Vascular Disease of the Kidneys

Question 1

Only one of PAN (polyarteritis nodosa) and MPA (microscopic polyangiitis) affects the lungs, which is it?

Answer 1

MPA (microscopic polyangiitis) affects the lungs by causing alveolar hemorrhage

PAN (polyarteritis nodosa) does not

Question 2

Blue toe syndrome and an acute rise in creatinine levels are associated with this renal disease

Answer 2

Atheroembolic renal disease

(another name for the cholesterol emboli)

Question 3

Your patient presents two weeks after being treated for pneumonia with an antibiotic with a fever, rash, and arthralgias. What vascular disease of the kidney might your patient have?

Answer 3

Serum sickness or SLLR

Starts one to two weeks after exposure to antibiotics (most commonly Cefaclor)

Question 4

Describe how PAN (polyarteritis nodosa) and MPA (microscopic polyangiitis) can be differentiated by which types of blood vessels blood vessels they affect.

Answer 4

PAN (polyarteritis nodosa) affects medium sized blood vessels

MPA (microscopic polyangiitis) affects small blood vessels

Question 5

Test of choice for diagnosing acute non-atheromatous occlusion of the renal arteries

Answer 5

CT with contrast

Question 6

Origin of clots that cause blockages in acute non-atheromatous occlusion of the renal arteries

Answer 6

Thromboembolism from the heart due to atrial fibrillation or endocarditis

Question 7

Which two organ systems are most involved in granulomatosis with polyangiitis (GPA/Wegener Granulomatosis)?

Answer 7

Respiratory (sinusitis, otitis, ENT symptoms)

Renal (glomerulonephritis)

(also muscle/joint pain, neuropathy, and skin purpura)

Question 8

Cefaclor is the most common cause of this vascular disease of the kidneys

Answer 8

Serum sickness and SSLR

(body reacts to meds as if they are antigens, deposit in tissues causing inflammation)

Question 9

In which phase of pregnancy does preeclampsia present with hypertension?

Answer 9

Late pregnancy - third trimester

Question 10

Granulomatosis with polyangiitis (GPA/Wegener Granulomatosis) is most common in adults from this area

Answer 10

Europe

Question 11

Best and worst treatments for renal complications of pregnancy (preeclampsia)

Answer 11

Best - delivery is definitive treatment

Worst - must avoid diuretics, ACE inhibitors, and ARBs

Question 13

Average age of patients with peak incidence of IgA vasculitis (Henonch-Schonlein)

Answer 13

5 years old

(90% of cases occur in kids)

Question 14

Which, GPA (Wegener’s), EGPA (Churg-Strauss), or both, have renal symptoms?

Answer 14

Only GPA (Wegener’s) has renal symptoms

Question 15

Both PAN (polyarteritis nodosa) and MPA (microscopic polyangiitis) occur in patients in this age group

Answer 15

Age 60+

Question 16

Which antibody is associated with granulomatosis with polyangiitis (GPA/Wegener Granulomatosis)?

Answer 16

c-ANCA

Question 17

Hepatitis C (only) is the most common cause of this vascular disease of the kidneys

Answer 17

Mixed cryoglobulinemia (Hep C causes 90% of cases)

(Hep B/C associated with PAN - polyarteritis nodosa)

Question 18

Which ethnicity and gender are most at risk of malignant hypertension leading to acute vascular damage in the kidneys, retina and brain (hypertensive emergency)?

Answer 18

Black males

Question 19

A child presents to your office with a cold, leg pain with a rash, abdominal pain, and bloody urine. What is a likely diagnosis?

Answer 19

IgA Vasculitis (Henoch-Schonlein)

Question 20

An adult patient who keeps coming to your office with recurrent ear infections over a two year period now complains of hematuria. What is your diagnosis?

Answer 20

Granulomatosis with polyangiitis (GPA/Wegener Granulomatosis)

Question 21

With patients who have sickle cell nephropathy surveillance is essential starting at age 3-5, their parents should also be educated about avoiding this common OTC medication

Answer 21

Avoid using NSAIDs which constrict afferent arteriole

(Use acetaminophen instead)

Question 22

Which, PAN (polyarteritis nodosa)
or MPA (microscopic polyangiitis) is more commonly associated with aneurysms?

Answer 22

PAN (polyarteritis nodosa)

(aneurysms in 60-90%, because it affects larger vessels)

Question 23

Classic tetrad of symptoms in IgA vasculitis (Henoch-Schonlein)

Answer 23

Purpura (in legs)

Arthralgia/arthritis (in legs)

Abdominal pain

Glomerulonephritis (proteinuria/hematuria)

(kids knees and kidneys)

Question 24

Best treatment for renal complications of scleroderma

Answer 24

ACE inhibitors are the agent of choice

Question 25

Females aged between 10-50 may have anemia symptoms, renal failure and anuria, neurologic abnormalities, low platelets, hypertension, and low hemoglobin due to this condition

Answer 25

Hemolytic uremic syndrome (HUS)

Question 26

Which ANCA antibodies are associated with: - GPA (Wegener's) - EGPA (Churg-Strauss) - PAN (Polyarteritis nodosa) - MPA (microscopic polyangiitis)

Answer 26

GPA (Wegener's) = cANCA EGPA (Churg-Strauss) - pANCA PAN (Polyarteritis nodosa) - *not* ANCA MPA (microscopic polyangiitis) - pANCA

Question 27

A patient with a history of atopy presents with peripheral neuropathy, rashes, and purpura. Lab testing shows presence of pANCA antibodies and high eosinophils. Your patient suddenly dies. What is the most likely cause of this patients death?

Answer 27

Patient had eosinophilic granulomatosis with polyangiitis (EGPA/Churg-Strauss) Over half of deaths in EGPA patients are from cardiac problems

Question 28

In this condition antibodies precipitate at cold temperatures and deposit in capillaries leading to purpura, fatigue, and arthralgias

Answer 28

Mixed cryoglobulinemia

Question 29

Women aged 20-50 with a history of Raynaud's phenomenon may present with marked elevations of blood pressure due to this condition

Answer 29

Renal complications of scleroderma

Question 30

This condition was described as a stroke of the kidneys

Answer 30

Acute non-atheromatous occlusion of the renal arteries

Question 31

Treatment goal of hemolytic uremic syndrome (HUS) are to correct volume depletion, restore hemoglobin levels (transfusion), and treat hypertension. But which classes of drugs should be avoided in the acute phase of the illness?

Answer 31

ACE inhibitors and ARBs (kidneys already poorly perfused, don't let the blood out of the glomerulus too freely)

Question 32

Most common form of hemolytic uremic syndrome and the illness that classically precedes it

Answer 32

STEC (Shiga toxin producing E.coli) Preceded by an episode of bloody diarrhea in a child

Question 33

Hepatitis B/C is most commonly associated with this vascular disease of the kidneys

Answer 33

PAN (polyarteritis nodosa) (Hep C is highly correlated with mixed cryoglobulinemia)

Question 34

First symptom of severe preeclampsia and when it presents

Answer 34

Headache (that doesn't go away with analgesics) is a sign of severe disease Shows up in late pregnancy - third trimester

Question 35

Describe the disease process in hemolytic uremic syndrome (HUS)

Answer 35

Toxin causes widespread inflammation in blood vessels Platelets form small clots in artery walls High blood pressure in arteries blasts blood past clots This wrecks the red blood cells like ships on the rocks Clots can damage vessels all over the body and cause renal failure