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MHD V: Renal > 11.4: Htn > Flashcards

11.4: Htn Flashcards

1
Q

What is blood pressure a product of?

A
  1. Cardiac output

2. Systemic vascular resistance

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2
Q

MAP equation

A

MAP = DBP + (SBP - DBP) / 3

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3
Q

What impacts stroke volume related to kidney?

A

Na balance

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4
Q

How does kidney in pact peripheral resistance?

A

RAS leads to vasoconstriction

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5
Q

Is hypertension usually result of increase CO or PVR?

A

Usually increased PVR

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6
Q

What are EDRF and endothelin?

A

Endothelium: causes constriction
EDRF: Causes dilation

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7
Q

What does increased adrenergic tone lead to?

A

Hypertension

  1. Increases vasc tone
  2. Increases NA Retention
  3. Increases inotropy
    - Blockade of sympathetics reduces BP
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8
Q

Effects of angiotensin II?

A
  1. Vasoconstriction
  2. Na resorption in prox tubule
  3. Increases aldosterone: increases Na reabsorption in ducts
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9
Q

Effect of salt on Htn.?

A
  • Increases BP
  • There is a subset of hypertensives who show exaggerated increase
  • It is recommended everyone should restrain Na although it does not impact everyone
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10
Q

What is the guyton hypothesis?

A

“Pressure natriuresis”

  • Kidneys regulate arterial pressure by altering renal Na and water excretion
  • Pressure goes up, excretion goes up
  • In Htn., pressure natriuresis is maintained at higher BPs
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11
Q

What is monogenic Htn. usually result of?

A
  • Na retention

- Most hypertension is polygenic

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12
Q

Role of kidneys in development of Htn.?

A
  • Pressure natriuresis is abnormal in all types of Htn.

- No particular renal defect has been determined however

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13
Q

Main causes for secondary Htn.?

A
  1. Kidney disease
  2. Renal artery stenosis
  3. Hyperaldosteronism
  4. Pheochromocytoma
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14
Q

Volume mediated causes of secondary hypertension?

A 
Non renal:
1. Hyperaldosteronism
2. Cushings
3. Mineralocorticoid tumors
Renal:
1. Renal failure
2. Acute glomerulonephritis
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15
Q

Vasoconstrictor mediated causes of secondary Htn.?

A
  1. Pheochromocytoma
  2. Unilateral renal artery stenosis
  3. Hypercalcemia
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16
Q

What is pheochromocytoma?

A
  • Tumor of Adrenal medulla
  • Enormous Ne productions
  • Leads to massive vasconstriction
17
Q

How is pheochromocytoma treated?

A
  • Surgery is standard of care
  • Phenoxybenzamine or Phentolamine used before surgery
  • These are Adrenergic blockers
18
Q

What does hypercalcemia cause?

A
  1. Enters smooth muscle cells and causes vasoconstriction
19
Q

Clinical presentation of renal artery stenosis?

A
  1. Severe and Difficult to control Htn.
  2. Kidney failure
  3. Flash pulmonary edema
20
Q

Disease processes of renal stenosis?

A
  1. Atherosclerotic 95%

2. Fibromuscular dysplasia

21
Q

Physiology when one kidney is stenosed?

A
  • Ischemic kidney releases renin
  • Healthy kidney has suppressed renin but demonstrates pressure natriuresis
  • Htn develops because ischemic kidney cant turn off RAS
  • **Treat by blocking RAS system of fix kidney
22
Q

How is treatment of stenosis different if ptn. only has solitary kidney?

A
  • RAS inhibitors can be used

- However, must also couple with diuretic as don’t have healthy kidney to decrease volume

23
Q

Problem in bilateral renal stenosis?

A
  • Both kidneys have increased RAS

- Neither can diurese so volume is problem

24
Q

Effect of excess aldosterone?

A
  • Increased Na and H2O retention leading to Htn.
25
Q

What is hyperaldosteronism usually a result of?

A
  • Adrenal hyperplasia
  • Tumor is rare
  • Diagnosed by high ADH w/ low Angiotensin
  • Ratio > 35% means primary aldosteronism
26
Q

How does kidney disease lead to Htn?

A
  • Decrease GFR leads to decrease Na/H20 excretion
  • Leads to excess volume worsening Htn.
  • In advanced kidney disease, Htn is volume related
27
Q

What leads to fibrinoid necrosis?

A

Malignant Htn.

28
Q

Kidney size change in essential and malignant Htn.?

A

Essential: Kidney size shrinks, hyaline arteriosclerosis
Malignant: Fibrinoid necrosis seen, normal kidney size

29
Q

What are the characteristics malignant retinopathy?

A
  1. Flame shaped hemorrhages
  2. Cotton wool exudates
  3. Papilledema
30
Q

How do kidneys protect self in systemic htn.?

A
  • Vasoconstriction of afferent arteriole
31
Q

What is autoregulatory range of kidney?

A
  • 60 -160 mmHg

- Beyond this GFR increase dramatically

32
Q

2 Mechanisms of autoregulation of GFR?

A
  1. Myogenic response

2. Tubuloglomerular feedback

33
Q

What is the myogenic response?

A
  • Reflex vasoconstriction of afferent in response to increase pressure by smooth muscle contraction
  • Can also be dilation
  • **Main mechanism of autoregulation
34
Q

What impairs autoregulation of kidneys?

A
  • Dihydropyridine Ca antagonists
  • Prevent normalization of glomerular pressure
  • Prevent Ca from entering which normally would allow for constriction
35
Q

Impact of dihydropyridine Ca antagonists?

A

Disables ability of kidneys to autoregulate

36
Q

Contraindications of dihydropyridine Ca antagonists?

A
  1. Renal disease

2. Proteinuria

37
Q

Impact of diabetes on autoregulation?

A

Impairs it

38
Q

In which form of renal stenosis is htn volume related? RAS?

A

RAS: unilateral, treat with blockers
Volume: Bilateral, one kidney,

MHD V: Renal (28 decks)

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