L12 Flashcards
What age bracket develops 2ary HTN
Too young for HTN: 30-50yo
Suddenly deteriorating w/ stable HTN
What are LV hypertrophy, hypokalemia, and abdominal bruits all clues for?
2ary HTN
Define chronic kidney disease
Damage to the renal tissue
↓# or fxn of nephrons
Why does CKD cause HTN?
Damage to nephrons
- ↑Na retention –> ↑BV
- Stimulate sympa & RAAS –> vasoconstriction
Define renovascular disease
Renal artery disease
- Atherosclerosis due to atheroma (=clots)
- Stenosis due to fibromuscular dysplasia
What are two key clues for pts with HTN due to renovascular disease
↑↑plasma renin
Smokers
Renovas pathology to cause HTN
Block causes ↓BF to kidney = ↓P
Thinks hypoperfusion is due to hypovolemia
↑renin
What are the 2 products of ↑renin? How do the effect the kidney?
AGT 2 = constrict EFFERENT arteriole -> maintain GFR
Aldosterone = ↑Na retention + ↑K excretion
What does the kidney secrete to try to maintain patency of the renal artery?
Prostaglandin I & E2
What is the renovas response to ACE inhibitor or angiotensin receptor blocker?
X AGT2 Efferent arteriole dilates - ↓GFR SIGNIFICANT ↓↓BP ↑↑plasma renin **Diagnostic for renovas disease as cause
Diagnose renovas HTN
MR angiogram
Duplex doppler
Treat renovas HTN
Same as coronary atherosclerosis
- Platelet inhibitors
- Anti-HTNs
- Anti-cholesterols
What 2 adrenal abnormalities would cause HTN?
Adenoma = unilateral benign adrenal tumor
or
Hyperplasia = bilateral ↑tissue growth
BOTH release aldosterone = fluid retention = HTN
Remember aldosterone mechanism
↑Na in @ collecting duct
↑K out via ENAC
Labs for pts with excess aldosterone - electrolytes and hormones
↓K serum + ↑K urine
- Normal pt should have ↓K urine to try to compensate for low plasma levels
↑aldosterone + ↓renin - plasma levels
Diagnose aldosterone excess as cause HTN
Saline loading test
- Induced hypervolemia - aldosterone stays high
+ Lasix
- No change renin levels b/c aldosterone overriding
Treat adrenal carcinoma
Surgeru
Treat adrenal adenoma
Surg if indicated - otherwise meds
Treat adrenal hyperplasia
Eplerenone = mineralcorticoid receptor antagonist
Which mineralcorticoid is in excess in Cushing’s disease?
Cortisol
What other pts might have ↑cortisol
Pts on steroids (body builders)
Black licorice or chewing tobacco
- Inhibit B-11-hydroxylase
Pathology of excess cortisol causing HTN
Excess –> acts on aldosterone R –> hypervolemia w/ hypokalemia
3 enzymes that if you’re missing due to genetic defect will yield HTN
21, 12, or 11 hydroxylase
Which genetic disease renders aldosterone useless b/c constitutive activation of Na reuptake channels in kidney?
Liddle’s syndrome
+ hypokalemia
What is glucocorticoid remediable HTN?
Genetic
↓renin + ↑aldosterone (since controlled by ACTH due to genetic mutation instead of AGT 2)
Treat glucocorticoid remediable HTN
+ exogenous minerocorticoid to suppress excess aldo = dexamethasone
What is the name of adrenal medulla tumor that originates in chromaffin cells
Pheochromocytoma = excess NE & E
Diagnose pheo
VMA in urine
or
Metanephrines in blood
Treat pheo
ABCs
1st alpha blockers
2nd beta blockers
Catecholamine synthesis inhibitor
2 types of sleep apnea
Central = drug related
Obesity
