Renal vascular disease

Question 1

what is renovascular disease defined as

Answer 1

stenosis of the renal artery or one of its branches

Question 2

causes of renovascular disease

Answer 2

atherosclerosis, fibromuscular dysplasia,. rarer- Takayasu’s arteritis, antiphospholipid syndrome, post renal transplant, thromboembolism, external compression

Question 3

signs renovascular disease

Answer 3

incr bp resistant to treatment; worsening renal function after ACEi/ARB; flash pulmonary oedema (sudden onset without LV impairment on cardiac echo); abdo, carotid and femoral bruits; weak leg pulses

Question 4

tests in renovascular disease

Answer 4

USS: renal size asymmetry, disturbance in renal blood flow on Doppler. CT/MRI

Question 5

treatment renovascular disease

Answer 5

antihypertensive regimens, transluminal angioplasty, stent, revascularisation surgery.

Question 6

what is haemolytic uraemic syndrome (HUS) characterised by

Answer 6

microangiopathic haemolytic anaemic- intravascular haemolysis and red cell fragmentation

Question 7

what happens in haemolytic uraemic syndrome (HUS)

Answer 7

endothelial damage triggers thrombosis, platelet consumption, fibrin deposition in renal microvasculature. destruction of passing RBCs

Question 8

what results from haemolytic uraemic syndrome (HUS)

Answer 8

thrombocytopenia and AKI

Question 9

causes of haemolytic uraemic syndrome (HUS)

Answer 9

90% from E coli strain O157. affects children commonly in outbreaks after eating undercooked meat

Question 10

signs haemolytic uraemic syndrome (HUS)

Answer 10

abdo pain, bloody diarrhoea, AKI

Question 11

what does haemolytic uraemic syndrome (HUS) involve (x3)

Answer 11

haemolytic anaemia (destruction RBCs), AKI (uraemia), low platelet count (thrombocytopenia)

Question 12

tests in haemolytic uraemic syndrome (HUS)

Answer 12

haematuria, proteinuria. blood film- fragmented RBC, decr platelets, decr Hb. clotting tests normal

Question 13

treatment haemolytic uraemic syndrome (HUS)

Answer 13

dialysis for AKI may be needed. plasma exchange. prognosis worse if non E coli case.

Question 14

what is MAHA

Answer 14

microangiopathic haemolytic anaemia

Question 15

what is the pathophysiology of Thrombotic thrombocytopenic purpura

Answer 15

deficiency of a protease that normally cleaves VWF. platelet aggregation and fibrin deposition leading to microthrombi

Question 16

there is overlap between which 2 conditions

Answer 16

HUS and TTP

Question 17

signs in Thrombotic thrombocytopenic purpura

Answer 17

MAHA, low platelets, can have AKI, fluctuating CNS signs and fever

Question 18

causes of Thrombotic thrombocytopenic purpura

Answer 18

idiopathic, autoimmunity, cancer, pregnancy, drug (quinine), bloody diarrhoea prodrome, haematopoietic stem cell transplant

Question 19

tests Thrombotic thrombocytopenic purpura

Answer 19

haematuria/ proteinuria. bloods

Question 20

treatment Thrombotic thrombocytopenic purpura

Answer 20

urgent plasma exchange. steroids. ecluzimab.

Question 21

what is the value for microalbuminaria

Answer 21

30-300mg albumin/24 hour

Question 22

what does microalbuminaria show

Answer 22

warning of impending renal problems, risk factor for cardio disease. specialised dipsticks- albumin:creatinine of >2.5 in men, >3.5 in women.

Question 23

if positive for microalbuminaria what should happen

Answer 23

start on ACEi or ARB