**4. Conclusion**

The increasing evidence from laboratory and clinical studies on chronic kidney disease and hypertension suggest that effective interventions at an early stage may be beneficial in preventing the development of both these disorders. Because of the high prevalence of both chronic kidney disease and hypertension amongst the general population, further research on the development of methods to induce regression of these conditions may be expected to result in widespread health benefits.

#### **5. References**


The increasing evidence from laboratory and clinical studies on chronic kidney disease and hypertension suggest that effective interventions at an early stage may be beneficial in preventing the development of both these disorders. Because of the high prevalence of both chronic kidney disease and hypertension amongst the general population, further research on the development of methods to induce regression of these conditions may be expected to

Aros C, and Remuzzi G. (2002). The renin-angiotensin system in progression, remission and

Bakris G. (2010). Are there effects of renin-angiotensin system antagonists beyond blood

Baramova E, and Foidart JM. (1995). Matrix metalloproteinase family. *Cell Biol Int* 19:239-42. Berl T. (2009). Review: renal protection by inhibition of the renin-angiotensin-aldosterone

Burgess E, Muirhead N, Rene de Cotret P, Chiu A, Pichette V, and Tobe S. (2009).

Chen S, Ge Y, Si J, Rifai A, Dworkin LD, and Gong R. (2008). Candesartan suppresses

Christensen KL, Jespersen LT, and Mulvany MJ. (1989). Development of blood pressure in

Cordonnier DJ, Pinel N, Barro C, Maynard M, Zaoui P, Halimi S, Hurault de Ligny B, Reznic

Dilley JR, Stier CT, Jr., and Arendshorst WJ. (1984). Abnormalities in glomerular function in rats developing spontaneous hypertension. *Am J Physiol* 246:F12-20. Durvasula RV, and Shankland SJ. (2006). The renin-angiotensin system in glomerular

Durvasula RV, and Shankland SJ. (2008). Activation of a local renin angiotensin system in

Feihl F, Liaudet L, Waeber B, and Levy BI. (2006). Hypertension: a disease of the

Fioretto P, Steffes MW, Sutherland DE, Goetz FC, and Mauer M. (1998). Reversal of lesions of diabetic nephropathy after pancreas transplantation. *N Engl J Med* 339:69-75. Folkow B. (1990). "Structural factor" in primary and secondary hypertension. *Hypertension*

Freslon JL, and Giudicelli JF. (1983). Compared myocardial and vascular effects of captopril

and dihydralazine during hypertension development in spontaneously

Supramaximal dose of candesartan in proteinuric renal disease. *J Am Soc Nephrol*

chronic renal inflammation by a novel antioxidant action independent of AT1R

spontaneously hypertensive rats after withdrawal of long-term treatment related to

Y, Simon D, and Bilous RW. (1999). Expansion of cortical interstitium is limited by converting enzyme inhibition in type 2 diabetic patients with glomerulosclerosis.

podocytes: mediator of glomerulosclerosis and link to hypertensive nephropathy.

regression of chronic nephropathies. *J Hypertens Suppl* 20:S45-53.

pressure control? *Am J Cardiol* 105:21A-9A.

blockade. *Kidney Int* 74:1128-38.

*Curr Hypertens Rep* 8:132-8.

16:89-101.

vascular structure. *J Hypertens* 7:83-90.

microcirculation? *Hypertension* 48:1012-7.

hypertensive rats. *Br J Pharmacol* 80:533-43.

system. *J Renin Angiotensin Aldosterone Syst* 10:1-8.

The Diabiopsies Group. *J Am Soc Nephrol* 10:1253-63.

podocytes by glucose. *Am J Physiol Renal Physiol* 294:F830-9.

**4. Conclusion** 

**5. References** 

result in widespread health benefits.

20:893-900.


Prevention and Regression of Chronic Kidney Disease and Hypertension 429

Oresic M. (2009). Metabolomics, a novel tool for studies of nutrition, metabolism and lipid

Parks WC, and Mecham RP. 2000. Matrix metalloproteinases Academic Press, Inc.: San

Perrin NE, Jaremko GA, and Berg UB. (2008). The effects of candesartan on diabetes

Pfister M, Schaedeli F, Frey FJ, and Uehlinger DE. (1999). Pharmacokinetics and

Qureshi AI, Suri MF, Kirmani JF, and Divani AA. (2005). Prevalence and trends of

Remuzzi G, Macia M, and Ruggenenti P. (2006). Prevention and treatment of diabetic renal disease in type 2 diabetes: the BENEDICT study. *J Am Soc Nephrol* 17:S90-7. Rossing K, Schjoedt KJ, Jensen BR, Boomsma F, and Parving HH. (2005). Enhanced

Rudberg S, Osterby R, Bangstad HJ, Dahlquist G, and Persson B. (1999). Effect of

Ruggenenti P, Schieppati A, and Remuzzi G. (2001). Progression, remission, regression of

Ruggenenti P, Perticucci E, Cravedi P, Gambara V, Costantini M, Sharma SK, Perna A, and

Sasamura H, Shimizu-Hirota R, and Saruta T. (2005). Extracellular matrix remodeling in

Sasamura H, Nakaya H, Julius S, Takebayashi T, Sato Y, Uno H, Takeuchi M, Ishiguro K,

Schiffrin EL, Deng LY, and Larochelle P. (1994). Effects of antihypertensive treatment on

Skov K, and Mulvany MJ. (2004). Structure of renal afferent arterioles in the pathogenesis of

Smallegange C, Hale TM, Bushfield TL, and Adams MA. (2004). Persistent lowering of

Stojiljkovic L, and Behnia R. (2007). Role of renin angiotensin system inhibitors in

Sun SZ, Wang Y, Li Q, Tian YJ, Liu MH, and Yu YH. (2006). Effects of benazepril on renal

treated with brief antihypertensive therapy. *Hypertension* 44:89-94.

of metalloproteinase-2 in diabetic rats. *Chin Med J (Engl)* 119:814-21.

Examination Surveys 1976 to 2000. *Med Sci Monit* 11:CR403-9.

diabetes and microalbuminuria. *Kidney Int* 68:1190-8.

diabetes mellitus. *Diabetologia* 42:589-95.

chronic renal diseases. *Lancet* 357:1601-8.

hypertension. *Curr Hypertens Rev* 1:51-60.

hypertension. *Acta Physiol Scand* 181:397-405.

rationale and study design. *Hypertens Res* 31:1851-1857.

*Am Soc Nephrol* 19:1213-24.

Suppl 3:S51-6.

13:1335-45.

glomerulopathy: a double-blind, placebo-controlled trial. *Pediatr Nephrol* 23:947-54.

haemodynamics of candesartan cilexetil in hypertensive patients on regular

prehypertension and hypertension in United States: National Health and Nutrition

renoprotective effects of ultrahigh doses of irbesartan in patients with type 2

angiotensin converting enzyme inhibitor or beta blocker on glomerular structural changes in young microalbuminuric patients with Type I (insulin-dependent)

Remuzzi G. (2008). Role of remission clinics in the longitudinal treatment of CKD. *J* 

Murakami M, Ryuzaki M, and Itoh H. (2008). Short treatment with the angiotensin receptor blocker candesartan surveyed by telemedicine (STAR CAST) study:

vascular remodeling in essential hypertensive patients. *J Cardiovasc Pharmacol* 24

pressure by transplanting kidneys from adult spontaneously hypertensive rats

cardiovascular and renal protection: a lesson from clinical trials. *Curr Pharm Des*

function and kidney expression of matrix metalloproteinase-2 and tissue inhibitor

dysfunction. *Nutr Metab Cardiovasc Dis* 19:816-24.

haemodialysis. *Br J Clin Pharmacol* 47:645-51.

Diego.


Lever AF, and Harrap SB. (1992). Essential hypertension: a disorder of growth with origins

Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J,

Liebau MC, Lang D, Bohm J, Endlich N, Bek MJ, Witherden I, Mathieson PW, Saleem MA,

Ma LJ, Nakamura S, Aldigier JC, Rossini M, Yang H, Liang X, Nakamura I, Marcantoni C,

Macconi D. (2010). Targeting the renin angiotensin system for remission/regression of

Macconi D, Sangalli F, Bonomelli M, Conti S, Condorelli L, Gagliardini E, Remuzzi G, and

Mauer M, Zinman B, Gardiner R, Suissa S, Sinaiko A, Strand T, Drummond K, Donnelly S,

McLennan SV, Kelly DJ, Cox AJ, Cao Z, Lyons JG, Yue DK, and Gilbert RE. (2002).

Morton JJ, Beattie EC, and MacPherson F. (1992). Angiotensin II receptor antagonist losartan

Moulder JE, Fish BL, Cohen EP, and Bonsib SM. (1996). Angiotensin II receptor antagonists

Nakaya H, Sasamura H, Hayashi M, and Saruta T. (2001). Temporary treatment of

Nakaya H, Sasamura H, Mifune M, Shimizu-Hirota R, Kuroda M, Hayashi M, and Saruta T.

Nankervis A, Nicholls K, Kilmartin G, Allen P, Ratnaike S, and Martin FI. (1998). Effects of

Neuringer JR, and Brenner BM. (1992). Glomerular hypertension: cause and consequence of

Ohtake T, Oka M, Maesato K, Mano T, Ikee R, Moriya H, and Kobayashi S. (2008).

mesangial proliferative glomerulonephritis. *Hypertens Res* 31:387-94.

chronic kidney disease. *Histol Histopathol* 25:655-68.

injury induced by ACE inhibition. *Am J Pathol* 174:797-807.

rat: lack of relation to vascular structure. *J Vasc Res* 29:264-9.

hypertensive nephrosclerosis. *J Am Soc Nephrol* 12:659-66.

a 3-year placebo-controlled biopsy study. *Metabolism* 47:12-5.

renal injury. *J Hypertens Suppl* 10:S91-7.

in the prevention of radiation nephropathy. *Radiat Res* 146:106-10.

and losartan in type 1 diabetes. *N Engl J Med* 361:40-51.

and Eknoyan G. (2003). National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. *Ann Intern Med* 139:137-

Pavenstadt H, and Fischer KG. (2006). Functional expression of the reninangiotensin system in human podocytes. *Am J Physiol Renal Physiol* 290:F710-9. Ma LJ, and Fogo AB. (2007). Modulation of glomerulosclerosis. *Semin Immunopathol* 29:385-

and Fogo AB. (2005). Regression of glomerulosclerosis with high-dose angiotensin inhibition is linked to decreased plasminogen activator inhibitor-1. *J Am Soc Nephrol*

Remuzzi A. (2009). Podocyte repopulation contributes to regression of glomerular

Goodyer P, Gubler MC, and Klein R. (2009). Renal and retinal effects of enalapril

Decreased matrix degradation in diabetic nephropathy: effects of ACE inhibition on the expression and activities of matrix metalloproteinases. *Diabetologia* 45:268-75.

has persistent effects on blood pressure in the young spontaneously hypertensive

prepubescent rats with angiotensin inhibitors suppresses the development of

(2002). Prepubertal treatment with angiotensin receptor blocker causes partial attenuation of hypertension and renal damage in adult Dahl salt-sensitive rats.

perindopril on renal histomorphometry in diabetic subjects with microalbuminuria:

Pathological regression by angiotensin II type 1 receptor blockade in patients with

in childhood? *J Hypertens* 10:101-20.

47.

95.

16:966-76.

*Nephron* 91:710-718.


**26**

*Colombia* 

**Health-Related Quality of Life in Chronic Renal** 

**Predialysis Patients Exposed to a Prevention** 

*School of Medicine, University of Antioquia, Pablo Tobón Uribe Hospital, Medellín,* 

Progressive transformation of disease profiles in the world can be partially explained by the existence of chronic diseases, as they are responsible for a large part of the worldwide morbidity and mortality rates, thus becoming pandemics. One of the diseases recognized as a public health problem is chronic renal failure (CRF) because of the negative impact it has on the health and health-related quality of life (HRQOL) of its sufferers (Atkins, 2005a,

The concept of HRQOL is still inaccurate because it has been approached from a variety of disciplines such as philosophy, economics, medicine, sociology, public health, politics,

According to the World Health Organization (WHO), HRQOL is the "individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns." (WHO, 2002) This concept includes physical and psychological aspects as well as the degree of independence, social relationships, environment and spirituality (Cardona et al., 2003). The approximately four hundred instruments for measuring HRQOL (Cardona & Agudelo, 2005) can be grouped into four categories: the ones that measure HRQOL in terms of its global definition, the ones using component-oriented approaches, those which focus on one component, and the combinations of any of the above (Fleury & Lana Da Costa, 2004).

The relationship between HRQOL in CRF patients and the treatment after renal failure has been studied repeatedly (Amoedo et al., 2004; De Alvaro et al., 1997; García et al., 2003; Leanza et al., 2000; Pérez et al., 2007; Rebollo et al., 1999, 2000a, 2000b; Sanz et al., 2004). However, there are insufficient studies on the relationship between early progression of renal damage and well-being (National Kidney Foundation [NKF], 2007). The recommendations of the Institute of Medicine (IOM) Workshop "Assessing Health and health-related quality of life Outcomes in Dialysis" are recorded in the KDOQI guidelines and supported by scientific evidence. The IOM recommends assessing the aforementioned relationship with valid, reliable, and useful instruments such as the Medical Outcomes

**1. Introduction** 

ethics, etc. (Cardona & Agudelo, 2005).

2005b).

**Program – Medellín, 2007-2008** 

Carlos E. Yepes Delgado, Yanett M. Montoya Jaramillo, Beatriz E. Orrego Orozco and Daniel C. Aguirre Acevedo

