Kidneys: The Victim Of Hypertension: Review

Abstract

Background & objectives: Our review discuss the relation between hypertension and the renal system ,and show the cyclic effect of both hypertension and chronic kidney damage on each other, our objectives are to control the high blood pressure with minimal renal affection due to side effects of medications. Materials & methods: many studies and trials compare between different antihypertensive drugs and their effects on kidneys which may decrease their efficiency. Results: Angiotensin converting enzyme inhibitor (ACE-Is), angiotensin II receptor blocker (ARBs), Beta-blockers and calcium channel blockers are identified to be the second line of treatment of hypertension according to a network meta-analysis conducted in 2003, ACE-Is were found to show a significant effect in slowing the progression of nephrosclerosis and slower declining of GFR more than β-blocker or calcium channel blocker. Conclusion: Kidney is indispensable organ in the body that we must protect it from the irreversible macroscopic and microscopic changes pathological as : macroscopic (small size, finely granular surface, adherent and difficulty stripped capsule, fibrotic, atrophic, not demarcated cortex on cut section, thick prominent arterioles and increased peripelvic fat) and microscopic (afferent and efferent arterioles show benign arteriosclerosis, gradual ischemic atrophy and fibrosis of the glomeruli, atrophy of non-functioning tubules related to atrophic glomeruli, may undergo compensatory cystic dilatation of tubule related to functioning glomeruli). ACE-Is is considered the drug of choice in hypertensive patients complicated with chronic kidney disease, In hypertensive patients that are refractory to medical treatment, renal sympathetic denervation is a safe alternative.