Vascular disease, CKD

Question 1

HTN nephrosclerosis

Answer 1

chronic kidney disease in a pt with long- standing, poor controlled HTn

typically, evidence of other target organ damage as well

Proteinuria is often presents

Question 2

Mophologic features

Answer 2

HTN nephrosclerosis (gross: normal to slightly small with dfinely granular subscaptular surface)

Lm Sub scapular Glomerular sclerosis, tubular atrophy, interstital fibrosis, arteriolar hyaline

Malignant HTN (mucod intimal thickening (arteries), glomerular capillary wrinkling, GBM duplication similar to TMA)

Question 3

renovascular HTN

Answer 3

Renal artery stenosis is a secondary cause of HTN with 2 main causes, atherosclerosis, fibromuscular dysplasia,

Other causes- trauma, dissection, extrinsic, compression

Causes inappropriate renin secretion

Atherosclerosis: stenosis is usually in proximal renal artery, eccentric plaque with intimal fibrosis, cell debris, lipid and foam cells
Medial and adventitial fibrosis, plaque may hemorrhage or dissect, calcification may occur

Fibromuscular dysplasia (Usually younger women, intimal medial and adventitial forms)

Question 4

Fibromuscular dysplasia (FMD)

Answer 4

Renal artery (60-75% bilateral - 35%, cervico cranial arteries, visceral arteries, extremities (under 10%)

2 vasculat beds involved in up to 28%

alternating thinned media and thickened fibromuscular ridges, forms string of beads radiographically, beading is larger than caliber of artery middle to distal artery

Question 5

renal artery stenosis

Answer 5

treatment surgical, angioplasty, medical management

Question 6

Thromboembolic diseases

Answer 6

Cortical infarcts, renal cholesterol microembolism syndrome, thrombotic microangiopathy

Morphology: renal artery occlusion (extensive parenchymal infarction), smaller branch (wedge shaped infarct, pale with hyperemic border, coagulative necrosis, hemorrhage, and acute inflammation, fibrotic

Question 7

Atheroembolic disease

Answer 7

Distruption of atherosclerotic plaque can cause acute and subacute renal failure

occurs after procedures that disrupt plaques in the aorta leading to a shower of cholesterol emboli that lodge in the renal microvasculature

could cause bowel infarct, digital infarct, stroke, eosinophil can be seen in the urine

Question 8

cholesterol atheroemboli

Answer 8

any size artery affected, cholesterol clefts in artery lumen , usually see cell reaction, may see parenchymal infarct distally, eosinophilia may be related to activation C5a which is chemotactic for eosinophils
outcome-stabilized or norm renal function in mild, isolated cases, chronic progressive deterioration in renal function in subacute cases

End stage renal disease in severe case, permanent dialysis may be necessary

Question 9

thrombotic microangiopathy

Answer 9

thrombosis in capillaties and arterioles, hemolytic anemia,thrombocytopenia, renal failure

Hemolytic uremic syndrome

TTP