Arterial hypertension in chronic glomerulonephritis:detectability and treatment efficacy

Abstract


Aim. To study prevalence of arterial hypertension (AH) in patients with chronic glomerulonephritis
(CGN), its relationship with activity of the renal process, renal function; to analyse policy and efficacy
of antihypertensive therapy.
Material and methods. A total of 250 CGN patients treated in 1993-2001 participated in the trial.
They had different morphological variants of CGN. AH was diagnosed in 193 patients. In the course
of the trial changes in antihypertensive treatment policy were observed.
Results. AH was most prevalent in mesangiocapillary (96.6%) and diffuse fibroplastic nephritis
(83.9%). In functional insufficiency of the kidneys AH occurred in 90.1%. AH was associated with
clinical and morphological signs of nephritis activity, severity of tubulointerstitial alterations, purin and
lipid metabolism. Uric acid level and age were independent prognostic factors of AH development. AH
correction was achieved in the initial and subsequent periods in 51.7 and 58.7% cases. Later, ACE
inhibitors were prescribed more often, both in monotherapy and in combination with other drugs; calcium antagonists were taken less frequently.
Conclusion. AH in CGN patients is a frequent finding and depends on a morphological nephritis variant, activity of the renal process and degree of renal failure. Age, gender and metabolic disorders are
also involved in AH development in CGN patients. Recently, there is a trend to more frequent prescription of combined treatment. Drugs of choice in the treatment of renal AH are ACE inhibitors.

References

  1. Ridao К, Luno J., Garsia de Vinuesa et al. Prevalence of hypertension in renal disease. Nephrol. Dial. Transplant. 2001; 16 (suppl. 1): 70-73.
  2. Buckalew V. M., Berg R. L., Wang S. R. et al. Prevalence of hypertension in 1795 subjects with chronic renal disease: the Modification of Diet in Renal Disease Study. Baseline Cohort.Am. J. Kidney Dis. 1996; 28: 811-821.
  3. Daniebon M., Kornerup H., Olsen S. et al. Arterial hypertension in chronic glomerulonephritis. An analysis of 310 cases. Clin. Nephrol. 1983; 19: 284-287.
  4. Кушаковский М. С. Гипертоническая болезнь и вторичные артериальные гипертензии. М.: Медицина; 1982.
  5. Мухин Н. А., Серов В. В., Козловская Л. В. Амилоидоз почек. В кн.: Тареева И. Е. (ред.) Нефрология: Руководство для врачей. М.: Медицина; 2000. 546-555.
  6. HeafJ., Lokkegaard К, Larsen S. The epidemiology and prog nosis of glomerulonephritis in Denmark 1985-1997. Nephrol. Dial. Transplant. 1999; 14: 1889-1897.
  7. Ritz E., Rambausek M., Hasslacher C., Mann J. Pathogenesis of hypertension in glomerular disease. Am. J. Nephrol. 1989; 9 (suppl. 1): 85-90.
  8. Eto Т., Yamamoto Y, Fujimoto S. et al. Factors contributing to blood pressure levels in chronic glomerulonephritis: An analysis of 105 biopsed patients. Nephron 1990; 55: 129-132.
  9. Kheder M. A., Ben Maiz H., Abderrahim E. et al. Hypertension in primary chronic glomerulonephritis. Analysis of 359 cases. Nephron 1993; 63: 140-144.
  10. Rambausek M., Waldherr R., Andrassy K., Ritz E. Hypertension in mesangial IgA glomerulonephritis. In: Proceedings of the European Dialysis and Transplant Association - ERA. 21st Congress. Pitman; 1984. 693-697.
  11. Тареева И. Е., Швецов М. Ю., Краснова Т. Н. Артериальная гипертония при волчаночном нефрите. Тер. арх. 1997; 6: 13-17.
  12. Мухин Н.А. Тубулоинтерстициальный нефрит и артериальная гипертония. Нефрология 2000; 4 (1): 109-111.
  13. Kang D. H., Nakagawa Т., Feng L. et al. A role for uric acid in the progression of renal disease. J. Am. Soc. Nephrol. 2002; 13 (12): 2888-2897.
  14. Iseki K, Ikemiya Y., Fukuyama K. Blood pressure and risk of end-stage renal disease in a screened cohort. Kidney Int. 1996; 49 (suppl. 55): S69-S71.
  15. Klahr S., Levey A. S., Beck G. J. et al. The effect of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N. Engl. J. Med. 1994; 330: 877-882.
  16. Lazarus J. M., Bourgoignie J. J., Buckalew V. M. et al. Hypertension 1997; 29: 641-650.
  17. Первый доклад экспертов научного общества по изучению артериальной гипертонии Всероссийского научного общества кардиологов и Межведомственного совета по сердечно-сосудистым заболеваниям (ДАГ-1). Профилактика, диагностика и лечение первичной артериальной гипертонии в Российской Федерации. Клин, фармакол. и тер. 2000; 9 (3): 1-23.
  18. Guidelines subcommittee 1999 World Health Organization - International Society of Hypertension. Guidelines for the management of hypertension. J. Hypertens. 1999; 11: 905- 918.
  19. Working Group on Primary Prevention of Hypertension (1993). Report of the National High Blood Pressure Education Program Working Group of Primary Prevention Hypertension. Arch. Intern. Med. 1993; 153: 186-208.
  20. Burt V. L., Whelton P., Roccella E. J. et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1998- 1991. Hypertension 1995; 25: 305.
  21. Джаналиев Б. Р. Клинико-морфологическая характеристика нозологических форм гломерулопатий: Дис. д-ра мед. наук. М.; 1999.
  22. Варшавский В. А., Проскурнева Е. П., Гасанов А. Б. и др. Об уточнении клинико-морфологической классификации хронического гломерулонефрита. Нефрол. и диализ 1999; 1 (2-3): 100-106.
  23. Кутырина И. М. Современные аспекты патогенеза почечной артериальной гипертонии. Нефрология 2000; 4 (1): 112-115.
  24. Kielstein J. Т., Bode-Boger S. M., Holler H., Flisre D. Func tional changes in the ageing Kidney: is there a role for asymmetric dimetilarginine? Nephrol. Dial. Transplant. 2003; 18: 1245-1248.
  25. Мухин Н. А., Балкаров И. М., Шоничев Д. Г., ЛебедеваМ. В. Формирование артериальной гипертонии при уратном тубулоинтерстициальном повреждении почек. Тер. арх. 1999; 6: 23-27.
  26. Sanchez-Lozada L. G, Tapia E., Avilo-casada С et al. Mild hyperuricemia induces glomerular hypertension in normal rats.Am. J. Physiol. 2002; 283 (5): F1105-F1110.
  27. Benetos A., Waeber В., Izzo J. et al. Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am. J. Hypertens. 2002; 15: 1101-1108.
  28. Maschio G., Alberti D., Janin G. et al. Effect of the Angiotensin-Converting-Enzyme inhibition benazepril on the progression of chronic renal insufficiency. N. Engl. J. Med. 1996; 334: 939-945.
  29. The GISEN (Gruppo Italiano di Studi Epidemiologici in Ne- frologia) Group: Randomized placebo controlled trial of effect of ramipril on declining in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997; 349: 1857-1863.
  30. Кутырина И. М., Лифшиц Н. Л., Рогов В. А. и др. Применение ингибиторов ангиотензинпревращаюшего фермента при хронической почечной недостаточности. Тер. арх. 2002;6: 34-39.
  31. Кутырина И. М., Тареева И. Е., Герасименко О. И. и др. Использование ингибиторов ангиотензинпревращающего фермента при хронических диффузных заболеваниях почек. Тер. арх. 1995; 6: 20-23.
  32. Швецов М. Ю. Блокаторы рецепторов ангиотензина II - первый опыт и перспективы применения в нефрологии. Тер. арх. 2000; 6: 73-79.
  33. Schwenger V., Zeier M., Ritz E. Antihypertensive therapy in renal patients - benefits and difficulties. Nephron 1999; 83: 202-213.
  34. Maschio G. How good are nephrologists at controlling blood pressure in renal patients? Nephrol. Dial. Transplant. 1999; 14: 2075-2077.

Statistics

Views

Abstract - 96

Cited-By


Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2003 Kutyrina I.M., Martynov S.A., Shvetsov M.Y., Livshits N.L., Miroshnichenko N.G., Golitsina E.P., Varshavsky V.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies