Renal hyptertension I

Question 1

definition: masked HTN

Answer 1

BP that is consistently elevated by out of office measurements but does not meet criteria for HTN based on office readings

Question 2

definition: hypertensive emergency

Answer 2

severe HTN with evidence of acute end organ damage

Question 3

definition: hypertensive urgency

Answer 3

severe HTN in asymptomatic patients

Question 4

CV morality doubles with each ________ mm Hg increase in BP

Answer 4

20/10

Question 5

how is HTN linked to vascular dementia?

Answer 5

HTN is associated with an increased likelihood of subclinical or silent stroke leading to vascular dementia

Question 6

HTN retinopathy - grades I - IV

Answer 6

grade I: arteriolar narrowing

grade 2: generalized and focal narrowing, AV nicking

grade 3: hemorrhage, microaneurysm, hard exudates, cotton-wool spots

grade 4: hypertensive retinopathy, optic disk swelling, macular edema

Question 7

what is the most common cause of end stage renal disease?

Answer 7

diabetes

Question 8

what % of people have pre HTN?

Answer 8

25%

Question 9

what % of people have HTN?

Answer 9

31%

Question 10

what are the causes of secondary HTN?

Answer 10

Apnea, aldosterone 
Bruits, bad kidneys 
Catecholamines, coarctation, cushing's 
Drugs, diet 
Erythropoietin, endocrine disorders

Question 11

what is the diagnostic study for sleep apnea?

Answer 11

formal sleep study

Question 12

what is the pathogenesis of primary aldosteronism?

Answer 12

resulting retention of excess salt and water suppresses renin levels

Question 13

what is the potassium status of patients with primary aldosteronism? why?

Answer 13

• hypokalemia

- increased urinary excretion

Question 14

what is the best initial diagnostic test for primary aldosteronism?

Answer 14

aldosterone : renin ratio

Question 15

what is the PAC / PRA ratio? what does a value over 30 indicate?

Answer 15

• plasma aldosterone concentration : plasma renin activity

- ratio over 30 = primary hyperaldosteronism

Question 16

PAC : PRA ratio over 30 indicates what disease?

Answer 16

primary hyperaldosteronism

Question 17

high PAC : high PRA and ratio under 10 indicates what disease?

Answer 17

secondary hyperaldosteronism

Question 18

low PAC : low PRA indicates what condition?

Answer 18

alternate mineralocorticoid stimulation (hypercortisolism, licorice root ingestion)

Question 19

what is the presentation that clues you in to renovascular HTN?

Answer 19

hypertensive patient with unexplained CHF / acute pulmonary edema

Question 20

acute elevation of creatinine after starting ACE / ARB therapy indicates what condition?

Answer 20

bilateral disease - renovascular HTN

Question 21

what is the gold standard test for abdominal bruit?

Answer 21

renal arteriography

Question 22

what are the factors that sustain HTN after anatomic correction?

Answer 22

• damage to contralateral kidney in unilateral disease

- vascular remodeling

Question 23

what is the most common cause of HTN in children (especially pre pubescent)?

Answer 23

renal parenchymal disease

Question 24

what is the diagnosis for renal parenchymal disease? (labs and test)

Answer 24

• high creatinine
• low GFR
• US

Question 25

what is the treatment for renal parenchymal disease?

Answer 25

aggressive treatment of HTN (ACE inhibitors)

Question 26

bilateral renal vascular disease should be suspected after what findings?

Answer 26

increase in creatinine of 30% after ACEi or ARB

Question 27

what should you suspect in a 30% increase of creatinine after ACEi or ARB?

Answer 27

bilateral renal vascular disease