Nephrology Dialysis Transplantation, Vol 14, Issue 7 1634-1639, Copyright © 1999 by Oxford University Press
R Tracy
As the interlobular arteries of the ageing kidney progressively accumulate
intimal fibroplasia, these fibroplastic changes appear to introduce
strictures upon the interlobular arteries. These strictures are expected to
generate nephron heterogeneity, which is a uniquely disturbed setting
peculiarly suited to sustaining both high and low renin forms of
hypertension. Fibroplastic renovasculopathy accumulates with age at varying
rates in different human populations, and these rates closely parallel the
rise of blood pressure with age, as documented by community surveys. Here,
I introduce the expression type 1 for hypertension in subjects with mild or
minimal renovasculopathy, and type 2 for those with severe vasculopathy.
Data reviewed here simply that variations in prevailing blood pressure
levels between populations can be attributed entirely, or almost entirely,
to type 2 hypertension. No practical test is available to detect nephron
heterogeneity clinically. Tests for this purpose have not been and are not
now in development. The reason for this deficiency is probably the general
lack of suspicion regarding the existence of this pathological entity. Once
the entity becomes the target of attention, a variety of tests for
measuring its severity in clinical patients should follow readily.
Key words: ageing; arteriolosclerosis; human;
nephrosclerosis; vasculopathy
PERSONAL OPINION
The heterogeneity of vascular findings in the kidneys of patients with benign essential hypertension
Louisiana State University Medical Center, 1901 Perdido Street, New Orleans, LA 70112, USA
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