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HYPERTENSION

Renal Vascular Diseases GENERAL OUTLINE. I. Hypertension “Benign” Nephrosclerosis “Malignant” Nephrosclerosis Renal Artery Stenosis Thrombotic Microangiopathies Miscellaneous Vascular Diseases. HYPERTENSION. Definition: diastolic > 90 mm Hg or systolic > 140 mm Hg

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HYPERTENSION

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  1. Renal Vascular Diseases GENERAL OUTLINE • I. Hypertension • “Benign” Nephrosclerosis • “Malignant” Nephrosclerosis • Renal Artery Stenosis • Thrombotic Microangiopathies • Miscellaneous Vascular Diseases HYPERTENSION • Definition: diastolic > 90 mm Hg or systolic > 140 mm Hg • pre-hypertension: 120/80 – 139/89 • Prevalence: • 20-25% population • 4th and later decades • 60% population after age 70 • Approximately 72 million in US • Complications: CVA, LVH and CHF, coronary • artery disease, renal disease

  2. TYPES OF HYPERTENSION • Primary Hypertension (Idiopathic) (could be genetic/polymorphisms w/mutations of Na Channels (90 - 95%) • Secondary Hypertension (5 - 10%) Renal • Acute Glomerulonephritis • Chronic Renal Disease • Polycystic Disease • Renal Artery Stenosis • Renal Vasculitis • Renin-producing Tumors (Juxtaglomerular Tumor) BP: Regulated by adjustments to CO and peripheral resistance. CO is influenced by blood volume. Blood volume is controlled by Na concentrations which is a major function of the kidney! • Endocrine • Cardiovascular • Neurologic Consequences of HTN: Cardiac disease and stroke Renal and retinal disease (half die of cardiac disease, 15% cerebrovascular accident, 10% renal failure) HTN  primary renal injury  ESRD

  3. Renal Vascular Diseases Primary (aka essential) hypertension is probably due to a combination of genetic factors and environmental factors: genetic; environmental; habits such as smoking, diet, alcohol; occupation; living conditions; and a host of other factors Essential hypertension is mainly treated by adjusting these factors, for example, reducing dietary intake of salt, performing moderate exercise, improve living conditions and in unresponsive cases, supplemented by antihypertensive drugs such as diuretics and ACE inhibitors. The main causes of secondary hypertension are: Renovascular Disorder, Renal Parenchymal Disease, Coarctation of the Aorta, Pheochromocytoma , Pregnancy Induced Hypertension.

  4. Renal Vascular Diseases PETECHIAE Wrinkled Glomerulous ONION SKIN LESION FIBRINOID NECROSIS FIBRINOID NECROSIS THROMBOSIS Young black men most commonly affected. Also women with toxemia of pregnancy, or persons with renal artery stenosis. Autoimmune diseases can also associate with mHtn.

  5. Renal Vascular Diseases RAS - Hyperplasia of JGA Renal Atrophy STENOSIS RAS - Atherosclerosis Crowded Glomeruli

  6. Renal Vascular Diseases Recent Old Infarcts Organizing Thrombosis Organizing Thrombosis Glomerular Thrombi Childhood HUS: verotoxin from E. Coli Adult HUS: causative agent varies – infections, chemo, radiation, pregnancy related, anti-phospholipid antibodies. Familial HUS: mutation in Factor H TTP: deficiency of metalloproteinase for von Willebrand factor Helmet Burr

  7. OTHER MISCELLANEOUS Renal Vascular Diseases Sickle cell nephropathy Cholesterol Clefts Atheroembolic Renal Disease Segmental sclerosis Infarct Ischemic Old Hemorrhagic Recent Medullary Fibrosis

  8. OTHER MISCELLANEOUS Renal Vascular Diseases

  9. OTHER MISCELLANEOUS Renal Vascular Diseases Renal Vein Thrombosis

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