Hypertension, type Ⅳ cardiorenal syndrome and chronic kidney disease: Pathophysiological and therapeutical approach

Hypertension represent one of the most important comorbid factors in chronic kidney disease(CKD) patients and its prevalence increases from 65% to 95% according to glomerular filtration rate decline. CKD patients need to maintain their blood pressure levels into 130/80 mm Hg according to most recent guidelines. Despite of many therapeutic agents, achievement of ideal blood pressure levels remains so far from the ideal ones. Hypertensive disease represent most important risk factor to develop a type Ⅳ cardiorenal syndrome, while prevalence of end stage renal disease is still raising and it represents worldwide epidemiological challenge. Correct management of hypertensive disease can obtain better control on CKD progression.

腹膜透析液添加尿激酶对腹透患者氧化应激及内皮功能的影响

目的探讨腹膜透析液添加尿激酶对腹透患者血清超氧化物歧化酶（SOD）、丙二醛（MDA）及血浆内皮素（endothelin，ET）、一氧化氮（nitricoxide，NO）的影响。方法将60例慢性肾脏病（CKD4期）患者随机分为治疗组（30例）和对照组（30例），两组基础治疗相同，治疗组在腹膜透析液中添加尿激酶，治疗4周后观察两组患者SOD、MDA、ET、NO及临床症状的变化。用比色法测定健康对照组、对照组、治疗组血清MDA和SOD水平，用放射免疫法测定测定ET的变化，NO采用硝酸还原法测定。结果与健康对照组比较，对照组、治疗组血清SOD活性降低（P〈0．05），NO升高（P〈0．05），MDA含量升高（P〈0．05），ET水平升高（P〈0．01）。对照组虽能够降低ET水平和NO，但未见SOD、MDA的变化，治疗组能够回升SOD活性，降低MDA含量，与健康对照组及对照组有明显差别（P〈0．05），与对照组比较，治疗组在降低ET和NO方面疗效更为显著（P〈0．01）。结论腹膜透析液添加尿激酶可通过降低氧化应激反应，改善血管内皮功能，降低ET和NO水平，对CKD患者有治疗作用。