Kamal et al. J Nephrol Ther 2015, 6:1 DOI: 10.4172/2161-0959.1000231 Open Access Review Article Volume 6 • Issue 1 • 1000231 J Nephrol Ther ISSN: 2161-0959 JNT, an open access journal Kidneys: The Victim Of Hypertension: Review Islam Kamal*, Rehab Hamdy and Nourhan M.sayed Kasr Alainy Faculty of Medicine, Cairo University, Egypt *Corresponding author: Islam Kamal, Medical Student, Kasr Alainy Faculty of Medicine, Cairo University, Egypt, Tel: 20 10 60 55056; E-mail: Islam.k.hamouda@ students.kasralainy.edu.eg Received: December 02, 2015; Accepted: December 23, 2015; Published: December 30, 2015 Citation: Kamal I, Hamdy R, Mohamed N (2015) Kidneys: The Victim Of Hypertension: Review. J Nephrol Ther 6: 231. doi:10.4172/2161-0959.1000231 Copyright: © 2015 Kamal I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Blood pressure dependency; Hypertension; Chronic renal failure; Renal denervation Introduction Normal blood pressure means the pressure that the blood afecting the normal body vessels and depends on many items like: cardiac output, vascular resistance and the total blood volume. In normal healthy people it should be below than 120 mmhg “systolic” and below than 80 mmhg “diastolic”. When your blood pressure rises more than 140/90 it means that you are hypertensive [1]. Hypertension is one of the most leading causes of non-infectious death all over the world and considered one of the most common conditions that doctors can see in the primary care. Hypertension has many serious efects as coronary artery disease, chronic renal failure, myocardial infarction, cerebral stroke, aortic aneurysm and so on. Kidneys are responsible for long term controlling blood pressure, except in hypotension, through the rennin angiotensin aldosterone system (RAAS) as follow (Figure 1): rennin is released form juxtaglomerular apparatus of the kidney which lead to cleavage of the angiotensinogen, secreted by the liver into blood, to form angiotensin1 and through angiotensin converting enzyme, produced by the lungs, which induce production of angiotensin2 from angiotensin1. ACE has many actions through its efect on AT1 & AT2, but mainly on AT1: On kidney: prevent natriuresis and cause vasoconstriction. -On blood vessels: cause potent vasoconstriction. -On adrenal cortex: increase release of aldosterone which stimulates sodium reabsorption from distal nephron. -On brain: have vasopressor action when injected intraventricular [2] Diabetes is the frst cause of CKD then HTN is the second one [3,4] also increase age has a role in such disease, CKD is defned as persistent kidney damage accompanied by reduction GFR and presence of albuminuria, So the damaged kidney fail to flter the blood from wastes and fuid, lead to increase the blood volume which cause increase in blood pressure (HTN), HTN has been found to occur in 85% to 95% of patients with CKD (stages 3-5) [5]. Te uncontrolled hypertensive patients have an increased intraglomerularal pressure that lead to damage of glomeruli & increase protein fltration, so this shows the relation between HTN and CKD, how both of them can cause the other Figure 2, and the importance of maintaining BP normal to decrease renal disease and cardiovascular morbidity and mortality [3]. Reno vascular hypertension refects the relation between anatomically evident artero-occulosion disease and hypertension. Approximately two third of renovascular hypertension caused by atherosclerosis of renal artery and the other one third caused by fbro muscular disease and other congenital anomalies [6]. Tere are other clinical entities as: acute renal thrombosis, embolism, cholesterol embolic disease, aortic dissection and so on. Renal artery stenosis (RAS) is one of the commonest causes of renovascular hypertension, its prevalence increases by aging and many risk factors especially smoking but doesn’t depend on race [6], RAS is characterized by narrow arterial lumen by formation of atherosclerotic plaque due to increase the permeability of plasma macromolecules as LDL and increase of cells as macrophages, smooth muscle cells & endothelial cells, which lead to this lesion when these Abstract Background & objectives: Our review discuss the relation between hypertension and the renal system ,and show the cyclic effect of both hypertension and chronic kidney damage on each other, our objectives are to control the high blood pressure with minimal renal affection due to side effects of medications. Materials & methods: many studies and trials compare between different antihypertensive drugs and their effects on kidneys which may decrease their effciency. Results: Angiotensin converting enzyme inhibitor (ACE-Is), angiotensin II receptor blocker (ARBs), Beta-blockers and calcium channel blockers are identifed to be the second line of treatment of hypertension according to a network meta-analysis conducted in 2003, ACE-Is were found to show a signifcant effect in slowing the progression of nephrosclerosis and slower declining of GFR more than β-blocker or calcium channel blocker. Conclusion: Kidney is indispensable organ in the body that we must protect it from the irreversible macroscopic and microscopic changes pathological as : macroscopic (small size, fnely granular surface, adherent and diffculty stripped capsule, fbrotic, atrophic, not demarcated cortex on cut section, thick prominent arterioles and increased peripelvic fat) and microscopic (afferent and efferent arterioles show benign arteriosclerosis, gradual ischemic atrophy and fbrosis of the glomeruli, atrophy of non-functioning tubules related to atrophic glomeruli, may undergo compensatory cystic dilatation of tubule related to functioning glomeruli). ACE-Is is considered the drug of choice in hypertensive patients complicated with chronic kidney disease, In hypertensive patients that are refractory to medical treatment, renal sympathetic denervation is a safe alternative. J o u r n a l o f N e p h r o l o g y & T h e r a p e u t i c s ISSN: 2161-0959 Journal of Nephrology & Therapeutics