ABSTRACT
HYPERTENSION AND RENAL DISEASE The kidney is one of the major target organs of hypertension. Kidney damage represents a frequent event in the course of hypertension. Franz Volhard and Fahr were the first to demonstrate that the kidneys from patients with hypertension are not normal (1). Early autopsy and biopsy studies showed the presence of preglomerular arteriolar disease (arteriolosclerosis) and tubulointerstitial changes in nearly all patients with hypertension (2,3). The two hallmarks of chronic kidney disease are reduced glomerular filtration rate and increased urinary albumin excretion. Both of these factors are influenced by increased blood pressure. Several individual factors contribute to the deleterious effects of high blood pressure on renal function that is, genetic susceptibility, degree of hypertension, as well as the type of underlying kidney disease. The kidney is exquisitely sensitive to a rise in blood pressure: hypertension is much more closely correlated with the presence of arteriolosclerosis in the kidneys (with a frequency of 98%) than with arteriolosclerosis involving other organs (with a frequency of less than 30%). Hypertension is also closely linked to the late phases of renal disease. Hypertensive nephrosclerosis is a common cause of end-stagerenal disease (ESRD), accounting for 17% of ESRD in Europe and for 24% cases of treated ESRDin the United States, according to registry data (4,5). However, it remains controversial as to whether benign essentialhypertension can cause ESRD (6,7). In an early study, 500 patients with hypertension were followed up until their death and shownthat 18% of them developed renal impairment (8). Several longitudinal studies in patients with mild-to-moderate essentialhypertension have also suggested that benign hypertension may leadto ESRD (9-11). In some post hoc analyses of intervention trials, similar observations have been made (12-14).
