Renal Hypertension

Question 1

stenotic kidney increases renin leading to salt and water retention, contralateral kidney decreases renin leading to salt and water excretion

Answer 1

stage 2 renovascular HTN

Question 2

Aldosterone increases (1), leading to increased volume (which also increases blood pressure).

Answer 2

1. sodium reabsorption

Question 3

The blood vessel problem in the affected kidney can be treated surgically, and (1) is reversible if identified before there is too much damage to the kidney with the stenotic blood vessel.

Answer 3

1. fibromuscular dysplasia

Question 4

Children with renovascular hypertension may have (1) (not a malignant type).

Answer 4

1. fibromuscular dysplasia

Question 5

The kidney secretes renin based on the amount of (1) determined by the (2) in the nephron.

Answer 5

1. blood flow (tubular sodium concentration actually) 2. juxtaglomerular apparatus

Question 6

AT II can also lead to contraction of the (1) which decreases the glomerular surface area, producing (2)

Answer 6

1. smooth muscle in mesangial cells 2. less filtration.

Question 7

• AngII effects vary in normal vs ischemic kidney:
• Good kidney: ↓BP activates _____
• Ischemic kidney: reduced afferent blood flow ____ (particularly if on ACE inhibitors ⇒ contraindicated for renovascular stenosis)

Answer 7

renin-AT –> ↑GFR ;

decreases GFR

Question 8

hypertension leads to renal hypo perfusion of kidneys

Answer 8

stage 3 renovascular HTN

Question 9

Histologically, in (3) the affected kidney is smaller, and tubules show (1) without much (2)

Answer 9

3. fibromuscular dysplasia 1. ischemic atrophy 2. interstitial fibrosis

Question 10

Fibromuscular dysplasia involves thickening of the (1) which alternates with (2) produces an arteriogram showing a (3) pattern.

Answer 10

1. medial arterial smooth muscle 2. atrophy 3. “string of beads”

Question 11

“string of beads” pattern on arteriogram

Answer 11

fibromuscular dysplasia

Question 12

Renin catalyzes the conversion of (1) to (2)

Answer 12

1. angiotensinogen to 2. angiotensin I.

Question 13

Examination of the stenotic or occluded renal artery shows (1) most of the time, and the disease is most common in men over 50.

Answer 13

1. atherosclerosis

Question 14

One can directly show in these patients that renal vein (1) is increased in the ischemic (poor blood flow) kidney but normal in the contralateral one.

Answer 14

1. renin

Question 15

Angiotensin II (AT II) also leads to production and release of (1) which can (2)

Answer 15

1. prostaglandins and nitric oxide 2. dilate the afferent arteriole.

Question 16

increased renin within kidney with stenosis leading to increased serum renin and hypertension

Answer 16

stage 1 renovascular HTN

Question 17

Angiotensin II has a greater vasoconstriction of the (1) arteriole which can lead to (2) in some circumstances, such as (3)

Answer 17

1. efferent 2. increased filtration 3. early diabetic nephropathy (stage I)

Question 18

Occasionally, renal artery vasculitis, (such as (1), can cause (2) in children or less commonly in adults.

Answer 18

1. Takayasu’s or giant cell arteritis which affect larger vessels 2. fibromuscular dysplasia

Question 19

Goldblatt blocked one renal artery in a rat and then showed that (1) were increased in the nephrons and venous return from that kidney whereas they were normal in the other kidney

Answer 19

1. renin, angiotensin II, and aldosterone

Question 20

Renovascular hypertension has three basic stages. The first stage has increased (1) within the kidney with the stenotic blood vessel which leads to (2).

Answer 20

1. renin 2. systemic hyperreninemia (increased serum renin) and hypertension

Question 21

In the second stage of renovascular hypertension, the two kidneys have opposing functions: the stenotic kidney has increased (1) and (2) sodium and water; the contralateral non-stenotic kidney (3) sodium and water, and has decreased (1) production.

Answer 21

1. renin 2. retains 3. excretes

Question 22

Because renal function in renovascular hypertension is highly dependent on renin and angiotensin II effects, the use of (1) in patients with renovascular stenosis can be complex or even counterproductive.

Answer 22

1. ACE inhibitors

Question 23

(1) cells have (2) which converts angiotensin I to angiotensin II, which has powerful vaso-constrictive actions and increased production of (3)

Answer 23

1. Pulmonary and renal endothelial 2. ACE (angiotensin converting enzyme) 3. aldosterone

Question 24

If the (1) is restored to the stenotic kidney during the first two stages of renovascular HTN, then the blood pressure will be normalized, so this is curable hypertension.

Answer 24

1. blood flow

Question 25

In the third stage of renovascular HTN, the hypertension leads to (2) of both kidneys and produces further renal damage.

Answer 25

2. renal hypoperfusion

Question 26

•Atherosclerotic plaques (embolisms from atherosclerosis within abdominal aortic aneurysms) block aortic ostia or narrow the renal artery lumen.

Atheroembolism may be spontaneous or initiated by trauma; can spread to as far as glomerular capillaries and may cause ____

Answer 26

acute renal failure

Question 27

Clinically, (1) can be heard over the stenotic renal artery because of the sound of the blood being pushed through the narrowing, but of course there would be no (1) with (2)

Answer 27

1. a bruit 2. complete stenosis

Question 28

The resulting (1) of fibromuscular dysplasia can also damage the “unaffected” (non-stenotic one) contralateral kidney if the disease is not diagnosed for a long time because (1) causes narrowing and occlusion of blood vessels in the kidney. This can lead to bilateral disease and renal failure.

Answer 28

1. hypertension

Question 29

The (1) that forms within (2) can embolize into the renal arteries blocking the ostia or narrowing the artery (because of flow patterns it affects the (3) renal artery more than the (4). These stenotic lesions can be identified as embolic because they will have (5) (areas of clear space where the lipid is washed out in the tissue processing).

Answer 29

1. atherosclerosis 2. abdominal aortic aneurysms 3. left 4. right 5. cholesterol clefts