Vol 22, No 1 (2018)
Original paper
Published online: 2017-12-14

open access

Page views 744
Article views/downloads 827
Get Citation

Connect on Social Media

Connect on Social Media

The relationship between blood pressure changes and the efficacy of treatment in patients with primary glomerulonephritis with special regard to kidney size

Elżbieta Marcinkowska1, Jacek Manitius2
DOI: 10.5603/AH.a2017.0023
Arterial Hypertension 2018;22(1):16-28.

Abstract

Introduction. Blood pressure plays a modulating role in the progression of glomerulonephritis. Kidney size could also constitute a factor influencing the efficacy of treatment.

The study sought to determine renal length and the influence of blood pressure changes and renal length on the efficacy of treatment.

Material and methods. This study included 53 adult patients (25 female and 28 male), aged 17 to 63. At the beginning of the observation period, the following tests were performed: percutaneous renal biopsy, anthropometric measurements, renal length in abdominal ultrasound scan. At the beginning of the observation period and after 24 months the following tests were performed: SBP, DBP, MAP, PP, serum creatinine level, GFR MDRD, DPL. Absolute renal length (D) was related to anthropometric parameters and values of relative renal length D/H, D/BSA, D/BMI were calculated.

Results. D value ranged from 93.5 mm to 135.5 mm. Mean values of parameters were: D/H 0.67 ± 0.07 mm/cm, D/BSA 61.8 ± 8.7 mm/m2, D/BMI 4.67 ± 0.79 mm/kg/m2. No correlations were found of DPL changes and GFR MDRD changes with arterial pressure. A correlation was found between DPL changes and D. In patients whose DPL values decreased by at least 50%, mean values of D, D/H and D/BSA were higher. No correlations were found of GFR MDRD changes with D, D/H, D/BSA or D/BMI.

Conclusions. No influence of arterial blood pressure on the efficacy of treatment was discovered. Renal length is not a prognostic factor for changes in glomerular filtration rate; however, it can be a prognostic factor for proteinuria changes.

Article available in PDF format

View PDF Download PDF file

References

  1. Idasiak-Piechocka I, Czekalski S. Nadciśnienie tętnicze w pierwotnych kłębuszkowych zapaleniach nerek. In: Czekalski S, Rutkowski B. ed. Nefropatia nadciśnieniowa. Nadciśnienie tętnicze w chorobach nerek. Termedia Wydawnictwo Medyczne, Poznań 2007: 163–170.
  2. D'Amico G, Bazzi C. Pathophysiology of proteinuria. Kidney Int. 2003; 63(3): 809–825.
  3. Couser WG. Pathogenesis of glomerular damage in glomerulonephritis. Nephrol Dial Transplant. 1998; 13 Suppl 1: 10–15.
  4. Baldwin DS. Chronic glomerulonephritis: nonimmunologic mechanisms of progressive glomerular damage. Kidney Int. 1982; 21(1): 109–120.
  5. Payton CD, McLay A, Jones JM. Progressive IgA nephropathy: the role of hypertension. Nephrol Dial Transplant. 1988; 3(2): 138–142.
  6. Buturović-Ponikvar J, Visnar-Perovic A. Ultrasonography in chronic renal failure. Eur J Radiol. 2003; 46(2): 115–122.
  7. Moghazi S, Jones E, Schroepple J, et al. Correlation of renal histopathology with sonographic findings. Kidney Int. 2005; 67(4): 1515–1520.
  8. Tyloch J, Woźniak M, Wieczorek A. Standardy badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego – aktualizacja. Badanie nerek, moczowodów oraz pęcherza moczowego. J Ultrasound. 2013; 13(54): 293–307.
  9. Jerassi R, Krusteva R, Kiperova B. Indications for renal biopsy in patients with renal failure based on ultrasound investigations. Int Urol Nephrol. 1991; 23(4): 393–397.
  10. Beland MD, Walle NL, Machan JT, et al. Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol. 2010; 195(2): W146–W149.
  11. Lucisano G, Comi N, Pelagi E, et al. Can renal sonography be a reliable diagnostic tool in the assessment of chronic kidney disease? J Ultrasound Med. 2015; 34(2): 299–306.
  12. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989; 5(5): 303–11; discussion 312.
  13. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6): 461–470.
  14. Emamian SA, Nielsen MB, Pedersen JF, et al. Kidney dimensions at sonography: correlation with age, sex, and habitus in 665 adult volunteers. AJR Am J Roentgenol. 1993; 160(1): 83–86.
  15. Buchholz NP, Abbas F, Biyabani SR, et al. Ultrasonographic renal size in individuals without known renal disease. J Pak Med Assoc. 2000; 50(1): 12–16.
  16. Miletić D, Fuckar Z, Sustić A, et al. Sonographic measurement of absolute and relative renal length in adults. J Clin Ultrasound. 1998; 26(4): 185–189, doi: 10.1002/(sici)1097-0096(199805)26:4<185::aid-jcu1>3.0.co;2-9.
  17. El-Reshaid W, Abdul-Fattah H. Sonographic assessment of renal size in healthy adults. Med Princ Pract. 2014; 23(5): 432–436.
  18. Wang X, Vrtiska TJ, Avula RT, et al. Age, kidney function, and risk factors associate differently with cortical and medullary volumes of the kidney. Kidney Int. 2014; 85(3): 677–685.
  19. Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med. 1995; 123(10): 754–762.
  20. Jafar TH, Stark PC, Schmid CH, et al. AIPRD Study Group. Angiotensin-Converting Enzymne Inhibition and Progression of Renal Disease. Proteinuria as a modifiable risk factor for the progression of non-diabetic renal disease. Kidney Int. 2001; 60(3): 1131–1140.
  21. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994; 330(13): 877–884.
  22. Ruggenenti P, Perna A, Mosconi L, et al. Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. Kidney Int. 1998; 53(5): 1209–1216.
  23. Blantz RC, Gabbai FB, Tucker BJ, et al. Role of mesangial cell in glomerular response to volume and angiotensin II. Am J Physiol. 1993; 264(1 Pt 2): F158–F165.
  24. Raij L, Azar S, Keane W. Mesangial immune injury, hypertension, and progressive glomerular damage in Dahl rats. Kidney Int. 1984; 26(2): 137–143.
  25. Kariyanna SS, Light RP, Agarwal R. A longitudinal study of kidney structure and function in adults. Nephrol Dial Transplant. 2010; 25(4): 1120–1126.