Mod3 Flashcards
Secondary causes of HTN
Sleep apnea Sns drugs CKD increases RAAS Primary aldosteronism Plaques Cushing Pheo Thyroid / pth Coarctation
Normotensive value
Less than 120
Pre HTN value
120-139
Stage 1 HTN
140-159
Stage 2 htn
160+
Other stuff to reduce htn
Reduce Na intake and increase k (DASH diet)
Limit alc
For CV get Ca and Mg
Reduce sat fat and cholesterol
What drugs do you give for stage 1 HTN
Without other issue
Give thiazides and maybe ACI ARB CC BB combo tx
Drugs given for stage 2 htn
2 drug combo first
Thiazide and other (see prev)
Drugs for HTN with comorbid conditions? Thiazides CKD Post MI HF
Give thiazides in all but post MI or CKD CKD give ACEI/ ARB Post MI BB ACEI or Aldo ant HF is all but CCB
Resistant HTN and causes
Uncontrolled BP despite 3 drug tx including diuretic
Could be from improper bp measurement, excess sodium intake, inadequate diuretic tx (may need loop instead of thiazide), med interaction (eg NSAIDS or herbal supplements), excess alc, diseases etc
Or could have secondary HTN due to sleep apnea etc
Clinical features of primary hyperaldo Na K H Bp Renin ARR
Aldo incr
So Na incr and k decr and h decr so alkalosis
Bp incr
Renin indep increase in aldo so low or normal renin
Aldo Renin Ratio should be > 30 to be primary hyperaldo
Active form of vitamin D?
1,25 aka calcitriol
What is CaSR and what does Ca do to it/ result?
So calcium stimulates CaSR to decrease PTH thus decreasing Ca keeping calcium in check (vitamin D can do this too!)
CASR
When stimulated by calcium CASR lowers pth
Pth effects on vitMin D and results
Increases vitamin d which increases ca in blood from bone resorption and DECREASES blood P.O.
Forms of vitamin D
Calciferol obtained via diet or skin
Liver forms 25 or Calcidiol (measured in this form)
Converted to calcitriol in kidney via 1 a hydroxylase
What does vitamin d do to ca P.O. and pth
Increases absorption of ca and P.O.
Reduces synth of pth
Central factor in Ca and P.O. blood homeostasis?
PTH!
And PTH itself is regulated by ca they CaSR
PTH effect on bone P.O. vs kidney P.O.
Opposite
PTH increases P.O. reabs in bone and decreases it in kidney
Increases in gut ( ca also incr in gut)
See img
What does low P.O. do to vitamin d and results in gut and bone?
Low P.O. increases vitamin d in kidney conversion which increases P.O. release from bone and P.O. reabs from gut
What does low calcium do to PT and results of ca and P.O. in bone kidney and gut?
low ca stimulates pth
which stimulates ca/P.O. reabs from bone and increases eats but decr P.O. from kidney (and increased vitamin d from kidney which is What increases ca absorption in gut and increased P.O. abs in gut)
What does P.O. do to pth
Stimulates pth release
What happens to phosphate PTH vitamin d and ca in CKD
less renal function means less vitamin d which increases pth
Have to excrete higher filtered load fraction of P.O. but caps at 60% so hyperphosphatemia
This further elevates pth
Ca can increase then decrease
Main drug for secondary HPT
cinacalcet
Decreases pth by acting on CaSR
What else can you give to decrease P.O. in HPT
P.O. binders
Citrate role in stones
Low citrate leads to stones
Genetics of ADPKD ARPKD RCC Prostatic adenocarcinoma
AD: PKD1 or PKD2
AR: PKDH1 6p arm
RCC: VHL tsg and 3p arm loss
Prostate cancer: 1q24-25
Other itises and their cell types:
Allergic interstitial nephritis
Xanthogranulomatous polynephritis
Malakoplakia
Allergic- eosinophils (from drugs/antibios)
Xanth- sheets of foamy histiocytes (macros), (chronic, assoc with stones and UTIs, mimics RCC with yellow nodules)
Malako- MG michaelis gutnamm bodies (from UTIs gram neg)
What does Translocation RCC involve and who is it with/clin pres?
Oncocytomas?
Translocation RCC is mut in TFE3 tf (fusion) on Xp11.2, in younger women, high stage/aggro
Wilm’s cell phases?
Triphasic
stromal cells (bckd)
epith/tubular cells (circles)
and blastemal cells (prim)
What K+ state can cause Torsades, and inhibits renin release?
HYPO!
How does digoxin cause hyperkalemia?
By blocking the Na/K-ATPase!
What K+ state can cause rhabdo?
HYPO!
What K+ state can BBs cause?
hyPER bc inhibit renin release!
What can albuterol do?
B agonist that can treat hyperkal
Examples of PO binders?
aluminum containing
Ca containing
Selvamer
Lanthanum
Most common prostate sarcoma in kids vs adults
kids: rhabdomyo
adults: leiomyo
Testosterine can do what to tumors?
increase it
