Vascular Disease of the Kidneys Flashcards
Only one of PAN (polyarteritis nodosa) and MPA (microscopic polyangiitis) affects the lungs, which is it?
MPA (microscopic polyangiitis) affects the lungs by causing alveolar hemorrhage
PAN (polyarteritis nodosa) does not
Blue toe syndrome and an acute rise in creatinine levels are associated with this renal disease
Atheroembolic renal disease
(another name for the cholesterol emboli)
Your patient presents two weeks after being treated for pneumonia with an antibiotic with a fever, rash, and arthralgias. What vascular disease of the kidney might your patient have?
Serum sickness or SLLR
Starts one to two weeks after exposure to antibiotics (most commonly Cefaclor)
Describe how PAN (polyarteritis nodosa) and MPA (microscopic polyangiitis) can be differentiated by which types of blood vessels blood vessels they affect.
PAN (polyarteritis nodosa) affects medium sized blood vessels
MPA (microscopic polyangiitis) affects small blood vessels
Test of choice for diagnosing acute non-atheromatous occlusion of the renal arteries
CT with contrast
Origin of clots that cause blockages in acute non-atheromatous occlusion of the renal arteries
Thromboembolism from the heart due to atrial fibrillation or endocarditis
Which two organ systems are most involved in granulomatosis with polyangiitis (GPA/Wegener Granulomatosis)?
Respiratory (sinusitis, otitis, ENT symptoms)
Renal (glomerulonephritis)
(also muscle/joint pain, neuropathy, and skin purpura)
Cefaclor is the most common cause of this vascular disease of the kidneys
Serum sickness and SSLR
(body reacts to meds as if they are antigens, deposit in tissues causing inflammation)
In which phase of pregnancy does preeclampsia present with hypertension?
Late pregnancy - third trimester
Granulomatosis with polyangiitis (GPA/Wegener Granulomatosis) is most common in adults from this area
Europe
Best and worst treatments for renal complications of pregnancy (preeclampsia)
Best - delivery is definitive treatment
Worst - must avoid diuretics, ACE inhibitors, and ARBs
Average age of patients with peak incidence of IgA vasculitis (Henonch-Schonlein)
5 years old
(90% of cases occur in kids)
Which, GPA (Wegener’s), EGPA (Churg-Strauss), or both, have renal symptoms?
Only GPA (Wegener’s) has renal symptoms
Both PAN (polyarteritis nodosa) and MPA (microscopic polyangiitis) occur in patients in this age group
Age 60+
Which antibody is associated with granulomatosis with polyangiitis (GPA/Wegener Granulomatosis)?
c-ANCA
Hepatitis C (only) is the most common cause of this vascular disease of the kidneys
Mixed cryoglobulinemia (Hep C causes 90% of cases)
(Hep B/C associated with PAN - polyarteritis nodosa)
Which ethnicity and gender are most at risk of malignant hypertension leading to acute vascular damage in the kidneys, retina and brain (hypertensive emergency)?
Black males
A child presents to your office with a cold, leg pain with a rash, abdominal pain, and bloody urine. What is a likely diagnosis?
IgA Vasculitis (Henoch-Schonlein)
An adult patient who keeps coming to your office with recurrent ear infections over a two year period now complains of hematuria. What is your diagnosis?
Granulomatosis with polyangiitis (GPA/Wegener Granulomatosis)
With patients who have sickle cell nephropathy surveillance is essential starting at age 3-5, their parents should also be educated about avoiding this common OTC medication
Avoid using NSAIDs which constrict afferent arteriole
(Use acetaminophen instead)
Which, PAN (polyarteritis nodosa)
or MPA (microscopic polyangiitis) is more commonly associated with aneurysms?
PAN (polyarteritis nodosa)
(aneurysms in 60-90%, because it affects larger vessels)
Classic tetrad of symptoms in IgA vasculitis (Henoch-Schonlein)
Purpura (in legs)
Arthralgia/arthritis (in legs)
Abdominal pain
Glomerulonephritis (proteinuria/hematuria)
(kids knees and kidneys)
Best treatment for renal complications of scleroderma
ACE inhibitors are the agent of choice
Females aged between 10-50 may have anemia symptoms, renal failure and anuria, neurologic abnormalities, low platelets, hypertension, and low hemoglobin due to this condition
Hemolytic uremic syndrome (HUS)
Which ANCA antibodies are associated with:
- GPA (Wegener’s)
- EGPA (Churg-Strauss)
- PAN (Polyarteritis nodosa)
- MPA (microscopic polyangiitis)
GPA (Wegener’s) = cANCA
EGPA (Churg-Strauss) - pANCA
PAN (Polyarteritis nodosa) - not ANCA
MPA (microscopic polyangiitis) - pANCA
A patient with a history of atopy presents with peripheral neuropathy, rashes, and purpura. Lab testing shows presence of pANCA antibodies and high eosinophils. Your patient suddenly dies. What is the most likely cause of this patients death?
Patient had eosinophilic granulomatosis with polyangiitis (EGPA/Churg-Strauss)
Over half of deaths in EGPA patients are from cardiac problems
In this condition antibodies precipitate at cold temperatures and deposit in capillaries leading to purpura, fatigue, and arthralgias
Mixed cryoglobulinemia
Women aged 20-50 with a history of Raynaud’s phenomenon may present with marked elevations of blood pressure due to this condition
Renal complications of scleroderma
This condition was described as a stroke of the kidneys
Acute non-atheromatous occlusion of the renal arteries
Treatment goal of hemolytic uremic syndrome (HUS) are to correct volume depletion, restore hemoglobin levels (transfusion), and treat hypertension. But which classes of drugs should be avoided in the acute phase of the illness?
ACE inhibitors and ARBs
(kidneys already poorly perfused, don’t let the blood out of the glomerulus too freely)
Most common form of hemolytic uremic syndrome and the illness that classically precedes it
STEC (Shiga toxin producing E.coli)
Preceded by an episode of bloody diarrhea in a child
Hepatitis B/C is most commonly associated with this vascular disease of the kidneys
PAN (polyarteritis nodosa)
(Hep C is highly correlated with mixed cryoglobulinemia)
First symptom of severe preeclampsia and when it presents
Headache (that doesn’t go away with analgesics) is a sign of severe disease
Shows up in late pregnancy - third trimester
Describe the disease process in hemolytic uremic syndrome (HUS)
Toxin causes widespread inflammation in blood vessels
Platelets form small clots in artery walls
High blood pressure in arteries blasts blood past clots
This wrecks the red blood cells like ships on the rocks
Clots can damage vessels all over the body and cause renal failure
