Create
Learn
Share

IM - RENAL CYSTIC DISEASES AND RENAL VASCULAR DISEASE

rename
tonystep1's version from 2017-07-31 15:28

RENAL CYSTIC DISEASES CLINICAL FEATURES

Question Answer
Adult Polycystic Kidney DiseaseHematuria , abdominal pain , HTN (50%) , palpable kidneys , Intracerebral berry aneurysm (in 5% to 20% of cases)
Medullary Sponge KidneyMay present with hematuria, UTis, or nephrolithiasis
Simple Renal CystsMay be single or multiple; usually asymptomatic and discovered incidentally on abdominal ultrasound or other imaging study
memorize

RENAL CYSTIC DISEASES DIAGNOSIS

Question Answer
Adult Polycystic Kidney DiseaseUltrasound is confirmatory-multiple cysts appear on the kidney.
Medullary Sponge KidneyDiagnosed by Intravenous Pyelogram (IVP)
Simple Renal Cystsdiscovered incidentally on abdominal ultrasound or other imaging study
memorize

RENAL CYSTIC DISEASE TREATMENT

Question Answer
Adult Polycystic Kidney DiseaseNo curative treatment, drain cysts, treat infections, and control HTN
Medullary Sponge KidneyNo treatment, just prevention of stone formation and recurrent UTIs
Simple Renal CystsNo treatment is necessary is most cases
memorize

RENAL VASCULAR DISEASE CLINICAL FEATURES AND DIAGNOSIS

Question Answer
Renal Artery Stenosis (Renovascular HypertensionHTN-Look for a sudden onset of HTN in a patient without a family history. HTN is often severe (may cause malignant HTN) and refractory to medical therapy//Decreased renal function//Abdominal bruit (RUQ, LUQ, or epigastrium) is present in 50% to 80% of patients; it is especially common in patients with fibromuscular hyperplasia.
Renal Vein ThrombosisClinical features depend on the acuity and severity flank pain, HTN, hematuria, and proteinuria.
Atheroembolic Disease of the Renal Arteries Symptoms of uremia ( Anorexia, nausea, vomiting, weakness, myoclonic jerks, seizure, confusion ,coma) rarely causes hypertension. Abdominal pain, nausea, and vomiting. Sudden blindness and formation of bright yellow retinal plaques (Hollenhorst plaques)
Hypertensive NephrosclerosisSystemic HTN , Renal manifestations: a rapid increase in Cr, proteinuria, hematuria, RBC and WBC casts in urine sediment, and sometimes nephrotic syndrome
SclerodermaRenal involvement (renal crisis-rapid malignant hypertension) occurs in patients
with diffuse disease (rare today).
Sickle Cell NephropathyNephrotic syndrome can develop (which can lead to renal failure). Ischemic injury to the renal tubules can occur, which increases the risk of dehydration (impaired urine concentration) , precipitating sickling crises
Diagnosis of Renal Artery StenosisRenal arteriogram is the gold standard, but contrast dye can be nephrotoxic-do not use it in patients with renal failure.
Diagnosis of Renal Vein ThrombosisDiagnostic tests include selective renal venography visualizing the occluding thrombus (definitive study) or IVP.
memorize

TREATMENT OF RENAL VASCULAR DISEASE CLINICAL FEATURES

Question Answer
Renal Artery Stenosis (Renovascular Hypertension)Revascularization with percutaneous transluminal renal angioplasty (PRTA) is the initial treatment in most patients
Renal Vein ThrombosisAnticoagulate to prevent pulmonary embolism
Atheroembolic Disease of the Renal ArteriesTreatment is supportive. Do not anticoagulate. Control BP. Amputation or surgical resection is only needed in extreme cases.
Hypertensive NephrosclerosisThe most important treatment for both benign and malignant forms is controlling the BP
memorize