Vascular Diseases 3

Question 1

What are the small vessel vasculitides?

Answer 1

Henoch-Schoenlein purpura, Cryoglobulinemic vasculitis, ANCA vasculitides (Wegener, Churg-Strauss, Microscopic Polyangiitis)

Question 2

The kidney biopsy of the glomerulus below is of a patient with Cryglobulinemic vasculitis. What are the observable characteristics of this specimen?

Answer 2

Conspicuous glassy aggregates (“hyaline thrombi”) in the capillary lumina

Question 3

What disease does cryoglobulinemic glomerulonephritis resemble?

Answer 3

Type I MPGN

Question 4

What renal diseases does HSP mimic?

Answer 4

IgA nephropathy

Question 5

What are the arteridites?

Answer 5

Polyarteritis nodosa, Kawasaki disease

Question 6

What are the larger artery vasculitides? Describe the major effect that they have on the kidney.

Answer 6

Giant Cell Arteritis, Takayasu Arteritis; Narrowing main renal artery results in renal ischemia and hypertension

Question 7

A kidney of a patient with hypertensive nephrosclerosis is shown. What accounts for the cortical granularity? Hypertensive nephrosclerosis IA kidney of a patient with hypertensive nephrosclerosis is shown. What accounts for the cortical granularity? Hypertensive nephrosclerosis IA kidney of a patient with hypertensive nephrosclerosis is shown. What accounts for the cortical granularity?

Answer 7

Sclerotic glomeruli and atrophic tubles cluster adjacent to preserved glomeruli and tubules

Question 8

Hypertensive sclerosis is shown. What are the characteristic findings?

Answer 8

Arterioles exhibiting concentric hyaline thickening of the wall (hyaline arteriolosclerosis)

Question 9

Malignant Hypertension is shown. What are the typical findings?

Answer 9

Fibrinoid necrosis, consolidation, and capillary congestion

Question 10

Describe the typical patient with malignant HTN

Answer 10

Young black men

Question 11

Describe the general mechanism of degradation caused by malignant HTN

Answer 11

High BP + uvascular vasoconstriction, cause endothelial injury as blood slams into narrowed vessels resulting in plasma constituents leaking into injured arteriolar walls (fibrinoid necrosis)

Question 12

What is Goldblatt kidney?

Answer 12

Kidney deprived of vascular supply

Question 13

Which renal artery is more commonly affected by atherosclerotic plaques?

Answer 13

Left

Question 14

By what mechanism do Takayasu’s and Giant Cell Vasculitis cause HTN?

Answer 14

Narrow the renal arteries, cause renal HTN, increase renin release…

Question 15

How does fibromuscular dysplasia result in HTN?

Answer 15

Results in narrowing of renal artery due to fibrous and muscular deposition

Question 16

Renal atherosclerosis is shown. What is seen in the cleft? What can it cause?

Answer 16

Cholesterol cleft atheroembolus; Ischemia and acute renal failure

Question 17

What is the mechanism of hemolytic-uremic syndrome leading to renal ischemia??

Answer 17

Endothelial damage allows plasma constituents to enter the intima of arteries, walls of arterioles, and subendothelial zone of glomerular capillaries, narrowing lumina and causing ischemia. Endothelial damage also promotes thrombus formation

Question 18

What causes typical HUS?

Answer 18

Toxin from the O157:H7 strain of E. coli

Question 19

What is Thrombotic thrombocytopenic purpura?

Answer 19

Acquired or genetic deficiency in protease used to cleave multimers of vWF resulting in platelet aggregation and uvascular thrombosis and potentially ischemia and renal failure

Question 20

What do both HUS and TTP result in?

Answer 20

Uangiopathic hemolytic anemia

Question 21

What are the differences betwixt HUS and TTP?

Answer 21

TTP is characterized by more numerous platelet-rich thrombi

Question 22

Describe the presentation and course of a patient with typical HUS

Answer 22

Diarrhea caused by O157:H7 E. Coli features MAHA, acute renal failure w/ little vascular disease outside of the kidney

Question 23

What is the most common cause of acute renal failure in children?

Answer 23

HUS

Question 24

What is the term used to describe HTN, proteinuria, edema, and convulsions in the third trimester?

Answer 24

Eclampsia

Question 25

Preeclampsia is shown. What are the characteristic findings?

Answer 25

Capillary lumens obliterated by swollen endothelial cells

Question 26

What is the most common organ manifestation of sickle cell anemia?

Answer 26

Nephropathy

Question 27

What do renal infarcts usually result from?

Answer 27

Embolization

Question 28

Why is infarction via occlusion of the main renal artery rare?

Answer 28

Collateral circulation generally maintains organ viability

Question 29

What are the typical steps that occur in renal infarction?

Answer 29

Acute inflamm, granulation tissue, fibrosis (coagulative necrosis)

Question 30

What is the differenct betwixt infarction and cortical necrosis?

Answer 30

Infarct occurs in one/few areas, cortical necrosis implies more-widespread ischemic necrosis

Question 31

Cortical necrosis is shown. What conditions typically cause cortical necrosis?

Answer 31

Hypovolemic/Endotoxic shock

Question 32

To what extent is the renal medulla affected in cortical necrosis?

Answer 32

The medulla is spared

Question 33

What does severe cortical necrosis clinically manifest as?

Answer 33

Acute renal failure