Systemic hypertension versus intraglomerular hypertension in progression

Abstract

A role for hypertension in the progression of renal failure has been postulated for decades [1,2], but interest in this issue has been stimulated enormously by the recent availability of potent and efficacious anti-hypertensive agents. In addition, the availability of suitable animal models and of techniques to assess renal and intraglomerular hemodynamics has focused attention on changes of intraglomerular events as non-specific factors perpetuating damage and promoting progression [3, 4]. More recently, based on histological [5] and other observations, the importance of extraglomerular events has also been widely appreciated [6].It is a difficult task to sort out the relative roles of systemic versus glomerular hypertension in the progression of renal disease in humans. This obviously relates to the fact that direct measurements of glomerular capillary pressure are not possible in humans. In the following we try to cautiously interpret such indirect evidence as is available in this field