HYPERTENSION AND THE KIDNEY

From our perspective, Priscilla Kincaid-Smith's major achievement in t he field of hypertension relates to the pathogenesis of vascular lesio ns. Our own studies of the hypertension of renal parenchymal disease h ave suggested a role for impairment of the cortisol-cortisone shuttle and decreased activity of the enzyme complex 11-beta-hydroxy-steroid d ehydrogenase. We have defined the renal functional consequences of ste roid-induced hypertension and shown that the rise in blood pressure pr oduced by steroids with predominant glucocorticoid activity is not dep endent on volume shifts or sodium status, although the magnitude of th e rise is modulated by dietary sodium content. We have shown that norm al pregnant women adapt readily to extremes of sodium intake while wom en with pre-eclampsia retain sodium, and have shown enhanced capillary permeability. Recent studies have defined an abnormal aldosterone:ren in ratio, dopaminergic inhibition of aldosterone, elevations of plasma atrial natriuretic peptide and reduced urinary prostacyclin:thromboxa ne ratios in women with pre-eclampsia.