Vascular Diseases of the Kidney

1. Benign Nephrosclerosis = hyaline thickening of arterioles, could be caused by extravasation of plasma proteins and their deposition of BM or median and intimal thickening of the vessel (Robbins, 6^th edition). Associated with hypertension.

2. Malignant Nephrosclerosis, associated with malignant phase of HTN (note: this has nothing to do with malignancies or tumors. “Malignancy” is simply a term used to designate rapid deteriorative change in BP). This often occurs on top of preexisting essential HTN.

   1. acute: fibrinoid necrosis of arterioles in kidney, causing stenosis of the lumen

   2. chronic: intimal fibrosis and concentric smooth muscle proliferation, looks like onion-skin, causing even more stenosis and less blood delivery to kidney

3. Renal stenosis: related to atherosclerosis (relatively uncommon cause of HTN)

4. Fibromuscular dysplasia—proliferation of the intima and an uncommon cause of HTN in young women.

5. Thrombolic Microangiopathic disorders in sm. Vessels

   1. HUS

   2. TTP

6. Embolic renal disease, related to underlying atherosclerosis, development of thrombi, complications, and eventual embolization into aorta. This embolus eventually reaches renal a. and causes a white infarct (remember that renal arteries are end arteries). Common origin of embolus if from a mural thrombus, which goes out of L. ventricle, travels in aorta, and reaches renal a. Vegetations of endocarditis can also produce emboli, called septic emboli, which impact in the kidney, among other places.

Category: Nephrology Notes