Document Detail


Renal volume, renin-angiotensin-aldosterone system, hypertension, and left ventricular hypertrophy in patients with autosomal dominant polycystic kidney disease.
MedLine Citation:
PMID:  19696226     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The relationship between renal volume and hypertension in autosomal dominant polycystic kidney disease (ADPKD) occurs in childhood. Hypertension is associated not only with increased kidney volume but also with significantly increased left ventricular mass index. Moreover, this increase in left ventricular mass index occurs in children who have ADPKD with borderline hypertension (75th to 95th percentile) and is prevented with angiotensin-converting enzyme inhibitor (ACEI) monotherapy. Progression from borderline to overt hypertension (> or =95th percentile) occurs during a 5-yr follow-up in approximately 50% of children with ADPKD and borderline hypertension. Renal cyst enlargement in ADPKD in adults is associated with stimulation of both the circulating and intrarenal renin-angiotensin-aldosterone system. In addition to hypertension, the resultant angiotensin in ADPKD is a pivotal factor in cyst proliferation and expansion, increased sympathetic and endothelin activity, oxidant injury, and fibrosis. There is a close correlation between the level of hypertension, left ventricular hypertrophy, deterioration of GFR, and the progressive enlargement of the cystic kidneys in adult ADPKD. Randomized clinical investigation indicates that ACEI and a BP goal of 120/80 mmHg are associated in a 7-yr study to reverse left ventricular hypertrophy. The effect of renin-angiotensin-aldosterone system inhibition with dual blockade, ACEI and angiotensin receptor antagonists, on renal volume and kidney function is under study in the Halt Progression of Polycystic Kidney Disease (HALT PKD) trial.
Authors:
Robert W Schrier
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2009-08-20
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  20     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-01     Completed Date:  2009-10-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1888-93     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Colorado Denver, Denver, Colorado, USA. robert.schrier@ucdenver.edu
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MeSH Terms
Descriptor/Qualifier:
Humans
Hypertension, Renal / complications*,  pathology*,  physiopathology
Hypertrophy, Left Ventricular / complications*
Kidney / pathology,  physiopathology
Polycystic Kidney, Autosomal Dominant / complications*,  pathology*,  physiopathology
Renin-Angiotensin System / physiology*
Grant Support
ID/Acronym/Agency:
5R01 DK 058793/DK/NIDDK NIH HHS; P01 DK 19928/DK/NIDDK NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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