1/7. Renovascular hypertension: a unique cause of unilateral focal segmental glomerulosclerosis.A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/7. Hemodialysis-resistant hypertension: control with an orally active inhibitor of angiotensin-converting enzyme.In two patients with end stage renal disease and dialysis-resistant hypertension, the orally active inhibitor of angiotensin-converting enzyme, captopril (SQ14,225; 2-D-methyl-3-mercaptopropranoyl-L-proline, dramatically lowered blood pressure both before and during dialysis. This agent holds promise as an alternate to bilateral nephrectomy in such patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/7. Recovery of renal function in patients with accelerated malignant nephrosclerosis on maintenance dialysis with management of blood pressure by captopril.Recovery of renal function to a self-sustaining level was observed in 4 patients with accelerated malignant hypertension who required chronic hemodialysis therapy. Excellent blood pressure control was achieved in all the patients on captopril therapy. Hemodialysis could be discontinued after 2-9 months of captopril therapy; on recovery of renal function levels of creatinine clearance became stable ranging from 28 to 56 ml/min within 5-15 months of captopril treatment, and remained at this level during 21-64 months of observation. The management of hypertension and the inhibition of the renin-angiotensin system afforded by chronic angiotensin-converting enzyme inhibition is very promising as a means of reversing the process of malignant nephrosclerosis.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
4/7. dexamethasone suppressible hyperaldosteronism in a child with nephrosclerosis.A 9 year old Mexican boy presented with severe hypertension, hypokalaemia and features suggesting acute glomerulonephritis. nephrosclerosis was present on renal biopsy. aldosterone levels were unresponsive to variations in dietary salt intake and plasma renin activity was suppressed. Following oral dexamethasone therapy (2 mg/day), plasma aldosterone decreased to undetectable levels, serum potassium normalized and plasma renin activity gradually increased. dexamethasone also restored the normal responsiveness of the renin-aldosterone system to postural stimuli. The patient exhibited a marked response to a single dose of ACTH with a rise in plasma aldosterone. Long-term blood pressure control and normal potassium levels have been achieved with oral prednisone therapy (5 mg/day) for a period of one year. This case of dexamethasone suppressible hyperaldosteronism (DSH) illustrates that the degree of hypertension in this syndrome may produce severe renal microvascular lesions. DSH should be considered in all children who present with low renin hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/7. Remission of essential hypertension after renal transplantation.Six patients in whom "essential hypertension" led to nephrosclerosis and kidney failure received kidney transplants from normotensive donors. After an average follow-up of 4.5 years, all were normotensive and had evidence of reversal of hypertensive damage to the heart and retinal vessels. These six patients, all of whom were black, and six control subjects matched for age, sex, and race were admitted to the General Clinical research Center for 11 days for observation of their blood pressure and their responses to salt deprivation and salt loading. Mean arterial pressure ( /- S.E.M.) among the patients who had previously had essential hypertension was similar to that of the normal controls (92 /- 1.9 vs. 94 /- 3.9; P not significant), and both groups had similar responses to salt deprivation and salt loading. Thus, essential hypertension in human beings is shown to be similar to the hypertension seen in spontaneously hypertensive rats in that both can be corrected by transplantation of a kidney from a normotensive donor. This observation supports the concept of the primary of the kidney in causing essential hypertension.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/7. Renal biopsy findings in presumed hypertensive nephrosclerosis.The 'classic' descriptions of renal histologic abnormalities in patients with hypertensive nephrosclerosis were based upon specimens obtained at autopsy or sympathectomy and were evaluated by light microscopy, without the aid of immunofluorescence or electron microscopy. patients with renal insufficiency accompanied by elevated blood pressure, hypertensive target organ damage (retinal disease and left-ventricular hypertrophy) and mild proteinuria are typically labelled as having hypertensive nephrosclerosis in the absence of renal biopsy material. Herein, we report the clinical summaries and renal pathology from 2 patients initially diagnosed with hypertensive nephrosclerosis. Glomeruli exhibiting focal and segmental sclerosis and interstitial scarring were present in both cases. The presence of primary renal disease in patients felt to have hypertensive nephrosclerosis is likely more common than currently appreciated. This may result from the lack of renal histologic material and the late presentation of these patients to nephrologists. Misclassification of hypertensive nephrosclerosis would impact greatly on the epidemiology of end-stage renal disease and the evaluation and treatment of patients with chronic renal insufficiency.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/7. Rapid-onset diabetic nephropathy in type II diabetes mellitus.We report a case of rapidly progressive diabetic nephropathy, from little diabetic change on renal biopsy to severe, nodular, diabetic nephrosclerosis over 32 months. The patient was taking an angiotensin converting enzyme inhibitor and had a mean arterial pressure of 95 mm Hg over this time period. Her dietary protein intake was low, at least upon presentation. She had three additional mechanisms or potential mechanisms of injury: monoclonal kappa light chains; IgA immune deposits on the first, but not the second biopsy; and longstanding hypertension. Her renal histology was typical for diabetic nephropathy but was not characteristic of kappa light chain disease. We suggest that diabetic nephropathy may develop more rapidly than previously assumed, especially when additional mechanisms of injury, or additional promoters of mesangial matrix accumulation are present.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |