HTN, Diabetes & the Kidney Flashcards
What is the definition of hypertension?
Raised blood pressure in the systemic vascular bed >140/90mmHg
Hypertension is divided into normal, pre-HTN. Stage 1 and Stage 2.
A patient has a blood pressure of 119/79.
What category is this BP?
Normal
as normal is <120/80
Hypertension is divided into normal, pre-HTN. Stage 1 and Stage 2.
A patient has a blood pressure of 138/89
What category is this BP?
Pre-HTN
as Pre-HTN ==> 120-139 / 80-90
Hypertension is divided into normal, pre-HTN. Stage 1 and Stage 2.
A patient has a blood pressure of 159/99
What category is this BP?
Stage 1
140-159 / 90 - 99
Hypertension is divided into normal, pre-HTN. Stage 1 and Stage 2.
A patient has a blood pressure of 162/102
What category is this BP?
Stage 2 BP as it is ==>
>160 / 100
95% of cases of hypertension are called essential HTN.
What is this?
no identifiable underlying cause found
Essential HTN is TF diagnosed in absence of an identifiable secondary cause
~5% of cases of HTN are secondary. What does secondary HTN mean?
What are examples of the causes of it?
There is an identifiable underlying cause found.
- Chronic renal disease
- Coarctation of aorta
- Endocrine disease
- raised intracranial pressure (cushings reflex)
- toxaemia of pregnancy / pre-exlampsia
- drugs
What drugs cause (secondary) HTN?
Steroids
OCP
NSAIDs
What endocrine disease cause secondary HTN?
- Cushings (hypersecretion of cortisol)
- Conns (adrenal glands = too much aldosterone)
- Phaeochromocytoma (adrenaline tumour)
- Acromegaly (GH excess)
What types of chronic renal disease cause secondary HTN?
e.g.
- diabetic nephropathy,
- obstructive nephropathy,
- renal vessel disease (RAS),
- adult polycystic kidney disease,
- chronic glomerulonephritis;
- acute glomerulonephritis
- (HTN presenting feature of nephritic syndrome aka nephritic = olido/haematuria, HT, proteinuria and red cell casts
- seen in IgA nephropathy,
- post-infectious GN,
- lupus nephritis);
- (HTN presenting feature of nephritic syndrome aka nephritic = olido/haematuria, HT, proteinuria and red cell casts
- autoimmune
- (vasculitis, systemic sclerosis),
- pyelonephritis,
- renal artery stenosis
Renin release from JGA & RAAS activation causing vasoconstriction & Na retention
What problem does HTN cause in the kidney?
Hyaline arteriosclerosis (thickening and hardening) in renal arterioles
–> chronic and progressive renal ischaemia
–> tubular atrophy & progressive glomerular sclerosis
–> progressive CKD - small, atrophied & fibrosed kidneys
= Visicious cycle of worsening HTN and CKD!
NB: basically every thing becomes sclerosed starting with renal arterioles then the glomeruli from the ischaemia then the kidneys as a whole and you get CKD as a result –> worsens HTN
What do small, atrophied and fibrosed kidneys indicate?
Progressive CKD!
Every person with DM should be screened annually for what?
microalbuminuria
+ a urine dip at every clinic appointment
Why is detecting microalbuminuria in DM pts important?
give early warning of impending renal problems
is also an RF for cardiovascular disease (HTN etc)
if positive for microalbuminuria, 30-300mg albumin/24 hrs (normal = <20) –> ACEi or ARB irrespective of BP! (ACEi are renoprotective over LT)
Does DM cause nephrotic or nephritic syndrome?
DM is a systemic cause of nephrotic syndrome
- significant proteinuria
- hypo-albuminaemia
- oedema
(hypercholesterolaemia/hyperlipidaemia, pro-coagulant/hypercoagulability, frothy urine)
