Human Reproduction, Vol 12, 236-240, Copyright © 1997 by Oxford University Press
A Delbaere, PJ Bergmann, C Gervy-Decoster, M Camus, V de Maertelaer and Y Englert
The pathophysiology of ovarian hyperstimulation syndrome (OHSS) remains
unclear. Several lines of evidence indicate that OHSS is associated with a
stimulation of the renin-angiotensin system (RAS), but its functional
significance as well as its role in the pathogenesis of the syndrome are
not yet determined. OHSS is associated with high plasma and ascitic
concentrations of total renin, renin activity (RA) and angiotensin II (Ang
II). Their ovarian or renal origin is, however, still a matter of debate.
To clarify these issues further, total renin, active renin, prorenin, RA
and aldosterone were measured in plasma and ascites of nine patients who
developed severe OHSS after in-vitro fertilization. Blood and ascites were
sampled simultaneously during therapeutic paracentesis. Total renin and
prorenin concentrations were significantly higher in the ascites (mean
concentration +/- SE respectively of 5920 +/- 1430 mIU/l and 5250 +/- 1350
mIU/l) than in the plasma (respectively 3060 +/- 740 mIU/l and 2000 +/- 460
mIU/l) (P = 0.020 and 0.017 respectively). Conversely, active renin and RA
concentrations tended to be lower, although not statistically significantly
so in the ascites (respectively 670 +/- 190 mIU/l and 47 +/- 11 ng Ang
I/ml/h) than in the plasma (respectively 1060 +/- 370 mIU/l and 75 +/- 21
ng Ang I/ml/h). Aldosterone concentrations were significantly higher in the
serum (2609 +/- 374 pg/ml) than in the ascites (2025 +/- 347 pg/ml) (P =
0.015). The concentration gradient between plasma and ascites for total
renin and prorenin supports the hypothesis of their ovarian origin in
ascites and, to a large extent, in plasma, while it is likely that the high
plasma active renin and RA concentrations reflect a peripheral activation
of the RAS. In conclusion, the present findings are consistent with a
marked stimulation of both ovarian and renal RAS during OHSS.
ARTICLES
Prorenin and active renin concentrations in plasma and ascites during severe ovarian hyperstimulation syndrome
Department of Gynecology and Obstetrics, Erasme Hospital, Brussels, Belgium.
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