Renal disorders in hypertension, treatment of hypertension and usage of diuretics in renal disease
1. Big picture
Hypertension and kidney disease form a vicious circle:
Hypertension damages renal vessels → nephron ischaemia and glomerulosclerosis → chronic kidney disease (CKD) → sodium/water retention and renin-angiotensin-aldosterone system (RAAS) activation → worse hypertension.
For the exam, think in three directions:
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Hypertension as a cause of kidney disease Mainly hypertensive nephrosclerosis and malignant hypertensive nephropathy.
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Kidney disease as a cause of hypertension Renal parenchymal disease and renovascular hypertension are major secondary causes.
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Treatment problem CKD patients need careful antihypertensive choice, albuminuria reduction, diuretic selection by estimated glomerular filtration rate (eGFR), and monitoring for hyperkalaemia, acute kidney injury (AKI), and volume depletion.
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