Progression of Chronic Renal Failure

Yu, Henry T.

doi:10.1001/archinte.163.12.1417

Cited by 121 publications

(91 citation statements)

References 264 publications

(292 reference statements)

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“…Pathophysiologically, it is consistent with the hypothesis that proteinuria perpetuates glomerular injury, leading to a progressive cycle of renal dysfunction through mechanisms such as cytokine release, promotion of interstitial damage, upregulation of the renin-angiotensin aldosterone system, and altered glomerular hemodynamics (16)(17)(18)(19)(20)(21). Clinically, it reinforces that African Americans with advanced kidney disease and proteinuria could benefit substantially from close monitoring and aggressive efforts to reduce proteinuria.…”

Section: Discussionsupporting

confidence: 75%

Interaction between GFR and Risk Factors for Morbidity and Mortality in African Americans with CKD

Erickson

Lea

McClellan

2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The African American Study of Kidney Disease Trial identified risk factors for CKD progression and suggested that GFR level may modify the association between these risk factors and CKD progression or death.Design, setting, participants, & measurements Enrollment in the African American Study of Kidney Disease Trial occurred between June of 1995 and September of 2001, with median follow-up of 48.6 months. Among 1094 patients with hypertensive kidney disease in the trial, this study tested whether the association between six previously identified risk factors for CKD progression (or death) and a composite clinical outcome (progression of CKD, ESRD, or death) depends on level of GFR. Multivariate Cox regression was used to control for other baseline risk factors.Results After controlling for baseline risk factors, only proteinuria was more closely associated with the composite clinical outcome at lower levels of GFR (P value for interaction term=0.002); increased hazards of the clinical composite outcome associated with a doubling of proteinuria ranged from 30% (95% confidence interval=21%-39%) with a GFR of 50 to 55% (95% confidence interval=40%-72%) with a GFR of 25.Conclusions The magnitude of the association between proteinuria and CKD progression, ESRD, or death in the African American Study of Kidney Disease Trial cohort depends on the level of GFR; proteinuria is a stronger independent predictor of the composite clinical outcome at lower levels of GFR. This finding reinforces that African Americans with proteinuria and lower GFR represent a population at particularly high risk for adverse outcomes.

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Section: Discussionsupporting

confidence: 75%

Interaction between GFR and Risk Factors for Morbidity and Mortality in African Americans with CKD

Erickson

Lea

McClellan

2013

Clinical Journal of the American Society of Nephrology

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“…Excessive activation of the RAA system and resulting hypertension play critical roles in the progression of renal failure [35,42]. Antagonism of the RAA system using ACE inhibitors or ANG receptor blockers corrects hypertension and suppresses the progression of chronic renal failure [5,8].…”

Section: Discussionmentioning

confidence: 99%

“…Antagonism of the RAA system using ACE inhibitors or ANG receptor blockers corrects hypertension and suppresses the progression of chronic renal failure [5,8]. Since the advent of ACE inhibitors, various types of ACE inhibitor have been developed and, along with ANG receptor blockers, have become mainstay conservative treatments for chronic renal failure in humans [8,18,35,42]. Effects of such ACE inhibitors as enalapril and benazepril on renal failure are also being recognized in dogs and cats [9,10,15].…”

Section: Discussionmentioning

confidence: 99%

Development of Hypertension and Effects of Benazepril Hydrochloride in a Canine Remnant Kidney Model of Chronic Renal Failure

Mishina

Watanabe

2008

The Journal of Veterinary Medical Science

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ABSTRACT. In order to determine whether hypertension would develop in dogs with chronic renal failure, we performed 7/8 renal ablation in 6 healthy dogs and compared pre-and post-ablation blood pressures determined by telemetry. One month after the renal ablation, blood urea nitrogen and creatinine were significantly increased (p<0.05), creatinine clearance was decreased (p<0.05), and blood pressure was increased significantly (p<0.05). Simultaneously, plasma renin activity, angiotensin I and II, and aldosterone were elevated significantly (p<0.05) compared with the values obtained from 11 healthy dogs with intact renal function. The dogs with induced renal failure and hypertension were administered an angiotensin-converting enzyme inhibitor, benazepril hydrochloride, once daily for 2 weeks at 2 mg/kg body weight, and changes in blood pressure and the renin-angiotensin-aldosterone (RAA) system were determined. During the administration of benazepril hydrochloride, blood pressure, angiotensin II and aldosterone decreased significantly (p<0.05) and, upon discontinuation of administration, increased to the pre-administration levels (p<0.05). Plasma renin activity and angiotensin I showed no significant changes throughout the administration study. These results provide experimental evidence that hypertension develops in dogs with chronic renal failure through mechanisms involving the RAA system and demonstrate that benazepril hydrochloride improves renal hypertension in dogs. KEY WORDS: angiotensin-converting enzyme inhibitor, benazepril, canine, renal ablation, renal hypertension.J. Vet. Med. Sci. 70 (5): [455][456][457][458][459][460] 2008 Hypertension is classified into essential and secondary hypertension and, in humans, essential hypertension accounts for 80 to 90% of hypertension patients [24]. In contrast, essential hypertension is relatively rare in veterinary practice [7,33]. Underlying reasons are that hypertension per se has no characteristic symptoms and blood pressure is not routinely determined in veterinary practice. Therefore, it is important to diagnose diseases that would lead to secondary hypertension and to identify the risk of developing secondary hypertension. Causes of secondary hypertension include renoparenchymal diseases, renovascular diseases, diabetes, Cushing syndrome, primary hyperaldosteronism, pheochromocytoma and hypothyroidism and, of those, renoparenchymal disease-associated hypertension is most common in humans [24]. The mechanism of renal hypertension is thought to involve renal insufficiency-associated body fluid retention, increases in cardiac output and peripheral vessel resistance, activation of the renin-angiotensin-aldosterone (RAA) system and suppression of the kallikrein-kinin-prostaglandin system [2,3,17].A link between chronic renal failure and hypertension has been suggested in dogs and cats [1,6,12,13,22,26,27,29,30,34,[36][37][38]. Activation of the RAA system and development of hypertension in association with renal failure have been reported in cats [20,30,41]. ...

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“…Measurements of urine protein were not performed at baseline, so we are not able test whether proteinuria confounds the relationship between low serum albumin and decline in renal function. The degree of proteinuria has previously been shown to be an important predictor of the progression of renal disease (25,26). Of note, the strength of the association of these inflammatory markers varied.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory and Prothrombotic Markers and the Progression of Renal Disease in Elderly Individuals

Fried

Solomon

Shlipak

et al. 2004

Journal of the American Society of Nephrology

201

144

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Abstract. Inflammatory and prothrombotic markers are elevated in individuals with mild to moderate renal disease. It was hypothesized that these markers may also be determinants of the progression of renal disease. The association of six markers-serum C-reactive protein (CRP), white blood cell (WBC) count, fibrinogen, factor VII, albumin, and hemoglobin-with subsequent elevations of creatinine and decline in estimated GFR in the Cardiovascular Health Study, a community-based cohort of elderly individuals, was analyzed. Linear regression was used to determine predictors of an annualized change in serum creatinine as the main outcome. Duration of follow-up was 7 yr for the original cohort and 4 yr for the more recently recruited black cohort. A total of 588 (12.7%) individuals had a decline in estimated GFR of at least 3 ml/min per yr per 1.73 m 2 . Higher CRP (P Ͻ 0.001), WBC count (P Ͻ 0.001), fibrinogen (P Ͻ 0.001), and factor VII (P Ͻ 0.001) levels and lower albumin (P Ͻ 0.001) and hemoglobin levels (P Ͻ 0.001) were associated with a rise in creatinine, after adjusting for age. With additional adjustments for race, gender, baseline creatinine, systolic and diastolic BP, lipid levels, weight, and packyears smoking, higher CRP, factor VII, fibrinogen, WBC count, and lower albumin and hemoglobin levels remained associated with a rise in creatinine. Similar results were found for decline in estimated GFR. The decline in GFR was greater with increasing number of inflammatory or prothrombotic markers that were above the median (below for hemoglobin and albumin). Inflammatory and prothrombotic markers are predictors for a change in kidney function in elderly individuals. Interventions that reduce inflammation might confer significant cardiovascular and renal benefits.Patients with renal failure have a high prevalence of cardiovascular disease, and it has been proposed that atherosclerosis may promote the progression of renal disease in older individuals (1). Diamond et al. (2) proposed that mechanisms that result in atherosclerosis also cause glomerulosclerosis and that renal disease in atherosclerosis is not simply the result of ischemia from renal artery disease. In his model, glomerulosclerosis results from the influx and accumulation of inflammatory cells (monocytes and macrophages), with mesangial cells responding in a similar manner to vascular smooth muscle cells. If this hypothesis is correct, then renal disease and cardiovascular disease should share similar risk factors. In particular, inflammatory and prothrombotic factors, which are risk factors for atherosclerosis (3), might be important factors in the progression of renal disease. The relationship of inflammation to a subsequent loss of renal function has not been previously examined in a population-based sample.We have previously found that inflammatory and prothrombotic markers are elevated in elderly individuals with mild to moderate renal insufficiency, a relationship that persisted after adjusting for the greater extent of atherosclerosis that is ...

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Progression of Chronic Renal Failure

Cited by 121 publications

References 264 publications

Interaction between GFR and Risk Factors for Morbidity and Mortality in African Americans with CKD

Interaction between GFR and Risk Factors for Morbidity and Mortality in African Americans with CKD

Development of Hypertension and Effects of Benazepril Hydrochloride in a Canine Remnant Kidney Model of Chronic Renal Failure

Inflammatory and Prothrombotic Markers and the Progression of Renal Disease in Elderly Individuals

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