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Renal vascular disease (Renal artery stenosis (RAS) (Diagnosis…
Renal vascular disease
Haemolytic uraemic
syndrome (HUS)
Clinical presentation
Reduced UO
Jaundice
Abdominal pain
Bloody diarrhoea
Diagnosis
Bedside
Obs (fever), fluid status
Urine
Dipstick (haematuria, proteinuria), MCS, ACR
Bloods
FBC (anaemia, thrombocytopenia), CRP (raised), U+E, GFR, Cr (deranged), LFTs, clotting, blood cultures,
Blood film (schistocytes due to fragmented RBCs)
Pathophysiology
Infection with E Coli 0157 (gastroenteritis)
Toxin causes endothelial damage, thrombosis, platelet consumption, fibrin strands disrupt and lyse RBCs
Get thrombocytopenia and AKI (renal)
Main affected site is renal vasculature
Management
Conservative
Referral ASAP to renal
Medical
IV fluids
Plasma exchange/dialysis
Definition
Triad of AKI, microagniopathic haemolytic anaemia and thrombocytopenia
Renal artery stenosis
(RAS)
Clinical presentation
Often asymptomatic
Resistant HTN
Aetiology
Vascular: atherosclerosis, thromboembolism, fibromuscular dysplasia
Autoimmune: Takayasu arteritis, vasculitis, anti-phospholipid syndrome
Iatrogenic: post-transplant
Neoplastic: tumour causing compression
Pathophysiology
Stenosis reduces perfusion to the kidney
RAAS activation and Angiotensin, Na and water retention, increases BP
Diagnosis
Examination
Abdominal bruits, weak leg pulses,
signs of pulmonary oedema (fine bibasal crackles)
Investigations
Bedside: obs (HTN)
Bloods: FBC, U+E, GFR, Cr, LFTs, glucose, lipids
Imaging: USS KUB (small shrunken kidney), Doppler USS (reduced flow), CT/MRI angio (stenosis of RA)
History
Often nil PC, resistant HTN
PMH of CVD etc.
Definition
Stenosis of renal artery or a branch
Management
Medical
Anti-HTN (not ACEi if bilateral)
Surgical
Angioplasty + stent
Revascularisation
Conservative
Information and advice
Lifestyle (weight loss, salt restriction, exercise, healthy diet)
Thrombotic thrombocytopenic
purpura (TTP)
Pathophysiology
Genetic deficiency of ADAMTS13 which cleave vWF
Excess vWF accumulates causing Plt aggregation
Fibrin deposion and clot formation, thrombi of small vessels
Spectrum with HUS
Aetiology
Idiopathic
Autoimmune: SLE
Neoplastic: cancer
Drugs: e.g. quinine
Definition
Genetic disease of altered enzyme
that forms aggregates causing thrombosis
Clinical presentation
Jaundice
Low UO
Fever
CNS signs (seizures, focal signs, confusion)
Diagnosis
Bedisde
Obs (fever)
Bloods
FBC (anaemia, low Plt), CRP/ESR (high), U+E, GFR, Cr,
LFTs, clotting (deranged), blood cultures (nil)
Urine
Dipstick (haematuria, proteinuria), MCS, ACR
Management
Conservative
Information, advice, support
Referral to renal ASAP
Medical
Steroids
Plasma exchange