Renal: 8. Leonard : Renovascular Disease

Front 1

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....

Back 1

Hypertensive nephrosclerosis

Front 2

for what population is hypertensive nephrosclerosis the leading cause of ESRD?

Back 2

African-Americans

Front 3

What are the LM findings of hypertensive nephrosclerosis in the large arteries and arterioles respectively

Back 3

large a: intimal fibrosis with duplication of the elastic lamina

Arterioles: hyaline thickening of the wall

Front 4

Diastolic pressures of over 130 mm Hg =

Back 4

Malignant Hypertension

Front 5

40 year old male presents with headache, dizziness, and visual disturbances. His BP is 180/137. What does he have?

Back 5

Malignant Hypertension

Front 6

what renovascular problem has the pathology of Cut surface is mottled red/yellow, with scattered infarcts
Fibrinoid necrosis, marked hyaline sclerosis, hyperplastic arteritis

Back 6

Malignant Hypertension

Front 7

Onion skin lesion=

Back 7

Malignant Hypertension

Front 8

can renal artery stenosis be reversed?

Back 8

Can be reversed with reestablishment of lumen

Surgical revascularization, angioplasty, nephrectomy

Front 9

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?

Back 9

Renal artery stenosis

Atherosclerosis (also vasculitis, fibromuscular dysplasia)

Front 10

what hormone will be elevated on the affected side in the renal vein in renal artery stenosis?

Back 10

Renin

Front 11

in Fibromuscular Dysplasia, what portion of the arterial wall is affected? which is most often

Back 11

Can affect intima, media, or and region of vessel wall from intima to adventitia
E.g., medial fibroplasia (most common; 66% of cases)

Front 12

string of beads pattern on angiogram=

Back 12

Fibromuscular Dysplasia

(Areas of thickening (e.g., medial) alternating with areas of atrophy)

Front 13

Systemic thrombus formation throughout small vessels (capillaries, arterioles) leading to ischemia

Back 13

Thrombotic Microangiopathies

Front 14

pt presents with Microangiopathic hemolytic anemia, thrombocytopenia, hypertension, renal failure... what do they have?

Back 14

Thrombotic Microangiopathies

due to the narrow lumen, the RBCs are getting hung up and are being destroyed

Front 15

Lab findings of Schistocytes (fragmented RBCs) in peripheral smear
Normal coagulation times; normal or slightly elevated FSPs

are consistent with?

Back 15

Thrombotic Microangiopathies

Front 16

the gross findings of:

ateriolar fibrinoid necrosis can be a feature of what 2 renovascular problems

Back 16

Thrombotic Microangiopathies

malignant hypertensive nephropathy

Front 17

if you see vascular thrombosis in microscopic features..what do you have?

Back 17

Thrombotic Microangiopathies

Front 18

what are the two forms of Hemolytic Uremic Syndrome (HUS)? What will be the pos/neg finding associated with each

Back 18

Typical (epidemic, classic, diarrhea-positive)

Atypical (diarrhea-negative, non-endemic)

Front 19

this problem is caused by ingestion of food contaminated with bacteria – Shiga-like toxin

Back 19

typical Hemolytic Uremic Syndrome (HUS)

Front 20

typical Hemolytic Uremic Syndrome (HUS) is found more in what population? onset?

Back 20

children

sudden (due to ingestion of bacteria)

will see sudden onset of bleeding in kids especially in diarrhea

Front 21

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?

Back 21

typical Hemolytic Uremic Syndrome (HUS)

Front 22

what causes atypical Hemolytic Uremic Syndrome (HUS)

Back 22

Inherited mutations in complement system proteins

Front 23

how do you have acquired atypical Hemolytic Uremic Syndrome (HUS)

Back 23

Acquired: anti-phospholipid antibodies; associated with: pregnancy, oral contraceptives, chemotherapy, radiation therapy, autoimmune vasculitides
Adults
Worse prognosis

Front 24

what is the classic pentad of clinical symptoms in Thrombotic Thrombocytopenia Purpura (TTP

****

Back 24

Fever,
neurologic symptoms,
microangiopathic hemolytic anemia,
thrombocytopenia,
ARF

Front 25

decrease function of the enzyme ADAMTS13 is seen in what? What does this cause?

Back 25

Thrombotic Thrombocytopenia Purpura (TTP)

Persistent very large vWF promotes platelet aggregation

you will bleed more than normal because your platelets are used up

Front 26

what is preeclampsia (3 features) and eclampsia?

Back 26

Preeclampsia in 3rd trimester of pregnancy: Hypertension, proteinuria, edema

Eclamspia: above plus seizures

Front 27

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?

Back 27

Sickle cell nephropathy

Front 28

tx for Sickle cell nephropathy?

Back 28

improve O2, increase number of functional RBCs

Red cell exchange procedure

Front 29

What is responsible for the majority of renal infarcts?

Back 29

Embolization

Front 30

What are 3 of the important sources of emboli for the kidney?

Back 30

1. Cardiac MURAL thrombi (ventricular wall dyskinesia from prior MI; atrial fib)

2. Cardiac VALVULAR vegetations (infected, noninfected)

3. Complicated atherosclerotic PLAQUES

Front 31

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

Back 31

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!

Front 32

Thrombotic microangiopathy in the kidneys =

Back 32

this is Hemolytic Uremic Syndrome (HUS)

Front 33

in gout, what deposits in synovial fluid?

Back 33

monosodium urate (MSU) crystals

Front 34

what type of birefringent is seen with gout?

Back 34

Negatively birefringent

Front 35

Henoch-Schonlein purpura affect what size vessel?

Back 35

Small vessels

Front 36

Cryoglobulinemic vasculitis affects what size vessel?

Back 36

Small vessels

Front 37

Goodpasture syndrome affects what size vessel?

Back 37

Small vessels

Front 38

Wegener granulomatosis affects what size vessel?

Back 38

Small vessels

Front 39

microscopic polyangitis affects what size vessel?

Back 39

Small vessels

Front 40

Churg-Strauss syndrome affects what size vessel?

Back 40

Small vessels

Front 41

Polyarteritis nodosa affects what size vessel?

Back 41

Medium sized vessels

Front 42

Kawasaki disease affects what size vessel?

Back 42

Medium sized vessels

Front 43

Giant Cell Arteritis affects what size vessel?

Back 43

Large vessels

Front 44

Takayasu arteritis affects what size vessel?

Back 44

Large vessels