10. Renovascular Disease - Sakrani

• Renovascular hypertension - most pts have what?

  abdominal bruits
•  ** Renal Atherosclerosis - diagnostic work up GOLD STANDARD

  • intraarterial angiography
• Renal atherosclerosis Tx

  • lifestyle modification
  • control HTN - use inhibitor of RAS
  • sugar control
  • angioplasty
• RAS - renal atherosclerosis - why is angioplasty done with stent?

  prevent recurrent of stenosis
• Fibromuscular Dysplasia (FMD) - pts

  • affects pre-menopausal women - age 15-50
• FMD affect which arteries

  • renal
  • carotid
  • iliac
• FMD can cause

  • stenosis
  • dissection
  • aneurysm
  • thrombosis
• History of people with FMD - HTN before 30 y/o

  • if abrupt HTN - consider it
• FMD diagnostic work up

  • CT angiography - beads on a string
• Aortic dissection is hypertensive ER

  • diagnosis - CXR - widened mediastinum
  • tx - reduce rate of increase in BP
• Atheroembolic Renal Disease - precipitating events

  • invasive arterial procedure
  • decline in kidney function btw 3 or more days
• Atheroembolic Renal Disease - definitive diagnosis

  • kidney biopsy - microvessel occlusion with cholesterol crystals that leave a cleft in the vessels
• Renal vein thrombosis is due to

  • endothelial damage
  • stasis
  • hypercoagulability
• Renal vein thrombosis - which renal condition is most at risk?

  membranous nephropathy
• Renal vein thrombosis - Diagnosis

  • CT angiography