Chronic Kidney Disease (CKD)-Renal Parenchymal Hypertension

Renal diseases produce hypertension in two ways:
*inability to excrete sodium and fluid leading to volume expansion
*altered secretion of rennin angiotensin with change in vascular tone

Renal hypertension is further divided into renovascular hypertension and renal parenchymal hypertension.

CKD or renal parenchymal disease is the most common form of secondary hypertension. Hypertension occurs in more than 80% of patients with chronic renal failure and is a major factor causing their increased CV morbidity and mortality seen in CKD.

Parenchymal disease ultimately decreases the glomerular filtration rate and thereby increases blood pressure by hindering the excretion of salt and excess fluid.

In patients with mild or moderate renal insufficiency, stringent blood pressure control is imperative to reduce the progression to end-stage renal disease and to reduce the excessive CV risk associated with CKD.
Chronic Kidney Disease (CKD)-Renal Parenchymal Hypertension

What are the symptoms of pulmonary hypertension?

The diagnosis of pulmonary hypertension is usually made four to seven years after the diagnosis of portal hypertension. In addition, the risk of developing pulmonary hypertension increases with the duration of portal hypertension.

With chronic pulmonary hypertension, patients present with progressive dyspnea and fatique. Dyspnea is caused by decreased CO (cardiac output) and ventilation/perfusion mismatch.

Syncope, due to atrial and ventricular arrhythmias, occurs in one third of patients. Syncope is due to a fixed CO with the inability of the heart to respond to a demand for increased output.

The reduction the systolic pressure gradient across the right ventricular (RV) myocardium and increased RV oxygen demand caused by RV walls stress may result in symptoms of angina in one-third of patients.

During physical examination of the parturient with pulmonary hypertension, a RV heave may be present and an ejection click may be heard over the pulmonic area.
What are the symptoms of pulmonary hypertension?