(2.1) Renal Pathology 1: Renal and Male GU (Putthoff) Flashcards
General functions of the kidneys?
- Excrete certain waste products of metabolsim
- Regulates the body’s concentration of water, salt, calcium and phosphorous
- Maintains acid balance of plasma
- Serves as an endocrine organ
_________ is the most common cause of CRF/ESRD
__________ is the second most common cause
Diabetes is the most common cause of CRF/ESRD
High blood pressure is the second most common cause
Which kidney is higher? Left or right?
Left is higher!!!
What is a good spinal marker for the location of the kidneys?
T12
Why is the right kidney lower than the left?
Liver pushes down on the right kidney
How do most diseases/disorders of the kidney present?
Hematuria
Proteinuria
Edema
What is the single most important question to ask a patient suspected of having renal disease?
“Have you had this before?”
What are some of the common imaging techniques of the kidney and associated GU organs?
Ultrasonography
KUB - plain abdominal film
CT Scan
MRI, MRA
Radionuclide imaging
Renal angiography
Renal tomography
IVP
Retrograde pyelography
What techniques are used to evaluate the ureter, bladder or urethra?
Cystography
Voiding cytourethrography
What are some techniques utilized on renal biopsy material?
Light microscopy
Fluorescence microscopy
Electron microscopy
State the commonly associated pathology with the anatomical structure:
Glomeruli =
Tubules =
Interstitium =
Vessels =
Glomeruli = Glomerulonephritis
Tubules = Bence-Jones protinuria
Interstitium = Fibrosis, inflammation or edema
Vessels = Vasculitis, nephrosclerosis
Define:
Azotemia
- Biochemical abnormality indicating an elevation of blood urea nitrogen (BUN) and creatinine levels
- Usually related to a decreased GFR
- Generally the result of renal disorders
How can azotemia arise?
Arises from one of two categories:
1) Prerenal azotemia
2) Postrenal azotemia
What is prerenal azotemia?
Occurs after hypoperfusion of kidneys
Arises after shock, volume depletion and CHF that impairs renal function in the absence of primary renal parenchymal damage
What is postrenal azotemia?
Seen whenever urine flow is obstructed DISTAL to the calyces and renal pelvis
*Removal of obstruction corrects the azotemia
What is uremia?
Azotemia PLUS a constellation of clinical findings and biochemical abnormalities resulting from renal damage
What are the signs/symptoms of uremia?
- N/V, weight loss, fatigue, anorexia
- Pruritus
- Polydipsia
- Electrolyte abnormalities
- Encephalopathy
- Bleeding manifestations due to platelet dysfuction
- Pericarditis
- Pleuritis/pleural effusion
What’s a normal GFR rate?
90-120 mL/min
What is acute kidney injury (AKI)?
- Rapid decline in GFR
- SEVERE forms exhibit oliguria or anuria
- May result from glomerular, interstitial, vascular or acute tubular injury (ATN)
- Can be reversible
What is chronic kidney disease (CKD)?
- Mild (clinically silent)
- Defined with diminished GFR
- Persistent albuminuria
- CKD is generally irreversible
Define:
End stage renal disease (ESRD)
GFR <5% of normal
End stage of uremia
Define:
Nephrotic syndrome
Glomerular disease characterized by severe proteinuria (more than 3.5 gm/day – (less in children)), hypoalbuminemia, severe edema, hyperlipidemia, and lipiduria
Define:
Nephritic syndrome
Glomerular disease dominated by acute onset of grossly visible hematuria, mild to moderate proteinuria, and hypertension
Define:
Rapidly progressive glomerulonephritis (RPGM)
Signs of nephritic syndrome with rapid delcine (days-weeks) in GFR
Implies severe glomerular injury
Define:
Isolated urinary abnormalities
Glomerular hematuria and/or subnephrotic range proteinuria
Associate the syndrome with the manifestations:
Hematuria, azotemia, oliguria, edema, hypertension
Nephritic syndrome
Associate the syndrome with the manifestations:
>3.5 gm/day proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria
Nephrotic syndrome
Associate the syndrome with the manifestations:
Acute nephritic, proteinuria, and acute renal failure
Rapidly progressive glomerulonephritis
Associate the syndrome with the manifestations:
Azotemia –> uremia progressing for months to years
Chronic renal failure
Associate the syndrome with the manifestations:
Glomerular hematuria and/or subnephrotic proteinuria
Isolated urinary abnormalities
What are the pathologic responses of the glomerulus to injury?
Hypercellularity (inflammatory, crescents)
Basement membrane (thickening, deposits)
Hyalinosis and Sclerosis
Descriptive patterns/distributions in the categorization of glomerular disorders:
Diffuse?
Diffuse involves all glomeruli
Descriptive patterns/distributions in the categorization of glomerular disorders:
Focal?
Focal involves only a subset of glomeruli
Descriptive patterns/distributions in the categorization of glomerular disorders:
Segmental?
Segmental of affected glomeruli, only portions are involved
Descriptive patterns/distributions in the categorization of glomerular disorders:
Global?
Global involves entire glomerulus
Table 20-5
Memorize? I guess. Sure.
LOOK UP THESE CONCEPT BOXES
Nephritic syndrome (key concepts page 913)
Nephrotic syndrome (key concepts page 922)
Isolated glomerular abnormalities (key concepts page 925)
What is the population commonly associated with acute proliferative glomerulonephritis?
Children
Describe acute proliferatie glomerulonephritis
Signs?
Immune complex injury trigged by exogenous bacterial, viral or fungal antigen
- Marked hypercellularity
- Leukocyte infiltration
What do we commonly see in acute proliferative glomerulonephritis on electron microscopy?
Subepithelial “hump” of immune complex
What frequently causes acute proliferative glomerulonephritis?
Strep B
Describe the histologic differences b/w a normal glomerulus and a RPGN glomerulus
Collapsed, compacted glomerular tufts
Crescent-shaped mass of proliferating visceral and parietal epithelial cells
Anti-Glomerular Basement Membrane Disese
“Goodpasture syndrome”
What is it?
Type 1 RPGN is an anti-GBM antibody induced disease, characterized by linear deposits of IgG and in many cases, C3 in the GBM
Anti-Glomerular Basement Membrane Disese
“Goodpasture syndrome”
Clinically, what occurs?
Pulmonary hemorrhage occurs in addition to renal disease
Define:
Nephrotic syndrome
A renal syndrome in which the basic defect is increased permeability of glomeruli to plasma proteins
Resulting in PROTEINURIA
What are the major clinical findings associated with nephrotic syndrome?
Severe proteinuria >3.5gm/24hrs
Hypoalbuminemia <3.0gm/dL
Edema
Hyperlipidemia
Most common cause of nephrotic syndrome in primary glomerular disease in CHILDREN?
Minimal-change disease
What is the main difference b/w primary and secondary renal disease?
Primary: comes from renal etiology
Seconday: comes from systemic diseases (DM, SLE)
Describe the histologic changes you’d see with membranous glomerulopathy
Marked diffuse thickening of capillary walls without increase in cellularity
What are the characteristics of minimal change disease (MCD)?
Edema
Peak incidence b/w 2-6 y/o
MCD is the most common cause of NS in children and may follow a respiratory infection or immunization
What is considered a therapy and diagnostic intervention for minimal change disease (MCD)?
Dramatic response to corticosteroid therapy
Yet another table to “memorize”
Yay.
Membranoproliferative GN (MPGN) is best considered a _______________ injury rather than a specific disease
Membranoproliferative GN (MPGN) is best considered a pattern of immune-mediated injury injury rather than a specific disease
*Protip:
Use Erik’s flashcards for the details of the lecture. He made them based off of the robbins chapter
