renal hypertension

Question 1

What is the definition of hypertension?

Answer 1

Diastolic of 90mmhg

Question 2

What are the mechanisms cysts/tumors/masses cause renal HTN?

Answer 2

Mass effect on renal artery

Tumors can secrete renin

Tumors or highly vascular lesions can cause shunting

Question 3

How does a juxtaglomerular tumor look on imaging?

Answer 3

Hypoenhancing soft tissue mass in the renal pelvis

Question 4

What is an ask-upmark kidney?

Answer 4

Segmental renal hypoplasia

Question 5

What is the association with ask upmark kidney?

Answer 5

Vesicoureteral reflux and UTI

Question 6

What is a page kidney?

Answer 6

Trauma induced subcapsular hematoma compresses renal parenchyma and causes compression iduced renin secretion

Question 7

What clinical signs suggest renal origin of HTN?

Answer 7

Rapid acceleration or severe HTN, severe hypertensive retinopathy

Question 8

What are the effects of renin?

Answer 8

Cleaves angiotensinogen - > angiotensin 1 - > angiotensin II

Stimulates aldosterone, arteriolar vasoconstriction, ADH/antinatriuretic effect on proximal tubule

Question 9

What causes renin secretion?

Answer 9

Baroreceptors in affarent arteriole

Question 10

Which type of FMD is most common?

Answer 10

Medial dysplasia

Question 11

What are the 4 types of takayasu arteritis as diagnosed on arteriography?

Answer 11

1 - narrowing of aortic arch or great vessels
2 - narrowing of descending thoracic and upper abdominal
3 - aortic arch vessels, abdominal aorta, and major branches
4 - pulmonary arteries

Question 12

How does takayasu appear on arteriography?

Answer 12

Smooth tapered narrowing

Question 13

What are the causes of middle aortic syndrome?

Answer 13

Chronic aortitis, atherosclerosis, cystic medial necrosis

Question 14

What is the difference between takayasu and middle aortic syndrome?

Answer 14

Takayasu - slightly older with clinical aortitis (fever, elevated ESR), involvement of the great vessels

Question 15

Which patients are selected for screening for renal hypertension

Answer 15

Age extreme (50)
Recent onset of HTN
Rapid acceleration of HTN
Malignant hypertension
Flank bruit

Question 16

What is a positive renal scintigraphy scan?

Answer 16

Profound decrease in the perfusion of the kidney when a significant RAS is present

Question 17

Where are renal vein samples obtained from? What is the cutoff ratio?

Answer 17

Main renal veins

> 1.5 ipsi:contra is indicative

Question 18

What is the mechanism of PTA?

Answer 18

Fracture of the atheromatous material with dehiscence of the intima and splitting of the media

Adventitia is stretched as well

Plauqe is forced into the medial portion of the artery and heals by fibrosis

Intiima is healed with reendothelialization

Question 19

What is the restenosis rate in PTA?

Answer 19

10-20%

Question 20

When is stent placement preferred?

Answer 20

Poor PTA results, recurrent stenosis, renal artery dissection, and obstructive intimal flaps

Also ostial lesions, eccentric stenosis, calcified plaque

Question 21

What is the efficacy of PTA in atherosclerotic renal hypertension?

Answer 21

75% good results with 25% cured

Question 22

What is the most common cause of pediatric renal hypertension

Answer 22

Renal parenchymal disease (most common FMD)

Question 23

What is the difference between FMD in kids vs adults

Answer 23

Kids - male > females, less sting of beads appearance

Adults - females > males, string of beads common

Question 24

Why is PTA more successful in adults?

Answer 24

Kids have smaller vessels, and usually more fibrosis which isnt as amenable to dilation