{"id":8107,"date":"2021-11-15T22:59:47","date_gmt":"2021-11-15T20:59:47","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/nephrology\/acute-and-chronic-renal-vascular-disease-renal-artery-vein-thrombosis-cholesterol-crystal-embolism-renovascular-hypertonia-ischemic-renal-disease\/"},"modified":"2021-11-22T18:14:52","modified_gmt":"2021-11-22T16:14:52","slug":"acute-and-chronic-renal-vascular-disease-renal-artery-vein-thrombosis-cholesterol-crystal-embolism-renovascular-hypertonia-ischemic-renal-disease","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/acute-and-chronic-renal-vascular-disease-renal-artery-vein-thrombosis-cholesterol-crystal-embolism-renovascular-hypertonia-ischemic-renal-disease\/","title":{"rendered":"Acute and chronic renal vascular disease (renal artery\/vein thrombosis, cholesterol crystal embolism, renovascular hypertonia, ischemic renal disease)"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Renal artery thrombosis <\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">A rare and life-threatening condition in which one or both renal arteries become occluded by a thrombus, leading to reduced perfusion and AKI.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The most common cause of renal artery thrombosis is thromboembolism originating in the heart or large arteries.<\/li><li>Risk factors include hypercoagulability (smoking, contraceptives, inflammation), DM<\/li><li>Other reasons may be polycythemia vera, SLE, and iatrogenically (surgical procedures)<\/li><li>Often misdiagnosed, as the symptom is flank pain<\/li><li>Untreated, my proceed to kidney infarction<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Investigations<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>CT angio<\/li><li>Ecocardiography to rule out intramural thrombosis (afib, prosthetic valve)<\/li><li>LDH<\/li><li>Urinalysis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Therapy<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Heparin, DOAC<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Renal vein thrombosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">A rare condition in which one or both renal veins become occluded by a thrombus.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Mostly seen in children with severe dehydration<\/li><li>In adults, it is associated with malignancy (most common, RCC invasion), nephrotic syndrome, and hypercoagulable states, renal transplantation<\/li><li>Thrombosis of the left renal vein (more common) will involve the adrenal gland and left gonad.<\/li><li>The RVT can be acute or chronic, with chronic cases being relatively asymptomatic due to the development of collateral circulation.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Symptoms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>Pain (flank, testicular)<\/li><li>Nausea, vomiting<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Investigations<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Urinalysis (proteinuria, microhematuria)<\/li><li>Venography<\/li><li>US (In acute RVT, massively enlarged kidney)<\/li><li>CT, MRI<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Heparin, DOAC<\/li><li>Thrombolysis with urikinase or tPA<\/li><li>Surgical (nephrectomy, thrombectomy)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Complications<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Rupture of the kidney and massive hemorrhage<\/li><li>PE (thromboembolization)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Cholesterol crystal emobolism (atheroemboli)<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<p class=\"wp-block-paragraph\">A relatively common complication that occurs after a surgical vascular intervention, but may also occur spontaneously in patients with severe atherosclerotic disease.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Surgical procedures such as angioplasty or stenting release thousands of embolic particles<\/li><li>Renal microinfarcts may manifest as AKI and may progress to ESRD<\/li><li>The atheroemboli will cause infarcts in other organs as well (TIA, stroke, MI, ulceration)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Symptoms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ul class=\"wp-block-list\"><li>Claudications<\/li><li>Abdominal pain<\/li><li>Vision loss<\/li><li>Livido reticularis, petichiae, purpura, ulcers and necrosis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Clinical (renal failure after renal artery procedure)<\/li><li>Elevated ESR, serum amylase, leukocytosis, anemia<\/li><li>Eosinophilia<\/li><li>Biopsy of an embolized lesion<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<p class=\"wp-block-paragraph\">No specific treatment, the best approach is prevention (embolic trapping devices). Medication that may help:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>ACEi<\/li><li>Steroids<\/li><li>Statins<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Renovascular hypertension<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<p class=\"wp-block-paragraph\">HTN is produced by partial or complete occlusion (stenosis) of one or both renal arteries.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Most common cause of 2ndary HTN.<\/li><li>The disease can be bilateral or unilateral<\/li><li>Stenosis or occlusion of a renal artery or one of its branches causes hypoperfusion and as a result, activation of RAAS.<\/li><li>Caused by atherosclerosis (most cases) or fibromuscular dysplasia (more common in women). Other causes include vasculitis, congenital abnormalities, aneurysm<\/li><li>Sudden HTN with oliguria<\/li><li>Asymptomatic. Renal artery bruit can be heard in 1\/2 of the patients<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_14\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_14\">\n\n\n<ul class=\"wp-block-list\"><li>Renal arteriogram<\/li><li>Doppler US<\/li><li>Magnetic resonance angiography<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_15\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_15\">\n\n\n<ul class=\"wp-block-list\"><li>ACEi, statins<\/li><li>Angioplasty and revascularization (fibromuscular dysplasia)<\/li><li>Bypass graft<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_16\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Ischemic renal disease<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_16\">\n\n\n<p class=\"wp-block-paragraph\">IRD describes the hemodynamic and structural changes seen in patients with reduced renal perfusion.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The conditions are what mentioned above (stenosis), and can be uni or bilateral.<\/li><li>Initially, there&#8217;s no ischemia. The reduced perfusion leads to reduction in GFR.<\/li><li>As the occlusion progresses, true ischemia occurs, manifesting as CKD or AKI.<\/li><li>In unilateral disease, the affected kidney with undergo chronic microinfarction and tissue changes and eventually atrophy; the normal kidney initially undergoes hypertrophy and hyperfiltration, but later will also develop CKD due to the effects of the sheer pressure and angiotensin.<\/li><li>In chronic IRD, usage of antihypertensive medication may cause AKI (due to the superimposed relative hypotension + hypoperfusion).<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">References <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK564380\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK564380\/<\/a><\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Renal artery thrombosis <\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Investigations<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Therapy<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Renal vein thrombosis<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Symptoms<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Investigations<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Complications<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Cholesterol crystal emobolism (atheroemboli)<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Symptoms<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Renovascular hypertension<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Ischemic renal disease<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Renal artery thrombosis A rare and life-threatening condition in which one or both renal arteries become occluded by a thrombus, leading to reduced perfusion and AKI. The most common cause of renal artery thrombosis is thromboembolism originating in the heart or large arteries. Risk factors include hypercoagulability (smoking, contraceptives, inflammation), DM Other reasons may be [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8107","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Acute and chronic renal vascular disease (renal artery\/vein thrombosis, cholesterol crystal embolism, renovascular hypertonia, ischemic renal disease) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/acute-and-chronic-renal-vascular-disease-renal-artery-vein-thrombosis-cholesterol-crystal-embolism-renovascular-hypertonia-ischemic-renal-disease\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/acute-and-chronic-renal-vascular-disease-renal-artery-vein-thrombosis-cholesterol-crystal-embolism-renovascular-hypertonia-ischemic-renal-disease\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/nephrology\\\/acute-and-chronic-renal-vascular-disease-renal-artery-vein-thrombosis-cholesterol-crystal-embolism-renovascular-hypertonia-ischemic-renal-disease\\\/\",\"name\":\"Acute and chronic renal vascular disease (renal artery\\\/vein thrombosis, cholesterol crystal embolism, renovascular hypertonia, ischemic renal disease) &#8211; 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