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Renal 15 Renovasc.
Leonard: Renovascular Disease
Question | Answer |
---|---|
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) |
Pathologic findings of hypertensive nephrosclerosis | Atrophic kidneys -Granular surface |
What would you see with light microscopy? | Prominent changes in the subcortical area Tubular atrophy (due to dysfunction of glomeruli) |
Appearance of the arteries | Larger arteries: intimal fibrosis Smaller arteries: medial fibrosis/sclerosis Arterioles: hyaline thickening of the walls (amorphic pink) |
Malignant hypertension | *Diastolic pressures >120-130* Accompanied by ocular changes: Retinal vascular changes, papilledema, renal dysfunction |
Etiology of Malignant Hypertension | Now well understood Develops de novo in some cases |
Clinical findings for Malignant Hypertension | M>W, ~ 40s *Headache, dizziness visual disturbances* Progressive renal dysfxn |
Pathology of MH | Kidneys vary in size Surface is mottled red/yellow with scattered *infarcts* *Fibrinoid necrosis, marked hyaline sclerosis, hyperplastic arteritis* |
What's seen with LM? | Fibrinoid necrosis *Onion skin lesion* |
Renal artery stenosis | *can be reversed* with reestablishment of lumen |
What might you see clinically with RAS? | Mild-moderate HTN +/- briuts |
Etiology of RAS | Increased activity of RAAS #1 cause is athrosclerosis |
Fibromuscular dysplasia | Fibrosis of the arterial wall with resultant stenosis *Medial fibroplasia* Areas of thickening altering with atrophy *String of beads" pattern. |
Thrombotic Microangiopathies | Systemic thromubus formation through out *small vessels* |
Clinical features of Thrombotic Microanhiopathies. | Hemolytic anemia, thrombocytopenia, HTN, renal failure |
Lab findings for TM. | *Schistocytes* in peripheral blood smear Normal coagtimes or normal/slightly elevated FPS |
Causes of TM. | Endothelial damage with leakage of plasma into subendothelial tissues |
Categories of TM causes | Infection Drugs Autoimmune disease Malignant HTN Pregnancy and postpatrum depression |
Morphology of TM | Somewhat similar to malignant HTN *arteriolar fibroid necrosis* Collapsing of glomeruli, necrosis or glomerular capillary congestion |
Two forms of Hemolytic Uremic Syndrome (HUS) | Typical (diarrhea +) Atypical (diarrhea -) |
Typical HUS | Ingestion of food contaminated with *bacteria* Generally E.coli Kids > adults Sudden onset of a GI bleed, oliguria and hematuria |
Atypical HUS | *Inherited mutations* of complement proteins *Acquired* anti-phopholipid antibodies Seen in adults Worse prognosis |
Classical pentad of symptoms for Thrombotic Thrombocytopenia Purpura (TTP) | Fever Neurologic symptoms Microangiopathic hemolytic anemia Thrombocytopenia ARF |
TTP is caused by ____ or a genetic defect resulting in ____ | *Antibiotics* *Decreased fxn of ADAMTS13* |
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 |
Renal Vasculitides | Diseases that affect small, medium, and large vessels in the kidney |
Where do small-vessel vasculitis attack? | Glomeruli Arterioles Interlobular arteries |
When can you see preeclampsia? | 3rd trimester of pregnancy |
Symptoms of preeclampsia | HTN proteinuria edema |
Eclampsia | HTN Proteinuria Edema *Seizures* |
Sickle cell nephropathy | From sickle cell dz or trait |
Sickle cell nephropathy clinical findings | hematuria Diminished concentrating ability of the kidney |
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 |
Tx for Sickle cell nephropathy | Improve oxygenation Red cell exchange |
Renal embolization | Reason for the majority of renal infarcts |
Sources of renal emboli | **************** Cardiac Mural thrombi Cardiac vavlular vegetations Complicated atherosclerotic plaques **************** |
Renal embolization results in... | *wedge-shaped* cortical infarcts |