Acute and chronic renal vascular disease (renal artery/vein thrombosis, cholesterol crystal embolism, renovascular hypertension, ischemic renal disease)

1. Big picture

Renal vascular diseases are kidney disorders caused by impaired arterial inflow, impaired venous drainage, or embolic occlusion of renal microvessels.

Think in four clinical patterns:

Pattern	Main disease	Clinical clue
Acute arterial occlusion	Renal artery thrombosis/embolism	Sudden flank pain + hematuria + high lactate dehydrogenase
Venous occlusion	Renal vein thrombosis	Nephrotic syndrome + flank pain/hematuria ± pulmonary embolism
Atheroembolism	Cholesterol crystal embolism	AKI after angiography + livedo/blue toes + eosinophilia
Chronic hypoperfusion	Renovascular hypertension / ischemic nephropathy	Resistant hypertension + abdominal bruit + kidney size asymmetry

Core oral-exam sentence:

“Renal vascular disease should be suspected when acute kidney injury or chronic kidney disease occurs with vascular risk factors, hypertension, embolic phenomena, nephrotic syndrome, sudden flank pain, or worsening renal function after renin-angiotensin system blockade.”

1. Big picture

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