Clinical Queries: Nephrology最新文献

The term hypertensive retinopathy is used for all the fundus changes caused by increased systemic arterial blood pressure. Retinal vasculature can be seen non-invasively through fundoscopy and their similarity to other microvasculature in the body make early diagnosis of hypertensive retinopathy very important in hypertensive risk stratification. The usual features of chronic hypertensive retinopathy are arteriolar attenuation, nerve fiber layer infarct, superficial flame shaped hemorrhage, lipid exudates, macular edema. In malignant hypertension choroidopathy and optic neuropathy can be seen in addition to retinopathy. Many of these changes resolve with time when control of blood pressure is good. For grading of hypertensive retinopathy Scheie classification and Keith-Wagener-Barker classification are most commonly used. Diagnosis of hypertensive retinopathy is clinical by ophthalmoscopy. Others like fundus photography, fluorescein angiography, optical coherence tomography can be used for added information. Decrease vision if occur is due to macular edema, secondary retinal pigment epithelial changes and due to optic neuropathy. Blood pressure lowering is the mainstay of treatment which should be in a slow and controlled manner in case of malignant hypertensive retinopathy to avoid ischemic damage.

Chronic kidney disease in paediatric age group is a life changing diagnosis. Unlike adult the underlying aetiology is usually congenital anomalies of kidney and urinary tract and initial manifestation can be subtle. Appreciation of the multiple functions of kidney and a multi-disciplinary team approach is the corner stone for its successful treatment.

Hypertension is a common problem encountered in day to day practice by physicians and often termed as “silent killer” because patients with mild to moderate disease are often asymptomatic. By the time symptoms appear due to organ damage, therapeutic options remain limited.

A clinical diagnosis of hypertension is established by demonstrating a systolic blood pressure (SBP) >140 mmHg and/or a diastolic blood pressure (DBP) >90 mmHg on at least 2 occasions as summarized in “The Seventh Report of Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure”.¹ However the usual definition of hypertension and target BP levels might not be applicable to the elderly hypertensive population. Also criteria for categorizing BP vary and have not been further characterized for the elderly.

In patients with primary hypertension, elevated blood pressure (BP) is considered to be a consequence of multiple factors. The 2 major factors involved are environmental factors and genes. A steady progress has been made from experimental animal studies to human genetic studies. Except for the rare monogenic hypertensive diseases, the association of genes and BP are yet to be confirmed, and the quest for “the blood pressure gene” continues. This review briefly discusses the role of genetics in HTN.

Renal transplantation has become the modality of choice for patients with end stage renal disease. Though it has led to improvement in survival and quality of life mortality still remains high. Cardiovascular disease is the most common cause of mortality in post-renal transplant patients. Hypertension (HTN) being the major traditional risk factor for atherosclerotic cardiovascular disease develops in up to 60–80% of renal allograft recipients. Risk factor for hypertension includes both patient and donor related factor. The major patient related factor includes the use of corticosteroids, calcineurin inhibitors (CNI) and transplant renal artery stenosis (TRAS). In this review we analyze the risk factors, pathogenesis and management of post-renal hypertension.

Membranoproliferative glomerulonephritis (MPGN) is a heterogeneous entity depicting a similar pattern of glomerular injury secondary to different aetiologies. It is one of the primary glomerular diseases contributing for development of end stage renal disease. There is no definitive treatment of MPGN owing to the lack of understanding the aetiopathogenesis. Over the last decade, there has been publication of enormous literature regarding its pathogenesis, understanding, clinically compatible reclassification and thus a step forward in treatment.

Acute kidney injury (AKI) in children involves a potentially reversible structural damage and functional impairment of the kidneys due to any sudden insult leading to fall in the glomerular filtration rate (GFR).