Pivotal Role of the Kidney in Hypertension
The kidneys play a pivotal role in causing some forms of hypertension and probably a permissive role in most, if not all, forms of hypertension. This concept of the critical role of the kidneys has been postulated for many years but has been solidified by the molecular unraveling of several monogenic forms of hypertension such as Liddle's syndrome, apparent mineralocorticoid excess and glucocorticoid-remedial aldosteronism. These and other hypertensive disorders cause sodium retention through excess Na reabsorption in the distal nephron. Some disorders of salt wasting and relative hypotension such as Bartter's syndrome, Gitelman's syndrome and pseudohypoaldosteronism also localize to Na transport abnormalities in the distal nephron. Hypertensive in the general population may also result from subtle abnormalities in sodium balance resulting from alterations in the distal nephron.