摘要:

Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematosus. The pathology seen on renal biopsy and clinical features of renal involvement remain major prognostic factors and therapeutic guides. Serologic markers also correlate with disease activity, but more significantly, the identification of cationic and anti-endothelial cell antibodies in patients may have pathogenetic implications. Experimental studies demonstrating pathogenic roles for cationic nuclear antigens, cationic and anti-idiotypic antibodies, and genetic control of antibody production, are being transferred to the clinic. Duplication of these results in patients suggests that similar mechanisms are operative in humans. Insights gained from pathological studies will lead to new therapeutic strategies, but at present lupus nephritis therapy is based on nonspecific immunosuppression. Therapeutic trials testing several established and new modalities have been published in the past year, but they are anecdotal and lacking in controls.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The initial management of idiopathic nephrotic syndrome with steroids alone is often reserved for patients with the highly responsive lesion of minimal change disease. This disease can be seen in up to 30% of adult patients, and appears to portend the same favorable prognosis as it does in children. However, adults respond more slowly to steroids than children, and therefore need a longer course of treatment to attain a remission rate similar to that of children. Patients with the lesion of focal segmental glomerular sclerosis do not respond so well to steroids; clinicians are often reluctant to treat such patients, particularly adults. Fourteen to 80% of adults with idiopathic nephrotic syndrome have this lesion, including the majority of black patients. Despite the previously poor results with steroids, remission rates of up to 60% have recently been reported with prolonged courses of therapy. Given these findings for minimal change disease and focal segmental glomerular sclerosis, steroid resistance in adults should perhaps be assumed only after failure to respond to a 4-month course of daily steroid therapy. Prospective trials are needed to confirm these data.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Genetic approaches are setting the stage for a new understanding of the biological mechanisms underlying blood pressure regulation and hypertension. Recently, substantial progress has been made in elucidating the molecular mechanisms that cause several rare forms of hypertension, including hypertension arising from mutations in the 11β- hydroxylase gene, Liddle's syndrome, and glucocorticoid-suppressible aldosteronism. New results have been obtained on the possible role of the angiotensinogen gene, and other candidate genes, such as the angiotensin II receptor Type I gene and the Sa gene, in human hypertension. Investigation of experimental models of hereditary hypertension have also been important in unravelling the genetic complexity of the disease.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

It has been suspected that abnormalities of the L-arginine-nitric oxide pathway could underlie certain forms of hypertension. In this review, we will consider the role of nitric oxide in primary and secondary models of experimental hypertension and discuss potential abnormalities of the L-arginine-nitric oxide pathway in hypertension in humans.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The vasculature is an integrated organ capable of modulating its structure in accordance with hemodynamic conditions and locally generated mediators. Vasoactive substances produced within the vasculature are important modulators of vessel structure and vessel tone. This review focuses on the pathogenic role of vasoactive substances in vascular remodeling in hypertension and the potential clinical implications of this pathobiological process. It is speculated that therapeutic strategies that influence vascular remodeling may be clinically more effective.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Vasoprotective drugs decrease the vulnerability of blood vessels to cardiovascular risk factors such as hypertension and hypercholesterolemia. Mechanistic treatment end-points of hypertension (normalization of endovascular pressure) may not correct non hypertensive components of the pathobiology of hypertension. Estrogen replacement therapy, antihypertensive treatment with angiotensin-converting enzyme inhibitors, and manipulations of nitric oxide metabolism may have beneficial effects on vessels in the absence of blood pressure normalization. Estrogens and L-arginine, the precursor of nitric oxide, can partly correct impaired endothelium-dependent vasodilation, a pathophysiologic hallmark of hypertensive states. Angiotensin-converting enzyme inhibitors preserve endothelium-dependent vasodilation and protect arteries against the atherogenic effects of hypercholesterolemia by a non-hypolipidemic, non-hypotensive mechanism.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Both a retrospective and a prospective study of hypertensive patients have detected a significant positive relationship between pretreatment renin and sodium profiles, and the occurrence of coronary artery disease events during treatment. The subgroup of patients with the highest renin-sodium profile, while controlling for other known coronary risk factors as well as pre-existing disease, were significantly more likely to experience a fatal or nonfatal myocardial infarction compared with those with normal or low renin-sodium profiles. A population of almost entirely normotensive subjects failed to show a similar relationship for plasma renin activity alone. In the normotensive patient in whom the plasma renin activity is physiologically linked to blood pressure level, no adverse effect of an elevated plasma renin activity is seen. By contrast, in the hypertensive patient, in whom plasma renin activity should approach zero, there is a direct correlation between the renin-sodium profile and the risk of developing subsequent heart attack.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This review summarizes gender differences in the epidemiology of hypertension, outlines aspects of hypertension as a risk factor for cardiovascular disease that are unique to women, and discusses new insights into approaches for the prevention and treatment of hypertension in women.

ISSN:1062-4821    

出版商:OVID    

年代:1995

数据来源: OVID