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

The aim of this review is to summarize current knowledge about atrial natriuretic peptide--its role in pathophysiology of renal disease. Presumed role of atrial natriuretic peptide (ANP) in renal pathophysiology is based on the study of blood levels and renal effects of ANP in the presence of different manipulations (variations in dietary sodium intake, posture, water immersion or infusion of synthetic ANP) in patients with different renal diseases. In most of nephrotic patients ANP increases diuresis and natriuresis. However, small to great difference in natriuretic response was found in comparing with healty volunteers. Increased release of ANP in humans with chronic renal insufficiency would be expected as consequence of volume overload, diminished glomerular filtration rate and hypertension. Elevated plasma concentrations of ANP in end-stage renal disease are restored to normal level by successful renal transplantation, indicating that renal function is determinant of plasma ANP concentration. Fluctuations in plasma ANP-level during acute renal failure are related to blood volume changes in these patients.
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PMID:[Atrium natriuretic peptide in kidney diseases]. 771 46

Functional voiding disorders and urinary tract infections are common in childhood, but are usually not accompanied by upper urinary tract deterioration. Nevertheless a small group of children remain at risk of developing chronic renal insufficiency (CRI). Clinically these children present day and night wetting. The most important parameter, however, is urinary retention which is reflected by an abnormal voiding pattern in the uroflow curve. After ruling out patients with neurogenic or anatomical disorders, nine girls with psychogenic urine retention were observed for 5 years. Terminal renal insufficiency was seen in one, CRI in five patients and in three patients the kidney function could be maintained, but they all had severe scarring of at least one kidney. Furthermore, all revealed a dilation of the bladder and the upper urinary tract. Vesicoureteral reflux occurred in six and obstruction of the ureterovesical junction in three patients. Two girls underwent repeated reflux surgery resulting in a rapid deterioration of renal function. Three patients developed hypertension and one had a hypertensive crisis with microangiopathic anaemia and acute renal failure. Psychogenic disorders and problematic family settings were observed in all cases. Bladder training, transitory suprapubic catheters, intermittent catheterisation, medication and psychotherapy can avoid severe kidney damage and achieve a stabilisation of renal function. It is important to bear this syndrome in mind when evaluating girls with asymptomatic bacteriuria and urinary retention.
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PMID:Non-neurogenic bladder and chronic renal insufficiency in childhood. 774 5

Modern therapeutic concepts of chronic renal insufficiency are based on observations showing a retardation of progressive renal failure by therapeutic measures. In the context emphasis is now placed on the treatment of arterial hypertension and on the patient's adherence to a protein-restricted diet. In addition to these conservative measures it is important to avoid nephrotoxins, to hydrate the patient sufficiently and to treat advanced hyperlipidemias. Deficiencies of active vitamin D should be treated by oral vitamin D substitution after correction of hyperphosphatemia. In the treatment of the latter, preparations of calcium carbonate are now the preferred mode of treatment. In advanced renal insufficiency it is important to maintain a salt-restricted diet and to treat any attendant hyperkalemia and hyponatremia.
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PMID:[Conservative treatment in chronic kidney insufficiency]. 778 98

Angiotensin-converting enzyme (ACE) inhibitors represent a major therapeutic breakthrough for treatment of hypertension, congestive heart failure and various chronic renal diseases. They are effective generally well tolerated and safe for most patients. However, acute renal insufficiency or overt renal failure occurs in some patients with underlying critical renal artery stenosis (RAS), hypertensive nephrosclerosis, autosomal dominant polycystic kidney disease, diabetes mellitus, and chronic congestive heart failure. Diuretic-induced sodium depletion and underlying chronic renal insufficiency are the major predisposing factors for renal insufficiency in all of these patient populations. Renal insufficiency is usually asymptomatic, nonoliguric, associated with hyperkalemia, and in nearly every case completely reversible after discontinuation of the offending agent. Moreover, it can usually be managed in the outpatient setting by discontinuation of the ACE inhibitor, concomitant diuretic or both. An asymptomatic increase in serum creatinine in patients administered ACE inhibitors should raise the possibility of RAS; however, more common renal diseases should be considered. The decision to pursue testing for RAS should be done on an individual basis; moreover, it is imperative that patient willingness to undergo invasive procedures including angioplasty and/or surgery should be determined prospectively.
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PMID:Renal insufficiency due to angiotensin-converting enzyme inhibitors. 784 22

Several factors promote the progression of renal disease, including glomerular hypertension and hypertrophy, molecular factors such as cytokines and growth hormones, proteinuria, acidosis, and hyperlipidemia. Regardless of the underlying etiology, many patients with chronic renal insufficiency will ultimately require kidney replacement therapy. Your goal is to delay the progression of renal failure, mainly through aggressive control of blood pressure. Other possible interventions include protein restriction, bicarbonate therapy, and lipid-lowering drugs.
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PMID:Chronic renal disease: new therapies to delay kidney replacement. 803 27

Analysis of the first year's experience of 94 patients in a tertiary referral center showed that 21% had had previous surgery. Fifty-seven percent had medical problems: 17.8% hypertension, 16% cardiac problems, 8.9% diabetes mellitus, and 6.2% chronic renal insufficiency. Four patients had hypercarbia and were acidotic. The conversion rate to open cholecystectomy was 8.7%. Only one patient required reoperation for a bile leak. Fifty-five percent of our procedures took < or = 2 h, but 45% took > or = 3 h. Just over 50% of our patients stayed 48 h postoperatively. In this complex group of patients, it appears possible to achieve results similar to those previously published, but more time was required for surgery, and length of stay was increased.
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PMID:Laparoscopic cholecystectomy in a tertiary referral center. 811 58

Indapamide, a molecule with moderate diuretic effect, is an efficient antihypertensive drug. Blood pressure control is mostly explained by a direct action on peripheral vascular resistance. This action on peripheral resistances, as opposed to that on sodium balance, has rarely been indisputably substantiated. In order to dissociate its diuretic effect from its activity on peripheral resistances, we undertook a study on the efficacy of adding indapamide to the antihypertensive regimen of 12 patients suffering from chronic renal failure complicated by hypertension, and in whom control of high blood pressure had not been achieved with one to four antihypertensive drugs, plus furesemide in case of overhydration. Renal insufficiency was defined by serum creatinine levels of (m +/- SD) 271 +/- 171 mumol/l and a glomerular filtration rate of 36.7 +/- 18.6 ml/min. Before indapamide was introduced, blood pressure was 172.4 +/- 23.1 mmHg/109.6 +/- 9.55 mmHg. After 1 to 6 months of treatment, blood pressure was normalised. Systolic BP was 141.6 +/- 19 mmHg (p < 0.001) and diastolic BP was 89.7 +/- 8.6 mmHg (p < 0.001). Absence of diuretic effect and/or of modification of water and electrolytes was verified by the stability of body weight and serum electrolytes. At end point, body weight, electrolytes and renal function were unchanged. This study confirms that indapamide exerts an antihypertensive effect by lowering peripheral vascular resistances and not by diminishing the volume of extracellular fluid. Indapamide can be listed among antihypertensive agents that are advisable in the treatment of high blood pressure in patients with chronic renal insufficiency. Its antihypertensive effect in such patients is independent of any natriuretic action.
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PMID:[Antihypertensive action of indapamide in hypertension of chronic renal failure]. 817 77

Cardiovascular diseases are the leading causes of death in the United States, with hypertension being amongst the most prevalent of the cardiovascular risk factors. Improvement of hypertension management has, in consequence, received much attention. Extensive pre- and post-marketing experience with the transdermal formulation of clonidine marketed in the USA in the mid-1980s has now been accumulated. Transdermal clonidine is effective as monotherapy in mild-moderate hypertension, and in combination with diuretics, calcium antagonists and ACE inhibitors in more resistant cases. It controls blood pressure throughout the 24-h circadian cycle. It is effective and generally well-tolerated in adolescents, the elderly, blacks, diabetics, and subjects with chronic renal insufficiency. It has been used perioperatively and for suppression of adrenergic symptoms in subjects withdrawing from addicting substances. In comparison with oral clonidine, transdermal clonidine reduces the incidence and severity of such symptomatic side-effects as dry mouth, drowsiness, and sexual dysfunction. Minor skin reactions occur at the site of application of the transdermal patch with moderate frequency. Adherence to transdermal clonidine therapy is high, and patients commonly prefer it to oral therapy. Transdermal administration of clonidine is a useful therapeutic advance in the long-term management of hypertension.
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PMID:The USA experience with the clonidine transdermal therapeutic system. 819 27

The following parameters were studied in a group of patients suffering from essential arterial hypertension complicated by chronic renal insufficiency (CRI), mean age = 64.31 +/- 1.84, with creatinine clearance (CrC) ranging between 30 and 60 ml/min: blood pressure (systolic and diastolic arterial pressure), heart rate, plasmatic renin activity (PRA), plasma levels of aldosterone (ALDO) both in clino- and orthostatism, as well as some metabolic parameters. All parameters were compared with those in a group of age- and sex-matched patients with slight or moderate essential arterial hypertension. Before starting the study all patients completed a wash-out period of one week to annual the effects of other drugs which might interfere with the RAA system. PRA levels were within the norm, whereas plasma levels of ALDO were high both in clino- and orthostatism. ALDO levels were also found to be inversely correlated with those of CrC. From these data it emerges that hyperaldosteronism, as observed in these patients with CRI, is a relatively reliable marker of the extent of CRI and may occur independently of the activation of the RAA system, given that other factors, such as orthostatic stimulation, alterations in the acid-base equilibrium, and the degree of aldosterone hepatic and urinary clearance, contribute to its pathogenesis.
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PMID:[Role of aldosterone in essential arterial hypertension complicated by chronic renal insufficiency]. 823 30

IgA nephropathy (IgA N) is the most common type of primary glomerulonephritis (GN) diagnosed in Taiwan. From February 1983 to May 1992, 194 patients with primary IgA N, representing 25.3% of the primary GN, were diagnosed by renal biopsy at this hospital. Clinicopathologic correlation was made in 175 cases of IgA N with adequate clinical and pathologic data including light-(LM), immunofluorescent (IF) and/or electron-(EM) microscopy. Modified classification of Meadow et al. was adopted for the histologic grading of glomerular lesions. Forty-nine biopsies (28.0%) showed Grade IV and V lesions (Grade IV, 10.9%; Grade V, 17.1%, respectively) in association with a high level of serum creatinine and a lower frequency of gross hematuria when compared with lesions of histologic Grades I to III. Patients with Grade V lesions revealed a high frequency of hypertension as compared with those with Grades I to IV. The frequencies of nephrotic range proteinuria in those with various grades of IgA N was not statistically significant in this study. One hundred and thirty patients were followed up for one to eight and half years or until end-stage renal disease (ESRD) developed (mean 3.9 years), excluding the biopsies done at ESRD or from the graft kidney. Forty-two patients (32.3%) had chronic renal insufficiency, of those 25 (19.2%) eventually developed ESRD. Seventy-five percent of the patients with histologic Grades IV and V showed progressive renal disease, while only 16% of patients with Grades I to III lesions revealed progressive disease, the latter indicating a more benign course (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Primary IgA nephropathy: a nine-year clinicopathologic study in the Veterans General Hospital-Taichung. 828 86


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