stenosis (renovascular hypertension) or disease of the renal parenchyma as
glomerulonephritis (Renoparenchymal hypertension).
Pathogenesis:
Hypertension may develop owing to either:
- Excess secretion of renin with a consequent more angiotensin II
activity. - Vasopressor substances as Endothelin will be released by the diseased
kidney. Endothelins are cyclic peptides released by arteriolar
endothelium. They may have a vasoconstrictor action and strong
platelet activation. - Failure to secrete salt and water load because of the decreased
nephron mass. This will lead to the expansion of the extracellular
volume and hypertension. - Failure to secrete vasodilator substances such as prostaglandins,
platelet activating factor and kinins due to decreased nephron mass.
Treatment:
1- Treatment of renal disease as renal artery stenosis by balloon
dilatation or bypass surgery and SLE by steroids and
immunosuppressive drugs.
2- Control of hypertension in renal patients may be a part of the
treatment of the renal disease as it is known that uncontrolled
hypertension is one of the major factors causing progression of renal
damage and scarring.
3- Any drug which controls hypertension will be valuable but it seems
that, in the presence of significant proteinuria, ACEIs may be superior
in the prevention of glomerular scarring. On the contrary, in the