20-5 (Vascular Diseases)

Question 1

What is Nephrosclerosis?

Answer 1

Sclerosis of renal arterioles and small arteries

Question 2

Sclerosis of renal arterioles and small arteries

Answer 2

Nephrosclerosis

Question 3

What is Nephrosclerosis strongly associated with?

– It can cause this or be a result of this –

Answer 3

Hypertension

Question 4

What are the 2 steps in the pathogenesis of Nephrosclerosis?

Answer 4

1. Medial and intimal thickening

2. Hyalinization of arteriolar walls

Question 5

What are the 2 steps in the pathogenesis of Nephrosclerosis?

Answer 5

1. Medial and intimal thickening

2. Hyalinization of arteriolar walls

Question 6

With nephrosclerosis there are narrowed lumens of the vessels affected. What does that result in?

Answer 6

Ischemia and loss of renal mass

Question 7

How do the kidneys look (size) with Nephrosclerosis and why?

Answer 7

Normal or small due to cortical scarring and shrinking

Question 8

Why are kidneys small with nephrosclerosis?

Answer 8

Cortical scarring and shrinking

Question 9

How does the surface of the kidneys look with nephrosclerosis?

Answer 9

Granular (grain leather)

Question 10

What 3 populations of people are more at risk for renal failure from nephrosclerosis?

Answer 10

Blacks
Diabetics
HTN

Question 11

How does Renal A. Stenosis cause HTN?

Answer 11

Increased renin production from the ischemic kidney

Question 12

How does Renal A. Stenosis cause HTN?

Answer 12

Increased renin production from the ischemic kidney

Question 13

The magnitude of the HTN from Renal A. Stenosis is proportional to the?

Answer 13

Narrowing

Question 14

With Renal A. Stenosis, renin is released. What happens next and what is a possible treatment for resulting HTN?

Answer 14

Renin –> Angiotensin 2 –> vasoconstriction

– Treatment = block angiotensin 2

Question 15

In males with Renal A. Stenosis, what is the most common cause?

Answer 15

Narrowing due to atheromatous plaque

Question 16

In females with Renal A. Stenosis, what is the most common cause?

Answer 16

Fibromuscular Dysplasia (medial type)

Question 17

How does Fibromuscular Dysplasia look?

Answer 17

String of beads – alternating narrow and wide areas

Question 18

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?

Answer 18

Bruit

Question 19

Thrombotic Microangiopathies are syndromes that lead to ___ in many places including the kidney

Answer 19

Thrombi

Question 20

What are 2 Thrombotic Microangiopathies?

Answer 20

Hemolytic Uremic Syndrome

Thrombotic Thrombocytopenic Purpura

Question 21

Typical HUS is acquired how?

Answer 21

Ingesting food that is contaminated with certain bacteria that produce shiga-like toxin

Question 22

Which bacteria are commonly to blame for Typical HUS?

Answer 22

E.coli strain 0157 that produces shiga-like toxin

Question 23

What populations are usually affected by Typical HUS?

Answer 23

Children or elderly

Question 24

Describe the symptoms seen with Typical HUS

Answer 24

• Diarrheal symptoms
• Sudden onset of GI bleeding symptoms
• Oliguria and possibly HTN

Question 25

Describe the symptoms seen with Typical HUS

Answer 25

- Diarrheal symptoms - Sudden onset of GI bleeding symptoms - Oliguria and possibly HTN

Question 26

What can restore the renal function lost with Typical HUS?

Answer 26

Dialysis

Question 27

Atypical HUS is usually due to?

Answer 27

Inherited genetic abnormalities/autoantibodies

Question 28

Atypical HUS involves dysregulation of the _____

Answer 28

Complement system

Question 29

Atypical HUS can involves deficiencies in complement proteins like?

Answer 29

Factor H, Factor I, CD46

Question 30

Atypical HUS can involve deficiencies in complement proteins that normally do what?

Answer 30

(-) activation of the complement | == Without them the complement is activated too much

Question 31

What is the main pathogenesis mechanism for HUS?

Answer 31

Endothelial activation

Question 32

What is the main pathogenesis mechanism for TTP?

Answer 32

Platelet aggregation

Question 33

Things like antiphospholipid syndrome, post-partum renal failure, kidney vascular diseases, certain drugs and irradiation can all cause acquired autoantibodies and thus?

Answer 33

Atypical HUS

Question 34

TTP is usually due to

Answer 34

Acquired autoantibodies

Question 35

What deficiency is present with TTP?

Answer 35

ADAMTS13

Question 36

What is the job of ADAMTS13?

Answer 36

Cleaves long multimers of vWF

Question 37

TTP involves an ADAMTS13 deficiency and thus long multimers of vWF arise. What is the pentad of symptoms in younger patients < 40?

Answer 37

1. Fever 2. Neuro sx 3. Microangiopathic hemolytic anemia 4. Thrombocytopenia 5. Renal failure

Question 38

What are the pentad of symptoms with TTP?

Answer 38

1. Fever 2. Neuro sx 3. Microangiopathic hemolytic anemia 4. Thrombocytopenia 5. Renal failure

Question 39

What is the treatment for TTP?

Answer 39

Plasma exchange to remove autoantibodies and give ADAMTS13

Question 40

Where is the necrosis seen with the thrombotic microangiopathies?

Answer 40

Cortical necrosis

Question 41

What causes Atheroembolic Renal Disease?

Answer 41

Embolization of fragments of atheromatous plaques from the aorta/renal arteries --> intrarenal vessels

Question 42

In what patients is Atheroembolic Renal Disease usually seen?

Answer 42

Older patients with severe atherosclerosis after surgery on the aorta

Question 43

What are the (3) symptoms of Sickle Cell Nephropathy?

Answer 43

Hematuria Diminished concentrating of urine Patchy papillary necrosis

Question 44

What are the (3) symptoms of Sickle Cell Nephropathy?

Answer 44

Hematuria Diminished concentrating of urine Patchy papillary necrosis

Question 45

What are the (3) symptoms of Sickle Cell Nephropathy?

Answer 45

Hematuria Diminished concentrating of urine Patchy papillary necrosis