Diabetic Nephropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Glomerular hypertension is caused by the complications of diabetes mellitus, chronic glomerulonephritis (including focal segmental glomerular sclerosis), and IgA nephropathy. Renal artery stenosis is a narrowing of the arteries that deliver blood to the kidneys. Causative factors include altered tubuloglomerular feedback changes and activation of vasoactive mediators (nitric oxide, the renin-angiotensin system, protein kinase C, and endothelins), which increase glomerular capillary pressure and secondary GFR. With chronic glomerulonephritis, glomerular hypertension is mostly dependent upon blood volume, and not related to deteriorated kidney function. Renal parenchymal hypertension develops along with diabetic nephropathy, acute or chronic glomerulonephritis, hypertensive nephrosclerosis, polycystic kidney disease, and renal microvascular disorders. Glomerular hypertension has also been linked to sickle cell disease, hyperaldosteronism, pregnancy, obesity, and metabolic syndrome.
Chronic hypertension and acute hypertensive crisis
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Many women with chronic hypertension are under the care of a primary care physician and already have been evaluated for causes of secondary hypertension, such as primary aldosteronism, pheochromocytoma, or Cushing’s disease (3). Women with paroxysmal hypertension, frequent “hypertensive crisis,” seizure disorders, or anxiety attacks should be evaluated for pheochromocytoma with measurements of 24-hour urine vanillylmandelic acid, metanephrines, or unconjugated catecholamines (10). Primary aldosteronism is rare in pregnancy, but may present with hypokalemia. Imaging studies (magnetic resonance imaging or computed tomography) may be helpful in demonstrating or localizing an adrenal tumor. Doppler flow studies or magnetic resonance angiography can reveal renal artery stenosis (3).
The Urinary System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Shaped like a bean, each kidney has a long convex lateral border and a shorter, indented medial border, as shown in Figure 11.1 (A). The upper end is topped by the suprarenalgland, also called the adrenal gland; either name is derived from the gland's position in relation to the kidney since supra- means "above" and ad- indicates "near." The indentation on the medial border of each kidney is called the hilum and is the point where the renal artery enters the kidney and the renal vein and ureter leave it.
Impact of drug adherence on blood pressure response to alcohol-mediated renal denervation
Published in Blood Pressure, 2022
Alexandre Persu, Frédéric Maes, Stefan W. Toennes, Sabrina Ritscher, Coralie Georges, Pierre Wallemacq, Nicole Haratani, Helen Parise, Tim A. Fischell, Lucas Lauder, Felix Mahfoud
This was a prospective, single-arm, open-label, multicentre trial intended to collect safety and efficacy data of the three-needle-based delivery device, the Peregrine Catheter, to perform bilateral alcohol-mediated RDN in hypertensive patients with a single dose of 0.6 mL of dehydrated alcohol per artery as the neurolytic agent. All patients had uncontrolled hypertension, defined as a mean office BP of ≥150/≥85 mmHg, with a 24-h mean ambulatory systolic BP of ≥135 mmHg while receiving a stable medication regimen of ≥3 antihypertensive medications of different classes (including a diuretic) for at least 4 consecutive weeks. As in most third-generation RDN trials, non- or poor drug adherence was not an exclusion criterion, but drug adherence was assessed at repeated time points by LC-MS/MS (see below). Patients were included if the renal artery diameter was ≥4 and ≤7 mm, with a renal artery length of ≥5 mm. Accessory renal arteries with similar anatomy were also eligible. The primary efficacy endpoint was a reduction of 24-h mean ambulatory systolic BP at 6 months vs. baseline. The trial was reviewed by the Ethics Committees of the participating research centres, and if applicable, by the relevant Competent Authorities. This trial was conducted in conformity with the ethical principles stated in the Declaration of Helsinki, and all patients provided written informed consent. The safety was monitored by a Data Safety Monitoring Board [11].
Effect of allisartan on blood pressure and left ventricular hypertrophy through Kv1.5 channels in hypertensive rats
Published in Clinical and Experimental Hypertension, 2022
Chunfang Xu, Ziying Zhao, Wang Yuan, Zhao Fengping, Yan Zhiqiang, Zhang Xiaoqin
Renal artery stenosis, an established method to induce hypertension, was performed according to the method described by Kaur and Muthuraman (20). The narrowing of renal artery due to clipping leads to increased BP (21). Briefly, left kidney of SD rats was exposed by left paracostal celiotomy after anesthetizing the animals with isoflurane inhalation. Blunt tipped vascular scissors and hooks were used to isolate renal artery, vein, and nerve, while left renal artery was clipped using a vascular clip and secured with nylon suture. A change in kidney color from dark brown to yellowish red was observed due to application of clip on the renal artery. Once the artery was clipped, the kidney was placed back in its original position, and then, the cavity was sutured in two layers (muscle and skin). Post-surgery, antibiotic powder was applied topically over the wound. During the surgery, the body temperature was maintained by placing the animal in supine position on a thermo controlled (37°C) heating pad and monitored using a digital rectal thermometer.
Clinical characteristics of concurrent primary aldosteronism and renal artery stenosis: A retrospective case–control study
Published in Clinical and Experimental Hypertension, 2021
Xu Meng, Yan-Kun Yang, Yue-Hua Li, Peng Fan, Ying Zhang, Kun-Qi Yang, Hai-Ying Wu, Xiong-Jing Jiang, Jun Cai, Xian-Liang Zhou
In the PA with RAS group, RAG or CT renal angiography confirmed that the degree of RAS was greater than 70% in at least one lesion. Six lesions were present in left renal arteries and four in right renal arteries. The most frequently involved vessel was the ostial renal artery (n = 7). Two other lesions were present in proximal renal arteries, and diffuse involvement of the entire artery was noted in one patient. Analysis of the radiological findings for the lesions showed that peripheral atherosclerosis was diagnosed in eight patients and was the most common cause among the 10 patients. The remaining two patients received diagnoses of Takayasu arteritis and fibromuscular dysplasia (n = 1, each). Adrenal adenoma and adrenal hyperplasia were the most common types of adrenal mass diagnosed by at least two experienced radiologists. Eight lesions were present on the left side and three on the right side (one patient had bilateral adrenal hyperplasia). AVS was performed in five patients, four of which had positive results that met the surgical indications for unilateral adrenalectomy. The remaining five patients declined to undergo AVS. The results of RAG and CT renal angiography are shown in Table 2.
Related Knowledge Centers
- Abdominal Aorta
- Aorta
- Inferior Vena Cava
- Pancreas
- Superior Mesenteric Artery
- Renal Vein
- Blood
- Cardiac Output
- Kidney
- Crus of Diaphragm