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Renal/Resp > Diabetic kidney problems > Flashcards

Diabetic kidney problems Flashcards

1
Q

What is the role of hyperfiltration in diabetics?

A

increase GFR due to glucose dependent arteriolar dilation

Ang II mediates contriction of efferent arteriole

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2
Q

What is the role of hypertrophy in diabetics

A

early in onset
size of kidney increases
associated with increase in mesangial cell and capillary loops

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3
Q

What is the role of mesangial changes in diabetics?

A

hallmarks of DN
-mesangial expansion
-nodular diabetic glomerulosclerosis
early mesangial lesion is characterized by a increase in mesangial cell number

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4
Q

What is the role of proteinuria in diabetics?

A

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

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5
Q

What is the role of fibrosiis in kidneys of diabetics?

A

tubulonintersitial fibrosis

casued by release of growth factors

tubular cell changes their phenotype and become fibroblasts

high glucose concentration

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6
Q

What is the lipid profile of diabetics?

A

low HDL
high TGs
Smaller LDL particle

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7
Q

What happens from amyloid deposits in the kidneys?

A

proteinuria
enlarged and HTN
renal tubular acidosis
polyuria-polydipsia

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8
Q

What is alport syndrome?

A

most commonly X-linked recessive (80)%
COL4A5
defect in BM

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9
Q

What is the renal manifestation of alport syndrome?

A

hematuria
proteinuria
HTN
ESRD in all affected males

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10
Q

What are the extra-renal manifestatoin ins alport syndrome?

A

ocular
cochlear defects
leiomyomatosis

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11
Q

What is acute kidney injury?

A 
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
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12
Q

What is the definition of oliguria?

A

less than 400-500 ml/day

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13
Q

What is teh definition of azotemia?

A

elevation of nitrogen waster products

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14
Q

What is uremia?

A

illness accompanying kidney failure which results from toic efects

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15
Q

What are casts?

A

caused by trapping of cellular elements in matrix portien secreted by renal tubule cells

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16
Q

What is the pre-reanl aki category?

A

impaired effective renal perfusion

17
Q

What is renal aki/

A

intrinsic renal disease

glomerular, tubulur, interstitial vascular

18
Q

What is post-renal AKI?

A

obstruction of urinary flow

19
Q

What is the pathogenesis of prerenal AKI?

A

decreased effective renal perfusion -> increased Ang II and vasporessin -> increased reabsorption of sodium -> conc. urine -> oliguria

20
Q

What is the most common cause of renal AKI?

A

ATN ->acute tubular necrosis

21
Q

What are the morphologic features of ATN?

A 
tubular dilation
attenuation of tubular epithelium
loss of epithelial cell brush border
granular cast material
miotic figures
22
Q

What is ATN:Tubular regeneration?

A

following ATN tubular regneration occurs in coordianted fashion
sublethally injried eithelial cells repop the tubules

23
Q

What is fractional excretion of sodium?

A

expressed as amount of sodium exccreted normally 1%

24
Q

What is the equation for fractional excretion of sodium?

A

(UNaPcr)/(PnaUcr)

25
Q

What is acute interstitial nephritis cause?

A

inflammation of renal tubules and interstitium

  • casued by HSN
  • Infxns
  • Autoimmune disease
26
Q

What are the morphological features of acute interstitial nephritis?

A

inflammation and edema of interstitium with involvement of tubulues
may see granulomas

27
Q

What are acute pyelonephritis?

A

acute inflammation of kidney due to a bacterial infection

typical urinary tract pathogens

28
Q

What are the predisposing conditions of pyelonephritis?

A 
urinary obstruction
urinary instrumentation
vesicoureteral reflux
pregnancy
diabetes
29
Q

What is muliple myeloma related to renal failure?

A 
develops in 25% of pts
chronic renal failure results from
-direct tubular toxicity
tubular obstruction
interstitial inflammation
30
Q

What is the myeloma cast nephropathy treatment?

A

acutely, hydrationa and urinary alkalinization to prevent tubular obstroction by casts
chemotherapy or stem cell transplantion

31
Q

What is medial fibromuscular dysplasia?

A

alternating thinned media nad thickened fibromusuclar ridges

32
Q

What is the treatment for renal artery stenosis?

A

surgical revascularization
angioplasty and stenting
medical management

33
Q

What can cause renal artery stenosis?

A

atherosclerosis or FMD

34
Q

How does renal artery stenosis present?

A

resistant HTN or kidney dysfunction often after ACE-I or ARB

Renal/Resp (22 decks)

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