Deck 19: Role of the Kidneys in Long-Term Control of Arterial Pressure and in Hypertension: the Integrated System for Arterial Pressure Regulation

Question 1

A decrease in which one of the following would most likely result in chronic hypertension?

A)Angiotensin II
B)Renal sympathetic nerve activity
C)Aldosterone
D)Nitric oxide

Answer 1

D

Question 2

A 40-year-old woman with a 16-year history of diabetes mellitus was seen in the emergency department with a blood pressure of 270/110 mm Hg. She had her blood pressure measured many times in the past and had never been noted to be hypertensive. She also complains of gradually progressive pedal edema. She denies polyuria, polydipsia, or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): $$\begin{array} { l l } \text { BUN: : } & 33 ( 9 - 20 \mathrm { mg } / \mathrm { dl } ) \\\text { Creatinine: } & 2.7 ( 0.7 - 1.4 \mathrm { mg } / \mathrm { dl } ) \\\text { Glucose: } & 296 ( 74 - 106 \mathrm { mg } / \mathrm { dl } ) \\\text { Total protein: } & 6.2 ( 6.3 - 8.2 \mathrm {~g} / \mathrm { dl } ) \\\text { Albumin: } & 3.0 ( 3.5 - 5.1 \mathrm {~g} / \mathrm { dl } ) \\\text { Cholesterol: } & 320 ( 120 - 199 \mathrm { mg } / \mathrm { dl } ) \\\text { Urinalysis: } & 3 + \text { proteinuria }\end{array}$$

-An angiotensin-converting enzyme inhibitor is administered to a 65-year-old man with a 20-year history of hypertension. The drug lowered arterial pressure and increased plasma levels of renin and bradykinin. An increase in which of the following would best explain the decline in blood pressure?

A)Preprobradykinin
B)Conversion of angiotensin I to angiotensin II
C)Angiotensin II
D)Kallikrein
E)Renal sodium excretory function

Answer 2

Renal sodium excretory function

Question 3

A 65-year-old woman with a 10-year history of essential hypertension visits her physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 2-3 times higher than normal. The patient is given a prescription for an angiotensin I receptor blocker (ARB). Which one of the following would you expect to occur in this patient following administration of the ARB?

A)Increase in total peripheral resistance
B)Increase in arterial pressure
C)Increase in plasma renin activity
D)Increase in aldosterone
E)Decrease in kidney's ability to excrete sodium

Answer 3

C

Question 4

A decrease in which one of the following would best explain the increase in blood pressure in this patient?

A)Angiotensin II
B)Aldosterone
C)Sympathetic nerve activity
D)Glomerular filtration rate
E)Endothelin

Question 5

Which of the following set of changes would be expected to increase sodium excretion by the kidney?

Question 6

A 45-year-old woman was seen by her physician for an upper respiratory infection. Blood pressure on that visit was noted to be 158/94 mm Hg. She was asked to return for two other visits, separated by 1 week each, for measurement of blood pressure. Repeat measures were similar. She has no previous history of hypertension. She denies any previous significant medical problems. There is a positive family history for hypertension. The rest of her history is unremarkable. Other than moderate obesity and the elevated blood pressure, her physical examination was completely normal. All routine laboratory studies were normal. Which diagnosis would you predict for this woman?

A)Renovascular hypertension
B)Primary hyperaldosteronism
C)Essential hypertension
D)Pheochromocytoma
E)Moderate aortic valve regurgitation

Question 7

A 40-year-old woman with a 16-year history of diabetes mellitus was seen in the emergency department with a blood pressure of 270/110 mm Hg. She had her blood pressure measured many times in the past and had never been noted to be hypertensive. She also complains of gradually progressive pedal edema. She denies polyuria, polydipsia, or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): $$\begin{array} { l l } \text { BUN: : } & 33 ( 9 - 20 \mathrm { mg } / \mathrm { dl } ) \\\text { Creatinine: } & 2.7 ( 0.7 - 1.4 \mathrm { mg } / \mathrm { dl } ) \\\text { Glucose: } & 296 ( 74 - 106 \mathrm { mg } / \mathrm { dl } ) \\\text { Total protein: } & 6.2 ( 6.3 - 8.2 \mathrm {~g} / \mathrm { dl } ) \\\text { Albumin: } & 3.0 ( 3.5 - 5.1 \mathrm {~g} / \mathrm { dl } ) \\\text { Cholesterol: } & 320 ( 120 - 199 \mathrm { mg } / \mathrm { dl } ) \\\text { Urinalysis: } & 3 + \text { proteinuria }\end{array}$$

-A 55-year-old man with a history of normal health visits his physician for a checkup. His blood pressure was 170/98 mm Hg. Further tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney. Which of the following set of findings would be most likely expected in this man with renovascular hypertension?

Question 8

A 45-year-old man with a history of normal health visits his physician for a checkup. His blood pressure measured 170/98 mm Hg. Further tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney. Which of the following set of findings would be most likely expected?

Question 9

A healthy 22-year-old female medical student with normal kidneys increases her sodium intake by 200% for a period of 2 months. A decrease in which of the following is expected to occur in response to the increase in sodium intake?

A)Arterial pressure
B)Plasma renin activity
C)Sodium excretion
D)Nitric oxide
E)Atrial natriuretic peptide

Question 10

A 55-year-old woman is diagnosed with a juxtaglomerular cell rennin-secreting tumor. Lab tests reveal a plasma concentration of angiotensin II five times normal. Which of the following set of findings would be expected?

Question 11

A 50-year-old man has a 3-year history of hypertension. He has taken several medications but has not achieved good blood pressure control. He has been off medications entirely for the last 6 months. He complains of fatigue and occasional muscle cramps. There is no family history of hypertension. The patient has not had any other significant medical problems. Examination reveals a blood pressure of 168/104 mm Hg. Additional laboratory tests indicate that he has primary hyperaldosteronism. Which of the following set of findings would be most likely expected?

Question 12

A patient with which sodium intake (in mmol/day) will have the greatest reduction in blood pressure in response to an angiotensin converting enzyme inhibitor?

A)300
B)200
C)100
D)50

Question 13

A 55-year-old woman with a 5-year history of hypertension visits her physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 3 to 4 times higher than normal. The patient is given a prescription for Capoten, an angiotensin II converting enzyme (ACE) inhibitor. An increase in which one of the following would you expect to occur in this patient following administration of the ACE inhibitor?

A)Total peripheral resistance
B)Arterial pressure
C)Angiotensin I
D)Aldosterone
E)Atrial natriuretic peptide