Chronic hypertension causes

Chronic Hypertension Microchapters
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2017 ACC/AHA Hypertension Guidelines
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian

Overview

Secondary hypertension is only responsible for 5% of cases of chronic hypertension whereas primary hypertension (also known as essential hypertension where no identifiable cause is identified) is responsible for 95% of cases. Common causes of secondary hypertension include obstructive sleep apnea, hyperaldosteronism, kidney diseases, excess catecholamines, coarctation of the arota, cushing syndrome among other diseases.

Chronic hypertension

Primary hypertension (also known as essential hypertension) (95% of the cases)

Secondary hypertension (5% of the cases)

Primary Hypertension

When a full evaluation yields no clear etiology for the elevated blood pressure, the latter is identified as primary hypertension. Primary or essential hypertension is considered a chronic disease requiring lifelong treatment and follow-up. If an underlying disease is identifiable as the cause, secondary hypertension is diagnosed. Secondary hypertension is a potentially curable condition in most cases. In comparison, the prevalence of primary hypertension is significantly higher than secondary hypertension, where only 5-10% of patients have a secondary etiology Classically, the common age range for the presentation of primary hypertension is 30 to 55 years, but age alone should never warrant a diagnosis of primary hypertension without a proper work-up.

Secondary Hypertension

When to Suspect Secondary Hypertension

It is not cost effective to evaluate all hypertensive patients for secondary hypertension. There are certain clinical scenarios, though, that should prompt further evaluation.

Early Onset Hypertension Under Age 30

Primary hypertension generally first occurs between 30 and 55 years. Onset of hypertension before puberty and before age 30 in the absence of risk factors should raise suspicion for secondary hypertension.

Refractory Hypertension

Evaluation of Secondary Hypertension

Evaluation of secondary hypertension

Investigation should be limited for patients with clues suggestive of potentially correctable causes. ❑ Presence of clues for renovascular hypertension (most common potentially correctable cause)? ❑ Onset of hypertension before the age of 30 years ❑ Onset of severe hypertension (SBP ≥180 mm Hg and/or DBP ≥120 mm Hg) after the age of 55 years ❑ New azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent ❑ Unexplained atrophic kidney or size discrepancy between kidneys of greater than 1.5 cm ❑ Sudden, unexplained pulmonary edema ❑ Accelerated hypertension (sudden and persistent worsening of previously controlled hypertension) ❑ Resistant hypertension (failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic) ❑ Malignant hypertension (hypertension with coexistent evidence of acute end-organ damage, i.e., acute renal failure, acutely decompensated congestive heart failure, new visual or neurological disturbance, and/or advanced [grade III to IV] retinopathy) ❑ Unexplained renal failure in the absence of proteinuria or an abnormal urine sediment ❑ Multivessel coronary artery disease ❑ Unexplained congestive heart failure ❑ Refractory angina

YES

NO

❑ Perform noninvasive diagnostic studies ❑ Duplex ultrasonography ❑ Gadolinium-enhanced magnetic resonance angiography ❑ Computed tomographic angiography (in individuals with normal renal function) ❑ Consider catheter angiography when noninvasive studies are inconclusive

Look for findings suggestive of other identifiable causes ❑ Pheochromocytoma ❑ Paroxysmal pounding headache ❑ Palpitations ❑ Profound perspiration ❑ Pallor ❑ Hand tremor ❑ Hyperaldosteronism ❑ Unexplained hypokalemia with urinary potassium wasting ❑ Obstructive sleep apnea ❑ Daytime somnolence ❑ Snoring ❑ Obesity ❑ Hyperparathyroidism ❑ Hypercalcemia ❑ Hypothyroidism ❑ Elevated TSH ❑ Puffy face ❑ Aortic coarctation ❑ Diminished or delayed femoral pulses and low or unobtainable blood pressures in the legs

Common Causes of Secondary Hypertension

Common causes of secondary hypertension are often memorized by the mnemonic ABCDE:

Letter	Causes of Secondary Hypertension
A	Accuracy, Apnea, Aldosteronism
B	Bruit, Bad Kidneys
C	Catecholamines, Coarctation, Cushing’s Syndrome
D	Drugs, Diet
E	Erythropoitin, Endocrine Disorders

Accuracy

An accurate assessment and re-assessment of blood pressures is an essential first step when a patient presents with high blood pressure. The accuracy of home BP measurements should be confirmed by calibrating the patient's measurement technique with that obtained in the doctor's office.

Apnea

Obstructive sleep apnea (OSA) is a respiratory disease characterized by repetitive narrowing or collapse of the upper airway during sleep leading to apnea, hypopnea, and a nocturnal decrease in oxygen tension. Symptoms and signs that might suggest OSA include daytime somnolence, obesity, snoring, and morning headache. Patients with sleep apnea also tend to have drug resistant hypertension and may retain sodium. Diagnosis is made by polysomnography. Treatment relies on maintaining airway patency at night and includes, among others, the use of continuous positive airway pressure (CPAP).

Aldosterone

Primary (hyporeninemic) and secondary (hyperreninemic) hyperaldosteronism result in excess sodium and water retention with slight hypernatremia along with excretion of potassium resulting in hypokalemia in one half of patients. Common symptoms of hyperaldosteronism include drug resistant hypertension, fatigue, headache, intermittent paralysis, muscle weakness, and numbness. The most common cause of primary hyperaldosteronism is an aldosterone-producing adenoma (an "aldosteronoma"), i.e. Conn’s Syndrome. Secondary hyperaldosteronism is due to an overactive RAAS, as seen in renin-secreting tumors, renal artery stenosis, pheochromocytoma, and other syndromes. The diagnosis is made by measuring the ratio of plasma aldosterone to plasma renin activity. It is elevated in primary hyperaldosteronism and decreased/normal with elevated renin in secondary hyperaldosteronism. It should be noted that obesity can also cause aldosterone levels to be elevated. Treatment depends upon the underlying etiology: surgery to resect an adenoma causing primary hyperaldosteronism and spironolactone, an aldosterone antagonist to treat secondary hyperaldosteronism.

Bruit

Renovascular hypertension is due to decreased blood supply to the kidneys secondary to renal artery stenosis and it is the most common correctable cause of secondary hypertension. Atherosclerosis of the renal artery (renal artery stenosis) in older patients above 50 years of age and fibromuscular dysplasia in younger patients are the most common etiologies.

According to the 2013 ACC/AHA Guidelines for the Management of PAD, diagnostic work-up for renal artery stenosis is indicated in the following conditions:

Class I Recommendations

• Hypertension of any stage before the age of 30
• Stage II hypertension (severe hypertension systolic blood pressure > 180 mm Hg or diastolic blood pressure > 120 mm Hg) in patients older than 55 years. If only mild hypertension is present, then renal artery stenosis is the underlying cause in only 1% of patients , but if the blood pressure is markedly elevated, then the risk of renal artery stenosis goes up 10 to 50 fold.
• Accelerated condition of previously controlled hypertension
• Resistant hypertension
• Malignant hypertension
• New azotemia (50% rise in creatinine that is sustained) within one week after administration of an Angiotensin Converting Enzyme (ACE)inhibitor or ARB
• Unexplained atrophic kidney or asymmetric kidneys that differ by > 1.5 cm. If the kidney is < 9 cm in size, there is a 75% chance that renal artery stenosis is present.
• Severe hypertension, impaired renal function, and recurrent flash pulmonary edema

Class IIa Recommendations

• Unexplained renal failure including patients starting renal replacement therapy

Class IIb Recommendations

• Presence of multi vessel CAD and no clinical clues of ARAS or PAD
• Unexplained CHF or refractory angina

Other Indications

• Severe hypertension in the presence of polyvascular disease (coronary artery disease or peripheral arterial disease)
• A unilateral systolic-diastolic abdominal bruit. Although a bruit is infrequent in documented renal artery stenosis (the sensitivity is only 40% percent) if it is auscultated, it is associated with a very high specificity of 99%.
• The association of race with renal artery stenosis is not clear. Reports that it is observed more often in white patients may be due to reporting bias.

Definitive diagnosis is made by magnetic resonance angiography (MRA) and renal arteriography. Other diagnostic methods include duplex ultrasound scanning, and captopril-augmented radio-isotopic renogram. Treatment is based upon the underlying etiology.

Bad Kidney (Chronic Renal Failure)

Renal parenchymal disease blunts the kidney’s physiological ability to maintain appropriate blood pressure. Notably, hypertension is both a cause and a consequence of renal parenchymal disease; the two are closely associated and may potentiate each other. The diagnosis is made by demonstration of a decreased GFR. The mechanisms by which renal parenchymal disease leads to the development of hypertension are numerous and include activation of the local RAAS, release of vasoconstrictor cytokines, and inappropriate natriuresis for any given blood pressure.

Catecholamines

Catecholamine excess occurs in several non-disease states, such as acute stress, the administration of medications with sympathomimetic activity, and illicit drug use such as cocaine and these conditions can be ruled out by thorough history taking. Pheochromocytoma, a tumor of the adrenal gland leading to excess secretion of epinephrine, should be considered in young patients with the triad of intermittent hypertensive episodes causing headache, sweating, and tachycardia. However, pheochromocytoma in older adults or a presentation with sustained hypertension is not uncommon. Diagnostic studies to evaluate pheochromocytoma include measurement of plasma free metanephrines and urinary fractionated metanephrines. The diagnostic value of plasma and urinary catecholamines is of limited value given the very short half-life of catecholamines. Treatment is usually by surgical resection of the secreting tumor with appropriate adrenergic blockade.

Coarctation

Coarctation of the aorta is a congenital heart defect, caused by a narrowing in a segment of the ascending or descending aorta. The diagnosis is often made in a neonate or an infant as a result of a weak femoral pulse or asymmetric brisk brachial pulses. Hypertension occurs as a result of a reduction in the effective circulation at the level of the kidneys which respond by increasing plasma volume which in turn causes hypertension in the upper extremities. Diagnosis is by CT angiography, but can also be made in neonates and infants by ultrasound of the heart and the great vessels. Definitive treatment is by surgical correction and or stenting.

Cushing’s Syndrome

Cushing's syndrome is an endocrine disorder caused by prolonged exposure to high endogenous or exogenous cortisol levels. Hypertension in Cushing’s syndrome has been classically attributed to the mineralocorticoid effects of cortisol. It manifests as an absent fall of nocturnal blood pressure physiologically seen in normotensive subjects with associated disturbance in the adrenocorticotropic hormone-glucocorticoid system. Symptoms of Cushing's syndrome include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity), a round face often referred to as a "moon face" along with central obesity, excess sweating, proximal muscle weakness, ecchymoses, insomnia, reduced libido, impotence, amenorrhoea, infertility and psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety. Although an ideal diagnostic test is not considered yet available, clinicians often assess the 24-hour urinary cortisol excretion, a low-dose dexamethasone suppression test, late evening serum or salivary cortisol, and a CRH a following a dexamethasone suppression test to establish the diagnosis.

Drugs

An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, oral contraceptive pills, some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.

Diet

In addition to the association of obesity with hypertension, the 2001 study “Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet” concluded that a high sodium diet above the recommended 100 mmol per day (2.4 g of sodium or 6 g of sodium chloride salt) is associated with hypertension. As a result, reduction of sodium levels below 100 mmol per day and following the DASH diet (rich in vegetables, fruits, with low-fat dairy products) can significantly lower BP. Ingestion of excessive amounts of liquorice can lead to elevation in the blood pressure.

Erythropoietin

Elevated erythropoietin is typically seen in COPD patients who have functional anemia due to chronic hypoxia and in hematologic disorders such as polycythemia. The pathogenesis of erythropoietin-induced hypertension includes increased hematocrit and blood viscosity, altered sensitivity to vasopressors, dysregulated vasodilatory factors, and vascular cell growth causing arterial remodeling and changes in arterial smooth musculature. Diagnosis and treatment are etiology-dependent.

Endocrine

In addition to the more common endocrine causes of hypertension such as hyperaldosteronism, Cushing’s syndrome, and pheochromocytoma, several other endocrine changes can cause hypertension. Both hypothyroidism and hyperthyroidism can cause hypertension by volume retention and by increased cardiac output, respectively. Also, hyperparathyroidism and hypovitaminosis D can cause hypertension due to poorly understood mechanisms, where parathyroidectomy seems to significantly decrease blood pressure in patients with parathyroid disease and elevated BP. Acromegaly can also be a cause of hypertension.

Causes by Organ System

Cardiovascular	Aortic regurgitation, aortic dissection, acute severe vascular damage, adams Nance syndrome , aneurysm, aortic coarctation , aortic stenosis, arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly , arteriosclerosis, atheroma, avasthey syndrome , carotid paraganglioma ,Congenital mitral stenosis , eisenmenger's Syndrome , fibromuscular dysplasia of arteries , grange syndrome , hemangiomatosis (familial pulmonary capillary disease), hypertensive heart disease , pulmonary artery agenesis , vasculitis , patent ductus arteriosus, third degree AV block
Chemical / poisoning	Acetaldehyde , aristolochic acid poisoning , arizona Bark Scorpion poisoning , black widow spider envenomation , cadmium poisoning, cocaine, ecstasy abuse , ginseng , heavy metal poisoning, Indian tobacco poisoning, jimsonweed poisoning , lead poisoning , lockwood-Feingold syndrome , mustard tree poisoning , nicotine addiction , pseudoephedrine poisoning , silicosis , toxic mushrooms -- Psychedelic , lobelia poisoning
Dermatologic	No underlying causes
Drug Side Effect	almotriptan, amitriptyline, Asenapine maleate, Atropine, Beractant, Betamethasone valerate, Benzphetamine, Betamethasone dipropionate, Butorphanol, Cidofovir, cocaine, combined oral contraceptive pill, cyclosporine, caspofungin acetate, desipramine, Desmopressin, Desogestrel and Ethinyl Estradiol, Diethylpropion, dihydroergotamine, diflunisal, Dimercaprol, Dipivefrine, doxepin, Drospirenone and Ethinyl estradiol, Eculizumab, Eletriptan, ephedrine, ergotamine, Erythropoietin, Estropipate, etodolac, febuxostat, Florbetapir F-18, formoterol, frovatriptan, gadoterate, glucocorticoid resistance , gadopentetate, Hydrocortisone, Hydroxocobalamin, Indomethacin, imipramine, interferon alfacon-1, isometheptene, Ketorolac tromethamine, Lanreotide, Leuprolide, Levalbuterol, Medroxyprogesterone, Mefenamic acid, Megestrol, Meloxicam, Meloxicam, Meropenem, Metipranolol, Methylene blue, Methylphenidate, Methylprednisolone, Metoclopramide, Methoxy polyethylene glycol-epoetin beta, Mifepristone, Milnacipran hydrochloride, Mirabegron, monoamine oxidase inhibitors, Nabilone, Naphazoline , nasal decongestants, Naproxen and esomeprazole magnesium, Norethindrone acetate and Ethinyl estradiol, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, nortriptyline, NSAIDs, Oxaprozin, Oxcarbazepine, Pentamidine Isethionate, Pergolide, phencyclidine, Phendimetrazine, phenylpropanolamine, Pilocarpine, Piroxicam, Pralidozxime, protriptyline, pseudoephedrine, prednisolone, Prednisone, Ramucirumab, Rasagiline, Repaglinide and Metformin hydrochloride, rizatriptan, Rotigotine, sedative dependence, serotonin toxicity, Sertraline, Sipuleucel-T, Sorafenib, steroid abuse, Sulindac, sumatriptan, Sunitinib, Thalidomide, Tiagabine, Tocilizumab, Tolmetin, Travoprost, Triamcinolone, Valganciclovir hydrochloride, zolmitriptan, Zolmitriptan, Zonisamide
Ear Nose Throat	Nephrosis -- deafness -- urinary tract -- digital malformation , Fitzsimmons-Walson-Mellor syndrome
Endocrine	Carcinoid Syndrome, acromegaly , adrenal incidentaloma , alcohol-induced pseudo-Cushing syndrome , apparent mineralocorticoid excess , congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency, congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency, Conn's syndrome, cushing's disease, cushing's syndrome , diabetes, Familial cushing syndrome , graves disease , hyperadrenalism , hyperparathyroidism , hyperpituitarism , hyperthyroidism, hypothyroidism, isolated secretion of corticosterone, isolated secretion of deoxycorticosterone, mineralocorticoid excess, multiple endocrine neoplasia type 1, myxoedema, pheochromocytoma, primary aldosteronism, primary cortisol resistance, pseudohyperaldosteronism , pseudohypoaldosteronism , Schroeder syndrome 1 , hyperthyroidism, hypoglycemia, isolated secretion of 18-hydroxy-deoxycorticosterone, renin-secreting tumors, dexamethasone sensitive hypertension
Environmental	No underlying causes
Gastroenterologic	Hepatorenal tyrosinemia , pancreatitis, retroperitoneal Fibrosis
Genetic	Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency, congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency, cockayne syndrome , down Syndrome , Fabry's Disease , isolated secretion of 18-hydroxy-deoxycorticosterone, Pierre Robin's sequence , Senior-Loken Syndrome, Turner Syndrome , Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency , Von Hippel-Lindau Disease , Werner syndrome , Williams Syndrome , Gaucher disease type 3 , mucopolysaccharidosis type I Hurler syndrome
Hematologic	Anemia, Atypical Hemolytic uremic syndrome, Catastrophic antiphospholipid syndrome , Essential mixed cryoglobulinemia , Faye-Petersen-Ward-Carey syndrome , hemolytic uremic syndrome , hypereosinophilic syndrome , Liddle's syndrome, Multicentric reticulohistiocytosis , polycythemia , thromboembolism , thrombotic thrombocytopenic purpura
Iatrogenic	No underlying causes
Infectious Disease	Poliomyelitis, meningitis, post streptococcal glomerulonephritis , renal tuberculosis, nipah virus encephalitis
Musculoskeletal / Ortho	Acrodynia , Allain Babin Demarquez syndrome , familial osteodysplasia - Anderson type, Paget's disease of bone , Grange syndrome , Faye-Petersen-Ward-Carey syndrome , oculo skeletal renal syndrome , Thieffry and Sorrell Dejerine syndrome
Neurologic	Guillain-Barre Syndrome, autonomic dysreflexia syndrome , Binswanger's Disease , Brain stem encephalitis, central sleep apnea , choroideremia -- hypopituitarism , disequilibrium syndrome , dysautonomia , hereditary sensory and autonomic neuropathy 3 , increased intracranial pressure, neurofibromatosis syndrome Type II , neurogenic hypertension , nipah virus encephalitis , obstructive sleep apnea , Sneddon Syndrome , upper spinal cord lesions, Wolfram's disease, meningitis, polyradiculitis, quadriplegia, Adams Nance syndrome , glycine encephalopathy - classical neonatal form, pituitary Cancer , Fitzsimmons-Walson-Mellor syndrome
Nutritional / Metabolic	Abdominal obesity metabolic syndrome , acute intermittent porphyria , congenital hepatic porphyria , Gaucher disease type 3, glycine encephalopathy - classical neonatal form, glycine synthase deficiency , gouty nephropathy, liquorice, metabolic syndrome, tyrosinemia , Von Gierke disease IB, increased salt intake, mucopolysaccharidosis type I Hurler syndrome, Fabry's Disease , vitamin D -- adverse effects
Obstetric/Gynecologic	Eclampsia , Fowler-Christmas-Chapple syndrome , gestational hypertension, HELLP syndrome , ovarian dysgenesis, PCOS, pregnancy toxemia /hypertension , twin-twin transfusion syndrome
Oncologic	Endothelin producing tumor, adrenal Cancer , familial adrenal adenoma , renal Cancer , neuroblastoma pituitary Cancer , renin-secreting tumors, rhabdoid tumor , Wilms' tumor , adrenal incidentaloma , familial renal cell carcinoma
Opthalmologic	Isolated Ectopia lentis, oculo skeletal renal syndrome
Overdose / Toxicity	Amphetamine abuse, almotriptan, dihydroergotamine, ergotamine, frovatriptan, isometheptene, rizatriptan, sumatriptan, zolmitriptan, amitriptyline, cyclosporine, desipramine, dexamethasone sensitive hypertension, doxepin, ephedrine, glucocorticoid resistance , imipramine, nasal decongestants, nortriptyline, combined oral contraceptive pill, phencyclidine, phenylpropanolamine, protriptyline, serotonin toxicity, steroid abuse, pseudoephedrine, cocaine
Psychiatric	Anxiety
Pulmonary	Asphyxia , bronchopulmonary dysplasia, COPD , Goodpasture syndrome , pulmonary cystic lymphangiectasis , pulmonary embolism , pulmonary fibrosis /granuloma , pulmonary veno-occlusive disease , pulmonary lymphangiomatosis, respiratory acidosis , respiratory failure , unilateral pulmonary agenesis , hyperventilation, obstructive sleep apnea , Wegener's granulomatosis
Renal / Electrolyte	Bartter's Syndrome, dissection of the renal arteries, acid-base imbalance , acute renal failure , albuminuria , analgesic nephropathy syndrome , autosomal dominant polycystic kidney disease , autosomal recessive polycystic kidney disease , bilateral renal artery stenosis , Bright's Disease , chronic kidney disease , chronic pyelonephritis, congenital membranous glomerulonephritis, congenital stenosis of renal artery, congenital hydronephrosis, diffuse mesangial sclerosis, familial renal cell carcinoma , Fitzsimmons-Walson-Mellor syndrome , glomerulonephritis , hereditary nephritis (X-linked), hypoplastic kidney, IgA nephropathy , kidney arteriovenous fistula , Kimmelstiel-Wilson disease, lupus nephritis , nephrocalcinosis , nephrosclerosis , nephrosis -- deafness -- urinary tract -- digital malformation , nephrotic syndrome , oculo skeletal renal syndrome , Pierson syndrome , Severe infantile polycystic kidneys with tuberous sclerosis , post streptococcal glomerulonephritis , renal artery thrombosis, renal artery stenosis, renal emboli, renal segmental hypoplasia-induced Hypertension , renal tuberculosis, Salcedo syndrome , simple kidney cysts , Thieffry and Sorrell Dejerine syndrome , urinary tract infections , urinary tract obstruction, vesicoureteral reflux , Wegener's granulomatosis , Gitelman's Syndrome, hepatorenal tyrosinemia , Atypical hemolytic uremic syndrome, gouty nephropathy, Goodpasture syndrome
Rheum / Immune / Allergy	Autoimmune Vasculitis , systemic lupus erythematosus, diffuse systemic sclerosis , polyarteritis nodosa , Takayasu arteritis
Sexual	No underlying causes
Trauma	Electrical burns , head injury, skull fracture
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Acquired total lipodystrophy , following kidney transplantation, aging, alcohol intake, alcohol withdrawal, amyloidosis , bone cement implantation syndrome, brachydactyly with hypertension, Carnevale-Canun-Mendoza syndrome , codeine withdrawal , collagen disease, essential hypertension, fever, Gram's syndrome , hypothermia, irradiation, Kashani-Strom-Utley syndrome , lymphomatoid granulomatosis , MSBD syndrome , neuroleptic malignant syndrome , obesity, physical inactivity , Selye syndrome , serotonin syndrome , shaken baby syndrome , stress-induced hypertension , type A personality, Wagener syndrome , pain, post-exercise, transfusion of large blood volumes, white coat hypertension

Causes in Alphabetical Order

Abdominal obesity metabolic syndrome Absence of pulmonary artery Acetaldehyde Acid-Base Imbalance Acquired total Lipodystrophy Acrodynia Acromegaly Acute intermittent porphyria Acute renal failure Acute severe vascular damage Adams Nance syndrome Adrenal Cancer Adrenal incidentaloma After Kidney transplantation Kidney tumor Aging Albuminuria Alcohol Alcohol withdrawal Alcohol-induced pseudo-Cushing syndrome Allain Babin Demarquez syndrome Almotriptan Amitriptyline Amphetamine abuse Amyloidosis Analgesic nephropathy syndrome Anemia Aneurysm Anxiety Aortic coarctation Aortic regurgitation Aortic stenosis Aortic valve disease Apparent mineralocorticoid excess Aristolochic Acid poisoning Arizona Bark Scorpion poisoning Arterial occlusive disease, progressive - -- heart defects -- bone fragility -- brachysyndactyly Arteriosclerosis Asphyxia Atheroma Atropine Atypical Hemolytic uremic syndrome Autoimmune Vasculitis Autonomic dysreflexia syndrome Autosomal dominant Polycystic kidney disease Autosomal Recessive Polycystic Kidney Disease Avasthey syndrome Bartter's Syndrome Betamethasone valerate Betamethasone dipropionate Bilateral Renal artery stenosis Binswanger's Disease Black widow spider envenomation Bone cement implantation syndrome Brachydactyly with hypertension Brain stem Encephalitis Bright's Disease Bronchopulmonary dysplasia Butorphanol Cadmium poisoning Carcinoid Syndrome Carnevale-Canun-Mendoza syndrome Carotid paraganglioma Catastrophic Antiphospholipid Syndrome Central sleep apnea Choroideremia -- hypopituitarism Chronic kidney disease Chronic pyelonephritis Cidofovir Cocaine Cockayne syndrome Codeine withdrawal Collagen disease Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency Congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency Congenital hepatic porphyria Congenital Membranous glomerulonephritis Congenital Mitral stenosis Congenital stenosis of renal artery Congenital Hydronephrosis Conn's syndrome COPD Cushing's disease Cushing's syndrome Cyclosporine Desipramine Desmopressin Desogestrel and Ethinyl Estradiol Dexamethasone sensitive hypertension Diabetes Diffuse Systemic sclerosis Diffuse mesangial sclerosis Dihydroergotamine Disequilibrium syndrome Aortic dissection Dissection of the renal arteries Down Syndrome Doxepin Dysautonomia Eclampsia Ecstasy abuse Eculizumab

Eisenmenger's Syndrome Electrical burns Endothelin producing tumor Ephedrine Ergotamine Essential hypertension Essential mixed Cryoglobulinemia Fabry's Disease Familial Renal cell carcinoma Familial Adrenal adenoma Familial Cushing syndrome Faye-Petersen-Ward-Carey syndrome Fever Fibromuscular dysplasia of arteries Fitzsimmons-Walson-Mellor syndrome Fowler-Christmas-Chapple syndrome Frovatriptan Gaucher disease type 3 Gestational hypertension Ginseng Gitelman's Syndrome Glomerulonephritis Glucocorticoid resistance Glycine encephalopathy - classical neonatal form Glycine synthase deficiency Goodpasture syndrome Gouty nephropathy Gram's syndrome Grange syndrome Graves Disease Guillain-Barre Syndrome Head injury Heavy metal poisoning HELLP syndrome Familial Hemangiomatosis - pulmonary capillary Familial Osteodysplasia - Anderson type Hemolytic uremic syndrome Hepatorenal tyrosinemia Hereditary nephritis (X-linked) Hereditary sensory and autonomic neuropathy 3 Hydroxocobalamin Hyperadrenalism Hypereosinophilic syndrome Hyperparathyroidism Hyperpituitarism Hypertensive heart disease Hyperthyroidism Hyperventilation Hypoglycemia Hypoplastic kidney Hypothermia Hypothyroidism IgA nephropathy Imipramine Increased intracranial pressure Increased salt intake Indian Tobacco Poisoning Infliximab Irradiation Isolated secretion of 18-hydroxy-deoxycorticosterone Isolated secretion of corticosterone Isolated secretion of deoxycorticosterone Isolated Ectopia lentis Isometheptene Jimsonweed poisoning Kashani-Strom-Utley syndrome Kidney arteriovenous fistula Renal Cancer Kimmelstiel-Wilson disease Lead poisoning Liquorice Liddle's syndrome Lobelia poisoning Lockwood-Feingold syndrome Lupus nephritis Lymphomatoid granulomatosis Medroxyprogesterone Meloxicam Meningitis Meropenem Metabolic syndrome Methylphenidate Mifepristone [Milnacipran hydrochloride]] Mineralocorticoid excess Monoamine oxidase inhibitors MSBD syndrome Mucopolysaccharidosis type I Hurler syndrome Multicentric Reticulohistiocytosis Multiple endocrine neoplasia type 1 Mustard tree poisoning Myxoedema Nasal decongestants Nephrocalcinosis Nephrosclerosis Nephrosis -- deafness -- urinary tract -- digital malformation Nephrotic syndrome Neuroblastoma Neurofibromatosis syndrome Type II Neurogenic hypertension Neuroleptic malignant Syndrome Nicotine addiction Nipah virus encephalitis Norgestrel and Ethinyl estradiol Nortriptyline NSAIDs Obesity

Obstructive sleep apnea Oculo skeletal renal syndrome Oral contraceptive pill Ovarian dysgenesis Oxaprozin Paget's disease of bone Pain Pancreatitis Patent ductus arteriosus Pergolide PCOS Pheochromocytoma Phencyclidine Phenylpropanolamine Physical inactivity Pierre Robin's sequence Pierson syndrome Pilocarpine Piroxicam Pituitary Cancer Poliomyelitis Polyarteritis nodosa Polycystic kidneys, severe infantile, with tuberous sclerosis Polycythemia Polyradiculitis Post streptococcal glomerulonephritis Post-exercise Pralidoxime Pregnancy toxemia /hypertension Primary aldosteronism Primary cortisol resistance Protriptyline Pseudoephedrine Pseudohyperaldosteronism Pseudohypoaldosteronism Pulmonary artery agenesis Pulmonary cystic lymphangiectasis Pulmonary embolism Pulmonary fibrosis /granuloma Pulmonary veno-occlusive disease Pulmonary Lymphangiomatosis Quadriplegia Ramucirumab Renal artery thrombosis Renal artery stenosis Renal emboli Renal segmental hypoplasia-induced Hypertension Renal tuberculosis Renin-secreting tumors Respiratory acidosis Respiratory failure Retroperitoneal fibrosis Rhabdoid tumor Rizatriptan Salcedo syndrome Schroeder syndrome 1 Scleroderma Sedative dependence Selye syndrome Senior-Loken Syndrome Serotonin Syndrome Serotonin toxicity Shaken Baby Syndrome Silicosis Simple kidney cysts Sipuleucel-T Skull fracture Sneddon Syndrome Sorafenib Steroid abuse Stress-induced hypertension Sumatriptan Sunitinib Systemic lupus erythematosus Takayasu arteritis Thieffry and Sorrell Dejerine syndrome Third degree AV block Thromboembolism Thrombotic thrombocytopenic purpura Tiagabine Toxic mushrooms -- Psychedelic Transfusion of large blood volumes Turner Syndrome Twin-Twin Transfusion Syndrome Type A personality Tyrosinemia Unilateral pulmonary agenesis Upper spinal cord lesions Urinary tract infections Urinary tract obstruction Valganciclovir hydrochloride Vasculitis Vater-like syndrome, with pulmonary hypertension, abnormal ears and growth deficiency Vesicoureteral reflux Vitamin D -- adverse effects Von Gierke disease IB Von Hippel-Lindau Disease Wagener syndrome Wegener's granulomatosis Werner syndrome White coat hypertension Williams Syndrome Wilms' tumor Wolfram's disease Zolmitriptan