When will you suspect reno vascular hypertension ?
Posted Sep 01 2010 10:52am
The much fancied criteria “suspect secondary HT” if the onset of hypertension is before 30 years later than 55 years ,may be useful .But a caution about this criteria : It does not mean you should not hesitate to diagnose renal HT between 30 -55 years. The real onset may be < 30years , but the patient may report to the physician late in his /her 40 or 50s !
Diastolic blood pressure > 120
Sudden acceleration blood pressure
Blood pressure which is resistant to control with three or 4 drugs ,that shall typically include a diuretic.
An episode of left ventricular failure (Often referred to as called flash pulmonary edema)
Presence of Hypertensive retinopathy
Para umbilical bruit
HT associated with significant CAD
Marked LVH in echocardiography
Finally , most importantly , worsening of renal function with ACE inhibitor is a strong clue the kidney is under perfused and the renal circulation is dependent on elevated angiotenisn 2 (Which ,if blocked worsens the GFR ).This implies every physician should take a baseline serum creatinine and urea before starting them on ACEI.(Which is rarely followed , as far as my country is concerned !)
Is there any simple way to differentiate reno vascular from renal parenchymal HT ?
It is very difficult to differentiate between these two clinically. It makes things more difficult , as combination of both occurs. Prolonged renal ischemia can result in parenchymal damage as well.
The simplest way is to do a rapid ultrasound imaging to assess kidney size and texture (Loss of cortical-medullary differentiation indicating early renal contraction phase ).Of course , our nephrology colleagues are always there to help you out .
* It need to be remembered the functional renal HT -Renal tubular acidosis, Adrenal HT (Conn’s /chromo-pheocytomas has to be ruled out , as these entities also occur in the same age group ).The combination of hypokalemia and mild alkalosis is a good clue to rule out many of these defects.
* The CT scan image used in the above illustration courtesy
The much fancied criteria “suspect secondary HT” if the onset of hypertension is before 30 years later than 55 years ,may be useful .But a caution about this criteria : It does not mean you should not hesitate to diagnose renal HT between 30 -55 years. The real onset may be < 30years , but the patient may report to the physician late in his /her 40 or 50s !
Is there any simple way to differentiate reno vascular from renal parenchymal HT ?
It is very difficult to differentiate between these two clinically. It makes things more difficult , as combination of both occurs. Prolonged renal ischemia can result in parenchymal damage as well.
The simplest way is to do a rapid ultrasound imaging to assess kidney size and texture (Loss of cortical-medullary differentiation indicating early renal contraction phase ).Of course , our nephrology colleagues are always there to help you out .
* It need to be remembered the functional renal HT -Renal tubular acidosis, Adrenal HT (Conn’s /chromo-pheocytomas has to be ruled out , as these entities also occur in the same age group ).The combination of hypokalemia and mild alkalosis is a good clue to rule out many of these defects.
* The CT scan image used in the above illustration courtesy
http://www.ajronline.org/cgi/content-nw/full/189/3/528/FIG21