Exam 2 Vascular issues of kidneys Flashcards by Amanda Beach

What is benign nephrosclerosis

a process in which there is hyaline sclerosis of the renal arterioles and small arteries. can lead to HTN

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What do kidneys look like in someone with nephrosclerosis

cotex has a grainy look. decreased size
medial hypertrophy with narrowed lumen
collagen in bowlmas space

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What are signs of nephrosclerosis

moderate dec in renal blood flow, GFR is normal or slightly reduced
there is mild proteniuria
multi focal ischemia of the kidney parenchyma

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what are the demographics of benign nephrosclerosis

older age and african american

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What renal disease is assoc with malignant HTN

accelerated nephrosclerosis- small vessel disease

severe changes

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What is the definition of malignant arteriolosclerosis/ nephrosclerosis

renal vascular disorder, exhibiting injury, associated with malignant or accelerated HTN

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what are the pathologic effects from malignant arterosclerosis

ischemic kidneys and extremely high levels of renin

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what is the pathogenesis of malignant HTN effects on kidneys begining with renal vascular disease

increased permeability of small vessels
endothelial ireeversible injury
focal vascular cell death
platelet deposition(thrombosis)
fibrinoid necrosis of arterioles and small arteries
hyperplastic arterolitis

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What are signs of malignant HTN

papilledema, retinal hemorrhage, encephalopathy, CV abnormalities, renal failure

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What do you do to Tx malignant HTN

aggressive anti HTN

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how many people with malignant nephrosclerosis regain renal function

50%

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What do kidneys look like from malignant HTN (gross) not microscopic

flea bitten appearance of renal hemorrhages

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What is renal artery stenosis/large vessel disease

athermatous plaque occlusion at origin of artery

or fibromuscular dysplasia of the renal artery

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what type of renal artery stenosis is most common in men

atheromatous plaque occlusion

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what type of renal artery stenosis is most common in women

fibromuscular dysplasia of renal arter

mainly in the media portion of artery

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What is important about the Tx for large vessel disease, renal artery stenosis

curable with surgery

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is renal artery stenosis more b/l or unilateral

uni

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what is the demographic for renal artery stenosis

younger age group of women

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what does fibromuscular dysplasia of renal artery look like on contrast CT

string of beads

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Where does angiotensin II work systemically

cardiac and vascular hypertrophy

systemic vasoconstriction, increased blood volume, renal sodium and fluid retention(from adolsterone and ADH too)

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what do the kidneys look like grossly in renal a stenosis

reduced in size

diffuse ischemic atrophy

What is the clinical presentation of large a disease/renal artery stenosis

looks like essential HTN
bruit of affected kidneys
elevated plasma renin
respond well to ACE inhibitor

what is used to Dx renal artery stenosis

renal scans, IV pyelography

what is the post surgery cure rate for renal artery stenosis

70-80%

What are the two main types of thrombotic microangiopathies and what does this mean

hemolytic uremic syndrome and thrombotic thrombocytopenic purpura diverse insults leading to excessive activation of platelets which deposit thrombi in capillaries and arterioles in various tissue beds

What are seen in peripheral blood smears in thombotic microangiopathies

schistocytes which are fragmented RBCs

What are common toxins that trigger endothelial injury

bacterial toxins, cytokines, viruses, certain medications | anti-endothelial Ab

What is the pathogenesis of typical HUS

associated with diarrhea from consuming contaminated food with shiga like toxin E coli O157:H7 mostly in children leads to platelet activation and vasoconstriction

describe atypical HUS

non-epidemic, non-diarrheal can he from inherited mutations of complement protein regulators (Factor H and I) multiple insults to endothelium antiphospholipid syndrome, pregnancy associated, systemic sclerosis and malignant HTN, chemo and kidney irradiation

what is the most common way to acquire atypical HUs in adults

chemotherapeutic agents and immunosuppressive drugs

What is associated with deficiency in ADAMS13 protease and what is the normal function of this protease

associated with TTP | protease regulates function on vWF (inhibitory regulation) so when deficient constitutively activated

what is a major sign of TTP and what age group is it seen most in

prominent neurologic involvement, presents as adults younger than 40

What is the mechanism of destruction with atypical HUs

platelet activaiton, thombosis in microvscular beds leading to increased endothelin production, vasoconstriction and hypoperfusion of tissues

What would the kidney look like during acute active disease of HUS or TTP

thick capillary walls, subendothelial deposits of fibrin, disruption mesangial matrix

What thrombotic microangiopathies can present with chronic disease? what does it look like

atypical HUS and TTP scarring of renal Cx, split BM of glomeruli arteries wall thickening (onion skinning) persistent hypoperfusion--> HTN

What is clinical presentation of typical HUS

influenza like diarrhea, sudden bleeding like hematemesis and melena, oliguria, hematuia, microangiopathic hemolytic anemia, thrombocytopenia and sometimes neuro Sx

What is the most common type of C' deficiency seen in atypical HUS

deficient Factor H

What is the clinical presentation of TTP

fever and neuro symptoms, microangiopathic hemolytic anemia, thrombocytopenia, renal failure in 50%

What does microangiopathic hemolytic anemia look like in peripheral blood smear

fragmented RBC, many immature RBC

What has worse prognosis typical or atypical HUS

atypical

What type of microangiopathy do you do plasmapheresis with

TTP successful in >80%

Is artherosclerotic ischemic renal disease unilateral or bilateral

b/l

What population is arteroembolic renal disease more likely in

older patients with severe atherosclerosis

Why are kidneys at high risk of damage from emboli

only have 1 main artery bringing in blood supply

what are underlying processes that can lead to arteroembolic renal disease

mural thrombosis from left side of the hear, vegetative endocarditis, aortic aneurysms, aortic atherosclerosis

what is clinical signs of sickle cell nephropathy

hematuria, hyposthenuria patchy papillary necrosis 30% have proteinuria, sub-nephrotic range

when does diffuse cortical necrosis occur

after obstetric emergencies, aburtption placenta, septic shock or extensive surgeries

what does diffuse cortical necrosis look like

massive ischemic necrosis limited to cortex | intravascular thrombosis focally

if diffuse cortical necrosis is b/l what is prognosis

fatal

what do renal infarcts look like microscopically and clinically

white anemic in fats, sharply demarcated ringed by zone of hyperemia usually clinically silent, somtimes Tender CVA with showers of RBC in urine can cause HTN