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A CASE OF UNEXPLAINED HYPOKALEMIA Prof.S.Sundar Unit Dr.R.Ganesan PG Internal medicine
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Past history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vitals ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object]
USG KUB ,[object Object],[object Object]
Renal artery doppler study RK PSV EDV RI Upper pole 184cm/s 29 0.6 Mid pole 153cm/s 10.3 0.8 Mesenchimal.A 186cm/s 22 0.7
LK PSV EDV RI Upper P 184cm/s 7.3 0.7 Lower P 181cm/s 13.1 0.58 Mesenchimal A 179cm/s 15.5 0.8
64 Slice MD CT-Abdominal angiogram ,[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
DEFINITION ,[object Object]
 
TWO KIDNEY  HYPERTENSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
ONE KIDNEY HYPERTENSION ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
TAKAYASU’S ARTERITIS ,[object Object],[object Object],[object Object],[object Object]
Scenarios in RA stenosis and hypertension ,[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
NONINVASIVE SCREENING TESTS ,[object Object],[object Object],[object Object]
MRA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CT-Angiography ,[object Object],[object Object],[object Object]
 
 
 
Renal duplex sonography ,[object Object],[object Object],[object Object],[object Object],[object Object]
Distel criteria ,[object Object],[object Object],[object Object],[object Object]
RESISTIVE INDEX ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
OTHER SCREENING  TESTS ,[object Object],[object Object],[object Object]
Angiography-Goldstandard TEST CONTRAST ARTERIAL   PUNCTURE RISK OF EMBOLI QUALITY OF IMAGE CONVENTIONAL  ++ YES +++ +++ INTRAVENOUS   SUBSTRACTION +++ NO NO + INTRAARTERIAL SUBSTRACTION + YES ++ ++ CO2 NON YES +++ +
MANAGEMENT OPTIONS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medical management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INDICATIONS FOR REVASCULARIZATION ,[object Object],[object Object],[object Object],[object Object]
 
PTRA ,[object Object],[object Object],[object Object],[object Object]
Renal complications of PTRA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ENDOVASCULAR STENTS ,[object Object],[object Object],[object Object]
Indicators of restenosis ,[object Object],[object Object],[object Object]
Surgical revascularisation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transplant renal artery stenosis ,[object Object],[object Object],[object Object]
Causes ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Hypertension Sus of RVH Medical Rx ,Follow-up Low suspicious High suspicious Medical Rx ,Follow-up Good BP control? Stable Renal Func ? yes No Candidate for revascularization Renal Func unstable or at risk Non invasive study Angiography Surgical revas PTRA with Stent Medical Rx ,Follow-up yes positive No negative Positive high grade lesion
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
 
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Renal toxicity with ACE-Is ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
 

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A Case of Bilateral Renal Artery Stenosis

  • 1. A CASE OF UNEXPLAINED HYPOKALEMIA Prof.S.Sundar Unit Dr.R.Ganesan PG Internal medicine
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. Renal artery doppler study RK PSV EDV RI Upper pole 184cm/s 29 0.6 Mid pole 153cm/s 10.3 0.8 Mesenchimal.A 186cm/s 22 0.7
  • 16. LK PSV EDV RI Upper P 184cm/s 7.3 0.7 Lower P 181cm/s 13.1 0.58 Mesenchimal A 179cm/s 15.5 0.8
  • 17.
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  • 29.
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  • 36.
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  • 45.  
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51. Angiography-Goldstandard TEST CONTRAST ARTERIAL PUNCTURE RISK OF EMBOLI QUALITY OF IMAGE CONVENTIONAL ++ YES +++ +++ INTRAVENOUS SUBSTRACTION +++ NO NO + INTRAARTERIAL SUBSTRACTION + YES ++ ++ CO2 NON YES +++ +
  • 52.
  • 53.
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  • 56.
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  • 64.
  • 65. Hypertension Sus of RVH Medical Rx ,Follow-up Low suspicious High suspicious Medical Rx ,Follow-up Good BP control? Stable Renal Func ? yes No Candidate for revascularization Renal Func unstable or at risk Non invasive study Angiography Surgical revas PTRA with Stent Medical Rx ,Follow-up yes positive No negative Positive high grade lesion
  • 66.
  • 67.
  • 68.  
  • 69.
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  • 73.  
  • 74.