Hypertension and CKD

Hypertension and CKD - ypertension and CKD The terms...

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Unformatted text preview: ypertension and CKD The terms nephrosclerosis or hypertensive nephropathy are usually applied to CKD associated with HTN Nephrosclerosis is described in patients with chronic kidney disease and essential hypertension with no other cause of kidney disease Even though considered the second most common cause of ESRD, hypertensive nephrosclerosis has been histologically confirmed in very few cases The causal relationship with hypertension is still a subject for debate The most characteristic microscopic lesion is hyalinosis of afferent arterioles The vascular changes cause glomerular ischemia (retraction of the glomerular tuft with focal or global sclerosis), and in some areas, interstitial fibrosis and tubular atrophy In other cases the hyalinization of afferent arterioles initially causes glomerular hypertrophy and, in the long term glomerulosclerosis lesions that would favor the development of proteinuria and disease progression These abnormalities are more frequent in black patients Hypertensive nephropathy is more frequent in African Americans Pharmacologic treatment of mild-to- moderate hypertension in African Americans has little impact on the incidence of CKD, whereas it significantly reduces the progression in Caucasians Those differences persist despite controlling for: Age Sex Initial serum creatinine concentration Initial and treated blood pressures Number of missed office visits Antihypertensive medications prescribed Kopp et al initially identified excess African ancestry on chromosome 22p in African Americans with idiopathic FSGS and HIV-associated collapsing FSGS MYH9 was eventually identified as the associated gene MYH9 was associated with clinically diagnosed hypertensive ESRD in African Americans as well The Family Investigation in Nephropathy and Diabetes (FIND) study rapidly replicated association in several nondiabetic forms of ESRD in African Americans, including idiopathic FSGS, HIVAN and clinically diagnosed hypertensive-ESRD Genovese and colleagues examined large chromosomal regions adjacent to MYH9 Statistically stronger associations were detected between two independent sequence variants in the APOL1 and nondiabetic nephropathy in African Americans, with odds ratios of 10.5 in idiopathic FSGS and 7.3 in hypertension- attributed ESRD The genetic risk that was previously attributed to MYH9 may reside, in part or in whole, in APOL1, although more complex models of risk cannot be excluded ffect of kidney disease on blood pressure Sodium retention is generally of primary importance, even if the degree of extracellular volume expansion is insufficient to induce edema Increased activity of the renin-angiotensin system (probably due to regional ischemia induced by scarring) is often responsible for at least part of the hypertension that persists even after the restoration of normovolemia Enhanced activity of the sympathetic nervous system has...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Hypertension and CKD - ypertension and CKD The terms...

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