9 - Renal Vascular Disease Flashcards
___ is seen in 1-2% of HTN pts?
Renal artery stenosis
Most Common Causes of renal artery stenosis
Athersclerosis
Other cause of renal artery stenosis?
Fibromuscular dysplasia (esp women <50yo)
Renal artery stenosis is aka?
Spillover aortic disease
2 problems caused by renal artery stenosis?
Renal vascular HTN
Ischemia nephropathy
Clues to diagnosis of renal artery stenosis?
- Resistant HTN
- HTN onset at weird age <20, >50yo
- Pulmonary edema w abrupt BP surges
- Abrupt increase in serum creatinine after starting ACEI
- Epigastric or renal artery bruits
15-25% of symptomatic lower limb atherosclerotic vascular disease leads to?
Renal artery stenosis
Why NEVER use ACEIs treat renal artery stenosis?
The stenosis leads to hypoperfusion to the glomerulus. W/o ACEI the efferent arteriole constricts which keeps GFR constant.
ACE blocks ATII and dilates the efferent arteriole leading to decreased GFR
BLUF - ACEI decreases back pressure on the glomerulus which when added to hypoperfusion leads to a low GFR
Look at slide 9 its got pics and shit
Labs for RAS will show?
H BUN
H serum creatinine
L GFR
Renal US for RAS?
Asymmetric kidney size
- marker for chronic disease
Definitive diagnostic test for RAS?
Renal angiograpy/arteriography
Other imaging options for RAS?
CT Angiography
MR Angiography
Contriindication for MRA?
GFR <30ml/min - no gandolinium
- leads to nephrotgenic systemic fibrosis
Nephrogenic systemic fibrosis is aka?
Nephrogenic fibrosing dermatitis
What is nephrogenic systemic fibrosis?
Pts w renal insufficiency
- expansion and fibrosis of dermis lead to skin thickening and hardening
- poss systemic involvement
Cause by gadolinium contrast
Prevention of further renal parenchymal damage?
- Tobacco
- Medical management of BP
- Interventional angiography and angioplasty (w or w/o stent)
- Surgical bypass
What is nephrosclerosis?
Kidney hardening due to overgrowth and contraction of interstitial connective tissue
Common cause of nephrosclerosis?
CKD
- DM - diabetic nephropathy
- HTN - hypertensive nephrosclerosis
Pathogenesis of nephrosclerosis?
Hypertrophic response to chronic HTN
- glomerular hyperperusion -> glomeruloscerosis -> remaining nephrons suffer increased workload -> cyclic perpetuates
Labs for nephrosclerosis?
Proteinuria
H BUN
H creatinine
Tx for nephrosclerosis
Tx underlying cause (DM, HTN)
Rare condition associated with nephrotic syndrome?
Renal vein thrombosis
Renal vein thrombosis may mimic nephrolithiasis bc they both have?
Flank pain (unilateral) Hematuria
Labs for renal vein thrombosis?
Consistent w/ Nephrotic syndrome
- L serum albumin (<2.0g/dL)
Best imaging for renal vein thrombosis?
Renal venogram
Tx for RVT?
Anticoagulation:
- heparin + warfarin
- catheter thrombectomy
- nephrectomy
MC cause of renal infarction?
- Subacute infective endocarditis
- atrial or ventricular thrombi
- atheriosclerosis
- trauma
Typically multi infarcts are involved
Presentation of renal infarction
Acute:
- flank pain
- nausea
- fever
HTN and or renal insufficiency
Labs for renal infarction?
UA
- hematuria
- proteinuria
- sloughing of renal tubular epithelial cells
CBC
- leukocytosis
H LDG (4x normal)
Renal infarction imaging?
Definitive diagnosis
- Renal angiography
- CT
Renal infarct tx?
TOC
- Anticoagulation w infusion of thrombolytics and IV heparin
HTN control
Surgical revascularization
England does not have a kidney bank
They have a liver pool
