Nephrology 15: HTN (HY)

Renal Artery Stenosis imaging modality: -1st? -followed by?

Imaging: doppler ultrasound is the best initial imaging modality, followed by CT angiogram ØStenosis <50%: decreased perfusion with normal oxygenation ØStenosis > 50%: decreased perfusion with decreased oxygenation

Renal Artery Stenosis: pathophysiology -(inc/dec) blood flow --> increases ___ --> increases --> increased retention of (2) + vaso(constriction/dilation) --> _____

Pathophysiology: decreased renal blood flow --> increases renin --> increases angiotensin II --> increase aldosterone synthesis --> increased Na and water retention + vasoconstriction--> hypertension

ØAssociations: Turner Syndrome

coarctation of aorta

panic attack like symptoms, intermittent

pheochromocytoma

ØClinical Triad: hypertension + metabolic alkalosis + hypokalemia

primary hyperaldosteronism aka Conns Syndrome

doppler US

renal artery stenosis

Primary Hyperaldosteronism: -clinical triad? -lab screening? -confirmatory test?

ØClinical Triad: hypertension + metabolic alkalosis + hypokalemia ØLab Screening: PAC to PRA Ratio > 20 ng/dL* ØPAC: Plasma Aldosterone Concentration ØPRA: Plasma Renin Activity ØConfirmatory Test: Salt Loading Test Plasma aldosterone

Coarctation of Aorta: -define -pathyphys -associations -exam? -treatment?

ØDefinition: Narrowing of thoracic aorta prior to left subclavian artery ØPathophysiology: RAAS upregulation ØAssociations: Turner Syndrome ØExam: Delayed femoral pulse when compared to upper extremities. Systolic ejection click ØTreatment: intervention if CoA gradient > 20 mmHg, systemic hypertension, or heart failure

Pheochromocytoma -define -PE

ØDefinition: neuroendocrine tumor releasing catecholamines (epinephrine, norepinephrine, dopamine) and metanephrines ØPhysical Exam: panic attack like symptoms, intermittent

Drug Induced Hypertension: # 1 cause?

ØNSAIDs: inhibit COX enzyme resulting in sodium retention