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44 Cards in this Set

  • Front
  • Back
In what groups is there a higher level of hypertension?
old people, family history, AA, exogenous factors like smoking
What is essential hypertension?
no cause is found
What are some causes of hypertension?
essential, excess aldosterone, excess NE or Epi, renin-producing tumors, hypercalcemia
neurogenic, iatrogenic, congenital structural lesions
What ist he leading cause of secondary hypertension?
kidney disease
How does kidney disease lead to hypertension?
renal parenchymal scarring, obstruction, renovascular lesions
How do kidneys influence blood pressure?
modulate salt/water under aldosterone, renin --> angiotensin II which is a vasoconstrictor and stimulus for aldosterone secretion
What increases blood pressure in renovascular idsease?
renal ischemia increases renin-angiotensin system activity
What causes higher blood pressure in renal parenchymal disease?
decreased nephron mass leads to lower GFR, retention of sodium and fluid, increased ECV
decreased perfusion to parenchyma increases angiotensin, aldosterone, vasoactive substances
What are the most common complications of untreated hypertension?
cardiac disease, stroke, renal and retinal disease
Why does hypertension accelerate the decline in GFR?
direct transmission of increased BP to injured glomerulus increases injury
What is the gross lesion in "benign" nephrosclerosis?
small kidneys with finely granular surface and thinned cortex
What is the microscopic lesion in "benign" nephrosclerosis?
interlobular arteries and afferent arterioles show hyalinization, medial hypertrophy
How are the glomeruli in "benign" nephrosclerosis?
ischemic collapse/sclerosis, tubular atrophy with proportional interstitial fibrosis
What are the gross lesions in malignant nephrosclerosis?
petechial subscapsular hemorrhage, mottling, occasional infarcts
What are the microscopic lesions in malignant nephrosclerosis?
fibrinoid necrosis of the arterioles, concentric onion-skin pattern of intimal fibrosis of interlobular arteries
Which type of diabetes causes more renal disease?
equal proportions of each
what ist he first sign of diabetic renal disease?
microalbuminuria with normal or increased GFR
At what point do diabetic develop renal disease?
about 15 yrs after diagnosis of diabetes
What is the course of diabetic nephropathy?
microalbuminuria, overt proteinuria, progressive decline in GFR
What do microscopic lesions of diabetic renal disease look like?
enlarged glomeruli with diffuse thickening of GBM, nodular/diffuse increase in mesangleial matrix and glomerulosclerosis
afferent and efferent arteiolar hyalinization with accompanying arteriosclerosis of larger vessels
Which vessels are hyalinized in hypertension?
afferent, not efferent arteriole
What groups are associated with worse kidney disease?
AAs, low birth weight at term birth
What do you give to diabetics for hypertension?
ACEI, ARBs
What are the mechanisms of prophylactic anti-hypertensives?
angiotensin inhibition, extracellular matrix accumulation in hypertension
inhibiting angiotensin II may block matrix production and augment matrix degradation
What do the microscopic lesions of systemic sclerosis look like?
fibrinoid necrosis acutely, organizing as intimal proliferation, proliferation of endothelial cells involving arterioles and interlobular arteries, glomeruli show ischemic collapse
Which vessels are involved in idiopathic malignant hypertension?
smaller vessels
What is the kidney injury in atherosclerosis?
narrowing at the origin of the renal artery, can cause acute renal failure due to ischemia if significant narrowing bilaterally
Who gets fibromuscular dysplasia?
younger women
What are the lesions in fibromuscular dysplasia?
intimal, medial, perimedial fibroplasia, some with aneurysms
What causes cholesterol embolization?
emboli of atheromatous plaque material, occludes interlobular arteries
How do kidney cholesterol emboli present?
acute renal failure, mimics vasculitis
What is thrombotic microangiopathy?
vascular lesion of endotehlial injury with fibrin thrombi in several clinical settings, including HUS, presenting as acute renal failure
What causes hemolytic uremic syndrome?
e. coli verotoxin
Waht does E. coli verotoxin do?
damages endothelium, causes microthrombi to be formed
What are the systemic manifestations of HUS?
hemolysis, decreased platelets, diarrhea
Who gets HUS?
children
What do the microscopic lesions of HUS look like?
glomerulus and afferent arteiole contain fibrin thrombi, swelling of capillary wall, inflammatory cell interposition give double contour appearance in chronic phase
What is preeclampsia?
hypertension, proteinuria, edema, decreased GFR in the third trimester, usually with first pregnancy
What is eclampsia?
preeclampsia plus seizures
What is the pathologenesis of preeclampsia?
placental ischemia, endothelial cell injury and vasoconstriction, could be due to VEGF
What do the microscopic lesions of preeclampsia look like?
glomerular endothelial swelling
What do the lesions of vasculitis look like?
necrotizing, crescentic glomerular lesions, varying involvement of other vessels, rapidly progressive glomerulonephritis
What do lesions of polyarteritis nodosa look like?
large arteries with segmental irregular nodose lesions with necrosis and inflammation in GI, liver, heart, CNS, kidney
What does polyarteritis microsocopic form look like?
glomeruli and small vessel involvement