Hypertension in a 74-year-old man with hydronephrosis and coronary disease

Use of Urine N-Terminal Prohormone of Brain-Natriuretic Peptide (NT-proBNP) as a Non-Invasive Indicator for Renal Function Recovery after Surgical Relief of Hydronephrosis

Cardiorenal syndrome is rarely discussed in patients with obstructive uropathy. On the other hand, there is currently no accurate and convenient clinical biomarker to predict the recovery of renal function after the resolution of ureteral obstruction. The purpose of this study is to explore the association between hydronephrosis and cardiorenal syndrome by measuring the change of the N-terminal prohormone of brain-natriuretic peptide (NT-proBNP), which is a biomarker typically used for cardiac failure, in patients receiving surgery to relieve obstructive uropathy. A total of 212 patients admitted for ureteroscopic (URS) procedures to relieve hydronephrosis were enrolled in this study. The severity of hydronephrosis as well as plasma and urine NT-proBNP levels were obtained before and after surgery. The results showed a significant correlation between urine NT-proBNP levels and renal function recovery following the resolution of hydronephrosis (OR 3.24, 95% CI 1.09−9.70, p = 0.035). Urine NT-proBNP could even predict the recovery of renal function with an area under the ROC = 0.775 (0.65−0.88, p < 0.001). In conclusion, urine NT-proBNP could be a useful early marker of renal function recovery after URS surgery, identifying patients whose renal and heart functions were compromised by the obstruction.

Hypertensive emergency preceding the progression of periaortitis and retroperitoneal fibrosis: case report and review of the literature

Hypertensive emergency is an important entity which should be managed adequately. A 65-year-old woman presented with blindness and elevated blood pressure of 254/131 mmHg. She was diagnosed with hypertensive emergency on physical examination, and brain magnetic resonance imaging showed posterior reversible encephalopathy syndrome (PRES) with bilateral thalamic haemorrhage. After controlling her blood pressure with intravenous antihypertensive agents, periaortitis and retroperitoneal fibrosis (RPF) were manifested by left hydronephrosis and creatinine elevation. She was diagnosed with periaortitis/RPF. Her blood pressure was well controllable, and PRES improved after treatment with prednisolone. Periaortitis/RPF should not be overlooked when hypertensive emergency suddenly occurs in patients with no history of hypertension.

The role of the renal medulla in blood pressure control

It is well established that the renal medulla exerts a potent endocrine-like antihypertensive action. The purpose of this paper is to summarize the data that define the extent to which the renomedullary antihypertensive action is involved in blood pressure regulation. It appears that in animals kept under physiological conditions, the renal medulla is not necessary for the maintenance of normotension, since its destruction does not usually result in hypertension. However, in animals exposed to hypertensive stimuli, the presence of renomedullary tissue appears to be the key factor in resisting the increase in blood pressure. Evidence is presented to show that inherited or acquired deficiency of renomedullary antihypertensive function may contribute to the development of various forms of hypertension. It is suggested that inherited differences in the antihypertensive capacity of the renal medulla may account for differing sensitivities of various strains of animals to hypertensive stimuli. Finally, data are presented to show that renomedullary deficiency induced by a decrease in renal perfusion pressure, which could be a consequence of hypertensive damage to renal vessels, may contribute to the increase in blood pressure in various forms of hypertension.