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[Intraglomerular hypertension. Physiopathology and therapeutic implications]
1Service de Néphrologie, Hôpital Lapeyronie, Montpellier.
Insights
Increased glomerular pressure causes kidney disease progression in rodents. Therapeutic strategies like protein restriction and ACE inhibition may slow renal failure in humans with conditions like diabetic nephropathy.
Area of Science:
- Nephrology
- Pathophysiology
- Experimental Nephrology
Context:
- Glomerular hypertension is implicated in progressive renal diseases in humans, including diabetic nephropathy, glomerulonephritis, essential hypertension, and kidney transplantation.
- Direct measurement of glomerular capillary pressure in humans is not feasible.
- Rodent models demonstrate that elevated glomerular pressure leads to focal and segmental glomerulosclerosis, proteinuria, and declining renal function.
Purpose:
- To review the effects of protein-restricted diets and angiotensin-converting enzyme (ACE) inhibition on the progression of renal failure in various clinical conditions associated with glomerular hypertension.
Summary:
- Studies investigating protein restriction and/or ACE inhibition suggest these interventions may slow the rate of renal disease progression.
- The efficacy of these strategies is particularly noted in diabetic nephropathy, although overall results remain somewhat controversial.
- These findings highlight potential therapeutic avenues for managing glomerular hypertension-related kidney diseases.
Impact:
- Provides insights into potential renoprotective strategies for chronic kidney diseases characterized by glomerular hypertension.
- Highlights the importance of managing intraglomerular pressure in conditions like diabetic nephropathy.
- Informs clinical practice regarding the use of dietary protein restriction and ACE inhibitors in slowing kidney disease progression.
Abstract:
It is now well-established in experimental models in rodents that increased glomerular pressure results in the development of focal and segmental glomerulosclerosis, proteinuria and progressive renal functional deterioration. In humans, direct measurement of glomerular capillary pressure is impossible. However, it is widely accepted that glomerular hypertension is present in different clinical situations, like diabetic nephropathy, chronic renal failure associated with glomerulonephritides, some forms of essential hypertension and cadaveric kidney transplantation. Many studies were performed on the effects of protein-restricted died and/or angiotensin converting enzyme inhibition on the rate of progression of renal failure in these renal diseases. Although controversial, the overall results suggest that these therapeutic strategies may reduce the rate of progression, particularly in diabetic nephropathy.