UW revision Secondary HTN causes table Flashcards
Renal parenchyma cause. Clues?2
What Ca levels?
Elevated Cr level
Abnormal urinalysis (proteinuria, RBC)
More likely hypocalcemic.
Renovascular cause. Clues?3
Recurrent flash pulmonary edema
Elevate Cr level (particularly with ACEI/ARB use)
Abdominal bruit (99 proc specificity)
Elevated Cr level
Abnormal urinalysis (proteinuria, RBC)
Cause?
RENAL DISEASE
Recurrent flash pulmonary edema
Elevate Cr level (particularly with ACEI use)
Abdominal bruit (99 proc specificity)
Cause?
RENOVASCULAR DISEASE
Primary hyperaldosteronism. Clues? 2
Hypokalemia (spontaneous or thiazide induced)
Metabolic alkalosis
Hypokalemia (spontaneous or thiazide induced)
Metabolic alkalosis
Cause?
Primary hyperaldosteronism.
OSA. Clues?2
Daytime somnolence
Increased neck circumference
Daytime somnolence
Increased neck circumference
cause?
OSA
Pheochromocytoma. Clues? 2
Paroxysmal hypertension and tachycardia
Headaches, palpitation, diaphoresis
Paroxysmal hypertension and tachycardia
Headaches, palpitation, diaphoresis
Cause?
Pheochromocytoma
Cushing syndrome. Clues?
Cushingoid body habitus and proximal muscle atrophy
Hyperglycemia
Cushingoid body habitus and proximal muscle atrophy
Hyperglycemia
Cause?
Cushing syndrome.
Thyroid disease. HYPER Clues?
anxiety, heat intolerance, weight loss, tachy
Thyroid disease. HYPO Clues?
fatigue, cold intolerance, weight gain, bradycardia
anxiety, heat intolerance, weight loss, tachy
Cause?
Thyroid disease. HYPERthyroidisim
fatigue, cold intolerance, weight gain, bradycardia
Cause?
Thyroid disease. HYPOthyroidism
Primary hyperparathyroidism. Clues? 3
Mild hypercalcemia +/- symptoms (eg constipation)
Kidney stones
PSYCH symptoms (eg depression)
Mild hypercalcemia +/- symptoms (eg constipation)
Kidney stones
PSYCH symptoms (eg depression)
Cause?
Primary hyperparathyroidism.
Coarctation of aorta. Clues?
Upper extremity hypertension with brachial-femoral pulse delay (common)
Lateralizing hypertension (less common)
Upper extremity hypertension with brachial-femoral pulse delay (common)
Lateralizing hypertension (less common)
Cause?
Coarctation of aorta.
Renovascular HTN/renal artery stenosis. Kidney size?
ASYMETRIC KIDNEY SIZE - small atrophic unilateral kidney
ASYMETRIC KIDNEY SIZE - small atrophic unilateral kidney. CAUSE?
Renovascular HTN/renal artery stenosis
Elevation of Cr in 30 proc. when used ACEI/ARB. Cause?
renal artery stenosis
High plasma aldosterone/renin ratio > 20:1. In what disease?
PRIMARY HYPERALDOSTERONISM
Primary hyperparathyroidism abbreviation?
stones, bones, abdoninal groans and psychiatric overtones.
Primary hyperparathyroidism. MCC?
80 proc = parathyroid adenoma.
Primary hyperparathyroidism. Why hypercalcemia?
incr. renal calcium absorption + GI Ca absorption + bone reabsorption.
Primary hyperparathyroidism. Symptoms?
Kidney stones, neuropsychiatric symptoms, MUSCLE WEAKNESS, polyuria, polydipsia, constipation, abdominal pain.
Primary hyperparathyroidism. Mechanism of HTN? 3
Increased renin secretion
Sympathetic hyperresponsiveness
Peripheral artery constriction
Primary hyperparathyroidism. HTN Tx?
Treat hyperparathyroidism –> HTN resolves
Thyroid. What HTN predominantly in hyperthyroidism?
systolic HTN
Thyroid. What HTN predominantly in hypothyroidism?
diastolic HTN
Thyroid. Hyperthyroidism on Ca?
increased calcium due to increased bone turnover
Thyroid. Hypothyroidism on Ca?
normal Ca. Hypothyroidism does not have significant effect on serum Ca concentration.
Clinical clues to renovascular disease. (table).
HTN related symptoms?
Resistant HTN (>=3 drugs but still uncontrolled)
Malignant HTN (with end organ damage)
Onset of severe HTN (180mmHg) after age 55 yo
Severe HTN with diffuse atherosclerosis
Recurrent flash pulmonary edema with severe HTN
Clinical clues to renovascular disease. (table).
Supportive evidence? Physical 2
Asymetric kidney (>1,5 cm)
Abdominal bruit
Clinical clues to renovascular disease. (table).
Supportive evidence? Labs
Unexplained rise in serum Cr (>30 proc) after starting ACEI or ARBs
Clinical clues to renovascular disease. (table).
Supportive evidence? Imaging
UNEXPLAINED ATROPHIC KIDNEY