While there are a number of conditions which can cause the combination of hypokalemia and metabolic alkalosis there are a limited number of disease processes which lead to hypokalemia, metabolic alkalosis, AND hypertension. In order to have hypertension…
There is a good review article in this month’s NEJM entitled “Use of Diuretics in Patients with Hypertension” by Ernst and Moser which focuses predominantly on the thiazide class of diuretics. The thiazides are considered a FUNCTIONAL rather…
One of the hallmarks of autosomal dominant polycystic kidney disease (ADPKD) is hypertension. True, most patients with advanced kidney disease get hypertension anyways–but often the degree of hypertension in ADPKD patients seems to be especially high. Is there…
Another day, another negative study… this is getting painful! The large, randomized ASTRAL trial comparing renal revascularization to medical therapy found no benefit, and substantial increased risk, in the interventional arm. 806 patients with atherosclerotic reno-vascular disease were…
One of the coolest aspects of the renin-angiotensin-aldosterone system (RAAS) is that it involves multiple organ systems: the liver, lung, adrenal gland, kidney, and vasculature are all prominently involved. It never hurts to review basic physiologic principles, right?…
Eclampsia and pre-eclampsia are characterized by the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. One of the major causes of morbidity to both mother & fetus is the occurrence…
The MRI above depicts a classic example of posterior reversible encephalopathy syndrome (PRES), sometimes also called reversible posterior leukoencephalopathy, an increasingly-recognized consequence of malignant hypertension. The whitish areas (“hyper-intense signal”) in the bilateral occipital and parietal lobes represent…
Fibromuscular dysplasia (FMD) accounts for a significant fraction of renal artery stenosis. The distinction between fibromuscular dysplasia and atherosclerotic renal artery stenosis is important as the former tends to respond much more readily to interventional therapy than the…
This week’s Lancet has an interesting article from The Indian Polycap Study (TIPS), in which investigators tested the efficacy and tolerability of a single pill containing up to FIVE different cardiovascular medications: a beta-blocker, an ACE-inhibitor, a thiazide…
What’s the most common cause of ESRD in the U.S. after diabetes? The classic answer here is “hypertension”, though this answer is a controversial one, as there are many who believe that hypertension alone is not sufficient to…
