Hypertension and Kidney 1 Dr.Ruba Nashawati

Statistics Hypertension is 2 nd cause of ESRD 2

Statistics Uncontrolled HTN 18% develop ESRD over year 3

Stable Blood Pressure 5

Kidney Brain Heart 6

7 HTNconsequenceCKDcause

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How Does High Blood Pressure Cause Kidney Damage? How Does High Blood Pressure Cause Kidney Damage? 9

1. Direct Effect On The Kidney 2. Side Effect Of Antihypertensive Drugs 10

Kidneys are packed with Arteries 11

12 HTN Artery Damage Decreased Filtration Electrolytes Fluid Disturbance Failure control BP

HYPERTENTION CAUSES: 13

1. Renal Insufficiency 2. Proteinuria 3. Hematuria 14

New HTN Normal Renal Function Stage 1 CKD Stage 2 CKD 15

Proteinuria 16

 MARKER of Vascular Disease and Cardiovascular Risk  6-40 % Primary HTN  with AGE & DURATION 17

% Microalbuminuria % Microalbuminuria 2 - 5% Nephrotic Fewer Non-Nephrotic

Hematuria 19

18% Renal Insufficiency 20

Histologically 21 Fibrotic Sclerotic Changes In GLOMERULUS And INTERSTITIUM

2 Clinical & Histological Patterns 22

BENIGN Nephrosclerosis MALIGNANT Nephrosclerosis 23

Benign Nephrosclerosis 24

Majority + Uncomplicated HTN Hyaline Arteriosclerosis Develop Slowly 25

Without Overt Proteinuria. Renal Function Not Seriously Compromised 26

Malignant Nephrosclerosis 28

Severe HTN Acute Disruptive Vascular & Glomerular Injury 29

Fibrinoid Necrosis & Thrombosis Renal Failure Develop Rapidly Without Therapy 30

The pathogenetic determinants of Hypertensive Renal Damage 33

load Systemic BP “load” transmitted The degree to which such load is transmitted to the renal vascular bed susceptibility barotrauma Local tissue susceptibility to any given degree of barotrauma 34

Autoregulation Vasoconstriction Preglomerular Autoregulatory Vasoconstriction of the Preglomerular Vasculature 35

Autoregulation Glomerular Hydrostatic Pressures maintained relatively Constant vasculature 36

Even Damage Develop in Absence of Severe Hypertension Renal Damage Still Develop if there Is enhanced Transmission 38

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Antihypertensive Drug 40

1. K 2. Long term 41

1.  K 2.  Na 3.  GFR 4. Lab test : Day 3 Week 2 42

Don’t DEHYDRATION Don’t use them Except in Overload patient  DEHYDRATION 43

Furosemide KK  Na  Ca  Cr 44

HCTZ KK  Na  Ca  U.Acide  Lipids  Glu  Cr 45

Spironolactone  K 46

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Control HTN ASAP and Keep an Eye on the Kidney 48

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