Clin Med - Renal Vascular Diseases Flashcards
(34 cards)
What are the renal vascular diseases? (5)
- Renal Artery Stenosis
- Renal Artery Thrombosis
- Renal Vein Thrombosis
- Renal Artery Aneurysm
- Atheroembolic Renal Disease
Define Renal Vascular Disease
Variety of complications that affect the arteries and veins of the kidneys.
What is renal vascular disease associated with?
HTN - the decreased blood flow to the kidneys results in an excessive amount of renin to be produced.
Define Renal Artery Stenosis
Narrowing or decrease in blood flow of an artery to the kidneys
Renal Artery Stenosis Etiology
- Major cause is atherosclerosis
- Fibromuscular dysplasia- condition that weakens the walls of medium sized arteries
- Takayasu’s arteritis- rare inflammatory d/o affecting the aorta and its branches
Renal Artery Stenosis Risk Factors
- 50-70 y.o.
- Smoking
- HLD, DMII, obesity and FH of heart disease
- HTN- both a cause and result
Renal Artery Stenosis Signs & Symptoms
- HTN that doesn’t get better with 3 or more medications
- Azotemia
- Abdominal bruit
- Sudden kidney failure when first taking an ACE for HTN and/or heart treatment
- Unexplained renal insufficiency
Renal Artery Stenosis Dx
- Renal arteriography (gold standard)
- CT or MRI, US
- Renal function studies
Renal Artery Stenosis Tx
- Control of HTN/HLD
- Angioplasty
- Surgical revascularization
Renal Artery Thrombosis (Occlusion) Definition
Complete blockage of blood flow of an artery to the kidneys.
Renal Artery Thrombosis Etiology
- Most common cause is thromboembolism.
- Thrombosis may occur spontaneously or after abdominal trauma, surgery, vaculitis, extrarenal compression, hypercoaguable state, aortic dissection.
Renal Artery Thrombosis Signs & Symptoms
- Steady and aching flank pain, fever, N/V, abdominal pain
- Leukocytosis
- May have gross hematuria, oliguria or anuria
- Renal dysfunction (if bilateral, or single functioning kidney)
Renal Artery Thrombosis Dx
- Renal arteriography (risk of contrast ATN)
- CT or MRI or US
- Renal function, UA, coag studies
Renal Artery Thrombosis Tx
- Prompt localization of occlusion and restoration of blood flow through
- Anticoagulation, thrombolysis, clot extraction, etc.
Renal Vein Thrombosis Definition
Blockage of renal vein
Renal Vein Thrombosis Etiology
- Most common cause of renal vein thrombosis is Nephrotic syndrome.
- Kidney tumor or cancer that puts pressure on the renal vein or inferior vena cava
- Hypercoagulability disorders
- Vasculitis
- SLE
- DMII
- Oral contraceptive use
Renal Vein Thrombosis Signs & Symptoms
- Pain in the back behind the lower ribs/hips
- Fever, n/v
- Oliguria
- Hematuria
Renal Vein Thrombosis Dx
- Nephrotic syndrome workup, UA
- CT angiography
Renal Artery Aneurysm Definition
a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery.
Renal Artery Aneurysm Etiology - True aneurysms
- include all layers of the artery and are usually inherited disorders.
- Extraparenchymal in 90% of cases
Saccular Renal Artery Aneurysm
- bulges or balloons out only on one side of the artery.
- usually due to congenital weakness of an artery wall or trauma.
- Seen in: Ehlers- Danlos Syndrome
Fusiform Renal Artery Aneurysm
- bulges or balloons out on all sides of the artery.
- Seen in: Fibromuscular dysplasia (FMD)
Renal Artery Aneurysm Etiology - False aneurysms
- AKA pseudo aneurysms; do not include all layers of the artery, are usually acquired. Can be extraparenchymal or intraparenchymal.
- Saccular in appearance
Renal Artery Aneurysm False Aneurysms Causes
- Blunt abdominal trauma
- Anastomotic
- Iatrogenic during endovascular procedures
- Spontaneous
- Dissection
- Kawasaki disease
