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44 Cards in this Set
- Front
- Back
this problem is normally asymptomatic, and is thought to be benign. Yet ultimately, these pts can end up with impaired kidney function due to decreased blood flow. This problem eventually will be one that accounts for 1/3 of cases of end stage renal disease....
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Hypertensive nephrosclerosis
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for what population is hypertensive nephrosclerosis the leading cause of ESRD?
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African-Americans
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What are the LM findings of hypertensive nephrosclerosis in the large arteries and arterioles respectively
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large a: intimal fibrosis with duplication of the elastic lamina
Arterioles: hyaline thickening of the wall |
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Diastolic pressures of over 130 mm Hg =
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Malignant Hypertension
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40 year old male presents with headache, dizziness, and visual disturbances. His BP is 180/137. What does he have?
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Malignant Hypertension
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what renovascular problem has the pathology of Cut surface is mottled red/yellow, with scattered infarcts
Fibrinoid necrosis, marked hyaline sclerosis, hyperplastic arteritis |
Malignant Hypertension
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Onion skin lesion=
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Malignant Hypertension
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can renal artery stenosis be reversed?
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Can be reversed with reestablishment of lumen
Surgical revascularization, angioplasty, nephrectomy |
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pt has mild to moderate HT. you auscultate a bruit over main renal artery, so you order images. What is going on here? What is the number one cause?
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Renal artery stenosis
Atherosclerosis (also vasculitis, fibromuscular dysplasia) |
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what hormone will be elevated on the affected side in the renal vein in renal artery stenosis?
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Renin
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in Fibromuscular Dysplasia, what portion of the arterial wall is affected? which is most often
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Can affect intima, media, or and region of vessel wall from intima to adventitia
E.g., medial fibroplasia (most common; 66% of cases) |
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string of beads pattern on angiogram=
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Fibromuscular Dysplasia
(Areas of thickening (e.g., medial) alternating with areas of atrophy) |
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Systemic thrombus formation throughout small vessels (capillaries, arterioles) leading to ischemia
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Thrombotic Microangiopathies
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pt presents with Microangiopathic hemolytic anemia, thrombocytopenia, hypertension, renal failure... what do they have?
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Thrombotic Microangiopathies
due to the narrow lumen, the RBCs are getting hung up and are being destroyed |
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Lab findings of Schistocytes (fragmented RBCs) in peripheral smear
Normal coagulation times; normal or slightly elevated FSPs are consistent with? |
Thrombotic Microangiopathies
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the gross findings of:
ateriolar fibrinoid necrosis can be a feature of what 2 renovascular problems |
Thrombotic Microangiopathies
malignant hypertensive nephropathy |
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if you see vascular thrombosis in microscopic features..what do you have?
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Thrombotic Microangiopathies
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what are the two forms of Hemolytic Uremic Syndrome (HUS)? What will be the pos/neg finding associated with each
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Typical (epidemic, classic, diarrhea-positive)
Atypical (diarrhea-negative, non-endemic) |
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this problem is caused by ingestion of food contaminated with bacteria – Shiga-like toxin
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typical Hemolytic Uremic Syndrome (HUS)
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typical Hemolytic Uremic Syndrome (HUS) is found more in what population? onset?
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children
sudden (due to ingestion of bacteria) will see sudden onset of bleeding in kids especially in diarrhea |
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Child presents to your office reporting bloody diarrhea. He says symptoms started after attending a family BBQ. Lab shows blood in the urine as well. What do they have?
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typical Hemolytic Uremic Syndrome (HUS)
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what causes atypical Hemolytic Uremic Syndrome (HUS)
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Inherited mutations in complement system proteins
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how do you have acquired atypical Hemolytic Uremic Syndrome (HUS)
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Acquired: anti-phospholipid antibodies; associated with: pregnancy, oral contraceptives, chemotherapy, radiation therapy, autoimmune vasculitides
Adults Worse prognosis |
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what is the classic pentad of clinical symptoms in Thrombotic Thrombocytopenia Purpura (TTP
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Fever,
neurologic symptoms, microangiopathic hemolytic anemia, thrombocytopenia, ARF |
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decrease function of the enzyme ADAMTS13 is seen in what? What does this cause?
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Thrombotic Thrombocytopenia Purpura (TTP)
Persistent very large vWF promotes platelet aggregation you will bleed more than normal because your platelets are used up |
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what is preeclampsia (3 features) and eclampsia?
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Preeclampsia in 3rd trimester of pregnancy: Hypertension, proteinuria, edema
Eclamspia: above plus seizures |
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this problem leads to papillary necrosis because vascular occlusion will lead to hypoxic infarction of the papilla. FSGS may develop in some.... what does this describe?
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Sickle cell nephropathy
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tx for Sickle cell nephropathy?
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improve O2, increase number of functional RBCs
Red cell exchange procedure |
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What is responsible for the majority of renal infarcts?
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Embolization
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What are 3 of the important sources of emboli for the kidney?
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1. Cardiac MURAL thrombi (ventricular wall dyskinesia from prior MI; atrial fib)
2. Cardiac VALVULAR vegetations (infected, noninfected) 3. Complicated atherosclerotic PLAQUES |
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a 6 year old child develpos fever, abdominal pain, and bloody diarrhea. Several other children in the neighborhood had similar sympotoms after eating at the same FF rest. The clin course in the child also includes hematuria and oliguria. What additional feature most likely would be associated with these findings?
1. hemoptysis 2. immune complex formation systemicall within large vessel vasculitis 3. immune complex formation systemically within small vessel vasculitis 4. malignant HT 5. thrombotic microangiopathy in the kidneys |
this is Hemolytic Uremic Syndrome (HUS)
Hemoptysis: seen in good pastures...(antibody against type IV collagen of basement membrane) 2: this would be giant cell arteritis or renal artery stenosis 3. nephritis like syndrome 4. Malignant HT---not even close 5. Thrombotic microangiopathy in the kidneys: this is exactly what HUS is! |
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Thrombotic microangiopathy in the kidneys =
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this is Hemolytic Uremic Syndrome (HUS)
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in gout, what deposits in synovial fluid?
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monosodium urate (MSU) crystals
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what type of birefringent is seen with gout?
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Negatively birefringent
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Henoch-Schonlein purpura affect what size vessel?
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Small vessels
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Cryoglobulinemic vasculitis affects what size vessel?
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Small vessels
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Goodpasture syndrome affects what size vessel?
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Small vessels
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Wegener granulomatosis affects what size vessel?
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Small vessels
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microscopic polyangitis affects what size vessel?
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Small vessels
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Churg-Strauss syndrome affects what size vessel?
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Small vessels
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Polyarteritis nodosa affects what size vessel?
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Medium sized vessels
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Kawasaki disease affects what size vessel?
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Medium sized vessels
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Giant Cell Arteritis affects what size vessel?
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Large vessels
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Takayasu arteritis affects what size vessel?
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Large vessels
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