Hypertension and Chronic Kidney Disease
Hypertension is a major public health problem and is the second leading cause of ESRD in the United States. Hypertensive nephrosclerosis is a diagnosis of exclusion and has been called into question with the recent discovery of specific genes associated w
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Hypertension and Chronic Kidney Disease Stephanie Riggen and Rajiv Agarwal
Before You Start: Facts You Need to Know
• Hypertension is the second leading cause of ESRD in the United States. • Uncontrolled hypertension is associated with accelerated progression to ESRD. • Recent genetic advances may provide more information on the cause and effect relationship of hypertension and kidney disease. • Renovascular hypertension and ischemic nephropathy are associated with progressive chronic kidney disease but their diagnosis and treatment remain complex and challenging. • Treatment of hypertension in CKD patients is important to delay progression of renal function loss and to protect against cardiovascular disease. • Resistant hypertension is defined as blood pressure that remains above goal (such as 140/90) in spite of the concurrent use of 3 antihypertensive agents of different classes.
S. Riggen, MD • R. Agarwal, MD, FASN, FAHA, FASH (*) Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA e-mail: [email protected]; [email protected]
Worldwide, hypertension is a major public health problem and is associated with morbidity and mortality due to cardiovascular and kidney diseases. In the United States, hypertension is present in approximately 80–85 % of patients with CKD and is the second leading cause of ESRD in the United States after diabetes. Uncontrolled hypertension is associated with accelerated progression to ESRD. This association was prospectively studied among 332,544 men screened for the Multiple Risk Factor Intervention Trial (MRFIT); among the 814 subjects who either died of or were treated for ESRD, it was found that elevated blood pressure was a strong independent risk factor for ESRD [1]. Although the association of hypertension and ESRD was strong, this study did not prove a cause and effect relationship. In fact, whether hypertension causes CKD or is a result of CKD or both remains debated. The diagnosis of hypertensive nephrosclerosis is a diagnosis of exclusion; it is a clinical diagnosis based on history, physical examination, urinalysis, and laboratory testing. The diagnosis is typically made in patients with chronic kidney disease who have had long-standing hypertension and subnephrotic range proteinuria without evidence of other kidney disease (based on serologic testing and imaging tests). Few patients diagnosed with hypertensive nephrosclerosis undergo renal biopsy. Histologic lesions of hypertensive nephrosclerosis are characterized by changes in vascular, glomerular, and tubulointerstitial structures.
M. Arici (ed.), Management of Chronic Kidney Disease, DOI 10.1007/978-3-642-54637-2_5, © Springer-Verlag Berlin Heidelberg 2014
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For example, vascular changes are characterized by afferent arteriolar narrowing and fibrosis, arteriosclerosis and arteriolosclerosis, and intimal fibrosis; glomerular changes by hyalinosis, global glomerulosclerosis, and segmental glomerulosclerosis; and tubulointerstitial changes by atrophy, inflammation, and fibrosis. To
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