Renal Vascular Disease Basics Flashcards
What is the most common secondary cause of HTN
Primary Renal Disease
Why does kidney disease lead to HTN
Retention of NA
Excess Renin secretion
Sympathetic nervous system overactivity
Who is at high risk for renal vascular HTN
Elderly with atherosclerosis
Fibromuscular dysplagia
How does large vessel occlusions cause renal htn
Compression of blood flow to the kidney
Intimal dissection
Stenosis
Atherosclerotic disease
What happens in Renal artery stenosis that leads to systemic HTN
Reduction in blood flow to the kidneys causes increase in Renin reducing Na excretion and activates sympathetic activity
S/S of renal artery stenosis or obstruction
Severe refractory HTN
LVH
Renal fibrosis
ABD/flank pain
Unexplained deterioration of renal function
What renal imaging can be ordered to r/o renal artery stenosis
Doppler: can indentify large lesion that lead to hemodynamic compromise
MRA or CTA
Catopril Radiology: evaluates GFR
Intra arterial angiography: Gold standard, identifies location and severity of lesion
What are invasive renal artery stenosis treatment options
Percutaneous renal artery stenosis revascularization
Stenting
What is the difference in treatment of FMD vs Atherosclerosis treatment of renal stenosis
FMD: Percutaneous renal artery angioplasty
Atherosclerosis: medical management
What are the pharmacological management options for renal artery stenosis
ACE or ARB
Smoking cessation
What is the pathophysiology behind artheroembolic renal artery occlusion
Cholesterol crystals break free and lodge into micro vasculature
What two disease processes are common in renal artery atheroembolic disease
Aortic aneurysm
Renal artery stenosis
What causes the the plaque to dislodge and cause renal artery atheroemoblic disease
Trauma
Blood thinners
Thrombolytic therapy
Vascular surgery
Coronary vessel agioplastic surgery
S/s of renal artery arterioembolic disease
Symptoms develop 1-14 days following the event
Fever, ABD pain, weight loss, livedo reticularis, localized gangrene, HTN, CKD or AKI
Laboratory findings in renal artery atherembolic disease
Elevated creatinine
Eosinophilia
Elevated ESR
Hypocomplementenemia
