RENAL ARTERY STENOSIS

RENAL ARTERY STENOSIS

  • Also known as Reno vascular hypertension
  • It is the narrowing of one or both of the renal arteries
ETIOLOGY:
  • most common cause - Atherosclerosis
  • fibromuscular dysplasia (FMD) - (young females)
  • Takayasu arteritis  - Asian population (pulseless disease)



CLINICAL FEATURE:

  • Refractory hypertension
  • sudden rise BP in preexisting HTN patient
  • flash pulmonary edema
  • presence of abdominal bruit (systole + diastole)
  • check peripheral pulses
  • poly arteritis nodosa - not cause of renal artery stenosis but can lead to Aneurysm formation



WORKUP:

  • USG - Asymmetric kidneys size
- Not responding to anti hypertensive medication

  • Doppler - best screening test
  • CT Angiography
  • Magnetic Resonant Angiography (MRA) - expensive
↓↓↓ 

- false positive results - due to turbulent flow
- Gadolinium - cause nephrogenic system fibrosis
  • IOC - Renal angiography (invasive test)(gold standard)
  • DTPA scan before and after giving ACE inhibitor (Captopril renogram)


TREATMENT:
  • ACE Inhibitors 
- Contraindicated in bilateral RAS because it causes efferent arteriole dilatation leading to loss of filtration gradient and increasing the risk of acute kidney injury
  • Calcium channel blockers
  • PTRA (percutaneous transluminal renal angioplasty)
↓↓↓
stenting
↓↓↓
preferred for - fibromuscular dysplasia

Comments

Post a Comment

Popular posts from this blog

HYPOKALEMIA(electrolyte imbalance)

Image
HYPOKALEMIA It is a low level of potassium(k ๋) in blood serum normal potassium level 3.5 - 5mmol/L Death can occur due to  respiratory muscle paralysis CAUSES: Decrease intake Alkalosis : Potassium shift into cells Sympathomimetics stimulation - trauma, thyrotoxic periodic paralysis, beta 2 agonist toxicity(salbutamol) Renal loss - excess aldosterone = conn's syndrome,bilateral adrenal hyperplasia, ascites , CHF                   - Barter's , Gitelman syndrome                                                                                                       - Salt wasting nephropathy                    ...
Read more

BRONCHIECTASIS

Image
Bronchiectasis : Destruction / Dilatation of large airways - airways are filled with pus results in the features of bronchorrhea HISTOPATHOLOGICAL  EXAMINATION: CYLINDRICAL / TUBULAR - MOST COMMON subtype - Represents airways are dilated and thick walled which filled with pus by the dangerous organisms like pseudomonas. this organism later will form the biofilm in the lungs which results in antibiotic resistant. expansion of pus filled cavity will erode the blood vessels of lungs which results is massive hemoptysis and death of the patient. Cause of  death - Massive hemoptysis Causes : A) FOCAL - Obstruction which subsequently cause infection in the airway and results in pus. following condition can cause focal bronchiectasis - Foreign body aspiration (children) - Pulmonary hamartoma (adults) - Bronchial carcinoid (adults) note: Benign tumor in adults like pulmonary hamartoma and carcinoid tumors which encroached the bronchus and result in obstruction of airways and causes ate...
Read more

COMMUNITY ACQUIRED PNEUMONIA

Image
Acute infection of pulmonary parenchyma Causative Organism : Streptococcus pneumoniae (pneumococci) - most common Haemophilus influenzae - 2nd most common Mycoplasma pneumonia Chlamydia pneumonia Rare : Legionella Staphylococcus aureus Gram negative organism ( klebsiella , pseudomonas) virus (adenovirus , meta pneumo virus) In India : - 20% cases of CAP - Tuberculosis - 40% cases of CAP - Not established PATHOLOGY : Initially there is a inhalational of bacteria into the lungs results in phase of Edema  ↓  proteinaceous exudates developed in the alveoli (so there can be a crepitation, crackles of  bronchial breathing in the patient and subsequently patients enter into the following phases) Red hepatization - RBC + Neutrophils (3-4 days) Grey hepatization - RBC lysis + Neutrophils (it signifies successful)(5 -7 days) Resolution - here Macrophages predominantly present because these cells restore the normal tissue Typical / lobar pneumonia : Lobar consolidation causative org...
Read more