Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seven patients had acute oliguric renal failure after intravenous urography (2), celiac arteriography (2), or cardiac angiography (3). Diatrizoate meglumine was the contrast media used in all of the cases. These patients had an average age of 63 years and six were 55 years of age or older. Diabetes mellitus, negative fluid balance before the procedure, underlying renal insufficiency, and hypertension were common, being present in three, four, five, and six of the patients respectively . Anuria or oliguria occurred within 24 hours of the procedure and persisted from 36 to 96 hours (72 hours average). The serum creatinine level rose significantly in all of the patients and reached a peak in two to seven days after the procedure. In six patients, recovery was complete by two to three weeks. The seventh patient experienced only partial recovery. These cases taken together with a mounting number of recent reports suggest that contrast media-induced oliguric renal failure is more common than generally believed. Diabetes mellitus, older age, and underlying renal insufficiency seem to be important predisposing factors.
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PMID:Contrast media-induced oliguric renal failure. 62 32

Autonomic dysreflexia (AD) is a syndrome that consists of facial flushing, excessive sweating, nasal congestion, throbbing headache and paroxysmal hypertension which may occur in response to bladder distension in patients with spinal cord lesions above the T6 level. We report the case of a C2 quadriplegic patient who developed clinical features of AD along with cortical blindness and seizures after administration of meglumine (Hypaque) for diagnostic cystogram.
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PMID:Seizures and cortical blindness after meglumine (hypaque) administration: a variant of autonomic dysreflexia. 812 Mar 39

Bromoethylamine (BEA, 30-40 mg/kg) was administered to dogs to determine whether damage to the inner medulla of the kidney, the putative source of a depressor hormone, causes hypertension in this species. Bromoethylamine produces hypertension in rats but this has not been confirmed in other species, although we have shown that this dose of BEA in dogs abolishes the release of a reno-medullary vasodepressor hormone in response to marked increases in renal perfusion pressure. During acute BEA administration over 1 h to conscious dogs, there were no significant effects on renal blood flow, arterial pressure or total peripheral resistance, but there was a significantly greater diuresis compared to vehicle administration. Over the first 10-14 days after BEA, daily urine output rose 5-10 fold initially and plasma creatinine concentration rose markedly. There was no significant effect on arterial pressure, cardiac output, total peripheral resistance, or renal blood flow over this period. BEA administration caused extensive damage to the thin limbs of the loops of Henle, widespread thrombosis of blood vessels and haemorrhage into the interstitium of the dog renal medulla. Reno-medullary interstitial cells were devoid of lipid droplets, were synthetic, and were associated with increased amounts of extracellular matrix. Thus extensive renal medullary damage by BEA administration to conscious dogs did not alter resting systemic haemodynamics, and these results therefore provide no evidence for a role for the medulla in the maintenance of resting arterial pressure in the dog.
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PMID:Renal and cardiovascular effects of renal medullary damage with bromoethylamine in dogs. 819 13

The purpose of the study was to compare the positive and negative predictive values of conventional renography (Reno-A), captopril renography (Reno-B) and ultrasound Doppler (UD) with regard to the diagnosis renal artery stenosis. These three tests, and in addition a renal angiography, were performed in consecutively admitted patients with arterial hypertension, owing to either suspicion of renovascular hypertension or refractoriness to treatment. Patients with occlusion of a renal artery or a serum creatinine level higher than 300 mumol/l, or a previous investigation for renovascular hypertension at another hospital, were excluded from the analysis. The European Multicenter Study (EMS) criteria and local criteria for abnormal renography were compared. Of 131 patients, 28 had a renal artery stenosis (RAS) exceeding 50% reduction in diameter of the artery and 19 exceeding 70%. Using the EMS criteria for renography the predictive values of a negative test for a RAS more than 50% were 0.88 for Reno-A, 0.90 for Reno-B, 0.86 for changes from Reno-A to Reno-B, 0.92 for abnormalities either in Reno-A, Reno-B or changes from Reno-A to Reno-B, and 0.91 for UD. The corresponding values for a RAS more than 70% were 0.94, 0.97, 0.93, 0.98 and 0.96, respectively. The predictive values of a positive test were clearly lower, ranging from 0.20 to 0.75, but best when changes from Reno-A to Reno-B were used, 0.69-0.75. Using local criteria for renography the predictive values of a negative test were almost equal to those obtained by using the EMS criteria, but the predictive values of a positive test were slightly lower. It is concluded that conventional renography, captopril renography and ultrasound Doppler all are very good screening tests for renal artery stenosis, but the positive predictive values are clearly highest when using changes from conventional renography to captopril renography. It is suggested that captopril renography always should be performed when conventional renography is abnormal and vice versa to obtain the highest positive predictive value, on the assumption that total renal function is normal or almost normal, and that renal function is not absent in the affected kidney.
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PMID:Diagnosing renal artery stenosis: a comparison between conventional renography, captopril renography and ultrasound Doppler in a large consecutive series of patients with arterial hypertension. 897 51

Angiotensin (Ang) II promotes renal infiltration by immunocompetent cells in double-transgenic rats (dTGRs) harboring both human renin and angiotensinogen genes. To elucidate disease mechanisms, we investigated whether or not dexamethasone (DEXA) immunosuppression ameliorates renal damage. Untreated dTGRs developed hypertension, renal damage, and 50% mortality at 7 weeks. DEXA reduced albuminuria, renal fibrosis, vascular reactive oxygen stress, and prevented mortality, independent of blood pressure. In dTGR kidneys, p22phox immunostaining co-localized with macrophages and partially with T cells. dTGR dendritic cells expressed major histocompatibility complex II and CD86, indicating maturation. DEXA suppressed major histocompatibility complex II+, CD86+, dendritic, and T-cell infiltration. In additional experiments, we treated dTGRs with mycophenolate mofetil to inhibit T- and B-cell proliferation. Reno-protective actions of mycophenolate mofetil and its effect on dendritic and T cells were similar to those obtained with DEXA. We next investigated whether or not Ang II directly promotes dendritic cell maturation in vitro. Ang II did not alter CD80, CD83, and MHC II expression, but increased CCR7 expression and cell migration. To explore the role of tumor necrosis factor (TNF)-alpha on dendritic cell maturation in vivo, we treated dTGRs with the soluble TNF-alpha receptor etanercept. This treatment had no effect on blood pressure, but decreased albuminuria, nuclear factor-kappaB activation, and infiltration of all immunocompetent cells. These data suggest that immunosuppression prevents dendritic cell maturation and T-cell infiltration in a nonimmune model of Ang II-induced renal damage. Ang II induces dendritic migration directly, whereas in vivo TNF-alpha is involved in dendritic cell infiltration and maturation. Thus, Ang II may initiate events leading to innate and acquired immune response.
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PMID:Immunosuppressive treatment protects against angiotensin II-induced renal damage. 1241 15

Reno-vascular disease, along with diabetes mellitus, is the leading cause of dialysis in the elderly population, accounting for 50-66% of cases in patients above 65 years of age. Reno-vascular disease is a broad term, which includes renal artery stenosis, ischemic nephropathy, such as atherosclerotic obstruction, thrombo-embolic phenomenon, nephrosclerosis secondary to hypertension and acute occlusion of renal arteries (either bilateral or unilateral in singlekidney patients). Renal artery stenosis, defined as a 50% or greater occlusion of a renal artery (unilateral or bilateral), is an important cause of secondary hypertension. It often presents as drug refractory hypertension or renal insufficiency. Atherosclerotic renal artery stenosis accounts for 90% of such cases, the remaining 10% being caused by fibro-muscular dysplasia. The incidence of atherosclerotic renal artery stenosis is increasing among the aging population, who are at an increased risk due to cardiovascular complications. This is a review of the emerging trends in the diagnosis and management of renal artery stenosis.
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PMID:Renal artery stenosis: an update on diagnosis and management. 1905 47

The role of renin-angiotensin-aldosterone system (RAAS) in regulating the volume and composition of extracellular fluid, blood pressure (BP) as well as onset and progression of cardiovascular and renal diseases has been studied for more than 150 years. The compounds that block the vital stages of the RAAS cascade, such as ACE-inhibitors (ACEI), AT1-receptor blockers (ARB) and aldosterone receptor antagonists, importantly extended our treatment options. However, the positive therapeutic effects of these compounds also have certain negative consequences. Administration of ACEIs and ARBs interrupts physiological feedback for renal renin release and leads to reactive elevation of circulating active renin and greater production of angiotensin I and angiotensin II with subsequent return of aldosterone secretion to the pre-treatment levels ('escape' phenomenon). These possible adverse effects of the intermediary products of incomplete RAAS blockade leading to organ complications have facilitated the efforts to develop compounds blocking the initial stages of renin-angiotensin cascade--i.e. direct renin blockers. After several years of unsuccessful attempts, the recent years have seen development of the first non-peptide, orally long-term effective renin inhibitor, aliskiren fumarate. In monotherapy or in combination with other antihypertensives (hydrochlorothiazide, ARB, ACEI), aliskiren reduces BP in a dose-dependent manner (75-600 mg/den). Aliskiren reduces plasma renin activity (PRA) and neutralises hydrochlorothiazide-induced RAAS activation. Once daily administration of the drug leads to longer than 24-hour activity and its prolonged blocking effects on the kidneys are the basis for its renoprotectivity. In addition to the significant antihypertensive effect, clinical studies also showed a range of organoprotective properties in patients with left ventricle hypertrophy (ALLAY study), heart failure (ALOFT study) and diabetic nephropathy (AVOID study). Similar to other AT1-blockers, aliskiren has a minimum of adverse side effects. Aliskiren for hypertension therapy was launched in clinical practice in USA in 2007 (Tekturna and combination formulation TekturnaHCl, respectively) and shortly after that in European Union as Rasilez. In the Czech Republic, aliskiren (Rasilez) was released for clinical use by diabetologists and nephrologists in patients with hypertension and concomitant diabetes, nephropathy and proteinuria in doses of 150-300 mg per day on 1. 8. 2009. It is recommended as monotherapy or in combination with other antihypertensives to treat conditions with elevated PRA, including PRA elevation following diuretic, ACEI or ARB administration. Aliskiren might be used in patients who do not tolerate ACEIs as well as in patients in whom angiotensin II participates in the pathogenesis of their diseases. Reno-protective properties leading to a reduction in proteinuria and delaying renal failure progression were observed in patients with diabetic as well as non-diabetic nephropathy. The drug is the subject to similar precautions and contraindications as ACEIs and ARBs, i.e. pregnancy and bilateral renal artery stenosis. To make meaningful conclusions about the so far positive contribution of this new treatment class and its broad applicability for the therapy of hypertension and other cardiovascular diseases, it will be imperative to assess its long-term effects on morbidity and mortality as well as to compare these agents with other RAAS blockers in long-term clinical studies; this represents a research effort for another 7-8 years.
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PMID:[Direct renin inhibitor aliskiren in the treatment of cardiovascular and renal diseases]. 2032 82

Reno vascular hypertension (RVH) is an important challenge for clinicians managing patients with hypertension. With recent advances in imaging techniques, the diagnosis and recognition of Renal artery stenosis (RAS) has increased resulting in a 3-4 fold increase in endovascular procedures. Recent prospective, randomized trials have demonstrated equivocal results for interventions and a third trial is under way. In managing such patients, clinicians need to consider the risk-benefit of expensive and invasive workup and interventions.
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PMID:Atherosclerotic renovascular hypertension: current trends in diagnosis and management. 2146 9

There are various causes of Reno Vascular Hypertension in children reported in the literature. Amongst these, Page kidney gets a rare mention. This phenomenon is a result of the accumulation of blood or urine in the perinephric or subcapsular space, resulting in compression of renal parenchyma, microvascular ischemia, alteration in the renin-angiotensin apparatus, and high renin hypertension. It has been well documented and studied in adults. Only a few cases are reported in the paediatric population. We report a rare presentation of Page kidney in a 5 year 8 months old girl. She initially presented with Dietl's crisis secondary to left Pelviureteric Junction obstruction (PUJO) causing massive hydronephrosis. She developed Page kidney phenomenon after spontaneous rupture of the pelvicalyceal system formed a tight compressive urinoma. She was managed successfully with internal JJ stenting and ultrasound-guided aspiration of the urinoma followed by elective delayed Pyeloplasty. To our knowledge, this is the first documented case of Page kidney in a child with severe PUJO.
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PMID:Page Kidney in a Child with Severe Pelviureteric Junction Obstruction. 3288 53