after midterm- nephron Flashcards
diabetes mellitus
desease of the glomerulus, arteries & arterioles, interstitium
what happens to the glomerulus in diabetes mellitus
Glomerulus
Thickened basement membrane (diffuse glomerulosclerosis)
Mesangial expansion ( grows so big that it can block blood flow by narrowing capilary lumen whic increases the pressure in the capilary lumen -nodules (Kimmelstiel-Wilson [K-W] disease)
Basement membrane disease leads to proteinuria
what happens in the blood vessels in diabetes mellitus
Vascular
Arterioles - Thickening of vessel wall - Narrowed lumen - Ischemia & tubular atrophy (kidneys stop working 20-30 years after getting diabetes, no blood coming coming in or out so its sclerotic)
Bacterial infection
Pyelonephritis (infection of the kidney)
Pyelonephritis
Bacterial infection (infection of the kidney)
Acute or chronic
Spread
Blood (hematogenous)
Up from urethra & bladder (ascending infection)
seen when there is obstruction from the bladder
which is more common for causing pyelonephritis
Ascending (♀ more common)
Bladder catheterization
After surgical procedures
Pregnancy (more pressure on the kidney)
Acute Pyelonephritis
Suppurative infection
May have abscesses or
Pus permeates entire kidney filling renal pelvis
Chronic Pyelonephritis
Usually evolves from acute pyelonephritis
- Destruction of renal parenchyma - Extensive scarring
Renal Cell Carcinoma
85% of Cancers of the Kidney 27,000 Diagnoses in USA Causes unknown May develop more frequently in end-stage kidneys smoking
two most common tumor in adults
renal cell carcinoma and
clear cell type
in children: wilms
how does renal cell carcinoma occur- pathology
Nodules or masses sharply demarcated from normal parenchyma
Invades through capsule into surrounding tissues
Commonly invades renal vein
smoking causes a hypoxic environment -
Cells reminiscent of Normal tubular cells
Filled with lipid - yellow colour
deletion of part of the 3rd chromosome which is suppose to help hypoxic enviro - 90% of ppl with renal cell carcinoma was this mutation
why are the tumors yellow in renal carcinoma
rich in lipids
Clinical Features od renal carcinoma- how do these patients present
Triad (seen 10% of time) Flank pain (spot on back where kidney is) Hematuria Abdominal mass Commonly discovered by CT Microscopic hematuria Five year survival = 40%
Wilms’ Tumour
Nephroblastoma Commonest tumour in infants Often present at birth Etiology: Wilms’ tumour gene 1 (WT-1)
Pathology- what does it look like
Renal mass replacing kidney
Micro
in the tumor there are Immature cells (like developing kidney)- stroma, glomeruli, tunule
Clinical Features of wilmès
Discovered by routine palpation or by parents
Highly malignant
Surgery & chemotherapy 85% cure rate
Renal Stones
“Nephrolithiasis” “Calculi” 5% of Adults 4 groups Calcium Struvite Uric Acid (gout) Cystine
calcium stones-
Calcium oxalate or Ca3 (PO4)2
75% of all Stones
Associated with abnormal Calcium metabolism
May be inherited- small in ureter or pelvis
Struvite Stones
MgNH4PO4
15% of all stones
Complication of infection (bacteria break down urea - NH4)
Uric Acid Stones
5% of all stones
50% of patients have Gout (hyperuricemia
usually dont cause symptoms- ppl with gout
Cystine Stones
1% of all stones
Rare condition from cystinosis
In born error of amino acid metabolism
Pathology- what is seen
Renal pelvis
Urinary bladder
Usually < 3 mm diameter (except struvite stones)
Struvite stones may form “staghorn calculi”
clinical features
Sex: M > F Age: usually 20 – 30 years Symptoms: Hematuria Renal colic Bladder stones chronic infections
cystitus
inflammation of the bladder wall- caused by bacteria, fungus, virus, parasite,
Acute or chronic
Urinary Tract Infections
Bacterial infections most common
Parasites
(e.g., Schistosoma hematobium)
rare in N. America, common elsewhere
Acute Cystitis
Visible congestion & mucosal hæmorrhages- very red
Occasionally see frank pus
Chronic Cystitis
See foci of Hæmorrhage Ulcers Thickening (from fibrosis) Resistant to Rx if: Diabetes Stones Prostate
Prostate- zones
located at the base of the bladder- divided into 3 zones (only know 2): 1: transitional zone- around the urethra- bening tumors are seen (cmpresses the urethra- bad pee stream, 2: peripheral zone- malignant appear here
Prostatic Hypertrophy
Enlargement of prostate
Benign Prostatic Hypertrophy (BPH)
Carcinoma
- 80% of all men over 80 will have bening tumor
Benign Prostatic Hypertrophy
Reactive benign hyperplasia
Relates to hormonal changes
Aging (makes less testosterone, sex hormones in adiposites can convert testosterone to estrogen
Nodular hyperplasia - compression of urethra
Requires testosterone
Exacerbated by estrogen
Relative E/T ratio with Age
Pathology
Nodular
Distort urethra
Compress peripheral portions into fibrous capsule
“surgical capsule”
Soft & pliable
Hyperplastic glands surrounded by fibro-muscular stroma
Bladder may become trabeculated
Clinical Features
Urethral compression & urinary retention Urgency Straining Dysuria Frequency
Chronic obstruction
Chronic cystitis
Hydroureter
Hydronephrosis
Clinical features of Nephrotic syndrome include all EXCEPT A. Edema B. proteinuria C. Hematuria D. Hyperlipidemia E. Hypertension
e,
All of the following features are correct for post infectious glomerulonephritis EXCEPT:
A. It usually occurs couple of weeks after sore throat.
B. It is a immune mediated glomerulonephritis
C. It usually presents as nephritic syndrome
D. Antibodies are usually against streptococcal bacterial antigen
E. It is fatal in children
e
All of the following are true regarding Minimal change disease EXCEPT
A. It a common cause of nephrotic syndrome in children.
b. it usually responds to corticosteroids
C. Cause is unknown but cytokines have been implicated
D. Dense immune type deposits are seen on EM
E. No abnormality is seen on light microscopy
d
All of the features are correct regarding Membranous nephropathy EXCEPT:
A. It is common cause of nephritic syndrome in adults
b. It is an immune mediated disorder
C. Glomerular basement membranes are thickened due to subepithelial deposits
D. It progresses to renal failure in 30-40% of cases
E. there is proteinuria but no hematuria
a
All of these statements regarding Diabetic nephropathy are correct EXCEPT:
Of all the patients with diabetes approximately 90% of patients develop renal disease.
Proteinuria usually develops 10-20 years after onset of diabetes.
The predominant pathologic findings in glomeruli are diffuse and nodular glomerulosclerosis.
Diagnostic lesion in glomeruli are known as Kimmelstiel Wilson type nodules
Altered/thickened basement membrane causes increased permeability to proteins.
a
Types of urinary stones include all EXCEPT:
A. Struvite (magnesium ammonia phosphate)
B. Calcium oxalate or phosphate
C. Arginine stone
D. Uric acid stone
E. Cystine stones
c
True/FalseAscending route of pyelonephritis is more common.
t
True/FalseMost common histologic type of renal cell carcinoma is transitional cell carcinoma, arising in transitional epithelium of renal pelvis.
f
True/FalseWilm’s tumor is most common malignant tumor of kidney in children and is due to mutation in retinoblastoma gene.
f
