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

Each of the three patients with a type of unilateral, localized cystic disease of the kidney that did not fit into a specific category of existing classifications had numerous cysts involving a part of one kidney. Selective angiography showed stretching of arteries around cysts that remained radiolucent in the nephrographic phase, and microscopic examination demonstrated that septa among the cysts contained compressed renal elements. The condition appeared to be neither progressive nor familial. All three had hypertension. Two patients who had nephrectomy for the cystic lesion became normotensive postnephrectomy. Despite some morphologic resemblances, this condition is believed to be different from adult type polycystic kidney disease in its clinical and genetic aspects.
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PMID:Localized cystic disease of the kidney: angiographic-pathologic correlation. 10 64

The records of 65 patients with adult type polycystic kidney disease were examined in an attempt to identify the problems and priorities in the management of these patients, with particular reference to ultimate haemodialysis or transplantation. The three main problems of patients presenting before the onset of terminal renal failure were hypertension (72 per cent), pain (36 per cent) and urinary tract infection (32 per cent). Less common complications included haematuria, splenomegaly, gastro-intestinal disturbances and disorders of calcium metabolism. The polycystic kidney patient who is considered for renal transplantation poses questions of the desirability and timing of bilateral nephrectomy, vagotomy and splenectomy. Eight patients died without receiving a transplant, five of them from uraemia. Thirty-one patients received 36 kidney transplants and 46 per cent of these were functioning one year after transplantation. Thirteen patients who had received transplants died. Analysis of the causes of death suggests that in nearly half, major contributing factors might have been anticipated and we therefore feel that regular surveillance from the time of diagnosis is essential for patients with polycystic kidney disease.
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PMID:The management of polycystic kidney disease with special reference to dialysis and transplantation. 33 26

A series of 106 cases of polycystic kidneys in adults is presented. The main clinical, exploratory and therapeutic data are analyzed. The average age of the patients at the time of the first clinical manifestation was 35 years; average age at the time of diagnosis was 43 years. The most common forms of presentation included renal colics, blood hypertension, noncolic lumbar pain, macroscopic hematuria, and polydipsia-polyuria. The most frequent symptoms were: abdominal pain of any type (73 patients), polydipsia-polyuria (66 patients), blood hypertension (61 patients), macroscopic hematuria (47 cases), episodes of urinary infection (41 cases), and passing of calculi (22 cases). Seventy-eight subjects had arterial high blood pressure; it was easily controlled in all except 14 cases. Proteinuria was slight in all except two cases. Values for hematocrit and hemoglobin remained high in relation to the degree of renal insufficiency. The mean value of hematocrit in patients with creatinine clearance below 10 ml/min was 30 percent. Renal function decreased gradually, from normal to a clearance of less than 10 ml/min over a period of 12 years on the average. Diagnosis was based mainly on abdominal physical examination and intravenous urography; 89 patients had palpable abdominal masses. Urography revealed typical images of polycystic kidney in every case. The following associated conditions were also discovered: liver cysts (17 cases among 57 liver scanning; bilateral ovarian cysts in one case; Cacci-Ricci's disease in one case; and cerebral arterial aneurysms in another patient. Treatment was conservative with the aim to control arterial blood pressure and urinary infection. Twenty-nine patients required saline replacement; peritoneal dialysis was practiced in two cases and permanent hemodialysis was prescribed for 15 individuals.
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PMID:[Polycystic kidneys in adults. A clinical study of 106 cases (author's transl)]. 52 27

A patient had unilateral renal artery stenosis and, at the same time, bilateral polycystic kidney disease. The renal venous renin ratio of 151:40, together with a high peripheral plasma renin activity, indicated that the hypertension was partially caused by renopressor mechanism. Correction of the obstructive lesion permitted a better control of hypertension with antihypertensive drugs, and the peripheral and renal venous renin activity returned to normal. The success in detecting one pathogenic mechanism responsible for arterial hypertension should not deter further diagnostic efforts.
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PMID:Renal artery stenosis and polycystic kidney disease. 67 87

During a retrospective study of 100 patients who underwent renal biopsy because of pregnancy complicated by hypertension, we found 19 patients whom proteinuria exceeded 5.0 Gm. per 24 hours and an additional eight patients in whom excretion ranged between 3.5 and 5 Gm. per day. Of these 27 patients, 23 had the kidney lesion of pre-eclampsia, and three of them had superimposed hypertensive changes in the vasculature. The remaining four had other renal diseases. We located and re-examined 10 of the 23 pre-eclamptic women, 12 to 104 (mean, 36) months after delivery. Serum creatinine levels were normal in all but one, who was discovered to have polycystic kidney disease. During the same time period, we located the records of six women who had heavy proteinuria during gestation but were normotensive. Thus, at our institution, pre-eclampsia is the most common cause of the nephrotic syndrome in pregnancy. The frequency of nephrotic proteinuria in pre-eclampsia appears higher than previously suspected, but, despite this fact, recovery was complete in most instances.
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PMID:Nephrotic proteinuria with pre-eclampsia. 92 Jul 65

Hypertension occurring in patients with adult polycystic kidney disease (PKD) without substantially decreased glomerular filtration rate (GFRs) has not been sufficiently evaluated. Seven patients with bilateral PKD and serum creatinine clearances greater than 70 ml/min were studied to examine the roles of sodium retention and the renin-angiotensin system in their hypertension. These individuals demonstrated evidence of volume expansion and sodium-dependent hypertension. However, the renin-angiotensin system was not consistently depressed as a consequence, and two of the seven had significantly increased plasma renin activity values. It seems that patients with PKD who had normal GFRs retain rather than waste sodium and may become hypertensive. The contribution of the renin-angiotensin system is variable and seems to be a function of such factors as symmetry of the cystic involvement and the degree of intravascular volume expansion.
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PMID:Hypertension in polycystic kidney disease without renal failure. 92 44

This study is a retrospective review of 30 patients with polycystic kidney disease analyzing the quantitative measurements of renomegaly reported in the literature and the correlation of radiographic findings with the clinical complications of uremia, hypertension, infection, and the need for dialysis. The only significant correlation noted was between renal size and the presence of infection. There was no significant correlation between renomegaly and the presence or development of hypertension, uremia, and the need for chronic dialysis.
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PMID:Role of intravenous urography in clinical assessment of polycystic kidney disease. 99 62

The results have been reviewed of 35 renal transplants performed on 31 patients with end stage polycystic renal disease. Patient survival is 81 per cent and 71 per cent of the patients have functioning grafts at an average followup of 3.1 years. The need for pre-transplant nephrectomy was evaluated early in the series and since then the operation has been practiced selectively. Twenty-two patients have received transplants with both polycystic kidneys in situ, while 2 patients have undergone transplantation after unilateral nephrectomy. In the absence of a history of renal infection or significant hematuria it has proved safe and desirable to leave the polycystic kidneys in situ. During the post-transplant period in such cases there has been no difficulty attributed to the in situ polycystic kidneys after more than 450 patient months of immunosuppressive therapy. The size of the polycystic kidneys has not been an indication of nephrectomy in our series and no significant technical difficulties have been encountered with large polycystic kidneys remaining in situ. Hypertension associated with end stage polycystic kidney disease has been controlled easily and has not proved an indication for pre-transplant nephrectomy.
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PMID:End stage polycystic kidney disease: management by renal transplantation and selective use of preliminary nephrectomy. 110 2

The pathogenesis of hypertension in autosomal-dominant polycystic kidney disease (ADPKD) is unclear, but increased activity of the renin-angiotension system may contribute. The renal and systemic hemodynamic response to lisinopril, an angiotension converting enzyme (ACE) inhibitor, in patients with ADPKD without renal failure was compared with the response in matched unaffected family members. Mean blood pressure and renal vascular resistance decreased in the affected group after lisinopril, with no significant change in the unaffected group. Glomerular filtration rate (GFR) was unchanged and therefore filtration fraction fell significantly. Changes in urinary excretion of 6-keto-PGF1 alpha and kallikrein suggested that increased renal synthesis of PGI2 or activation of the renal kallikrein-kinin system were not likely to be responsible for the hemodynamic effects. The acute decrease in renal vascular resistance without change in GFR suggests that ACE inhibition may have a particular value in the treatment of hypertension associated with ADPKD which should be assessed by further long-term studies.
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PMID:Effects of angiotensin converting enzyme inhibition in adult polycystic kidney disease. 131 77

We report three cases of primary aldosteronism associated with autosomal dominant polycystic kidney disease. The diagnosis of primary hyperaldosteronism was based on the presence of hypokalaemia with excessive urinary potassium excretion and/or the characteristic hormonal changes. Renal function impairment due to autosomal dominant polycystic kidney disease could mask hypokalaemia. The interpretation of adrenal imagery may be hindered by adjacent renal cysts. In one case an adrenal adenoma was detected and surgically removed, with only partial correction of the blood pressure. This could be explained by the persisting underlying autosomal dominant polycystic kidney disease. We conclude that in a hypertensive patient with polycystic kidney disease, extrarenal causes of hypertension may be present.
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PMID:Autosomal dominant polycystic kidney disease with primary hyperaldosteronism. 839 25


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