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Essential hypertension, progressive renal disease, and uric acid: A pathogenetic link?

Title
Essential hypertension, progressive renal disease, and uric acid: A pathogenetic link?
Authors
Johnson R.J.Segal M.S.Srinivas T.Ejaz A.Mu W.Roncal C.Sanchez-Lozada L.G.Gersch M.Rodriguez-Iturbe B.Kang D.-H.Acosta J.H.
Ewha Authors
강덕희
SCOPUS Author ID
강덕희scopus
Issue Date
2005
Journal Title
Journal of the American Society of Nephrology
ISSN
1046-6673JCR Link
Citation
Journal of the American Society of Nephrology vol. 16, no. 7, pp. 1909 - 1919
Indexed
SCI; SCIE; SCOPUS WOS scopus
Document Type
Review
Abstract
Hypertension and hypertension-associated ESRD are epidemic in society. The mechanisms responsible for renal progression in mild to moderate hypertension and those groups most at risk need to be identified. Historic, epidemiologic, clinical, and experimental studies on the pathogenesis of hypertension and hypertension-associated renal disease are reviewed and an overview/hypothesis for the mechanisms involved in renal progression is presented. There is increasing evidence that hypertension may exist in one of two forms/stages. The first stage, most commonly observed in early or borderline hypertension, is characterized by salt-resistance, normal or only slightly decreased GFR, relatively normal or mild renal arteriolosclerosis, and normal renal autoregulation. This group is at minimal risk for renal progression. The second stage, characterized by salt-sensitivity, renal arteriolar disease, and blunted renal autoregulation, defines a group at highest risk for the development of microalbuminuria, albuminuria, and progressive renal disease. This second stage is more likely to be observed in blacks, in subjects with gout or hyperuricemia, with low level lead intoxication, or with severe obesity/metabolic syndrome. The two major mechanistic pathways for causing impaired autoregulation at mild to moderate elevations in BF appear to be hyperuricemia and/or low nephron number. Understanding the pathogenetic pathways mediating renal progression in hypertensive subjects should help identify those subjects at highest risk and may provide insights into new therapeutic maneuvers to slow or prevent progression. Copyright © 2005 by the American Society of Nephrology.
DOI
10.1681/ASN.2005010063
Appears in Collections:
의과대학 > 의학과 > Journal papers
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