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Year2 Renal > Exam 2 Vascular issues of kidneys > Flashcards

Exam 2 Vascular issues of kidneys Flashcards

1
Q

What is benign nephrosclerosis

A

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

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2
Q

What do kidneys look like in someone with nephrosclerosis

A

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

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3
Q

What are signs of nephrosclerosis

A

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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4
Q

what are the demographics of benign nephrosclerosis

A

older age and african american

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5
Q

What renal disease is assoc with malignant HTN

A

accelerated nephrosclerosis- small vessel disease

severe changes

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6
Q

What is the definition of malignant arteriolosclerosis/ nephrosclerosis

A

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

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7
Q

what are the pathologic effects from malignant arterosclerosis

A

ischemic kidneys and extremely high levels of renin

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8
Q

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

A 
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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9
Q

What are signs of malignant HTN

A

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

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10
Q

What do you do to Tx malignant HTN

A

aggressive anti HTN

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11
Q

how many people with malignant nephrosclerosis regain renal function

A

50%

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12
Q

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

A

flea bitten appearance of renal hemorrhages

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13
Q

What is renal artery stenosis/large vessel disease

A

athermatous plaque occlusion at origin of artery

or fibromuscular dysplasia of the renal artery

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14
Q

what type of renal artery stenosis is most common in men

A

atheromatous plaque occlusion

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15
Q

what type of renal artery stenosis is most common in women

A

fibromuscular dysplasia of renal arter

mainly in the media portion of artery

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16
Q

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

A

curable with surgery

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17
Q

is renal artery stenosis more b/l or unilateral

A

uni

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18
Q

what is the demographic for renal artery stenosis

A

younger age group of women

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19
Q

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

A

string of beads

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20
Q

Where does angiotensin II work systemically

A

cardiac and vascular hypertrophy

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

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21
Q

what do the kidneys look like grossly in renal a stenosis

A

reduced in size

diffuse ischemic atrophy

22
Q

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

A

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

23
Q

what is used to Dx renal artery stenosis

A

renal scans, IV pyelography

24
Q

what is the post surgery cure rate for renal artery stenosis

A

70-80%

25
Q

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

A

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

26
Q

What are seen in peripheral blood smears in thombotic microangiopathies

A

schistocytes which are fragmented RBCs

27
Q

What are common toxins that trigger endothelial injury

A

bacterial toxins, cytokines, viruses, certain medications

anti-endothelial Ab

28
Q

What is the pathogenesis of typical HUS

A

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

29
Q

describe atypical HUS

A

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

30
Q

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

A

chemotherapeutic agents and immunosuppressive drugs

31
Q

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

A

associated with TTP

protease regulates function on vWF (inhibitory regulation) so when deficient constitutively activated

32
Q

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

A

prominent neurologic involvement, presents as adults younger than 40

33
Q

What is the mechanism of destruction with atypical HUs

A

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

34
Q

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

A

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

35
Q

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

A

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

36
Q

What is clinical presentation of typical HUS

A

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

37
Q

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

A

deficient Factor H

38
Q

What is the clinical presentation of TTP

A

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

39
Q

What does microangiopathic hemolytic anemia look like in peripheral blood smear

A

fragmented RBC, many immature RBC

40
Q

What has worse prognosis typical or atypical HUS

A

atypical

41
Q

What type of microangiopathy do you do plasmapheresis with

A

TTP successful in >80%

42
Q

Is artherosclerotic ischemic renal disease unilateral or bilateral

A

b/l

43
Q

What population is arteroembolic renal disease more likely in

A

older patients with severe atherosclerosis

44
Q

Why are kidneys at high risk of damage from emboli

A

only have 1 main artery bringing in blood supply

45
Q

what are underlying processes that can lead to arteroembolic renal disease

A

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

46
Q

what is clinical signs of sickle cell nephropathy

A

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

47
Q

when does diffuse cortical necrosis occur

A

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

48
Q

what does diffuse cortical necrosis look like

A

massive ischemic necrosis limited to cortex

intravascular thrombosis focally

49
Q

if diffuse cortical necrosis is b/l what is prognosis

A

fatal

50
Q

what do renal infarcts look like microscopically and clinically

A

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

Year2 Renal (20 decks)

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