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

Investigation in a patient aged 46 years with decompensated heart failure and severe renal insufficiency demonstrated a small, poorly functioning right kidney and severe stenosis of the left renal artery. Cardiac decompensation was corrected and the left kidney revascularised by autotransplantation. Renal function recovered considerably (FG 75/min) and the severe hypertension was reduced. In hypertension patients by main renal artery stenosis, renal autotransplantation is recommended, since it is a safe method without technical difficulty and has given good results. The mutual dependence of hypertension and renal insufficiency is reviewed. When renal function is poor, revascularisation of the stenosed kidney will lead to recovery. The hypertension will usually improve but will always become more responsive to drug therapy.
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PMID:Severe renal insufficiency and renovascular hypertension. 78 49

Histologic and morphologic methods were employed to study the influence of chronic hemodialysis on kidney vessels in chronic renal insufficiency. Arteries of contracted kidneys from patients with and without hemodialysis treatment were investigated. The dialysis group was made up of 33 patients, 28 having undergone bilateral nephrectomy and 5 having died. The control group consisted of 21 patients with chronic renal insufficiency, who died in uremic coma without prior hemodialysis. A statistical evaluation was done by comparing measurements from corresponding arteries in the dialysis- and control groups. The correlation pattern from a BMD 03D-program, in which each group was separately assessed for the possible influence of various clinical findings, was determined. Clinical influences taken into account included the course of the kidney disease, grade of renal insufficiency, duration and degree of hypertension as affecting the renal arteries. The statistical results showed that hemodialysis treatment, even taking clinical data into consideration, influenced the development of intimal fibrosis in the arteries of contracted kidneys in an increasing positive manner. Decreased perfusion of the kidneys during hemodialysis suggested as a possible cause. The examination of early lesions in renal arteries following short-term dialysis treatment lends support to this possibility. Here edema and proliferation of the intimal cells in the arteries, similar to that in vessels having a reduced blood flow, is observed.
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PMID:[Obliterative intimofibrosis of the renal arteries under the influence of hemodialysis in patients with chronic renal insufficiency (author's transl)]. 81 4

Morphometrical and clinical investigations were performed in 34 patients with the so-called hypercellular form of focal glomerulosclerosis (FGS), i.e., a form showing clear diffuse mesangial hypercellularity beside focal sclerosis with the light microscopy. This form was compared with focal glomerulosclerosis without remarkable mesangial hypercellularity, with mild mesangioproliferative glomerulonephritis (gn), as well as with normal kidneys. The results were as follows: 1. Morphometrically both the increase in relative mesangial volume as well as in mesangial cell count is statistically significant in the hypercellular form compared with the nonhypercellular form and with controls. Comparison with mild mesangioproliferative gn shows no difference. 2. Even the so-called nonhypercellular form contains more mesangial matrix and mesangial cells than the controls. 3. The frequency of the hypercellular form is higher in males and in older patients. 4. All of our patients with hypercellular FGS had at the time of biopsy manifested nephrotic syndrome. The frequency of additional clinical symptoms (hematuria, hypertension, renal insufficiency) corresponds with the nonhypercellular form, but is different in mild mesangioproliferative gn. 5. Therapeutic response and prognosis is worse in the hypercellular form. The hypercellular form of FGS has to be separated from the nonhypercellular form as a defined entity.
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PMID:Diffuse mesangial cell proliferation in focal sclerosing glomerulonephritis. 82 13

The cases of 23 nephrotic children in whom percutaneous renal biopsies or postmortem studies showed focal and segmentary sclerosis were reviewed. It was more common in males and the average age at the onset was 6 years. The main symptoms were edema, hematuria and unspecific general manifestations. On admission, nephrotic syndrome was present in 91% of the cases and in a lesser proportion, edema hematuria and high blood pressure were found. The lesion was diagnosed at the first biopsy in 19 cases and in 4, subsequent biopsies or postmortem studies supported the diagnosis. Only 9 out 21 patients treated showed response to steroids and 5 of the resistant cases were given cyclophosphamide, but only one responded. They were checked at different periods of time ranging from 7 months to 10 years and by the end of the study, 11 patients were still under control showing normal renal function in six of them; 4 other cases showed mild renal insufficiency and in the remaining one, there was moderate renal insufficiency. Two died. A good correlation was evident between response to steroids and conservation of renal function. The findings are compared to those from other authors and emphasis is placed on the need to suspect the entity when a nephrotic syndrome with minimal changes is resistant to steroids, or when persistent hematuria is present; also, in cases showing initial lesions of tubular atrophy or interstitial fibrosis.
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PMID:[Focal sclerosing and segmentary nephropathy in children]. 84 9

In 55% of 100 patients (54 with glomerulonephritis and 46 with pyelonephritis) who had been dialysed in the permanent dialysis treatment for more than one year the tactics of a dialysis per week was estabished at the beginining of the permanent dialysis treatment: in the diuresis of more than 1 litre a day with the residual glomerular filtration about 5 ml/min, in stabilised body-weight, in controllable hypertension and in the compensated clinical picture of renal insufficiency. The residual glomerular filtration can be presumed only in the optimally hydrated patients. The canulation of the subclavian vein has proved significant for the evaluation of optimum hydration.
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PMID:[Importance of residual diuresis in patients with chronic pyelonephritis under constant dialysis treatment]. 84 45

A 70-year-old woman with chronic hypertension and previously normal renal function had acute oliguric renal failure requiring hemodialysis. Renal arteriograms revealed the presence of bilateral renal artery stenosis and normal-sized kidneys. Nineteen days after admission to hospital, after undergoing nine hemodialysis procedures, surgical revascularization of renal artery stenosis was performed utilizing a single bypass graft of the left renal artery. Postoperatively, an immediate diuresis ensued, with resolution of acute renal failure. It is critically important in the evaluation of patients with anuria, acute renal failure without obvious cause, or impending uremia in patients with chronic stable renal insufficiency, to consider the possibility of renal artery stenosis or thrombosis. Recognition and then surgical correction of significant renal arterial hypoperfusion allows the reasonable potential for reversibility of this important form of acute or progressive renal failure.
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PMID:Bilateral renal artery stenosis causing acute oliguric renal failure. Report of a case corrected by renovascular surgery. 85 4

On the basis of a clinical case, the authors review the principal signs of Bourneville tuberose sclerosis and show the renal manifestations which may be encountered. The most common is the presence in both kidneys of tumours which are hamartomas. In addition, this patient suffered from hypertension and renal insufficiency. Their frequency and pathogenesis are discussed in the context of this disease.
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PMID:[A rare association of hamartomas of the kidney, renal insufficiency, Bourneville disease and arterial hypertension (author's transl)]. 85 54

A series of 262 children suffering from vesico-ureteric reflux is presented. Nearly all presented with a urinary tract infection and the age at onset of symptoms was predominantly in the pre-school years. The reflux was not diagnosed in the majority until after the children started attending school. Over one-third had symptoms for more than half their lives before reflux was diagnosed. The incidence of hypertension and renal insufficiency in the series were 4% and 7-8% respectively. Nearly 60% of the children were selected by defined criteria for operation as their initial treatment. The remainder were treated conservatively in the first instance but 30% of these subsequently required operation. Reflux was eliminated in 96.3% of the children at the first operation and 5.5% developed postoperative ureteric dilatation, none of them permanently. Reflux disappeared spontaneously in two-thirds of the children treated conservatively but took more than 3 years in 46%. Infection recurred in 24% of children treated by operation and in 29% treated conservatively. The incidence with which reflux disappeared spontaneously in the children treated conservatively was related to time, not to the infection recurrence rate.
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PMID:The management of ureteric reflux in children. 87 Jan 34

The symptoms and clinical course of chronic hypokalemic nephropathy are described in 21 patients with longstanding potassium deficiency. In 14 patients (group A) the potassium depletion was caused by malnutrition and/or abuse of laxatives and/or diuretics. 7 patients (group B) suffered from primary (6 cases) or secondary (1 case) aldosteronism. The average duration of potassium depletion was 8.8 years in group A and 3.4 years in group B. Depending on the duration of potassium depletion, chronic renal disease develops which may end in terminal renal failure. Urinalysis is non-specific or negative. The clearance of creatinine slowly decreases. Metabolic alkalosis is a constant finding and in group A occurs with a tendency to hyponatremia and hypochloremia, with the development of metabolic acidosis only in advanced renal insufficiency. In contrast to patients of group B, patients of group A have normal or low blood pressures converting to hypertension, if at all only in the late phase. The cases of group A had secondary aldosteronism (and, correspondingly, a hyperplastic juxtaglomerular apparatus). Although urinary tract infection is a regular finding in advanced stages, the clinical, radiological and histological evidence suggests that bacterial pyelonephritis, if occurring at all, is rather a complication than the cause of the disease. In 5 patients 7 instances of acute renal failure of unknown origin were observed which was lethal in one case. Another patient died from terminal renal failure, a third from an intercurrent pneumonia. Renal histology obtained from 13 patients showed the picture of diffuse chronic abacterial interstitial nephritis.
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PMID:Symptoms and course of chronic hypokalemic nephropathy in man. 87 Feb 67

Blockade of prostaglandin synthesis with indomethacin (1) did not induce significant changes in blood pressure or in renal circulation in renovascular hypertensive rabbits with normal renal blood flow; (2) induced renal insufficiency and aggravated hypertension in hypertensive rabbits whose renal blood flow was below normal levels; (3) did not alter the reversal of renovascular hypertension produced by the release of the renal arterial constriction; and (4) induced a decrease in plasma renin activity by decreasing renin release. These findings indicate that the vasodilator and natriuretic actions of prostaglandins may play an important role in protecting the kidney against ischemia; the facilitating role of renal prostaglandins on renin release raises the possibility that a primary hypersecretion of renal prostaglandins is responsible for Bartter's syndrome, whereas a primary deficiency may be responsible for "low-renin hypertension."
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PMID:Hypertension and the interrelated renal circulatory effects of prostaglandins and the renin-angiotensin system. 87 71


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