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Renal Changes in Hypertension *

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RENAL CHANGES IN HYPERTENSION* H. E. MACMAHON It is customary, in dealing with the problem of hypertension, to divide it roughly into two groups-"primary" or "essential" hyper- tension, and "renal" hypertension, the latter being secondary to dis- eases of the urinary system. This group comprises not only states of renal insufficiency due to glomerular and tubular injury, but also a variety of extra-renal conditions which may lead to urinary reten- tion. In "essential" hypertension, on the other hand, the cardio- vascular system appears to play the dominant rOle, and renal path- ology, if present, occurs simultaneously or more often secondarily as the result of changes in the vascular tree. The terms "essential" and "primary" hypertension are not ideal, at least from the stand- point of pathology, as they suggest a disease entity per se, rather than a mere sign of disease. There appears to be good evidence that a number of conditions may exist-for example, various endo- crine disturbances-which may precede and upon which vascular pathology, both functional and morphological, -may depend. Furthermore, in cases of long standing "essential" hypertension, the resulting vascular changes, through the development of arteri- olosclerosis and capillary fibrosis, may readily contribute to the eti- ology of this so-called "primary" disease, thus setting up a vicious circle. This brief report is restricted to a consideration of the renal changes in "primary" hypertension. A description of the gross and microscopic changes in the kidney in the varied forms of "renal" hypertension, including glomerulonephritis, the nephroses, pyelo- nephritis, etc., is quite beyond the scope of such a paper. A study of a large number of cases belonging to the group of "primary" hypertension quickly shows that one is not dealing with a single but with several clinical syndromes. For clarity the follow- ing grouping may be used: (1) A group of young to middle-aged individuals showing only *Presented before the Yale Medical Soc

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