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nephro Boards > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the definition of resistant hypertension?

A

uncontrolled HTN despite being on 3 antihypertensive agents, including at least one diuretic

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2
Q

what imaging test helps locate pheochromocytoma

A

MIBG imaging.
It detects tiny amounts of an injected radioactive compound taken up by pheochromocytomas or paragangliomas.

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3
Q

Fibromusclar dysplasia is most common in which common combination of gender and race?

A

white women

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4
Q

FMD can affect vessels other than the renal arteries. which is the most common?

A

Brain circulation.

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5
Q

what adrenal hormone is elevated in HTN associated with Cushing syndrome?

A

Cortisol. Cortisol has mineralocorticoid activity but is typically inactivated in the kidney by renal 11-beta-hydroxysteroid dehydrogenase unless cortisol levels are so high that they overwhelm the enzyme OR the enzyme is inactivated by glycyrrhizic acid a/w licorice

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6
Q

name a potential cause if a patient presents with HTN, hypokalemia, and low aldosterone. (hint: 3)

A
  1. Cushing hypercortisolism 2. liddle syndrome 3. apparent mineralocorticoid excess or real licorice intake (not twizzlers)
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7
Q

name a disorder that a patient with hypokalemia, HTN, high renin and high aldosterone have. (hint:3)

A
  1. reninoma 2. renal artery stenosis 3. malignant HTN
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8
Q

in a patient with uncontrolled HTN and CKD, which is the most important: blocking SY outflow, blocking aldosterone, or reducing ECV?

A

reducing ECV is most important

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9
Q

what is the cause of HTN that develops after blunt trauma to the kidney?

A

Page kidney. compression of the renal parenchyma causes renal swelling confined in the renal capsule, decreasing renal blood flow and leading to increased renin/ aldosterone HTN (HTN)

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10
Q

what is the BP threshold for ruling out white coat HTN?

A

BP > 160/100 should not be blamed on white coat HTN. Treatment is required

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11
Q

name 3 patient characteristics that would prompt a secondary workup for HTN?

A
  1. extremes of age, 2. significantly elevated BP 3. unprovoked hypokalemia 4. abdominal bruit 5. variable BP with tachycardia, sweting and tremor, 6. family history 7. poor response to therapy
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12
Q

what cells in the kidney are affected when a renin-secreting tumor is present?

A

Juxtaglomerular cells.
treat with ACEI, ARBs or surgery

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13
Q

what is the cause of hypertension when there is a difference in BP between the arms and the legs?

A

Coarctation of the aorta. Especially if the coarctation is distal to the left subclavian artery

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14
Q

when checking serum aldosterone and renin, how long should spironolactone be stopped before measurement?

A

2 weeks

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15
Q

what is deficient in apparent mineralocorticoid excess syndrome?

A

11-beta-hydroxysteroid dehydrogenase. This enzyme usually converts cortisol to cortisone, which means that cortisol is not available to stimulate Na retention and K wasting. It can be congenital or acquired (licorice or posaconazole) and there will be excess cortisol and low aldosterone.

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16
Q

how do VEGF inhibitors cause HTN?

A

VEGF inhibitors decreases NO production & so it increases vascular resistance

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17
Q

Usually the goal of HTN emergency is to decrease SBP by 25% from the baseline but there are exceptions, name 4 conditions and their goal BP

A
  1. preeclampsia, goal is SBP < 140
  2. intracranial hemorrhage, goal is SBP < 140
  3. aortic dissection, goal is SBP 100-120 within 20 minutes
  4. ischemic stroke (keep higher level for longer)
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18
Q

what disorder includes altered mental status in a person without evidence of stroke, significant HTN or characteristic findings on MRI?

A

posterior reversible encephalopathy syndrome (PRES)

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19
Q

name 3 genetic HTN syndromes that follow an autosomal dominant pattern of inheritance

A
  1. Liddle syndrome
  2. Glucocorticoid suppressible hyperaldosteronism
  3. Geller syndrome
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20
Q

what is a rare autosomal dominant syndrome that cause new onset or worsening HTN with hypokalemia during pregnancy?

A

Geller syndrome.
There is an activating mutation of the mineralocorticoid receptor. Progesterone (& spironolactone) acts as an agonist on the MR, leading to salt reabs. and K wasting. (normally, progesterone acts as an MR antagonist) The renin and aldosterone levels are low (vs primary aldosteronism which has low renin and high aldosterone)

21
Q

Name 2 conditions associated with low renin, high aldosterone HTN syndrome

A

primary aldosteronism, glucocorticoid remediable aldosteronism

22
Q

True or false, a normal serum K rules out primary hyperaldosteronism

A

False

23
Q

what enzyme can be inhibited by substances containing glycyrrhizic acid?

A

11-beta-hydroxysteroid dehydrogenase

24
Q

does licorice induced HTN have low or high renin and low or high aldosterone?

A

low renin and low aldosterone

25
Q

What is the aldosterone:renin ratio and aldosterone level in primary aldosteronism?

A

ARR > 20
Aldosterone > 12

26
Q

If the ARR and aldosterone is suggestive of primary aldosteronism, what is the next diagnostic step?

A

Abd CT with adrenal vein sampling

27
Q

What is the lateralization ratio that suggests a unilateral adenoma?

A

Lateralization ratio > 4

28
Q

What is the next step if the aldosterone and renin are equivocal but you still suspect underlying primary aldosteronism?

A

Saline suppression test
(How? Give 2L of NSS for 4 hours, with aldosterone levels pre and post)
Primary aldo: aldosterone will still be high, > 5

29
Q

Treatment for liddle syndrome

A

Amiloride (blocks ENaC)

Liddle syndrome- gain of function mutation of ENaC; high Na, low K, volume retention suppresses renin and aldo

30
Q

Treatment for glucocorticoid remediable aldosteronism (GRA)

A

Steroids - to suppress ACTH

GRA: ACTH causes aldosterone production

31
Q

What is the next drug to add if a patient has uncontrolled resistant Hypertension, on 3 meds including a diuretic?

A

add spironolactone (an MR antagonist)

32
Q

What is the defect in Liddle syndrome?

A

Gain of function mutation of ENaC, resulting in increased number of functioning ENaC

33
Q

what is the genetic defect in glucocorticoid remediable aldosteronism?

A

an autosomal dominant condition caused by the chimeric fusion between the promoter region of the gene encoding 11β-hydroxylase, which responds to ACTH, and the gene encoding aldosterone synthase. he net effect of this defect is ACTH-dependent activation of aldosterone synthase and hyperaldosteronism, although patients with GRA often have normal potassium levels

34
Q

what is the genetic defect in syndrome of apparent mineralocorticoid excess (SAME)?

A

autosomal recessive inheritance pattern and is caused by a deficiency of 11β-hydroxysteroid dehydrogenase enzyme type 2, which normally detoxifies cortisol to cortisone; in this condition Cortisol levels are high

35
Q

What is the mechanism of HTN in a subscapular renal hematoma, aka Page Kidney?

A

high BP is renin mediated

36
Q

What antihypertensive is contraindicated in patients with Geller syndrome

A

Spironolactone

37
Q

What is the syndrome that causes an autosomal dominant hypertension, hyperkalemia and NAGMA?

A

Gordon syndrome
aka Familial hyperkalemic hypertension

38
Q

What is the mutation in Gordon syndrome?

A

inactivating mutation in WNK4 and activating mutation in WNK1

Inactivation of WNK4 leads to increased NaCl reabsorption

39
Q

Treatment for Gordon syndrome?

A

Thiazides and salt restriction

40
Q

what enzyme can be inhibited by substances containing glycyrrhizic acid?

A

11-beta-hydroxysteroid dehydrogenase

41
Q

does licorice induced HTN have low or high renin and low or high aldosterone?

A

low renin and low aldosterone

42
Q

type A aortic dissection is managed, medically or surgically?

A

surgically

43
Q

type B aortic dissection is managed, medically or surgically?

A

medically. give esmolol or labetalol, target SBP 100-120 in 20 minutes

44
Q

Treatment for liddle syndrome

A

Amiloride (blocks ENaC)

Liddle syndrome- gain of function mutation of ENaC; high Na, low K, volume retention suppresses renin and aldo

45
Q

Treatment for glucocorticoid remediable aldosteronism

A

Steroids - to suppress ACTH

GRA: ACTH causes aldosterone production

46
Q

what is the pathophysiology of alcohol induced hypertension?

A

related to increased intracellular calcium in the arterial smooth muscle cells caused by excess alcohol consumption

47
Q

what resistive index is suggestive of renovascular hypertension?

A

resistive indices > 0.7

48
Q

a patient with controlled hypertension but non-dipping pattern should undergo what type of testing?

A

polysomnography to evaluate for OSA

49
Q

what is the target BP in the management of hypertensive urgency?

A

treat with oral antihypertensives, with goal BP reduction of 25% over 48 hours

nephro Boards (9 decks)

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