CP4-4 medical renal pathology Flashcards
What three areas of the kidney are often affected by renal pathologies?
The vessels
The gloerulus
The tubules/interstitium
What are examples of renal diseases of the vessels?
Renal artery stenosis
Vasculitis
HTN
Diabetes
What are examples of renal diseases of the glomerulus?
Diabetes
Glomerulonephritis
Amyloid
Myeloma
What are examples of renal diseases of the tubules/interstitium?
Myeloma
Acute tubular necrosis
Tubuleo-interstitial nephritis
What does a high EGFR show?
Healthy kidneys - higher = better
How does acute renal failure (AKI/ARF) affect urea and creatinine levels?
Rapid rise in urea and creatinine
How does chronic kidney failure (CKD/CRF) affect urea and creatinine?
Slow increase in urea and creatinine
What are symptoms/signs of nephrotic syndrome?
Oedema, high proteinuria and hypoalbuminaemia
What are symptoms/signs of nephritic syndrome?
Oedema, mild proteinuria, haematuria, hypertension and renal failure
Which has a lower EGFR, nephrotic syndrome of nephritic syndrome?
Nephritic
How are causes of acute renal failure classified?
Pre-renal- problems before the kidneys I.e. the not enough blood going to the kidneys e.g. in sepsis
Intrarenal- problems in the kidney itself
Post-renal- problems after the kidneys e.g. in urinary tract or bladder
What are 4 common complications of ARF?
What treatment are these an acute indication for?
Refractory hyperkalaemia
Acidosis
Uraemic symptoms (nausea, pruritus and malaise)
Therapy resistant fluid overload
Dialysis
What are the two top who causes of CKF?
Diabetes mellitus
Hypertension
What are complications of CKD?
Overall risk of all-cause mortality increases as CKD worsens
Falling GFR = inability to excrete toxins/electrolytes/maintain fluid balance = need for dialysis
Anaemia
Hypertension
CVD
Hyperparathyroidism
How does CKD lead to hyperparathyroidism?
CKD leads to low serum calcium, low activated vit D and high serum phosphate which lead to increase in parathyroid hormones
How does hypertension manifest in the kidneys?
Causes damage to vessels in kidney = vessel walls thicken = lumen diameter reduces = decreased blood flow = hypoxia = loss of nephrons due to benign nephrosclerosis
How do patients with kidney disease due to hypertension present?
Often asymptomatic until severe
How does renal disease as a result of diabetes manifest?
Uncontrolled blood sugar = hyperglycaemia = damage to basement membranes and small vessels = excess extracellular matrix production and ischaemia and tubular damage
What are the nodules produced as a result of excess extracellular matrix production by damaged basement membranes in the kidneys called?
Kimmmelstiel-Wilson nodules
How do patients with diabetes associated renal disease present?
Often asymptomatic but can present with nephrotic syndrome
How does renal disease as a result of vasculitis present?
Autoimmune damage to blood vessels lead to inflammation. In glomerular vessels = clotting and obliteration of capillary lumen. In larger renal arterioles = tubule hypoxia
How do patients with vasculitis associated renal disease present?
Often as part of a systemic disease
How does renal disease as a result of myeloma manifest?
The neoplasms of plasma cells results in deposition of abnormal proteins (amyloid), light chain cast nephropathy and replacement of parenchyma by the tumour.
How do patients with myeloma relates renal disease present?
Not specifically unwell with AKI or with CKD
How does renal disease as a result of amyloidosis manifest?
Deposition of amyloid in tissues. Can be AL amyloid due to myeloma or AA amyloid due to chronic inflammatory conditions. These deposits often occur in the glomerulus causing impaired filtration
How do patients with amyloidosis associated renal disease present?
With CKD and nephrotic syndrome
What is Glomerulonephritis?
Inflammation of the glomerulus usually autoimmune
What are the 8 kinds of Glomerulonephritis?
Minimal change disease
IgA nephropathy (aka Bergers)
Membranous nephropathy
Focal segmental glomerulosclerosis (FSGS)
Lupus nephritis
Post infectious Glomerulonephritis
Granulomatosis with polyangiitis (used to be called Wegners - not called this anymore as he was a nazi)
Goodpastures disease (aka anti GBM)
What does molar rash in lupus look like?
Butterfly rash on face
What is tubulointerstitial nephritis (TIN)?
A type IV hypersensitivity reaction against the tubules/interstitium usually triggered by drugs or infection.
How does TIN present?
Like AKI
What is acute tubular necrosis?
Direct epithelial damage in the kidneys due to toxins or ischaemia
What is autosomal poly cystic kidney disease?
A mutation in PKD1/2 resulting in ESRF +/- liver cysts, berry aneurysms and heart valves problems
What is autosomal recessive PCKD?
A PKHD1 gene mutation resulting in cystic kidneys and underdeveloped lungs at birth.
What is the prognosis of autosomal recessive poly cystic kidney disease?
1/3 die I first month of life
Why do babies with poor renal function in the womb have underdeveloped lungs?
As kidneys are not effective there is not enough production of amniotic fluid for the alveoli of the lungs to develop properly
