Clinical V Renal Flashcards
what are histological alterations of the filtration mechanism associated with glomerular injury?
hypercellularity
thickening of the BM
hyalinosis and sclerosis
what are causes of glomerular kidney disorder?
immunological
toxic or infectious agents
what are example of glomerular kidney disorders?
glomerulonephritis
IgA nephropathy
what are some causes of tubular kidney disorders?
toxic
ischemia
mechanical
what are some causes of interstitial kidney disorders?
infectious
medication
what are examples of vascular kidney disorders?
hypertension
vasculitis
what is acute proliferative (post streptococcal Post infectious) glomerular nephritis
inflammation reaction = injury of the capillary wall
there is an escape of RBCs
leads to nephrotic syndrome
what are the symptoms associated with nephrotic syndrome?
hematuria oliguria HTN proteinuria edema
where might you find Ag-Ab complexes - electron dense deposits?
subendothelial - circulating, granular
subepithelial - in situ, granular
membranous - in situ, linear
mesangial
what occurs with hypercellularity in post streptococcal GN?
endothelial and mesangial cells
infiltration of neutrophils
crescent formation
what can you see with immunoflourescence in post streptococcal GN?
GRANULAR deposits of IgG, IgM and complement along BM
what can you see using electron micrograph in post streptococcal GN?
subendothelial intramembraneous and subepithelial hump against the GBM
what is Mesangial proliferative GM (IgA nephropathy)? What population is it commonly found in? What type of injury?
upper respiratory tract infection
young children and adults
diffuse and global injury
what are histological symptoms of Mesangial proliferative GM (IgA nephropathy)
increased mesangial maxtrix and cellularity
EM = electron dense deposits in the mesangium
IF = deposits of IgA (HALLMARK)*
associated with nephrotic syndrome
what is nephrotic syndrome?
increase in permeability of the capillary wall to plasma proteins
what are characteritstics of the PCT?
resorption
excretion
Mv
what is the function of the loop of Henle in relation to the tubules?
create a hypertonic environment surrounding the tubules
what are characteristics of the DCT?
macula densa
well developed basal foldings
what can cause tubular and interstitial injury?
drugs iodine containing contrast agents metals infections hypovolemic shock
what protein is affected in the adolescent congenital polycystic disease of the kidney?
fibroystin
what type of disease is the kind that affects kids congenital polycystic disease of the kidney?
autosomal recessive PKD
what protein is defective in adult congenital polycystic disease of the kidney?
polycystin
what type of disease is adult congenital polycystic disease of the kidney?
autosomal dominant PKD
what is the most common cause of acute tubular necrosis?
acute ischemia
what can you see with light microscopy of acute tubular necrosis(tubular injury)?
PCT - dilated tubules and flat epithelium
loss of brush borders and infoldings
what are common causes of acute pyelonephritis?
acute suppurative bacterial infection
BPH
pregnancy
what will you find in light microscopy of acute pyelonephritis?
neutrophil infiltration of the renal interstitum and tubules
chronic inflammation and obstruction of the drainging system (calyces, ureters) associated with acute pyelonephritis may result in what?
hydronephrosis /hydroureters
what does chronic pyelonephritis result in?
vesicourethral reflux
corticomedullary scaring
papillary necrosis
what is hydronephrosis/ hydroureters? What can it lead to?
obstruction of the collecting system draining the kidney
maintained pressure in the system can lead to permanent kidney damage
what is one of the principle causes of renal failure?
untreated HTN
what does increased tension in the vessels lead to?
thickening of the walls and reduction in the calibre of the vessel
what can you see using light microscopy of htn?
thickened and eosinophilic vessel walls
what are the risks associated with DM in kidneys?
infections
atherosclerosis
what are the histological changes seen in the kidney with DM?
icrease mesangial matrix (KIMMELSTEIL-WILSON NODULES)
increase thickness of the basement membrane with EM
what is the frequency of renal cell carcinoma
80-85% adults
who is at risk for renal cell carcinoma?
males , 60-70 yo, smokers, obesity, htn
where is the common location of renal cell carcinoma?
cortex - renal tubular epithelium
how often is hematuria present with renal cell carcinoma?
50% of cases
what are the symptoms of renal cell carcinoma?
flank pain ab mass prolonged fever polycythemia paraneoplastic symptoms metastases - lung, bone etc.
where is the origin of renal cell carcinoma?
renal tubular epithelial cells (adenocarcinoma)
what are the subtypes of renal cell carcinoma?
clear cell
papillary (chromophil)
chromophobe
what is the growth patterns of renal cell carcinoma?
trabeculae or cordlike or tubular
what kind of cells are present with renal cell carcinoma?
rounded or polygonal with clear or granular cytoplasm
what types of cells are found in papillary carcinoma?
cuboidal or low columnar cells
what types of cells are found in chromophobe carcinoma?
pale eosinophilic cells with perinuclear halo
what is the major cause of renal artery stenosis?
atheromatous plaques - atherosclerosis
what is a less common >1% cause of renal artery stenosis??
htn
what will untreated renal artery stenosis result in?
renal atrophy
is renal artery stenosis curable?
yes
what is the htn effect due to with renal artery stenosis?
increased production of renin and subsequent circulation of angiotensin II
