Drug therapy to reduce hypertension is designed to decrease either cardiac output or peripheral resistance or both. Drug therapy to increase blood pressure increases cardiac output, peripheral resistance, or both. Diuretics, beta-blockers, and central adrenergic inhibitors decrease cardiac output. Diuretics are first line therapy for treating low renin hypertension. The Beta blockers are used for treating high renin hypertension and patients suffering additional coronary artery disease. ACE inhibitors can be given for treating high renin hypertension particularly in conjunction with diabetes, heart failure or left ventricular hypertrophy. Combining ACE inhibitors with diuretics potentiates the antihypertensive effect.
syndrome. Which is mostly observed in childrens with hematuria and mild proteinuria41
Lupus Nephritis: It may result from auto-antibodies (lupus erythematous) binding to circulating antigens, forming preformed immune complexes, or autoantibodies binding to antigens deposited from the circulation in the glomerular vessel walls, causing in situ immune complex formation, with initiation of an inflammatory and cytotoxic reaction.40
Goodpasture’s syndrome (GS) is a rare and organ-specific autoimmune disease that is mediated by anti-glomerular basement membrane (anti-GBM) antibodies43 and has pathology characterized by crescentic glomerulonephritis with linear immune fluorescent staining for IgG on the GBM. It typically presents as acute renal failure caused by a rapidly progressive glomerulonephritis. It was first described as a distinctive syndrome by Pasture in 1919. The disease is caused by autoantibodies against the NC1 domain of the alpha 3 chain of type IV collagen. It occurs when the immune system attacks the walls of the lungs and the tiny filtering units in the kidneys. Without early diagnosis and treatment, the disease can lead to bleeding in the lungs, kidney failure, and even death.42
DIABETIC NEPHROPATHY: It is progressive kidney disease caused by damage to the capillaries in the kidneys’ glomeruli (changes in the blood flow in the small vessels of the glomerular capsule).44It is characterized by nephrotic syndrome and diffuse scarring of the glomeruli. It is due to longstanding diabetes mellitus, and is a major reason for dialysis in many developed countries. It is classified as a small blood vessel complication of diabetes and further it leads to chronic kidney disease (CKD).45
HYPERTENSIVE KIDNEY DISEASE: It is a medical condition referring to damage to the kidney due to chronic high blood pressure. It is also known as “Hypertensive Nephropathy (HN).” HN can be divided into two types: A) Benign and B) Malignant. Benign nephrosclerosis is common in individuals over the age of 60, Whereas
Malignant nephrosclerosis is uncommon and affects 1-5% of individuals with high blood pressure, that have diastolic blood pressure passing 130 mm Hg.46The relative risk of developing ESRD is increased by up to 20 times in hypertensive patients.47
In addition, the glomerulus has a unique structure, with both an afferent and an efferent arteriole, which permits modulation of glomerular perfusion and pressure without corresponding systemic blood pressure change.48
When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys. If the kidneys’ blood vessels are damaged, they may stop removing wastes and extra fluid from the body. Extra fluid in the blood vessels may then raise blood pressure even more, creating a dangerous cycle. And opposite
