Renal vascular disease

Question 1

______________ is a hypercoagulable state of the kidneys occuring most often in newborns. It may develop after trauma or have no predisposing factors.

Answer 1

Renal vein thrombosis

Question 2

____________may either cause or result from renal vein thrombosis

Answer 2

NephrOtic syndrome

Question 3

Most commonly occuring in newborns, how does renal vein thrombosis present?

Answer 3

sudden development of abdominal mass, oligouria, hematuria (usually). (Older children c/o flank pain)

Question 4

What is the best way to dx renal vein thrombosis?

Answer 4

US

Question 5

How do you treat renal vein thrombosis?

Answer 5

Heparin, consider long term anticoagulant

Question 6

Sudden onset of severe hypertension in children prior to age 10 should prompt you to check for _________________

Answer 6

Renal arterial disease

Question 7

The buildup of plaque in the arteries that lead to the kidneys is called _____________________

Answer 7

renal artery disease OR renal artery stenosis (surprise, its the same thing)

Question 8

Renal artery stenosis (RAS) can lead to what complications?

Answer 8

uncontrolled htn, CHF, kidney failure

(CHF b/c blood is getting backed up at the renal arteries which increases the blood pressure and the afterload of the heart)

Question 9

Most RAS is caused by the same conditions as PVD or CAD (atherosclerosis). What else could lead to this condition?

Answer 9

fibromuscular dysplasia (congenital thickening of arterial walls, no plaque buildup)

Question 10

What are the major symptoms of RAS?

Answer 10

Uncontrolled htn (despite multi htn drug therapy)**

Also fluid retention, CHF in some cases.
Severe cases have already caused kidney failure which leads to SOB, fatigue.

Question 11

How is RAS diagnosed definitively?

Answer 11

US, MRA, CTA, nuclear testing, angiogram

Question 12

Treatment for RAS?

Answer 12

same as for atherosclerosis: medical mgmt of BP, glucose, cholesterol. Diet control, wt loss, smoking cessation, low salt. Severe cases need angioplasty/stent, endarterectomy, bypass.

Question 13

________________is the most common glomerular vascular cause of acute renal failure in childhood

Answer 13

Hemolytic-Uremic syndrome

Question 14

What causes hemolytic-uremic syndrome (HUS)?

Answer 14

Shigella and E.coli from meats. OR cyclosporin meds.

Question 15

What are the symptoms of HUS?

Answer 15

Bloody diarrhea***, abdominal pain, vomiting, followed by hemolysis and renal failure.

Question 16

What is the mechanism that causes the kidneys to become involved if the problem is n/v/d and hemolysis?

Answer 16

Destroyed RBC’s need to be processed. They are made of protein (among other things). Protein byproducts are ammonia. Liver attempts to convert the ammonia to BUN. BUN levels will be very high and can lead to acute kidney failure. Kidney failure can lead to the oliguria, htn, sz, fluid overload. Anemia is the primary problem, but if kidneys fail there won’t be adequate erythropoietin to replace rbcs.

Question 17

How do you treat HUS?

Answer 17

Balance fluids/electrolytes. Control htn. DO NOT use antimotility agents or antibiotics as this causes the shiga toxin to be released in mass. This will typically clear on its own, but severe cases with neuro symptoms/severe anemia may require transfusions, dialysis, erythropoietin tx. So provide support for 2-3 weeks until bacteria clears.