Now with these differentials, we have taken
a look at these before, but the parameters
here are a little a bit different, but incredibly
important. Let me set this up. We have the
condition and the differentials in the first
column. We will have the blood pressure went
only relevant to your pathology. PRA stands
for plasma renin activity and the aldosterone
magnesium only once relevant and urine calcium
when it is only relevant. That what you find
in red is what you truly paying attention
to because that unique for that particular
pathology. Blue is going to be the consequence
of. So let us begin. In Bartter syndrome,
where is my pathology? It is going to be in
the thick ascending limb. It is a problem
with the sodium, potassium to chloride, isn't
it? So you are going to have issues with what
exactly? You are going to have issues with
your concentrating ability and diluting ability.
What else to talk about the Bartter syndrome?
We said that there would be increase in prostate
glandins. So, therefore, one step of management
a border, in fact, is indomethacin. In addition,
Bartter syndrome has a unique feature in which
I want to go to last column here where the
urine calcium is elevated, elevated, elevated.
On this entire table of differentials, Bartter
syndrome is going to be the only one that
you and I are going to see as having hypercalciuria.
So, therefore, is it possible just possible
that you might have secondary hypoparathyroidism?
Yes or no? Good. Yes. You will have secondary
hypoparathyroidism. Now in Bartter syndrome,
there would be an increase in PRA and aldosteron
and because of that, you would have a decrease
in plasma renin activity. Keep that in mind.
Let's move on.
In Gitelman syndrome, where are you? My problem
is in the thiazide-sensitive. You remember
that your sodium channel cotransporter T gene.
T representing the thiazide-sensitive. Here
right off the back with Gitelman, I want you
to go to urine calcium. You see the difference.
Here you find your calcium to be really low
and with Gitelman, the two big things here
is an increase in PRA, plasma renin activity
and an increase in aldosterone. Now in addition
to your urine calcium being quite low, the
serum magnesium will be low. There is enough
information here with Gitelman and once again
in terms of electrolytes and the pathophysiology,
you should not be able to get or you should
be able to answer any question confidentially
and of the two conditions here, Gitelman and
Bartter, what is more, common in our society?
Gitelman, Gitelman, Gitelman. So you want
to spend a little bit more time on Gitelman
in getting these facts down because it is
much more common than Better. But I can clearly
say that both are commonly asked.
Liddle syndrome is interesting. With Liddle
syndrome, all that you want to know is the
labs here and that would be good enough for
you to get any question right. I don't want
to be in a situation where every once in a
while you are doing a question and you might
not know one condition, but do not know two
or three conditions is rather frustrating.
Liddle syndrome, you will find an increase
in blood pressure and you will find a decrease
in plasma renin activity and aldosterone.
That is the forest you need to go now with
Liddle know that it exists. Now SIADH, we
talked about this earlier. We will then find
an increase in ADH. You are then going to
find an increase in blood pressure. In SIADH,
you will not find pitting edema euvolemic.
You have a decrease in aldosterone and a decrease
in plasma renin activity. Once again what
did I say? Euvolemic. Why? It is SIADH. Is
that really reabsorbing or secreting sodium
any of that functioning here? No. So sodium
is not going to be part of the equation when
you have that fluid accumulation. That is
interesting and should be known. In Conn's
syndrome, what is my problem? It is the primary
adrenal cortex in which you are only producing.
You see that arrow in orange. That is my primary
problem. Too much aldosterone, decrease in
plasma renin activity, your patient has what
kind of hypertension? Secondary hypertension
and then we have reninoma. Reninoma where
is your problem? Where do you begin? Take
a look at the orange arrow. It is plasma renin
activity first and with that occurring understand
that your blood pressure here is, in fact,
going to be increased. This is then called
secondary once again hypertension. Two very
important tables they give you a bunch of
differentials that are then affecting the
kidney in some way, shape or form, this table
might or might not be too familiar. Make it
familiar. All these labs will be shown and
it is important that you come up with good
differentials. You will be impressed.