Could these tests document that a pt is dealing with under/untreated pain?

It is a fairly well accepted theory that under/untreated pain can/may cause elevated blood pressure and also that the 4 or 5 different categories of Pharma produced blood pressure meds will not do little/nothing to lower the pt’s blood pressure, because there is a separate biological pathway that is used to elevate blood pressure that the pharma meds do not address.

Here is the current levels and how they are categorized by the American Heart Assoc https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

It is a known fact that high blood pressure can cause kidney damage. IF a pt has been told that their pain meds are going to be lowered. Would it be a good idea for the pt to request lab test for these substances that are generated by the kidneys – to establish a base line – and when the pt’s blood pressure goes up – especially to HYPERTENSIVE CRISIS LEVEL to ask that they be run again and if they have changed dramatically and especially if they are outside of the normal range, would it suggest that the pt is/could be experiencing kidney damage because of their under/untreated pain. There is a number of damage to a pt’s body caused by elevated blood pressure, and the higher the blood pressure the more likely the damage will progress at a more rapid rate.  The DEA has always “hung their hat” on the claim that there is no way to document that a pt is dealing with pain and/or the intensity of their pain.  If the pt has had their pain meds reduced and their blood pressure has gone up – especially to  HYPERTENSIVE CRISIS LEVEL and their lab values from substance created by the kidney are now outside of normal values, could we back the DEA down? Would it be a good idea to put the pt back on their pain meds for 30 to 60 days and see if the pt’s blood pressure goes back down.  Then  perhaps it is time for some clinical trials to establish the relationship between under/untreated pain, high blood pressure and the lab values of those specific substances created by the kidneys being out of range.  All practitioners  are  suppose  be healers and allowing a pt to be at risk of all the potential damages of high blood pressure because of the failure to treat the pt’s chronic pain. The same theory should apply to Pharmacist who claim that they are “not comfortable” to fill pain meds for a pt.  Could some clinical trials turn the CDC dosing guidelines UPSIDE DOWN and be justification to have those guidelines and the MME system TOSSED IN THE TRASH?

Are there any substances produced by the kidneys that will affect or control blood pressure

Yes, the kidneys produce several substances that affect and control blood pressure:

1. Renin: This enzyme is produced by special cells in the kidneys and released into the bloodstream when blood pressure drops too low[2]. Renin plays a crucial role in activating the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure[3].

2. Angiotensin: While not directly produced by the kidneys, angiotensin is part of the RAAS. Renin from the kidneys acts on angiotensinogen (produced by the liver) to form angiotensin I, which is then converted to angiotensin II. Angiotensin II causes blood vessel constriction, increasing blood pressure[6].

3. Urotensin: The kidneys produce urotensin, which causes blood vessels to constrict and helps raise blood pressure[7].

4. Nitric oxide and prostaglandins: These substances, produced by the kidneys, help regulate blood flow and pressure within the kidneys and can influence overall blood pressure[1].

The kidneys also play a crucial role in regulating blood pressure by controlling sodium excretion. When too little sodium is excreted, blood pressure is likely to increase[7]. Additionally, the kidneys’ ability to excrete sodium in response to elevated blood pressure (pressure natriuresis) is a major factor in long-term blood pressure regulation[1][3].

Citations:
[1] https://www.jci.org/articles/view/72274
[2] https://my.clevelandclinic.org/health/body/22506-renin
[3] https://www.clinhypertensionjournal.com/articles/ach-aid1011.php
[4] https://newsroom.uvahealth.com/2022/01/11/blood-pressure-drugs-may-cause-kidney-damage-study-suggests/
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC5515225/
[6] https://my.clevelandclinic.org/health/articles/23359-angiotensin
[7] https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/biology-of-the-kidneys-and-urinary-tract/kidneys
[8] https://newsroom.uvahealth.com/2024/11/18/blood-pressure-kidney-damage/


Is there a way to detect those substances in the patient’s blood

Yes, there are several ways to detect kidney-produced substances that affect blood pressure in a patient’s blood:

## Renin Test

A renin test, often performed alongside an aldosterone test, can measure the levels of renin in the blood[1][5]. This test is particularly useful for:

– Diagnosing the cause of high blood pressure, especially in younger patients
– Determining if high blood pressure is related to salt sensitivity
– Identifying potential adrenal gland issues

The test involves taking a blood sample, typically in the morning when renin levels are highest[1].

## Angiotensin II and Angiotensin (1-7) Test

This test directly measures the levels of Angiotensin II and Angiotensin (1-7) in plasma using liquid chromatography-tandem mass spectrometry (LC-MS/MS)[3]. It can be used as:

– An adjunct to plasma renin activity and aldosterone measurements
– A tool for investigating potential associations with outcomes of coronavirus infection

## Urotensin II Test

While less common, urotensin II levels can be measured in blood serum. This test has been used in research settings to study conditions like inflammatory bowel disease and may have implications for blood pressure regulation[4].

## ACE (Angiotensin-Converting Enzyme) Test

The ACE test measures the level of angiotensin-converting enzyme in the blood[7]. This enzyme plays a crucial role in the renin-angiotensin-aldosterone system, which regulates blood pressure.

When conducting these tests, it’s important to consider factors that may affect the results, such as:

– Time of day
– Patient’s body position
– Medications (especially blood pressure medications)
– Salt intake
– Stress levels
– Pregnancy

Healthcare providers may need to adjust a patient’s medications or diet before conducting these tests to ensure accurate results[1][6].

Citations:
[1] https://www.webmd.com/hypertension-high-blood-pressure/renin-test
[2] https://www.columbiadoctors.org/health-library/test/renin-blood-test/
[3] https://www.mayocliniclabs.com/test-notifications/attachment.php?id=64257
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC8476337/
[5] https://www.labcorp.com/tests/002006/renin-activity-plasma
[6] https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Genetics/Renin-and-aldosterone-test-2433-PIL.pdf
[7] https://www.ucsfhealth.org/medical-tests/ace-blood-test
[8] https://www.nature.com/articles/pr2017183
[9] https://medlineplus.gov/lab-tests/renin-test/
[10] https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=167&contentid=angiotensin_converting_enzyme_blood
[11] https://www.mayocliniclabs.com/test-catalog/overview/8060


would those substances be higher or lower in the pt’s blood if the pt’s blood pressure in higher

In patients with higher blood pressure, the levels of substances produced by the kidneys that affect blood pressure can vary:

## Renin

Renin levels can be either high or low in patients with high blood pressure, depending on the underlying cause:

– High renin: This may indicate salt sensitivity or kidney problems[3][5].
– Low renin: This could suggest a condition called low renin hypertension (LRH) or primary aldosteronism[7][3].

## Angiotensin II

Angiotensin II levels are typically higher in patients with hypertension:

– Higher than normal angiotensin II levels cause excess fluid retention and high blood pressure[6].
– Elevated angiotensin II can contribute to heart enlargement in hypertensive patients[6].

## Aldosterone

Aldosterone levels can also be elevated in some forms of hypertension:

– High aldosterone with low renin may indicate primary aldosteronism, a cause of high blood pressure[3][5].
– Elevated aldosterone causes the kidneys to retain more water and salt, increasing blood volume and pressure[5].

## Angiotensinogen

Recent research has shown a positive association between angiotensinogen levels and blood pressure:

– Higher angiotensinogen levels are associated with higher odds of prevalent hypertension[2].
– The relationship between angiotensinogen and blood pressure appears to be stronger in males compared to females[2].

It’s important to note that the relationship between these substances and blood pressure is complex and can vary depending on the specific cause of hypertension. Measuring these substances, particularly through tests like the renin activity test and aldosterone levels, can help healthcare providers determine the underlying cause of high blood pressure and guide appropriate treatment.

Citations:
[1] https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/renin-test
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10352958/
[3] https://www.webmd.com/hypertension-high-blood-pressure/renin-test
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC1693859/
[5] https://my.clevelandclinic.org/health/body/22506-renin
[6] https://my.clevelandclinic.org/health/articles/23359-angiotensin
[7] https://www.healthline.com/health/high-blood-pressure-hypertension/low-renin-hypertension
[8] https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16514
[9] https://www.healthcentral.com/condition/hypertension/renin-activity-test


what are the normal lab values for these substances Renin, Angiotensin, Urotensin, renin-angiotensin system activity, Nitric oxide and prostaglandins

Based on the provided search results, here are the normal lab values for some of the substances you inquired about:

## Renin

The normal range for Plasma Renin Activity (PRA) in adults varies slightly depending on the source:

– 0.7 to 3.3 ng/mL/hr (or 0.7 to 3.3 mcg/L/hr in SI units)[1]
– 0.2 to 1.6 ng/mL/hour while lying down and 0.5 to 4.0 ng/mL/hour while standing[4]

## Nitric Oxide

For serum nitric oxide metabolites (NOx):

– Men: 11.5 to 76.4 micromol/L
– Women: 10.1 to 65.6 micromol/L[3]

For exhaled nitric oxide (FeNO):

  • Values below 25 parts per billion (ppb) are considered low
  • Values above 50 ppb are considered high and consistent with type 2 inflammation

It’s worth noting that nitric oxide levels can vary based on factors such as age, height, gender, and certain medical conditions.

## Prostaglandin D2

For adults:

– 35-115 pg/mL[7]

## Angiotensin, Urotensin, and Renin-Angiotensin System Activity

The search results do not provide specific normal values for angiotensin, urotensin, or direct measurements of renin-angiotensin system activity.

It’s important to note that “normal” values can vary depending on the specific laboratory, testing method, and patient factors such as age, sex, and medical conditions. Additionally, some tests, like the aldosterone-renin ratio (ARR), use combinations of these values for diagnostic purposes. For example, an ARR greater than or equal to 20 with serum aldosterone greater than or equal to 15 ng/dL may indicate probable primary aldosteronism[2].

Citations:
[1] https://www.primaryaldosteronism.org/step-1-aldosterone-renin-ratio-arr/
[2] https://pediatric.testcatalog.org/show/PRA
[3] https://pubmed.ncbi.nlm.nih.gov/19782059/
[4] https://www.ucsfhealth.org/medical-tests/renin-blood-test
[5] https://pubmed.ncbi.nlm.nih.gov/8662293/
[6] https://journals.physiology.org/doi/full/10.1152/ajpregu.1999.276.4.R1125
[7] https://www.mayocliniclabs.com/test-notifications/attachment.php?id=58887

 

One Response

  1. U know..thinken the exact same…but gotta come up w/the $$$$$ for another out of pocket/deductable..Getting pictures blood test etc,,,on my once effective dose,,then force reduced dose,,and seeing the difference,,,I know my primary will go for it,,,cause unlike my pain doc,,,the dea isn’t breathing down the primarys neck,,,Thats what destroyed all this,,,federal government regulatory intrusion into medicine,,thus again violating federal law cfr42-1395,,,mw

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