Vascular Diseases of the Kidney Flashcards
9/10/19
What 2 pathologies occur if the renal blood vessels are obstructed?
- hypertension
- decreased GFR
1 cause of renal artery stenosis, as well as 2 other common ones
Atherosclerosis, fibromuscular dysplasia, takayasu arteritis
Essential vs secondary hypertension
Essential means the cause is unknown, secondary is due to another pathology
Renal artery stenosis caused by atherosclerosis is an example of a ___ hypertension
2ndary
Onset of hypertension before age 30 strongly suggests…
…Renal artery stenosis
4 clinical features of renal artery stenosis
- unexplained hypokalemia (due to aldosterone release)
- abdominal bruits
- abrupt onset of hypertension before age 30
The risk factors for Renal artery stenosis are the same as those for….
…coronary artery disease
A rare but significant symptom of bilateral renal artery stenosis
Unexplained flash pulmonary edema
2 labs/diagnostic studies for renal artery stenosis (gold standard and the cheaper preferred method)
- Renal arteriogram (invasive but almost guaranteed to find)
- renal ultrasound (cheaper and less iinvasive)
2 Treatments for renal artery stenosis (why are we cautious with one of them)
- medical management of hypertension with ACEI or ARB (use caution because already have decreased GFR)
- revascularization for severe cases
Renal artery stenosis prognosis
4 year mortality rate up to 40%, improved survival with treatment
Fibromuscular dysplasia affects ___ 2-10x more and its cause is…
women, unknown
What system is used to classify fibromuscular dysplasia today?
Angiographic classification system
Fibromuscular dysplasia definition
A fibrotic change in one of the layers of vasculature in medium sized vessels that often affects the carotid or renal arteries creating aneurisms that look like “beads”
Fibromuscular dysplasia presentation (5)
- hypertension
- headache
- pulsatile tinnitus
- neck pain
- cervical bruit
Fibromuscular dysplasia mech of action
Symptoms of hypertension, headache, neck pain, etc are result of ischemia due to stenosis, dissection occlusion of arteries, and rupture of aneurysms
Fibromusucular dysplasia prognosis
Shorter duration of Hypertension, better outcomes
Takayayasu arteritis definition, what sex is it most common in? Where is it most often found?
Inflmammatory arteritis of the aorta, females, Asia
Takayayasu arteritis clinical presentation (3)
- Female with uncontrolled hypertension
- <40 years old
- diminished pulse and limb claudication
The human kidney can tolerate ___ minutes of ischemia
60-90
Treatment of renal artery occlusion
-heparin followed by oral coumadin, potentially surgical intervention
Polyarteritis nodosa definition
Very very rare systemic arterial vasculitis
Polyarteritis nodosa 3 diagnostic criteria
1) necrotizing vasculitis affecting small arteries
2) no association with primary or secondary glomerulopathy
3) not an ANCA associated vasculitis
Polyarteritis nodosa mechanism of action
- autoimmune reaction where immune cells attack the arteries
- mostly idiopathic but some associated with hep B and C infection
Polyarteritis nodosa treatment (2)
Steroids and autoimmune suppression
Kawasaki disease clinical presentation (5)
- a fever lasting longer than 5 days
- bilateral bulbar conjunctival infection
- oral mucous membrane changes
- erythema of palms and soles and rash
- cervical lymph adenopathy
Kawasaki disease definition
A systemic vasculitis uncommon to be of renal origin
Kawasaki disease treatment
- Treatment within 10 days needed
- high aspirin dose (even in children)
- IVIG
Reye syndrome
A severe encephalopathy that also affects the liver resulting from children recovering from viral illness and associated with aspirin treatment
Atheroembolitic disease definition
Cholesterol crystal embolism occuring due to wide spread atherosclerosis
Atheroembolitic disease treatment
- Lipid controls via statins
- hydration
Thrombotic thrombocytopenic purpura characteristics (3)
Fever, purpura, CNS signs
Hemolytic uremic syndrome
Hemolysis often following gastrointestinal infection where toxins cause hemolysis affecting most often children putting them into renal failure
Triad of hemolytic uremic syndrome
- Thrombocytopenia
- hemolytic anemia
- acute renal failure
Malignant hypertension can cause ___ to the kidneys. Sickle cell nephropathy can cause ___ resulting in renal inssuficiency
Damage, recurrent infarction
