Vascular disorders of kidney Flashcards
How do we call…
Thickening of renal arteioles and small arteries
Nephrosclerosis
2 most common cause of nephrosclerosis
1.Hypertension
2.Diabetus mellitus
Pathophysiology of nephrosclerosis
Damaged arterial walls–>
1.Leaky proteins–>Hyaline deposition
2.Activation of platlets (incr PDGF) promoting intimal thickening –>decr lumen size–>atrophy of organ and loss of function.
Diagnosis relating kidney.
-2 most comm associations?
-Nephrosclerosis
-Hypertension and Diabetus
Description and diagnosis
-Fine Granular Cortical surface
-Nephrosclerosis
Diagnosis
Pathophysiology
-Hyperplastic arteriolosclerosis=Malignant Hypertension.
-SBP>200 or DBP >120–> Endothelial damage –>massive intimal proliferation due to ECM deposition.
Diagnosis
Describe
-Malignant Nephrosclerosis=Hyperplastic nephrosclerosis
-Groos:Flea Bitten kidney ( BV rupture–>petechia in kidney in cortical surface)
-Hyperplastic arteriolosclerosis+Fibrinoid necrosis
-Hematuria, protenuria, RBC cast…SBP>200
Diagnosis and describe
-Malignant nephritis
-Cerebral edema (Nawored sulci and Wide Gyri)
Diabetic Retinopathy Pathophysiology
-Ass with chronic Hyperglycemia.
1.Proliferative-Neovascularization due to Chronic Hypoxia–> traction retinal detachment.
2.Non-Proliferative (most comm)-obstruction BV–>micro-aneurysm, Cotton wool spots, macular edema (vision loss).
Hypertensive Retinopathy Pathophysiology
-Cotton woot spots, Exudate Edema.
-Papilledema presence is indicative of Hypertensive emergency–>imediate lowering od BP.
-Bi-lateral renal artery stenosis
-Uni-lateral renal artery stenosis + absence od other kidney.
Volume overload
2 most commonest causes of Renal Artery Stenosis?
-**Atherosclerosis (85%), Fibromuscular-dysplasia. **(strings of beads)
Diagnosis:
-Female (20’s) with Hypertension but otherwise is normal.
-String of Beads(Fibromuscular Dysplasia).
-Could also be PAN.
Renovascular Hypertension association
1.Refractory Hypertension
2.Sudden onset of azotemia after administration od ACE inhb and ARB
3.Abd. bruit in setting of increased BP
4.Sudden Hypertension after 30 yrs or 50 yrs.
TTP pathogenesis
ADAM13 defciency–>excessive vWF activation–>platlet consumption–>small thrombies to form.
Presentation in TTP
-Fever,Purpura (petechial–>small bleeding),CNS thrombi (mental status change, seizures),Kidney injury (azotemia),Micro-angiopathic Hemolytic Anemia (schistocytes).
Treat of TTP
-Plasmapherisis (add ADAM13)
Differential diagnosis
-Evidence of clot formation but NORMAL PT and PTT and Fibrinogen.
-TTP and HUS
-Typical HUS
-O:157H:7 E.Coli–>Shiga Toxin damaging endothelial BV–>excessive coagulation–>kidney damage.
-Damages intestinal + BV linning–>Bloody diarrhea.
-Transmitted Undercooked meat (Hamburgers)
Where is E.Coli present when it causes HUS?
-Bacteremia (blood)
-Normaly affects GI tract causing bloody diarrhea.
What does HUS trigger?
->Thrombocytopenia
HUS association
-Thrompocytopenia, kidney ischemia(uremia),Microangiopathic Hemolytic anemia (schitocyte), +Bloody diarrhea.
Diff between DIC and TTP/HUS?
-DIC:consumptive coagulopathy
-TTP/HUS:NO consumption
Diagnosis
-**Rhomboid cleft **(consequence of atheromatous plaque ruptures from abd aorta or renal artery–> releases cholesterol crystals)
-Embolous effect of atherosclerosis of renal artery.
3 most comm cause of Kidney infarcts?
-Atheromatous plaque
-A.Fib
-Mural thrombi
Commonest area to be affected on Kidney infarcts?
-PCT, most active area in nephron (uses most ATP)
Renal Papillary necrosis ass…
Sickle cell or trait.
Pathophysiology of Renal Papillary necrosis
-Hypoxia triggers sickling, necrosis of medulla and papillae–>sloughing of cells –>post-renal obtsr–>renal faliure.
Do you see change in urine osmolality and urine volume in Renal Papillary necrosis?
-NO, because cells slought off (NO V2 recep present)
-HYPOSTHENURIA (inability of kidney to concentrate urine)
Renal Papillary Necrosis signs
-Most ass with GROSS Hematuria,painless
What is located in renal cortex?
Glomerulus (filtration occurs)
Diffuse Cortical Necrosis ass?
-Sepsis (massive hypoperfusion)
-Placental abruption –>DIC.
Diagnosis
Severe oliguria–>anueria, after placental abruption.
Limited to cortex
Diffuse Cortical Necrosis.
Diagnosis and description
-Ass with massive anuria
-Diffuse cortical necrosis
-Yellow and soft.
Where do you see “string of beads” app in angiography(2)?
-Fibromuscular dysplasia
-**PAN **(transmural granulomatosis)
2 most common causes of Renal Papillary necrosis?
-Sickle cell and NSAIDS (chronic)
- This presents similarly to kidney stones (flank pain, GROSS hematuria), but the CT scan is negative for the presence of stones.
renal papillary necrosis.
- Why do you see clots in urine in Renal Papillary nercrosis?
-sloughing of the papilla, producing “clots”** in the urine along with hematuria
