Renal Vascular Diseases

Question 1

Azotemia:

Answer 1

Elevation of BUN and Cr

- Related to decreased GFR

Question 2

Uremia:

Answer 2

When renal failure causes clinical signs and symptoms in other systems

Question 3

Pre-renal disease BUN:Cr:

Answer 3

> 20:1

Question 4

Renal disease BUN:Cr:

Answer 4

< 10:1

Question 5

Progression to renal failure (4):

Answer 5

1. Diminished renal reserve (GFR ~ 50%)
2. Renal insufficiency (GFR 20-50%)
3. Chronic renal failure (GFR < 20-25%)
4. End stage renal disease (GFR < 5%)

Question 6

Benign nephrosclerosis - pathogenesis (2):

Answer 6

• Medial and intimal thickening

- Hyaline deposition in arterioles

Question 7

Malignant nephrosclerosis - histology (2):

Answer 7

• Fibrinoid necrosis of arterioles

- Hyperplastic arterioloschlerosis

Question 8

Renal artery stenosis - pathogenesis (4):

Answer 8

• Unilateral constriction decreases intrarenal circulation/blood pressure
• Cells of JGA release renin
• ATII (vasoconstrictor) is produced –> HTN
• Aldosterone conserves Na+ and H2O

Question 9

Renal artery stenosis - morphology (3):

Answer 9

• Atherosclerotic place occlusion (more common in men)
• Fibromuscular dysplasia of renal artery (more common in women)
• Contralateral kidney shows effects of HTN

Question 10

Hemolytic uremic syndrome:

Answer 10

Endothelial injury leads to platelet activation and thrombosis

Question 11

Typical HUS:

Answer 11

Endothelial injury triggered by Shiga-like toxin

Question 12

Atypical HUS:

Answer 12

Excessive activation of complement

Question 13

Thrombotic thrombocytopenic purpura:

Answer 13

Platelet aggregation from very larger multimers of vWF.

- Deficiency of plasma metalloprotease ADAMTS13

Question 14

Atypical HUS is distinguished from TTP by:

Answer 14

Atypical HUS has normal ADAMTS13 levels

Question 15

TTP pentad of clinical features (5):

Answer 15

• Fever
• Neurologic symptoms
• Microangiopathic hemolytic anemia
• Thrombocytopenia
• Renal failure

Question 16

Atherosclerotic ischemic renal disease (3):

Answer 16

• Bilateral renal artery disease
• Common cause of chronic ischemia, renal insufficiency in older adults
• Surgical intervention preserves remaining renal function

Question 17

Diffuse cortical necrosis (4):

Answer 17

• Follows catastrophic conditions such as abruptio placentae, septic shock
• Cortex only
• Massive ischemic coagulative necrosis
• May have intravascular and intraglomerular thromboses