Joel L. Chinitz

Hemodynamics of Hypertension in Chronic End-Stage Renal Disease

This study was undertaken to define the hemodynamic changes in hypertension of chronic end-stage renal disease. Mean cardiac index in 75 uremic patients was higher (P < 0.001) than that of 42 normal volunteers while stroke index was not different from normals. The higher cardiac indices of uremic patients were accounted for by increased heart rates. Despite the significantly higher blood pressure in the uremics, their mean total peripheral resistance index was not different from that of normals.The total group of 75 patients included 52 hypertensive and 23 normotensive uremics. Cardiac index, heart rate, and stroke index were the same in 52 hypertensive and 23 normotensive uremics while mean total peripheral resistance index of hypertensive uremics was higher (P < 0.001) than normotensive uremics. Therefore, the hypertension in end-stage renal disease is sustained by a high total peripheral resistance.Bilateral nephrectomy in 12 hypertensive uremics resulted in no changes in cardiac index; a consistent decrease in blood pressure (P < 0.001) and a decrease in total peripheral resistance index (P < 0.001) occurred. Bilateral nephrectomy in eight additional uremics with malignant hypertension resulted in an actual increase in cardiac index (P < 0.001) with a consistent reduction in blood pressures (P < 0.001) and an even more dramatic decrease in total peripheral resistance (P < 0.001).These findings imply that a vasopressor substance of renal origin increasing peripheral resistance is the major factor in the pathophysiology of renal hypertension in the late stage of its natural history.

Esophageal varices in adult patients with polycystic kidney and liver disease.

IN the cases presented below, two middle-aged patients had polycystic kidneys and esophageal varices secondary to polycystic liver disease. One patient died after hemorrhage, which might have been ...

Radiological Contrast Study of Arteriovenous Dialysis Cannulae

Abstract Radiographic contrast studies of shunts are helpful in defining the causes of cannula dysfunction. X -ray examination has confirmed the presence of thrombi and revealed the adequacy of declotting procedures, indicating circumstances under which such techniques should be avoided. Radiographic studies provide a sound anatomical basis for the selection of shunt sites. Dilute contrast media are recommended.

Surgical Correction of Uremic Constrictive Pericarditis

Abstract Constrictive pericarditis developed in two patients on home hemodialysis. Diagnosis in each case was confirmed by cardiac catheterization, and both patients were successfully treated by pe...

Clonidine, a New Potent Antihypertensive Agent.

Excerpt Clonidine (Catapres⌖) is a new imidazoline derivative with potent antihypertensive effect. The acute hemodynamic effects of Clonidine were evaluated in seven hypertensive patients. Two dist...

Bilateral Carotid Sinus Nerve Electrical Stimulation (Baropacer) Therapy of Refractory Hypertension.

Excerpt Eight patients with moderate to severe essential hypertension were treated with implanted bilateral carotid sinus-nerve electrical stimulator (Baropacer). All patients were either refractor...