B4.042 Renal Failure Due to HTN

Question 1

reasons for renal parenchymal disease

Answer 1

glomerulonephritis
chronic renal failure of any cause
polycystic kidney disease
Liddle's syndrome (excessive sodium reabsorption)
familial hyperaldosteronism

Question 2

reasons for renovascular disease

Answer 2

renal artery stenosis

fibromuscular dysplasia

Question 3

pathology of large arteries in HTN

Answer 3

accelerated atherosclerosis
elastic hyperplasia
aneurysms
-decreased compliance and palpable rigidity of artery

Question 4

pathology of small arteries/arterioles in HTN

Answer 4

hypertrophy of the smooth muscle
elastic lamina enlargement
hyaline sclerosis
growth of the intima
-obstruction of flow and weakness/absence of pulses

Question 5

pathology of heart in HTN

Answer 5

concentric LVH
LV failure
diastolic dysfunction

Question 6

pathology of brain in HTN

Answer 6

atherosclerosis
little aneurysms
predisposition to stroke

Question 7

pathology of retina in HTN

Answer 7

atherosclerosis
arterial wall thickening
hemorrhage
arteriolar spasm
edema of retina and optic nerve

Question 8

discuss the link between HTN and the kidney

Answer 8

the kidney can be the target of HTN and the cause that perpetuates primary HTN

Question 9

what is CKD

Answer 9

chronic kidney disease
initially goes without symptoms and is only detected by increased serum creatinine or proteinuria
eventually leads to renal insufficiency

Question 10

epidemiology of CKD

Answer 10

gfr < 60

1: 8 americans have it
24. 5% of those 60 years and older

Question 11

etiology of CKD

Answer 11

1. diabetes
2. HTN
3. glomerulonephritis
4. cystic kidney
5. urologic diseases

Question 12

symptoms of CKD

Answer 12

loss of appetite, nausea, vomiting, weight loss, fatigue, changes in urine output, itching

Question 13

signs of CKD

Answer 13

hypertension, peripheral edema, SOB, chest pain, GFR decrease, increased creatinine and BUN

Question 14

gross appearance of HTN in the kidney

Answer 14

normal or reduced size

cortical petechial hemorrhages, scarring, and shrinking

Question 15

histology of kidney arterioles w HTN

Answer 15

narrowing of lumen

thickening and hyalinization of the walls (hyaline atherosclerosis)

Question 16

what is hyalinization

Answer 16

deposit of proteins

pink appearance on histology

Question 17

histology of kidney interlobal-arcuate arteries w HTN

Answer 17

same as arterioles +
fibroelastic hyperplasia
-medial hypertrophy
-reduplication of elastic lamina
-growth of intima

Question 18

histology of glomeruli in HTN

Answer 18

collapse of GBM
collagen deposits in Bowmans space
glomerular fibrosis
in malignant HTN:
-areas of thrombosis and necrosis
-hemorrhages of the parenchyma

Question 19

histology of renal tubules in HTN

Answer 19

patchy ischemic atrophy

interstitial fibrosis

Question 20

do new nephrons get generated during life?

Answer 20

no

born w 1 million, when they die they die

Question 21

what are the overarching functional defects of HTN on the kidney

Answer 21

glomerular filtration is impaired

tubular function is impaired