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Review Paper

Proteinuria in Hypertensive Nephropathy: A Review

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DOI: 10.4236/ojneph.2014.42013    5,085 Downloads   7,220 Views   Citations

ABSTRACT

Hypertension defined as a systolic blood pressure of ≥140 and a diastolic blood pressure ≥90 is anextremely prevalent condition; and it is responsible for significant mortality and morbidity. NHANESdata from 2005-2006 found that nearly 30% of adult US population has HTN; and nearly 8% of the population has undiagnosed HTN. HBP mortality in 2008 was 61,005. Any mentioned mortality in 2008 was 347,689 (NHLBI tabulation of NCHS mortality data). More than 20% of patients with systemic hypertension have chronic renal insufficiency (NHANES). Hypertensive nephropathy is a leading cause of end-stage renal disease (ESRD) requiring dialysis or transplantation or leading to death. The incidence of hypertension is high but only a subset of hypertensive patients progress to frank renal failure. A subset of hypertensive patients develop proteinuria during the course of disease and manifest nephrotic syndrome. This syndrome includes marked proteinuria, edema, and low serum albumin. Neither the incidence nor the clinical significance of proteinuria in hypertension without diabetes is known. Progression to chronic renal failure in some patients is preceded by proteinuria as indicated on “dip-stick” analyses of random urine samples. It appears that proteinuria is likely to increase both prior to and during evident loss of glomerular filtration, but this clinical observation has never been formally confirmed. There is a need for large studies to answer these questions. We also need to focus on the roles that genetic and environmental factors play in development and progression of renal disease in the setting of hypertension and proteinuria.


Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Sharma, R. , Kamalakar, S. , McCarthy, E. , Fields, T. , Gupta, K. , Barua, R. and Savin, V. (2014) Proteinuria in Hypertensive Nephropathy: A Review. Open Journal of Nephrology, 4, 92-99. doi: 10.4236/ojneph.2014.42013.

References

[1] Ostchega, Y., et al. (2008) Hypertension Awareness, Treatment, and Control--Continued Disparities in Adults: United States, 2005-2006. NCHS Data Brief, 3, 1-8.
[2] Centers for Disease Control and Prevention (2012) Vital Statistics Public Use Data Files―2008 Mortality Multiple Cause Files.
http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm-Mortality_
[3] Rutkowski, B., Tylicki, L. and Debska-Slizien, A. (2003) Pathogenetic and Epidemiological Aspects of Hypertensive Nephropathy. Polskie Archiwum Medycyn Wewnetrznej, 110, 1167-1171.
[4] US Renal Data System (2011) USRDS. Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National In-stitute of Diabetes and Digestive and Kidney Diseases, Bethesda.
[5] Udani, S., Lazich, I. and Bakris, G.L. (2011) Epidemiology of Hypertensive Kidney Disease. Natural Review of Nephrology, 7, 11-21.
http://dx.doi.org/10.1038/nrneph.2010.154
[6] Schmieder, R.E. (2010) End Organ Damage in Hypertension. Dtsch Arztebl International, 107, 866-873.
[7] Harvey, J.M., et al. (1992) Renal Biopsy Findings in Hypertensive Patients with Proteinuria. Lancet, 340, 1435-1436.
http://dx.doi.org/10.1016/0140-6736(92)92624-O
[8] D’Agati, V.D. and Mengel, M. (2013) The Rise of Renal Pathology in Nephrology: Structure Illuminates Function. American Journal of Kidney Disease, 61, 1016-1025.
http://dx.doi.org/10.1053/j.ajkd.2012.12.019
[9] Dasgupta, I., et al. (2007) “Benign” Hypertensive Nephrosclerosis. QJM, 100, 113-119.
http://dx.doi.org/10.1093/qjmed/hcl139
[10] Nonaka, K., et al. (2013) Clinical and Pathological Evaluation of Hypertensive Emergency-Related Nephropathy. Internal Medicine, 52, 45-53.
[11] Freedman, B.I., et al. (1994) Renal Biopsy Findings in Presumed Hypertensive Nephrosclerosis. American Journal of Nephrology, 14, 90-94.
http://dx.doi.org/10.1159/000168695
[12] Mujais, S.K., et al. (1985) Marked Proteinuria in Hypertensive Nephrosclerosis. American Journal of Nephrology, 5, 190-195.
http://dx.doi.org/10.1159/000166931
[13] Obialo, C.I., Hewan-Lowe, K. and Fulong, B. (2002) Nephrotic Proteinuria as a Result of Essential Hypertension. Kidney Blood Press Research, 25, 250-254.
http://dx.doi.org/10.1159/000066345
[14] Viazzi, F., Leoncini, G. and Pontremoli, R. (2013) Global Cardiovascular Risk Assessment in the Management of Primary Hypertension: The Role of the Kidney. International Journal of Hypertens, 2013, 542-646.
[15] Rahman, M., Douglas, J.G. and Wright Jr., J.T. (1997) Pathophysiology and Treatment Implications of Hypertension in the African-American Population. Endocrinology and Metabolism Clinics of North America, 26, 125-144.
http://dx.doi.org/10.1016/S0889-8529(05)70237-1
[16] Striker, G.E. (1992) Current KUH Notations. American Journal of Kidney Diseases, 20, 673.
http://dx.doi.org/10.1016/S0272-6386(12)70239-1
[17] Wright Jr., J.T., Bakris, G., Greene, T., Agodoa, L.Y., Appel, L.J., Charleston, J., et al. (2002) Effect of Blood Pressure Lowering and Antihypertensive Drug Class on Progression of Hypertensive Kidney Disease: Results from the AASK Trial. JAMA, 288, 2421-2431.
http://dx.doi.org/10.1001/jama.288.19.2421
[18] Appel, L.J., Wright Jr., J.T., Greene, T., Agodoa, L.Y., Astor, B.C., Bakris, G.L., et al. (2010) Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. The New England Journal of Medicine, 363, 918-929.
http://dx.doi.org/10.1056/nejmoa0910975
[19] Kopp, J.B., Smith, M.W., Nelson, G.W., Johnson, R.C., Freedman, B.I., Bowden, D.W., et al. (2008) MYH9 Is a Major-Effect Risk Gene for Focal Segmental Glomerulosclerosis. Nature Genetics, 40, 1175-1184.
http://dx.doi.org/10.1038/ng.226
[20] Genovese, G., Friedman, D.J., Ross, M.D., Lecordier, L., Uzureau, P., Freedman, B.I., et al. (2010) Association of Trypanolytic ApoL1 Variants with Kidney Disease in African Americans. Science, 329, 841-845.
http://dx.doi.org/10.1126/science.1193032
[21] Cooke, J.N., Bostrom, M.A., Hicks, P.J., Ng, M.C., Hellwege, J.N., Comeau, M.E., et al. (2012) Polymorphisms in MYH9 Are Associated with Diabetic Nephropathy in European Americans. Nephrology Dialysis Transplantation, 27, 1505-1511.
http://dx.doi.org/10.1093/ndt/gfr522
[22] Lipkowitz, M.S., Freedman, B.I., Langefeld, C.D., Comeau, M.E., Bowden, D.W., Kao, W.H., et al. (2013) Apolipoprotein L1 Gene Variants Associate with Hypertension-Attributed Nephropathy and the Rate of Kidney Function Decline in African Americans. Kidney International, 83, 114-120.
http://dx.doi.org/10.1038/ki.2012.263
[23] Nguyen, K.D., Pihur, V., Ganesh, S.K., Rakha, A., Cooper, R.S., Hunt, S.C., et al. (2013) Effects of Rare and Common Blood Pressure Gene Variants on Essential Hypertension: Results from the Family Blood Pressure Program, CLUE, and Atherosclerosis Risk in Communities Studies. Circulation Research, 112, 318-326.
http://dx.doi.org/10.1161/CIRCRESAHA.112.276725
[24] Mao, S. and Huang, S. (2013) Lack of Association of Angiotensin II Type 1 Receptor A1166C Gene Polymorphism with the Risk of End-Stage Renal Disease. Renal Failure, 35, 1295-1301.
http://dx.doi.org/10.3109/0886022X.2013.820663
[25] Hallan, S.I., Coresh, J., Astor, B.C., Asberg, A., Powe, N.R., Romundstad, S., et al. (2006) International Comparison of the Relationship of Chronic Kidney Disease Prevalence and ESRD Risk. Journal of the American Society of Nephrology, 17, 2275-2284.
http://dx.doi.org/10.1681/ASN.2005121273
[26] Fields, L.E., Burt, V.L., Cutler, J.A., Hughes, J., Roccella, E.J. and Sorlie, P. (2004) The Burden of Adult Hypertension in the United States 1999 to 2000: A Rising Tide. Hypertension, 44, 398-404.
http://dx.doi.org/10.1161/01.HYP.0000142248.54761.56
[27] Rao, G.N., Corson, M.A. and Berk, B.C. (1991) Uric Acid Stimulates Vascular Smooth Muscle Cell Proliferation by Increasing Platelet-Derived Growth Factor A-Chain Expression. Journal of Biological Chemistry, 266, 8604-8608.
[28] Susic, D. and Frohlich, E.D. (2011) Hypertensive Cardiovascular and Renal Disease and Target Organ Damage: Lessons from Animal Models. CardioRenal Medicine, 1, 139-146.
http://dx.doi.org/10.1159/000329334
[29] Scialla, J.J., Appel, L.J., Astor, B.C., Miller 3rd, E.R., Beddhu, S., Woodward, M., et al. (2012) Net Endogenous Acid Production Is Associated with a Faster Decline in GFR in African Americans. Kidney Internatinal, 82, 106-112.
http://dx.doi.org/10.1038/ki.2012.82
[30] Luyckx, V.A., Bertram, J.F., Brenner, B.M., Fall, C., Hoy, W.E., Ozanne, S.E., et al. (2013) Effect of Fetal and Child Health on Kidney Development and Long-Term Risk of Hypertension and Kidney Disease. The Lancet, 382, 273-283.
http://dx.doi.org/10.1016/S0140-6736(13)60311-6
[31] Lüscher, T.F. and Barton, M. (2000) Endothelins and Endothelin Receptor Antagonists: Therapeutic Considerations for a Novel Class of Cardiovascular Drugs. Circulation, 102, 2434-2440.
http://dx.doi.org/10.1161/01.CIR.102.19.2434
[32] Brown, M.J., Coltart, J., Gunewardena, K., Ritter, J.M., Auton, T.R. and Glover, J.F. (2004) Randomized Double-Blind Placebo-Controlled Study of an Angi-otensin Immunotherapeutic Vaccine (PMD3117) in Hypertensive Subjects. Clinical Science (Lond), 107, 167-173.
http://dx.doi.org/10.1042/CS20030381
[33] Tissot, A.C., Maurer, P., Nussberger, J., Sabat, R., Pfister, T., Igna-tenko, S., et al. (2008) Effect of Immunisation against Angiotensin II with CYT006-AngQb on Ambulatory Blood Pressure: A Double-Blind, Randomised, Placebo-Controlled Phase IIa Study. The Lancet, 371, 821-827.
http://dx.doi.org/10.1016/S0140-6736(08)60381-5
[34] Navaneethan, S.D., Lohmeier, T.E. and Bisognano, J.D. (2009) Baroreflex Stimulation: A Novel Treatment Option for Resistant Hypertension. Journal of the American Society of Hypertension, 3, 69-74.
[35] Schlaich, M.P., Schmieder, R.E., Bakris, G., Blankestijn, P.J., Böhm, M., Campese, V.M., et al. (2013) International Expert Consensus Statement: Percutaneous Transluminal Renal Denervation for the Treatment of Resistant Hypertension. Journal of the American College of Cardiology, 62, 2031-2045.
http://dx.doi.org/10.1016/j.jacc.2013.08.1616
[36] Bhatt, D.L., Kandzari, D.E., O’Neill WW, D’Agostino, R., Flack, J.M., Katzen, B.T., et al. (2014) A Controlled Trial of Renal Denervation for Resistant Hypertension. The New England Journal of Medicine, 370, 1393-1401.
http://dx.doi.org/10.1056/NEJMoa1402670
[37] Hicks, L.S., Sequist, T.D., Ayanian, J.Z., Shaykevich, S., Fairchild, D.G., Orav, E.J., et al. (2008) Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial. Journal of General Internal Medicine, 23, 429-441.
http://dx.doi.org/10.1007/s11606-007-0403-1

  
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