Hipertensi and the Kidney New

8/9/2019 Hipertensi and the Kidney New

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Hypertension and TheKidney


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Introduction

• >1/2 the people with CKD have high BP

• Hypertension increases the chance that idney diseaseget worse!

• "very year# hypertension causes >2$#%%% new cases o&idney &ailure in the '(

• 1/) adults in the 'nited (tates has hypertension !

• Higher a*ong patients with CKD# progressively

increasing with the severity o& CKD!

• 2)!)+ o& individuals without CKD# and )$!,+ o& stage1# -,!1+ o& stage 2# $.!.+ o& stage )# and ,-!1+ o&stage -$ CKD patientsKKD34IIDDK# 2%%5

Introductio

n


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• 6iset Kesehatan Dasar 76isesdas82%%5

• Hypertension in the population age >1, years old 9 prevalence )1#5+#only 5#2+ understand that they havehypertension and only %#-+ use

hypertension *edicine!


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Introduction

• Hypertension in CKD increases the ris o&i*portant adverse outco*es9

– loss o& idney &unction and idney &ailure# – early develop*ent and accelerated progression o&

C:D#

– pre*ature death

KKD34IIDDK

Hypertension


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Patophysiology# Hypertension andidney disease

1! High ;lood pressure is a leadingcause o& CKD!

• Da*age ;lood vessels reduce the;lood supply to the idneys!

• High BP da*ages glo*erulus inidneys! The idneys *ay stopre*oving wastes and e


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Hypertension and idneydisease

2! co*plication o& CKD!

• idneys play a ey role in eeping;lood pressure

• Diseased idneys are less a;le tohelp regulate ;lood pressure!


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Hypertension


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Kidney utoregulation o& BloodPressure

• (y*pathetic nervous syste*s

• ?yogenic *echanis*

•

Tu;uloglo*erular eed;ac• 6( (yste*


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eural re=ect arcs

• High pressure ;aroreceptors in the aorticarch and carotid sinus

• @ow pressure cardiopul*onary

;aroreceptors in the ventricles and atria• Intrarenal ;aroreceptor 9 renin secreting

granular cells act as ;aroreceptors#*easuring pressure in the late aAerent aa!

• secretion is inversely related to arteriolarpressure


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The 6ole sy*pathetic ervous(yste*s

• Increase heart rate

• Direct vasoconstriction eAect

•

Induce release o& epinephrine &ro*adrenal *edulla thus lead tovasoconstrictor e&&ect through and adrenergic receptor

• Induce renin release


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?yogenic ?echanis*# Tu;uloglo*erular

eed;ac and 6( (yste*s


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• The myogenic mechanism is how arteries andarterioles react to an increase or decrease o&;lood pressure to eep the ;lood =ow within the;lood vessel constant!

http://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Arteriolehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Arteriolehttp://en.wikipedia.org/wiki/Artery


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denosin

aK2Clcotransporter

http://en.wikipedia.org/wiki/Na-K-2Cl_cotransporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_cotransporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_cotransporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_cotransporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_cotransporterhttp://en.wikipedia.org/wiki/Na-K-2Cl_cotransporter


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• u


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The 6ole o& ngiotensin II

• Constricts vascular s*ooth *uscle

• (ti*ulates aldosteron secretion

• Potentiates sy*pathetic nervous syste* activity

•

(ti*ulates salt and water rea;sorption in thepro


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The 6ole o& ldosterone

• ?ediates changes in sodiu*channels in distal tu;ular epitheliu*#leading to sodiu* retention and

potassiu* e


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Co*prehensive Clinical


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(pecial DeFnition

• Pre hypertension 9 lac o& uni&or*agree*ent# *ost use&ully deFned asBP o& 1)% to 1)./,$,. **Hg

• Ghite Coat Hypertension 9 BP that isnor*al during usual daily activities;ut is hypertensive in clinical setting

• ?ased Hypertension 9 BP that islower in the clinical setting co*paredwith a*;ulatory BP

Co*prehensive Clinical


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• Isolated Hypertension9 (BP o& 1-% orhigher and DBP o& .% **Hg or lower;ecause o& increase stiAness o&

artery due to arterioclerosis

• 6esistant Hypertension 9 BP that isnot achieve the treat*ent goal

despite opti*al doses o& threeantihypertensive drugs includingdiuretic


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• ccelerated Hypertension 9 severe diastolic hypertension 7usually > 12% **Hg8in the presence o& grade III retinopathy

• Hypertensive urgencies 9 (ystolic 1,% and diastolic 12% and asy*pto*atic

• Hypertensive e*ergencies are acute# li&ethreatening# and usually associatedwith *ared increases in ;lood pressure 7BP8# generally 1,%/12% **Hg There

are two *aor clinical syndro*es induced ;y the severe hypertension9• ?alignant hypertension is *ared hypertension with retinal he*orrhages#

e


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Al ith f T t t f H t i


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Algorithm for Treatment of Hypertension

Not at goal blood pressure (


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IC"# 2%11

Hypertension9 IC" guideline ! 2%11


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Teri*a Kasih

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Hipertensi and the Kidney New