20-5 (Vascular Diseases) Flashcards
What is Nephrosclerosis?
Sclerosis of renal arterioles and small arteries
Sclerosis of renal arterioles and small arteries
Nephrosclerosis
What is Nephrosclerosis strongly associated with?
– It can cause this or be a result of this –
Hypertension
What are the 2 steps in the pathogenesis of Nephrosclerosis?
- Medial and intimal thickening
2. Hyalinization of arteriolar walls
What are the 2 steps in the pathogenesis of Nephrosclerosis?
- Medial and intimal thickening
2. Hyalinization of arteriolar walls
With nephrosclerosis there are narrowed lumens of the vessels affected. What does that result in?
Ischemia and loss of renal mass
How do the kidneys look (size) with Nephrosclerosis and why?
Normal or small due to cortical scarring and shrinking
Why are kidneys small with nephrosclerosis?
Cortical scarring and shrinking
How does the surface of the kidneys look with nephrosclerosis?
Granular (grain leather)
What 3 populations of people are more at risk for renal failure from nephrosclerosis?
Blacks
Diabetics
HTN
How does Renal A. Stenosis cause HTN?
Increased renin production from the ischemic kidney
How does Renal A. Stenosis cause HTN?
Increased renin production from the ischemic kidney
The magnitude of the HTN from Renal A. Stenosis is proportional to the?
Narrowing
With Renal A. Stenosis, renin is released. What happens next and what is a possible treatment for resulting HTN?
Renin –> Angiotensin 2 –> vasoconstriction
– Treatment = block angiotensin 2
In males with Renal A. Stenosis, what is the most common cause?
Narrowing due to atheromatous plaque
In females with Renal A. Stenosis, what is the most common cause?
Fibromuscular Dysplasia (medial type)
How does Fibromuscular Dysplasia look?
String of beads – alternating narrow and wide areas
With renal a. stenosis, you need an arteriography to localize the lesion. What is a possible sound that can be heard on auscultation of the renal arteries?
Bruit
Thrombotic Microangiopathies are syndromes that lead to ___ in many places including the kidney
Thrombi
What are 2 Thrombotic Microangiopathies?
Hemolytic Uremic Syndrome
Thrombotic Thrombocytopenic Purpura
Typical HUS is acquired how?
Ingesting food that is contaminated with certain bacteria that produce shiga-like toxin
Which bacteria are commonly to blame for Typical HUS?
E.coli strain 0157 that produces shiga-like toxin
What populations are usually affected by Typical HUS?
Children or elderly
Describe the symptoms seen with Typical HUS
- Diarrheal symptoms
- Sudden onset of GI bleeding symptoms
- Oliguria and possibly HTN
Describe the symptoms seen with Typical HUS
- Diarrheal symptoms
- Sudden onset of GI bleeding symptoms
- Oliguria and possibly HTN
What can restore the renal function lost with Typical HUS?
Dialysis
Atypical HUS is usually due to?
Inherited genetic abnormalities/autoantibodies
Atypical HUS involves dysregulation of the _____
Complement system
Atypical HUS can involves deficiencies in complement proteins like?
Factor H, Factor I, CD46
Atypical HUS can involve deficiencies in complement proteins that normally do what?
(-) activation of the complement
== Without them the complement is activated too much
What is the main pathogenesis mechanism for HUS?
Endothelial activation
What is the main pathogenesis mechanism for TTP?
Platelet aggregation
Things like antiphospholipid syndrome, post-partum renal failure, kidney vascular diseases, certain drugs and irradiation can all cause acquired autoantibodies and thus?
Atypical HUS
TTP is usually due to
Acquired autoantibodies
What deficiency is present with TTP?
ADAMTS13
What is the job of ADAMTS13?
Cleaves long multimers of vWF
TTP involves an ADAMTS13 deficiency and thus long multimers of vWF arise. What is the pentad of symptoms in younger patients < 40?
- Fever
- Neuro sx
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- Renal failure
What are the pentad of symptoms with TTP?
- Fever
- Neuro sx
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- Renal failure
What is the treatment for TTP?
Plasma exchange to remove autoantibodies and give ADAMTS13
Where is the necrosis seen with the thrombotic microangiopathies?
Cortical necrosis
What causes Atheroembolic Renal Disease?
Embolization of fragments of atheromatous plaques from the aorta/renal arteries –> intrarenal vessels
In what patients is Atheroembolic Renal Disease usually seen?
Older patients with severe atherosclerosis after surgery on the aorta
What are the (3) symptoms of Sickle Cell Nephropathy?
Hematuria
Diminished concentrating of urine
Patchy papillary necrosis
What are the (3) symptoms of Sickle Cell Nephropathy?
Hematuria
Diminished concentrating of urine
Patchy papillary necrosis
What are the (3) symptoms of Sickle Cell Nephropathy?
Hematuria
Diminished concentrating of urine
Patchy papillary necrosis
