Estadísticas

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      "titulo" => "How to Prevent Renal Disease Progression?"
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    "textoCompleto" => "NEFROLOG&#205;A&#46; Vol&#46; XX&#46; Suplemento 1&#46; 2000 Introducci&#243;n E&#46; Ritz Universidad de Heidelberg&#46; Alemania&#46; The kidney plays a crucial role in the maintenance of blood pressure as proposed by Guyton and established in elegant transplantation experiments by Rettig&#46; He showed that hypertension &#40;and normotension&#41; go with the kidney&#46; This is also true in humans as suggested by the observations of Curtis in renal graft recipients&#46; In view of the crucial role of the kidney in blood pressure regulation it is not surprising that hypertension is common in renal disease&#46; Nevertheless&#44; the relation between renal disease and hypertension is not as simple as thought in the past&#46; Studies in families of propositi with diabetic nephropathy and with non-diabetic renal disease showed that&#44; &#171;essential&#187; hypertension was more frequent in first degree relatives&#44; indicating that genetic predisposition to hypertension in somehow linked to the risk of&#44; and potentially also the rate progression of&#44; primary renal disease&#46; Obviously&#44; hypertension- associated genes are candidate genes for renal risk&#44; but the evidence for specific genes is not yet in&#46; Elegant crossing experiments of Jacobson showed that in one rat strain of progressive glomerulosclerosis &#40;fawn hooded rat&#41; blood pressure-independent gene loci code for the risk of glomerulosclerosis&#46; Whether this is part of the explanation of the notable familial aggregation of endstage renal failure in humans remains to be seen&#46; Blood pressure starts to rise very early in primary renal disease&#44; even before GFR is reduced&#44; presumably because GFR is still maintained within the normal range by an elevation of SNGFR even when renal parenchyma has been reduced&#46; In the past 2 paradigms were proposed to explain hypertension in renal disease&#44; i&#46;e&#46; &#40;a&#41; the tendency to retain sodium and &#40;b&#41; inappropriate activation of the renin angiotensin system&#46; More recently&#44; both experimental and clinical studies showed an important role of the activation of the sympathetic nerve system on blood pressure in renal disease&#44; primarily through stimulatory afferent signals emanating from the diseased kidney&#46; These findings provide a clear rationale for selection of antihypertensive drugs&#46; One particularly important point is the issue which blood pressure is optimal for renal protection in individuals with renal disease&#46; It has become obvious that blood pressure values much lower than normotension according to WHO and JNC VI are optimal in diabetic and non-diabetic renal disease&#46; The NKF recommendation is target blood pressure of 125&#47;75 mmHg&#44; although such low levels are very difficult to achieve and are associated with considerable side effects&#46; There is no doubt that effective antihypertensive treatment is one of most powerful instruments for the nephrologist to interfere with progression of renal disease&#46; 3 "
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