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Clinical Med - Nephrology > HTN Renal Disease / Vasculitis > Flashcards

HTN Renal Disease / Vasculitis Flashcards

1
Q

What disease processes can result in renal HTN?

A
  1. Pheochromocytoma
  2. Primary Aldosteronism
  3. Artheroscelrosis
  4. Cushing’s
  5. Hypothyroidism and Hyperthyroidism
  6. Hyperparathyroidism
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2
Q

At what BP would you start to be concerned over Malignant HTN?

Is this often associated with hypertensive emergency or urgency?

A

> 180/120 mmHg

HTN Emergency

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3
Q

What are the retinal manifestations of Malignant HTN?

What about HTN Encephalopathy?

A

Retinal: Hemorrhages, Exudates, Papilledema

Encephalopathy: Cerebral Edema, SAH, Lacunar Infarctions

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4
Q

What may be present on UA in a patient with Malignant HTN?

Renal Biopsy?

A

UA: Hematuria, Proteinuria

Biopsy: Fibrinoid Fibrosis

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5
Q

How is Malignant HTN treated?

A

IV Labetalol
IV Nitroprusside
Nicardipine

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6
Q

__________ HTN is one of the most common causes of secondary HTN.

It can often present as an acute onset of severe resistant increase in BP at a young age, refractory HTN, flash pulmonary edema, or an increase in sCr after starting ACEi

A

Renovascular HTN

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7
Q

If on US you noticed a unilaterally smaller kidney, what underlying disorder (regarding BP) may be present?

A

Renovascular HTN

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8
Q

Are Doppler US, CTA, MRA, and Aortogram all viable imaging modalities for renovascular HTN work up?

What is most diagnostic and therapeutic if renal artery stenosis is involved?

A

Yes

Angiography

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9
Q

T/F: Medical Management (ie: anti-hypertensives) is given to all patients with renovascular HTN

A

True

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10
Q

Other than medical therapy, what additional treatment options are available for renovascular HTN?

A

Angioplasty with stenting
Surgical Revascularization
Nephrectomy (of the “pressor” kidney)

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11
Q

_________ disease results from cholesterol crystal break off from a plaque and embolize distally from their origin

A

Atheroembolic Disease

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12
Q

T/F: Atheroembolic Disease is typically Iatrogenic

A

True

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13
Q

What are examples of iatrogenic events that may result in atheroembolic disease?

Spontaneous?

A

Iatrogenic: Angiography, Cardiovascular Surgery, Anti-coagulation

Spontaneous: Hemodynamic Stress

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14
Q

What is the classic clinical triad of atheroembolic disease?

A
  1. Precipitating Event (Cardiac Procedure, Angiography, etc…)
  2. Subacute or AKI
  3. Blue Toe Syndrome / Livedo Reticularis
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15
Q

What may be seen on fundoscopy in a patient with atheroembolic disease?

A

Hollenhorst Plaque in a retinal artery

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16
Q

How may the renal artery appear on histology in a patient with atheroembolic disease?

A

Cleft Like Spaces in the the lumen

17
Q

How is Atheroembolic managed?

A

Supportive:

Statins
ASA
Anti-HTN
Smoking Cessation
Glucose Control
18
Q

What percentage of patients with with atheroembolic disease progress to ESRD?

19
Q

What FIVE ‘things’ compose Thrombotic Microangiopathies?

A
  1. Thrombocytopenia
  2. Microangiopathic Hemolytic Anemia
  3. Neurological Sx
  4. Renal Function Abnormalities
  5. Fever
20
Q

T/F: Idiopathic TTP-HUS is NOT a medical emergency

A

False

It is a medical emergency (fatal if not treated)

21
Q

What is the most diagnostic study in diagnosing thrombotic microangiopathies?

What would be seen on this?

A

Biopsy

Schistocytes

22
Q

What deficiency is often found in patients with thrombotic microangiographies?

23
Q

What are examples of ANCA associated vaculitis?

A
  1. Wegner’s (Granulomatosis with polyangitis) - GPA
  2. Microscopic Polyangitis - MPA
  3. Churg-Strauss Syndrome - CSS
  4. Renal Limited Vasculitis
24
Q

How is MPA distinguished from GPA and CSS?

A

Absence of granuloma formation in the presence of necrotizing vasculitis.

25
Q

Will GPA, MPA, or CSS have immune complex deposits on histology?

26
Q

What are unique clinical manifestations of GPA?

A
  1. Nasal and Oral Inflammation (Ulcers, Purulent/Bloody discharge)
  2. CXR with nodules, infiltrates, or cavities
  3. Abnormal urinary sediment (hematuira +/- RBC casts)
  4. Granulomatous inflammation on biopsy of an artery or perivascular area
27
Q

If a patient had a stenonic renal artery what may be auscultated on examination?

A

Renal Artery Bruit

28
Q

In _____ vasculitis, 50% of the glomeruli are normal

29
Q

In _____ vasculitis, 50% of the glomeruli have (Cellular/Fibrotic) crescents present

A

Crescentric

30
Q

In _____ vasculitis, 50% of the glomeruli are globall sclerotic

31
Q

Is GPA associated with PR3-ANCA or MPO-ANCA?

What about MPA?

A

GPA: PR3-ANCA

MPA: MPO-ANCA

32
Q

T/F: A Vasuclitis diagnosis (GPA or MPA) needs to be confirmed by biopsy

33
Q

What combination of medications is used to treated vasculitis?

A

Cyclophosphamide and Steroids

34
Q

If angiography is preformed and the damaged kidney can not be saved, what needs to occur?

A

Nephrectomy

Clinical Med - Nephrology (7 decks)

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