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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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Minerva Urologica e Nefrologica 2003 March;55(1):101-9

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

Hypertension after renal transplantation

Dikow R., Zeier M., Ritz E.

Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany


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­With cur­rent immu­no­sup­pres­sion ele­vat­ed ­blood pres­sure is ­found in ­almost 90% of ­renal ­graft recip­ients. ­Major caus­es of ­this find­ing are impair­ment of ­renal func­tion, sec­on­dary to chron­ic allo­graft neph­rop­a­thy or (­less fre­quent­ly) recur­rence of pri­mary ­renal dis­ease, the use of cal­ci­neu­rin inhib­i­tors as immu­no­sup­pre­sants, uncon­trolled ­renin secre­tion by the shrunk­en kid­neys of the recip­i­ent, ste­nos­- ing ­lesions of the trans­plant ­artery (or the ­upstream arter­ies of the recip­i­ent), poly­cy­te­mia and (genet­ic pre­dis­po­si­tion to) hyper­ten­sion of the ­graft ­donor. ­Even ­minor ­degrees of ­blood pres­sure ele­va­tion ­have a sig­nif­i­cant ­impact on sur­vi­val of the recip­i­ent and on ­graft sur­vi­val, pre­sum­ably by ampli­fy­ing vas­cu­lar inju­ry to the ­graft. In ­this ­respect, ele­va­tion of sys­tol­ic ­blood pres­sure and an abnor­mal cir­ca­dian ­blood pres­sure pro­file are of par­tic­u­lar rel­e­vance. In con­trast to pre­vi­ous opin­ion, ACE inhib­i­tors are indi­cat­ed in the treat­ment, but, giv­en the cau­sal ­role of sodi­um reten­tion in ­graft vaso­con­stric­tion, diu­ret­ics and cal­cium chan­nel block­ers ­remain ­main ­stays of anti­hy­per­ten­sive treat­ment in the ­renal allo­graft recip­i­ent.

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