Anesthetic and surgical considerations for staged bilateral nephrectomies in a pediatric patient: A case report / Consideraciones anestésicas y quirúrgicas en nefrectomía bilateral en dos tiempos en un paciente pediátrico: Reporte de caso

Abstract We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.

Resumen Se presenta un paciente de 9 años de edad con enfermedad renal terminal, en diálisis peritoneal, quien se sometió a nefrectomía bilateral retroperitoneoscópica estadificada en posición prona. Se indicó la nefrectomía bilateral en preparación para trasplante renal en el contexto de predisposición genética hacia desarrollar una patología maligna al estar inmunosuprimido. Las dos cirugías en espejo permiten hacer una comparación del manejo anestésico y de los desenlaces en un mismo paciente. Las características de interés para los anestesiólogos incluyen el abordaje de un niño con enfermedad renal crónica, con requisitos diferentes de antihipertensivos intraoperatorios; estrategias para el manejo del dolor, incluyendo una comparación de bloqueo del plano del erector espinal con y sin dexmedetomidina adyuvante; manejo anestésico de cirugía pediátrica retroperitoneoscópica y la primera descripción del uso de una bolsa Foley conectada a un catéter de diálisis peritoneal para ayudar en el diagnóstico y la reparación de la entrada de la cavidad peritoneal posterior.

Captopril renal scintigraphy in diagnosis of renovascular hypertension and the impact of plasma renin activity / 中国医学影像技术

Objective: To observe the diagnostic efficiency of Captopril renal scintigraphy (CRS) for renovascular hypertension (RVH) and the impact of plasma renin activity (PRA). Methods: Plasma levels of PRA, angiotensin Ⅱ (AngⅡ) and aldosterone (ALD) in peripheral blood in orthostatic position and supine position of 35 RVH patients who underwent basic renal scintigraphy and CRS examination were retrospectively analyzed. According to CRS, the patients were divided into positive group and negative group. The levels of PRA, AngⅡ and ALD were analyzed. ROC curve was used to analyze PRA and obtain the minimum threshold. Results: There were 24 cases in positive group and 11 cases in negative group. The orthostatic position PRA in positive group was significantly higher than that in negative group (Z=3.11,P0.05). ROC curve analysis showed that the area under the curve was 0.84. When the threshold point of PRA was 2.47 ng/(ml·h), the sensitivity and specificity were 83.33% and 81.82%, respectively. Conclusion: Orthostatic position PRA is an important impact factor of diagnostic sensitivity of CRS for RVH. Combining with orthostatic position plasma PRA can improve the value of CRS for diagnosis and treatment of RVH.

Therapeutic effect of valsartan combined beraprost sodium on hypertension complicated early renal in‐jury／ / 心血管康复医学杂志

To observe and analyze therapeutic effect of valsartan combined beraprost sodium on patients with hypertension (EH) complicated early renal injury (ERI).Methods : A total of 480 EH + ERI patients treated in our hospital in near two years were randomly and equally divided into valsartan group and combined treatment group (received valsartan combined beraprost sodium) , both groups were treated for three months .Levels of blood pressure , renal function related indexes were compared between two groups before and after treatment .Results :Compared with before treatment , after three months , there were significant reductions in levels of blood pressure , serum creatinine , urine β2 microglobulin and D‐dimer , and significant rise in creatinine clearance rate (Ccr) in two groups , P＝0.001 all.Compared with valsartan group after treatment , there were significant reductions in levels of blood pressure [ (130. 92 ± 5.92)／(80.18 ± 6.69) mmHg vs.(120. 93 ± 6. 53)／(69.98 ± 6.32) mmHg] , serum creatinine [ (93.92 ± 10. 49) μmol／L vs.(83. 14 ± 11. 03) μmol／L] , urine β2 microglobulin [ (385.41 ± 35.54) μg／L vs.(362.65 ± 26.59) μg／L] and D‐dimer [ (1. 75 ± 0.44) mg／L vs.(1. 01 ± 0.11) mg／L] , and significant rise in Ccr [ (63.22 ± 7. 66) ml／min vs.(79.13 ± 8.83) ml／min] in combined treatment group , P＝0.001 all.Conclusion :Compared with valsartan monotherapy , valsartan combined beraprost sodium can more significantly reduce blood pressure and protect renal function in hypertensive patients with early renal injury .

Mechanisms of Naoshuantong capsule in the prevention of cold wave-induced stroke in hypertensive rats: a differential proteomics study / 国际脑血管病杂志

Objective To investigate the preventive effect and mechanisms of Naoshuantong capsule in stroke induced by artificial cold wave in hypertensive rats.Methods A total of 130 SD rats were randomly divided into a sham operation group (n =30),a model control group (n =50) and a Naoshuantong treatment group (n=50;intragastric administration of Naoshuantong,0.5 g/kg,2/d for 7 days).Renovascular hypertensive rats model were established by two-kidney,two clip method.At 13th week after operation,rats were exposed to artificial cold wave for 3 days (12 h light of 22 ℃ and 12 h dark of 4 ℃,3 cycles).The brain tissue samples were extracted at the end of the experiment.Differential protein proteomic techniques were used for the identification,functional classification and preliminary analysis of the differentially expressed protein spots,and Western blot was used for the validation of some key proteins.Results There was no occurrence of stroke in the sham operation group,and the incidence of stroke in the model control group (36.00％,18/50) was significantly higher than that in the Naoshuantong treatment group (18.00％,9 / 50;x2 =4.110,P =0.043).With the two-dimensional gel electrophoresis analysis,6 different proteins were identified from 14 protein spots.Among them,the up-regulated superoxide dismutase 2 (SOD2) and the down-regulated B-cell lymphoma 10 (Bcl-10) were found to be at the central location of protein interactions,which has been verified by Western blot.Conclusion Naoshuantong can reduce the occurrence of stroke induced by artificial cold wave in renovascular hypertensive rats.SOD2 up-regulating and Bcl-10 downregulating may be involved in the mechanisms of of Naoshuantong in the prevention of cold wave-induced stroke in hypertensive rats.

Ruthenium Complex Improves the Endothelial Function in Aortic Rings From Hypertensive Rats / Complexo de Rutênio Melhora a Função Endotelial em Anéis de Aorta de Ratos Hipertensos Renais

Abstract Background: The endothelium is a monolayer of cells that extends on the vascular inner surface, responsible for the modulation of vascular tone. By means of the release of nitric oxide (NO), the endothelium has an important protective function against cardiovascular diseases. Objective: Verify if cis- [Ru(bpy)2(NO2)(NO)](PF6)2 (BPY) improves endothelial function and the sensibility of conductance (aorta) and resistance (coronary) to vascular relaxation induced by BPY. Methods: Normotensive (2K) and hypertensive (2K-1C) Wistar rats were used. For vascular reactivity study, thoracic aortas were isolated, rings with intact endothelium were incubated with: BPY(0.01 to10 µM) and concentration effect curves to acetylcholine were performed. In addition, cumulative concentration curves were performed to BPY (1.0 nM to 0.1 µM) in aortic and coronary rings, with intact and denuded endothelium. Results: In aorta from 2K-1C animals, the treatment with BPY 0.1µM increased the potency of acetylcholine-induced relaxation and it was able to revert the endothelial dysfunction. The presence of the endothelium did not modify the effect of BPY in inducing the relaxation in aortas from 2K and 2K-1C rats. In coronary, the endothelium potentiated the vasodilator effect of BPY in vessels from 2K and 2K-1C rats. Conclusion: Our results suggest that 0.1 µM of BPY is able to normalize the relaxation endothelium dependent in hypertensive rats, and the compound BPY induces relaxation in aortic from normotensive and hypertensive rats with the same potency. The endothelium potentiate the relaxation effect induced by BPY in coronary from normotensive and hypertensive rats, with lower effect on coronary from hypertensive rats.

Resumo Fundamento: O endotélio é uma monocamada de células que se estende sobre a superfície interna vascular, responsável pela modulação do tônus vascular. Por meio da liberação de óxido nítrico (NO), o endotélio tem uma função protetora importante contra doenças cardiovasculares. Objetivo: Verificar se o cis- [Ru (BPY)2 (NO2) (NO)] (PF6) 2 (BPY) melhora a função endotelial e a sensibilidade da condutância (aorta) e da resistência (coronária) ao relaxamento vascular induzido por BPY. Métodos: Foram utilizados ratos Wistar normotensos (2K) e hipertensos (2K-1C). Para o estudo de reatividade vascular, as aortas torácicas foram isoladas, os anéis com endotélio intacto foram incubados com: BPY (0,01 a 10 µM) e se realizaram curvas de efeito de concentração para acetilcolina. Adicionalmente, foram feitas curvas de concentração cumulativas para BPY (1,0 nM a 0,1 µM) nos anéis aórticos e coronários, com endotélio intacto e nu. Resultados: Na aorta de animais 2K-1C, o tratamento com BPY 0,1 µM aumentou a potência do relaxamento induzido pela acetilcolina e foi capaz de reverter a disfunção endotelial. A presença do endotélio não modificou o efeito da BPY na indução do relaxamento em aortas de ratos 2K e 2K-1C. Na coronária, o endotélio potencializou o efeito vasodilatador do BPY em vasos de ratos 2K e 2K-1C. Conclusão: Nossos resultados sugerem que 0,1 µM de BPY é capaz de normalizar o relaxamento dependente do endotélio em ratos hipertensos, e o composto BPY induz relaxamento na aorta de ratos normotensos e hipertensos com a mesma potência. O endotélio potencializa o efeito de relaxamento induzido pela BPY em coronárias de ratos normotensos e hipertensos, com menor efeito em coronárias de ratos hipertensos.

The clinical study ofXuebijing injection combined with routine western medicine therapy on the treatment of hypertensive renal damage / 国际中医中药杂志

Objective To evaluate the curative effect ofXuebijing injection combined with routine western medicine therapy in the treatment of hypertensive renal damage.Methods A total of 114 patients with hypertension were randomly divided into 2 groups according to the random number table method, 57 patients in each group. The control group was given conventional treatment (maleic acid enalapril and amlodipine and atorvastatin cutting atorvastatin calcium), and the treatment group were givenXuebijing injection based on the conventional treatment. The two groups were treated for 6 months. The changes of blood pressure, renal function and serum inflammatory cytokine levels were evaluated.Results After treatment, the mean value of 24 h systolic blood pressure, mean value of 24 h diastolic blood pressure, systolic blood pressure variability and diastolic blood pressure variability in the treatment group were significantly lower than those in the control group (2 months after treatment:t values were 5.256, 5.595, 5.265, 2.564,P<0.05; 6 months after treatment:t values were 6.251, 5.267, 4.466, 5.264,P<0.05); the urinary mAlb, beta 2-MG, and urine albumin to creatinine ratio in the treatment group were significantly lower than those in the control group (2 months after treatment:t value were 5.566, 5.282, 2.862,P<0.05; 6 months after treatment:t value were 5.263, 6.565, 3.642,P<0.05);two plasma D-dimer, IL-6, TNF-α and fibrinogen levels in the treatment group were significantly lower than those in the control group (2 months after treatment:t value were 3.565, 5.652, 3.985, 5.251,P<0.05; 6 months after treatment:t value were 5.268, 4.836, 3.622, 4.265,P<0.05).ConclusionsXuebijing injection combined with routine western medicine therapy on hypertensive renal damage may have protective effect, and its curative effect was superior to simple maleic acid enalapril and amlodipine and atorvastatin cutting atorvastatin calcium therapy.

Tianma-Gouteng decoction combined with valsartan for renal hypertension / 国际中医中药杂志

Objective To observe and explore clinical efficacy ofTianma-Gouteng decoction combined valsartan in the treatment of patients with renal hypertension and its effects on renal function. Methods A total of 130 patients with renal hypertension were enrolled and randomly divided into a study group (68 patients) and a control group (62 patients). Both groups were given prescription of lower sodium diet, exercising and enalaprilscheme. On this basis, the control group plus valsartan, and the study group was further added withTianma-Gouteng decoction. After 2 courses treatment, renal function, and blood pressure of both groups were compared, and clinical efficacy on blood pressure were evaluated.Results After treatment, the SBP (126.8 ± 9.1 mmHg vs. 134.1 ± 8.8 mmHg,t=4.648), DBP (82.4± 5.0 mmHgvs. 85.3 ± 5.4 mmHg, t=3.167), Scr (148.5 ± 46.3μmol/Lvs. 172.1 ± 52.0μmol/L, t=2.723), BUN (8.3 ± 2.7 mmol/Lvs. 9.7 ± 3.1 mmol/L,t=2.734) and 24hAlb (1.7 ± 0.6 gvs. 1.9 ± 0.7 g,t=2.209) in the study group were significantly lower than control group (P<0.05 orP<0.01). The total effective rate in the study group was significantly increased than that in the control group (91.2%vs. 79.0%;χ2=0.383,P=0.050).Conclusion Valsartan combined with Tianma-Gouteng decocntion can reduce blood pressure, and alleviate the kidney damage effectively.

The therapeutic effect of elderly dialysis patients with refractory hypertension / 中国医师进修杂志

Objective To investigate the treatment of elderly dialysis patients with refractory hypertension.Methods Sixty-six patients were randomly divided into two groups of A group and B group,with 33 cases in each group.Patients in A group were treated by routine hemodialysis 3 times per week and hemoperfusion 1 time every 2 weeks.Patients in B group were treated by routine hemodialysis 2 times per week and hemodiafiltration 1 time per week plus hemoperfusion 1 time every 2 weeks.The levels of blood pressure,plasma endothelin (ET),angiotensin-Ⅱ (AT Ⅱ),renin (RA),parathyroid hormone (PTH) in two groups before and after treatment were compared.Results Before and after treatment,the levels of blood pressure,ET,AT Ⅱ,RA and PTH in A group were (183.42 ± 16.20)/(109.15 ± 7.69) and (151.45 ± 3.31)/(88.71 ±4.95) mmHg(1 mmHg =0.133 kPa),(173.45 ±41.25) and (160.38 ±25.31) ng/L,(69.21 ± 18.47)and(57.25 ± 23.34) ng/L,(1.21 ± 0.15) and (0.87 ± 0.14) μ g/L,(530.27 ± 43.28) and (272.43 ± 34.19) ng/Lrespectively.Before and after treatment,the levels of blood pressure,ET,AT Ⅱ,RA and PTH in B group were (185.34 ± 12.26)/ (112.38 ± 6.24) and (141.59 ± 4.15)/ (80.39 ± 2.73) mmHg,(178.21 ± 34.35) and (149.12 ±21.34) ng/L,(68.38 ±23.57) and (47.17 ± 15.61) ng/L,(1.19 ±0.29) and (0.69 ±0.41) μg/L,(528.62 ± 42.53) and (253.15 ± 31.62) ng/L respectively.The levels of blood pressure,ET,AT Ⅱ,RA and PTH in two groups after treatment were significantly decreased compared with those before treatment (P ＜0.05),and there were significant differences between two groups (P ＜ 0.05).Conclusion Combined with hemoperfusion in the treatment of elderly hemodialysis patients with refractory hypertension,the effect of combined hemodiafiltration is significant,and it is worthy of promotion.

Clinical application of prostaglandin E1 in the treatment of hypertensive renal damage of early stage / 中国医师进修杂志

Objective To observe the effect ofprostaglandin E1 intravenously in the improvement of the function of renal glomeruli and renal tubules in hypertensive patients complicated with microalbuminuria.Methods Totally 60 hypertensive patients complicated with microalbuminuria and nocturia who had received losartan for above 12 weeks,according to random number table method were divided into treatment group and control group,with 30 cases in each group.Original antihypertensive drugs were used continuously in treatment group and control group,and patients in treatment group received prostaglandin E1 intravenously for 3 courses of treatment,with losartan and other antihypertensive drugs routinely.Using self-contrast before and after treatment and contrast with control group,the change of urinary level of microalbumin (mALB),osmotic pressure,β2-microglodulin (β 2-MG) and N-acetyl-β-D-glucosaminidase (NAG) were compared.Results The blood pressure after treatment in both groups were decreased,but there was no statistically significant difference compared with that before treatment (P ＞ 0.05).After treatment of 12 weeks,urinary levels of mALB,β 2-MG and NAG in treatment group were lower than those in control group [(88.6 ± 14.2)μg/min vs.(123.9 ± 14.8) μg/min,(0.84 ±0.41) mg/L vs.(1.61 ±0.49) mg/L,(30.2 ± 10.5) U/L vs.(75.7 ± 12.8) U/L],and osmotic pressure was higher than that in control group [(591 ± 71) mmol/L vs.(454 ± 67) mmol/L],the difference had statistical significance (P ＜ 0.01).Conclusion Prostaglandin E1can reduce the renal ischemic state in early stage of hypertensive renal damage and can improve renal function.

A Comparison Study of Combined Medication of Telmisartan with Amlodipine on the Reversal Left Ventricular Remodeling in Renal Hypertensive Rats / 天津医药

Objective To compare the effects of telmisartan and (or) amlodipine on the reversal left ventricular re-modeling in two-kidney one clip hypertensive rats. Methods A total of 50 healthy male SD rats were randomly divided into 5 groups (n=10):two-kidney one clip renal hypertensive (2KIC) model group, sham group, telmisartan (10 mg/kg) group, am-lodipine (2.5 mg/kg) group and telmisartan (10 mg/kg)+amlodipine(2.5 mg/kg) group. The model of two-kidney one clip re-nal hypertensive rats was established. The tail arterial blood pressure was detected once a week. After 20 weeks, rats were sacrificed and specimens were collected. The left ventricular mass index (LVMI) was assessed. The myocardial ultrastructur-al changes were observed by electron microscope. Values of plasma renin activity (PRA), angiotensionⅡ(AngⅡ) and atrial natriuretic peptide (ANP) were measured by enzyme linked immunosorbent assay (ELISA).Results Compared with sham group, the levels of systolic blood pressure (SBP), LVMI, PRA, AngⅡand ANP were significantly higher in 2KIC group (P＜0.01). Compared with 2KIC group, values of SBP, LVMI, PRA and ANP were significantly lower in telmisartan group and am-lodipine group (P＜0.01), but the value of AngⅡwas significantly higher (P＜0.01). The levels of SBP, LVMI, AngⅡand ANP were significantly lower in combined medication group than those of single drug medication group (P＜0.01). There was no significant difference in the plasma PRA level between those groups (P>0.05). Results of myocardial electron microsco-py showed that the left ventricular remodeling was significantly improved in combined treatment group. Conclusion Telmisartan and amlodipine can effectively improve the left ventricular remodeling induced by hypertension. There was more effective therapy using both medications together.

Renal stenosis resulting from fibromuscular dysplasia and its surgical treatment: report of 16 cases / 中华普通外科杂志

Objective To evaluate the clinical characteristics and surgical treatment of renal stenosis resulting from fibromuscular dysplasia ( FMD ). Methods 16 cases from 1998 to 2011 were reviewed,the average age was (28 ± 13 ) years old. Among them, all patients suffered refractory hypertension and only one presented renal dysfunction. Aorto-renal bypass was performed in 2 cases.Resection and reconstruction was performed in 2 cases,balloon angioplasty in 10 and stent implantation in 3.Results There was 1 death peri-operatively.13 out of 15 cases were followed-up with no death.Significant decline of blood pressure [ (134 ± 14 )/( 83 ± 8 ) mm Hg vs.( 151 ± 17 )/( 96 ± 16 ) mm H g ( P ＜ 0.01 ) ]and 100％ effective rate were observed.The creatine level were preserved after surgical treatment [ (61 ±22) μmol/L vs.(69 ± 22) μmol/L,(P ＞ 0.05 ) ] with 4 cases improved and the other 9 stable.12 patients received ultrasound surveillance with only one case of 20％ restenosis. Conclusions Renal stenosis due to FMD are most common in children and the youth with hypertension as major presentation. Balloon angioplasty is the first choice of surgical treatment with positive efficacy.

Rol del riñón en la hipertensión sal-sensible / Role of the kidney in salt sensitive hypertension

An important proportion of patients with essential hypertension are salt sensitive, defined as those who experience signifcant blood pressure changes according to the amount of salt intake. They have a disturbance in the pressure induced natriuresis mechanism and their kidneys have functional and morphological alterations con-sistent with an acquired tubulointerstitial alteration, afferent arteriole damage and alteration of peritubular capillaries. All these alterations lead to disturbances in sodium load excretion under normal pressures. There is also an associated activation of kidney vasoconstrictor/salt retaining systems and a reduction in the vasodilator/ salt eliminating mechanisms. These alterations, that originate early in life, generate a new blood pressure level, that corrects natriuresis at the expense of a sustained hypertension.

Effects of enalapril on expression of MMP-2 and MMP-9 in renal hypertension rats with focal cerebral ischemic reperfusion / 中国基层医药

Objective To observe the effects of ACEI( enalapril) on expression of MMP-2 and MMP-9 in renal hypertension rats with focal cerebral ischemia-reperfusion injury. Methods Twenty-eight Wistar male rats were randomly divided into two groups: hypertension group and normaltension group. The former which formed model of renal hypertension rats by constricted renovascular were randomly divided into enalapril group (Y) and hypertension ischemia and reperfusion group(HIR),which fed with enalapril 2mg/kg and equal volum saline respectively;The latter were divided into sham-operation group ( N) and normaltension ischemia and reperfusion group (IR). The focal cerebral ischemia model was established in Wistar rats by using the method of thread inserting left middle cerebral artery occlusion(MCAO) for 2h. After ischemic 24h,the expression of MMP-2 and MMP-9 were measured by immunohisto-chemistry,and the gray scale value was measured by imaging analysis. Results Compared with N,the gray scale values of MMP-2 and MMP-9 in IR were higher(P <0. 01); Compared with IR, the gray scale values of MMP-2 and MMP-9 in HIR were higher(P<0. 05);Compared with HIR,the gray scale values of MMP-2 and MMP-9 in Y were lower(P<0.01). Conclusion Hypertension can increase the expression of MMP-2 and MMP-9 in rats with focal cerebral ischemia-reperfusion. ACEI (Enalapril) could inhibit the expression of MMP-2 and MMP-9 in renal hypertension rats with focal cerebral ischemia-reperfusion.

Evaluation of Renal Volume by Ultrasonography in Patients with Essential Hypertension in Ile-Ife; South Western Nigeria

To determine renal volume in adult patients with essential hypertension and correlate it with age, sex, body mass index (BMI), body surface area (BSA) and duration of hypertension. Patients and methods: A total of 150 patients (75 males, 75 females) with essential hypertension and normal renal status were evaluated sonographically in this prospective study. Fifty healthy individuals (25 males, 25 females) without hypertension were also evaluated as control. Renal volume was then calculated from the kidney's length, width and anterio-posterior diameter using the formula LWAP0.523. Results: The range of renal volume obtained was 51.65205.02 cm3, with a mean of 114.06929.78 cm3 for the left kidney and 47.37177.50 cm3 with a mean of 106.14925.42 cm3 for the right kidney. The mean volumes of the right and left kidneys in males (112.98925.56 cm3 and 123.11932.49 cm , respectively), were significantly higher than in females (99.31923.07 cm3 and 105.01923.77 cm3, respectively). Renal volume correlated significantly with BSA and BMI but decreased with age. The renal volume showed no correlation with duration of hypertension. Conclusion: Renal volume is higher in the left than the right kidney in hypertensive patients of both sexes and female hypertensive patients have smaller kidney size compared to males. The study also shows that volume of both kidneys decreases with age and positive correlation between renal volume, BSA and BMI. However, there is no correlation between renal size and duration of hypertension.

Risk factors of hypertension in IgA nephropathy / 中华内科杂志

Objective To explore the risk factors of hypertension in patients with IgA nephropathy in South China. Methods The clinical and renal pathological data of 280 primary IgA nephropathy patients diagnosed by biopsy were analyzed to extinguish the risk factors of hypertension. Results A total of 96 patients were suffered with hypertension (34.3%). A single-variable analysis showed that the age (≥40 years), body weight (≥60 kg), absence of macrohematuria, duration of disease (≥60 months), blood urea nitrogen≥8 mmol/L, serum creatinine (≥133 μmol/L), hyperuricaemia, degree of 24 h-proteinuria (≥1.5 g), segmental glomerular lesions (≥25% ), globe glomerular sclerosis (≥10%), tubular atrophy (≥25%), interstitial fibrosis (≥25%), interstitial inflammation (≥25% ) and arteriole hypertrophy (≥10% ) were all risk factors related to hypertension; multivariate logistic regression analysis showed that serum creatinine, age, arteriole hypertrophy, body weight and 24 h-proteinuria were the independent risk factors. Conclusion Many factors were related the hypertension in patients with IgA nephropathy, while serum creatinine, age, arteriole hypertrophy, body weight and 24 h-proteinuria were the independent risk factors of hypertension.

Long-term Effect of Different Antihypertensive Agents on Renal Hemodynamics / 中国康复理论与实践

@#ObjectiveTo investigate the long term effect of different antihypertensive agents on renal hemodynamics with ultrasound Doppler.Methods52 essential hypertensive patients were divided into three groups according to the antihypertensive agent they took: angiotensin-converting-enzyme inhibitor (ACEI), calcium channel blocker (CCB) and β-adrenoceptor blocker (βB). The blood pressures of right upper arms were measured with mercury column blood pressure gauge using Korotkoff method. Renal hemodynamics were examined with ultrasound Doppler before and after treatment with agents. ResultsSystolic blood pressure (SBP) and diastolic blood pressure (DBP) of all patients were decreased significantly. An significant correlation was found between the deceases of blood pressure and the betterment of renal homodynamic parameters in ACEI and CCB groups, but not in βB group. ConclusionTo a degree, the betterment of renal hemodynamics is correlation with the reduction of systemic blood pressure and mechanism of action of antihypertensive agents.

Endovascular treatment of renal artery stenosis / 中国实用内科杂志

Objective To assess the outcome of renal artery stenosis approached by percutaneous transluminal renal angioplasty (PTRA) and stents.Methods Seventy-two patients (50 males and 22 female) were diagnosed as renal stenosis by renal angiography.Of them,68 cases were with atherosclerosis.The PTRA was done via femoral access site.Changes in blood vessel diameter and blood flow nd complications were recorded.Renal angiograph was performed to check the restenosis.Patient’s blood pressure and serum creatine level before and after the were observed.Results Angiograph showed unilateral artery lesion in 60 cases and bilateral stenosis in 12 cases.The ostium was involved in 72 sites and mid-part in 8.The lumen diameter of stenosis was 60%-95%.The stents were successfully implanted in 68 cases with 78 stents and 4 cases only by balloon.The lumen diameter of lesion increased from 2.0mm (0.8-2.6mm) to 6.5mm (4.0-8.0mm).TIMI flow decreased in 3 cases and renal function was impaired in 4 cases,but not severe.Blood pressure in 42 cases with hypertension decreased significantly.One case was complicated with perirenal hematoma.and there was no perioperative death.Conclusion PTRA and stenting treatment for renal artery disease are feasible and safe.

Role of Tyrosine Kinases in Norepinephrine-Induced Vascular Contraction in Renal Hypertensive Rats

BACKGROUND AND OBJECTIVES: Protein tyrosine kinases appear to be involved in the signal transduction mechanisms, which result in vascular smooth muscle contraction, as well those required in cell growth. The present study was conducted to examine the role of tyrosine kinases in the norepinephrine-induced vascular smooth muscle contraction of isolated aortae from two-kidney, one clip (2K1C) hypertensive rats. MATERIALS AND METHODS: 2K1C hypertension was made by clipping the left renal artery of the rats, with age-matched rats receiving a sham treatment serving as controls. Thoracic aortae denuded of endothelium were mounted in tissue baths to measure the isometric tension. RESULTS: The putative tyrosine kinase inhibitors, genistein and tyrphostin 25, significantly inhibited the contractile responses of the aorta to norepinephrine in the control rats, but not in the 2K1C rats. The protein tyrosine phosphatase inhibitor, sodium orthovanadate, selectively potentiated the contractile response to norepinephrine, but only in the controls. Genistein, tyrphostin 25 and sodium orthovanadate did not affect KCl-induced vascular contractions in either the 2K1C or the controls. The vascular contraction elicited by phorbol 12, 13 dibutyrate, in the presence and absence of genistein, did not alter in either the 2K1C or the controls. CONCLUSION: These findings indicate that protein tyrosine kinases participate in the norepinephrine-induced contraction of rat aortic smooth muscle, where the role is attenuated in 2K1C renal hypertension.

Markers of monitoring early renal injury in hypertension patients / 中华检验医学杂志

Objective To study diagnostic methods for early renal injury in hypertension patients. Methods Urinary microalbumin (mALB) and ? 2 microglodulin(? 2 MG) levels were measured with rate nepherometry. Total quantitative enzyme immunoassay was employed to measure urinary retinol binding protein (RBP) levels, rate for urinary N acetyl beta D glucosaminidase (NAG), and Jaffes rate for urinary creatinine (Cr). Results The levels of urinary RBP, mALB, ? 2 MG, NAG in hypertension patients were significantly higher than those in controls ( P

Unsuppressed renin activity and secondary hypertensive kidney damage in primary hyperaldosteronism / 中华泌尿外科杂志

Objective To detect plasma renin activity(PRA) and kidney damage in primary hyperaldosteronism(PA). Methods The duration of hypertension,serum creatinine and aldosterone levels,recumbent and upright PRA levels were detected and studied in 76 PA patients.Correlation was measured between creatinine and other parameters. Results Serum creatinine level correlates closely with upright PRA ( P