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

The renal glomeruli are vulnerable to injury by a number of drugs and other toxic agents. These agents may lead to damage by one of two basic mechanisms: direct, dose-related toxic injury; indirect, immunologically mediated injury, largely dose-independent. Proteinuria is the simplest and most important functional indicator of glomerular injury. It occurs almost immediately in direct toxic injury, but there is a latent period of weeks to months with immunologically mediated processes. Of the two mechanisms, the second is by far the more common in clinical settings. The best studied experimental agent causing direct toxic injury is the aminonucleoside of puromycin. Clinically, perhaps the most important agent is Cyclosporine A. Although this agent is usually thought of primarily as a tubular toxin, it is capable of giving rise to a microangiopathic glomerular lesion similar to that in the hemolytic uremic syndrome. The classic model for immunologic glomerular lesion is Heymann nephritis, which produces a membranous glomerulopathy. Clinically, most drug mediated glomerulopathies also take the form of a membranous nephropathy, usually with a frank nephrotic syndrome. Among the more common offenders are penicillamine, gold salts used in rheumatoid arthritis, and captopril used in hypertension. The other common type of drug-related glomerulopathy occurs as part of a lupus-like syndrome induced by a variety of drugs, including hydralazine, procainamide, and penicillamine. All of these give rise to a variety of antibodies, most prominently antinuclear antibodies, and in the more severe cases there may be lupus-like glomerular lesions as well.
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PMID:Drug-associated glomerulopathies. 294 Jun 67

The clinical courses of 33 pregnancies in 24 patients with biopsy proven membranous glomerulonephritis have been analyzed. Twenty-four percent (8) of pregnancies resulted in fetal loss, 43% (14) in premature delivery and 33% (11) in a live birth after 36 weeks gestation. Maternal renal function declined during pregnancy in 9% (3) of the pregnancies and in 46% (15) hypertension developed. In 55% (18) proteinuria increased significantly during pregnancy. In 30% (10) nephrotic range proteinuria was recorded in the first trimester. Presence of nephrotic range proteinuria during the first trimester correlated with both poor fetal and poor maternal outcome (p less than 0.0004 and p less than 0.0002, respectively). It is concluded that pregnancy in patients with membranous glomerulonephritis is associated with increased fetal loss and, in some instances, a worsening in maternal renal function. The literature on this topic is reviewed in relation to these findings.
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PMID:Membranous glomerulonephritis and pregnancy. 330 31

Eleven of 30 patients with MCTD, followed for a mean of 10 years, developed immune complex nephropathy (five membranous, two mesangial, one mixed, and one sclerosing) with NS in nine of 11. Another patient had membranous nephropathy at autopsy. Patients with renal disease tended to have more systemic manifestations than those without. NS was at times of abrupt onset, recurrent, and/or persistent. Anti-RNP and serum complement were not helpful in predicting nephritis. Seventy-two percent of nephropathy and 62% of NS episodes resolved or improved after corticosteroid therapy. Five patients became hypertensive, two developed chronic renal failure and required chronic dialysis, and one needed acute dialysis twice. One patient progressed to focal proliferative crescentic nephritis with necrotizing arteritis. Three patients with nephropathy died, two of pulmonary hypertension with acute cor pulmonale and one of overwhelming sepsis. Nephropathy is relatively common in MCTD, is associated with substantial morbidity, and with the risk of hypertension and chronic renal failure.
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PMID:Renal involvement in mixed connective tissue disease: a longitudinal clinicopathologic study. 356 25

Nodular regenerative hyperplasia of the liver was found in a 67-yr-old man who had been suffering from nephrotic syndrome for years. Main clinical symptoms and signs were edema, proteinuria, hypertension, and abnormal studies of electrocardiogram. His renal disease had been relatively well controlled by administration of corticosteroids, but he died suddenly on March 12, 1986. Autopsy revealed fresh and old myocardial infarct and membranous glomerulonephritis. The liver weighed 1530 g and showed a diffuse nodular configuration except for in the area of Zahn's red infarct. Fibrosis was minimal in most areas, and each nodule was circumscribed by compressed atrophic parenchyma. However, this case was unusual compared to most cases of nodular regenerative hyperplasia because there was prominent fibrosis in the perihilar portion. Paucity of interlobular arterial branches was confirmed by a crude morphometry. We describe herein this somewhat unusual nodular regenerative hyperplasia case with some discussion concerning the histogenesis.
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PMID:Nodular regenerative hyperplasia of the liver associated with idiopathic membranous glomerulonephritis. 360 29

Membranous nephropathy was diagnosed in 54 patients between January 1975 and June 1983 in the Royal Infirmary, Glasgow. It was the commonest cause of the nephrotic syndrome and, with IgA nephropathy, the commonest primary glomerular disease. A cause was found in 10 patients. The last seven patients diagnosed were enrolled in the MRC trial. The natural history of the remaining 37 patients with idiopathic membranous nephropathy was studied. After an average observation period of 64 months, 50 per cent had stable renal function with or without proteinuria and 50 per cent had progressive renal failure or had died of other causes (five patients). Of the factors examined only heavy proteinuria and hypertension were significantly more common in patients who developed progressive renal failure. No patient who entered remission relapsed. Vascular complications were an important cause of morbidity and mortality. Incidence of events of arterial occlusion was significantly higher in these patients compared with patients with IgA nephropathy. Treatment of patients with membranous nephropathy should, therefore, be judged not only by its efficacy in preventing progressive renal failure, but also by its effect on vascular disease and by its toxicity.
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PMID:The natural history of membranous nephropathy in the West of Scotland. 377 62

The prevalence of hypertension in 288 patients with primary chronic glomerulonephritis was compared with that observed in a control group of 3,477 subjects from the same geographic area. 23.3% of the patients and 12.8% of the general population were hypertensive (p less than 0.01). However, if only patients with normal renal function were considered, prevalence of hypertension (12.7%) was not higher than in the control group. Hypertension was more frequent in focal segmental sclerosis (30%) and in membranous glomerulonephritis (26%) than in IgA nephropathy (9%), membranoproliferative glomerulonephritis (11%) and IgM mesangial glomerulonephritis (12%). Five years after renal biopsy, 92% of normotensive and 47% of hypertensive patients remained with normal renal function (p less than 0.001). These findings suggest that the high prevalence of hypertension in chronic glomerulonephritis is related to the declining renal function. On the other hand, hypertension appears to represent a bad prognostic sign.
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PMID:Hypertension in primary chronic glomerulonephritis: analysis of 288 biopsied patients. 380 44

Ninety five children with chronic glomerulonephritis were studied to analyze the correlation between hypertension and functional deterioration in each of the following histology groups; minor glomerular abnormalities (MGA), proliferative glomerulonephritis (PGN), membrano-proliferative glomerulonephritis (MPGN), membranous glomerulonephritis (MGN) and focal segmental glomerulosclerosis (FSGS). Among the 95 patients, 14 patients revealed to be hypertensive. All patients with MGA and MGN revealed normal blood pressure. There were no statistically significant differences in the prevalence of hypertension in patients with PGN, MPGN and FSGS. The overall incidence of renal insufficiency was significantly higher in the hypertensives (50.0%) than in the normotensives (4.9% p less than 0.0001). The incidences of renal insufficiency were significantly higher in the hypertensives than in the normotensives in patients with PGN (P less than 0.01) and MPGN (P less than 0.05). These data suggest that there is a significant correlation between functional deterioration and hypertension, and that the hypertensive patients with PGN and MPGN are at risk for progression to renal insufficiency.
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PMID:Hypertension and renal insufficiency in children with chronic glomerulonephritis. 381 77

The course of 66 pregnancies was studied in 48 women with primary glomerular diseases. In all cases diagnoses were established by biopsy before pregnancy. They were: membranoproliferative glomerulonephritis in 16 patients, focal glomeruloesclerosis in 13, IgA nephropathy in 10, membranous nephropathy in seven and focal glomerulonephritis in two women. The clinical status of the nephropathy before conception was that 43 had only mild renal dysfunction, five had moderate renal insufficiency, serum creatinine (1.3 to 1.9 mg%), eight women had hypertension (150/100 mm Hg) and eight had nephrotic range proteinuria. Their clinical course was compared with a control group of 36 women with primary glomerular disease who did not become pregnant, and were matched for similar age, histological type, and status of nephropathy (renal function, blood pressure and proteinuria). After one year and at the end of the five year follow-up period, the incidence of hypertension, proteinuria, and renal failure was similar in the two groups. The fetal survival rate was 92%; 51 pregnancies ended in full-term delivery, with a mean birthweight of 3,242 +/- 320 g. There were seven pre-term deliveries (2,170 +/- 135 g), three small for gestational-age (2,340 +/- 135 g), two stillbirths and three spontaneous abortions. These patients had more pre-term deliveries (10.6%) and perinatal mortality (31%) than a normal population (5.5% and 9.6%, respectively). Blood pressure increased during pregnancy in 13 women; in 10 it was reversible, and in four it persisted after delivery. Ten gravidas developed increased proteinuria (reversible in six of them) and two others developed permanent impairment of renal function.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Successful pregnancy in primary glomerular disease. 382 Sep 41

Hypertension has been shown to accelerate the course of experimental nephritis. On the other hand, Heymann nephritic rats undergoing long-term DOCA-NaCl treatment develop hypertension with a malignant course. The present study examined the effect of a short-term DOCA-NaCl load on the development of hypertension and progression of nephritis. Heymann nephritic rats were treated with DOCA-NaCl between weeks 2 and 6 after the first immunization with brush border antigen. Within six weeks, hypertension developed in Heymann nephritis-DOCA-NaCl rats but not in Heymann nephritic rats without DOCA-NaCl treatment whereas DOCA-NaCl-treated rats developed a moderate elevation of blood pressure. During that time, anti-brush border antibodies and immune deposits typical of membranous nephropathy ensued, preceding appearance of proteinuria or histopathologically detectable renal changes in the immunized rats. After discontinuation of DOCA-NaCl treatments at week 6, blood pressure nearly normalized in DOCA-NaCl-treated rats. Within one year, however, blood pressure rose most markedly in nephritic rats treated initially with DOCA-NaCl. The rise in blood pressure at that time correlated with glomerular sclerosis, tubulo-interstitial changes and proteinuria. It is concluded that, during acute nephritis, immunological and hypertensinogenic mechanisms interact, leading to hypertension and aggravated course of nephritis. These experimental observations on nephritis-associated hypertension may have important bearings on human hypertension as well.
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PMID:Hypertension and progression of experimental nephritis. Interaction between immunological and haemodynamic factors. 391 83

Sixty-seven patients with idiopathic membranous glomerulonephritis (iMGN) were analyzed clinically. Their mean age was 39.3 years, and 47 (70%) of them were male. Fifty (74.6%) showed nephrotic syndrome (NS) initially and five (7.5%) had additionally chronic renal failure. Hypertension was present in 27%. During the follow-up (mean 6.7 years) renal death occurred in four patients 12-151 (mean 84.2) months after the diagnosis of iMGN. Four patients died of non-renal causes. The actuarial life-table survival at 5, 10 and 15 years was 94%, 83% and 69%, respectively. To some extent renal function deteriorated in 13 patients (19%). These patients were older (49.9 vs. 36.8 years, p less than 0.01) than those with preserved renal function, and many of them had serum creatinine levels of 125 mumol/l or more initially. Sex did not correlate with the development of renal insufficiency. Patients with slight proteinuria never showed loss of renal function. The retrospective comparison of survival in patients who did (N = 31) or did not (N = 19) receive corticosteroids and/or immunosuppressive drugs for the treatment of NS revealed no evident difference at 5 or 10 years. This clinical analysis emphasizes the fairly favorable outcome of patients with iMGN. Hence a reserved view must be taken when treatment with potentially dangerous agents is considered in a disease with unknown etiology and pathogenesis.
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PMID:Survival in idiopathic membranous glomerulonephritis. 395 13


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