ABSTRACT
Hypertensive nephrosclerosis is one of the leading causes of end-stage renal disease as listed in registries throughout the world, and particularly affects African Americans. The African-American Study of Kidney Disease study was designed to determine if interventions with antihypertensives could affect progressive loss of glomerular filtration rate in African Americans with presumed hypertensive nephrosclerosis. Glomeruli with ischemic injury in hypertensive nephrosclerosis are postulated to eventually progress to global glomerulosclerosis. The so-called “benign hypertensive nephrosclerosis” vascular lesions vary depending on the size of the vessels involved. Arcuate and larger arteries show intimal fibrosis and sometimes splitting of the internal elastic lamina. Transforming growth factor beta is a fibrogenic cytokine with manifold actions, including cell proliferation and differentiation, development, matrix turnover, tissue repair, apoptosis, and immune response. The resetting of the operating point is postulated to cause an imbalance between the vascular tones of the afferent/efferent arterioles, a rise in the glomerular capillary hydraulic pressure, and consequent hyperfiltration.
