128
hypertension is critical for the management of hypertension in CKD. However,
there are large gaps in our understanding of pathogenesis and treatment of CKD-
related hypertension.
Pathogenesis of Hypertension in CKD
The role of the kidney in CKD-related hypertension is complex because the kidney
both contributes to hypertension and is damaged by hypertension. Blood pressure
typically rises with declining kidney function, and sustained elevations in blood
pressure accelerate the progression of kidney disease [ 8 ]. It is well established that
hypertension improves after renal transplantation. In a series of patients with CKD
due to histologically proven hypertensive nephrosclerosis, renal transplantation
from normotensive donors resulted in the resolution of their hypertension [ 9 ].
Primary hypertension is the product of dynamic interactions between multiple
genetic, physiological, environmental, and psychological factors. The kidneys play
a pivotal role in long-term blood pressure regulation. The kidneys possess an enor-
mous microvascular surface, which receives approximately 20–25% of cardiac out-
put. Basically, high blood pressure is caused by an increase in cardiac output and/or
increase of total peripheral resistance. Both can be deteriorated by a variety of dif-
ferent mechanisms in CKD (Fig. 8.1).
Fig. 8.1 Current concepts for the underlying mechanisms of hypertension in CKD
F. Turgut et al.