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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physicians may be called upon to guide patients with renal disease on the advisability of conceiving or maintaining a gestation, or to manage pregnancies permitted to continue. The prevailing view is that the degree of functional impairment and the presence or absence of hypertension prior to conception determine both pregnancy outcome and the effect of gestation on the natural history of the kidney disorder (Table 4). Normotensive women with minimal dysfunction have a 90% chance of success and there is little evidence that gestation will adversely affect the disease. Presence of hypertension increases the complications rate substantially, and prognosis is also poorer in women with moderate renal dysfunction. Most gestations in the latter group succeed, but at considerable maternal risk: over 20% of these women experience renal functional deterioration, and 30-40% of them have major problems with hypertension. Thus we tend not to recommend pregnancy in patients with moderate renal insufficiency, and definitely discourage gestation when GFR is severely impaired. There are a number of diseases in which pregnancy should not be undertaken, including scleroderma and periarteritis. Some authors believe that women with membranoproliferative glomerulonephritis also do poorly, and opinions differ on the effects of gestation on IgA nephropathy, focal glomerulosclerosis, and reflux nephropathy. Table 5 summarizes our view concerning pregnancy in a number of specific renal disorders. Finally, in addition to the controversies noted above, there are other unresolved problems requiring further study. For instance, protein restriction should be avoided until the effect of this therapeutic manoeuvre on fetal development is evaluated. Also needed are conclusive studies on whether or not the physiological hyperfiltration of human pregnancy affects adversely pre-existing renal disease.
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PMID:Gestation in women with kidney disease: prognosis and management. 333 Apr 93

Scleroderma renal crisis (SRC) is defined as sudden development of accelerated hypertension, hyperreninemia, and acute renal failure in a patient with progressive systemic sclerosis (PSS). Although the diagnosis of PSS is generally straightforward because of dermal fibrosis, we report 2 patients who had PSS with SRC without the characteristic fibrotic skin changes of scleroderma. PSS should be considered in the differential diagnosis of unexplained acute renal failure and accelerated hypertension even though the cutaneous fibrotic manifestations of the disease may be absent.
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PMID:Acute renal failure without fibrotic skin changes in progressive systemic sclerosis. 334 51

The calcium antagonist, felodipine, was used to treat 21 patients with severe uncontrolled hypertension: 13 had renoparenchymatous hypertension, 5 essential hypertension and 3 renovascular hypertension. Mean arterial blood pressure of patients was 195 +/- 8/122 +/- 3mm Hg in spite of treatment with 3 or more antihypertensive drugs. The majority of the patients (n = 17) were treated with an ACE inhibitor. Mean glomerular filtration rate (GFR) for 20 patients was 39 +/- 6 ml/min/1.73m2 body surface area (Cr-EDTA clearance) before felodipine administration. All patients had an immediate blood pressure fall after 5-10mg of felodipine administered orally. This fall persisted when the drug was given 2 or 3 times daily in combination with previous medication except the former vasodilating drugs. 15 patients are on long term treatment with felodipine and their blood pressure after 1 year (n = 14) was 152 +/- 4/89 +/- 2mm Hg. Patients with moderately impaired renal function and no signs of progressive kidney disease (n = 8) improved their GFR significantly after 1 year on felodipine. Six patients stopped felodipine therapy within 3 months (4 because of adverse reactions, 1 died of scleroderma and 1 became normotensive after the start of dialysis treatment). In patients with renoparenchymatous disease and documented progressive deterioration of renal function the addition of felodipine did not prevent a decline in filtration rate but did slow the rate of deterioration (from 9 +/- 2 to 5 +/- 1 ml/min/year).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical evaluation of felodipine in patients with refractory hypertension. 344 59

Trichloroethylene (CHCL = CCL2) is a colorless aliphatic organic solvent with both historical use in medicine as an anesthetic agent and current use in industry as a degreasing agent. Although neither the etiology nor pathogenesis of progressive systemic sclerosis (scleroderma) has been established, this disease has been associated with a wide variety of seemingly unrelated compounds, including exposure to organic solvents. The authors describe a 47-year-old woman with previous excellent health who developed fatal progressive systemic sclerosis after a single 2.5-hour predominantly dermal exposure to trichloroethylene. During a period of 10 months the patient developed proximal scleroderma, reflux esophagitis, microangiopathic hemolytic anemia, restrictive pulmonary disease, pericarditis with effusion, and renal insufficiency with severe hypertension. Renal and skin biopsies were consistent with progressive systemic sclerosis.
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PMID:Progressive systemic sclerosis associated with exposure to trichloroethylene. 361 22

This report describes a case of stable mixed connective tissue disease (MCTD) with development of acute scleroderma with hypertension, oliguric renal failure, microangiopathic hemolytic anemia, and pulmonary infiltrates. The renal histology in the acute episode was that of scleroderma with intimal sclerosis and 'onion skinning' of vessels and glomerular ischemic injury but with no evidence of damage by immune complexes either histologically or by immunofluorescence. improvement occurred after treatment with plasmapheresis, cyclophosphamide, and captopril with return of near normal renal function.
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PMID:Acute scleroderma in stable mixed connective tissue disease: treatment by plasmapheresis. 367 85

We conducted a prospective study of captopril therapy in patients with scleroderma and combined hypertension and renal insufficiency. In all seven patients studied during a 1-year period, control of blood pressure was achieved, and in six of the seven, renal function stabilized or improved. The total daily dosage of captopril ranged from 32 to 100 mg, divided into doses taken every 6 to 8 hours. Although one patient had a suspected captopril-induced rash for a short time, none of the other patients had any adverse side effects. Renal biopsies were performed in six patients; in three of them, specimens were obtained both at the beginning and at the end of the study. The initial biopsy specimens showed changes that were similar to those described in other reports. Findings on repeat biopsies were unchanged except for evidence of chronicity. In the six patients with controlled blood pressure and improved or stabilized renal function, the improvement was maintained for 1 1/2 to nearly 3 years on this drug therapy. Using specific measurements of skin compliance and vascular blood flow in the upper extremities, we could detect no evidence, however, of concomitant improvement in these other features of the disease. Although the blood pressure was controlled with captopril, one patient had progressive skin induration, one had progressive pulmonary insufficiency, and another had progressive renal failure.
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PMID:Use of captopril as early therapy for renal scleroderma: a prospective study. 390 66

DMSO is a clear odorless liquid, inexpensively produced as a by-product of the paper industry. It is widely available in the USA as a solvent but its medical use is currently restricted by the FDA to the palliative treatment of interstitial cystitis and to certain experimental applications. Cutaneous manifestations of scleroderma appear to resolve (albeit equivocally) following topical applications of high concentrations of DMSO. A limited number of small clinical trials indicate that intravenous DMSO may be of benefit in the treatment of amyloidosis, possibly by mobilizing amyloid deposits out of tissues into urine. Dermal application of DMSO seems to provide rapid, temporary, relief of pain in patients with arthritis and connective tissue injuries. However, claims for antiinflammatory effects or acceleration of healing are currently unwarranted. There is no evidence that DMSO can alter progression of degenerative joint disease, and, for this reason, DMSO may be considered for palliative treatment only and not to the exclusion of standard antiinflammatory agents. The safety of DMSO in combination with other drugs has not been established; neurotoxic interactions with sulindac have been reported. In experimental animals, intravenous DMSO is as effective as mannitol and dexamethasone in reversing cerebral edema and intracranial hypertension. An initial clinical trial in 11 patients tends to support this latter application. DMSO enhances diffusion of other chemicals through the skin, and, for this reason, mixtures of idoxuridine and DMSO are used for topical treatment of herpes zoster in the UK. Adverse reactions to DMSO are common, but are usually minor and related to the concentration of DMSO in the medication solution. Consequently, the most frequent side effects, such as skin rash and pruritus after dermal application, intravascular hemolysis after intravenous infusion and gastrointestinal discomfort after oral administration, can be avoided in large part by employing more dilute solutions. Most clinical trials of DMSO have not incorporated the components of experimental design necessary for objective, statistical evaluation of efficacy. Randomized comparisons between DMSO, placebo and known active treatments were rarely completed. Final approval of topical DMSO for treatment of rheumatic diseases in particular will require a multi-center, randomized comparison between high and low concentrations of DMSO and an orally-active, nonsteroidal antiinflammatory agent.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Medical use of dimethyl sulfoxide (DMSO). 391 2

In this review, the cardiac lesions which develop in association with the various collagen-vascular diseases are described. In rheumatoid arthritis, the most frequent lesions are: fibrous obliterative pericarditis, with pericardial deposits of calcium, fibrin, cholesterol, and rheumatoid granulomas; granulomatous or nonspecific myocarditis; valvulitis, vasculitis, and amyloid deposits. In ankylosing spondylitis, the lesions involve mainly the valves (aortic and mitral valves) and the aorta. In systemic lupus erythematosus, the predominant cardiovascular lesions are: pericarditis, Libman-Sacks endocarditis, nonspecific myocarditis, vasculitis with fibrinoid necrosis, and acceleration of atherosclerosis. In scleroderma, the main cardiac lesion is fibrosis with only scanty inflammatory cells; pericarditis and nonbacterial thrombotic endocarditis also occur. In dermatomyositis/polymyositis, fibrous or fibrinous pericarditis can occur, as well as myocarditis with infiltrates of lymphocytes and plasma cells and with degeneration and necrosis of myocytes; valvulitis is uncommon except when the disease is related to mucinous adenocarcinoma. In polyarteritis nodosa, various stages of necrotizing vasculitis involve all layers of the arterial walls; foci of myocardial necrosis of various sizes can occur in association with these lesions; cardiac hypertrophy related to hypertension and pericarditis related to uremia, may also be found. In Wegener's granulomatosis, pericarditis, inflammatory infiltrates, necrotizing granulomas, and vasculitis have been observed in the heart.
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PMID:Cardiovascular lesions in collagen-vascular diseases. 391 76

The occurrence of renal scleroderma (RSc) was sought retrospectively in 36 consecutive patients with scleroderma, seen in a single rheumatology unit, over a 12-year period. The diagnosis RSc was considered when at least one of the following findings was present: systolic blood pressure greater than or equal to 95 mmH, proteinuria greater than or equal to 0.5 gr/24 hr., and creatinine clearance less than or equal to 50 ml/min.: at least one of these features was found in 16 patients. Hypertension was the most frequent feature of RSc (15 out of 16 patients). Two forms of hypertension were observed. Firstly: malignant hypertension occurring early in the course of RSc, seen in 5 patients, 4 of whom rapidly developed terminal renal insufficiency. Secondly: a moderate hypertension, seen in 10 patients with a more favourable outcome, occurring on average 53 months after the diagnosis of scleroderma was made. Proteinuria was only seen in association with malignant hypertension. Renal impairment occurred in 7 patients. Of the 36 patients with scleroderma, 14 died; 10 of these 14 patients had RSc. Thus the death rate in patients with RSc was very high, whereas only 4 out of 20 died in the group without RSc.
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PMID:Renal scleroderma, value of clinical markers. 408 59

The renin-angiotensin system was studied in 14 normotensive and hypertensive patients with scleroderma and polyarteritis nodosa (PAN). The variations in blood pressure, plasma renin activity (PRA) and serum aldosterone were compared after the Captopril test. Mean arterial pressure fell 15,7 +/- 2,6 p. 100 (p less than 0,01) in hypertensive patients, but no change was observed in normotensive subjects. PRA and serum aldosterone did not change significantly in hypertensives with scleroderma. Large variations in blood pressure, PRA and serum aldosterone were observed in 2 out of 3 patients with PAN, the third one presenting a fall in blood pressure without significant changes in PRA or serum aldosterone. These results suggest that other mechanisms are responsible for hypertension in these patients and that the Captopril acted on other factors than the renin-angiotensin system.
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PMID:[The renin-angiotensin system in hypertensive patients with scleroderma and polyarteritis nodosa (author's transl)]. 612 48


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