Hypertension – causes

Eighty percent of secondary (i.e. non-essential) hypertension is caused by renal disease:

• Renal
  1. Acute glomerulonephritis
  2. Chronic glomerulonephritis
  3. Reflux nephropathy
  4. obstructive uropathy
  5. haemolytic uraemic syndrome
  6. polycystic kidney disease
• Coarctation of Aorta
• Renal artery stenosis – hypertensive state maintained by renin hypersecretion
• Pheochromocytoma
• Androgenital syndrome
• Essential

General Clinical Presentation and Workup of Hypertension

Symptoms: ask about polyuria, polydipsia, enuresis, headaches

Physical examination:

• urinalysis
• serum creatinine and electrolytes
• renal tract ultrasound scan (USS)
• DMSA (dimercapto-succinic acid) renal scan – scarring from reflux nephropathy
• DTPA (diethylenetriamine pentaacetate) or MAG3 renal scan – obstructive uropathy

Look for signs of more severe hypertension:

• fundi
• CXR
• ECG

Pharmacotherapy for HTN (acute / subacute):

• diuretics, β-blockers etc.
• low salt diet
• weight loss
• exercise