Leonard: Renovascular Disease
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| Hypertensive Nephrosclerosis | Does not typically lead to significant renal impairment
*Often asymptomatic*
*Accounts for 1/3 of ESRD*
Most prevalent in African-Americans (leading cause of ESRD)
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| Pathologic findings of hypertensive nephrosclerosis | Atrophic kidneys
-Granular surface
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| What would you see with light microscopy? | Prominent changes in the subcortical area
Tubular atrophy (due to dysfunction of glomeruli)
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| Appearance of the arteries | Larger arteries:
intimal fibrosis
Smaller arteries:
medial fibrosis/sclerosis
Arterioles: hyaline thickening of the walls (amorphic pink)
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| Malignant hypertension | *Diastolic pressures >120-130*
Accompanied by ocular changes:
Retinal vascular changes, papilledema, renal dysfunction
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| Etiology of Malignant Hypertension | Now well understood
Develops de novo in some cases
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| Clinical findings for Malignant Hypertension | M>W, ~ 40s
*Headache, dizziness visual disturbances*
Progressive renal dysfxn
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| Pathology of MH | Kidneys vary in size
Surface is mottled red/yellow with scattered *infarcts*
*Fibrinoid necrosis, marked hyaline sclerosis, hyperplastic arteritis*
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| What's seen with LM? | Fibrinoid necrosis
*Onion skin lesion*
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| Renal artery stenosis | *can be reversed* with reestablishment of lumen
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| What might you see clinically with RAS? | Mild-moderate HTN
+/- briuts
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| Etiology of RAS | Increased activity of RAAS
#1 cause is athrosclerosis
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| Fibromuscular dysplasia | Fibrosis of the arterial wall with resultant stenosis
*Medial fibroplasia*
Areas of thickening altering with atrophy
*String of beads" pattern.
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| Thrombotic Microangiopathies | Systemic thromubus formation through out *small vessels*
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| Clinical features of Thrombotic Microanhiopathies. | Hemolytic anemia, thrombocytopenia, HTN, renal failure
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| Lab findings for TM. | *Schistocytes* in peripheral blood smear
Normal coagtimes or normal/slightly elevated FPS
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| Causes of TM. | Endothelial damage with leakage of plasma into subendothelial tissues
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| Categories of TM causes | Infection
Drugs
Autoimmune disease
Malignant HTN
Pregnancy and postpatrum depression
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| Morphology of TM | Somewhat similar to malignant HTN
*arteriolar fibroid necrosis*
Collapsing of glomeruli, necrosis or glomerular capillary congestion
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| Two forms of Hemolytic Uremic Syndrome (HUS) | Typical (diarrhea +)
Atypical (diarrhea -)
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| Typical HUS | Ingestion of food contaminated with *bacteria*
Generally E.coli
Kids > adults
Sudden onset of a GI bleed, oliguria and hematuria
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| Atypical HUS | *Inherited mutations* of complement proteins
*Acquired* anti-phopholipid antibodies
Seen in adults
Worse prognosis
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| Classical pentad of symptoms for Thrombotic Thrombocytopenia Purpura (TTP) | Fever
Neurologic symptoms
Microangiopathic hemolytic anemia
Thrombocytopenia
ARF
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| TTP is caused by ____ or a genetic defect resulting in ____ | *Antibiotics*
*Decreased fxn of ADAMTS13*
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| What does ADAMTS13 do, and what does its absence result in? | ADAMTS13 normally cleaves large multimers of vWF
Lack of this results in large vWF multimers autoinducing platelet aggregation
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| Renal Vasculitides | Diseases that affect small, medium, and large vessels in the kidney
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| Where do small-vessel vasculitis attack? | Glomeruli
Arterioles
Interlobular arteries
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| When can you see preeclampsia? | 3rd trimester of pregnancy
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| Symptoms of preeclampsia | HTN
proteinuria
edema
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| Eclampsia | HTN
Proteinuria
Edema
*Seizures*
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| Sickle cell nephropathy | From sickle cell dz or trait
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| Sickle cell nephropathy clinical findings | hematuria
Diminished concentrating ability of the kidney
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| Etiology/pathology of Sickle cell nephropathy | Medullary interstitium is hypertonic and hypoxic
Promotes sickling of RBCs
Vascular occlusion with hypoxia *papillary necrosis*
FSGS may develope
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| Tx for Sickle cell nephropathy | Improve oxygenation
Red cell exchange
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| Renal embolization | Reason for the majority of renal infarcts
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| Sources of renal emboli | ****************
Cardiac Mural thrombi
Cardiac vavlular vegetations
Complicated atherosclerotic plaques
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| Renal embolization results in... | *wedge-shaped* cortical infarcts
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