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