Just after pelvic surgery, patient has left flank pain that radiates to the groin and ballotable left flank mass. What is the cause of these findings?
Hydronephrosis: The ureter was ligated on accident which causes obstruction with hydronephrosis and flank pain due to distention of the ureter and renal pelvis.
Most common causes of vascular calcification? Hyperphosphatemia and calcemia.
Hypertensive nephrosclerosis: Prolonged elevation of systemic blood pressure causes renal arterioles to undergo compensatory medial hypertrophy and fibrointimal proliferation. | Pathophysiology: Endothelial damage leading to hyaline arteriolosclerosis (deposits of plasma proteins in arteriolar walls). | The luminal narrowing restricts renal blood flow, resulting in glomerular ischemia and fibrosis (glomerular sclerosis). | Biopsy findings: Collapse of capillary loops and Bowman capsule thickening. Gross Exam: Mild renal atrophy with finely granular appearance. Reduced EPO production causes anemia |
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12 year old girl with hypertension, Recurrent fever, abdominal pain with dilated renal calyces with overlying cortical atrophy bilaterally, mostly in upper and lower lobes. Cause? Reflux Nephropathy: Recurrent Pyelonephritis: due to retrograde flow of infected urine from the bladder into the ureter.
Effect of lisinopril on patient with bilateral renal artery stenosis?
A: Bilateral RAS leads to lower GFR, and activation of RAAS. ACE inhibitors lower ANG II levels causing reduced systemic pressures and relative dilation of efferent arteriole. In patients with bilateral RAS, rduced systemic pressures are no longer enough to overcome the stenosis and so renal blood flow drops. Dilation of efferent arteriole leads to reduction of intraglomerular filtration pressure wihch results in reduction of GFR and filtration fraction.
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