Kidney in Essential Hypertension

The kidney, similar to the heart, plays a three-fold role in essential hypertension. First, it participates in the patho­ genesis of arterial hypertension. Second, it suffers as a target organ of long-standing hypertension, and third, it experiences the effects of antihypertensive therapy. Perhaps most contested at the present time is the involvement of the kidney in the patho­ genesis of essential hypertension. More than a century ago, William Osler put forward three basic hypotheses about the "genuine contracted kidney. "l 1. "The hypertrophy can be regarded as an effect to overcome a sort of stop-cock action of the vessels when under the influence of an irritating ingredient in the blood greatly contracted and increased the peripheral resistance. " Clearly this hypothesis of an "irritating ingredient" is perhaps the most convincing nowadays, and numerous attempts have been made to identify a specific vasoconstrictive agent in the blood in essential hypertension. 2. "The obliteration of a large number of capillary territories in the kidney materially raised the arterial pressure. An additional factor of dimin­ ished excretion of water also heightened the pressure within the blood vessel. " Today we know that fluid volume overload in the presence of reduced renal mass seems to be the most likely mechanism accoun­ ting for renal parenchymal hypertension and, as shown by Guyton's group, for certain forms of experimental hypertension. 3.

Contenu

The Kidney in the Pathogenesis of Essential Hypertension.- 1. The Role of a Circulating Sodium Transport Inhibitor to Essential Hypertension.- 2. Atrial Natriuretic Factor.- 3. The Physiology and Cell Biology of the Renin-Angiotensin System in Hypertension.- 4. Prostaglandins and Hypertension.- 5. Kallikrein and Kinins in Epithelial Ion Transport.- 6. Renal Afferent Nerves: Evidence for a Role in Cardiovascular Regulation and the Pathogenesis of Experimental Hypertension.- 7. Renal Blood Flow and Function in Essential Hypertension.- 8. The Kidney and Experimental Hypertension.- The Kidney as a Target Organ in Essential Hypertension.- 9. Determinants of Exaggerated Natriuresis in Arterial Hypertension.- 10. Renal Hemodynamics in Obese and Lean Essential Hypertensive Patients.- 11. Sodium and Water Excretion in Patients with Congestive Heart Failure and Cirrhosis.- 12. Comparison of Renal Hemodynamics in Black and White Patients with Essential Hypertension.- Antihypertensive Treatment and the Kidney.- 13. Effects of Beta-Adrenergic Antagonists and Diuretics on Kidney Function in Hypertensive Patients.- 14. The Effects of Central Alpha-Adrenoceptor Agonists and Adrenergic-Neuronal Blocking Agents on the Kidney.- 15. Effects of Alpha1-Adrenoceptor Antagonists and Directly Acting Vasodilators on the Kidney.- 16. Diuretics and the Kidney.- 17. Converting Enzyme Inhibition and the Kidney: Effect on Potassium Homeostasis and Renal Function.- 18. Systemic and Renal Hemodynamic Effects of Enalapril in Patients with Essential Hypertension.- 19. Antihypertensive Treatment in Renal Failure.