Nephropathy

Question 1

What pathological changes happen in hypertension

Answer 1

Renal vessels (small):
Hypertrophy: lumen shrinks
Protein deposition
Glomerular sclerosis
Tubular atrophy
Interstitial fibrosis

Question 2

What are signs of small vessel ischemic nephropathy?

Answer 2

Decrease GFR
Bland urine (glomeruli gets shut down)
Slow progression
Normal imaging

Question 3

Treatment for small vessel ischemic nephropathy

Answer 3

Blood pressure control: can use ace but could use others
Control lipids
Control sugars
Lifestyle

Question 4

Risk factors for large vessel ischemic nephropathy

Answer 4

Atherosclerosis

Fibromuscular dysplasia

Question 5

Signs of large vessel ischemic nephropathy

Answer 5

Bilateral: flash pulmonary edema with HTN
Decrease in GFR greater than 30% with ACEi

Unilateral: HTN

Question 6

Investigations showing large vessel ischemic nephropathy

Answer 6

Abdominal Bruits
Imaging
Renal angiogram etc
Ultrasound etc

Question 7

Treatment large vessel nephropathy

Answer 7

Lifestyle mod
Aspirin, statins
If unilateral: ace
If bilateral: avoid ace

Consider stenting

Question 8

Natural history of diabetic nephropathy?

Answer 8

Initial increase in GFR: hyper filtration (micro albumin)
Followed by decline in GFR and proteinuria

Eventually a cause of nephrotic syndrome

Question 9

Treatment of diabetic nephropathy

Answer 9

Glycemic control (legacy effect in DM1)
ACEi very effective in preventing ESRD
BP control (more impactful in DM1)

Question 10

Characteristics of diabetic nephropathy

Answer 10

Persistent albuminuria
Bland urine sediment
Slow progression of disease
Low GFR with overt proteinuria 
Other diabetic complications
Known duration of diabetes greater than 5 years

Question 11

When does risk of nephropathy occur?

Answer 11

At 10 years