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

Renal parenchymal disease is the most common cause of secondary hypertension, accounting for 2.5% to 5.0% of all cases. Hypertension associated with renal parenchymal disease occurs as a complication of a wide variety of glomerular and interstitial renal diseases and may accelerate the decline in renal function if inadequately controlled. Renal parenchymal hypertension most probably represents the combined interactions of multiple independent mechanisms: potential factors include impaired sodium handling leading to volume expansion, perturbations of the renin-angiotensin system, alterations in endogenous vasodepressor compounds, and possibly increased activity of vasoactive substances. The past several years have witnessed newer insights into both the pathophysiology and the therapeutics of this disorder. The characterization of endothelin and the nitric oxide (NO)-arginine pathway and their roles in biology and medicine has provided additional new insights with regard to the pathogenesis of hypertension in renal parenchymal disease. For example, methylated L-arginine derivatives that possess NO synthase inhibitor capabilities including NG-N-dimethylarginine and N-monomethyl-L-arginine are found in human plasma and in urine. Patients with chronic uremia have impaired elimination of these compounds, and circulating concentrations of these compounds may increase sufficiently to result in inhibition of NO production. Thus, accumulation of endogenous NO synthase inhibitors might contribute to the hypertension of advanced renal failure. Similarly, it has been proposed that increased endothelium-derived endothelin that results from hypertensive injury to vascular endothelium could lead to further vasoconstriction and worsening of hypertension. Additional insight into this fascinating problem must await further biochemical characterization of some of the mediators and a more precise delineation of their pathophysiological role.
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PMID:Renal parenchymal disease and hypertension. 777 24

Renal parenchymal disease is a common but often unrecognized cause of hypertension. Chronic renal disease and systemic hypertension may coexist in two distinct settings. First, essential hypertension is an important cause of chronic renal disease. Second, renal parenchymal disease is a well-established cause of secondary hypertension. Renal parenchymal disease is the most common cause of secondary hypertension, accounting for 2.5% to 5.0% of all cases of systemic hypertension. Secondary hypertension may also accelerate the decline in renal function if inadequately controlled. Therefore, hypertension is both a cause and a consequence of renal disease, and it may be difficult to distinguish them clinically.
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PMID:Renal Parenchymal Hypertension: current concepts of pathogenesis and management. 862 71

Renal parenchymal disease after urinary tract infection (UTI) has been associated with the development of hypertension and renal functional impairment. A systematic literature review and meta-analysis was performed to determine how effectively the finding of primary vesicoureteric reflux (VUR) on micturating cystography (MCU) in children hospitalized with UTI predicted renal parenchymal disease on (99m)Technetium-dimercaptosuccinic acid ((99m)Tc-DMSA) scintigraphy. Medline, Embase, and PubMed were use to find reports with original data for children hospitalized with bacteriologically-proven UTI who had undergone both MCU and (99m)Tc-DMSA scintigraphy, and which also reported both positive and negative results of these tests. A meta-analysis of likelihood ratios positive and negative for MCU was then performed, including tests for heterogeneity. Twelve valid studies were found, seven with data for 537 children, with a positive (99m)Tc-DMSA scan prevalence of 59% overall, and seven studies with data for 1062 kidneys, with a positive (99m)Tc-DMSA scan prevalence of 36%. The likelihood ratio positive for MCU was 1.96 (95% CI, 1.51 to 2.54) for children, and 2.34 (1.53 to 3.57) for kidneys. The likelihood ratio negative was 0.71 (0.58 to 0.85) for children and 0.72 (0.61 to 0.86) for kidneys. There was evidence of heterogeneity. The meta-analysis showed that a positive MCU increases the risk of renal damage in hospitalized UTI patients by about 20%, whereas a negative MCU increases the chance of no renal involvement by just 8%. VUR is hence a weak predictor of renal damage in pediatric patients hospitalized with UTI. Physicians should be aware of the limitations of using MCU-detected primary VUR as an effective screening test for renal damage in this population. Furthermore, the pathogenesis of renal damage in such patients is probably complex because it is often detected without demonstrable VUR.
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PMID:Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. 1259 11

Hypertension in children is the major risk for cardiovascular disease in adult. Limited data are available for hypertension in children in Southeast Asia. To determine the cause, treatment, and long-term outcome of hypertension in Thai Children, the authors retrospectively studied 62 patients (age <15 years) diagnosed with hypertension at Thammasat University hospital, from December 01, 2004 through November 30, 2009. The mean age was 9.2 +/- 4.2 years; median follow-up 8 months. Fifty five (88.7%) patients had secondary hypertension. Patients presented with stage 2 hypertension (67.7%), and hypertensive emergency (9.7%). Renal parenchymal disease caused 67.3% of secondary hypertension. End organ damage included left ventricular hypertrophy (11.3%) and hypertensive retinopathy (6.4%). Hypertensive emergency was caused mostly by acute poststreptococcal glmoerulnephritis (APSGN, 66.7%). Intravenous diuretic coupled with oral antihypertensive drugs gave uncontrolled blood pressure in APSGN with hypertensive emergency. Seventy percents of patients with essential hypertension had obesity. Majority of the patients had controlled hypertension without medication. Acute poststreptococcal glomerulonephritis remained the common cause of transient hypertension and hypertensive emergency in Thai children. The high incidence of obesity among essential hypertension in children demonstrated in the present study should alert Thai pediatrician to measure blood pressure in every obese child. Treatment of childhood hypertension was associated with good long-term outcome.
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PMID:Hypertension in Thai children: a report from a hospital in suburban area. 2129 3