Diabetic kidney problems Flashcards
What is the role of hyperfiltration in diabetics?
increase GFR due to glucose dependent arteriolar dilation
Ang II mediates contriction of efferent arteriole
What is the role of hypertrophy in diabetics
early in onset
size of kidney increases
associated with increase in mesangial cell and capillary loops
What is the role of mesangial changes in diabetics?
hallmarks of DN
-mesangial expansion
-nodular diabetic glomerulosclerosis
early mesangial lesion is characterized by a increase in mesangial cell number
What is the role of proteinuria in diabetics?
widening of GBM -accumulation of type IV collagen and net reduction in negatively charged heparin
podocyte changes -incrase width of foot
serum protein cross the rhe BM due to disrupted textures gaps and holes
What is the role of fibrosiis in kidneys of diabetics?
tubulonintersitial fibrosis
casued by release of growth factors
tubular cell changes their phenotype and become fibroblasts
high glucose concentration
What is the lipid profile of diabetics?
low HDL
high TGs
Smaller LDL particle
What happens from amyloid deposits in the kidneys?
proteinuria
enlarged and HTN
renal tubular acidosis
polyuria-polydipsia
What is alport syndrome?
most commonly X-linked recessive (80)%
COL4A5
defect in BM
What is the renal manifestation of alport syndrome?
hematuria
proteinuria
HTN
ESRD in all affected males
What are the extra-renal manifestatoin ins alport syndrome?
ocular
cochlear defects
leiomyomatosis
What is acute kidney injury?
acute renal failure reduction in GFR resulting in azotemia renal ischemia or toxins usually reversible absence of Sxs of chronic uremia kidney size usually preserved
What is the definition of oliguria?
less than 400-500 ml/day
What is teh definition of azotemia?
elevation of nitrogen waster products
What is uremia?
illness accompanying kidney failure which results from toic efects
What are casts?
caused by trapping of cellular elements in matrix portien secreted by renal tubule cells
What is the pre-reanl aki category?
impaired effective renal perfusion
What is renal aki/
intrinsic renal disease
glomerular, tubulur, interstitial vascular
What is post-renal AKI?
obstruction of urinary flow
What is the pathogenesis of prerenal AKI?
decreased effective renal perfusion -> increased Ang II and vasporessin -> increased reabsorption of sodium -> conc. urine -> oliguria
What is the most common cause of renal AKI?
ATN ->acute tubular necrosis
What are the morphologic features of ATN?
tubular dilation attenuation of tubular epithelium loss of epithelial cell brush border granular cast material miotic figures
What is ATN:Tubular regeneration?
following ATN tubular regneration occurs in coordianted fashion
sublethally injried eithelial cells repop the tubules
What is fractional excretion of sodium?
expressed as amount of sodium exccreted normally 1%
What is the equation for fractional excretion of sodium?
(UNaPcr)/(PnaUcr)
What is acute interstitial nephritis cause?
inflammation of renal tubules and interstitium
- casued by HSN
- Infxns
- Autoimmune disease
What are the morphological features of acute interstitial nephritis?
inflammation and edema of interstitium with involvement of tubulues
may see granulomas
What are acute pyelonephritis?
acute inflammation of kidney due to a bacterial infection
typical urinary tract pathogens
What are the predisposing conditions of pyelonephritis?
urinary obstruction urinary instrumentation vesicoureteral reflux pregnancy diabetes
What is muliple myeloma related to renal failure?
develops in 25% of pts chronic renal failure results from -direct tubular toxicity tubular obstruction interstitial inflammation
What is the myeloma cast nephropathy treatment?
acutely, hydrationa and urinary alkalinization to prevent tubular obstroction by casts
chemotherapy or stem cell transplantion
What is medial fibromuscular dysplasia?
alternating thinned media nad thickened fibromusuclar ridges
What is the treatment for renal artery stenosis?
surgical revascularization
angioplasty and stenting
medical management
What can cause renal artery stenosis?
atherosclerosis or FMD
How does renal artery stenosis present?
resistant HTN or kidney dysfunction often after ACE-I or ARB
