1: HTN and the Kidney

Question 1

Explain relationship between kidney and HTN

Answer 1

• Renal disease can cause or exacerbate HTN

- HTN causes glomerulosclerosis that can worsen renal disease

Question 2

What are the two types of HTN

Answer 2

Primary HTN

Secondary HTN

Question 3

What are the 3 etiological categories of secondary HTN

Answer 3

• Endocrine
• Renal
• Other

Question 4

What are the endocrine causes of HTN

Answer 4

• Conn’s syndrome
• Cushing’s syndrome
• Pheochromocytoma
• Hyperthyroidism
• CAH

Question 5

What are the renal causes of secondary HTN

Answer 5

Intrinsic renal disease (75%)

• Glomerulonephritis
• ADPKD
• Polyarteritis nodosa
• Systemic sclerosis

Renovascular disease (15%)
- Renal artery stenosis

Question 6

What are 3 other causes of HTN

Answer 6

• Coarctation
• OSA
• Medications (COCP, NSAIDs, Cocaine, Amphetamines)

Question 7

Describe pathophysiology of HTN on the kidney

Answer 7

HTN causes narrowing of the renal artery which reduces blood supply to nephrons. This decreases GFR. A drop in GFR stimulates juxtaglomerular cells to release renin increasing RAAS- results in HTN. This causes a cycle where further narrowing causes a drop in GFR. Eventually leads to ischaemia causing glomerulosclerosis

Question 8

If CKD patients are non-diabetic and do not have proteinuria, what is BP target

Answer 8

<140/90

Question 9

If CKD patients have proteinuria what is BP target

Answer 9

<130/80

Question 10

What is first-line for HTN in CKD

Answer 10

Restrict salt intake to less-than 2g/day

Exercise

Question 11

What is second-line for HTN in CKD

Answer 11

ACEi

Question 12

If eGFR drops below 45 or ACEi are ineffective. what is added

Answer 12

Furosemide