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