Nephron Number in Patients with Primary Hypertension

The presence of a relatively low number of nephrons at birth, which may gradually damage the kidney as a result of the increased workload per nephron, has been proposed as a major contributor to the development of hypertension. The authors tested this hypothesis by comparing histologic findings and the number and volume of glomeruli in 10 middle-aged white patients with a history of primary hypertension or left ventricular hypertrophy (or both) with those in 10 normotensive controls; all the subjects had died in accidents. Patients with hypertension had fewer glomeruli, a larger glomerular volume, and more severe arteriolosclerosis than did the controls.

The data support the hypothesis that the number of nephrons is reduced in some patients with primary hypertension.

Related Perspective

The Pattern of Alcohol Consumption and Coronary Heart Disease
It is widely accepted that moderate alcohol consumption protects against coronary heart disease. This large study in men adds new information by assessing the roles of the drinking pattern and the type of beverage consumed. Men who drank alcohol at least three to four times per week had a reduced risk of myocardial infarction. The association was strongest with beer and liquor, the predominant types of beverage consumed by this population.

The concept that a higher frequency of alcohol consumption (at least three to four days per week) provides enhanced protection against coronary disease is new, but it is tempered by an awareness of the known detrimental effects of alcohol consumption, such as hepatotoxicity and an increased risk of trauma.

Related Editorial

Treatment of Multidrug-Resistant Tuberculosis in Lima, Peru
This report describes a community-based outpatient treatment program for patients with chronic, multidrug-resistant tuberculosis. Probable cures were achieved in 55 of 66 patients who completed at least four months of individualized therapy. Predictors of a poor outcome were a low hematocrit and low body-mass index.

This program shows that effective outpatient treatment of multidrug-resistant tuberculosis is possible in an economically disadvantaged area. The results run counter to the conventional view that in low-income countries treatment of multidrug-resistant tuberculosis is too expensive and is not feasible outside referral centers.

Trends in Care by Nonphysician Clinicians in the United States
This study of data from national surveys of patients in 1987 and 1997 documents an increase in visits to nonphysician clinicians (e.g., nurse practitioners, physician assistants, and physical therapists) during this period. The increase was explained by a rise in the proportion of patients who received care from both physicians and nonphysician clinicians.

The increase in visits to nonphysician clinicians between 1987 and 1997 supplemented, rather than replaced, visits to physicians.

Related Editorial

Medical Progress: Pathophysiology and Treatment of Sepsis
Sepsis is the leading cause of death in critically ill patients in the United States. Yet the individual host response to septicemia is variable, depending on the patient's immune response, age, nutritional status, and coexisting conditions, as well as on the virulence of the organism and the size of the inoculum. This review examines evolving concepts of sepsis and discusses new and potential therapies. Recent clinical advances include therapy with activated protein C, stringent control of blood glucose, and early goal-directed therapy to treat cellular oxygen deficit. Future therapies may be focused on modulating the immune response in the light of the characteristics of the specific pathogen, the genetic profile of the patient, and the duration of the disease.

Complement C5a in the Sepsis Syndrome

In sepsis, activation of the complement system introduces large amounts of C5a into the circulation. The excess of this peptide paralyzes neutrophils and increases susceptibility to infection. In tissues, by contrast, C5a has effects on neutrophils that protect against infection. Neutralization of circulating C5a by an antibody protects against the lethal effects of sepsis in an animal model.

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