Boris Hlebec
Contents
What is it ?
Who gets it ?
What causes it ?
What are the symptoms ?
How is it diagnosed ?
What is the treatment ?
How can you prevent it ? (Can you ?)
What is it ?
Hypertension Mean arterial pressure consistently > 110
mmHg (Dia >90 ; Sys >140)
Secondary hypertension: identifiable cause
Renovascular: hardening and stenosis of the renal artery
Who gets it ?
6 out of 100,000 people
Age of onset depends upon cause Men: >45 years => Atherosclerosis Women : <45 years => Fibromuscular
dysplasia 10% of children with fibromuscular
dysplasia
Some risk factors
Smoking High salt intake Obesity Stress Heavy metals (not music)
What causes it ?
Renal ischemia ! Atherosclerosis Fibromuscular dysplasia Injury Tumour Clots
Whatever that might narrow the renal artery
How does that affect blood pressure ?
Kidney – a selfish bastard
RAASA – Renal corpuscleB – Proximal tubuleC – Distal convoluted tb.D – Juxtaglomerular app.
1. Basal lamina2. Bowman's capsule – parietal layer
3. Bowman's capsule – visceral layer3a. Pedicels (podocytes)3b. Podocyte
4. Bowman's space
5a. Mesangium – iIntraglomerular cell5b. Mesangium – extraglomerular cell
6. Juxtaglomerular cells
7. Macula densa
8. Myocytes 9. Afferent arteriole10. Glomerulus Capillaries11. Efferent arteriole
3 main stimuli for renin release:
sympathetic nerve β1-adrenoceptors
renal artery hypotension systemic hypotension or renal artery stenosis
juxtaglomerular apparatus
decreased sodium delivery to the distal tubules
macula densa
10 8
Angiotensin II
Constricts resistance vessels (via AII [AT1] receptors) thereby increasing systemic vascular resistance
Adrenal cortex releases aldosterone => increase sodium and fluid retention
Release of vasopressin (ADH) from the posterior pituitary = water retention
Stimulates thirst centers within the brain
Facilitates noradrenaline release from sympathetic nerve endings and inhibits norepinephrine re-uptake by nerve endings, thereby acting as a sympathomimetic agent
Stimulates cardiac hypertrophy and vascular hypertrophy
Symptoms
High blood pressure ( Sherlock)
all the following complications:
Headache Fatigue Nausea and vomiting Chest pain Vision problems, confusion, anxiety Excessive perspiration, pale or reddened skin Sudden pain in the side and bloody urine – CLOT! No symptoms at all
Diagnosis
Severely high blood pressure that is difficult to control
Vascular murmur over left or right lumbar and/or periumbilical regions of abdomen bruit
Ultrasound Angiography Levels of renin production
Fibromuscular dysplasia (DSA)
Treatment
Lifestyle changes Medication
ACE inhibitors !!!!! ATII-R blockers !!!!! Beta blockers Ca antagonists
Catheterisation (baloon) - MOVIE Surgery
Bypass Renectomy
Literature
Pathophysiology: Kovač, Marušić, Gamulin (2005)
Guyton’s physiology (2004) Wikipedia http://www.hmc.psu.edu/healthinfo/
r/renovascularhypertension.htm
Mentor: A. Žmegač Horvat