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

Immune complexes play an important role in the pathogenesis of malaria-associated nephropathies. Two main types of lesion are demonstrable: (a) acute (transient-reversible) lesions typical of falciparum infections in man, with mild clinical symptoms developing a week or two after infection. Renal biopsies at that time show deposits of immunoglobulins, complement, and sometimes antigen. The lesions respond to antimalarials. (b) Chronic (progressive) lesions characteristic of quartan infections in man, developing slowly into a chronic stage with persistent proteinuria and gradually deteriorating renal function and hypertension. Renal biopsies at the onset of the disease show deposits of immunoglobulins, complement, and P. malariae antigens in glomerular capillary walls. Antimalarial therapy has no effect. Recent immunochemical findings confirm that these lesions are of the immune-complex type and are associated with malaria infection. However, several questions remain to be solved.
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PMID:Immunopathology of nephropathies associated with malaria. 108 8

Serum C4 and C3 concentration and binding of double-stranded-DNA (ds-DNA) were measured in sera from ninety-nine patients with systemic lupus erythematosus and clinical evidence of nephritis. C3 and C4 concentrations correlated poorly with ds-DNA binding. In sera from fifty-three patients, precipitating antibody was sought using the counterimmunoelectrophoretic technique. Precipitating antibody was detected on at least one occasion in 44% of the patients, and these sera with precipitating antibody showed higher binding of ds-DNA and lower C4 concentrations than those without precipitating antibody. In thirty-two patients, serial assessments of the activity of the renal disease were made using decline or improvement in glomerular filtration rate, degree of proteinuria, oedema and hypertension as indices of "activity". All patients were receiving immunosuppressive drugs. Active nephritis was rarely found in patients showing, at that time, a normal serum C4 or normal ds-DNA binding; but a raised ds-DNA binding or lowered serum C4 were found in both active and inactive nephritis. There was no correlation of activity with serum concentrations of C3, or the presence or absence of precipitating antibody. We conclude that measurements of serum-complement concentrations and binding of ds-DNA are of most use in the diagnosis of systemic lupus erythematosus, and that in patients with nephritis and taking immunosuppressive drugs, these tests are of limited use in guiding treatment.
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PMID:Disease activity in the nephritis of systemic lupus erythematosus in relation to serum complement concentrations. DNA-binding capacity and precipitating anti-DNA antibody. 108 78

Although many investigators have felt that humoral antibody was responsible for chronic rejection, attempts to detect it in the sera of recipients in the presence of functioning renal allografts have been largely unsuccessful. A modification of the mixed antiglobulin reaction has increased its sensitivity so that the development of low titers of immunoglobulin (IgG) antibody antibody specific for donor kidney cells can be detected in renal allograft recipients while renal function is still good. Donor-specific antibody was detected in the sera of 11 of 13 patients whose transplants had ceased to function from 5 to 43 months after transplantation. In five recipients the antibody was present prior to as well as after transplantation and in six recipients antibody developed after transplantation from 3 to 25 months prior to the cessation of function. In the patients with antibody, chronic rejection was characterized by hypertension which required treatment with multiple drugs, by proteinuria of greater than one gram per day, by a gradual, progressively rising serum creatinine, and by an absence of acute ologuric rejection episodes. Pathologically there was extensive intimal proliferation and occlusion of the intrarenal arteris. There also was significant glomerulonephritis which consisted of thickening of the basement membranes, mesangial cell proliferation, simplification of the capillary loops, and in some patients fibroepithelial crescent formation. These findings suggest that IgG antibodies directed against cell-surface antigens of the donor are the chief cause of chronic renal allograft rejection.
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PMID:Donor-specific IgG antibody and the chronic rejection of human renal allografts. 109 75

The present study discusses the light, electron and immunofluorescence microscopy as well as some clinicopathologic correlations of rejection change in human renal allograft glomeruli. It is based on examination of 126 tissue specimens from 54 grafts obtained from 50 patients (1966-1973). The most frequent and characteristic lesion was membranous transplant glomerulopathy (MG) with irregular fibrillar thickening of capillary walls but without conspicuous hypercellularity. This thickening was caused by subendothelial depositsdifferent from classical fibrinoid lesions. During further progression, widening and peripheral extension of mesangium with degenerative changes became apparent. Advanced MG was encountered most frequently in the 2nd year after transplantation (TPL) at moderate to medium proteinuria and hypertension. It was accompanied by endarteristic rejection changes, and renal insufficiency set on usually in the course of the 3rd year. Nevertheless, the course, symptoms, and graft survival exhibited considerable variations. - The morphology and manifestations of destructive segmental transplant glomerulopathy (SG) depended on the time of its development. In the early stage (within about 3 months after TPL), the lesion was characterized by areas of fibrinoid insudation and necro(bio)sis associated with severe vascular changes, most frequently obliterative arterio(lo)pathy (OA). The ultrastructure was characterized by endothelial defects with host's polynuclear reaction and focal intravascular coagulation. The grafts thus affected failed soon, their function usually subsiding within the first trimester at a moderate, but gradually increasing proteinuria and severe persistent hypertension. The late from of destructive SG presenting as fibrohyaline obliteration of the loops with foam cells always accompanied advanced MG with severe arterial lesions. - Fluorescence microscopy revealed both linear and focal fixation of antisera, which, however had no apparent correlation with the microscopical and clinical presentations.
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PMID:Glomerulopathies in human renal allografts. 109 48

The risks of treating allograft rejection are primarily related to high-dose steroid therapy. To determine when the possible benefit of anti-rejection therapy might not justify the risks, we analysed 20 severe rejection (SAR) episodes for indices of reversibility. Prior renal function was similar in all patients. Ccr fell to 10 ml/min or less, but degree of renal dysfunction was not predictive of reversibility, nor were time since transplant, oliguro/anuria, proteinuria, or hypertension. The only consistent finding was that function began to improve in reversible rejection 3.8 +/- 1 days after beginning therapy. Our rejection treatment, based on this finding, is to use gram doses of IV prednisolone, up to three times in five to seven days. Among 41 patients with 45 grafts so treated, there was no fatality or gastrointestinal haemorrhage. Other complications (fistulae and/or infections) were related to total dose and frequency, to intensive therapy during severe renal dysfunction or to urinary leaks. Limitation of the period of high-dose steroid therapy was associated with reduced morbidity and mortality in renal allograft recipients.
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PMID:Minimising the risks of treating acute allograft rejection. 110 56

Plasma prolactin levels were measured in 68 pregnant women with hypertension at 32 weeks gestation. They were raised in pregnancies with pre-eclamptic features, most significantly in women with a rising plasma urate level. No correlation was found between the level of the untreated blood pressure and prolactin. Proteinuria did not influence prolactin levels independently of changes in the plasma urate. The differences in prolactin levels could not be ascribed to the drugs administered.
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PMID:Prolactin in hypertensive pregnancy. 111 91

Three patients with right renal tumors extending into the inferior vena cava underwent ligation of the left renal vein coincident with right nephrectomy and en bloc resection of the vena cava. Two patients exhibited no postoperative renal dysfunction while the third demonstrated renal dysfunction which cleared by 9 days postoperatively. Features of the temporary renal dysfunction included proteinuria, elevated serum creatinine levels, oliguria, hypertension, elevated peripheral venous renin level, as well as radiographic evidence of swelling the kidney. The collateral venous drainage of the left kidney makes it possible to ligate the main vein of a solitary kidney with survival of the patient. However, postoperative temporary renal dysfunction may occur and a plan to deal with this problem should be fromulated.
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PMID:Ligation of the renal vein in the solitary kidney: effects on renal function. 111 94

The prognosis of chronic glomerulonephritis based on renal function was assessed using a statistical technique of the Markov process, where the absorbing state was assumed to be an uremic state, 194 adult patients with different types of disease were subjected to study. The 15 min value obtained in the intravenous PSP excretion test was divided into five states; SI (greater than 34%, normal), SII(25-34), SIII(15-24), SIV(5-14) and SV (greater than 5, uremic). The rates of SV with time were calculated with respect to several clinical characteristics. The prognosis of the patients with hypertension, distinct proteinuria and hematuria, or cellular cylindruria appeared to be relatively poor. The estimated number of years from each state to SV were also calculated. The results were similar to those already reported and gave us more exact information about the prognosis.
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PMID:Prognosis of chronic glomerulonephritis in adult patients estimated on the basis of the Markov process. 112 60

In a population of 744 diabetics composed mainly of elderly female patients, 172 developed hypertension after the onset of diabetes. Compared to normotensive diabetics, they had an increased prevalence of diabetic retinopathy (p less than 0.001), cerebral accidents, ischemic disorders of the lower limbs and a decreased glomerular filtration rate (p less than 0.05); they are frequently insulin-dependent and difficult to manage. In 173 other indivuals the diabetes emerged several years after the hypertension. This group was characterized by relatively easily controlled blood sugar and increased prevalence of angina and myocardial infarction (p less than 0.001). The association of hypercholesteremia with hypertension increases the risk of coronary disease (p less than 0.02) and, to a lesser degree, of glomerular insufficiency. The prevalence of coronary symptoms increases with obesity (p less than 0.05) while retinopathy increases with insulin dependence (p less than 0.001). From this information it may be concluded that the importance of various risk factors in the diabetic chiefly varies according to the vascular territory involved: cerebral vascular accidents occur mainly in hypertensives, while the presence of retinopathies, proteinuria and peripheral ischemia is directly related to the diabetes and particularly to insulin dependence. The risk of coronary lesions increases considerably when hypertension is added to the diabetes, with an even greater risk in the case of a diabetic, hypertensive, hypercholesterolemic nexus.
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PMID:[Factors of arterial and renal complications in diabetes]. 112 60

Since 1969 it has been the policy of this department to perform regular cardiotocograms on all patients admitted during the antenatal period for severe hypertension, with or without proteinuria, and on those in whom poor intrauterine fetal growth was suspected. In five such patients where the fetus died in utero, beat-to-beat variation was reduced and late decelerations were observed. In a further twelve patients similar changes made delivery by elective Caesarean section appear advisable. Half of the infants so delivered had severe metabolic acidosis at birth.
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PMID:Antepartum diagnosis of the "terminal" fetal state by cardiotocography. 113 99


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