits of the 95% confidence intervals for values in the reference population. Kidney International 2005 67, 668-677DOI: (10.1111/j.1523-1755.2005.67123.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 3 Relationships between creatinine clearance and plasma concentrations of catecholamines, free metanephrines, or deconjugated metanephrines in patients with renal insufficiency (•) and VHL syndrome (○). Kidney International 2005 67, 668-677DOI: (10.1111/j.1523-1755.2005.67123.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 4 Relationships between creatinine clearance and clearances of deconjugated normetanephrine and deconjugated metanephrine in patients with renal insufficiency (•) and VHL syndrome (O). Kidney International 2005 67, 668-677DOI: (10.1111/j.1523-1755.2005.67123.x) Copyright © 2005 International Society of Nephrology Terms and Conditions