ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Hypertension Mechanisms In Acute And Rapidly Progressive Renal Failure And Principles Of Anti-hypertensive Treatment
Dr. Asuman YAVUZ,a Dr. Gülşen YAKUPOĞLUa
aNefroloji BD, Akdeniz Üniversitesi Tıp Fakültesi, ANTALYA
Hypertension can be seen in 40% of patients with acute renal failure (ARF). According to the etiology of ARF, hypertension is present in 15% of tubulointerstitial disease compared to 73% of glomerular vascular diseases resulting in ARF. Multifactorial reasons cause hypertension in ARF. It can be very serious in atheroembolic renal disease. Other glomerular vascular diseases resulting in hypertension are; the vasculitides, especially polyarteritis nodosa and the thrombotic microangiopathies. The thrombotic microangiopathies consist of hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, scleroderma renal crisis, preclampsia and malign hypertension. All of these diseases result in endothelial damage in renal arterioles causing platelet thrombosis, and sometimes renal cortical necrosis due to arterial lesions. Endothelial damage is due to cytopathic, immunologic, pressure-related, intrinsic cellular and hypoxic insults. Persistence or recurrence of endothelial damage and intimal fibrosis cause progressive obliterative arteriopathy. Renal ischemia occurs causing a vicious cycle. Renin-angiotensin production leads to accelerated hypertension and progressive renal failure. Breaking this vicious cycle can best be done with ACE inhibitors or angiotensin II receptor blockers. Extracorporeal shock wave lithotripsy or renal trauma also result in hypertension via renin mediated mechanisms. Acute glomerular diseases and bilateral hydronephrosis cause volume-mediated hypertension, unilateral ureteral obstruction cause hypertension via renin-mediated mechanisms. Treatment should be targeted to break the relevant mechanisms involved in the development of hypertension.Keywords: Hypertension, rapidly progressive renal failure, acute renal failure, antihypertensive treatmentTurkiye Klinikleri J Int Med Sci 2005, 1(38):104-109
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