الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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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
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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.
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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.