Renal Vascular Disease

Question 1

How can renal disease cause secondary HTN?

Answer 1

Activation of RAS

Retention of Na and water due to ↓ excretion

Question 2

What can cause Renovascular Disease?

Answer 2

Atherosclerosis
Fibromuscular dysplasia
Thromboembolism
External mass compression

Question 3

What are some of the features of Renal vascular disease?

Answer 3

Refractory hypertension
Worsening renal function after ACEi/ARB
Flash pulmonary oedema (no LV impairment on echo)

Question 4

What investigations can be done in a patient with suspected Renal vascular disease?

Answer 4

US + doppler: small kidney + ↓ flow
CT/MR angiogram
Renal angiography: gold standard

Question 5

How can you manage Renal vascular disease?

Answer 5

Treat medical CV risk factors

Angioplasty and stenting

Question 6

What is Thrombotic Thrombocytopenia Purpura (TTP)?

Answer 6

Genetic or acquired deficiency
Tends to be adult females
Fever
CNS signs: confusion, seizures
Thrombocytopenia
Renal failure
Haemolytic anaemia

Question 7

What is the management of Thrombotic Thrombocytopenia Purpura?

Answer 7

Plasmapheresis
Immunosuppression
Splenectomy

Question 8

What is Haemolytic Uraemic Syndrome (HUS)?

Answer 8

E. Coli verotoxin → endothelial dysfunction

Tends to occur in young children eating undercooked meat

Question 9

What is Haemolytic Uraemic Syndrome (HUS)?

Answer 9

Bloody diarrhoea and abdominal pain precedes:
Haemolytic anaemia
Thrombocytopenia
Renal failure

Question 10

What investigations can be done in patients with Haemolytic Uraemic Syndrome?

Answer 10

Schistocytes (Divided/split RBC)
↓ plats
↓Hb
Normal clotting

Question 11

What is the treatment for Haemolytic Uraemic Syndrome?

Answer 11

Usually resolves spontaneously

Dialysis or plasma exchange may be needed if severe