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

There are indications that there is an increased risk of chronic renal failure (CRF) in the Negroid race, yet few studies have been carried out in the native 'black' environment. A clinico-pathological study of 100 consecutive Nigerian subjects with CRF, seen over a 3-year period, is presented. Primary chronic glomerulonephritis (CGN) accounted for 50, accelerated hypertension for 25, and various aetiological entities for a further nine; these included, chronic pyelonephritis (two), diabetic nephropathy (two), calculous nephropathy (one), toxaemia of pregnancy (one), renal dysplasia (one), tuberculosis (one) and polycystic disease in the ninth subject. In 16 cases, no definitive aetiological diagnosis could be made. Combinations of the following features, protracted hypertension, proteinuria, significant analgesic intake and gouty arthritis, were observed. CGN and accelerated hypertension still remain the leading causes of CRF, while diseases such as diabetes mellitus and chronic pyelonephritis do not contribute significantly to CRF in Nigerians. Recognition of the early features and the causes of CRF would considerably reduce the prevalence of this condition.
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PMID:Diseases causing chronic renal failure in Nigerians--a prospective study of 100 cases. 254 87

The Dialysis Centre at the Lagos University Teaching Hospital became operational in November 1981 and caters for acute haemodialysis, chronic maintenance haemodialysis and continuous arteriovenous haemofiltration. In the past 5 years, over 600 patients had presented out of whom 245 could be accommodated within the realities of available facilities and patients' financial status. Of the 245 patients, 25 were discharged against medical advice and five were transferred to hospitals abroad but did not survive. There were 117 patients in end-stage renal failure (ESRF), 75 males, 42 females, ratio M:F 1.8:1, age range 13-69 years, mean 37.5. There were 51 males and 47 females in acute renal failure (ARF), ratio 1.1:1, age range 13-76 years, mean age 32.3 (Table 1). All patients in ESRF had moderate to severe hypertension (diastolic pressure of greater than or equal to 120 mmHg or 22.1 kPa) and a creatinine clearance of less than or equal to 5 ml/min and about 75% had established cardiac decompensation. Full pertinent investigations were precluded or contra-indicated in most patients in ESRF because of late presentation. In only 13 patients was renal biopsy performed and the pathohistologies were end stage renal disease (8), chronic glomerulonephritis (4) and glomerulosclerosis (1). In ARF the cause of the renal damage was multifactorial in 66.7%, with sepsis being the direct cause of death in 60.0%. The commonest conditions were septicaemia (61.4%), nephrotoxin (17.2%), trauma (31.3%), septic abortion (33.3%) and toxaemia of pregnancy (29.0%) (Table 2). The dialysis associated complications which were encountered included shunt infection (7%), burst membrane (9%), suspected pyrogen reaction (5.6%) and femoral vein perforation (0.9%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Five years experience of haemodialysis at the Lagos University Teaching Hospital--November 1981 to November 1986. 255 Nov 60

Glomerular and fascicular zones of the adrenal gland and the incretory renal structures of patients who had died from benign (20) and malignant (10) forms of essential hypertension, chronic glomerulonephritis (10) and of rats with a genetic hypertension (10) were examined by morphometric methods. Hypertrophy of glomerular and fascicular zones is observed in both forms of the hypertension disease, spontaneous hypertension and chronic glomerulonephritis. Correlation analysis revealed moderate and strong links between the volumes of nuclei and nucleoli; within each zone and between the zones. This may indicate an increased functional activity of the two zones and their close interaction. Factorial analysis revealed a sign indicator--nucleus volume of the glomerular zone cells. Numerous moderate and strong correlations between the incretory renal structures and the adrenal cortex in the malignant form of the hypertension disease may indicate not only the involvement of the renin-angiotensin-aldosteron- and prostaglandin-synthesizing systems in the pathogenesis of this disease but their interaction as well.
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PMID:[The morphology of the adrenals and kidney incretory structures in arterial hypertension]. 261 Jun 2

Renal functional and structural studies were performed in 46 patients with arterial hypertension: out of them 12 had hypertensive disease, 13, chronic pyelonephritis, 21, a hypertensive type of chronic glomerulonephritis. In each case, the clinical diagnosis was evidenced by one of the invasive techniques. Dynamic computed tomography was conducted by the original methods; the findings were analyzed by taking into account time-density curves which made it possible to gain an insight into the status of blood flow and filtration in each individual kidney. Computed tomography and dynamic computed tomography revealed that hypertensive disease was characterized-by normal volume and thickness of the renal cortical layer and symmetric time-density curves, whereas a hypertensive type of chronic glomerulonephritis featured lower renal cortical layer thickness, reduced renal volume, symmetrically decrease amplitudes of the first and second peaks of the time-density curve, chronic pyelonephritis showed asymmetric time-density diagrams due to the lower density areas in the afflicted kidney.
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PMID:[Hypertensive disease and renal hypertension (structural and functional studies of the kidneys using dynamic computerized tomography)]. 261 78

In order to elucidate the pressor mechanism in renal parenchymal hypertension, we examined blood volume, hemodynamics, and humoral factors, before and after salt intake restriction from 10 to 2 g daily, in patients with chronic glomerulonephritis (GN), with and without hypertension, and in a normotensive control group. Such salt restriction reduced body weight, blood volume, cardiac index (CI) and urinary sodium excretion equally in all groups, whereas mean blood pressure was reduced by 16 mm Hg in only ten hypertensive GN, but not in normotensive GN and the control group. In hypertensive GN the reduction of blood pressure was accompanied by blunt responses in the total peripheral resistance index (TPRI) and plasma norepinephrine (PNE). By contrast, in normotensive GN and the control group the reduction of CI was compensated for by increased TPRI, resulting in unchanged blood pressure. Among GN with and without hypertension, changes in TPRI by salt restriction were significantly correlated with changes of PNE. In conclusion, renal parenchymal hypertension is sustained by elevated vascular resistance and increased plasma norepinephrine as well. Blood pressure reduction by salt restriction is consistent with the low responses in TPRI and PNE.
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PMID:Effects of salt restriction on blood volume, hemodynamics and humoral factors in hypertensive patients with chronic glomerulonephritis. 267 77

Hypertension is an important risk factor in the progression of renal failure, particularly in patients with pre-existing glomerulopathies such as diabetes and chronic glomerulonephritis. The mechanisms involved in hypertensive glomerular injury are currently unclear and cannot be studied in humans because of the constraints of human experimentation. However, recent animal studies have elucidated mechanisms which may explain the variable relationship between systemic hypertension and glomerular injury. Experimentally, at similar levels of systemic hypertension, glomerular injury only develops when preglomerular resistances are ineffective, thus allowing the development of glomerular hypertension. The mechanisms by which the haemodynamic stress of elevated intracapillary pressures and flows lead to progressive glomerular damage are at present unknown. Endothelial cell injury, increased mesangial traffic and/or trapping of macromolecules and epithelial cell injury appear to occur early, followed by in situ inflammatory and microthrombotic mechanisms. The intrarenal renin-angiotensin system appears to play an important role in the pathogenesis of progressive glomerular injury. Haemodynamically, angiotensin II (Ang II) has a relatively greater vasoconstrictive effect on efferent than on afferent arterioles. In addition, Ang II decreases the glomerular ultrafiltration coefficient. These combined effects result in increased intraglomerular capillary pressures. Angiotensin II increases the uptake and decreases the egress of circulating macromolecules in the glomerular mesangium and fosters mesangial cell mitogenesis. Thus, inhibition of Ang II generation may explain why angiotensin converting enzyme (ACE) inhibitors may be effective in arresting or slowing the progression of renal failure in experimental animals and in man.
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PMID:Possible mechanism for the renoprotective effect of angiotensin converting enzyme inhibitors. 269 55

A retrospective multicentre study of 341 children with persistent/recurrent, isolated haematuria is described. The haematuria was isolated for at least 6 months at the beginning of observation. The duration of follow-up was 2-5 years in 201, 5-10 years in 119, 10-15 years in 19, and over 15 years in 2 cases. Of these patients 47.8% became symptom-free. In 18.4% the haematuria remained isolated; in 13.8% it was combined with proteinuria over 250 mg/day more than 2 years later. The occurrence of associated proteinuria increased progressively with time. It was 8.6% between the 3rd and 5th years, and 37.0% after the 5th year. Renal biopsy was performed because of the symptoms of glomerular disease in 47 cases at an average time of 12 months following the appearance of proteinuria. Proteinuria appeared after a 2-5, 5-10, 10-15 and more than 15 years follow-up period in 16, 23, 6, and 2 patients respectively; 14 of them had Alport's nephropathy. The percentage of more serious azotaemia was 1.7 (creatinine clearance: 10-50 ml/min per 1.73 m2) and 0.3 (creatinine clearance: less than 10 ml/min per 1.73 m2). Mortality was 0.58%. Most of the patients who developed severe azotaemia had persistent microscopic haematuria at the beginning. The prevalence of hypertension was only 1.2%. The time of its appearance was above 5 years in 2 and below 5 years in 2 cases. All these patients had chronic glomerulonephritis. The haematuria was associated with hypercalciuria in 19.9%. In 14.3% of the overall group of patients urolithiasis developed 2-15 years after onset. All of these had hypercalciuria.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up of patients with persistent/recurrent, isolated haematuria: a Hungarian multicentre study. 270

The study involved 33 patients with chronic glomerulonephritis of hypertonic type (CGNHT), in their number 8 with the signs of a moderate renal failure, 25 with a latent form of the disease (CGNLF), 10 ones with hypertension, and 20 healthy age-matched subjects. Patients with CGNHT and hypertension patients were comparatively studies for the blood pressure values. Fatty acid, glycerine, malonic dialdehyde contents were investigated in all the examinees. Some patients were studied for the fraction composition of fatty acids as well. The majority of CGNHT and hypertensive patients demonstrated a significant increase in the levels of fatty acids, glycerine and malonic dialdehyde versus healthy and CGNLF subjects, whereas the content of polyunsaturated fatty acids was found to be decreased (exemplified by linoleic acid) and the content of monounsaturated ones increased (exemplified by myristic acid). The aforementioned changes were mostly pronounced in those CGNHT patients who had higher systolic pressure whereas the signs of renal failure were of no importance for the value variance. No differences were revealed in the parameters of hypertensive and CGNHT patients. Accounting for the role of fatty acids, polyunsaturated ones predominantly, which provide the energy consumption of myocardium (raised in those with higher blood pressure values) the authors suggested that arterial hypertension played a definite role in the aforementioned alterations. The results obtained could be of a certain clinical value for dietetic and medicamentous improvement of the deficiency in the levels of polyunsaturated fatty acids in the patients with CGNHT, possible normalization of fatty acid content and composition during the decrease of the blood pressure.
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PMID:[Arterial hypertension and fatty acids of the blood in patients with chronic glomerulonephritis without the nephrotic syndrome]. 271 86

When chronic glomerulonephritis (CGN) proceeds to chronic renal failure (CRF), there are decline of fibrinolytic activity and deposition of fibrin in glomeruli with resulting thromboembolic lesions. 46 CGN patients with complicating CRF were thus treated with defibrase made from viper venom. Defibrase in a dose of 0.025 unit/kg dissolved in 250 ml 10% glucose was infused slowly once every 3 days in a total of 6 times. After the treatment, BUN and serum creatinine levels decreased, creatinine cleance improved and the clinical manifestations of uremia alleviated or disappeared. In some patients there were increase of hemoglobin concentration and decrease of urinary protein excretion. Hypertension was controlled in 17 out of 20 patients treated in combination with captopril. Level of plasma fibrinogen was significantly reduced after defibrase administration, but the reduction was not related to the therapeutic effect. Urinary output was increased in most of the patients, being related to the therapeutic effect. The authors are of the opinion that renal function may be improved in CGN patients after defibrase treatment due probably to elimination of fibrin deposition and resolution of thromboembolic lesions in glomeruli. However, a suitable dose has to be determined as there is no effective way to monitor the most dreaded complication of defibrase therapy bleeding.
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PMID:[Therapeutic effect of defibrase in chronic glomerulonephritis with chronic renal failure]. 280 53

Serum gamma-glutamyltranspeptidase (GGTP) and alpha-amylase clearance were determined in a total group of 90 patients of whom 60 with renal diseases and 30 with extrarenal diseases. The renal patients were distributed, according to diagnosis in the following groups: acute glomerulonephritis, chronic glomerulonephritis, acute pyelonephritis, chronic pyelonephritis, nephrotic syndrome and manifest chronic renal failure. The 30 controls were hospitalized for different extrarenal diseases such as: pneumonia, gastroduodenal ulcer, arterial hypertension stage I and angina pectoris. Serum GGTP assay was performed in 60 patients (40 renal patients and 20 controls) using Boehringer monotest kits and in 30 patients (20 renal patients and 10 controls) using Romanian kits (I.C.C.F.). No changes suggesting a particular type of nephropathy were observed. The results obtained by using the two types of kits for the serum GGTP assay have proved to be very close. Alpha-amylase clearance was determined in all the patients with Spofa (R.S.C.) tablets concomitantly with the urea and creatinine clearance. Important decreases of alpha-amylase clearance in concordance with decreases of urea and creatinine clearances were observed in all the patients with severe renal failure. More moderate decreases of alpha-amylase clearance were observed in the patients with acute and chronic glomerulonephritis. The utility of this clearance as a test of glomerular filtration and sometimes as a prognostic test, is discussed.
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PMID:Preliminary clinical and methodologic observations on the determination of serum gamma-glutamyltranspeptidase and of the alpha-amylase clearance in nephropathies. 286 37


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