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Flashcards in Renal Vascular Disease Deck (14):

Most common cause of secondary HTN and pathophysiology behind it

renal artery stenosis

decrease in blood flow to juxtaglomerular apparatus -> activation of RAAS system -> HTN


2 causes of renal artery stenosis

1. atherosclerosis (2/3rds of cases) - most often in elderly men, bilateral in 1/3rd cases
2. fibromuscular dysplasia - often seen in young women, bilateral in 50%


Clinical features of renal artery stenosis

- sudden onset HTN, often severe and in patient with no family hx, refractory to medical therapy may cause malignant HTN
- decreased renal function
- abdominal bruit (esp in fibromuscular dysplasia)


How to dx renal artery stenosis

- renal arteriogram = gold standard, BUTTTTTTT contrast dye is nephrotoxic so avoid in renal failure
- MRA (magnetic) newer test, not nephrotoxic
- duplex doppler U/S of renal arteries


Treatment for renal artery stenosis

- revascularization with percutaneous transluminal renal angioplasty (PRTA) is INITIAL TREATMENT for most patients, better success with fibro musc than athero
- bypass surgery of revasc unsuccessful
- conservative: ACE inhibitors, CCBs, alone or in combo to revasc


Clinical features of RVT

decreased renal perfusion (can lead to renal failure), flank pain, HTN, hematuria, and proteinuria


RVT can be seen in what clinical settings?

nephrotic syndrome (most commonly from membranous nephropathy), renal cell carcinoma, pregnancy, trauma, dehydration


how to diagnose RVT

selective renal venography or IVP


how to treat RVT

anticoagulate!!!! also prevents PE


What is atheroembolic disease of renal arteries

SHOWERRRRRS of cholesterol crystals that dislodge form plaques in large arteries and embolize to the renal vasculature...can occur in other organs as well


How is HTN harmful to kidneys?

systemic HTN increases capillary hydrostatic pressure in the glomeruli leading to bengin or malignant sclerosis...MCC of ESRD under what....??



benign vs malignant nephrosclerosis

benign - mild to moderate Cr increase, microscopic hematuria, mild proteinuria
malignant - RAPID decrease in renal function, accelerated HTN due to diffuse renal injury....can lead to proteinuria, hematuria, RBC and WBC casts, sometimes nephrotic syndrome
can also present with microangiopathic hemolytic anemia


Which area of kidney is most affected in sickle cell nephropathy and what does it lead to?


leads to papillary necrosis -> renal failure/high frequency of UTI
also leads to nephrotic syndrome or ESRD...can also affect tubules which inhibits concentration of urine


What meds can be helpful in sickle cell nephropathy