Treatments of Hemodynamic Maladjustment and Oxidative Stress Prevent Renal Disease Progression in Chronically Severe Glomerulonephritides

Abstract

Hemodynamic maladjustment is a unique observation in chronically severe glomerulonephritides. It is characterized by a markedly elevated efferent arteriolar resistance (RE), an elevated intraglomerular hydrostatic pressure (PG) and a markedly decreased renal plasma flow (RPF), and peritubular capillary flow (PTCF). A correction of such hemodynamic maladjustment can be accomplished by administering a combination of vasodilators (angiotensin receptor antagonist, angiotensin converting enzyme inhibitor, and calcium channel blocker) in 14 chronic glomerulonephritides with severe renal function impairment (mean serum creatinine 3.6 + 1.3 mg/dL). Doses titration aim for maximal renal perfusion effect (increased RPF, PTCF) or maximal renal function improvement (increased CCr, reduced FE Mg) usually higher than needed for maximal blood pressure reduction. Evidence of oxidative stress is also corrected with high doses of vitamins C and E. After a mean period of treatment for 13.5 months, improvements in CCr (pre R_x 22 ± 10 vs. post R_x 32 ± 13 mL/min/1.73 m²), and FE Mg (pre R_x 11.9 ± 4% vs. post R_x 10 ± 3%) were observed in conjunction with the improvement in intrarenal hemodynamics namely RPF (pre R_x 201 ± 71 vs. post R_x 288 ± 99 mL/min/1.73 m²), PTCF (pre R_x 161 ± 57 vs. post R_x 242 ± 90 mL/min/1.73 m²), PG (pre R_x 56.7 ± 0.5 vs. post R_x 51 ± 0.1 mm Hg), and RE (pre R_x 12085 ± 6503 vs. post R_x 6550 ± 1872 dyne.s.cm⁻⁵).

• Hemodynamic
• Oxidative stress
• Vasodilators
• Chronic glomerulo-nephritides
• Pathogenesis