CP4-4 medical renal pathology

Question 1

What three areas of the kidney are often affected by renal pathologies?

Answer 1

The vessels
The gloerulus
The tubules/interstitium

Question 2

What are examples of renal diseases of the vessels?

Answer 2

Renal artery stenosis
Vasculitis
HTN
Diabetes

Question 3

What are examples of renal diseases of the glomerulus?

Answer 3

Diabetes
Glomerulonephritis
Amyloid
Myeloma

Question 4

What are examples of renal diseases of the tubules/interstitium?

Answer 4

Myeloma
Acute tubular necrosis
Tubuleo-interstitial nephritis

Question 5

What does a high EGFR show?

Answer 5

Healthy kidneys - higher = better

Question 6

How does acute renal failure (AKI/ARF) affect urea and creatinine levels?

Answer 6

Rapid rise in urea and creatinine

Question 7

How does chronic kidney failure (CKD/CRF) affect urea and creatinine?

Answer 7

Slow increase in urea and creatinine

Question 8

What are symptoms/signs of nephrotic syndrome?

Answer 8

Oedema, high proteinuria and hypoalbuminaemia

Question 9

What are symptoms/signs of nephritic syndrome?

Answer 9

Oedema, mild proteinuria, haematuria, hypertension and renal failure

Question 10

Which has a lower EGFR, nephrotic syndrome of nephritic syndrome?

Answer 10

Nephritic

Question 11

How are causes of acute renal failure classified?

Answer 11

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

Question 12

What are 4 common complications of ARF?

What treatment are these an acute indication for?

Answer 12

Refractory hyperkalaemia
Acidosis
Uraemic symptoms (nausea, pruritus and malaise)
Therapy resistant fluid overload

Dialysis

Question 13

What are the two top who causes of CKF?

Answer 13

Diabetes mellitus
Hypertension

Question 14

What are complications of CKD?

Answer 14

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

Question 15

How does CKD lead to hyperparathyroidism?

Answer 15

CKD leads to low serum calcium, low activated vit D and high serum phosphate which lead to increase in parathyroid hormones

Question 16

How does hypertension manifest in the kidneys?

Answer 16

Causes damage to vessels in kidney = vessel walls thicken = lumen diameter reduces = decreased blood flow = hypoxia = loss of nephrons due to benign nephrosclerosis

Question 17

How do patients with kidney disease due to hypertension present?

Answer 17

Often asymptomatic until severe

Question 18

How does renal disease as a result of diabetes manifest?

Answer 18

Uncontrolled blood sugar = hyperglycaemia = damage to basement membranes and small vessels = excess extracellular matrix production and ischaemia and tubular damage

Question 19

What are the nodules produced as a result of excess extracellular matrix production by damaged basement membranes in the kidneys called?

Answer 19

Kimmmelstiel-Wilson nodules

Question 20

How do patients with diabetes associated renal disease present?

Answer 20

Often asymptomatic but can present with nephrotic syndrome

Question 21

How does renal disease as a result of vasculitis present?

Answer 21

Autoimmune damage to blood vessels lead to inflammation. In glomerular vessels = clotting and obliteration of capillary lumen. In larger renal arterioles = tubule hypoxia

Question 22

How do patients with vasculitis associated renal disease present?

Answer 22

Often as part of a systemic disease

Question 23

How does renal disease as a result of myeloma manifest?

Answer 23

The neoplasms of plasma cells results in deposition of abnormal proteins (amyloid), light chain cast nephropathy and replacement of parenchyma by the tumour.

Question 24

How do patients with myeloma relates renal disease present?

Answer 24

Not specifically unwell with AKI or with CKD

Question 25

How does renal disease as a result of amyloidosis manifest?

Answer 25

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

Question 26

How do patients with amyloidosis associated renal disease present?

Answer 26

With CKD and nephrotic syndrome

Question 27

What is Glomerulonephritis?

Answer 27

Inflammation of the glomerulus usually autoimmune

Question 28

What are the 8 kinds of Glomerulonephritis?

Answer 28

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)

Question 29

What does molar rash in lupus look like?

Answer 29

Butterfly rash on face

Question 30

What is tubulointerstitial nephritis (TIN)?

Answer 30

A type IV hypersensitivity reaction against the tubules/interstitium usually triggered by drugs or infection.

Question 31

How does TIN present?

Answer 31

Like AKI

Question 32

What is acute tubular necrosis?

Answer 32

Direct epithelial damage in the kidneys due to toxins or ischaemia

Question 33

What is autosomal poly cystic kidney disease?

Answer 33

A mutation in PKD1/2 resulting in ESRF +/- liver cysts, berry aneurysms and heart valves problems

Question 34

What is autosomal recessive PCKD?

Answer 34

A PKHD1 gene mutation resulting in cystic kidneys and underdeveloped lungs at birth.

Question 35

What is the prognosis of autosomal recessive poly cystic kidney disease?

Answer 35

1/3 die I first month of life

Question 36

Why do babies with poor renal function in the womb have underdeveloped lungs?

Answer 36

As kidneys are not effective there is not enough production of amniotic fluid for the alveoli of the lungs to develop properly