Vascular Disease of the Kidney - JKB Flashcards
What happens if renal blood vessels are obstructed?
Impaired renal blood flow → Net Result is HTN and ↓ GFR
What are the 3 categories of vessel disease?
- Large (Atherosclerosis, RAS, Fibromuscular dysplasia, Takayasu Arteritis, Renal Vein or Artery Thrombosis)
- Medium (Polyarteritis nodosa, Kawasaki Disease)
- Small (Many forms of Glomerulonephritis)
What are the clinical features of RAS?
- Usually due to atherosclerosis
- Onset of HTN before 30 or after 50
- Absence of FHx of HTN
- Resistance to anti-HTN therapy
- Signs of CAD
- ↓ Renal Function when on ACEI or ARB
- Abdominal Bruit
- Unexplained Hypokalemia
What is the GOLD standard for renal Labs/Diagnostic studies?
-Renal Arteriogram
What is the Tx for Atherosclerotic RAS?
- Goal → control BP, stabilize renal function, and reduce cardiovascular complications
- Treat other comorbidities
Is Fibromuscular Dysplasia (FMD) more common is women/men? What is the cause?
- 2-10 times more common in women
- Cause is unknown
What is the Clinical presentation of Fibromuscular Dysplasia?
- Hypertension
- Headache
- Pulsatile Tinnitus
- Neck pain
- Cervical bruit
What is the Tx for FMD?
Angioplasty to cure HTN
What is Takayasu Arteritis? Is it more common in women/men? What s the cause?
- Inflammatory arteritis of the aorta
- Females to males 9:1
- 100x’s more common in Asia
- Genetic predisposition
- Environmental trigger
What is the clinical presentation of Takayasu Arteritis?
- Female with uncontrolled HTN
- <40 years old
- Diminished or absent pulses
- Bruits
- Limb claudication
- Blood pressure discrepancies (>10mmHg)
- Aortic regurgitation
What is the cause of Renal Vein Thrombosis and what is it’s clinical presentation?
- Cause: complication of nephrotic syndrome
- Pain in the sides of your abdomen, legs, or thighs
- Fever, nausea, vomiting
- Hematuria, proteinuria
- Enlarged, palpable kidney
- HTN
- Sudden severe swelling in your leg
- Dyspnea
What is the Tx for Renal Vein Thrombosis?
- LMWH then PO Warfarin x 1 year (potentially life-long therapy)
- Prognosis depends on underlying condition
What is the Tx for Renal Artery Thrombosis?
- URGENT Tx → Heparin/LMWH followed by PO Coumadin
- Surgical Intervention if bilateral occlusion (↑ risk of morbidity)
- Strict medical care to control HTN and hydration
What are the 3 criteria for Polyarteritis Nodosa?
1) Necrotizing Vasculitis affecting small arteries
2) No association with primary or secondary glomerulopathy
3) Not an ANCA-associated vasculitis
What is the cause of Polyarteritis Nodosa? What is the Tx?
- Cause is unknown; occurs as an autoimmune reaction
- Tx: steroids and autoimmune suppresion
