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Tag: kidney

Can we really lower blood pressure by a surgical procedure?

Teachable moment in classrooms:

  1. cardiovascular system/ hemodynamics chapter – smooth muscle layer in arteries and veins
  2. cardiovascular system/ hemodynamics chapter – physiological regulation of blood pressure
  3. autonomic nervous system chapter – sympathetic innervation of the kidneys

The news item:  Recently this report appeared online

New Procedure Treats High Blood Pressure

The first renal denervation (RDN) procedure at Springhill Medical Center was completed last week by Dr. John Galla of Cardiology Associates. The blood pressure procedure is now offered for certain patients and was approved by the U.S. Food and Drug Administration (FDA) in 2023.

The article states that the Simplicity renal denervation procedure targets nerves near kidneys. During the procedure a catheter is introduced into an artery near the kidney, and energy is delivered to calm the excessive activity of nerves. The article also states that this procedure is approved for people with hypertension where lifestyle changes or medication did not sufficiently control blood pressure.

So, Why Do I Care??  High blood pressure (hypertension) is a disorder that affects about half the US adult population, almost 120 million people. There are over 600,000 deaths in the USA from causes that can be linked to hypertension. This is a huge health problem, and while medications can do a good job controlling hypertension, only 27% of patients take their medication, so new procedures do not depend on taking a daily pill can provide a practically useful alternative.

Plain English, Please!!! First, let’s talk about why high blood pressure develops. Normal blood pressure of 120/80 mmHg is carefully maintained in our bodies by hormones, and the nervous system. Hormones such as renin, angiotensin II, aldosterone, epinephrine, norepinephrine are used in our bodies to increase blood pressure. All those hormones act on the smooth muscle layer of small arteries and make them contract resulting in narrowing (vasoconstriction) of small arteries. The sympathetic nerves of the kidneys normally play a small role in lowering blood pressure. Overactive renal nerves, however, increase blood pressure by increasing renin and aldosterone production.

Second, let’s talk about why high blood pressure is damaging to our bodies. Chronic (long-duration) high blood pressure physically stretches and damages thinnest and weakest small arterioles. Those kinds of arterioles are found in the renal corpuscle, the retina, and in the healing wounds. Therefore, when patients don’t control their high blood pressure kidney failure develops, vision loss develops, and ulcers develop from non-healing wounds.

How can finerenone help patients with both kidney disease and heart disease?

Teachable moment in classrooms:

  1. urinary system chapter – parts of the nephron and their functions
  2. endocrine system chapter – location and action of receptors for lipid-soluble hormones
  3. heart chapter within cardiovascular system – location of myocardium in the heart wall

The news item:  Recently the following article appeared online:

Utilization of Finerenone by Patients With T2D, CKD | Docwire News

Two years after its approval, researchers studied the use of finerenone in adults with type 2 diabetes and chronic kidney disease (CKD).

The report states that finerenone – a mineralocorticoid receptor antagonist – is approved for several medical conditions (type 2 diabetes, chronic kidney disease, end-stage renal disease, heart failure) where glomerular filtration rate was declining. The author states that utilization rate is still low for this drug.

So, Why Do I Care??  In the USA alone the combined number of people suffering from type II diabetes, chronic kidney disorder (CKD), end-stage renal disease (ESRD) and heart failure is over 100 million. Those disorders cause the death of over 500,000 people every year, and force many patients into hospitalizations, and into major changes in the quality of life. Therefore, it is worth finding and using new pharmaceutical treatments that may lower those disease and death numbers.

Plain English, Please!!! First, let’s talk about what is the shared, common, physiological malfunction in CKD, ESRD, and heart failure. In all three disorders damaged cells start inflammation, and the tissue is repaired by formation of scar tissue. In the case of CKD and ESRD the kidney accumulates unusually large amount of connective tissue (develops fibrosis) made by overstimulated fibroblast. In heart failure the myocardium portion of the heart wall accumulates unusually large amount of connective tissue. In the kidneys the filtration by the nephrons is slowed down by fibrosis, while in the heart the contraction of the ventricles is made difficult by the fibrosis.

Second, let’s talk about why fibrosis appears in the kidneys and in the heart. During early stage kidney disease and early-stage heart disease the cells of the nephron in the kidneys, and the cardiac muscle cells

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