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

Chronic pyelonephritis secondary to vesicoureteral reflux has been shown to cause occasionally systemic hypertension. The hypertension may occur in the presence or absence of bacterial urinary infection, is renin-mediated and may develop years after ureteral reimplantation. Surgical excision of a scarred atrophic renin-producing segment may result in amelioration of the hypertension or at least provide better medical control with less toxic antihypertensive agents. Surgical removal of renal tissue is not recommended in patients with depressed renal function unless the hypertension is malignant and uncontrolled.
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PMID:Pediatric hypertension as a delayed sequela of reflux-induced chronic pyelonephritis. 91 66

Ultrasonic dopplerography of the renal arteries was used to improve the differential diagnosis of arterial hypertension before hospitalization. Dopplerograms of the renal arteries of normal subjects were characterized by almost symmetrical parameters of the blood stream. In patients with vasorenal hypertension a marked asymmetry of the blood stream was seen with its reduction and qualitative changes in the dopplerogram on the side of the stenosed renal artery, that was confirmed by angiographic findings. Chronic pyelonephritis was dopplerographically characterized by hemodynamically insignificant asymmetry of the blood stream in the renal arteries with its reduction on the side of the involved kidney. In essential hypertension the type of asymmetry of blood stream parameters in the renal artery seemed similar to that in normal subjects.
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PMID:[The use of Doppler ultrasound of the renal arteries for the diagnosis of vasorenal hypertension at the outpatient stage]. 130 5

Chronic pyelonephritis (c.p.) is by definition an infectious tubulo-interstitial nephritis. It has to be differentiated from other etiologic forms of tubulo-interstitial nephritis. Therefore strict morphological criteria are needed for diagnosis. The characteristic lesion is a large cortico-medullary scar overlying a dilated chronically inflammed calyx. The macroscopic aspect and the histologic survey picture are more important than histologic details. A diagnosis on renal biopsies is therefore not warranted. Vesico-renal reflux and papillary morphology play an important pathogenetic role. Beside the more common focal scar a diffuse form of scarring can be observed. A limited number of conditions only have to be considered in differential diagnosis. The Ask-Upmark kidney seems to be a special form of c.p. related to urinary tract infection and reflux in early infancy. Pelvi-calyceal lithiasis without superimposed infection causes a picture very similar to a pyelonephritic scar. A reliable differentiation between c.p. and analgesic nephropathy may cause problems in endstage kidneys with sloughed off papillae. Various mechanisms of renal damage such as bacterial infection, immunological mediated inflammation, leakage of urinary constituents into the interstitium especially Tamm-Horsfall-protein and ischemia have to be considered. Despite the frequency of urinary tract infections chronic progressive pyelonephritis is rare. Predisposing factors are needed for progression of the disease. These include congenital or acquired urinary tract obstruction, vesico-renal reflux and papillary damage with intrarenal obstruction to the urinary flow. Other important factors are focal and segmental glomerulosclerosis and hypertension.
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PMID:[Chronic pyelonephritis and its differential diagnosis. A disease changing with time]. 248 12

Chronic pyelonephritis is secondary to urinary tract infection associated with vesico-ureteric reflux or obstructive uropathy. Pyelonephritis scarring almost always occurs in early childhood and is linked to the concomitant presence of urinary tract infection and renal papillae allowing intrarenal reflux. When bilateral, pyelonephritis scarring may lead to end-stage renal disease. Destruction of the renal parenchyma occurs over years and is often accompanied by arterial hypertension and proteinuria. Surgical correction of vesico-ureteric reflux does not prevent further renal scarring. Since sterile reflux does not appear to be harmful, it is important to diagnose vesico-ureteric reflux early and prevent urinary tract infection by administering chemoprophylaxis during the first seven years of life.
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PMID:[Importance of vesico-ureteral reflux in the pathogenesis of chronic pyelonephritis]. 634 Jan 86

To evaluate the clinical validity of 99m Tc DTPA renal investigation, we have studied 60 patients with different renal diseases: 1) Renovascular hypertension (22 patients); 2) Chronic pyelonephritis (11 patients); 3) Renal hypoplasia (12 patients); 4) Bilateral parenchymatous nephropathy with hypertension (15 patients). We observed a good correlation between the creatinine clearance and the total DTPA clearance (N = 51: r = 0.68; p less than 0.001); and also a good correlation between the respective renal surface extrapolated from renal X-Rays, and the respective renal function of each kidney (expressed in percentage) measured from DTPA data. This correlation is higher in group 1 and lower in group 2. From individual kidney function percentage and glomerular filtration rate measurement or estimation, we could calculate the GFR of each kidney, which serves as a guideline for surgical decisions.
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PMID:[Comparative evaluation of the function of each kidney using Tc 99m DTPA]. 637 85

In the present study we report the renal pathological findings from autopsy material along with relevant clinical data on 21 spinal cord injury patients with end-stage renal disease (SCI-ESRD) treated with maintenance haemodialysis. These data are compared with the relevant clinical and post-mortem findings on 43 ambulatory dialysis patients who expired during the same time period. The SCI-ESRD patients exhibited markedly different clinical and renal histopathological data when compared to the ambulatory--ESRD group. Chronic pyelonephritis and amyloidosis dominated the findings and were the major causes of renal insufficiency. Acute pyelonephritis, papillary necrosis, calculous disease, pyonephrosis and perinephric abscess formation were also more frequently present in the SCI-ESRD patients. Hypertension and nephrosclerosis, which were common findings in the ambulatory--ESRD patients were comparatively rare in the SCI-ESRD patients. In addition, the incidence of acquired cystic disease (ACD) was considerably less in the SCI-ESRD group. Although the reasons for these findings are not entirely clear several possible explanations are given. Infection with gram negative sepsis was the predominant cause of death in the SCI-ESRD patients, while death secondary to cardiovascular disease predominated in the ambulatory-ESRD group. Furthermore, the urinary tract and infected decubitus ulcers were determined to be the major source for sepsis in the SCI patients. From these findings it would follow that more effective prevention and control of these infections would result in not only a lower incidence of renal failure but also a substantially reduced morbidity and mortality in chronic SCI.
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PMID:Renal pathology in end-stage renal disease associated with paraplegia. 671 46

Chronic pyelonephritis (CP) is now ranking first among renal disorders, its incidence still tends to grow. Despite an impressive antibacterial armory, the efficacy of CP treatment remains low. In search of more effective and tolerable methods, the author directed his attention to CP balneotherapy. In addition to well-known health resorts where CP is successfully treated, Zheleznovodsk and Truskavets, a less known place is mentioned. It is the spa Kuka in the Transbaikal region. Mineral water Kukinskaya or Kuka (pH 6.18) comprises carbon dioxide, hydrocarbon-calcium and magnesium hydrocarbonates. The spa treatment was given to 65 CP patients. They underwent a general examination and evaluation of hemostasis. It was found that oral treatment with Kukinskaya mineral water produced a positive action on the blood coagulability and fibrinolysis. After the crenotherapy the pain persisted in 11.8%, leukocyturia in 9.9%, nephrogenic hypertension in 16.4% of the patients only. This proves the method effective for CP.
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PMID:[The effect of Kuka mineral water on blood coagulability and fibrinolysis in patients with chronic pyelonephritis]. 794 Nov 37

Forty five (24 male & 21 female) moderate to severe degree of predialysis CRF patients were prospectively studied over a period of 6 months (July- December, 2004) to see the effect of Recombinant Human Erythropoietin (rHuEpo/EPO) therapy on renal anaemia, progression of renal excretory function & quality of life at 3 and 6 months intervals from the starting of EPO therapy. Mean +/- SD age of the patients was 56 +/- 12 (30-77 yrs) and causes of CRF were Diabetic Nephropathy (DN)=15 (33%), Chronic Glomerulonephritis (CGN) =14(31%), Hypertension (HTN)=11(21%), Chronic Pyelonephritis (CPN)=03 (6.5%) and Obstructive Uropathy (OU)=02 (4.5%). Doses of rHuEpo was 80-100 IU/k week subcutaneously (SC) until the target Hb 11gm% & Hct 30% were achieved; there after the dose was titrated as appropriate. Serum Iron & Ferritin levels were also kept within normal reference level by iron therapy during the study period. Mean +/- SD base line (before starting EPO therapy) level of haemoblobin were 8.4 +/- 0.81(gm%), Hct 27.86 +/- 1.6 (%), blood urea 21.72 +/- 10.5 (mmol/L), S. creatinine 431.93 +/- 228.79 (mmol/L) & Ccr. 21.25 +/- 10 mum respectively. The results showed that significant improvement of haemoglobin level occurred (gm%) from 8.4 +/- 0.81 (gm%) to 9.51 +/- 1.02 (p<0.001) at 3 months and 8.4 +/- 0.81 to 11.10 +/- 1.4, (p<0.001) at 6 months interval. Haematocrit (Hct%) value also significantly increased from 27.86 +/- 1.5 to 30.57 +/- 3.62, (p<0.001) at 3 months and 27.86 +/- 1.5 to 32.81 +/- 3.92 (p<0.001) at 6 months of EPO therapy. Mean blood urea and S. creatinine levels decreased from base line level during the study period but did not show any statistical significance. There was no significant side-effects like uncontrolled hypertension, seizure or hyperviscosity syndrome in any of the study population. The quality of life in terms of improvement of physical ability and sense of well being were also improved in all the study patients. In conclusion, this study showed that the effect of rHuEpo therapy is beneficial for the correction of renal anaemia, can delay the progression of renal failure and improvement of overall quality of life in predialysis CRF patients.
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PMID:Effect rHuEpo on predialysis CRF patients: study of 45 cases. 1696 14

Diabetes and hypertension are at present the major causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. The stages 0-5 of CKD are defined according to the estimated glomerular filtration rate. The term chronic renal failure (CRF) typically corresponds to CKD stages 3-5. Cardiovascular disease is the main cause of morbidity and mortality in patients of CRF and ESRD. This study was undertaken to analyze the age and sex incidence, clinical features, etiology, pathology of various organs in detail, and causes of death of CRF patients. All autopsies performed on known cases of CRF and those who were diagnosed as CRF at autopsy at a tertiary care hospital in India over a 7-year period were studied. The highest number of cases of CRF fell within the 56-65 years age group with a male/female ratio of 1.38:1. Oliguria and anasarca were the most common presenting features. Chronic pyelonephritis was the most common cause of CRF in our study, followed by hypertension, diabetes, and chronic glomerulonephritis. Other causes included amyloidosis, autosomal poly- cystic kidney disease, and ischemic and multiple myeloma. Most common cause of death found was cardiovascular, followed by infections, cerebrovascular, metabolic, and other causes.
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PMID:Chronic renal failure: An autopsy study. 2854 Aug 91