Renal failure oral contraceptives

Materials and Methods. Subjects ranging in age between 21-89 years were randomly selected from the Domiciliary Care Veterans Facility at the Central State Hospital. Determination of copper and ceruloplasmin was made on venous blood drawn from 180 males and 44 females. We have made no attempt to exclude from this study patients with chronic illnesses since it would be highly unlikely that such aged populations would be completely free of these conditions. However, patients with acute intercurrent illnesses and hepatic renal or symptomatic cardiovascular diseases were eliminated from this study. Individuals with acute illnesses as well as pregnant females or females on oral contraceptive agents also have been excluded. Some of the older patients did have evidence of atherosclerosis, mild diabetes mellitus, or compensated heart failure. 

Secondary hyperaldosteronism results from stimulation of the zona glomerulosa by an extra-adrenal factor, usually the renin-angiotensin system. Excessive potassium intake can create a physiologic increase in aldosterone, as can oral contraceptive use, pregnancy (10 times normal by the third trimester), and menses. Congestive heart failure, cirrhosis, renal artery stenosis, and Bartter s syndrome also can lead to elevated aldosterone concentrations. 

Malignant hypertension with irreversible renal failure has been described in a 27-year-old woman who had previously been well and who had been normotensive during her first pregnancy (109 ). After 2 years of oral contraceptive treatment her blood pressure had risen to 180 mm systolic. She stopped oral contraceptive medication, became pregnant and during pregnancy her blood pressure never exceeded 120/80 mm Hg. After delivery she started to take oral contraceptives the blood pressure rose to 270/150 mm Hg and renal failure developed. Bilateral nephrectomy had to be performed, after which she underwent a renal graft and was well and normotensive 10 months later. A cause-effect relationship... 

Blanc Brunat, N. and Traegcr, J. (1975) Malignant hypertension with irreversible renal failure due to oral contraceptives. Brit. med. J 4, 326. 

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