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Senior - GU Test 1 > 9 - Renal Vascular Disease > Flashcards

9 - Renal Vascular Disease Flashcards

1
Q

___ is seen in 1-2% of HTN pts?

A

Renal artery stenosis

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2
Q

Most Common Causes of renal artery stenosis

A

Athersclerosis

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3
Q

Other cause of renal artery stenosis?

A

Fibromuscular dysplasia (esp women <50yo)

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4
Q

Renal artery stenosis is aka?

A

Spillover aortic disease

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5
Q

2 problems caused by renal artery stenosis?

A

Renal vascular HTN

Ischemia nephropathy

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6
Q

Clues to diagnosis of renal artery stenosis?

A
  • 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
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7
Q

15-25% of symptomatic lower limb atherosclerotic vascular disease leads to?

A

Renal artery stenosis

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8
Q

Why NEVER use ACEIs treat renal artery stenosis?

A

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

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9
Q

Labs for RAS will show?

A

H BUN
H serum creatinine
L GFR

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10
Q

Renal US for RAS?

A

Asymmetric kidney size

- marker for chronic disease

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11
Q

Definitive diagnostic test for RAS?

A

Renal angiograpy/arteriography

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12
Q

Other imaging options for RAS?

A

CT Angiography

MR Angiography

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13
Q

Contriindication for MRA?

A

GFR <30ml/min - no gandolinium

- leads to nephrotgenic systemic fibrosis

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14
Q

Nephrogenic systemic fibrosis is aka?

A

Nephrogenic fibrosing dermatitis

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15
Q

What is nephrogenic systemic fibrosis?

A

Pts w renal insufficiency

  • expansion and fibrosis of dermis lead to skin thickening and hardening
  • poss systemic involvement

Cause by gadolinium contrast

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16
Q

Prevention of further renal parenchymal damage?

A
  1. Tobacco
  2. Medical management of BP
  3. Interventional angiography and angioplasty (w or w/o stent)
  4. Surgical bypass
17
Q

What is nephrosclerosis?

A

Kidney hardening due to overgrowth and contraction of interstitial connective tissue

18
Q

Common cause of nephrosclerosis?

A

CKD

  • DM - diabetic nephropathy
  • HTN - hypertensive nephrosclerosis
19
Q

Pathogenesis of nephrosclerosis?

A

Hypertrophic response to chronic HTN

- glomerular hyperperusion -> glomeruloscerosis -> remaining nephrons suffer increased workload -> cyclic perpetuates

20
Q

Labs for nephrosclerosis?

A

Proteinuria
H BUN
H creatinine

21
Q

Tx for nephrosclerosis

A

Tx underlying cause (DM, HTN)

22
Q

Rare condition associated with nephrotic syndrome?

A

Renal vein thrombosis

23
Q

Renal vein thrombosis may mimic nephrolithiasis bc they both have?

A 
Flank pain (unilateral)
Hematuria
24
Q

Labs for renal vein thrombosis?

A

Consistent w/ Nephrotic syndrome

- L serum albumin (<2.0g/dL)

25
Q

Best imaging for renal vein thrombosis?

A

Renal venogram

26
Q

Tx for RVT?

A

Anticoagulation:

  • heparin + warfarin
  • catheter thrombectomy
  • nephrectomy
27
Q

MC cause of renal infarction?

A
  • Subacute infective endocarditis
  • atrial or ventricular thrombi
  • atheriosclerosis
  • trauma

Typically multi infarcts are involved

28
Q

Presentation of renal infarction

A

Acute:

  • flank pain
  • nausea
  • fever

HTN and or renal insufficiency

29
Q

Labs for renal infarction?

A

UA

  • hematuria
  • proteinuria
  • sloughing of renal tubular epithelial cells

CBC
- leukocytosis

H LDG (4x normal)

30
Q

Renal infarction imaging?

A

Definitive diagnosis

  • Renal angiography
  • CT
31
Q

Renal infarct tx?

A

TOC
- Anticoagulation w infusion of thrombolytics and IV heparin

HTN control

Surgical revascularization

32
Q

England does not have a kidney bank

A

They have a liver pool

Senior - GU Test 1 (13 decks)

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