THE IMPORTANCE OF HYPERTENSION PROTEINURIA IN CKD: ACE INHIBITORS BEYOND

摘要

With alteration of preglomerular resistance, healthy kidneys can maintain relatively stable glomerular capillary pressures despite variations in systemic blood pressure. This pressure regulatory process is termed renal autoregulation. Autoregulation can be reduced when renal disease results in loss of nephrons. Compromised autoregulation allows high systemic blood pressure to be transmitted to glomerular capillaries. This glomerular hypertension has been documented by micropuncture studies in dogs and cats with surgically reduced renal mass. In these models, glomerular hypertension was associated with glomerular hypertrophy and sclerosis and proteinuria. Systemic hypertension is relatively common in dogs with renal disease. In a recent study of dogswith spontaneous chronic kidney disease (CKD), 29 out of 45 dogs (64%) had systolic blood pressure > 144 mmHg and 14/45 (31%) had systolic blood pressure > 161 mmHg. In cats with naturally occurring CKD, systemic hypertension has been observed in 19% to65% of cases, depending on the definition of hypertension.