1. Pathology of the kidney, ureters and bladder 1 Flashcards
4 roles of the kidney?
- Fluid and electrolyte balance
- Resorption of solutes
- Excretion e.g. of conjugated xenobiotics
- Endocrine
- Renin for bp control
- Erythropoietin for RBC production
4 examples of congenital renal abnormalities?
- Hypoplasia (possibly due to RA stenosis)
- Potter syndrome (bilateral renal agenesis)
- Vesicoureteric reflux (from bladder back up ureters, leading to irritation and infection)
- Renal artery stenosis cyst
Genetic renal abnormalities?
- Autosomal dominant polycystic disease (leads to chronic renal failure and dialysis)
- Simple cyst (common, not worry)
- Familial mediterranean fever
- Alport’s syndrome
Glomerular disease:
Mediated by? There associated to..
Examples of primary and secondary?
Medicated by Immunological processes therefore HLA association
Primary: Glomerulonephritis
Secondary: Vascular, autoimmune e.g. SLE, amyloid, diabetes, acquired.
SLE stands for?
Systemic lupus erythematosus
What is the consequence of type II hypersensitivity in the glomerulus?
Features?
Appearance?
- Anti-GBM antibodies and Complement fixation (by antibodies IMG and IGG)
- Diffuse damage and fibrin leakage
Features
- Proliferated parietal endothelial cells due to fibrin
- Focal disruption of BM
- Increased mesangial cells
- Focal loss of foot processes
- Fibrin present on parietal cells.
Appearance: Crescent due to proliferation of parietal epithelium and inflammatory cells. Forms scar so glomerulus is lost.
What is good pastures syndrome?
Goodpasture disease is a term used to describe glomerulonephritis (type II hypersensitivity), with or without pulmonary hemorrhage, and the presence of circulating anti–glomerular basement membrane (anti-GBM) antibodies.
Leads to characteristic proliferation of parietal epithelium and inflammatory cells –> Crescents
Clinical effects of type 2 hypersensitivity in the glomerulus?
Fast Haematuria: Yes Proteinuria: Yes but not a lot Less urine due to nephron comprise, oliguria Lung involvement
What is the consequence of type III hypersensitivity in the glomerulus?
Features?
Immune complex deposition
Size determines where deposition occurs
+/- complement fixation
Features:
- Proliferated endothelial cells
- Increased mesanglial cells
- Immune complexes present
Causes of type 2 hypersensitivity in the glomerulus?
Goodpastures-autoimmune
Vasculitis - ANCA (Anti-neutrophil cytoplasmic antibodies)
SLE
Organic solvent
Clinical effects and causes of type 3 hypersensitivity in the glomerulus?
Clinical effects:
-Fast or slow. depends on immune complex formation
-Haematuria: Yes
-More or less urine
-Proteinuria: Little
-Pain: yes due to inflammation and swelling
=Nephritic syndrome
Causes:
- Post infection e.g. strep.
- Vasculitis e.g. ANCA
- SLE
Membranous GN:
What is it?
Clinical effects?
Causes?
What is it?
An immunologically mediated disease in which immune complexes deposit in the subepithelial space
Clinical effects: Slow process Haematuria: A little More urine initially Proteinuria: YES Pain: No, due to to active inflammation =Nephrotic syndrome
Causes:
- Males>females
- Adults
- Hep B
- Idiopathic
- Penicillamine
- SLE
Minimal lesion GN: Who? Treat with? Clinical effect? Causes? Type of hypersensitivity?
Who: Children
Treat with steroids
Clinical effect: Marked proteinuria
Causes: Hodgkins lymphoma, remission with measles
Type 4 HS= Foot processes fuse leads to proteinuria, nephrotic syndrome, high lipids, cell mediated.
Consequence of glomerular damage?
Glomerular damage
–>
Increased permeability of glomerular capillaries to protein
–> Proteinuria
–> Hypoproteinemia
1. Compesatory synthesis of proteins by liver (increasing lipoproteins) –> HYPERLIPIDEMIA
2. Decrease plasma oncotic pressure –> Edema
Difference between nephritic and nephrotic syndrome?
Nephrotic syndrome involves the loss of a lot of protein
Nephritic syndrome involves the loss of a lot of blood.
Clinical features of nephritic syndrome?
Blood
Pain
Less proteinuria
Oliguria
Causes of proteinuria apart from nephritic and nephrotic syndrome?
Diabetes
Amyloidosis
Causes of focal and segmental necrotising GN?
Proliferative GN
Vasculitiis
SLE
Tubulointerstitial disease
Cause: Drug hypersensitivity *, also due to ischaemia and SLE
Leads to acute tubular necrosis and ascending infection
TTTIS classification of renal pathology
TRAUMA
-Trauma
TUMOUR
- Non-neoplastic
- Benign
- Malignant (primary/secondary)
TUBERCLE
-Chronic inflammatory
INFLAMMATION
- Infection
- Acute inflammation
- Immunological
STONE
- Genetic
- Metabolic
What is the effect of kidney hypoplasia due to renal artery stenosis on bp?
Leads to hypertension and the failure kidney thinks it’s ischaemic leading to renin release
3 components of glomerulus filter?
- Fenestrated endothelial cells
- Charge of BM
- Foot processes of podocytes which forms slit diaphragm
Examples of nephritic and nephrotic syndrome?
Nephrotic syndrome: Minimal change, FSGS, membranous
Nephritic syndrome: Proliferative GN, mesangiocapillary GN
Common vascular diseases affecting the kidneys
- Hypertension
- Vasculitis
- Mesangial IgA disease
- TTP
- HUS
