L12

Question 1

What age bracket develops 2ary HTN

Answer 1

Too young for HTN: 30-50yo

Suddenly deteriorating w/ stable HTN

Question 2

What are LV hypertrophy, hypokalemia, and abdominal bruits all clues for?

Answer 2

2ary HTN

Question 3

Define chronic kidney disease

Answer 3

Damage to the renal tissue

↓# or fxn of nephrons

Question 4

Why does CKD cause HTN?

Answer 4

Damage to nephrons

1. ↑Na retention –> ↑BV
2. Stimulate sympa & RAAS –> vasoconstriction

Question 5

Define renovascular disease

Answer 5

Renal artery disease

• Atherosclerosis due to atheroma (=clots)
• Stenosis due to fibromuscular dysplasia

Question 6

What are two key clues for pts with HTN due to renovascular disease

Answer 6

↑↑plasma renin

Smokers

Question 7

Renovas pathology to cause HTN

Answer 7

Block causes ↓BF to kidney = ↓P
Thinks hypoperfusion is due to hypovolemia
↑renin

Question 8

What are the 2 products of ↑renin? How do the effect the kidney?

Answer 8

AGT 2 = constrict EFFERENT arteriole -> maintain GFR

Aldosterone = ↑Na retention + ↑K excretion

Question 9

What does the kidney secrete to try to maintain patency of the renal artery?

Answer 9

Prostaglandin I & E2

Question 10

What is the renovas response to ACE inhibitor or angiotensin receptor blocker?

Answer 10

X AGT2 
Efferent arteriole dilates 
- ↓GFR
SIGNIFICANT ↓↓BP ↑↑plasma renin
**Diagnostic for renovas disease as cause

Question 11

Diagnose renovas HTN

Answer 11

MR angiogram

Duplex doppler

Question 12

Treat renovas HTN

Answer 12

Same as coronary atherosclerosis

• Platelet inhibitors
• Anti-HTNs
• Anti-cholesterols

Question 13

What 2 adrenal abnormalities would cause HTN?

Answer 13

Adenoma = unilateral benign adrenal tumor
or
Hyperplasia = bilateral ↑tissue growth
BOTH release aldosterone = fluid retention = HTN

Question 14

Remember aldosterone mechanism

Answer 14

↑Na in @ collecting duct

↑K out via ENAC

Question 15

Labs for pts with excess aldosterone - electrolytes and hormones

Answer 15

↓K serum + ↑K urine
- Normal pt should have ↓K urine to try to compensate for low plasma levels
↑aldosterone + ↓renin - plasma levels

Question 16

Diagnose aldosterone excess as cause HTN

Answer 16

Saline loading test
- Induced hypervolemia - aldosterone stays high
+ Lasix
- No change renin levels b/c aldosterone overriding

Question 17

Treat adrenal carcinoma

Answer 17

Surgeru

Question 18

Treat adrenal adenoma

Answer 18

Surg if indicated - otherwise meds

Question 19

Treat adrenal hyperplasia

Answer 19

Eplerenone = mineralcorticoid receptor antagonist

Question 20

Which mineralcorticoid is in excess in Cushing’s disease?

Answer 20

Cortisol

Question 21

What other pts might have ↑cortisol

Answer 21

Pts on steroids (body builders)
Black licorice or chewing tobacco
- Inhibit B-11-hydroxylase

Question 22

Pathology of excess cortisol causing HTN

Answer 22

Excess –> acts on aldosterone R –> hypervolemia w/ hypokalemia

Question 23

3 enzymes that if you’re missing due to genetic defect will yield HTN

Answer 23

21, 12, or 11 hydroxylase

Question 24

Which genetic disease renders aldosterone useless b/c constitutive activation of Na reuptake channels in kidney?

Answer 24

Liddle’s syndrome

+ hypokalemia

Question 25

What is glucocorticoid remediable HTN?

Answer 25

Genetic

↓renin + ↑aldosterone (since controlled by ACTH due to genetic mutation instead of AGT 2)

Question 26

Treat glucocorticoid remediable HTN

Answer 26

+ exogenous minerocorticoid to suppress excess aldo = dexamethasone

Question 27

What is the name of adrenal medulla tumor that originates in chromaffin cells

Answer 27

Pheochromocytoma = excess NE & E

Question 28

Diagnose pheo

Answer 28

VMA in urine
or
Metanephrines in blood

Question 29

Treat pheo

Answer 29

ABCs
1st alpha blockers
2nd beta blockers
Catecholamine synthesis inhibitor

Question 30

2 types of sleep apnea

Answer 30

Central = drug related

Obesity