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

To explore the role of systemic hematocrit in the vascular adaptations which characterize desoxycorticosterone-salt hypertension, studies were performed in three groups of rats with uninephrectomy, desoxycorticosterone administration, and 1% saline in the drinking water. One group received recombinant human erythropoietin to increase hematocrit, and another group was subjected to phlebotomy and fed a low-iron diet to induce anemia. Control rats exhibited systemic and glomerular capillary hypertension, proteinuria, and substantial glomerular sclerosis at 8 wk. Erythropoietin modestly increased hematocrit and blood pressure and substantially aggravated glomerular capillary pressure, proteinuria, and glomerular sclerosis. In contrast, reduction of hematocrit with a low-iron diet significantly attenuated systemic and glomerular hypertension, proteinuria, and sclerosis. It was concluded that the pace of progression of glomerular injury can be limited by chronic reduction in hematocrit, which effectively ameliorates both systemic and glomerular hypertension in this model of salt-sensitive hypertensive renal disease.
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PMID:Anemia ameliorates progressive renal injury in experimental DOCA-salt hypertension. 176 13

Focal sclerosing glomerulopathy and especially focal segmental glomerulosclerosis (FSGS) have been recognized as a distinct clinical entity, however, there still exist controversies in terms of prognostic risk factors of progression and optimal mode of treatment. A total of 32 patients (2 with focal global sclerosis; FGS, the remainder with FSGS) were followed up for a mean period of 82 months (3-240 months). Fourteen presented with nephrotic syndrome and 18 had proteinuria with or without hypertension. Thirteen patients, all of whom except 1 were nephrotic, received steroid treatment with or without other immunosuppressive agents (cyclophosphamide/cyclosporin A/azathioprine). Three of the steroid-treated remained stable in complete remission; 5 nephrotic non-responders had renal death. The mean slope of 1/creatinine versus time for steroid-treated and non-treated groups was -0.23 and -0.043, respectively (p = 0.04), suggesting that nephrotic range proteinuria might be prognostically important. However, for the population of FSGS/FGS as a whole, only the initial serum creatinine predicted renal survival (p = 0.001 by Cox's regression model). Hypertension and hypercholesterolaemia were not important variables by themselves. Nevertheless, we found that the 9 patients treated with antihyperlipidaemics (gemfibrozil/probucol/cholestyramine/maxEPA) fared better, mean slope being -0.023 versus -0.103 for non-treated, though not reaching statistical significance (p = 0.96). Controlled prospective study involving a larger number of patients might be worthwhile.
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PMID:Focal sclerosing glomerulopathy. Risk factors of progression and optimal mode of treatment. 176 95

The major renal pathologic changes of diabetes include thickening of all renal extracellular basement membranes and mesangial matrix and, to a lesser extent, mesangial cell expansion. Two renal lesions appear critical in diabetic nephropathy. Mesangial expansion out of proportion to the size of the glomerulus is closely and inversely related to measures of peripheral capillary wall filtration surface and to clinical features of proteinuria, hypertension, and decreasing glomerular filtration rate (GFR). Arteriolar hyalinosis is related to global glomerulosclerosis, and both are correlated with the clinical features of nephropathy. These lesions are markedly advanced by the time renal dysfunction is clinically detectable. Relationships of structure and function early in the course of the diabetes have not been examined satisfactorily.
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PMID:Structural-functional relationships in type I insulin-dependent diabetes mellitus in humans. 177 56

A 66-year-old male patient of renovascular hypertension with nephrotic syndrome was described. Besides, focal segmental glomerulosclerosis like lesion was accompanied in the contralateral kidney. On admission, his blood-pressure amounted to 220/140 mmHg. Laboratory investigation included; urinary protein 10.5 g/day, serum creatinine 1.8 mg/dl, creatinine clearance 71.4/day, plasma renin activity 10.0 ng/ml/hr, angiotensin I 890 pg/ml and angiotensin II 40.0 pg/ml. Renogram and renal scintigram showed non-functioning pattern of left kidney. Arteriography disclosed approximately more than 95% stenosis of left main artery. Administration was discontinued because of poor control both in blood pressure and in proteinuria. After the left nephrectomy, the former normalized and the latter decreased. Microscopic examination of the right kidney revealed focal segmental glomerulosclerosis like lesion. So far as we know, this report is the first designed to elucidate renovascular hypertension with nephrotic syndrome accompanied by focal segmental glomerulosclerosis like lesion. The relationship between renovascular hypertension and nephrotic syndrome, and microscopic findings has been briefly discussed. It is suggested that the etiology of focal segmental glomerulosclerosis like lesion may be based on compensatory glomerular hyperfiltration caused by renovascular hypertension.
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PMID:[A case of renovascular hypertension with nephrotic syndrome, accompanied by focal segmental glomerulosclerosis-like lesion in the contralateral kidney]. 177 Jun 22

Three years following successful liver transplantation, a child developed proteinuria, hematuria and hypertension in the setting of progressive renal insufficiency. These abnormalities did not resolve with lower doses of ciclosporin. Because multiple drugs were required to control the hypertension and because no other etiology of the urinary abnormalities could be found, a renal biopsy was performed. The renal biopsy revealed findings consistent with severe IgA nephropathy, including glomerulosclerosis, segmental crescents, mesangial cell and matrix expansion, mesangial deposits, and positive immunofluorescence for IgA.
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PMID:IgA nephropathy as a possible cause of renal insufficiency following liver transplantation. 177 6

An analysis of 4 cases of the thrombotic thrombocytopenia in children of 4 to 10 years of age is performed. The disease was characterized by fever, purpura, headache and abdominal pains, arterial hypertension, microangiopathic haemolytic anemia, thrombocytopenia, increase of blood urea and serum creatinine, micro-haematuria and proteinuria. The duration of the disease was from 4 days to 7 months. Anuria, gangrene of the ears, scrotum, penis and soft tissues of legs and feet were registered in a 5-year-old patient with a fulminant disease. The cause of death of other patients was heart failure with acute lung oedema, brain haemorrhages and haemorrhagic pancreonecrosis. The diagnosis of the thrombotic thrombocytopenia was confirmed by the finding in the autopsy material of thrombotic microangiopathy of small arteries, veins, arterioles, venules and capillaries in kidneys and other organs and tissues. Kidney damage in fulminant disease is complicated by segmentary cortical necrosis, in a more prolonged disease--by glomerulosclerosis or mesangio-capillary glomerulonephritis.
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PMID:[Thrombotic thrombocytopenic purpura in children]. 180 69

In this study, the effect of the antihypertensive agents nifedipine (4.5 mg/day) and hydralazine (50-200 mg/l of drinking water) on the progression of chronic renal failure and scarring was evaluated in rats submitted to subtotal (5/6) nephrectomy (SNx). The effect of blood pressure reduction was studied in groups of rats fed either a medium-protein diet (24%) or high-protein diet (50%). SNx rats fed a high-protein diet had significantly higher levels of proteinuria and severer renal scarring at sacrifice (120 days after SNx). Nifedipine reduced proteinuria in SNx rats fed a high-protein diet. Both drugs significantly reduced systemic hypertension in SNx rats. Hydralazine and nifedipine also reduced hypertriglyceridaemia but had no effect on blood cholesterol levels. However, in spite of adequate control of systemic hypertension with the agents studied, the severity of renal scarring (glomerular sclerosis or tubulo-interstitial scarring) was not affected by treatment. We confirm that the control of systemic hypertension is not sufficient to prevent renal scarring in rats submitted to extensive renal ablation.
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PMID:Effect of antihypertensive therapy in experimental chronic renal failure. 182 85

The effect of streptozotocin (STZ) treatment on blood pressure in adult spontaneously hypertensive rats (SHR) was compared with that in neonatal SHR. Three-month-old SHR were intravenously given 10, 30 or 50 mg/kg of STZ. When STZ was given in adult SHR, weight loss, overt hyperglycemia and the reduction of blood pressure occurred dose dependently. Two-day-old pups from SHR were subcutaneously injected with 100 mg/kg of STZ. Neonatal STZ treatment did not attenuate the development of hypertension in SHR. Since neonatally STZ-treated SHR develop mild diabetic symptom with hypertension and develop mild diabetic glomerulosclerosis, they are a good model for studying vascular complications or other disorder relating to the synergism between hypertension and diabetes mellitus.
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PMID:Hypertensive diabetic rats: different effects of streptozotocin treatment on blood pressure in adult SHR and in neonatal SHR. 183 61

Urinary tract infections, in association with ureteral reflux or dysperistalsis, may lead to invasive renal parenchymal infection and residual scarring (reflux nephropathy). Such infections in infants are often not diagnosed during the acute phase. Late sequelae of reflux nephropathy include hypertension, proteinuria, or chronic renal failure. The latter may eventuate in the subset of patients with urinary tract infection and unilateral reflux extending to a solitary kidney or bilateral reflux. Proteinuria may herald the inexorable progression of glomerular sclerosis in patients destined to progress to end-stage renal disease, despite the absence of further recurrences of urinary tract infections. The mechanism of progression is probably similar to that occurring in other forms of chronic, diffuse parenchymal renal disease, which all have similar alterations in glomerular hemodynamics (an increase in glomerular capillary flow, pressure, and filtration). The consequent hyperfiltration per nephron may be related to the level of dietary protein intake or to some derivative of the protein load. Hyperfiltration appears to recapitulate the presumed renal hemodynamic response to the relatively high level of episodic meat consumption by paleolithic hunter-gatherers. A prudent therapeutic intervention in children with progressive reflux nephropathy may be a proportional reduction in protein intake.
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PMID:Paleonephrology and reflux nephropathy. From the 'big bang' to end-stage renal disease. 185 21

The safety and tolerability of cyclosporin A (CyA, Sandimmun) in idiopathic nephrotic syndrome were analyzed in 661 patients enrolled in 10 clinical studies. The majority had minimal-change nephropathy (MCN, 34%) or focal-segmental glomerulosclerosis (FSGS, 33%). The safety experience covered 435 patient years of CyA exposure. The initial CyA dose averaged 5 mg/kg/day in adults and 6 mg/kg/day in children, and was further titrated according to efficacy or adverse reactions. Relevant CyA-induced renal dysfunction occurred almost exclusively in patients (mostly FSGS) who had abnormal baseline renal function. Renal tolerability was better in patients who had complete remission of nephrotic syndrome than in those who did not respond to treatment. However, in the latter, the risk was still relatively low if CyA treatment was stopped after three to four months of treatment. Sixty-nine patients had a renal biopsy performed after one to three years of continuous CyA therapy, and CyA-associated nephropathy, especially interstitial fibrosis, was seen in a few of these patients. Kidney biopsies may therefore be advisable in MCN patients treated successfully for one to two years and in whom further CyA therapy is indicated. Hypertension occurred in approximately 10% and was usually well controlled with conventional antihypertensive therapy. There were a few infectious complications, but the course of these was not unusual. Malignancies developed in five patients, including Hodgkin's lymphoma in two. Overall, adverse reactions resulted in CyA treatment discontinuation in 7.4% of patients, half of them because of renal dysfunction.
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PMID:Safety and tolerability of cyclosporin A (Sandimmun) in idiopathic nephrotic syndrome. Collaborative Study Group of Sandimmun in Nephrotic Syndrome. 186 Feb 68


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