The Kidney and Hypertension Flashcards
Renal causes of HTN
Abnormalities in primary
Parenchymal dz
Vascular dz
Renal damage from HTN
Progression of chronic
Benign HTN nephrosclersis
Malignant nephroscleoriss
Salt sensitivie kidney
No matter how high the CO or TPR is, renal excretion has the capacity to return BP to normal
Therefore maintenance of crhonic HTN requires renal participation
Maybe result of decreased ability to excrete Na load…a higher AP required to maintan Na balance
Salt wasting disorders
Associated with low BP disorders
Salt sensitivity
High salt intake correlate with increase prevalene of ess HT
INceease sensitivity due to genetics…more in AA
OTher causes of salt-sensitive HTN
Low brith weight (nephron underdosing)
Primary glomerular dz
Aging, diabetes, obesity
Secondary HTN causes
Monogenetic tubular defects (Liddle syndrome)
Renal parenchymal
renal vascular dz
Renal parenchymal dz
Leading cause of HTN
RPomotes HTN and HTN promotes progression of kidney dz
Circle of HTN and kidney
Primary dz…dec neprhon number…hypertrophy and vasodilation of sruving neprhon and increased pressure…increase GFR and pressure…increase glomerular scelorisis…decrease neprhon number
COnstriction of the efferent arteriole and dilatio nof afferent to increase the pressure
Vascular causes of renal HTN
Ateromatous renal artery stenosis and fibromuscular renal artery hyperplasia
Renovascular HTN
Most commonly atherscelorsis
Less common fibromuscular dysplasia
Renovascular HTN clinical
Onset under 30 or over 55
SUdden onset uncontrolled in previously well controlled
Accelerated/malignant HTN
Intermittnet pulm edema
Epigastric bruit, particularly systolic/diastolic
Azotemia induced by ACEI
Unilateral small kdiney
Unexplained hypokalemia
Stensosi effects
INcreased renin…goes to AT2…Vasoconstriction, renal sodium retention, aldosterone secretion
Constricts efferent arteriole to help increase the GFR
Unilateral renal artery stenosis
Reduced perfusion…increased in RAAS system in that side…leads to increased renal perfusion in the ther kidney (increased Na excretion and suppressed RAS)
Effect of RAS blockade
Dx tests
Unilateral renal artery stenosis
Reduced AP, enhanced lateralization of diagnostic tests, GFR in stenotic kidney may fall
Plasma renin activity elevated
Lateralized features
ACEI effect in affected unilaterla renal steoniss dz
Will drop the GFR by dilating the effernt artieole
Bilateral renal stenosis path
Bilateral…reduced perfusion…activated RAS and impaired Na and water excretion…volume expansion so RAS is then turned off…then increased arterial pressure