Wk 8

Question 1

Renal artery disease

Answer 1

50 million in US have hypertension.
6% of hypertensive patients have underlying renal disease.
Renal artery disease is the most common correctable cause for hypertension.

Question 2

Renovascular hypertension and renal artery stenosis

Answer 2

Stenosis or occlusion May cause ischemia.
Triggers Renin-angiotensin mechanism to increase BP and flow to kidney.
Stenosis leads to parenchymal damage.

Question 3

Renal artery stenosis

Answer 3

Asymptotic “incidental RAS”
Renovascular hypertension.
Ischemic nephropathy.
Accelerated CV disease.

Question 4

Stenosis of renal artery process

Answer 4

Releases renin, then to angiotensinogen, then to angiotensinogen 1, then to angiotensinogen 2.
Angiotensinogen is natural in body but kidney releases more since it thought the body was hypertensive

Question 5

Patient clinical history

Answer 5

Hypertension 
Abnormal urinalysis
Hematuria
CHF
Renal failure
Flash pulmonary edema

Question 6

Renal artery variants

Answer 6

Duplicate RA and polar accessory RA in 12-22%.
Most arose below RA and terminate at polar surface.
Accessory RA can arise from aorta or Iliacs.
Occurs more on left.

Question 7

Renal artery and vein anatomy

Answer 7

RA inferior to SMA.
RRA longer
Arteries are posterior to vein
LRV courses between aorta and SMA.

Question 8

Renal vasculature pathology

Answer 8

Atherosclerosis 
FMD
Embolism aneurysm
AV fistula
External compression
Vasculitis

Question 9

Common risk factors

Answer 9

Age
Hypertension 
Hyperlipidemia
Smoking 
Diabetes
Family history
Race 
Obesity
Coronary artery disease

Question 10

Exam indications

Answer 10

Sudden onset or worsening symptoms. 
Elevated BUN. 
Cystic kidney disease. 
Atrophic kidney
Aneurysm 
Hypertension in young patients

Question 11

Transverse orientation

Answer 11

RA comes off around 11 o’clock

LA comes off around 4-5 o’clock.

Question 12

Renal artery duplex

Answer 12

Follow artery to hilum.
Obtain Doppler in ostium, prox, mid, dist of each artery.
Look for high PSV and disturbed flow.
Turn to lateral decubitus to see vessels better.-measure kidney in long

Question 13

Diagnostic criteria

Answer 13

Normal PSV 90-120.
PSV and EDV decrease from artery to cortex.
HS RAS is >60%

Question 14

Renal aortic ratio

Answer 14

PSV RA/PSV aorta

Aorta PSV 80-100.

Question 15

Normal criteria

Answer 15

Sharp upstroke, low resistance EDV.
PSV<180.
RAR<3.5

Question 16

Normal <60% criteria

Answer 16

PSV >180

RAR<3.6

Question 17

> 60% criteria

Answer 17

Stenosis
PSV>180
RAR>3.5
Post stenotic turbulence

Question 18

Rena artery occlusion

Answer 18

No signal
If flow, <10
Kidney size 8-9cm

Question 19

FMD

Answer 19

Non atherosclerotic 
Typically in young females. 
Mid distal segments
Affects ICA mid dist segments too
String of beads

Question 20

Nutcracker syndrome

Answer 20

Compression of LRV as passes SMA and aorta.
Increased PSV at compression.
May be asymptotic

Question 21

Treatment options

Answer 21

Anti-hypertension meds
Surgery
Stent, angioplasty

Question 22

Diuretics

Answer 22

Increase urine to remove water and sodium

Question 23

ACE inhibitors

Answer 23

Angiotensin converting enzyme.

Angiotensin causes vessels to constrict. ACE stops angiotensin from releasing and dilated vessels.

Question 24

Beta blockers

Answer 24

Bind to receptors in the heart.

Construct vessels and raises BP

Question 25

Calvin channel blockers

Answer 25

Slow rate calcium passes into heart muscle and into vessel walls.
Relaxes vessels and lowers BP