[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Physiology](https://durgical.com/en/physiology/) › [Cardiovascular](https://durgical.com/en/physiology/areas/cardio/) › How specific hypertensions arise: volume loading, Goldblatt kidney, obesity, neurogenic and monogenic # How specific hypertensions arise: volume loading, Goldblatt kidney, obesity, neurogenic and monogenic - Mechanism - For completeness Each kind of high blood pressure ends the same way: the kidney needs a higher pressure to excrete the salt it receives. Updated Nov 13, 2026 Also called: Goldblatt hypertension, Renovascular hypertension, Obesity hypertension, Monogenic hypertension **See it in 3D:** [Kidneys](https://durgical.com/en/anatomy/kidney/) · [Left renal artery](https://durgical.com/en/anatomy/renal-artery/) · [Left adrenal gland](https://durgical.com/en/anatomy/suprarenal-gland/) ## Key points - Volume loading (reduced renal mass + high salt): first output rises, then autoregulation raises resistance; output returns toward normal while pressure stays high. - Two-kidney, one-clip Goldblatt: the clipped kidney secretes renin; the other kidney is exposed to high pressure. Renin is high and the hypertension is angiotensin-dependent. - One-kidney, one-clip: renin rises at first, then falls as volume expands; the hypertension becomes volume-dependent. - Obesity: more sympathetic renal activity, higher angiotensin II and aldosterone, leptin effects and kidney compression by fat raise renal sodium retention. - Monogenic, low-renin forms: Liddle syndrome (overactive ENaC), glucocorticoid-remediable aldosteronism, apparent mineralocorticoid excess. ## What it is Experimental and clinical forms of hypertension share one final mechanism: the renal output curve moves to a higher pressure. Reduced kidney mass plus salt causes volume-loading hypertension; a clamped renal artery causes renin-dependent (two-kidney) or volume-dependent (one-kidney) Goldblatt hypertension. Obesity raises sympathetic activity, angiotensin II and renal compression, and rare single-gene disorders cause low-renin hypertension by excess distal sodium reabsorption. ## How it works, step by step - Any cause that makes the kidney retain more sodium at a given pressure shifts the renal output curve to the right. - Salt and water are retained until extracellular volume and output rise. - Tissues receive more flow than they need, so local autoregulation constricts arterioles over days to weeks (higher resistance). - Output returns near normal while resistance and pressure stay high; the higher pressure lets the kidney excrete normal intake (pressure natriuresis). - In renin-dependent forms, angiotensin II both constricts vessels and retains sodium directly, so pressure rises without large volume change. ## Models compared | Type | Renin | Main driver | | --- | --- | --- | | Reduced renal mass + salt | Low | Volume | | [Two-kidney, one-clip Goldblatt](https://durgical.com/en/conditions/renovascular-hypertension/) | High | Angiotensin II from the clipped kidney | | [One-kidney, one-clip Goldblatt](https://durgical.com/en/conditions/renovascular-hypertension/) | High, then normal | Volume after early renin rise | | Renin-secreting tumour | Very high | Angiotensin II | | [Primary aldosteronism](https://durgical.com/en/conditions/primary-hyperaldosteronism/) | Low | Aldosterone, sodium retention | | [Obesity](https://durgical.com/en/conditions/obesity/) | Normal or high | Sympathetic, RAAS, renal compression | | Liddle syndrome | Low (aldosterone low) | Gain of function of ENaC | | [Neurogenic (e.g. acute baroreceptor denervation, pheochromocytoma)](https://durgical.com/en/conditions/phaeochromocytoma/) | Variable | Sympathetic or catecholamine excess | ## Clinical notes - Renal artery stenosis (atherosclerosis in older adults, fibromuscular dysplasia in younger women) is the human counterpart of Goldblatt hypertension. - In bilateral renal artery stenosis or a single kidney, blocking angiotensin II can sharply lower GFR, because filtration depends on efferent constriction. - Obstructive sleep apnea adds nightly sympathetic activation to obesity-related hypertension. ## Memory aid Two kidneys, one clip: the clip shouts renin. One kidney, one clip: volume takes over. ## Test yourself Think of the answer, then tap the question to see it. ## Why is renin high in two-kidney, one-clip but not, later, in one-kidney, one-clip Goldblatt hypertension? With two kidneys the normal kidney excretes extra sodium, so volume does not expand and the clipped kidney keeps secreting renin; with one kidney volume expands and renin falls back. ## In volume-loading hypertension, why does cardiac output return near normal while pressure stays high? Excess flow to tissues triggers long-term autoregulation, which constricts arterioles; resistance rises, output returns, and pressure stays high. ## What is the defect in Liddle syndrome, and what are renin and aldosterone? A gain-of-function mutation of the collecting-duct sodium channel (ENaC) retains sodium; volume expansion suppresses both renin and aldosterone. ## Which three mechanisms link obesity to hypertension? Higher sympathetic renal activity (partly via leptin), more angiotensin II and aldosterone, and compression of the kidneys by visceral and perirenal fat. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/physiology/how-specific-hypertensions-arise-volume-loading-goldblatt-kidney-obesity-neuroge/) [More Physiology questions →](https://durgical.com/en/practice/?f=physiology) ## Connections ## See it in 3D 3 The structures of Durgical's 3D anatomy where it happens. - [Kidneys](https://durgical.com/en/anatomy/kidney/) - [Left renal artery](https://durgical.com/en/anatomy/renal-artery/) - [Left adrenal gland](https://durgical.com/en/anatomy/suprarenal-gland/) ## Related topics 5 - [Physiology of hypertension](https://durgical.com/en/physiology/physiology-of-hypertension/) - [Long-term blood pressure control by the kidney](https://durgical.com/en/physiology/long-term-blood-pressure-control-by-the-kidney/) - [The renin–angiotensin–aldosterone system](https://durgical.com/en/physiology/the-renin-angiotensin-aldosterone-system/) - [Distal tubule and collecting duct](https://durgical.com/en/physiology/distal-tubule-and-collecting-duct/) - [Energy balance, food intake and obesity](https://durgical.com/en/physiology/energy-balance-food-intake-and-obesity/) ## Related conditions 6 - [Renovascular hypertension (renal artery stenosis)](https://durgical.com/en/conditions/renovascular-hypertension/) - [Primary hyperaldosteronism (Conn syndrome)](https://durgical.com/en/conditions/primary-hyperaldosteronism/) - [Obesity](https://durgical.com/en/conditions/obesity/) - [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/) - [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/) - [Phaeochromocytoma](https://durgical.com/en/conditions/phaeochromocytoma/) ## In Biochemistry 2 - [Aldosterone](https://durgical.com/en/biochemistry/molecules/aldosterone/) - [Angiotensin-converting enzyme (ACE)](https://durgical.com/en/biochemistry/enzymes/angiotensin-converting-enzyme/) ## In Pharmacology 2 - [ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/) - [Spironolactone](https://durgical.com/en/pharmacology/spironolactone/) [← All of physiology](https://durgical.com/en/physiology/) Educational physiology content; not a diagnostic or treatment guide and no substitute for a health professional's advice. Values are approximate references. No doses are given. Sources: [Renovascular hypertension: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000204.htm) (MedlinePlus, US National Library of Medicine, 2026); [Liddle syndrome: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/liddle-syndrome/) (MedlinePlus, US National Library of Medicine, 2026); [Epidemiologic and Etiologic Considerations of Obesity](https://www.ncbi.nlm.nih.gov/books/NBK585067/) (StatPearls (NCBI Bookshelf), 2024); [Essential Hypertension](https://www.ncbi.nlm.nih.gov/books/NBK539859/) (StatPearls (NCBI Bookshelf), 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/physiology/how-specific-hypertensions-arise-volume-loading-goldblatt-kidney-obesity-neuroge/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/physiology/how-specific-hypertensions-arise-volume-loading-goldblatt-kidney-obesity-neuroge/