B4-042 Renal Failure due to Hypertension Flashcards
in young patients, HTN is usually due to
high cardiac output
in adult patients, HTN is usually due to
increased TPR
- no obvious underlying cause
- diagnosis of exclusion
- 90-95% of hypertension
primary HTN
damage of the kidney due to chronic renal HTN
hypertensive kidney disease
GFR <60 mL/min/m2
chronic kidney disease
two main causes of CKD
- diabetes
- HTN
signs of CKD
6
- HTN
- peripheral edema
- SOB
- chest pain
- decreased GFR
- increased creatinine/BUN
dictate filtration in capillary beds
starling forces
hydrostatic pressure > oncotic pressure
filtration
in the beginning, HTN causes […] filtration
increased
tapers over time due to damage
in the beginning of HTN, the increased intraglomerular pressure will result in […] GFR
increased or maintained
over time of HTN, vessel damage will lead to […] GFR
decreased
decreased perfusion results in
2
- glomerular damage (podocyte effacement, detachment)
- microalbuminuria/proteinuria
damage of […] allows passage of proteins into urine
glomerular membrane
damage to the glomerulus causes proliferation of mesangial cells. proliferation of mesangial cells causes
2
- decreased filtration (due to capillary compresion)
- increased renin production
angiotensin 2 causes
2
- vasoconstriction
- Na+ retention
low perfusion of the kidney causes increased sympathetic nerve activity resulting in
vasoconstriction
as GFR decreases, the amount of plasma creatinine
increases
BUN/Cr> 15 indicates
glomeruli more affected than tubules
urea retained
BUN/Cr<15 indicates
tubules more affected
decreased urea reabsorption
decreased GFR causes […] retention, leading to volume overload
sodium
edema, HTN
treatment of CKD
- treat HTN
- sodium restriction
- diuretics
first manifestation of renal hypertensive disease
microalbuminuria
ACE inhibitors block the conversion of
angiotensin 1 to angiotensin 2
which would you expect to be reduced in the plasma of a patient on an ACE?
angiotensin 2
water retention and tissue edema is caused by
sodium retention
provides best assessment of kidney function
creatinine in plasma
renal insufficiency is commonly accompanied by
anemia
the kidney produces […], important for RBC production
EPO
renal insufficiency causes the rention of […] in plasma
2
urea
creatinine
plasma potassium […] in renal insufficiency
increases
renal insufficiency causes anemia due to
decreased EPO production
the kidney participates in the activation of vitamin D to
calcitriol
calcitriol is vital for maintaining
bone density
continuous high pressure results in the […] of the renal arteriole wall
hyalinization
