Renal Case: 32-year-old Man with New-onset Hypertension

00:01 Let's go to a couple of clinical cases to see if we can solve them using some of the techniques that we talked about today.

00:08 So if you have a 32 year old gentleman, he seen in the clinic for new-onset hypertension and he was started on a thiazide diuretic.

00:15 They came in for follow-up with his PCP one week later with severe weakness.

00:20 His laboratory showed a potassium of 2.8.

00:23 We can see that that's very low.

00:26 His serum bicarbonate was high at 29.

00:29 A potassium at 29 to creatinine ratio was 88 milliequivalents per gram of creatinine.

00:34 Further investigations also demonstrated a suppressed plasma renin activity at 0.6 and an elevated aldosterone concentration at 32.

00:44 So the question is what is the most likely etiology of this gentleman's hypokalemia? Let's go through our history and see if we can answer a question.

00:52 So our first step is we want to check is acid-based status serum bicarbonate here is 29.

00:58 So that's really suggestive of a metabolic alkalosis.

01:01 Step two. We want to check his volume status.

01:05 Is the hyper or hypotensive is actually being treated with an antihypertensive.

01:09 So he's more on the hypertensive side.

01:13 Our third step, is we want to check that potassium to creatinine ratio is it less than or greater than 15? And in this case, he's greater than 15 Milli equivalents per gram of creatinine, which means that he's got renal wasting.

01:26 Now our fourth step as we want to decipher a little bit further as to where this is coming from.

01:31 So checking a renin in aldosterone level can be very helpful to determine whether there's excess mineralocorticoid.

01:37 In this situation, he has a suppressed renin and but a very high aldosterone level.

01:42 That is very suggestive of primary hyperaldosteronism syndrome.

01:46 So, in fact this gentleman has mineralocorticoid excess as the cause of his hypokalemia, and this is specifically due to primary hyperaldosteronism.