10 - HTN - Nephrologist's approach Flashcards Preview

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Flashcards in 10 - HTN - Nephrologist's approach Deck (17):
1

hallmark of renal pathology due to HTN

glomerulosclerosis

2

how does kidney damage from HTN further contribute to worsening HTN?

inc peripheral resistance due to vascular damage > inc RAAS and SYNS
tubular atrophy and glomerulosclerosis > Na retention due to inability to excrete Na load

3

main consequence of salt sensitive HTN

lose sensitivity of regulatory process

4

etiologies of RAS

atherosclerosis (60-80% of cases) - old guys, mostly proximal 1/3 of main renal artery
fibromuscular dysplasia (20-40%) - young women, distal 2/3 and branches
neurofibromatosis
vasculitis
radiation

5

Goldblatt's hypothesis about acquired renal injury

primary renal microvascular dz > renal ischemia > oxidative stress > inflammatory cells > Na retention > HTN

6

what happens when only one renal artery is stenosed?

inc in aldosterone > hypokalemia
other kidney can maintain normal blood volume due to pressure natriuresis at this stage

7

phases of RAS

acute - RAAS and SYNS stim. volume normal due to pressure natriuresis in nl kidney. BP elevated due to vasconstriction and inc CO

transitional - more sensitive to ATII and SNS, expanded volume, still treatable w/ reversal of stenosis

chronic - HTN w/ normal or slightly inc RAAS and SNS. HTN no longer treatable after stenosis removal, nl kidney gets damaged from high pressure

8

bilat renal stenosis makes ____ dependent HTN

volume

9

clinical presentation of RAS

severe HTN in previously well controlled pt
flash pulm edema
renal failure w/ ACEis

10

what happens when you add ACEis to a person w/ bilateral RAS?

kidney failure - removes contraction of efferent arteriole, so now GFR is even further reduced

11

tx of RAS

control BP as well as possible
stop smoking
lipid lowering drugs
anti platelet drugs
surgical tx

12

5 P's of pheochromocytoma

pressure
pain (HA)
perspiration
palpitation
pallor
(paroxysms are 6th P)

13

pheo rule of 10

10%:
extra adrenal
occur in children
familial
bilat or multiple
recur
malignant
discovered incidentally

14

best biochem tests for dx of pheos

Urine catecholamines + metanephrines
plasma metanephrines

15

tx of pheo

alpha and beta adrenergic blockers (phentolamine and propanolol)
surgery

16

primary hyperaldosteronism presentatino

hypokalemia and metab alkalosis

17

tx of primary hyperaldosteronism

spironolactone or eplerenone
adrenalectomy