The kidney and hypertension
Dr. Ali Jasim Al-Saedi Consultant Physician- Nephrologist Center of Nephrology & Transplantation Medical City College of Medicine University of BaghdadThe kidney as the cause of hypertension The kidney as the victim of hypertension role of hypertension in CKD patients progression cardiovascular risk
Components of hypertension: Renin Sodium
Renin Is an enzyme secreted from specialized cells in the efferent arteriole of the glomerulus (JGA). Maintains blood pressure through vasoconstriction when there is inadequate salt to maintain volume.RAS
Has a central role in acute and chronic regulation of BP
Factors controlling Renin release:RAS blockade was one of the stunning successes of 20th century medicine.
Hypertension is a frequent finding in both acute and chronic renal disease,Depends on type of renal disease and its duration. Glomerular Vascular
Acute glomerular disease Patients with acute glomerular disease, such as poststreptococcal glomerulonephritis or membranous nephropathy, tend to be volume expanded and edematous due to sodium retention.
Vascular disease Hypertension is also common in acute vascular diseases, such as vasculitis or scleroderma. In these settings, the elevation in blood pressure results from ischemia-induced activation of the renin-angiotensin system rather than volume expansion.
A patient presenting with acute renal failure, hypertension, and red cells and red cell casts in the urine sediment almost certainly has either glomerulonephritis or vasculitis. The absence of edema in this setting would point strongly toward a primary vascular disease.
Chronic renal failure Hypertension is present in approximately 80 to 85 percent of patients with chronic renal failure. Data from the Modification of Diet in Renal Disease Study, showed that the prevalence of hypertension rose progressively from 65 to 95 percent as the GFR fell from 85 to 15 mL/min per 1.73 m2
Hypertension may occur or be exacerbated in patients with advanced chronic renal failure treated with erythropoietin. Patients with end-stage renal disease are more likely to have an increase in pulse pressure and isolated systolic hypertension (? increased aortic stiffness).
Targets of antihypertensive treatment in patients with renal disease 130/80 mmHg if proteinuria > 1g/day lower target values lowering proteinuria to values as near to normal as possible to reduce proteinuria ACEi,ARB or combination are required Guidelines for the management of arterial hypertension J.Hypertens. (2007) 25:1105
The desired degree of blood pressure control can usually be safely achieved with combined therapy: ACE inhibitor or angiotensin II receptor blocker a diuretic, a calcium channel blocker, and, a beta blocker.
THE KIDNEY IS AT HEART OF HYPERTENSION SAVE YOUR HEART BY PROTECTING YOUR KIDNEY DEPATMENT OF NEPHROLOGY AND HYPERTENSION HYPERTENSION CLINIC MOUSEL : PROFESSOR KHALID ABDULALLA 1970 HEART – KIDNEY INTERACTION : THE CARDIO-RENAL SYNDROME
PATIENTS WITH CKD HAVE HYPERTENSION AND ARE MORE PREDISPOSED TO HEART ATTACKS , STROKES , AND CV MORBIDITY AND MORTALITY THAN DEVELOPING ESRDROBERT SCHRIERISN LEADERKIDNEY DISEASE AND HIGH BLOOD PRESSURE ARE LINKED SO A COLLABORATION BETWEEN ISN AND ISH –INTERNATIONAL SOCIETY OF HYPERTENSION – SEEMED NATURAL
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