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renin-angiotensin-aldosterone axis

Electrolyte Channels and Aldosteronism

Over the past few years, it has become apparent that hyperaldosteronism is far commoner than was once suspected and screening of unselected patients with hypertension reveals that about 5-10% of patients have primary hyperaldosteronism. In patients with resistant…

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Paging the doctor

I recently saw a young hypertensive patient who had suffered a motor vehicle accident complicated by a transected aorta that was successfully repaired several years back. He has had hypertension since then and was referred to us for…

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A great combination

Since the retraction of the COOPERATE trial by the Lancet late last year (following Regina Kunz’s famous ‘letter of concern’), combination RAAS blockade has suffered something of a fall from grace. This was dealt a second blow by…

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A trap for angiotensin type 1 receptors

The renin-angiotensin system is powerful regulator of blood pressure homeostasis. An article published in the March 24 issue of JASN highlights an emerging area of research into the modulation of AT1 receptors on different tissues. The majority of…

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SGLT Inhibitors

A promising new class of oral hypoglycemic agents for type 2 diabetes, the SGLT inhibitors, are on the horizon. As they work on the kidney, and potentially have renal side effects, it may be helpful to review them….

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Fibromuscular Dysplasia

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…

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Mineralocorticoid-Blocking Activity of Oral Contraceptives

I didn’t learn this until recently, but some commonly used oral contraceptives–for example Yasmin-28 (the progestin-derivative drospirenone + ethinyl estradiol)–has some mineralocorticoid blocking effect, similar to that seen for spironolactone. It may therefore be associated with hyperkalemia, particularly…

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