Dustan HP
Does keloid pathogenesis hold the key to understanding black/white differences in hypertension severity?

Hypertension (Dec) 26:858 1995

The incidence of End-Stage Renal Disease attributed to hypertensive nephrosclerosis in the United States in 1991 was 29% and the ratio of black/white patients with this lesion is about 6:1. The reasons for the marked racial differences in the incidence of ESRD in the United States are unknown. In this clinical conference, Dustan points out that progressive renal disease may occur despite blood pressure lowering in hypertensive blacks, thus raising the possibility that other factors are important in progression of renal disease.

Keloids, benign tumors of the skin or cornea, occur much more frequently in blacks as compared to whites and recent evidence suggests that growth factors including transforming growth factor beta (TGF-B) and platelet-derived growth factor (PDGF) play an important role in the pathogenesis of keloids. Dustan hypothesizes that differences in the production or action of these cytokines which are known growth factors for both fibroblasts and vascular smooth muscle cells may be one reason for the racial differences in ESRD. Blacks with hypertensive nephrosclerosis exhibit changes in blood vessels which resemble atherosclerosis: hypertrophy, increased extracellular matrix, increased collagen and luminal narrowing. In relation to this process she points out that cytokines, in particular TGF-B may play an important role in the pathogenesis of glomerulosclerosis in hypertension as has been shown for patients with glomerulonephritides. She suggest the renal vasculature of blacks may be more susceptible to the effects of hypertension because of differences in the response of renal cells to growth factors inlcuding TGF-B and PDGF.

The hypothesis is very reasonable considering that we are still uncertain as to whether blood pressure lowering per se can prevent progressive renal disease in patients with established renal insufficiency caused by hypertension. Both basic and clinical studies aimed at better understanding of the pathogenesis of the renal disease and its treatment in relation to these and other growth factors is an important priority in nephrology. (Toto)

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H: Special problems : Ethnic populations