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Pathophysiology of Hypertension (PPPP) (Sodium/Renal)
Terms in this set (14)
How do you calculate the blood pressure?
BP = CO x TPR
What are the 6 main causes of hypertension?
1. Excess salt intake
2. Reduced nephron number
4. Genetic alteration
6. Endothelium derived factors
How much sodium is too much?
How does sodium sensitivity vary among people?
Some are more sensitive and thus more prone to hypertension than others.
What are some proposed mechanisms of sodium sensitivity?
1. Defect in renal Na+ excretion
2. Impaired NO synthesis (decreased vasodilation)
3. Increased insulin resistance
4. Paradoxical rise in ANP
5. Mononuclear Phagocyte System and lymphatics
What is the process of pressure natriuresis in a healthy person?
Increased blood pressure ---> increased sodium and water excretion ---> decreased blood volume ---> blood pressure returns to normal
What happens to pressure natriuresis in patients with HTN?
There is a failed (resetting) pressure natriuresis response such that the kidney needs an even higher blood pressure to excrete the sodium. The blood pressure can therefore not be returned to normal because less sodium would be excreted. Sodium and water accumulates, and there is an increase in blood pressure.
What are the different hypotheses explaining the reasons for abnormal renal sodium retention?
What is Dahl's hypothesis?
A proposed explanation for abnormal sodium retention in patients with HTN. It suggests a congenital abnormality in renal sodium excretion, where the failed pressure natriuresis is inherited.
What is Brenner's hypothesis?
A proposed explanation for abnormal sodium retention in patients with HTN. He suggests that there is a decreased filtration surface in the kidneys of patients with HTN. A congenital reduction in the number of nephrons limits the ability to excrete sodium thus raising the blood pressure.
How is nephron number related to hypertension?
Nephron number at birth is inversely related to the risk of developing hypertension later in life.
What is a normal nephron count?
About 40% of individuals under age 30 have fewer than the presumably normal number of nephrons (600,000/kidney).
What is the Laragh hypothesis?
A proposed explanation for abnormal sodium retention in patients with HTN. It states that there is a decreased filtration surface AND RAAS activation. Low renin levels are expected in patients with essential HTN. However, the majority of patients with essential HTN have normal or even elevated levels of renin.
What is the function of nephron heterogenecity (Laragh hypothesis)?
There are two kinds of nephrons in the kidney: normal ones and ischemic ones. The ischemic ones decrease the surface area but also increase renin secretion. This leads to hypertension.
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