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

The reported case of 2 brothers suffering from medullary sponge kindeys is unique in that uremia developed in spite of the absence of urinary tract obstruction, infection or hypertension. With the exception of congenital nystagmus and psoriasis, none of the extrarenal malformations often associated with medullary sponge kidneys was observed.
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PMID:[Familial medullary cystic kidney with progressive kidney failure]. 38 16

Mechanisms of progression of chronic renal failure (CRF) have been well documented in the rat but may not be relevant in man. Factors which may modify clinical CRF include underlying disease, diet, hypertension, intercurrent events, and adverse or beneficial effects of drug therapy. It has been argued that progression in many forms of renal disease is inexorable below a certain level of renal function. In other diseases, eg primary malignant hypertension, analgesic nephropathy, function frequently improves in both the short and long term with appropriate management. Thus knowledge of the nature of the underlying disease is essential in assessing progression. The value of diet in preserving renal function has been debated, particularly the relative roles of protein and phosphate control. In our own unit, a prospective randomized study showed a benefit of protein restriction. Development of accelerated hypertension is an important cause of progression of renal disease and clinical and experimental evidence supports the view that non-accelerated hypertension is also a factor in progression, amenable to treatment. Various intercurrent events may accelerate progression and function may be lost permanently following sepsis, urinary tract obstruction, renal arterial or venous obstruction, hypotension and in some cases pregnancy. Numerous drugs can have deleterious effects on the kidney. The possibility that converting enzyme inhibitors might preserve renal function is attracting attention but in view of their side effects their place in therapy should be determined by prospective controlled studies in which the above factors are carefully considered.
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PMID:Preservation of renal function in chronic renal failure. 141 42

The incidence of end-stage renal disease among hypertensive patients is increasing. Early recognition of renal insufficiency is critically important, since reversible causes of renal failure, such as urinary tract obstruction and renal artery stenosis, may be identified and corrected. Control of hypertension slows the progression of renal failure. Once renal failure develops, special attention must be given to diet and drug therapy.
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PMID:Hypertension and renal insufficiency: recognition and management. 154 95

Congenital urinary tract obstruction is a common cause of renal failure accounting for up to 20% of end-stage renal disease cases. Intrauterine obstruction often results in parenchymal loss and renal dysfunction. The pathophysiology of obstructive nephropathy and its further depression of renal function is related to severe renal vasoconstriction, which is in large part angiotensin mediated. Signs suggestive of urinary obstruction in the newborn may include an abdominal mass, hypertension, oligoanuria/polyuria, urosepsis, and hyperchloremic acidosis. The combination of renal ultrasound, diuretic renal scans, and voiding cystourethrogram are the main diagnostic modalities in infants with hydronephrosis. Nonsurgical management of ureteropelvic junction obstruction has become more popular, particularly in mild to moderate cases. Early fulguration or bypassing the obstruction of urethral valves is essential and a decrease in serum creatinine to below 1 mg/dL within 1 month of relief of obstruction is a favorable prognostic sign. Obstruction complicated by infection is dangerous and requires prompt intervention. Any newborn with a urinary tract infection, regardless of sex, should be presumed to have urinary obstruction or reflux until proven otherwise.
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PMID:Urinary tract obstruction and infection in the neonate. 157 69

A 16 year old boy presented with accelerated hypertension and urinary tract obstruction caused by phimosis. Relief of the obstruction by circumcision reversed the hypertension. We believe that accelerated hypertension secondary to phimosis has not previously been described.
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PMID:Accelerated hypertension caused by severe phimosis. 159 50

Urinary tract infections (UTI) in children are common. In the case of high grade vesico-ureteric-renal reflux (VUR) or urinary tract obstruction the abnormality may lead to end-stage renal failure. An early evaluation and adequate therapy after UTI are mandatory. Between 1980 and 1987 we evaluated 63 children with VUR. The symptoms of UTI are variable and age-dependent. Only in 13% of the children the urinary tract was evaluated after their first UTI. In 70% of the cases there were more than 1, mostly multiple UTI. The remaining 17% were admitted for other reasons. The relation boys to girls was 1:2. In boys the diagnosis of VUR was made earlier than in girls: 57% of boys and 17% of girls in their first year of life. In 24% of the boys and in 36% of the girls VUR was found between the 5th and 15th year of life. In the case of high grade reflux (IV-V) the kidneys showed heavy damage, loss of function and hypertension at the time of diagnosis. The aim must be early diagnosis and adequate therapy to prevent avoidable damages.
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PMID:[Importance of early diagnosis of urinary tract infections in childhood. Results of a retrospective study of children with vesico-uretero-renal reflux]. 181 93

Urinary schistosomiasis presenting with the clinical signs of acute glomerulonephritis is described in 20 African children. Nineteen had oedema, 10 had circulatory overload, 11 had hypertension, 12 had oligoanuria and all had obstructive uropathy with hydronephrosis. Lack of support for a diagnosis of post-streptococcal glomerulonephritis (PSGN) was the absence in these patients of a raised anti-streptolysin 0 titre and marked reduction in C3, which are noted in about 93% of those with PSGN. Furthermore, casts were not detected in freshly voided urine. Six of these patients required peritoneal dialysis. Signs in 16 reverted to normal within 3 weeks and two children died. One child had severe interstitial fibrosis and dilated and atrophic tubules with normal glomeruli, and died 18 months later in renal failure; the other had disseminated schistosomiasis and focal areas of chronic inflammatory cells with fibrin thrombi in small vessels in the kidney and died 6 days after admission. Obstructive uropathy cleared within 4-12 weeks in all seven patients who were followed up. Preliminary findings in a few children suggest a non-glomerular origin for this disease: a tubulo-interstitial disorder secondary to obstructive uropathy seems the most likely cause of this clinical problem. As renal biopsies were not ethically indicated, it is not possible to exclude PSGN completely in all these children. This syndrome could have escaped notice and may have been interpreted as glomerulonephritis with associated bilharzia, and therefore may constitute a previously unrecognized complication of Schistosoma haematobium infestation.
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PMID:Acute obstructive urinary schistosomiasis mimicking clinical glomerulonephritis: an unrecognized syndrome. 248 1

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

The cardiovascular effects of relief of obstruction were examined in 21 patients with painless urinary retention and hydronephrosis and hydroureter associated with hypertension (diastolic blood pressure 95-120 mm Hg, mean 107, 11 patients), severe peripheral oedema (8 patients), raised jugular venous pressure (5 patients), or clinical evidence of pulmonary oedema (5 patients). Before relief of obstruction fractional sodium excretion was appropriate for the reduced rate of glomerular filtration. After urethral catheterisation blood pressure fell (p less than 0.001) and the other cardiovascular abnormalities were rapidly reversed without further therapeutic measures. This improvement was associated with an increase (p less than 0.05) in both absolute and fractional urinary sodium excretion that was greatest at 24 h. 5% of patients undergoing surgery for obstructive disorders of the lower urinary tract have hydronephrosis and hydroureter. Hypertension related to chronic urinary tract obstruction may be the commonest form of surgically correctable renal hypertension.
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PMID:Reversible hypertension associated with unrecognised high pressure chronic retention of urine. 288 94

Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. The treatment for this condition is still controversial. This is the case study of a 14-year-old girl with documented right-sided obstructive uropathy secondary to Crohn's disease associated with renin-mediated hypertension secondary to her obstructive uropathy. The patient had complete resolution of her hypertension following surgery, which involved only resection of the involved bowel without ureterolysis.
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PMID:Hypertension associated with unilateral hydronephrosis as a complication of Crohn's disease. 343 Mar 14


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