2. Predict how hypertension and diabetes each would impact the delicate tissues of the kidney.
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Answer:
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Explanation:
Hypertension is common among patients with chronic kidney disease (CKD) and diabetes mellitus. In this population hypertension increases risk for kidney disease onset and progression and cardiovascular (CV) morbidity and mortality. Diabetic nephropathy is the most common cause of CKD in those with diabetes and is the leading attributable cause for incident end stage renal disease (ESRD) in the United States (US). The mechanism of hypertension in diabetic nephropathy is complex, incompletely understood, and includes excess sodium retention, sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) activation, endothelial cell dysfunction (ECD), and increased oxidative stress. Both non-pharmacological and pharmacological interventions, including RAAS antagonists, are critically important in the management of hypertension in diabetic nephropathy. The purpose of this article is to examine the pathophysiology of hypertension in diabetic nephropathy and the clinical trials that support the implementation of strategies aimed at these pathophysiologic mechanisms. Evidence from prior and very recent clinical trials in patients not on dialysis is reviewed. Management of hypertension in patients on dialysis is an important topic that is beyond the scope of this review, but has been well reported previously
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