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Clinical Pathology > Diseases of the renal system 1 > Flashcards

Diseases of the renal system 1 Flashcards

1
Q

What are the functions of the kidney?

A
  • Eliminating metabolic waste products
  • Regulating fluid and electrolyte balance
  • Influencing acid-base balance
  • Production of some hormones
    • Renin: fluid balance
    • Erythropoietin: stimulates red cell production
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2
Q

What is the presentation of acute renal failure?

A
  • Rapid rise in creatinine and urea

- Generally unwell

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3
Q

What is the presentation of nephrotic syndrome?

A
  • Oedema + proteinuria + hypoalbuminaemia

- Proteinuria >3g per 24h (mostly albumin)

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4
Q

What is the presentation of nephritic syndrome?

A
  • Oedema
  • proteinuria
  • haematuria
  • renal failure
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5
Q

What is the presentation of chronic renal failure?

A

Slowly declining renal function

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6
Q

What is the course of blood through the nephron?

A
  • Branches of the renal artery
  • Afferent arteriole
  • Glomerulus
  • Efferent arteriole
  • Proximal convoluted tubule
  • Vasa recta
  • Distal convoluted tubule
  • Branches of the renal vein
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7
Q

What are the immunological mechanisms of glomerular damage?

A
  • Circulating immune complexes deposit in glomerulus
  • Circulating antigens deposit in glomerulus
  • Antibodies to basement membrane or other components of glomerulus

-All damage basament membrane -> Complement activation, neutrophil activation, reactive oxygen species and clotting factors -> glomerular damage

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8
Q

What are non-immunological mechanisms of glomerular damage?

A
  • Injury to endothelium of vessels -> damage to vessels
  • Altered basement membrane due to hyperglycaemia in diabetes
  • Abnormal basement membrane or podocytes due to inherited disease
  • Deposition of abnormal proteins in the kidney e.g. amyloid
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9
Q

What are the ischaemic mechanisms of tubular damage?

A
  • Hypotension
  • Damage to vessels within kidney
  • Glomerular damage

= Reduced blood supply to tubules

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10
Q

What are the toxic mechanisms of tubular damage?

A
  • Direct toxins
  • Hypersensitivity reactions e.g. to drugs
  • Deposition of crystals in tubules
  • Deposition of abnormal proteins in the tubules
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11
Q

What is thrombotic microangiopathy?

A
  • Thrombi in capillaries and small arterioles
  • Due to damage endothelium
  • Causes of endothelial damage include bacterial toxins, some drugs, abnormalities in complement or clotting systems
  • e.g. Haemolytic uraemic syndrome
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12
Q

What is vasculitis?

A
  • Acute or chronic inflammation of blood vessel walls
  • obliteration of lumen by inflammation
  • various different types affecting different sizes of vessel
  • adults and children can be affected
  • e.g. Wegener’s granulomatosis
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13
Q

What are the mechanisms of vascular damage to the kidney?

A
  • Thrombotic microangiopathy
  • Vasculitis
  • Hypertension
  • Diabetes
  • Atheroma e.g. renal artery stenosis
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14
Q

What is always the cause of nephrotic syndrome?

A

Damage to glomerulus

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15
Q

What are the clinical features of nephrotic syndrome?

A
  • Oedema
  • Proteinuria (>3g in 24h)
  • Hypoalbuminaemia
  • +/- hypertension
  • +/- hyperlipidaemia
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16
Q

What are the possible complications of nephrotic syndrome?

A
  • Infection

- Thrombosis

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17
Q

What are the common pathophysiologies of nephrotic syndrome?

A
  • Membranous nephropathy (most common)
  • Focal segmental glomerulosclerosis (FSGS)
  • Minimal change disease
  • Other causes: diabetes, lupus nephritis, amyloid
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18
Q

What is membranous nephropathy?

A
  • Idiopathic
  • Primary glomerular disorder of unknown cause
  • Usually adults 30-60, M>F
  • 20-30% progress to end stage renal failure
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19
Q

What is focal segmental glomerulosclerosis (FSGS)?

A
  • A pattern of kidney damage with various possible causes (idiopathic, genetic, heroin use, HIV. Most are idiopathic)
  • M>F
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20
Q

What is minimal change disease?

A
  • Biopsy is normal on light microscopy

- M=F

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21
Q

What are the causes of nephrotic syndrome in children?

A
  • Minimal change disease (most common)
    • No abnormality seen on light microscopy
    • Majority of children have excellent prognosis
  • Focal segmental glomerulosclerosis (FSGS)
  • Other causes are rare
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22
Q

What are the features of acute nephritis?

A
  • Oedema
  • Haematuria
  • Proteinuria
  • Hypertension
  • Acute renal failure
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23
Q

What are the common causes of acute nephritis?

A
  • Post-infective glomerulonephritis
  • IgA nephropathy
  • Vasculitis
  • Lupus
  • Other forms of primary glomerulonephritis
24
Q

What is post-infective glomerulonephritis?

A
  • Typically occurs a few weeks after Streptococcal throat infection
  • Most recover completely
  • The pathophysiology of this disorder is consistent with an immune complex mediated mechanism, a type III hypersensitivity reaction.
25
Q

What is IgA nephropathy?

A
  • Most common primary glomerular disease worldwide
  • Teenagers and young adults with haematuria
  • 20-50% progress to renal failure over 20 years
26
Q

What are the features of vasculitis?

A

Fever, generally unwell, may have rash, myalgia, arthralgia

27
Q

What are the common causes of acute nephritis in children?

A
  • Post-infective glomerulonephritis
  • IgA nephropathy
  • Henoch-Schonlein purpura
  • Haemolytic-uraemic syndrome
28
Q

What are the features of Henoch-Schonlein purpura?

A
  • Specific type of IgA nephropathy, M>F
  • Typically young boys/teenagers with arthralgia, abdo pain, rash, haematuria, acute renal failure
  • Most recover completely
29
Q

What are the features of haemolytic-uraemic syndrome?

A
  • Typically children with E. Coli 0157 enteritis

- Acute nephritis + haemolysis + thrombocytopaenia

30
Q

What are the features of acute renal failure?

A

anuria/oliguria + raised creatinine and urea

31
Q

What is the treatment for acute renal failure?

A
  • Short term dialysis may be needed in some patients

- Many patients will recover and have good renal function if they had healthy kidneys previously

32
Q

What are the pre-renal causes of acute renal failure?

A
  • Reduced blood flow to kidney (most common)
    • Severe dehydration
    • Hypotension e.g. Bleeding, septic shock, left ventricular failure
  • Obstructed urinary tract
    • Tumours of urinary tract
    • Tumours in pelvis
    • Bladder stones
    • Prostatic enlargement
  • Renal biopsy not helpful
33
Q

What are the renal causes of acute renal failure?

A
  • Damage to kidney

- Renal biopsy not helpful

34
Q

What will all biopsies show in acute renal failure?

A

“ATN” – acute tubular necrosis/ injury/damage/acute kidney injury (ATI/ATD/AKI)

35
Q

What are the causes of acute renal failure in adults?

A
  • Vasculitis
  • Acute interstitial nephritis/tubulointerstitial nephritis (tubular damage with inflammation, most commonly caused by drug reactions) – most recover
36
Q

What are the causes of acute renal failure in children?

A
  • Henoch-Schonlein purpura
  • Haemolytic uraemic syndrome
  • Acute interstitial nephritis
37
Q

What are the possible complications of acute renal failure?

A
  • Cardiac failure (fluid overload)
  • Arrythmias (electrolyte imbalance)
  • GI bleeding
  • Jaundice (hepatic venous congestion)
  • Infection, especially lung and urinary tract
38
Q

What is the treatment for acute renal failure?

A
  • Short term dialysis may be needed

- Treat the underlying cause

39
Q

What is chronic renal failure?

A

Permanently reduced GFR – reduced number of nephrons

40
Q

What are the stages of chronic renal failure?

A

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)

Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Kidney failure (GFR

41
Q

What are the effects of chronic renal failure?

A
  • Reduced excretion of water and electrolytes: oedema, hypertension
  • Reduced excretion of toxic metabolites
  • Reduced production of erythropoietin: anaemia
  • Renal bone disease
42
Q

What are the likely cause of haematuria +/- proteinuria with normal renal function?

A
  • IgA nephropathy
  • Thin basement membrane disease
  • Alport type hereditary nephropathy
43
Q

What is thin basement membrane disease?

A
  • Inherited condition causing abnormally thin basement membranes in the glomerulus
  • If no other renal disease present, kidney function will remain normal
44
Q

What is Alport type hereditary nephropathy?

A
  • Inherited abnormalities of collagen type IV cause abnormal basement membrane in the glomerulus, sometimes with eye and ear problems
  • Renal failure +/- deafness +/- ocular problems
  • May be autosomal or X-linked
45
Q

What is ‘isolate protienuria’?

A

Proteinuria less than the nephrotic range, without haematuria, renal failure or oedema

46
Q

What are the possible causes of isolate proteinuria?

A

May be benign e.g. Postural, related to pyrexia or exercise.

May be due to renal disease

  • Adults
    • FSGS
    • Diabetes
    • Lupus
  • Children
    • Henoch-Schonlein purpura
    • FSGS
47
Q

What is pyelonephritis?

A

Infection of the kidney

48
Q

What are the causes and complications of acute pyelonephritis?

A
  • Ascending infection (more common in women)
  • Instrumentation of urinary tract
  • Diabetics
  • Structural abnormalities of urinary tract

Complications - abscess formation

49
Q

What are the common causes of chronic renal failure in adults?

A
  • Diabetes (commonest)
  • Glomerulonephritis
  • Reflux nephropathy
50
Q

What are the common causes of renal failure in children?

A
  • Developmental abnormalities/malformations
  • Reflux nephropathy
  • Glomerulonephritis
51
Q

What are the causes and complications of chronic pyelonephritis?

A
  • Most associated with obstruction of urinary tract and reflux of urine up ureter, leads to scarring of the kidney and can lead to renal failure

Complications - scarring of kidney, chronic renal failure

52
Q

What are the causes and features of renal artery stenosis?

A
  • Due to atheroma (most common) or arterial dysplasia
  • Leads to ischaemia of the affected kidney
  • Activation of renin-angiotensin-aldosterone system leads to hypertension
  • Loss of renal tissue due to ischaemia leads to reduced renal function
53
Q

What is the effect of vasculitis on the kidney?

A
  • Inflammation can affect the glomerular vessels and lead to clotting with obliteration of capillary lumens and destruction of the glomerulus
  • Inflammation of larger arterioles within the kidney can lead to hypoxia of the tubules
  • Often affects other vessels around the body causing rash, muscle and joint pains
  • Patients can also have fever and weight loss due to the inflammation
54
Q

What is the effect of hypertension on the kidney?

A
  • Hypertension damages renal vessels leading to thickening of the vessel wall and reduction in size of the lumen
  • This produces chronic hypoxia which leads to loss of renal tubules and reduced renal function
  • Reduced blood flow in the kidney leads to activation of the renin-angiotensin-aldosterone system which exacerbates hypertension
55
Q

What is the effect of diabetes on the kidney?

A
  • Diabetes is the commonest cause of end-stage renal failure in Europe and the USA
  • Hyperglycaemia is the main cause of diabetic nephropathy by damaging the basement membrane
  • Basement membrane becomes thicker and the glomerulus produces excess extracellular matrix which forms nodules
  • Diabetes also damages small vessels leading to ischaemia and damage to renal tubules
56
Q

What is the effect of myeloma on the kidney?

A
  • Tumour of plasma cells producing immunoglobulins
  • Excess immunoglobulins deposit in kidney tubules
  • Tubules become damaged
  • Inflammation and fibrosis of kidney occurs
  • Loss of renal tubules leads to declining kidney function
  • Renal impairment due to myeloma is usually irreversible

Clinical Pathology (65 decks)

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