1. Hypertension and Kidney 1 Dr.Ruba Nashawati

2. Statistics Hypertension is 2 nd cause of ESRD 2

3. Statistics Uncontrolled HTN 18% develop ESRD over 10-15 year 3

5. Stable Blood Pressure 5

6. Kidney Brain Heart 6

7. 7 HTNconsequenceCKDcause

8. 8

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

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

11. Kidneys are packed with Arteries 11

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

13. HYPERTENTION CAUSES: 13

14. 1. Renal Insufficiency 2. Proteinuria 3. Hematuria 14

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

16. Proteinuria 16

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

18. 18 15 - 30% Microalbuminuria 15 - 30% Microalbuminuria 2 - 5% Nephrotic Fewer Non-Nephrotic

19. Hematuria 19

20. 18% Renal Insufficiency 20

21. Histologically 21 Fibrotic Sclerotic Changes In GLOMERULUS And INTERSTITIUM

22. 2 Clinical & Histological Patterns 22

23. BENIGN Nephrosclerosis MALIGNANT Nephrosclerosis 23

24. Benign Nephrosclerosis 24

25. Majority + Uncomplicated HTN Hyaline Arteriosclerosis Develop Slowly 25

26. Without Overt Proteinuria. Renal Function Not Seriously Compromised 26

28. Malignant Nephrosclerosis 28

29. Severe HTN Acute Disruptive Vascular & Glomerular Injury 29

30. Fibrinoid Necrosis & Thrombosis Renal Failure Develop Rapidly Without Therapy 30

33. The pathogenetic determinants of Hypertensive Renal Damage 33

34. 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

35. Autoregulation Vasoconstriction Preglomerular Autoregulatory Vasoconstriction of the Preglomerular Vasculature 35

36. Autoregulation Glomerular Hydrostatic Pressures maintained relatively Constant vasculature 36

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

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40. Antihypertensive Drug 40

41. 1. K 2. Long term 41

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

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

44. Furosemide KK  Na  Ca  Cr 44

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

46. Spironolactone  K 46

47. 47 TakeHomeMessagesTakeHomeMessages

48. Control HTN ASAP and Keep an Eye on the Kidney 48

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