Small Group 7- Secondary Hypertension, Stones Flashcards Preview

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Flashcards in Small Group 7- Secondary Hypertension, Stones Deck (10):

1. Describe clinical presentations of renovascular disease.

recent increase in BP medication requirements
rise in creatinine in last year
no proteinuria
history of arteriolar disease/presences of bruits


2. List the kidney disease that present with no proteinuria.

renal artery stenosis (>70% are considered significant)
obstructive nephropathy
on occasion HTN
(also negative dipstick with myeloma)


3. Describe diagnostic tests for renovascular disease and explain which tests are structural and which tests are functional.

anatomical: Gold standard is arteriogram, but CT angiogram (contrast) and MRA are excellent (peripheral venous injection)

physiology/flows: duplex ultrasound (resistive index; measuring higher velocity); ACEI renogram- GFR is decreased in stenotic side (unhelpful in bilateral stenosis, costly, longer time); some MRA flow studies available (contrast can cause nephrogenic systemic fibrosis)


4. Describe what imaging tests are best for stone disease.

spiral CT (no contrast)


5. List disease associated with hypokalemia and hypertension and describe clinical findings which discriminate between theses diseases .

renovascular disease secondary to hyperaldosteronism
pheochrocytoma causing adrenergic shift into cells
Cushing's syndrome causing excess glucocoritocoids and distal K excretion
primary hyperaldosternoism

would run serum aldosterone and plasma renin activity for ratio (common cause of secondary HTN)


6. Describe what imaging tests are best for acute nephrolithiasis.

spiral CT (non contrast) is best
X-ray may show radio opaque stones (including Ca), not much resolution


7. List therapies for acute nephrolithiasis.

pain meds, IV fluids (normal saline), possibly medical expulsive therapy (alpha blockers- tamsulosin)


8. List reasons for hospitalization for acute nephrolithiasis.

1) unable to keep down fluids or pain meds
2) kidney failure
3) UTI
4) stone requiring urologic intervention based on CT (stone size important determinant)


9. List stone types and associated systemic diseases.

Type I RTA associated with Ca++ stones
primary hyperparathyroidism associated with high Ca++ in serum and urine (Ca++ stones)


10. Describe general and specific therapies for prevention of stone formation.

general: drink at least 2 L fluids a day, no caffeine or alcohol (diuretics)

specific: surgical removal of parathyroids for PTH; sodium bicarbonate or potassium citrate to correct the acidosis, citrate can inhibit stone formation