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The Kidney as a Target Organ in Hypertension

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Renovascular and Renal Parenchymatous Hypertension

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Abstract

The kidney often plays a causative role in the pathogenesis of systemic hypertension. As reviewed in other chapters in this book, vascular and parenchymal diseases of the kidney are the most common causes of secondary or nonessential hypertension. However, inherent renal abnormalities such as abnormal renal sodium handling [24, 36] or reduction in filtration surface area due to a congenitally decreased nephron number [13], may underly primary or essential hypertension. This has been most elegantly demonstrated in cross-transplantation experiments in rats with a genetic predisposition to spontaneous or salt-induced hypertension [9, 17]. Thus, renal abnormalities may be responsible for diverse types of systemic hypertension. It is also clear, however, that the kidney may be a “victim” of systemic hypertension [33]. Systemic hypertension complicates the clinical course of most patients with chronic renal failure [35] and it has long been recognized that effective treatment of hypertension slows or prevents the development of progressive renal insufficiency [40], especially in patients with severe hypertension [18, 63]. The role of systemic hypertension in the development of both experimental and clinical glomerular injury will be the focus of this chapter.

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References

  1. Anderson JR, Christiansen JS, Andersen JK etal. (1983) Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25: 496–501

    Article  Google Scholar 

  2. Anderson S, Meyer T, Rennke HG, Brenner BM (1985) Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest 76: 612–619

    Article  PubMed  CAS  Google Scholar 

  3. Anderson S, Rennke HG, Brenner BM (1986) Therapeutic advantage of converting enzyme inhibitors in arresting progressive renal disease associated with systemic hypertension in the rat. J Clin Invest 77: 1993–2000

    Article  PubMed  CAS  Google Scholar 

  4. Arendshorst WJ, Beierwaltes WH (1979) Renal and nephron hemodynamics in spontaneously hypertensive rats. Am J Physiol 236: F246–F251

    PubMed  CAS  Google Scholar 

  5. Azar S, Johnson MA, Wai LJ et al. (1978) Single nephron dynamics in “post-salt” rats with chronic hypertension. J Lab Clin Med 91: 156–166

    PubMed  CAS  Google Scholar 

  6. Azar S, Johnson MA, Schineman J et al. (1979) Regulation of glomerular capillary pressure and filtration rate in young Kyoto hypertensive rats. Clin Sci 56: 203–209

    PubMed  CAS  Google Scholar 

  7. Azar S, Limas Z, Iwar J et al. (1979) Single nephron dynamics during high sodium intake and early hypertension in Dahl rats. Jpn Heart J 20: 138–140

    Google Scholar 

  8. Bauer JH, Reams GP, Sunder ML (1987) Renal protective effect of strict blood pressure control with enalapril therapy. Arch Intern Med 147: 1397–1400

    Article  PubMed  CAS  Google Scholar 

  9. Bianchi G, Fox U, DiFrancesco DF et al. (1974) Blood pressure changes produced by kidney cross-transplantation between spontaneously hypertensive rats and normotensive rats. Clin Sci Mol Med 47: 435–438

    PubMed  CAS  Google Scholar 

  10. Bidani AK, Schwartz MM, Lewis EJ (1987) Renal autoregulation and vulnerability to hypertensive injury in the remnant kidney. Am J Physiol 252: F1103–F1110

    Google Scholar 

  11. Brenner BM, Humes HD (1977) Mechanisms of glomerular ultrafiltration. N Engl J Med 297: 148–154

    Article  PubMed  CAS  Google Scholar 

  12. Brenner BM, Meyer TW, Hostetter TH (1982) Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation and intrinsic renal disease. N Engl J Med 307: 652–659

    Article  PubMed  CAS  Google Scholar 

  13. Brenner BM, Garcia DL, Anderson S (1988) Glomeruli and blood pressure: Less of one, more of the other? Am J Hypertens 1: 335–347

    PubMed  CAS  Google Scholar 

  14. Brunner FP, Thiel G, Hermle M et al. (1989) Long-term enalapril and verapamil in rats with reduced renal mass. Kidney Int 36: 969–977

    Article  PubMed  CAS  Google Scholar 

  15. Chanutin A, Ferris EB (1932) Experimental renal insufficiency produced by partial nephrectomy. I. Control diet. Arch Intern Med 49: 767-787

    CAS  Google Scholar 

  16. Dahl LK, Schackow H (1964) Effects of chronic excess salt ingestion: Experimental hypertension in the rat. Can Med Assoc J 90: 155–160

    PubMed  CAS  Google Scholar 

  17. Dahl LK, Heine M, Thompson K (1973) Genetic influence of the kidneys on blood pressure. Evidence from chronic renal homografts in rats with opposite predispositions to hypertension. Circ Res 34: 94–101

    Google Scholar 

  18. Davidov M, Mroczek W, Gavrilovich L, Finnerty F (1975) Long term follow-up of aggressive medical therapy of accelerated hypertension with azotemia. Angiology 26: 396–407

    Article  Google Scholar 

  19. Dworkin LD, Feiner HD (1986) Glomerular injury in uninephrectomized spontaneously hypertensive rats: a consequence of glomerular capillary hypertension. J Clin Invest 77: 797–809

    Article  PubMed  CAS  Google Scholar 

  20. Dworkin LD, Feiner HD, Randazzo J (1987) Glomerular hypertension and injury in desoxy- corticosterone-salt rats on antihypertensive therapy. Kidney Int 31: 718–724

    Article  PubMed  CAS  Google Scholar 

  21. Dworkin LD, Bernstein J, Feiner HD etal. (1988) Nifedipine prevents glomerular injury without reducing glomerular pressure (PGC) in rats with desoxycorticosterone-salt ( DOC- salt) hypertension (abstract ). Kidney Int 33: 374

    Google Scholar 

  22. Dworkin LD, Grosser M, Feiner HD et al. (1989) Renal vascular effects of antihypertensive therapy in uninephrectomized SHR. Kidney Int 35: 790–798

    Article  PubMed  CAS  Google Scholar 

  23. Feld LG, VanLieu JB, Galaske RG et al. (1977) Selectivity of renal injury and proteinuria in the SHR. Kidney Int 12: 332–343

    Article  PubMed  CAS  Google Scholar 

  24. Guyton AC, Coleman PJ, Cowley AW et al. (1974) A systems analysis approach to under-standing long range arterial blood pressure control and hypertension. Circ Res 35: 159–176

    Google Scholar 

  25. Harris DCH, Hammond WA, Burke TJ et al. (1987) Verapamil protects against progression of experimental chronic renal failure. Kidney Int 36: 41–46

    Article  Google Scholar 

  26. Harris DCH, Chan L, Schrier RW (1988) Remnant kidney hypermetabolism and progression of chronic renal failure. Am J Physiol 254: F267–F276

    PubMed  CAS  Google Scholar 

  27. Heeg JA, DeJong PE, VanderHem GK et al. (1987) Reduction of proteinuria by angiotensin converting enzyme inhibition. Kidney Int 32: 78–84

    Article  PubMed  CAS  Google Scholar 

  28. Hostetter TH, Olson JL, Rennke HG etal. (1981) Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol 241: F85–F93

    PubMed  CAS  Google Scholar 

  29. Hostetter TH, Troy JL, Brenner BM (1981) Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int 19: 410–415

    Article  PubMed  CAS  Google Scholar 

  30. Hostetter TH, Rennke HG, Brenner BM (1982) The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 72: 375–380

    Article  PubMed  CAS  Google Scholar 

  31. Ichikawa I, Miele JF, Brenner BM (1979) Reversal of renal cortical actions of angiotensin II by verapamil and manganese. Kidney Int 16: 137–147

    Article  PubMed  CAS  Google Scholar 

  32. Jackson B, Johnston CI (1988) The contribution of systemic hypertension to progression of chronic renal failure in the rat remnant kidney: effect of treatment with an angiotensin converting enzyme inhibitor or a calcium inhibitor. J Hypertens 6: 495–501

    Article  PubMed  CAS  Google Scholar 

  33. Klahr S (1989) The kidney in hypertension _ villain or victim? N Engl J Med 320: 731–733

    Article  PubMed  CAS  Google Scholar 

  34. Krowelewski AS,Canessa M, Waram JH et al. (1988) Predisposition to hypertension and susceptibility to renal disease in insulin dependent diabetes mellitus. N Engl J Med 318: 140’145

    Article  Google Scholar 

  35. Lazarus J, Hampers CI, Merril JP (1974) Hypertension in chronic renal failure. Arch Intern Med 133: 1059–10066

    Article  PubMed  CAS  Google Scholar 

  36. Ledingham JM, Cohen RD (1963) The role of the heart in the pathogenesis of renal hypertension. Lancet 2: 979–981

    Article  PubMed  CAS  Google Scholar 

  37. Loutzenhizer R, Epstein M (1985) Effects of calcium antagonists on renal hemodynamics. Am J Physiol F619–F629

    Google Scholar 

  38. Mangili R, Bending JJ, Scott G etal. (1988) Increased sodium-lithium countertransport activity in red cells of patients with insulin-dependent diabetes and nephropathy. N Engl J Med 318: 146–150

    Article  PubMed  CAS  Google Scholar 

  39. Meyer TW, Anderson S, Rennke HG et al. (1987) Reversing glomerular hypertension stabilizes established glomerular injury. Kidney Int 31: 752–759

    Article  PubMed  CAS  Google Scholar 

  40. Moyer JH, Heider C, Pevey K, Ford RV (1958) The effect of treatment on the vascular deterioration associated with hypertension, with particular emphasis of renal function. Am J Med 24: 177–192

    Article  PubMed  CAS  Google Scholar 

  41. Nath KA, Hostetter MK, Hostetter TH (1985) Pathophysiology of chronic tubulointerstitial disease in rats. Interactions of dietary acid load, ammonia and complement component C3. J Clin Invest 76: 667–675

    Article  PubMed  CAS  Google Scholar 

  42. Nath KA, Kren SM, Hostetter TH (1986) Dietary protein restriction in established renal injury in the rat: selective role of glomerular capillary pressure in progressive glomerular dysfunction. J Clin Invest 78: 1199–1205

    Article  PubMed  CAS  Google Scholar 

  43. Nath KA, Hostetter MK, Hostetter TH (1989) Ammonia-complement interaction in the pathogenesis of progressive renal injury. Kidney Int 36 [Suppl 27]: S52–S54

    Google Scholar 

  44. Navar LG, Champion WJ, Thomas CE (1986) Effects of calcium channel blockade on renal vascular resistance responses to changes in perfusion pressure and angiotensin-converting enzyme inhibition in dogs. Circ Res 58: 874–881

    PubMed  CAS  Google Scholar 

  45. Olson JL, Wilson SK, Heptinstall RH (1986) Relation of glomerular injury to preglomerular resistance in experimental hypertension. Kidney Int 29: 849–857

    Article  PubMed  CAS  Google Scholar 

  46. Raij L, Keane WF (1985) Glomerular mesangium: its function and relationship to angiotensin II. Am J Med 79 [Suppl C]: 37–41

    Article  PubMed  CAS  Google Scholar 

  47. Raij L, Azar S, Keane W (1984) Mesangial immune injury, hypertension and progressive glomerular damage in Dahl rats. Kidney Int 26: 137–143

    Article  PubMed  CAS  Google Scholar 

  48. Raij L, Azar S, Keane W (1985) Role of hypertension in progressive glomerular injury. Hypertension 7: 398–404

    PubMed  CAS  Google Scholar 

  49. Raij L, Chiou X, Owens R et al. (1985) Therapeutic implications of hypertension-induced glomerular injury. Comparison of enalapril and a combination of hydralazine, reserpine and hydrochlorothiazide in an experimental model. Am J Med 79 [Suppl 3C]: 37–41

    Article  PubMed  CAS  Google Scholar 

  50. Raij L, Dalmasso A, Stalely N etal. (1989) Renal injury in DOCA-salt hypertensive C5- sufficient and C5-deficient mice. Kidney Int 36: 582–592

    Article  PubMed  CAS  Google Scholar 

  51. Reams GP, Bauer JH (1986) Effect of enalapril in subjects with hypertension associated with moderate to severe renal dysfunction. Arch Intern Med 146: 2145–2148

    Article  PubMed  CAS  Google Scholar 

  52. Rostard SG, Brown G, Kirk KA et al. (1989) Renal insufficiency in treated essential hypertension. N Engl J Med 320: 684 - 688

    Article  Google Scholar 

  53. Ruilope LM, Miranda B, Morales JM et al. (1989) Converting enzyme inhibition in chronic renal failure. Am J Kidney Dis 13: 120–126

    PubMed  CAS  Google Scholar 

  54. Seaquist ER, Goetz FC, Rich S et al. (1989) Familial clustering of diabetic kidney disease. Evidence for genetic susceptibility to diabetic nephropathy. N Engl J Med 320: 1161–1165

    Article  PubMed  CAS  Google Scholar 

  55. Shinamura T, Morrison AB (1975) A progressive glomerulosclerosis occurring in partial five-sixths nephrectomized rats. Am J Pathol 79: 95–101

    Google Scholar 

  56. Shultz PJ, Raij L (1989) Role of calcium channels in human mesangial cell ( MC) proliferation (abstract ). Kidney Int 35: 183

    Google Scholar 

  57. Tolins JP, Raij L (1989) Genetic factors and susceptibility to diabetic nephropathy. N Engl J Med 319: 180–181

    Google Scholar 

  58. Tolins JP, Hostetter MK, Hostetter TH (1987) Hypokalemic nephropathy in the rat. Role of ammonia in chronic tubular injury. J Clin Invest 79: 1447–1458

    Article  PubMed  CAS  Google Scholar 

  59. Tolins JP, Coffee K, Raij L (1988) Disparate effects of converting enzyme inhibitor (CEI) and dietary protein restriction on glomerular injury. Influence of genetically determined renal hemodynamic responses (abstract). Kidney Int 33: 386

    Google Scholar 

  60. Tolins JP, Shultz P, Raij L (1988) Mechanisms of hypertensive glomerular injury. Am J Cardiol 62: 54G–58G

    Article  PubMed  CAS  Google Scholar 

  61. Tolins JP, Raij L (1990) Comparison of converting enzyme inhibitor and calcium channel blocker in hypertensive glomerular injury. Hypertension 16: 452–461

    PubMed  CAS  Google Scholar 

  62. Tolins JP, Melemed A, Sulciner D et al. (1989) Calcium channel blockade inhibits platelet activating factor (PAF) production by human umbilical vein endothelial cells ( EC) (abstract ). Clin Res 37: 302

    Google Scholar 

  63. Veterans Administration Cooperative Study Group on Antihypertensive Agents (1967) Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129mmHg. J Am Med Assoc 202: 1028 - 1034

    Article  Google Scholar 

  64. Weening JJ, Beukers JJ, Grond J et al. (1986) Genetic factors in focal segmental glomerulosclerosis. Kidney Int 29: 789–798

    Article  PubMed  CAS  Google Scholar 

  65. Yoshida Y, Fogo A, Shiraga H et al. (1988) Serial micropuncture analysis of single nephron function in the rat model of subtotal renal ablation. Kidney Int 33: 855–867

    Article  PubMed  CAS  Google Scholar 

  66. Yoshida Y, Fogo A, Ichikawa I (1989) Glomerular hemodynamic changes vs hypertrophy in experimental glomerulosclerosis. Kidney Int 345: 654–660

    Article  Google Scholar 

  67. Yoshida Y, Kawamura T, Ikoma M et al. (1989) Effects of antihypertensive drugs on glomerular morphology. Kidney Int 36: 626–635

    Article  PubMed  CAS  Google Scholar 

  68. Zatz R, Meyer TW, Rennke HG, Brenner BM (1985) Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad Sei USA 82: 5963–5967

    Article  CAS  Google Scholar 

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Authors
  1. J. P. Tolins
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  2. L. Raij
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Editors and Affiliations

  1. Departement Innere Medizin, Kantonsspital Basel Petersgraben 4, CH-4031, Basel, Switzerland

    Thomas F. Lüscher

  2. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75 235-8899, Dallas, TX, USA

    Norman Meyer Kaplan

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© 1992 Springer Verlag, Berlin Heidelberg

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Tolins, J.P., Raij, L. (1992). The Kidney as a Target Organ in Hypertension. In: Lüscher, T.F., Kaplan, N.M. (eds) Renovascular and Renal Parenchymatous Hypertension. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-61239-8_18

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  • DOI: https://doi.org/10.1007/978-3-642-61239-8_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64756-7

  • Online ISBN: 978-3-642-61239-8

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