Chronic Pyelonephritis and Arterial Hypertension

Butler, Allan M.

doi:10.1172/jci100915

Cited by 226 publications

(31 citation statements)

References 12 publications

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“…Similar trends have been shown with reduction in hypertension following nephrectomy in patients with kidney disease including those with unilateral disease and single nephrectomy [e.g. for pyelonephritis or congenital hypoplasia (6)(7)(8)] and in patients with bilateral disease and bilateral nephrectomy (9,10). Though in the aforementioned observations, improvements in blood pressure control could be explained by interruption of sympathetic signals to and from the diseased kidneys, it is also conceivable that explantation of the diseased kidneys mediates the blood pressure improvement by a reduction in renin-angiotensin-aldosterone system activity that is typically increased in patients with chronic kidney disease whose kidneys remain in place.…”

Section: Afferent Renal Sympathetic Nervous Systemsupporting

confidence: 65%

Renal denervation

Drexel¹,

Bertog²,

Vaškelytė³

et al. 2014

Anadolu Kardiyol Derg

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Severe hypertension, resistant to conventional antihypertensive medications, is associated with major adverse cardiovascular and cerebrovascular events and renal insufficiency. Renal sympathetic nerve over-activity frequently accompanies essential hypertension. Catheter-based renal sympathetic denervation leads to a reduction in renal and overall sympathetic nerve activity and improvement in blood pressure in the setting of severe resistant hypertension. In the following, we review the role of the renal sympathetic nervous system in blood pressure control and recent clinical experience with renal denervation. Furthermore, potential beneficial effects on diabetes control, obstructive sleep apnea, atrial and ventricular arrhythmias are discussed. (Anadolu Kardiyol Derg 2014; 14: 186-91)

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Section: Afferent Renal Sympathetic Nervous Systemsupporting

confidence: 65%

Renal denervation

Drexel¹,

Bertog²,

Vaškelytė³

et al. 2014

Anadolu Kardiyol Derg

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“…Although a figure is hard to arrive at, a significant reduction of pressure following extirpation of a unilaterally pyelonephritic kidney may be expected in "less than half of such cases" (23), whereas a significant improvement in the range of 75% has been reported (24) following surgery for occlusive renal arterial disease. However, one must account for those isolated reports of definite improvement following excision of a unilaterally pyelonephritic kidney (25). In this regard it is of interest that, although the mean angiotensinase level was not significantly elevated above the normal mean, 2 of the 4 cases of unilateral pyelonephritis had a level above the normal range.…”

Section: Methodsmentioning

confidence: 99%

Plasma Angiotensinase Activity in Patients With Hypertension and Edema*

Hickler¹,

Lauler²,

Thorn³

1963

J. Clin. Invest.

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An abnormal metabolism of angiotensin II in essential hypertension has been suggested by several studies. Wood (1) reported that the venous blood of hypertensive patients showed a decreased capacity to inactivate an in vitro admixture with synthetic angiotensin' as judged by the pressor response on reinfusion into the hypertensive donors. Wolf and associates reported a prolonged radiochemical half-life of I131-labeled angiotensin in hypertensive patients after intravenous administration (2), but found a shortened radiochemical half-life in a purely in vitro system (3). Klaus (4) described a system in which the measurement of the amount of valine freed from synthetic valyl-5-angiotensin II after an in vitro admixture with plasma was equated to angiotensinase activity and reported no significant difference between hypertensive and normotensive plasma.Thus in vitro chemical methods leave the difficult problem of equating the chemical end-point to residual biological activity. It seemed that an in vitro system employing the loss of pressure response in a standard bioassay rat preparation to the serial injection of an admixture of plasma and angiotensin might obviate some of these difficulties and contribute to an understanding of this intricate problem. MATERIALS AND METHODSA. The assay. An in vitro admixture of synthetic angiotensin II 1 and plasma was studied for the progressive loss of pressor activity by serial inj ections into a 250-g vagotomized rat prepared with 'Nembutal and pentolinium. The left jugular vein was cannulated with polyethylene tubing and injected with a microsyringe containing a standard (1 /Ag per ml) dilution of angiotensin II (preserved as a 20%o ethanol solution). The right jugular vein was similarly connected to a microsyringe containing a mixture of 1 ml of the standard angiotensin solution and 1 ml of plasma. A stop watch was started at the time of the admixture, and room temperature was constant at 25 + 10 C. Alternate equal doses of standard angiotensin solution and standard solution mixed with plasma were administered every 3 to 4 minutes. The right carotid artery was cannulated with polyethylene tubing and the arterial pressure response recorded on a direct-writing pen-float mercury manometer. At the top of Figure 1 is shown the rat's pressure recording in a study on the plasma from a normotensive subject. The hatched spikes represent the serial pressure response of the plasma-angiotensin mixture and show the progressive reduction in the response; the nonhatched spikes represent the serial pressure response of the standard angiotensin solution alone and show full sensitivity of the rat to the serial injection of 10 m/Ag throughout the study. Variations, particularly a decrease of the standard response by more than 2 mm, are unsatisfactory and indicate that the study should be repeated. A minimal rat sensitivity of 1 mm Hg pressure rise per m/Ag of injected angiotensin is required. In a given study the serial dose was either 5, 10, or 15 m/Ag, whichever was necessary to ensure a pres...

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“…7 The BP reduction following renal excision provides evidence that detrimental sympathetic signals originate from diseased kidneys. 8 …”

Section: The Rationale For Renal Sympathetic Denervationmentioning

confidence: 99%