Figure 214

Mechanisms of glomerular injury in hypertension and progressive renal failure. This schematic diagram summarizes the general mechanisms by which disturbances linked to elevated arterial pressure in patients with parenchymal renal disease may lead to further tissue injury. Hemodynamic changes lead to increased glomerular perfusion pressures, whereas local activation of growth factors, angiotensin, and probably several other factors both worsen peripheral resistance and increase tissue fibrotic mechanisms. (From Smith and Dunn [1].)

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