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Brenner > Cp 47 Renovascular HPN > Flashcards

Cp 47 Renovascular HPN Flashcards

1
Q

refers to rise in arterial pressure definitely induced by reduced renal perfusion

A

Renovascular HPN

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2
Q

pressure gradient between aorta and poststenotic renal artery required before measurable renin release occurs

A

At least 10-20mmhg

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3
Q

luminal obstruction “critical” lesions before hemodynamic effects can be detected

A

70-80%

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4
Q

Hypertension not ANG II dependent

A

Bilateral RAS or solitary kidney

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5
Q

Effects of blockade of RAS in Unilateral RAS

A
  1. Reduced arterial pressure
  2. Enhanced lateralization of diagnostic tests
  3. Glomerular filtration rate (GFR) in stenotic kidney may fall
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6
Q

effect of bloacled of RAS in bilateral RAS

A
  1. Reduced arterial pressure only after volume depletion
  2. May lower GFR
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7
Q

Plasma renin elevated
Unilateral or bilateral RAS?

A

Unilateral RAS

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8
Q

Explain the adaptive mechanism to reduced renal perfusion

What happens to the cortical? Medulla?

A

Reduced blood flow —> collaterals develop

Chronic reduced BF in medulla—> activate adaptive maintenance of tissue perfusion

More severe—> oberwhelm adaptive mechanisms—> cortical hypoxia —> tubular atrophy (due to necrosis and apoptosis)

Tubular atrophy can be reversible (“hibernating state”)

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9
Q

Reduced blood flow a tivated numerous pathways of vascular and toasue injury including increase in?

A

ANG II
ET
Oxidative stress

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10
Q

What happens to the Nitric oxide in reduced perfusion?

How about ANG II?

A

Reduced perfusion leads to diminished shear stress distal to the stenosis —> decrease NO production post stenosis and inc ANG II and TXA—> intrarenal vasoconstriction

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11
Q

A direct consequence of reduced perfusion in the postetonic kidney (histo)

A

Progressive rarefaction—> tubular collapse

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12
Q

Late event and usually reflects severe loss of the GFR

A

Glomerulosclerosis

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13
Q

No-reflow phenomenon

A

Worsen during reperfusion phase

Reflect vascular damage and Acitvation of leukocytes - primed to obstruct distal capilliaries

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14
Q

Is a risk facor for disease progression of FMD

A

Smoking

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15
Q

What is rhe most common subtype of FMD ?
Appearance?

A

Medial fibroplasia
String of beads

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16
Q

Usually Affected arteris in FMD

A

Renal arteries 65-75% (bias on right renal artery)
Cerebral a. 25%

17
Q

Location of FMD lesions

Location of ARAS

A
  1. Away form the origin
    Midportion
    First bifurcation
  2. Near the origin
    Can occur anywhere
18
Q

Risk factors for ARAS

Strongly assoc with?

A
  1. Incrwasing age
  2. Elevated cholesterol
  3. Smoking
  4. Hypertension
  5. Preexisting HPN
    Cardiovascular lipid risk
    Diabetes
    Smoking
    Abnormal renal function
19
Q

Syndrome associated with Renovascular HPN

A

1.Early or late-onset hypertension (<30 yoars or >50 yoars)
2. Acceleration of treated essential hypertension
3. Deterioration of renal function in treated
essential hypertonsion
4. Acute renal fallure during treatment of hypertension
5. Flash pulmonary edema
6. Progressive renal fallure
7. Refractory congestive cardiac failure

** symptoms 5-7 are MC In patients with BILATERAL disease

20
Q

MC presentation of RAS

A

Progressive worsening of preexisting HPN

21
Q

Strongest predictors of RAS

Other clincial predictors?

A
  1. Age and crea

Recent progression
Other vascular dss (eg claudication)
Abdominal bruit

22
Q

Flash pulmonary edema arise in?

A

HPN with left ventricular systolic function ( preserved)

Sudden rise in arterial pressure impairs cardiac function due to rapidly developing diastolic dysfunction

23
Q

Those with declining renal function have a poor survival rate regardless of intervention, the strongest predictor of which is

A

Low baseline GFR

24
Q

Potential benefit of revascularization ia greatest when serum crea is

A

<3mg/dL

25
Q

Provides measurements of localized velocities of blood flow and characteristics of renal tissue

A

Doppler

26
Q

Used to monitor restejosis and target vessel patency

A

Doppler

27
Q

Primary criteria for renal artery studies (doppler)

A
  1. Peak systolic velocity above 180cm/sec
    And/or relative velocity above 3.5 as compared wirh the adjacent aortic flow
28
Q

Dampening of waveforms in Doppler labeled as parvus and tardus ar signs of

A

Indirect sign of upstream vaacular occlusive phenomena

29
Q

Resistive index of ______ was assoc with a >90% faborable BP response and stable to improved renal function

A

< 80

30
Q

Normal study excludes rebovascular HPN

A

Captopril renography

31
Q

Allows calculation of single kidney GFR

A

Nuclear imaging

32
Q

Enhances the release of renin from the stenotic kidney

A

Measurement of captopril stimulated renin activity

33
Q

Lateralization predictive of
improvement in blood pressure with revascularization

A

Measurement of renal vein renin activity

34
Q

Measures the level of activation of the renin-angiotensin system

A

Measurement of peripheral plasma renin activity

35
Q

Excellent accuracy for evaluation of in-stent restenosis

A

Computed Tomography Angiography

Brenner (4 decks)

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