renal essay - hypertension

Question 1

What are the most common causes of secondary hypertension?

Answer 1

Obstructive sleep apnoea, renal disease, endocrine disorders, renal artery stenosis

Question 2

What are the principles of the pressure-natriuresis relationship?

Answer 2

Normally, an increase in dietary salt produces a transient rise in fluid volume and therefore blood pressure, which elicits an appropriate response by the kidney to eliminate excess sodium and restore normal BP.

Question 3

What are the effects of hypertension on the kidneys?

Answer 3

Renal arteries are narrowed due to hyaline deposition in their media. They become stiffened due to reduced endothelial cell mediated vasodilation and changes in smooth muscle activation. High pressure in the glomerulus leads to glomerulosclerosis. Loss of autoregulation of Na/H2O increases the risk of kidney injury as protective mechanisms are lost.

Question 4

What is the effect of hypertension on the heart?

Answer 4

The forward pressure wave, which is usually reflected in diastole is prematurely reflected in mid-systole, resulting in systolic hypertension and widened pulse pressure. Impaired perfusion of the heart during diastole worsens function

Question 5

What are the principles of management for patients with CKD and hypertension?

Answer 5

ACE inhibitor/ARB (particularly if there is proteinuria), diuretic

Question 6

What is cardio-renal disease?

Answer 6

Heart disease that diminishes renal function, which further damages the heart. There will be remodelling of the heart and the glomerulus