Vascular Diseases Flashcards
TMA
Def
Path
HUS
TTP
Group of dz by presence of microangiopathic hemoltic anemia (MAHA), thrombocytopenia and signs of organ injury due to platelet thrombosis
Endothelial injury, pltelet aggregation and vascular throbosis
Diarrhea (shigatoxin) - assocaited, atypical HUS (complement)…AKI is predominan
TTP - Due to def in metalloproteinase ADAMTS 13 which cleaves vWF…abnormla large vWF leads ot platelet aggregation
More neurological sx here
Histo of HUS/TTP
Helmet, burr, RBC fragments
Glomerular thrombi
Organizing thrombosis
TMA tx
Shigatoxin induced - supportive only…will resolve spontaneously.
TTYP - plasma exchanfe to replace missing ADAMTS13 or remove anti-ADAMTS13 ABs
Recently monoclonal to complement C% (eculizuma) for atypical HUS
Atheroembolic renal vascular dz
Older pts with atherosclerotic vasc dz
Multiple cholesterol emobli showering to distal locations
Precipitated by catheter or spontaenous
Acute or subacute kidney injuyry withdistal ischemic changes most often in GI tract or lower extremities
Needle shaped clefts in renal vasculature with inflammation that obliterates the lumen
Poor prognosis with no effective therapy
Renal infarction
Abrupt interruption of RBF
Sx - sudden onset of loin/flank or ab pain
Hematuria, accelerated HTN, oliguria/anuria if bilateral, fever
Labs - leukocytosis with elevated LDH, transaminase, and CK
Dx with imaging studies
Renal infarctio non histo
Zones of coagulative necrosis
Renal vein thrombosis
Comp of neprhotic syndrome or after renal trauam or with tumors
Flank pain and hematuria with worsening proteinuria
May present with PE
Enlarged kidney on US
Gross - large, swollen, hemorrhagic kidney
Micro - vasc congestion, edema, hemorrhage
Mlaginant HTN
Systolic over 180 and diastolic over 110…acute tissue injury in mult organs
Prior hx of HTN, papilledeam, retinal hemorrhae, neurologic sx, CHF, AKI
Patho and course of malignant HTN
Vascular changes due ot preceding HTN complicated by renal ischemia and activation of RAAS
MEdical emergency
Gross malignant HTN
Petechiae
Histo - onion skin lesion, fibrinoid necrosis, thrombosis
Ischemic glomerulus in malignant nephroscleoris
Shriveled glomerulus with exp Bowman space
Wrinkled GBM
Benign HTN nephrosclerosis
Scleoris of small arteries/arterioles with renal parenchymal changes due ot long stading poor controlled HTN
SUstained HTN f LT duration…more in AA (apolipoprotein L1 in Chromosome 22)
Hemodynamic changes, genetic predispositions or both result in abnormalities in the wall of small arteries and arterioles (edial and intimal thickening and hyaline deposition)
HTN neprhoscelrosis
Small kidney
Thickening of medial and intimal layers and reduplication of elastic lamina
Arteriolar hyalinosis - narrowing of lumen
Glomerulus - become obsolescent with obliterated cap lumens
When to start HTN meds
Younger than 60 - 140/90
Over 60 - 150/90
CKD or diabeteswhenever - 140/90
