Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pathophysiological characteristics and long-term prognosis were studied retrospectively in 69 malignant hypertensives associated with grade III or IV retinopathy and the diastolic blood pressure greater than 120 mmHg. Thirty three (48%) cases had essential hypertension (EHT) as the underlying disease, 26 (38%) as chronic glomerulonephritis (CGN), and the remaining 10 (14%) as others including chronic pyelonephritis, renovascular hypertension, hydronephrosis, multiple calyceal diverticula, and unknown original disease. The role of the renin-angiotensin system in malignant hypertension was investigated by measuring plasma renin activity (PRA) and determining the blood pressure response to angiotensin (ANG)II antagonist, (Sar1, Ile8) ANG II. Basal PRA was significantly higher in the EHT group than the CGN group, and the ANG II antagonist-induced reduction of blood pressure was only evident in the former group. The regression analysis revealed that PRA was linearly correlated with both mean blood pressure (MBP) and serum creatinine prior to antihypertensive treatment in the EHT group but not in CGN patients, although there was inverse correlation between PRA and serum sodium in both groups. Therefore, the renin-angiotensin system seems to play a significant role in elevating blood pressure and deteriorating renal function in malignant hypertension developed from EHT, while it is less important in that from CGN. The 5-year survival rate was 90% in total 69 patients with malignant hypertension, while the 5-year renal survival rate defined as the probability of surviving without maintenance hemodialysis was 37%, indicating that the treatment with hemodialysis as well as antihypertensive drug therapy contributed to an improvement of prognosis of malignant hypertension. The EHT group showed a poor prognosis for life compared with the CGN group, while in the latter group most patients rapidly developed endstage renal failure. Although the pretreatment serum creatinine levels were matched, the renal function more rapidly deteriorated after development of malignant hypertension in the CGN group than did in the EHT group, indicating renal survival rate to be shorter in the former group. Hence, underlying diseases may affect the long-term prognosis of malignant hypertension. The results obtained from this study suggest that the pathophysiological characteristics of malignant hypertension are different and its long-term prognosis is varied by underlying diseases such as EHT and CGN.
 ...
PMID:[Pathophysiology and prognosis in malignant hypertension: comparison by underlying diseases]. 251 35

Novel approaches to managing refractory arterial hypertension (AH) have been tested in 130 patients aged 28 to 59 years with severe or malignant hypertension. Hemosorption was performed in 70 patients in whom AH was caused by chronic diffuse glomerulonephritis (49 cases) or chronic pyelonephritis (21 cases) accompanied by the appearance of chronic renal failure. In all patients, blood pressure after hemosorption decreased by 15% to 16% on the average, resulting in progressively improved renal function and a nearly 2.0-fold reduction in plasma aldosterone concentration (PAC), and allowing the doses of antihypertensive drugs to be reduced. Plasmapheresis was performed in 31 patients with refractory severe or malignant AH due to essential hypertension or parenchymatous diseases of the kidneys. After two to four plasmapheresis sessions with up to 2 L of plasma exchanged, blood pressure dropped by 24% compared to baseline while the doses of antihypertensive drugs were diminished and some were discontinued completely in several cases. Analysis of the sensitivity to antihypertensive drugs after plasmapheresis using the rosette technique revealed a significant decrease in the number of rosette-forming cells. The level of angiotensin II and urinary excretion of aldosterone-18-glucuronide declined progressively by nearly 50% after plasmapheresis, correlating with the antihypertensive effect of plasmapheresis. In 32 patients with severe AH complicated by refractory cardiac failure, isolated ultrafiltration was used. After one to eight sessions and the removal of 1.0 L to 35.8 L of fluid, the signs of cardiac failure diminished, the blood pressure level responded to drug therapy, and the PAC level decreased significantly. Although the mechanisms of the antihypertensive actions of hemosorption, plasmapheresis, and isolated ultracentrifugation are still not completely elucidated, these data suggest that hemosorption may act by removing nitrogenous residues from the body and reducing PAC, plasmapheresis by deblocking receptors for antihypertensive drugs and reducing the concentration of angiotensin II and the synthesis of aldosterone in the body, and isolated ultrafiltration by eliminating hyperhydration and edema of the parenchymatous organs.
 ...
PMID:Extracorporeal methods in the management of severe and malignant arterial hypertension. 324 17

Intestine is seldom a site of clinical manifestation of malignant hypertension, particularly in childhood. This report deals with a case of malignant nephrosclerosis superimposed on benign nephrosclerosis which probably resulted from a unilateral obstructive uropathy and chronic pyelonephritis. Clinical features included severe hypertension, neuroretinopathy with retinal exudate and hypertensive encephalopathy. An acute abdomen due to transmural infarction of the ileum caused by multiple thrombotic occlusion of necrotizing arteritis involving bowel wall and the mesentery was noted.
 ...
PMID:Necrotizing arteriolitis of ileum, as the initial manifestation of malignant hypertension in childhood. 325 15

Captopril was used in 21 patients with various forms of stable and malignant hypertension. In symptomatic hypertension the drug had a good antihypertensive effect. When applied in patients with essential hypertension caused by chronic diffuse glomerulonephritis or chronic pyelonephritis captopril neither increased pathological changes in the urine, nor inhibited renal function.
 ...
PMID:[Effect of captopril on the level of arterial pressure and functional state of the kidney in symptomatic (renal) stable and malignant arterial hypertension]. 635 26

The low graft survival rate in black recipients (36 +/- 2% at 1 year) as compared with the graft survival rate in white recipients (48 +/- 1%) might be secondary to a higher incidence of vascular lesions, inducing hypertensive disease, in blacks than in whites. The relative frequency of malignant hypertension in black recipients was six times that of white recipients, and recipients with malignant hypertension had a significant lower graft survival rate (43 +/- 2%) than recipients with glomerulonephritis (54 +/- 1%). In addition, patients with vascular lesions (diabetes, malignant hypertension, and glomerulonephritis) showed significantly lower graft survival rates in black than in white recipients, in contrast to patients with primary tubular or interstitial lesions (polycystic kidneys and pyelonephritis), who showed similar graft survival rates in blacks and whites. Only a small fraction of this racial effect could be traced back to the higher incidence of Lewis-negative phenotypes in black recipients and a similar beneficial effect of transfusions, on graft survival, was observed in both black and white recipients. The effects of graft survival of age (6%), race (9%), and transfusions (18%) were significant in good (A) and poor (B) centers. No overlap between A and B centers was observed for any of these three parameters when analyzed separately. However, when the cumulative effects of these three risk parameters were analyzed together a partial overlap appeared, i.e., higher graft survival rates were observed in low-risk recipients that received transplants in B centers than in high-risk recipients that received transplants in A centers. Consequently, the selection of the recipient may play a role in the overall results of different transplantation units, leading to their classification into A or B centers, but cannot explain all of the differences between A and B centers.
 ...
PMID:Influence of the original disease, race, and center on the outcome of kidney transplantation. 703 19

In high arterial hypertension conditioned by main renal arteries stenosis of different genesis, 21.1% of patients were found to have a combination of renovascular hypertension with parenchymatous renal diseases, most often chronic pyelonephritis. The incidence of development of the malignant hypertension syndrome in combined lesions was noted to be 1.5 times higher than in isolated renovascular hypertension and makes 38.8% of patients. The described features of the clinical course, laboratory, radiological and radionuclide data as well as morphologic state of kidneys make it possible to distinguish this form of symptomatic hypertension as a special one, that is renovascular-parenchymatous hypertension.
 ...
PMID:[Combined renal forms of symptomatic arterial hypertension]. 709 44

31 therapeutic vascular embolizations were performed: 4 for osteolytic lesions; 24 for renal tumors and 3 for malignant hypertension in 3 patients with chronic pyelonephritis and corresponding bilateral kidney shrinkage with the kidneys left in the patients (- one patient being put on chronic dialysis and 2 having undergone renal transplantation). Opacifying chemical substances (Ethibloc) and non-opacifying chemical substances (Fibrospum, Butyl-2-Cyanoacrylat) were sometimes used for embolization; but most of the time, metal spiral (licenced by Gianturco) were taken, because of the following advantages: Their insertion is simple and easily controlled by fluoroscopy; they cause less pain, and they induce progressive thrombosis in the embolised artery. In cases, however, where catheterisation is difficult or impossible (narrow lumen/collaterals), embolization with chemical substances has to be done in addition to that by spiral.
 ...
PMID:[Results and technical problems of therapeutic vascular embolization with special reference to the use of spirals (author's transl)]. 741 75

The aim of the present study is to investigate the pathophysiological characteristics of a number of recent cases of malignant hypertension (MHT) and to compare them to the characteristics of earlier cases. Patients with MHT (age 25-76, mean 44+/-2 years) who were admitted to our hospital from 1984-1999 were retrospectively studied. All of the patients had either grade III or IV retinopathy and diastolic blood pressure levels higher than 120 mmHg. The observations in this study were compared to previously reported findings regarding 59 MHT patients who were admitted from 1971-1983. Of the 37 recent MHT patients, 20 had essential hypertension (EHT) as the underlying disease, 13 had chronic glomerulonephritis (CGN), and the remaining 4 presented with other diseases including pyelonephritis and renovascular hypertension. A positive family history of hypertension was more prevalent in the EHT patients than in other patients, and persistent proteinuria, microhematuria, and anemia were more prevalent in the CGN patients. These characteristics were similar between the recent and previous cases. Within 4 weeks after admission, hemodialysis was initiated in 3 of the 13 patients (23%) with CGN and 2 of the 20 (10%) patients with EHT. The prevalence of renal death at 1 year after admission was 30%, which was lower than the prevalence in the previous cases (42%). Grade IV retinopathy was seen in 45% of the patients admitted from 1984-1999, significantly less than in the patients admitted from 1971-1983 (66%, p<0.05). In addition, left ventricular hypertrophy was less frequently observed on electrocardiogram in the recent cases (67%) than in the previous cases (88%, p<0.05). Our results suggest that the recent cases of MHT demonstrate less severe organ damage.
 ...
PMID:Trends in the pathophysiological characteristics of malignant hypertension. 1167 41