Hypertension associated kidney disease

Case study level Mb - Hypertension-associated kidney disease... 

Case study level 3 - Pre-dialysis patient with anaemia 359 Case study level Ma - Diabetes and renal impairment 361 Case study level Mb - Hypertension-associated kidney disease 363... 

Acetaminophen may worsen kidney function and increase blood pressure.1516 Nevertheless, acetaminophen remains the preferred analgesic for mild to moderate pain in patients with hypertension or kidney disease owing to the greater risks associated with NSAID use.17 Monitoring specifically for these toxicities generally is unnecessary. 

Lead nephropathy does not account for renal failure in all hypertensives with kidney disease any more than it accounts for renal failure in all gout patients with kidney disease. The heavy metal may, however, contribute to the association of gout with hypertension, as well as to the variable incidence of renal failure in each of these conditions. 

Electrolyte balance Concern about the risk of hyperkalemia associated with ACE inhibitors in patients with chronic kidney disease probably inhibits their use in such patients despite the beneficial effects of ACE inhibitors on progression of chronic kidney disease. In 1094 non-diabetic African-American adults with hypertensive chronic kidney disease, hyperkalemia was associated with increasing age, baseline protein excretion, glomerular filtration rate (GFR), and baseline potassium concentrations. Use of a potassium-wasting diuretic reduced the risk of hyperkalemia [36 ]. 

Lead nephropathy has also been complicated by the toxicological interactions of chronic kidney disease with adverse cardiovascular effects such as hypertension. Hypertension, as noted in this chapter, is a risk factor for Pb-associated and non-Pb-associated kidney disease, while mechanisms for inducing hypertension include the participation of kidney biochemistry and physiology via, for example, the renin—angiotensin pathway. 

In the study of Beevers et al. (1976), Scottish subjects residing in an area with very elevated tap water Pb levels showed elevated PbB associated with elevated water Pb, while both serum uric acid and hypertension were correlated with PbB. U.S. military veterans described earlier were also examined for hypertension and chelatable lead with or without the presence of kidney failure. Chelant was administered as a single, 2-g dose over 3 days to patients with both hypertension and renal failure and to patients with hypertension but without kidney failure. Individuals with hypertension and kidney disease had the higher amounts of mobilized Pb. 

Excessive lead exposure has also been implicated as a causative agent in kidney disease associated with gout and essential hypertension (Batuman et al. 1981, 1983). Gout patients with renal impairment, and hypertensive patients with renal impairment, had significantly higher lead stores (as determined by the 3-day EDTA lead mobilization test) than gout patients or hypertensive patients without renal impairment, respectively. Therefore, excessive lead absorption may be involved in the renal impairment seen in patients with gout or essential hypertension. 

Nephropathy has been associated with chronic lead poisoning. " A study of two large cohorts of heavily exposed lead workers followed through 1980 demonstrated a nearly threefold excess of deaths attributed to chronic nephritis or other hypertensive disease, primarily kidney disease. Most of the excess deaths occurred before 1970, among men who began work before 1946, suggesting that current lower levels of exposure may reduce the risk. Experimental animal studies suggest there may be a threshold for lead nephrotoxicity, and in workers, nephropathy occurred only in those with blood levels over 62p,g/dl for up to 12 years."... 

Bumetanide is used for relieving edema associated with cardiac insufficiency, for liver and kidney diseases including nephrotic syndrome, for ascites, and hypertension. Synonyms of this drug are bumex and others. 

Chronic exposure can result in obstructive lung disease, emphysema, and kidney disease. Cadmium may also be related to increases in blood pressure (hypertension) and is a possible lung carcinogen. Cadmium affects calcium metabolism and can result in bone loss. This condition has been referred to as Itai-Itai disease, which means Ouch-Ouch in Japanese and reflects the bone pain associated with cadmium effects on calcium. 

It is comforting to hear Beyer say that the various concepts of the etiology of essential hypertension are not mutually exclusive and that a combination of these theories may be the correct idea. He, too, agrees that the initial vasoconstriction is probably motivated by autonomic impulses, with the release of pressor substances that induce the development of vascular disease in the kidneys and other organs. The weakness of Beyer s concept is that there is no unequivocal proof that hypertension per se produces arteriosclerosis. Even in the hypertension associated with pheochromocytoma, for example, the development of vascular disease in the kidneys or other organs, as a direct result of the hypertension, has not been established. 

The effects of chronic hypertension on the human organism are, with one exception, of little interest to the investigator studying pathogenesis, although of great import to the sufferer and his physician. That exception is failure of the kidneys. Disease and failure of the heart are probably caused by chronic overstrain, often associated with another metabolic disease, arteriosclerosis of the coronary arteries. They account for about two thirds of the deaths primarily due to hypertension. Strokes of apoplexy, or cerebral vascular accidents, from rupture or thrombosis of a cerebral artery weakened by disease cause another sixth, uremia about one twelfth, and other conditions the remainder (28). Except for uremia, these events are usually the result of overwork and increased arterial tension. Only rarely does the heart escape hypertrophy. 

ACE-inhibitors may be considered as first-choice therapy in patients with all forms of primary hypertension, but they are preferred in hypertension associated with heart failure, reduced systolic left ventricular ejection fraction or diabetic nephropathy, previous MI or stroke, chronic kidney disease and patients with high coronary disease risk, based on the compelling evidence of the efficacy of these drugs in such patient populations [8]. 

Incidence estimates of CKD have generally been extrapolated from the USRDS. The fonr most common medical conditions associated with incident Stage 5 CKD are diabetes meUitns, hypertension, glomerulonephritis, and polycystic kidney disease. The respective incidence rates for these conditions are 150 cases/million, 80 cases/ million, 22 cases/million, and 5 cases/milhon. Mnch like the prevalence data, the estimates of incident Stage 5 cases are also greatly increased in the presence of advanced age and black race. For example, the rate of Stage 5 CKD is fonrfold higher for African-Americans as compared to Cancasians. ... 

As CKD presentation is often asymptomatic, recommended screening studies include serum creatinine measurement, urinalysis, and/or imaging studies of the kidneys. Diabetes, hypertension, genitourinary abnormalities, and autoimmune diseases represent some of the more common conditions associated with kidney disease. People who are older or those who have a family history of kidney disease should also be screened. If the serum creatinine is elevated, or more appropriately the GFR decreases, or if there are abnormalities in the urinalysis or imaging studies, an evaluation for CKD should be performed. ... 

Sarnak MJ, et al. Kidney disease as a risk factor for development of cardiovascular disease A statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003 42 1050-1065. 

Individuals with hypertension and elevated Pb exposures appear to be at increased risk for Pb nephropathy (hypertensive nephrosclerosis), although the question of direction of any association remains problematic, in that hypertension aggravates the severity and course of kidney disease while Pb exposure has a hypertensive effect in the human cardiovascular system. 

Using the African American Study of Kidney Disease and Hypertension (AASK) database, non-diabetic adults were randomly assigned to ACE inhibitors, beta adrenoceptor antagonists, or calcium channel blockers [42 ]. Hjq)erkalemia was associated with a reduced glomerular filtration rate (below 41 ml/minute/1.73 m ). Hjq)erkalemia was also significantly more common with ACE inhibitors. The use of a potassium-wasting diuretic was associated with a 59% reduction in the risk of hyperkalemia. 

Epoetin delta differs from the other erythropoietin derivatives in that it is produced in a human cell line using gene-activation technology. It has been approved in Europe but not in the USA for the treatment of anemia associated with chronic kidney disease. In patients with cancer and anemia who were given epoetin delta, possible treatment-related serious adverse events were hypertension, increased serum creatinine, and peripheral vascular disease [99 ]. There was a correlation with higher doses, suggesting that a dose of 150 lU/kg would be most appropriate to start with for this indication. 

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