Chapter 129 - Renovascular disease acute occlusive and ischemic events Flashcards

1
Q

Renal ischemic injury mechanism

A

Glomerular collapse + tubular necrosis –> reduced glomerular filtration –> loss of tubular function

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2
Q

Reperfusion renal injury

A

Endothelial dysfunction –> excess cytokine secretion –> leukocyte influx

Excessive NO and ROS –> parenchymal damage

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3
Q

1 hour warm ischemia associated with this much renal function loss
how much recovery is expected?

A

70-80%

Complete recovery within weeks

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4
Q

2 hours warm ischemia time how much recovery is expected

A

30-50%

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5
Q

Collaterals of the renal artery

A

1) inferior adrenal
2) gonadal
3) ureteral
4) internal iliac
5) lumbar
6) intercostal
7) capsular arteries
8) IMA

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6
Q

Prevalence of assessory/aberrant or duplicate renal arteries

A

24-42%

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7
Q

Symptoms of acute renal ischemia

A

1) abdominal/back pain
2) dyspnea
3) nausea vomiting
4) hematuria
5) anuria
6) acute HTN

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8
Q

Differential diagnosis to acute renal ischemia

A

1) pyelonephritis
2) renal carcinoma
3) mesenteric ischemia
4) cholecystitis
5) biliary colic
6) gastritis
7) splenic infarction
8) myocardial infarction
9) pulmonary embolism

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9
Q

Classic triad of renal vein thrombosis

A

1) flank mass
2) gross hematuria
3) thrombocytopenia

only in 13% of neonates with renal vein thrombosis

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10
Q

Lab findings of acute renal ischemia

A

1) leukocytosis
2) elevated LDH
3) microscopic/gross hematuria
4) proteinuria
5) elevated D-dimer
6) eosinophilia (atheroembolism)

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11
Q

does normal Cr rule out renal ischemia

A

no, contralateral kidney may still function well

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12
Q

CTA sensitivity for renal ischemia

A

80%

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13
Q

CTA sen and spe for renal vein thrombosis

A

100%; 100%

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14
Q

CTA finding on renal infarct

A

1) hypoattenuation with associated mass effect

2) cortical rim sign - rim of functioning nephrons from capsular collaterals

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15
Q

US in renal artery ischemia

A

Only useful in detecting total occlusions

Otherwise poor sensitivity

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16
Q

Nuclear scan in renal ischemia

A

97% sensitivity

Sign: Marked reduction of renal blood flow with preserved kidney size

17
Q

Renal artery embolism incidence in hospital

18
Q

Risk factors of cholesterol crystal embolization

A

1) male
2) HTN
3) atherosclerosis
4) following arterial cath

19
Q

Cholesterol crystal embolization to kidney and association with dialysis in 2 years

20
Q

Percentage of patients with renal artery embolism with previous thromboembolism

21
Q

Outcome of renal artery embolization

A

11% death 1 month
61% return to normal
8% dialysis

22
Q

Mortality following surgical renal artery thrombectomy

23
Q

Causes of renal artery thrombosis

A

1) atherosclerosis
2) aortic occlusion
3) aortic/renal dissection
4) renal aneurysm
5) FMD
6) Takayasu
7) stent thrombosis
8) hypercoagulable state
9) trauma
10) antiphospholipid antibody
11) factor V Leiden
12) HITT
13) Bechet

24
Q

Prevalence of renal artery atherosclerotic stenosis

25
5 year rate of thrombosis in pre-existing renal artery stenosis
5%
26
Risk factors for progression to renal artery thrombosis
1) SBP > 160 2) DM 3) > 60% stenosis
27
Factors associated with risks of spontaneous renal artery dissection
1) FMD 2) Ehlers-Danlos 3) cocaine use 4) strenuous exercise
28
Success of endovascular treatment of renal artery thrombosis
70% technically successful 25% recover renal function
29
Mortality after open surgical revasc for renal thrombosis salveage of renal function
15-25% mortality 65% salvage
30
Mortality after renal artery trauma
21% usually due to associated injuries 10.3% mortality without other major organ injuries
31
Kidney salvage rate in unilateral traumatic renal artery injury
25%
32
Grade IV/V kidney injury predictors of poor outcome
1) blunt trauma 2) dialysis or Cr > 200 3) <25% remaining renal function of affected kidney 4) postinjury HTN
33
Causes of renal vein thrombosis
1) malignancy (RCC, lymphoma, retroperitoneal tumor) 66% 2) nephrotic syndrome 20% 3) inherited thrombophilia 4) local surgery/inflammation 5) oral contraceptive use 6) pregnancy 7) infection 8) iatrogenic (IVC filter)
34
Risk factors that precipitate renal vein thrombosis
1) CVC 2) dehydration 3) prolonged hypotension
35
Risk of recurrent renal vein thrombosis
1%/year
36
Mortality 6 months after acute renal vein thrombosis
40% largely due to malignancy and infection
37
Survival advantage treatment for renal vein thrombosis
Warfarin therapy
38
Indication for thrombectomy/thrombolysis in renal vein thrombosis
1) failure of oral anticoagulation (propagation, PE) 2) bilateral thrombosis 3) thrombosis of solitary kidney 4) caval thrombosis 5) acute renal failure 6) persistence of symptoms (flank pain)