الفهرس | Only 14 pages are availabe for public view |
Abstract Renal transplantation is believed to be the most preferable and logic form of treatment of end-stage renal failure as successful transplant restores not merely life, but an acceptable quality of life. This work aimed to the study the incidence of hypertension after transplantation and to throw lights on the diffe~ent mechanisms that contribute in pathogenesis of hypertension after successful renal transplantation in order to find out the proper way for its management and so protect our patients from an important risk factor for cardiovascular morbidity and mortality. This work comprised 140 renal allograft recepients. All had received renal graft from living donners and they were followed up for-at least- one year folowing transplantation They were classified into 4 group according to the hypertensive state before and after transplantation . The incidence of hypertension after renal transplantation was found to be 70.7 % In comparison, 54.3 % of the patients studied were hypertensive before transplantation , also, 59.4 % of the previously normotensive patients, while on dialysis, became hypertensive after renal transplantation. This reflects the magnitude of the problem . Hypertension following renal transplantation has been shown to be multifactorial process, the present study suggest that direct damage -367- of the transplanted kidney due to repititive clinical or subclinical acute rejection episod~~ O~ ch~onic vascular rejection, graft failure, excessive steroids used to comba t rejection crises. the presence of host kidney, the develop~ent of arterial stenosis in the graft kidney, the increased activity of renin-angiotensin system, the occurance of post-operative acute tubular necrosis and urinary tract infection are the main factors implicated in the pathogenesis of post- transplantation hypertension. The presence of positive family history of hypertension amon~ hypertensive patients strongly implicate the genetic factor in the pathogenesis of hypertension. No direct correlation between hypertension nnd the originnl kidney disease, post-transplant ion erythrocytosis, duration of hemodialysis, cyclosporin A therapy and diabetes mellitus following transplantation could be found . Acute ureter~l obstruction. hypercalcaemia are important but less frequent causes of post-transplantation hypertension in the studied patients. Graft and patient survivals were found to be statistically depressed in hypertensive than in normotensive patients. Successful management of hypertension using drug therapy was achieved using Beta Blockers or Prazocin monothera~~,in mild hypertension, combination of Beta Blocker with either Captopril, Prazocin or Furosemide for patients with moderate hypertension, and also the combination of Beta Blockers , Prazocin, Captopril or Beta Blockers and Minoxidil or Betablockers and Nifedipine were found effective in severe and resi~tant hypertension. -368- - ’---, ---- - ------,-- ---------,--- In conclusion, we can suggest that using low dose of corticosteroids to suppress rejection, surgical removal of the host’ diseased kidneys prior to transplantation is severly hypertensive patients before transplantation and the development of increasingly effective means of handling immunologic rejection of the transplanted kidney utilizing lower doses of steroids as ATG/ALG, monoclonal antihodies appear to have benefical effect in lowering the incidence of acute rejections and hypertension after renal transplantation. The presence of positive family history of hypertension among hypertensive patient groups strongly implicates the genetic factor in the pathogenesis of hype r t en s ion. There was no statistically significant difference between the protocols used for immunosuppression on the incidence of post··transplantation hypertension aIthough chronic cyclosporin A nephrotoxicity can be implicated as a causative factor &this needs futhur evaluation. The occurance of post-transplantation graft art er-y stenosis, acute tubular necrosis, graft failure, graft pyelonephritis, the incrcased activity of the renin-angiotension system are important factors in the genesis of post-transplantation hypertension. The use of B blokers, Minoxidil, Captopril monotherapy or in combinat t onsc accor-d ing to the degrees of hypertension-were found effective to control hypertension following kidney transplantation. |