Renal vascular diseases - diseases of intrarenal vessels

Question 1

Microvascular disorders associated with acute renal damage

Answer 1

Thrombotic microangiopathy - HUS and TTP
DIC
Malignant hypertension
Small-vessel vasculitis
Systemic sclerosis (scleroderma)
Atheroemboli (cholesterol emboli)

Question 2

Accelerated phase hypertension

Answer 2

Associated with acute damage to renal and other arterioles

Often symptomatic - headache, impaired vision, renal impairment

Question 3

Accelerated phase hypertension - PE

Answer 3

PE - severe hypertension, evidence of hypertensive retinopathy
Papilloedema - almost always
Clinical features of microangiopathy may be present - fragmented RBCs and anemia, glomerular capillary thrombosis
Absence of history - difficult to distinguish from HUS and hypertension

Question 4

Accelerated phase hypertension - treatment

Answer 4

Most respond to effective control of blood pressure

Renal function is permanently lost in 20%

Question 5

Common features

Answer 5

Microangiopathic hemolytic anemia - damage to RBC during passage through abnormal vessels