Glomerular hypertension: cause and consequence of renal injury

Glomerular capillary hyperfiltration and hypertension occur in certain disease states and also in response to a reduction in the number of functional nephrons. Experimental studies have shown that these glomerular hemodynamic changes are maladaptive, and ultimately damaging to the kidney. Amelioration of glomerular hyperfunction by dietary protein restriction or antihypertensive therapy lessens glomerular injury in several experimental models of chronic renal disease.

Hyperfiltration may similarly occur in humans with diabetes mellitus, a solitary or remnant kidney, or acquired renal disease. There is evidence to suggest that these people may therefore be at increased risk for the development of renal injury.

Clinical studies have shown that dietary protein restriction and antihypertensive therapy may beneficially affect the course of chronic renal failure in humans. Large multicenter trials are currently underway on the effects of these therapeutic maneuvers on the progression of chronic renal disease.