NEPHROPATHIES AND TREATMENT OF HYPERTENSI ON

High prevalence: Hypertension is observed in 85% of patients with end- stage renal disease. Its prevalence is also very high in renal transpl ant recipients. Possible mechanisms: High blood pressure in primary re nal disease may be related to water-electrolyte overload resulting fro m reduced sodium excretion (volume - or sodium- dependent mechanism). It could also result from renin-dependent mechanisms as in patient wit h unilateral disease or polycystic kidneys. Prognosis: High blood pres sure is a factor predicting poor prognosis in renal disease. It has be en demonstrated that controlling hypertension has a beneficial effect on the course of renal failure. Other factors: Hyperfiltration and hig h glomerular capillary pressure also play a role in the progression of chronic renal disease. The polymorphism of the angiotensin converting enzyme gene is also involved. In the diabetic patient as well as in p atients with renal disease other than diabetes, a large amount of work has shown that converting enzyme Inhibitors have more effect on slowi ng the progression of renal failure than do other antihypertensive dru gs.