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GU1 - Nephrology > Clin Med - Renal Vascular Diseases > Flashcards

Clin Med - Renal Vascular Diseases Flashcards

1
Q

What are the renal vascular diseases? (5)

A
  • Renal Artery Stenosis
  • Renal Artery Thrombosis
  • Renal Vein Thrombosis
  • Renal Artery Aneurysm
  • Atheroembolic Renal Disease
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2
Q

Define Renal Vascular Disease

A

Variety of complications that affect the arteries and veins of the kidneys.

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3
Q

What is renal vascular disease associated with?

A

HTN - the decreased blood flow to the kidneys results in an excessive amount of renin to be produced.

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4
Q

Define Renal Artery Stenosis

A

Narrowing or decrease in blood flow of an artery to the kidneys

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5
Q

Renal Artery Stenosis Etiology

A
  • Major cause is atherosclerosis
  • Fibromuscular dysplasia- condition that weakens the walls of medium sized arteries
  • Takayasu’s arteritis- rare inflammatory d/o affecting the aorta and its branches
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6
Q

Renal Artery Stenosis Risk Factors

A
  • 50-70 y.o.
  • Smoking
  • HLD, DMII, obesity and FH of heart disease
  • HTN- both a cause and result
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7
Q

Renal Artery Stenosis Signs & Symptoms

A
  • HTN that doesn’t get better with 3 or more medications
  • Azotemia
  • Abdominal bruit
  • Sudden kidney failure when first taking an ACE for HTN and/or heart treatment
  • Unexplained renal insufficiency
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8
Q

Renal Artery Stenosis Dx

A
  • Renal arteriography (gold standard)
  • CT or MRI, US
  • Renal function studies
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9
Q

Renal Artery Stenosis Tx

A
  • Control of HTN/HLD
  • Angioplasty
  • Surgical revascularization
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10
Q

Renal Artery Thrombosis (Occlusion) Definition

A

Complete blockage of blood flow of an artery to the kidneys.

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11
Q

Renal Artery Thrombosis Etiology

A
  • Most common cause is thromboembolism.
  • Thrombosis may occur spontaneously or after abdominal trauma, surgery, vaculitis, extrarenal compression, hypercoaguable state, aortic dissection.
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12
Q

Renal Artery Thrombosis Signs & Symptoms

A
  • Steady and aching flank pain, fever, N/V, abdominal pain
  • Leukocytosis
  • May have gross hematuria, oliguria or anuria
  • Renal dysfunction (if bilateral, or single functioning kidney)
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13
Q

Renal Artery Thrombosis Dx

A
  • Renal arteriography (risk of contrast ATN)
  • CT or MRI or US
  • Renal function, UA, coag studies
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14
Q

Renal Artery Thrombosis Tx

A
  • Prompt localization of occlusion and restoration of blood flow through
  • Anticoagulation, thrombolysis, clot extraction, etc.
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15
Q

Renal Vein Thrombosis Definition

A

Blockage of renal vein

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16
Q

Renal Vein Thrombosis Etiology

A
  • Most common cause of renal vein thrombosis is Nephrotic syndrome.
  • Kidney tumor or cancer that puts pressure on the renal vein or inferior vena cava
  • Hypercoagulability disorders
  • Vasculitis
  • SLE
  • DMII
  • Oral contraceptive use
17
Q

Renal Vein Thrombosis Signs & Symptoms

A
  • Pain in the back behind the lower ribs/hips
  • Fever, n/v
  • Oliguria
  • Hematuria
18
Q

Renal Vein Thrombosis Dx

A
  • Nephrotic syndrome workup, UA

- CT angiography

19
Q

Renal Artery Aneurysm Definition

A

a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery.

20
Q

Renal Artery Aneurysm Etiology - True aneurysms

A
  • include all layers of the artery and are usually inherited disorders.
  • Extraparenchymal in 90% of cases
21
Q

Saccular Renal Artery Aneurysm

A
  • bulges or balloons out only on one side of the artery.
  • usually due to congenital weakness of an artery wall or trauma.
  • Seen in: Ehlers- Danlos Syndrome
22
Q

Fusiform Renal Artery Aneurysm

A
  • bulges or balloons out on all sides of the artery.

- Seen in: Fibromuscular dysplasia (FMD)

23
Q

Renal Artery Aneurysm Etiology - False aneurysms

A
  • AKA pseudo aneurysms; do not include all layers of the artery, are usually acquired. Can be extraparenchymal or intraparenchymal.
  • Saccular in appearance
24
Q

Renal Artery Aneurysm False Aneurysms Causes

A
  • Blunt abdominal trauma
  • Anastomotic
  • Iatrogenic during endovascular procedures
  • Spontaneous
  • Dissection
  • Kawasaki disease
25
Q

Renal Artery Aneurysm Etiology - Intrarenal

A

are either true or false aneurysms within the renal parenchyma and account for fewer than 10% of all RAAs.

26
Q

Management of intrarenal aneurysms

A
  • is usually with nephrectomy or coil embolization
  • Polyarteritis nodosa
  • Tuberculosis
  • Neurofibromatosis
27
Q

Renal Artery Aneurysm Signs & Symptoms

A
  • Most renal artery aneurysms (RAAs) are asymptomatic and are found incidentally during investigation of other intra-abdominal pathologies.
  • HTN is the most common symptom found in symptomatic RAA
28
Q

Renal Artery Aneurysm Dx

A
  • CBC, CMP, coag panels, UA
  • Note: imaging studies are only required for preintervention planning or longitudinal follow-up care. Imaging includes: 2D US, CTA, MRA
29
Q

Atheroembolic Renal Disease (AERD) Definition

A

occurs when small particles made of hardened cholesterol and fat spread to the small blood vessels of the kidneys.

30
Q

AERD Etiology

A
  • Atherosclerosis
  • Spontaneous after renal artery manipulation or surgery, angiography
  • Anticoagulants can actually worsen disease by interfering with plaque healing
31
Q

AERD Signs & Symptoms

A
  • Acute or chronic- fatigue, nausea, loss of appetites, difficulty concentrating.
  • Progressive renal failure
  • HTN
32
Q

AERD Dx

A
  • Renal function, CBC, UA

- Kidney biopsy

33
Q

When do you suspect atheroembolic kidney disease??

A

Suspect atheroembolic kidney disease in a person who has a decline in kidney function after a procedure that involved the aorta.

34
Q

AERD Tx

A
  • Treatment of source of emboli
  • Treatment of high blood pressure
  • Sometimes dialysis

GU1 - Nephrology (16 decks)

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