Hypertension in CKD: Core Curriculum 2019. 2019

Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
Division of Nephrology and Pediatric Nephrology, Departments of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA. Electronic address: elaine.ku@ucsf.edu.

Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologic states, such that sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can conversely lead to worsening blood pressure (BP) control. The pathophysiology of hypertension in CKD is complex and is a sequela of multiple factors, including reduced nephron mass, increased sodium retention and extracellular volume expansion, sympathetic nervous system overactivity, activation of hormones including the renin-angiotensin-aldosterone system, and endothelial dysfunction. Currently, the treatment target for patients with CKD is a clinic systolic BP < 130mm Hg. The main approaches to the management of hypertension in CKD include dietary salt restriction, initiation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic therapy. Uncontrolled hypertension can lead to significant cardiovascular morbidity and mortality and accelerate progression to end-stage kidney disease. Although intensive BP control has not been shown in clinical trials to slow the progression of CKD, intensive BP control reduces the risk for adverse cardiovascular outcomes and mortality in the CKD population.

UI MeSH Term Description Entries
D006973 Hypertension Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more. Blood Pressure, High,Blood Pressures, High,High Blood Pressure,High Blood Pressures
D010346 Patient Care Management Generating, planning, organizing, and administering medical and nursing care and services for patients. Care Management, Patient,Management, Patient Care
D012084 Renin-Angiotensin System A BLOOD PRESSURE regulating system of interacting components that include RENIN; ANGIOTENSINOGEN; ANGIOTENSIN CONVERTING ENZYME; ANGIOTENSIN I; ANGIOTENSIN II; and angiotensinase. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming ANGIOTENSIN I. Angiotensin-converting enzyme, contained in the lung, acts on angiotensin I in the plasma converting it to ANGIOTENSIN II, an extremely powerful vasoconstrictor. Angiotensin II causes contraction of the arteriolar and renal VASCULAR SMOOTH MUSCLE, leading to retention of salt and water in the KIDNEY and increased arterial blood pressure. In addition, angiotensin II stimulates the release of ALDOSTERONE from the ADRENAL CORTEX, which in turn also increases salt and water retention in the kidney. Angiotensin-converting enzyme also breaks down BRADYKININ, a powerful vasodilator and component of the KALLIKREIN-KININ SYSTEM. Renin-Angiotensin-Aldosterone System,Renin Angiotensin Aldosterone System,Renin Angiotensin System,System, Renin-Angiotensin,System, Renin-Angiotensin-Aldosterone
D004730 Endothelium, Vascular Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components. Capillary Endothelium,Vascular Endothelium,Capillary Endotheliums,Endothelium, Capillary,Endotheliums, Capillary,Endotheliums, Vascular,Vascular Endotheliums
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D051436 Renal Insufficiency, Chronic Conditions in which the KIDNEYS perform below the normal level for more than three months. Chronic kidney insufficiency is classified by five stages according to the decline in GLOMERULAR FILTRATION RATE and the degree of kidney damage (as measured by the level of PROTEINURIA). The most severe form is the end-stage renal disease (CHRONIC KIDNEY FAILURE). (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002) Kidney Insufficiency, Chronic,Chronic Kidney Diseases,Chronic Kidney Insufficiency,Chronic Renal Diseases,Chronic Renal Insufficiency,Chronic Kidney Disease,Chronic Kidney Insufficiencies,Chronic Renal Disease,Chronic Renal Insufficiencies,Disease, Chronic Kidney,Disease, Chronic Renal,Diseases, Chronic Kidney,Diseases, Chronic Renal,Kidney Disease, Chronic,Kidney Diseases, Chronic,Kidney Insufficiencies, Chronic,Renal Disease, Chronic,Renal Diseases, Chronic,Renal Insufficiencies, Chronic

Related Publications

Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
August 2019, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
August 2010, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
April 2019, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
July 2015, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
December 2011, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
January 2019, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
August 2018, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
October 2008, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
December 2019, American journal of kidney diseases : the official journal of the National Kidney Foundation,
Elaine Ku, and Benjamin J Lee, and Jenny Wei, and Matthew R Weir
December 2019, Pediatric pulmonology,
Copied contents to your clipboard!