Renal microvascular dysfunction, hypertension and CKD progression Journal Article

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Authors: Bidani, A. K.; Polichnowski, A. J.; Loutzenhiser, R.; Griffin, K. A.
Article Title: Renal microvascular dysfunction, hypertension and CKD progression
Abstract: PURPOSE OF REVIEW: Despite apparent blood pressure (BP) control and renin-angiotensin system (RAS) blockade, the chronic kidney disease (CKD) outcomes have been suboptimal. Accordingly, this review is addressed to renal microvascular and autoregulatory impairments that underlie the enhanced dynamic glomerular BP transmission in CKD progression. RECENT FINDINGS: Clinical data suggest that failure to achieve adequate 24-h BP control is likely contributing to the suboptimal outcomes in CKD. Whereas evidence continues to accumulate regarding the importance of preglomerular autoregulatory impairment to the dynamic glomerular BP transmission, emerging data indicate that nitric oxide-mediated efferent vasodilation may play an important role in mitigating the consequences of glomerular hypertension. By contrast, the vasoconstrictor effects of angiotensin II are expected to potentially reduce glomerular barotrauma and possibly enhance ischemic injury. When adequate BP measurement methods are used, the evidence for BP-independent injury initiating mechanisms is considerably weaker and the renoprotection by RAS blockade largely parallels its antihypertensive effectiveness. SUMMARY: Adequate 24-h BP control presently offers the most feasible intervention for reducing glomerular BP transmission and improving suboptimal outcomes in CKD. Investigations addressed to improving myogenic autoregulation and/or enhancing nitric oxide-mediated efferent dilation in addition to the more downstream mediators may provide additional future therapeutic targets.
Journal Title: Current opinion in nephrology and hypertension
Volume: 22
Issue: 1
ISSN: 1473-6543; 1062-4821
Publisher: Unknown  
Journal Place: England
Date Published: 2013
Start Page: 1
End Page: 9
Language: eng
DOI/URL:

10.1097/MNH.0b013e32835b36c1

10.1097/MNH.0b013e32835b36c1
Notes: ID: 13149; GR: DK-40426/DK/NIDDK NIH HHS/United States; GR: DK-61653/DK/NIDDK NIH HHS/United States; GR: IK2 BX001285/BX/BLRD VA/United States; GR: R01 DK061653/DK/NIDDK NIH HHS/United States; GR: Canadian Institutes of Health Research/Canada; JID: 9303753; ppublish