Renal vascular disease Flashcards
Renovascular disease def
Stenosis of renal artery or its branches
Causes of renovascular disease
Atherosclerosis
Fibromscular dysplasia (young)
Takayasu’s arteritis
Antiphospholipid
Signs of renovasc disease
Resistant HTN
Rapid onset pulmonary oedema
Worseining GFR after ACEi/ARBi
Bruits (abdo/femoral/carotid)
Ix for renovascular disease
USS: one artery smaller than the other
Doppler/MRI/CT: reduced renal blood flow
Renal angiogrpahy: gold standard (invasive so do others first)
Rx of renovascular disease
antihypertensives
transluminal angioplasty +/- stent
Revascularisation surgery
Haemolytic uraemic syndrome (HUS) pathophysiolgy
Endothelial damage causes clot formation, platelet consumption and fibrin strand deposition esp in renal microvasulature
Strands cause mechanical destruction of RBC
HUS main complications
Thrombocytopaenia
AKI
Cause of HUS
E coli O157 (90%), produces verotoxin, damaging endothelial cells
Common presentation of HUS
Young children eating undercooked meat
HUS sx
abdo pain
bloody diarrhoea
AKI
Blood results for HUS
Low platelet, Hb, fragmented RBC
Clotting normal
Rx of HUS
Dialysis if AKI
Refer to experts
Thrombotic thrombocytopenic purpura (TTP) pathophysiology
Genetic or acquired deficiency in a protease (ADAMTS13)
Protease normally cuts vWF
Larger vWF multimers
Leads to easier thrombi formation
TTP causes
Idiopathic 40%
Autoimmune (SLE)
Cancer
Pregnancy
Blood results of TTP
Low platelet, Hb
Fragmented RBC on film
Clotting normal