All are causes of hypertension with hypokalemia except,
**Core Concept**
Primary hyperaldosteronism, Cushing's disease, and bilateral renal artery stenosis are characterized by excessive aldosterone production or action, leading to sodium retention, volume expansion, and hypertension. These conditions often present with hypokalemia due to potassium wasting.
**Why the Correct Answer is Right**
End-stage renal disease (ESRD) typically presents with hyperkalemia, not hypokalemia. The kidneys in ESRD are unable to effectively excrete potassium, leading to its accumulation in the blood. This is in contrast to the other options, which are all associated with aldosterone-mediated potassium wasting.
**Why Each Wrong Option is Incorrect**
**Option A:** Bilateral renal artery stenosis can cause hypertension and hypokalemia due to activation of the renin-angiotensin-aldosterone system (RAAS), which stimulates aldosterone release.
**Option C:** Primary hyperaldosteronism is characterized by excessive aldosterone production, leading to sodium retention, volume expansion, hypertension, and hypokalemia due to potassium wasting.
**Option D:** Cushing's disease, caused by excess cortisol, can also lead to hypertension and hypokalemia. Cortisol stimulates mineralocorticoid receptors, mimicking the effects of aldosterone.
**Clinical Pearl / High-Yield Fact**
Aldosterone-mediated hypertension is often associated with hypokalemia, whereas hyperkalemia is more commonly seen in conditions with impaired potassium excretion, such as ESRD.
**Correct Answer:**
✓ Correct Answer: B. End stage renal disease.