Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

1280 Renal Artery Stenosis Renal Calculi

complications and prognosis

■Progressive atherosclerotic disease: worsening vascular stenosis

develops in 30–50% of lesions over 5 years. Total occlusion is rel-

atively infrequent (3%) but does occur.

■Vascular restenosis after stenting (15–30% in 1 year): May appear as

recurrent or refractory hypertension and declining renal function.

May require re-imaging and repeat endovascular intervention.

■Atheroemboli may appear as progressive decline in renal function,

occasionally with lower extremity focal tissue necrosis.

RENAL CALCULI

MARGARET S. PEARLE, MD

history & physical

History

■personal or family history

■history of gout, chronic diarrhea secondary to to gastrointestinal

disorders (intestinal resection, Crohn’s disease, ulcerative colitis,

celiac sprue, pancreatic insufficiency), chronic urinary tract infec-

tion, hyperthyroidism, primary hyperparathyroidism

■use of calcium supplements, vitamin C or D, acetazolamide

Signs & Symptoms

■abrupt onset sharp, paroxysmal pain lasting a few minutes or more

at a time

■pain originates in flank, radiates to lower abdomen, groin or testicle

(labia)

■nausea and vomiting

■gross hematuria

■irritative bladder symptoms (frequency, urgency) with distal ureteral

stones

■elevated pulse and blood pressure secondary to pain

■low-grade temperature (≤ 100 ◦F) not uncommon, but high fever

should alert to possibility of pyelonephritis

■tenderness over flank or anterior abdomen but no peritoneal signs

tests

Basic Blood Tests

■CBC: mild leukocytosis common