Cardiac morphology in renal failure and arterial hypertension

Cardiovascular complications are the leading cause of death in patients tre ated with dialysis over a long period. Cardiac death does not only result f rom coronary arteries, but also from a specific uremic cardiomyopathy. Myoc ardial structure shows hypertrophy of myocytes, interstitial myocardial fib rosis, reduction of capillary supply and damage of small arteries. Similar alterations are regularly found in arterial hypertension without impaired r enal function. Experimental and retrospective autoptic investigations estab lished renal insufficiency as determinant of the myocardial anomalies indep endent on hypertension. It is suggested that the renin-angiotensin-system, parathormone and the endothelin-system are involved in the pathogenesis of uremic heart disease. With respect to cardioprotection in renal failure opt imal therapy is likely to be different to patients with arterial hypertensi on and normal renal function.