What disease processes can result in renal HTN?
- Primary Aldosteronism
- Hypothyroidism and Hyperthyroidism
At what BP would you start to be concerned over Malignant HTN?
Is this often associated with hypertensive emergency or urgency?
> 180/120 mmHg
What are the retinal manifestations of Malignant HTN?
What about HTN Encephalopathy?
Retinal: Hemorrhages, Exudates, Papilledema
Encephalopathy: Cerebral Edema, SAH, Lacunar Infarctions
What may be present on UA in a patient with Malignant HTN?
UA: Hematuria, Proteinuria
Biopsy: Fibrinoid Fibrosis
How is Malignant HTN treated?
__________ HTN is one of the most common causes of secondary HTN.
It can often present as an acute onset of severe resistant increase in BP at a young age, refractory HTN, flash pulmonary edema, or an increase in sCr after starting ACEi
If on US you noticed a unilaterally smaller kidney, what underlying disorder (regarding BP) may be present?
Are Doppler US, CTA, MRA, and Aortogram all viable imaging modalities for renovascular HTN work up?
What is most diagnostic and therapeutic if renal artery stenosis is involved?
T/F: Medical Management (ie: anti-hypertensives) is given to all patients with renovascular HTN
Other than medical therapy, what additional treatment options are available for renovascular HTN?
Angioplasty with stenting
Nephrectomy (of the “pressor” kidney)
_________ disease results from cholesterol crystal break off from a plaque and embolize distally from their origin
T/F: Atheroembolic Disease is typically Iatrogenic
What are examples of iatrogenic events that may result in atheroembolic disease?
Iatrogenic: Angiography, Cardiovascular Surgery, Anti-coagulation
Spontaneous: Hemodynamic Stress
What is the classic clinical triad of atheroembolic disease?
- Precipitating Event (Cardiac Procedure, Angiography, etc…)
- Subacute or AKI
- Blue Toe Syndrome / Livedo Reticularis
What may be seen on fundoscopy in a patient with atheroembolic disease?
Hollenhorst Plaque in a retinal artery
How may the renal artery appear on histology in a patient with atheroembolic disease?
Cleft Like Spaces in the the lumen
How is Atheroembolic managed?
Statins ASA Anti-HTN Smoking Cessation Glucose Control
What percentage of patients with with atheroembolic disease progress to ESRD?
What FIVE ‘things’ compose Thrombotic Microangiopathies?
- Microangiopathic Hemolytic Anemia
- Neurological Sx
- Renal Function Abnormalities
T/F: Idiopathic TTP-HUS is NOT a medical emergency
It is a medical emergency (fatal if not treated)
What is the most diagnostic study in diagnosing thrombotic microangiopathies?
What would be seen on this?
What deficiency is often found in patients with thrombotic microangiographies?
What are examples of ANCA associated vaculitis?
- Wegner’s (Granulomatosis with polyangitis) - GPA
- Microscopic Polyangitis - MPA
- Churg-Strauss Syndrome - CSS
- Renal Limited Vasculitis
How is MPA distinguished from GPA and CSS?
Absence of granuloma formation in the presence of necrotizing vasculitis.
Will GPA, MPA, or CSS have immune complex deposits on histology?
What are unique clinical manifestations of GPA?
- Nasal and Oral Inflammation (Ulcers, Purulent/Bloody discharge)
- CXR with nodules, infiltrates, or cavities
- Abnormal urinary sediment (hematuira +/- RBC casts)
- Granulomatous inflammation on biopsy of an artery or perivascular area
If a patient had a stenonic renal artery what may be auscultated on examination?
Renal Artery Bruit
In _____ vasculitis, 50% of the glomeruli are normal
In _____ vasculitis, 50% of the glomeruli have (Cellular/Fibrotic) crescents present
In _____ vasculitis, 50% of the glomeruli are globall sclerotic
Is GPA associated with PR3-ANCA or MPO-ANCA?
What about MPA?
T/F: A Vasuclitis diagnosis (GPA or MPA) needs to be confirmed by biopsy
What combination of medications is used to treated vasculitis?
Cyclophosphamide and Steroids
If angiography is preformed and the damaged kidney can not be saved, what needs to occur?