12 Secondary HTN Flashcards
“describe the mechanism of how chronic kidney disease causes HTN”
“nephron damage makes others have to work harder
salt retention, RAS and SNS induced, NO synthesis disturbed as a result
“
angiotension II functions
- induce aldosterone
- stimulate SNS centrally/peripherally
- vasoconstricts(preferentially efferent arteriole to maintain GFR)
- salt retention
- degrades bradykinin(and indirectly reduces PGIs)
if a patient’s SBP drops 30mmHg or more on an ACEi and blood renin spikes, what is at the top of your DDx?
renovascular HTN
types of renovascular hypertension(RVH)
fibromuscular dysplasia
atheroma related stenosis
characteristics of renovascular HTN
severe and abrupt in onset
abdominal bruit
low K
elevated BUN/creatinine
spironolactone
antagonist to aldosterone’s binding site
manifestations of adrenal disease causing HTN
adenoma, hyperplasia, carcinoma
describe the relationship between aldosterone and renin normally
describe the relationship in adrenal disease
usually renin induces aldosterone
in adrenal disease, they are dissociated so that even if there is no renin, aldosterone will be high
signs of pheochromocytoma
HTN
HAche
Sweating
Palpitations
Nausea
Vomiting
Chest pain
CHPS HANV pheo
medications prior to pheochromocytoma surgery
phenoxybenzamine(irreversible a1/2 blocker)
phentolamine(reversible a1/2 blocker)
types of congenital adrenal hyperplasia(CAH)
“21bH deficiency - salt wasting/hypotension/virilization 90% of all CAH
11bH deficiency - elevated deoxycorticosterone which can bind aldo receptors
17bH deficiency - pseudohermaphroditism for boys; amenorrhea girls
“
liddle’s syndrome
constitutively active Na+ channels
excessive reabsorption –> HTN, hypokalemia
NO ALDOSTERONE DETECTED
glucocorticoid remeidable HTN
hyperaldosteronism caused by ACTH induced aldosterone production
usually ACTH does not have this relationship
