Vascular Diseases Flashcards
What is nephrosclerosis?
- Renal pathology associated with sclerosis of renal arterioles and small arteries
- Strongly associated with HTN
What is seen in nephrosclerosis?
- Associated with advanced age
- More frequent in blacks than in whites
- Hypertension and diabetes increase the incidence and severity of the lesions
What do the kidneys look like in nephrosclerosis?
- Either normal or moderately reduced in size
- Cortical surfaces have a fine, even granularity that resembles grain leather
What causes hypertension secondary to renal artery stenosis?
- Increased production of renin from the ischemic kidney
What is fibromuscular dysplasia?
- Focal irregular thickening in medium and large muscular arteries including renal, carotid, splanchnic, and vertebral vessels
What does fibromuscular dysplasia look like?
- Segments of the vessel wall are focally thickened by a combination of medial and intimal hyperplasia and fibrosis, resulting in luminal stenosis
What syndromes are encompassed under thrombotic microangiopathies?
- Thrombotic thrombocytopenic purpura (TTP)
- Hemolytic-uremic syndrome (HUS)
What is the most likely cause of typical HUS?
- Intestinal infection with with strains of E. coli that produce shiga like toxins
Who does typical HUS affect?
- Can occur at any age, but children and older adults at higher risk
What is seen in typical HUS?
- Following a prodrome of influenza like or diarrheal symptoms
- Sudden onset of bleeding manifestations
- Severe oliguria
- Hematuria, associated with microangiopathic hemolytic anemia, thrombocytopenia, and prominent neurologic changes
- HTN
What are some causes of atypical HUS?
- Autoantibodies against complement regulatory proteins
- Antiphospholipid syndrome (either primary or secondary to SLE)
- Complications of pregnancy or the postpartum period
- Vascular diseases affecting the kidney
- Chemotherapeutic and immunosuppressive drugs
- Irradiation of the kidney
Who is affected with TTP?
- Adults younger than 40
What is the pentad of TTP?
- Fever
- Neurologic symptoms
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- Renal failure
What is the initiating event of TTP?
- Platelet aggregation induced by very large multimers of vWF, which accumulate due to a deficiency of ADAMTS13
What is the treatment for TTP?
- Plasma exchange, which removes autoantibodies and provides functional ADAMTS13
How is bilateral renal artery disease usually diagnosed?
- Definitively by arteriography
What does bilateral renal artery disease usually cause?
- Chronic ischemia with renal insufficiency in older individuals, sometimes in the absence of hypertension
What is the importance of recognizing bilateral renal artery disease?
- This condition is that surgical revascularization can prevent further decline in renal function
What is seen in sickle cell nephropathy?
- Hematuria
- Diminished concentrating ability
- Patchy papillary necrosis may occur and could be associated with cortical scarring
- Proteinuria is also common
