Systemic and glomerular hypertension in progressive renal disease

Loss of renal function leads to further loss of renal function, so that most patients with glomerular filtration rates below about 25 ml per minute, regardless of etiology, will eventually require dialysis or transplantation. One risk factor contributing to acceleration of renal disease is systemic hypertension, which may be both cause and consequence of chronic renal disease. Recently, studies in animal models of hypertensive renal disease have provided insights into the complex and variable relationship between systemic and glomerular hypertension. Recognition that systemic and glomerular hypertension are not necessarily accompaniments, and that therapeutic interventions may affect systemic and glomerular capillary pressures in opposite directions, may explain variable renal responses to systemic hypertension and to antihypertensive therapy.