May 12, 2016 - Ischemic Nephropathy

Question 1

Ischemic Nephropathy - Definition

Answer 1

A long-term cause of hypertension and renail failure.

Question 2

Changes to Glomerulus in Ischemic Nephropathy

Answer 2

Medial hypertrophy and intimal fibroblastic thickening

Hyaline deposition in the arteriolar wall

Sclerosis of the glomeruli (usually global)

Focal segmental glomerulosclerosis

Interstitial fibrosis and tubular atrophy

Question 3

Risk Factors for Ischemic Nephropathy

Answer 3

The four horsemen of the apocalypse…

Hypertension, diabetes, dyslipidemia, and smoking

Question 4

Signs of Ischemic Nephropathy

Answer 4

Bland urine (no blood / protein)

Risk factors

Slowly progressive

Normal imaging

Other diagnoses excluded

Question 5

Investigating Ischemic Nephropathy

Answer 5

Creatinine / eGFR

Electrolytes

Urinalysis

ACR

Ultrasound

CBC

Calcium

Phosphate

SPEP/UPEP (for myeloma)

Question 6

Imaging of Ischemic Nephropathy

Answer 6

Renal angiogram

CTA of renal arteries

MRA with gadolinium

(​These are the most specific and sensitive but more invasive)

Ultrasound

Doppler ultrasound

Captopril renal scan

Question 7

Treatment of Ischemic Nephropathy

Answer 7

Lifestyle

ASA

Statins

With hypertension, if it is unilateral treat with ACE/ARB and if bilateral treat with anything else.