Renal: vascular, structural, congenital Flashcards
Renal artery stenosis
- causes
- common in who
- age range
- RFs
- atherosclerosis of the renal artery
- uni or bilateral
- common in PTs with diffuse arteriosclerosis
- patients usually >50 YO
RF
- **HTN
- *****SMOKING
- *CKD
- *DM
how does RAS cause HTN
atherosclerosis–>stenosis of artery–>decrs afferent arteriole pressure–>decrs renal artery perfusion–>stimulates release of RENIN–>incrs angiotensin II and aldosterone levels VIA RAAS
- ***ang2 is a potent vasoconstrictor and incrs sympathetic activity
- **aldosterone increases reabosprtion of NA and water–>increases blood volume–>incrs CO
fibromuscular dysplasia
- define
- primary defect?
- involved where
- stenosis of the renal arteries 2nd
- twisting of the BVs
- areas of dilation——internal elastic lamina is absent—-primary defect
Can have involvement of exracranial cerebrovascular arteries—-carotid and vertebral arteries
list the three mechanisms of HTN
- incrs intravascular volme
- incrs RAAS
- incrs sympathetic nerve activity
Upper UT obstruction
- whats invovled
- complications
- compensatroy mechansims
upper=kidneys and ureter
complications
- hydroureter—dilation of ureters
- hydronephorsis–dilation of renal pelvis
- uretro-hydronephrosis
- tubulointerstitial fibrosis
- leads to excess cell destrctuon and death of neprhons
comp mechanisms
- hypertrophy
- hyperfunction
Nephrolithiasis
- cause
- MCC
- RF
-causes MCC=genetics -dietary -systemic dz-->hyperparathyroidism -drugs
RF
- fam hx
- increased oxalate absorption—ie GI bypass, Chrons dz
- acidic urine
- genetic factors—hypercalcuria, hypocaitraturia,
- diet high in oxalate, salt, protein,
- decr fluid intake
- infections with specific urase-producing organisms
what is an inhibitor to kidney stones
citrate
horsehsoe kidney
- occurs hwere
- assoc with?
- cm
occurs @ lower poles
-assoc with urogenital abdnormalities and renal pelvic tumors, turners syndrome and Tri 18
30% asympto
other can develop hydronephrosis, infection, stones, etc
lots of stasis**
Polycytic kidney dz
- define
- MC?
- types
- commonly assoc with?
-multisystemic progressive genetic disorder–numervous cystic growths with kidney enlargement
MC inherited cause of kidney dz
TYPES
- autosomal dominant (ADPKD)
- Autosomal recessive PKD
Assoc with:
- 40% have cystic liver dz
- excessive angiogenesis—fragile vessels in the wall—which bleed into cyst–>can incr the cyst size and cause a LOT of pain—can also rupture and cause gross hematuria
NO increase in renal cell CA
autosomal dominant PKD–where is the defect
PKD1 and PKD2
PKD1–>short arm of chromosome 16—-85-90% pts ****
PKD2—>long arm chromosome 4
role of PKD1 and PKD2
–>encode proteins polycystin 1 and 2—which regulate morpholgic changes of epithelial cells
what hormone increases with PKD
vasopressin–>causes HTN and cysts
bladder tumors
- mc type?
- biggest RF
MC=urothelial transitional cell CA
- -RF= SMOKING****
others: exposure to metabolites of phenaciten, aniline dyes or arsenic in water
renal tumors
- list them
- MC?
BENIGN= renal adneomas
Renal transitional cell CA=rare
MC=renal cell carcinoma
Renal cell carcinoma
- mutation of?
- CM
- strongest rf
mutation of Von Hippel-Lindau gene
- form from epithelial cell in PCT
- MC in polyangial epithelail cells filed with clear cytoplasm–consists of CHOs and lipids
- linked to mutations on the short arm of chromosmoen 3
CM
- hematuria
- dull and aching flank pain
Strongest RF= smoking
other RF= obestiy, fam hx, diuretics, male, age >55, AA, dialysis, HTN, Adv Kidney Dz
TX
-localized: surgical removval of affected kidney
