Reclast Side Effect:Blood pressure is not just influenced by physiological factors like varying heart rates and the muscular tone of blood vessels. Genetic susceptibility may also influence a person’s blood pressure. Just as in diabetes research, determining which specific genes are responsible for blood pressure and their relative contribution to hypertension has been very difficult. Researchers do not expect that a mutation in a single gene is responsible for hypertension. Most likely, the interplay of many genes promotes hypertension. Environment and lifestyle can also contribute to hypertension through a complex gene-environment interaction. One example of this type of interaction is excessive salt (sodium) intake and retention.
Excess salt intake can lead to hypertension. However, each person responds to salt differently. At the extremes, some people are very sensitive to salt, whereas some are insensitive. These differences suggest that salt sensitivity has a genetic component. The renin-angiotensin system evolved to combat dehydration by retaining sodium and maintaining blood pressure when the body loses sodium. In this system alone, it is possible that many genes could be altered in a way that promotes hypertension.
Research on genes underlying hypertension is still in its infancy and will require many more studies to identify the specific genes responsible. Future research may also yield new medications to reduce hypertension. Because hypertension plays such an important role in kidney disease, these new medications may give physicians better tools to prevent kidney failure.
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Obesity contributes to hypertension as well as kidney damage induced by other diseases discussed in this chapter. Kidney diseases themselves are associated with increased blood pressure by a variety of mechanisms. Obese people often take in an excessive amount of salt, which can lead to hypertension. The high pressure on the glomerulus can slowly degrade its filtering capacity and precipitate reactions similar to those that occur in diabetes-induced kidney failure. In addition, accumulating fat can contribute to hypertension. Considering that obesity, hypertension, and diabetes often accompany one another, it is hard to know which problem came first. However, obesity is often the primary cause of hypertension and diabetes.
We know that hypertension slowly destroys the kidneys’ ability to filter the blood, but how does hypertension lead to kidney failure? With prolonged hypertension, the excess pressure can injure small blood vessels in the kidney and can destroy the filtering ability of the glomerulus, leading to kidney failure. Using the hose metaphor, if you attach cheesecloth tightly over the end of the hose, water will flow through the cheesecloth without harming it. But if you pinch the hose, increasing the flow pressure, the cheesecloth will begin to degrade and eventually rupture.
Glomerular diseases are a complex set of disorders and are the third leading cause of kidney failure in the United States, accounting for 5 percent of cases. Glomerular disease often results in inflammation of the glomerulus, which can eventually cause the formation of scar tissue. As a result, protein leaks into the urine instead of being absorbed back into circulation. Like diabetes and hypertension, glomerular diseases slowly destroy the filtering ability of the glomerulus. Excess pressure on the sensitive glomerulus can lead to kidney failure. The three main causes of glomerular diseases are autoimmune diseases, hereditary nephritis, and infections.
The bodys immune system provides the first line of defense against infections by generating antibodies and immunoglobulins. However, there are times when antibodies and immunoglobulins cause harm to the body which can lead to a number of medical problems. One of these complications is the deposit of antibodies in the glomeruli, causing inflammation.
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Lupus erythematosus, another autoimmune disease, primarily involves inflammation of the skin and joints. This disease affects more women than men. When lupus erythematosus attacks the kidney, autoantibodies form or are deposited in the glomeruli and cause scarring. Drugs that suppress the immune system are generally used to treat the inflammation in the kidney.
One inherited form of glomerular diseases is Alport syndrome. Alport syndrome not only affects the kidney but may also impair vision and hearing. More men have difficulty with this disease than women, experiencing a decline in kidney function in their twenties and reaching total kidney failure by age 40.
Glomerular diseases are also caused by infections in other parts of the body. Similar to what happens in autoimmune diseases, the high number of antibodies produced to combat these infections can deposit in the kidneys and reduce kidney function. Although infections usually do not cause permanent damage, people with chronic infectious diseases like HIV/AIDS and hepatitis C have a risk of developing chronic kidney failure.
Focal segmental glomerulosclerosis is another glomerular disease that disproportionately affects African Americans. It results in scarring of the glomerulus or clustering of glomeruli in a specific segment of the kidney. Focal segmental glomerulosclerosis can be difficult to diagnose and treat. Biopsies to search for scarring in kidney tissue are the best means of a diagnosis. (A biopsy is a procedure in which a small amount of tissue is removed from the body for investigation and testing.) Flowever, if the biopsy sample is from an unaffected area of the kidney, scarring will not be evident. Thus, repeated biopsies in different segments of the kidney are needed to confirm a diagnosis of focal segmental glomerulosclerosis.
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