Vascular Diseases of the Kidney

Question 1

What 2 pathologies occur if the renal blood vessels are obstructed?

Answer 1

• hypertension

- decreased GFR

Question 2

1 cause of renal artery stenosis, as well as 2 other common ones

Answer 2

Atherosclerosis, fibromuscular dysplasia, takayasu arteritis

Question 3

Essential vs secondary hypertension

Answer 3

Essential means the cause is unknown, secondary is due to another pathology

Question 4

Renal artery stenosis caused by atherosclerosis is an example of a ___ hypertension

Answer 4

2ndary

Question 5

Onset of hypertension before age 30 strongly suggests…

Answer 5

…Renal artery stenosis

Question 6

4 clinical features of renal artery stenosis

Answer 6

• unexplained hypokalemia (due to aldosterone release)
• abdominal bruits
• abrupt onset of hypertension before age 30

Question 7

The risk factors for Renal artery stenosis are the same as those for….

Answer 7

…coronary artery disease

Question 8

A rare but significant symptom of bilateral renal artery stenosis

Answer 8

Unexplained flash pulmonary edema

Question 9

2 labs/diagnostic studies for renal artery stenosis (gold standard and the cheaper preferred method)

Answer 9

• Renal arteriogram (invasive but almost guaranteed to find)

- renal ultrasound (cheaper and less iinvasive)

Question 10

2 Treatments for renal artery stenosis (why are we cautious with one of them)

Answer 10

• medical management of hypertension with ACEI or ARB (use caution because already have decreased GFR)
• revascularization for severe cases

Question 11

Renal artery stenosis prognosis

Answer 11

4 year mortality rate up to 40%, improved survival with treatment

Question 12

Fibromuscular dysplasia affects ___ 2-10x more and its cause is…

Answer 12

women, unknown

Question 13

What system is used to classify fibromuscular dysplasia today?

Answer 13

Angiographic classification system

Question 14

Fibromuscular dysplasia definition

Answer 14

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”

Question 15

Fibromuscular dysplasia presentation (5)

Answer 15

• hypertension
• headache
• pulsatile tinnitus
• neck pain
• cervical bruit

Question 16

Fibromuscular dysplasia mech of action

Answer 16

Symptoms of hypertension, headache, neck pain, etc are result of ischemia due to stenosis, dissection occlusion of arteries, and rupture of aneurysms

Question 17

Fibromusucular dysplasia prognosis

Answer 17

Shorter duration of Hypertension, better outcomes

Question 18

Takayayasu arteritis definition, what sex is it most common in? Where is it most often found?

Answer 18

Inflmammatory arteritis of the aorta, females, Asia

Question 19

Takayayasu arteritis clinical presentation (3)

Answer 19

• Female with uncontrolled hypertension
• <40 years old
• diminished pulse and limb claudication

Question 20

The human kidney can tolerate ___ minutes of ischemia

Answer 20

60-90

Question 21

Treatment of renal artery occlusion

Answer 21

-heparin followed by oral coumadin, potentially surgical intervention

Question 22

Polyarteritis nodosa definition

Answer 22

Very very rare systemic arterial vasculitis

Question 23

Polyarteritis nodosa 3 diagnostic criteria

Answer 23

1) necrotizing vasculitis affecting small arteries
2) no association with primary or secondary glomerulopathy
3) not an ANCA associated vasculitis

Question 24

Polyarteritis nodosa mechanism of action

Answer 24

• autoimmune reaction where immune cells attack the arteries

- mostly idiopathic but some associated with hep B and C infection

Question 25

Polyarteritis nodosa treatment (2)

Answer 25

Steroids and autoimmune suppression

Question 26

Kawasaki disease clinical presentation (5)

Answer 26

• 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

Question 27

Kawasaki disease definition

Answer 27

A systemic vasculitis uncommon to be of renal origin

Question 28

Kawasaki disease treatment

Answer 28

• Treatment within 10 days needed
• high aspirin dose (even in children)
• IVIG

Question 29

Reye syndrome

Answer 29

A severe encephalopathy that also affects the liver resulting from children recovering from viral illness and associated with aspirin treatment

Question 30

Atheroembolitic disease definition

Answer 30

Cholesterol crystal embolism occuring due to wide spread atherosclerosis

Question 31

Atheroembolitic disease treatment

Answer 31

• Lipid controls via statins

- hydration

Question 32

Thrombotic thrombocytopenic purpura characteristics (3)

Answer 32

Fever, purpura, CNS signs

Question 33

Hemolytic uremic syndrome

Answer 33

Hemolysis often following gastrointestinal infection where toxins cause hemolysis affecting most often children putting them into renal failure

Question 34

Triad of hemolytic uremic syndrome

Answer 34

• Thrombocytopenia
• hemolytic anemia
• acute renal failure

Question 35

Malignant hypertension can cause ___ to the kidneys. Sickle cell nephropathy can cause ___ resulting in renal inssuficiency

Answer 35

Damage, recurrent infarction