1.3 Renal Artery Stenosis/Occlusion/Thrombosis

Question 1

What does ACUTE Renal vein thrombosis present with (2)

Answer 1

1. Pain

2. Hematuria

Question 2

What will you see on Ultrasound with ACUTE RV thrombosis? (4)

Answer 2

1. Enlarged kidney
2. Altered parenchymal echogenicity
3. Enlarged renal vein
4. Absent Doppler signal

Question 3

What does CHRONIC Renal vein thrombosis present with ?

Answer 3

1. Asymptomatic
   OR
   1) Nephrotic syndrome OR 2) hematuria

Question 4

What 2 things may block the vein?

Answer 4

1. Intraluminal thrombus

2. Extrinsic compression

Question 5

What is the most common reason for RV thrombosis?

Answer 5

Primary renal disease

Question 6

What disease can RV thrombosis cause?

Answer 6

Parenchymal disease

Question 7

What can Parenchymal disease lead to?

Answer 7

Renal failure

Question 8

Why may venous flow still be seen in the kidneys with RV thrombosis?

Answer 8

Collateral vessels

Question 9

What can stenosis or occlusion cause?

Answer 9

renal ischemia

Question 10

What can renal ischemia lead to?

Answer 10

Hypertension

Question 11

Stenosis causes __________damage

Answer 11

Parenchymal Damage

Question 12

What located the renal arteries and detects flow disturbances indicating stenosis?

Answer 12

Color Flow

Question 13

What quantifies stenosis severity?

Answer 13

Spectral Doppler

Question 14

What % diameter reduction suggests a significant stenosis?

Answer 14

50-60%

Question 15

What type of patients should Renal artery stenosis be investigated in?

Answer 15

Young with hypertension
Uncontrollable hypertension
Renal insufficiency
Inconsistant kidney sizes

Question 16

What is the most common cause of stenosis in a patient > 50 years of age?

Answer 16

Atherosclerosis

Question 17

What is the most common cause of stenosis in a patient < 40 years of age?

Answer 17

Fibromuscular Dysplasia (FMD)

Question 18

Other causes of stenosis (4)

Answer 18

1. Vasculitis
2. Neurofibromatosis
3. Congenital bands
4. Extrinsic compression

Question 19

What is the normal PSV for Renal Arteries?

Answer 19

74-127 cm/sec

Question 20

What is PSV that indicates a significant stenosis in Renal Arteries?

Answer 20

> 180 cm/sec

Question 21

What is the Renal Artery /Aorta Ratio indicating a significant stenosis?

Answer 21

> 3.5

Question 22

What waveform suggests renal disease?

Answer 22

Dampening of intrarenal arteries

Question 23

What acceleration time is abnormal indicating a renal stenosis of >60%?

Answer 23

> 0.07 seconds

Question 24

What is the most correctable cause of hypertension?

Answer 24

Renal Artery Stenosis

Question 25

What are often used to preserve patency and prevent occlusions?

Answer 25

Stents

Question 26

What are the 4 features of SEVERE Renal artery stenosis

Answer 26

1. Decreased kidney size (atrophy)
2. Renal infarct (hypoechoic area within kidney)
3. Renal hypoperfusion
4. Narrowed artery with area of aliasing and increased PSV

Question 27

What are the 4 features of SEVERE Renal artery OCCLUSION

Answer 27

1. Decreased kidney size (atrophy)
2. No main artery is visualized
3. Absent flow/low
4. Dampened intrarenal flow

Question 28

Other conditions that can cause increased resistance within the kidney include (2)

Answer 28

1. UT obstruction

2. Acute and chronic parenchymal disease

Question 29

When may a false postitive diagnosis of RA occlusion happen?

Answer 29

With poor visualization of artery and kidney