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 Rx 22 ± 10 vs. post Rx 32 ± 13 mL/min/1.73 m2), and FE Mg (pre Rx 11.9 ± 4% vs. post Rx 10 ± 3%) were observed in conjunction with the improvement in intrarenal hemodynamics namely RPF (pre Rx 201 ± 71 vs. post Rx 288 ± 99 mL/min/1.73 m2), PTCF (pre Rx 161 ± 57 vs. post Rx 242 ± 90 mL/min/1.73 m2), PG (pre Rx 56.7 ± 0.5 vs. post Rx 51 ± 0.1 mm Hg), and RE (pre Rx 12085 ± 6503 vs. post Rx 6550 ± 1872 dyne.s.cm−5).