Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The heart atrium, as well as under certain pathophysiological conditions the ventricle, synthesize and release ANP. Exerting natriuretic, diuretic and vasorelaxant effects, this peptide plays an important role in the body's blood volume and blood pressure homeostasis. Whereas the pharmacological actions of ANP have been quite convincingly demonstrated, its physiological and pathophysiological role is less well defined. ANP plasma levels tend to be increased in diseases with salt and water retention, such as essential hypertension, congestive heart failure, renal failure or liver cirrhosis. With regard to its hemodynamic effects, ANP seems to be beneficial in patients with hypertension. ANP appears to have little therapeutic potential as a diuretic in patients with congestive heart failure and liver cirrhosis, possibly due to the decreased renal responsiveness to ANP in these diseases. However, ANP might to be a valuable therapeutic agent in acute renal failure.
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PMID:[Atrial natriuretic peptide. II. Pathophysiology and possible clinical significance. Review]. 214 57

The effects of angiotensin-converting enzyme (ACE) inhibitors on renal hemodynamics vary widely depending on the preexisting physiologic and pathologic state of the kidneys. Although some studies of ACE inhibitors in primary essential hypertension have demonstrated increases in glomerular filtration rate (GFR) and effective renal plasma flow in patients with renal impairment, other studies have not shown these same beneficial results. The difference may involve the choice of ACE inhibitor used in the investigations, but controlled comparison trials are needed to determine whether this is the case. The use of ACE inhibitors in renovascular hypertension remains controversial. ACE inhibition can interfere with the autoregulation of GFR mediated by angiotensin II and may lead to deterioration of renal function, especially in patients with bilateral renal artery stenosis or stenosis of a solitary kidney. Additionally, ACE inhibitors have been shown to cause a decline in GFR in the kidney affected by the stenosis, whether or not clinically apparent renal insufficiency occurs. Although the functional impairment associated with ACE inhibitors in renal artery stenosis has generally been reversible following removal of the drug, the consequences of a long-term reduction in GFR are unknown. Treatment of stable congestive heart failure (CHF) with ACE inhibitors can result in enhancement of GFR and reduction of sodium and fluid retention, thus improving the clinical state. However, in patients with decompensated cardiac failure, renal perfusion pressures may already be at or near the autoregulatory breakpoint and ACE inhibition may cause deterioration of renal function. In general, ACE inhibitors can be used safely in CHF if they are initiated cautiously, with adjustment of ACE inhibitor and diuretic dosages to avoid systemic hypotension and sodium and fluid depletion. In studies comparing the agents, enalapril and lisinopril have both been shown to cause higher incidences of renal function deterioration than has captopril. These findings suggest that the more complete or sustained ACE inhibition seen with the longer-acting agents may be detrimental to renal function in patients with CHF. The use of ACE inhibitors in the treatment of proteinuria is the newest area of research with these agents. At present it appears that ACE inhibitors reduce urinary protein excretion the most effectively in diabetic patients with mild proteinuria and in hypertensive patients with renal insufficiency and proteinuria due to glomerular disorders. More study is needed to determine whether these agents can reduce the rate of renal failure progression and to define the patient populations expected to benefit most.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Angiotensin-converting enzyme inhibitors and renal function. 218 38

A total of 42 patients with malignant arterial hypertension (MAH) were examined. Of these, 32 patients had essential hypertension (26 with normal renal function and 6 with renal failure treated by programmed hemodialysis) and 10 suffered from chronic glomerulonephritis. The patients were examined for central hemodynamics, hormonal background (plasma renin activity) (PRA), plasma aldosterone and cortisol concentration. 14 patients underwent closed puncture biopsy of the kidneys. All the patients manifested high PRA associated activation of gluco- and mineralocorticoid adrenal function along with the hyperkinetic syndrome. MAH was characterized by dramatic discrepancy between the stroke and cardiac indices and specific peripheral resistance. Nephrosclerosis whose extent varied, attaining maximum in patients with associated essential hypertension and renal failure and in autopsy material, in addition to severe lesions of the renal vessels appeared to be the common feature of all morphological alterations. Plasmic impregnation and fibrinoid necrosis of the arterioles were not detectable in all the patients, being of focal character. The same alterations were identified in the patients during exacerbation of glomerulonephritis and in the absence of MAH. The data obtained point to the nonuniformity of MAH. Four clinicomorphological variants of MAH are suggested.
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PMID:[The malignant hypertension syndrome: incontrovertible and questionable truths]. 221 9

Angiotensin-converting enzyme (ACE) inhibitors have been available for about 10 years for the treatment of various forms of hypertension. Essential hypertension responds particularly well to the administration of this group of drugs, especially when combined with diuretics. A pronounced fall in blood pressure can be achieved in renovascular hypertension with high plasma renin levels; when ACE inhibitors were administered in diagnosed renal artery stenosis there was a significant rise in plasma renin activity on the affected side. Renoparenchymatous hypertension and hypertension in diabetes mellitus can also be improved by the long-term administration of ACE inhibitors, and the progression of renal failure in these disorders seems to be slowed down. Side effects such as neutropenia, exanthema, hearing disorders and pronounced hypotension with an acute deterioration in renal function are substance- and dose-dependent; regular monitoring of the patients greatly reduces their occurrence.
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PMID:Angiotensin-converting enzyme inhibition in renal and hypertensive disorders. 225 21

We reviewed the data of 3,632 patients with end-stage renal failure entered into the South African Dialysis and Transplantation Registry over a six-year period. The male to female ratio was 1.4:1. Of these patients, 48.8% were white, 26.2% black, 17.6% coloured and 7.4% Asian. Essential hypertension was the cause of end-stage renal failure in 15.9% of patients. Malignant hypertension was the diagnosis in 57% of the essential hypertensives. Hypertension was responsible for 34.6% of end-stage renal failure in blacks, 20.9% in coloureds, 4.3% in whites and 13.8% in Asians. In the age group 30-39 years, 37.4% of patients with malignant hypertension commenced dialysis, while 28.4% and 28.8% of benign hypertensives commenced dialysis in the 30-39 and 40-49 age groups, respectively. The survival at 36 and 72 months was the same whether hypertension was the cause of end-stage renal failure or not, and whether the hypertension was malignant or benign. Cardiac causes were responsible for most of the deaths. The percentage of deaths from cardiac causes was similar in patients with renal failure from essential hypertension and other causes (33.2% and 29.3% respectively). Hypertension is the commonest cause of end-stage renal failure in black South Africans and the most common preventable cause of end-stage kidney disease in the country.
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PMID:Hypertension as a cause of end-stage renal failure in South Africa. 225 79

A prospective study involving 1,980 patients aimed at defining the pathological basis of endstage (chronic) renal failure in Nigerians was carried out over a six-year period in Benin City, Nigeria. Using information derived from intravenous pyelography, ultrasonography, renal biopsies and autopsies, it was found that 43% of cases of chronic renal failure were due to hypertensive nephrosclerosis, 33% due to obstructive uropathy and 18% due to chronic glomerulonephritis. Chronic atrophic pyelonephritis was a rare finding. The frequency and severity of essential hypertension in Nigerians and their propensity to go into renal failure are similar to what obtains in American blacks. In a society which cannot afford regular dialysis and transplant facilities, there is need for early detection and adequate treatment of essential hypertension.
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PMID:The pathological basis of endstage renal disease in Nigerians: experience from Benin City. 227 31

The prescription of cardiac glycosides is usually controlled by immunological measurement of their plasma concentration. The observation of false positive digoxin measurements in patients free of this drug and the hypothesis that endogenous digitalis-like compounds might participate in body sodium and water homeostasis have led us to investigate the presence in plasma of compounds interacting with digoxin-antibodies under various physiological and pathological conditions in man and rats. The apparent levels of digoxin-equivalents in plasma of healthy control subjects (n = 21) and patients with essential hypertension (n = 48) or end-stage renal failure (n = 13) were 24.7 +/- 3.2, 34.4 +/- 4.4 and 98.7 +/- 17.4 pg/ml, p less than 0.05 and p less than 0.01 respectively. Positive correlations were observed between systolic and diastolic blood pressure and the apparent immunoreactivity of either whole or deproteinized plasma, in particular when only male subjects were considered. No relationship was found with the renal Na+ excretion or the plasma renin activity and the apparent immunoreactivity of the plasma. Its levels were however correlated with its ability to inhibit ouabain binding to the erythrocyte Na+ pump and to its capacity to reduce the renal Na+, K+-ATPase activity. In rats with experimental hypertension, induced by chronic excess salt intake either alone or associated with reduced renal mass, the cross reactivity with antidigoxin antibodies was also enhanced when compared to control rats (71.6 +/- 10.2 pg/ml, n = 12 and 57.3 +/- 5.0 pg/ml, n = 33 respectively compared to 43.4 +/- 3.7 pg/ml, n = 36, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Compounds of the digoxin type in essential and experimental hypertension]. 243 46

By measuring in vitro the effect of deproteinized plasma on canine kidney Na+K+-ATPase activity, evidence was sought for the presence of a circulating inhibitor of the enzyme in 31 patients with end-stage renal failure, 10 patients treated with digoxin, and 22 patients with untreated essential hypertension. In the renal failure group, mean Na+K+-ATPase activity with plasma samples taken just before a regular haemodialysis was 88% of that obtained with plasma from a normotensive control group (P less than 0.001). In digoxin-treated patients, the result was 94% of that obtained in control subjects (P less than 0.005). There was no significant difference in mean Na+K+-ATPase activity with plasma, between the hypertensive and control groups, or between age- and sex-matched subsets of these groups. The hypertensive group did not differ significantly from the control group in plasma renin activity or erythrocyte Na+ concentration. It was concluded that a circulating digitalis-like sodium-pump inhibitor was readily detectable in volume-expanded renal failure, but not in normal-renin essential hypertension.
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PMID:Measurement of circulating sodium-pump inhibitory activity in uraemia and essential hypertension. 244 Oct 15

The possibility of exploiting the cardiovascular and renal action of dopamine for therapeutic purposes is enhanced by its conversion into orally active prodrugs. Following an outline of the medicinal chemistry bases of the development of these prodrugs, laboratory and clinical pharmacology of ibopamine, levodopa, gludopa, and TA-870 are reviewed, pointing out the interesting indications of various preliminary studies in heart failure, essential hypertension, and renal failure on the one hand, and the extensive therapeutic experience with ibopamine as an "inodilator" in the chronic treatment of congestive heart failure on the other hand. New experimental results are also reported for ibopamine and for the novel prodrug Sim 2055, i.e., epinine-4-O-phosphate. The latter is shown to act as a selective renal vasodilator on oral administration in dogs and it is therefore proposed for clinical investigation in renal failure and in essential hypertension.
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PMID:Cardiovascular and renal action of dopaminergic prodrugs. 248 41

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.
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PMID:[Pathophysiology and prognosis in malignant hypertension: comparison by underlying diseases]. 251 35


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