| Hypertension in autosomal dominant polycystic kidney disease. | |
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MedLine Citation:
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PMID: 20219618 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Hypertension is common and occurs in a majority of autosomal dominant polycystic kidney disease (ADPKD) patients before the loss of kidney function. Hypertension relates to progressive kidney enlargement and is a significant independent risk factor for progression to ESRD. The pathogenesis of hypertension in ADPKD is complex and dependent on many factors that influence each other. Pkd1 and Pkd2 expression levels are highest in the major vessels and are present in the cilia of endothelial cells and in vascular smooth muscle cells. Decreased or absent polycystin 1 or 2 expression is associated with abnormal vascular structure and function. Pkd1/Pkd2 deficiency results in reduced nitric oxide (NO) levels, altered endothelial response to shear stress with attenuation in vascular relaxation. Ten percent to 20% of ADPKD children show hypertension and the majority of adults are hypertensive before any loss of kidney function. Cardiac abnormalities such as left ventricular hypertrophy and carotid intimal wall thickening are present before the development of hypertension in ADPKD. The activation of the renin-angiotensin-aldosterone system occurs in ADPKD because of decreased NO production as well as bilateral cyst expansion and intrarenal ischemia. With increasing cyst size, further activation of the RAAS occurs, blood pressure increases, and a vicious cycle ensues with enhanced cyst growth and hypertension ultimately leading to ESRD. The inhibition of the angiotensin aldosterone system is possible with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. However, interventional studies have not yet shown benefit in slowing progression to renal failure in ADPKD. Currently, large multicenter studies are being performed to determine the beneficial effects of RAAS inhibition both early and late in ADPKD. |
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Authors:
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Arlene B Chapman; Konrad Stepniakowski; Frederic Rahbari-Oskoui |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Review |
Journal Detail:
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Title: Advances in chronic kidney disease Volume: 17 ISSN: 1548-5609 ISO Abbreviation: Adv Chronic Kidney Dis Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-11 Completed Date: 2010-06-07 Revised Date: 2013-01-03 |
Medline Journal Info:
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Nlm Unique ID: 101209214 Medline TA: Adv Chronic Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 153-63 Citation Subset: IM |
Copyright Information:
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2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Emory University School of Medicine, Atlanta, GA, USA. Arlene.chapman@emoryhealthcare.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angiotensin II Type 1 Receptor Blockers
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therapeutic use* Humans Hypertension, Renal* / drug therapy, etiology, pathology Polycystic Kidney, Autosomal Dominant* / complications, drug therapy, pathology Renin-Angiotensin System / drug effects, physiology* |
| Grant Support | |
ID/Acronym/Agency:
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T32 DK007656/DK/NIDDK NIH HHS; U01 DK056956-01/DK/NIDDK NIH HHS; U01 DK056956-02/DK/NIDDK NIH HHS; U01 DK056956-03/DK/NIDDK NIH HHS; U01 DK056956-04/DK/NIDDK NIH HHS; U01 DK056956-04S1/DK/NIDDK NIH HHS; U01 DK056956-04S2/DK/NIDDK NIH HHS; U01 DK056956-05/DK/NIDDK NIH HHS; U01 DK056956-05S1/DK/NIDDK NIH HHS; U01 DK056956-06/DK/NIDDK NIH HHS; U01 DK056956-07/DK/NIDDK NIH HHS; U01 DK056956-08/DK/NIDDK NIH HHS; U01 DK056956-09/DK/NIDDK NIH HHS; U01 DK056956-10/DK/NIDDK NIH HHS; U01 DK062408-01/DK/NIDDK NIH HHS; U01 DK062408-01S1/DK/NIDDK NIH HHS; U01 DK062408-02/DK/NIDDK NIH HHS; U01 DK062408-03/DK/NIDDK NIH HHS; U01 DK062408-04/DK/NIDDK NIH HHS; U01 DK062408-05/DK/NIDDK NIH HHS; U01 DK062408-05S1/DK/NIDDK NIH HHS; U01 DK062408-06/DK/NIDDK NIH HHS; U01 DK062408-07/DK/NIDDK NIH HHS; U01 DK062408-08/DK/NIDDK NIH HHS; U01 DK062408-08S1/DK/NIDDK NIH HHS; U01 DK56956/DK/NIDDK NIH HHS; U01 DK62408/DK/NIDDK NIH HHS; UL1 RR025008/RR/NCRR NIH HHS; UL1 RR025008/RR/NCRR NIH HHS; UL1 RR025008-01/RR/NCRR NIH HHS; UL1 RR025008-02/RR/NCRR NIH HHS; UL1 RR025008-02S1/RR/NCRR NIH HHS; UL1 RR025008-03/RR/NCRR NIH HHS; UL1 RR025008-03S1/RR/NCRR NIH HHS; UL1 RR025008-03S2/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin II Type 1 Receptor Blockers |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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