Histology #7 (Urinary) Flashcards

1
Q

Renal Corpsucle

A

Marks the begining of the Nephron
- Nephron = basic functional unit of the kidney

Encompasses Bownman’s Capsule and Glamerulus

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2
Q

Bowman’s Capsule

A

A hollow sphere formed by a simple layer of squamous epithelial parietal cells

Has two poles:
Vasulure pole = Afferent and Efferent arterioles

Urinary pole = Begning of proximal convulated tubule (PCT)

Image - see shell that bowmans capsule creates for glamerulus

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3
Q

Afferent vs. Efferent arterioles

A

Afferent arterioles - ushers unfiltered blood into the glamerulus

Efferent Arteriole - Usgers filtered blood out of the glamerulus

PCT = tube that ushers filterate (filtered water) out of the glamerous (out of the nephron)

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4
Q

Bowman’s Capsule Histology

A

Bowmans capsule - circular boarder of cells that provde a base for glamerous inside

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5
Q

Glomeruslus

A

A filtration appertatus composed of fenestrated capilaries + golmerular mesengial cells + Podocytes

Three compoents:
1. Fenstarted capilaries
2. Glamerular mesengial cells
3. Pdocytes

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6
Q

Glomeruslus Histology

A

Glomerous = looks lke interweaving capialeiries (looks like tarn ball)

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7
Q

Fenetratsed capilaries

A

Function - responsible for filtering blood + creating urine + reabsorbing nutrients

Lined with fenetrated endothelial cells
- Fenetsrated = pore within the endothelial cells that allows substances to go through

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8
Q

Fenetratsed capilaries Histology

A

EM - have siluete of capilaries

***stains are hard to find

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9
Q

Golmerular mesengial Cells

A

Function - Repsonsible for turning over the basal lamina (replaces old cells with new ones) + controlling capilary diameter + sereting vasoactive compound and cytokines

Mesengial cell types prodvides structural supprt to glomerular tuft (supports ball of capilaries)

Cells are dispersed between capilary branches

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10
Q

Golmerular mesengial Cells Histology

A

See nucleus of mesengial cells

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11
Q

Podocytes

A

Overall - Unique visceral epithelial cell type

Function:
1. Provides extensive processes that completey enclose glamerular capilaries
- Preform encapsulation giving sheath to capilaries
2. Creates barriers of filtration slits
3. Maintains gloerular basement membrane

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12
Q

Podocytes Histology

A

EM - see A is complete podocyte ; B shows processes that are extension form protocyte that allow capialries to be engulfed and protexted

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13
Q

Golmeular filter

A

Golmeular filter = how we keep unwanted things out of capilaries

Composed of 3 compoenets:
1. Fenestrated epithelieum
2. Thcik badsal lamina
3. Pedicles - filtration slits between podocytes procsses

Function - stop the passage fo proteins 68kDA or larger
- 68kDa (size of albumin)

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14
Q

Golmeular filter Histology

A

See podocyte + glemalar basement membrane + endothlial + foot processes of the podocyte

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15
Q

Proximal conculated Tubule (PCT)

A

Overall - first elements where the filtrate from the renal capsule is modified

Largest section of the nephorn tubule
- Provides more opperyunity to absorb ions and molescules from the lumen

Follows a twisting conveluted path (coils in the cortext)
- When PCT enters the medulla it becomes a proximal straight tubule (Proximal straight tubules is parallel to other elements in the medula)

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16
Q

Epithelial cells in PCT

A

Epithelial cells in PCT:
1. Large
2. Eosenphilic cytoplasm
3. Forms a simple cuboidal epithelium

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17
Q

Proximcal conveluted tubule (PCT) histology

A

Becomes convuled = have different orientations (Round vs. Oval vs. straiht structures)

PCT epithelial cells = large + can’t aways see nuclei (look like they ave fewer nuclei but they don’t)
- Have esoenophilc cytoplasm

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18
Q

PCT epithelial cells Histology

A

Pink is less densly packed

See microvilli around PCT

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19
Q

Featires for PCT reabsorptoion

A

Has features on the:
1. Apical surface
2. Basolaeteral surface
3. Cytoplasm

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20
Q

Features for PCT reabsportion (Apical surfcae)

A

Apical surface has microvilli (forms brush boarder)

Has Na+-dependt co-trasnprts to imporatnt specifci molecules from the lumen into epithelial cells
- Example - absorbs all glucose + Amino Acids + Na (65% of na)

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21
Q

Features for PCT reabsportion (basolateral surfcae)

A

Has basolateral invagination

Has Na-K pumps - maintains Na and K grdainets
- ALSO has absorptive role by pumoing Na from the lumen into the iterstitial to peritubular capialries

Has chanels for molecules absorbed from the PCT lumen to exit the cells

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22
Q

Features for PCT reabsportion (cytoplasm)

A

Cytoplasm of PCT ells = has densley packed mitocondria making ATP to support Na/K pumps

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23
Q

PCT histology

A

EM - shows PCT epithelial cells (see mitocodnria + microvilli + basostatsitons)
- Basostraitoons = because of basoinvaginations

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24
Q

Loops of henle (overview)

A

First - Entering medual is the Thin decdending limb - comes from the proximal convuluted tubule

THEN as it dips it makes a 180 degre turn at the bottom

THEN becomes a thin acending limb

THEN trasnitions into the tick ascending limhb

Exits the medula back into the cortext

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25
Q

Loops of henle Thin dedcening limb

A

Function:
1. Allows water to move out of the tubule into the interstitial space
- Conatin pasive trasnports down concetration gradient - aquaporins (water moves through aquporins)
3. Concetrates filtrate

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26
Q

Loops of henle Thin dedcening limb Histology

A

Thin dcesninding is lined with simple squamous epitheliam

No Apical brush boarder

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27
Q

Loops of henle Thin ascending limb

A

Function:
1. Reabsorb Na and Cl form filtrate into the interstitial fluid through Na and Cl transporters
- Conatains passive Na and Cl chanels
- Impermable to water = diluares diltrate as it is passing through

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28
Q

Loops of henle Thin ascending limb Histology

A

Lined with simple squamous epithelum

No apical brush boarder

Image - Thin ascending and decscedning
- Left - section of thin lined with simple squamous + can see lopp

  • Right - shows the thin has simple sqamous epithelium
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29
Q

Loops of henle thick ascending limb

A

Function:
1. Activley transports Na, Cl, K into interstitial fluid
- Conatins active pumps
- Impermeable to water
- Further dilates filtarte because impermebale to water

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30
Q

Loops of henle thick ascending limb Histology

A

Lined with simple Cuboidal epitheliam

No Apical Brish boarder

Uniform luminal space (disctict luminal space)

Image -
Left - lined with cuboidal
Right - Has smaller diamter than collecting ducts + uniform luminal space

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31
Q

Distal convaluted tubules

A

Follow the thick ascending limb

Have a coiled path (similar to PCT) found mainly in the corext
- Less convoluted and shorter than PCT

Intial segment lies next to the corpsucle and forms the juxtagolmerular appuratus

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32
Q

Distal convaluted tubules Histology

A

Always occupy less space than PCT
- DCT epithelial cells are smaller than PCT epithelial cells
- Tall + simple cudoidal epitheluum

In any given sectio of kidney the corext - less space is distal convaluted tube compared to prximal tube

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33
Q

Distal convaluted tubules function

A

Overall function - fine tuning of Na reapsoption (<5%)

Apical surface - Na-dependent co-trasnporters and Na chanels (imports Na from lumen into epithelial cells)

Basolateral surface - Na/K pumps (transports Na from the fitrate (urine) in lumen into the interstitium)

Cytoplasm - densly packed mitocondria

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34
Q

Distal convaluted tubules Histology (EM)

A

Shows DCT epithelialc ells + shows apical microvilli + basoinvagination + packed eloggated mitcondira

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35
Q

Summary of beinging Loop of henley histology

A
36
Q

Collecting Duct

A

Location - Cortext and the medulla of the kdiney

Several collecting tubules –> leads to one collecting duct in corext –> leads to medullary collecting duct

Composed of simple cubodial epithelial cells –> then have columnar epithelial cells
- Simple cuboidal cells = helps fluid reabsorption of Na and water
- Columnar = helps mainati acid base homoestasis (secrets acids or bases depending on pH needed)

Histology - stain pale with distict boarder of the cells

Function - site for fluid reabsorption and acid-base balance

37
Q

Uriter

A

Layers:
1. Urothelieum (innermost)- stratofied epithlieum with multinucleated cells
2. Lamina propria - connective tissue
3. Muscularis - smooth muscle and connective tissue
- Have 2 layers –> arranged in 2-3 layers of longitudal and circular layers
- Smooth muscle contracts to push fluid
- Closer to the bladder is longitudnal layer = does parastlysis to move urine to the bladder)
4. Adventitia - loose connective tissue

38
Q

Uriter

A

Left - Urithelium is at the top –> has umbrella cells + bi/multinucleated cells)
- Sits on top of lamina propina
- Lamina propria sites on top of Muscaris
- Muscalris = can see longitunal on tomm of circulare)
- See adnevtitia after muscularis

39
Q

Macula Densa Cells

A

Abdunece of epithelial cells located in the juxtaglomerular apparatus

Function - Responds when NaCl concetration is out of standrad range (gulates NaCl concetration)

40
Q

Juztaglomerular Apparatus (JGA)

A

Functional Unit in the nephron
- Location - in vasular pole
- Junction of the glemerous and afferernt and effecter arterials

Function - Tubuloglamerlar feedback system conrtols renal blood flow
- Controls glemalular filtration rate (GFR) by sneinsg amount fluid in ascending limb
- Tubular control of renin section - has role in startng angiostestin-aldostrone system

41
Q

Juztaglomerular Apparatus (JGA) Components

A

JGA has 3 cell types:
1. Macula densa cells - thick yellow layer
- Thick layer of cells in bottom of distal tubule (on glamerular side)
2. Juxtaglomerular cells (granular cells)
3. Extraglomerular mesangial cells (lacis cells)

42
Q

Macula densa cells

A

Dense spot in the thick ascending limb

Monotor NaCl concetration in filtarte through membrane trasnporters

Signals to speed up or slow down to change concetration:
- When concetation is too high –> slow down filtraton GFR (signlals affertent arterioles to constroct through adenosine which causes constriction)
- When concetration is too Low –> speed up the filtration GFR so less solute is oulled out (signal juxtaglomerular cells to release renin –> get angiogenstin) –> angiogenstin causes arterioles to constict + other systemic effects of angiotenisin

Images - circled - dense cells in circle on glomeular cells

43
Q

Juxtaglomerular cells (granilar cells)

A

Location - tunica media of afferent arteriole at entrance to glomeruli(build around affernt aretrioeles ; localize to tunica media)
- Image - blue cell around edge of afferent arteriol ; tunica media is on side

Modified smooth muscle cells

Function - Produce + store + secrete renin

Senses blood pressure in aretiole through bacorecptors - increased BP –> secretes renin
- Have dark vacule filled with renin

Responds to signal from from macula densa cells + sympathetic nervous system (highly innervated)

EM image AA and G is in the dark layer of cells around both side of granial cells

44
Q

How do Juxtaglomerular cells secrete renin

A

Sercet renin through own barrow receptors + from siglas in sena + nerve fibers

45
Q

Extraglomereular Mesangial cells (lacis cells)

A

Location - Within prymid juncton between afferent and eferent arteriole and macula densa
- purple cells in middle of junction

Modified smooth muscle

Function - Not fully known
- Possible involovment i stimulating renin secresyon
- Remove trapped residue/deris from the glomerular basment membrane

Image -
H/E - block arrow shows prydimd
EM - see afferent and effernet - Extraglomereular Mesangial cells are between them

46
Q

Renin and Blood Pressure Homeostasis

A

Renin = enzyme produced by Juxtraglomerular cells

Regulates blood pressre via renin-angiostensin - aldostrone system (RAAS)
- Maintains BP homoestsis
- Low BP = helps increase BP by starting angiogenstin-aldostrine system)

Release inhibited by arterial natruitic peptide (ANP) from stretched atria in heart in repsonse to increase in blood pressure

47
Q

Juxtaglomerular apparatus and blood pressure control

A

Produced by Jaxtaglomerula cells in repsonse to:
1. Low BP (hpotension)/reduced extracellular fluid
- Detected by barorecptores in the afferent arteriole
2. Low NaCl concetration (Hypoantremia)
- Detected by macula dense cells the distal convoluted tubule
3. Sympathetic nervous sytem activation
- Beta-1 Adregenic recptors on JG cells

48
Q

Renin-Angiogenstin-Aldosrtone System

A

Renin is made –> Renin is released for the kidney –> converts angiogenstin (made in the liver) to angiogenstin 1 –> angiostine 1 is converted to angiogenstin 2 by angiogenstin convertying enzyme (ACE) –> angiogenstin 2 is the main effector of the system

49
Q

Effect of Angiogenstin 2

A

Angiogenstin 2 –> hormone that has widepsread effect to raise BP and blood volume

Effects:
1. Acts on arterilals –> causes constriction = increase BP
2. Acts o kidney = increase na absorption
3. Acts on adremal gland
4. Acts on cortext –> increase secertion of aldostrone = affects Na Absorption
5. Increases ADH = increases thrist = increase blood volume + increases water reabsprotion

50
Q

Renin-Angiogenstin Aldostrine system (overall)

A
51
Q

Extrarenal collcting system

A

Extrarenal collcting system = Urters + bladder + urithra

NOW there is no reabsportion = have the urothelial –> urotheliuam has chemcial restsince + is reststent to stretching

52
Q

Urothelium

A

Urine is toxic waste

Urothelium - specialized proetxtive epitheliual cells
- Chemical restince
- Prevent leaskge even when stretchs

Layers of Urothelium:
1. Superfical umbrella cells (outter)
2. Intermiate cells
3. basal Cell layer (bottom)

Other tissue layers (below the urothelium) -
Lamina propria
mascularis
Adventia

53
Q

Urothelium - Umbrella cells

A

Most apical layer of cells (single layer)
- Top layer in Image

Often Binucleated

Width can range from 25-250 um long

Specialized disk shaped vesciles

54
Q

Urothelium - Umbrella cells Histology

A

See relaxed vs stretched –> can do this because of discoidal vesicles
- See discoidal vesicles on EM (discoid vesicles = also called fusiform vesicles)

55
Q

Urothelium - Umbrella cells Histology #2

A

See how expandsion and contraction occurs as cell stretches

56
Q

Urothelium in Urinary Bladder

A

Urothelum is >6 cells thick

Thin cubmucosa

Mucsularis - has a extra 3rd circular layer (dentrusor)

Superior portion of the adventitia is mesothelium

Image
- H/E - see three layers of mucularis –> change orientation in each layer

57
Q

Urothelium in Urinary Bladder histology #2

A
58
Q

Urothelium (urethra)

A

Includes a 3rd layer of muscle (3rd layer is skelatal muscle) (External Urinary sphicter)

Has Skeltal muscle in proximal part of urtehra (because volentary action)

Along its length its transitions from urothelieum to psudostratified columnar to non-keritinized startified squamous
- Chnages from urethelium to standrad epithelum and will be continus with skin

59
Q

Urothelium (urethra) transition

A

Urothlium transitions along the urethra

Histology - Logitudnal section of fossa Navicularis
- See trasnition of Psuodstratified columanr to statified squamous

60
Q

Chronic kidney disease (overall)

A

Overall - Damage to the kidney - can’t prefrom their function (Ex. no filtration)
- Main function of kidney = filtered blood = gets rid of waste + excess fluid

Chronis and progressive - occurs slowley over a long period (has multiple stages)
- Last stage = kidney failure = kidney is not functioning = can’t get rid of waste = have buldup of waste = many side effects

Result - leads to a build up of waste in body

61
Q

How do you test kidney function

A

Test kidney function with GFR (Glamerular filtraton rate)

Low GFR = have issues with kidneys - IF continues = can lead to CKD

62
Q

CKD causes and symptoms

A

Caused by many things:
1. Age
2. Obesity
3. Family histpry
4. Diabetes - main cause
5. Hypertention - main cause

Have many symptoms (many are unrealted to kidney)
1. Puffy eye
2. Issue sleeping

Treatment - dialysis + kidney transplant in late stage kidney failure

62
Q

Diabetes

A

Diabetes - chronic condiation charcterized by high blood glucose levels due to insufficet insulin production or use

63
Q

Acute vs. Chronic failure

A
64
Q

Causes of chronic kideny disease

A
  1. Diabetes
  2. Hypertension

BOTH can cause chronic kidney failure

65
Q

Diabetes

A

Inaqdeuwate insulin or insulin s not working properly –> leads to high glucose –> leads to thicking of vessles and damage of nephron + lose protein in urine

66
Q

Diabetic Nephropathy

A

Symptomes:
Blood vessel damage - high blood glucose causes the vessels of the kidney to become narrow and clogged

Nephrone damage - thicken and scaring causing proteniuria

Nerve damage - Bladder can’t signal to the brain when full –> high pressure damages the kidneys (damage kidneys because have backup)

Increased risk factors of diebetic nueropathy - smokeing + poor diabetes managment + high salt diet

Treatment - manage disease progression by managing diabetes

67
Q

Diabetic Nephropathy Glemerular basement membane thcikening

A

A - Healthy basment membrane (thin)

B - Diabettic - basement membrane is thicker
- Hypoglycosylation end product buildup = thickens basment membrane = not getting filtration = have protenueria (loss of protein ; maily albumin)

First sign of diabetic nueropathy (early stage)

68
Q

Diabetic nueropathy histological signs

A

Diabetic nueropathy histological signs:
1.Glemerular basement membane thcikening
2. Mesangial expasnion
3. Nodular Scelrosis
4. Global Glameruloscelrosis

69
Q

Diabetic Nephropathy Mesangial expasnion

A

Diabetic - cells increase in area + there are more of them + more ECM = dagamge kidney strcuture = damage function = get protoneuria

70
Q

Diabetic Nephropathy Nodular Scelrosis

A

Nodule scelrosis = lesions (big circles) - main indictaor of diabetic related CDK (point of no retrun)

Main marker looked for

71
Q

Diabetic Nephropathy Global Glomeruloscerlsois

A

Hardening and scaring of the gloemerus (blood vessels are impared)
- No filtration
- Cause by hyperglycemmia
- No Kidney function
- Need Dialysis

72
Q

Hypertension

A

Blood pressure is blood vessles in consisteny too high (130/80)
- Second stage hypernetsion = higher than 140/90

Second leading cause of kidney failure in US

Danrous cycle of hypertension–> kidney function inhibition –> more hypertension
- Hypertension causes Blood vessels to constrict = inhibits kideny function = kidney can’t extret water and ions = leads to more hypertenstion because can’t reasborb water and ions

Image - see can cause thickening of Blood vessels

73
Q

Hypertesnion pharmacologicla treatments

A

Overall - use Indiction of diuresis and vasodilation

Main goal of treatments = induce diureses to release pressure in Blood vessels or do vasodialtion

Chart = shows meds:
1. ACE inhibitors
2. AABrs - act on angiotenstin system
3. Alpha and Beta blockers - act on cardiac muscle to induce vasodilation

74
Q

Diuretics

A

Mechanismof action - increase urine production by infleunceing the kidney to exrete extra water and sodium to releive Blood pressure and Blood vessels

Sveral classes of diuretics exist with varing efficac and act on various parts of the kidney nephron unit

75
Q

Classes of Diuretics

A
  1. Carbonic anhydrase inhibitors - increase bicarbinate + Na + Cl extretion in PCT
  2. Loop diuretics - inhibit Na/K/2Cl co-trasnprter and Na reabsorption in the loop of henle
    - Affect thick ascending limb
  3. Thriazide - inhibits Na/Cl co-trasnporter in DCT and reabsoprtion of Na
    • Affecst distal convluted tube
  4. K Sparing - Aldostrone receptor antagpnist (inhibits synthessis of Na cganges = lose Na absprtion function) + EnaC blocker (inhibits influs of Na in collecting ducts)–> BOTH act on the collecting duct ENaC chanels
76
Q

Issues with diuretics

A

Different drugs have different eficacey
- If inhibit eralier – then neprhone will try and compenstae later

Diuretics have many side effects –> can lead to low K because kidney is trying to get more Na t the end of the nephron = pushes K out

77
Q

Renin inhibitors

A

Mechansim of action - Bind to active site of renin molecule to prevent it from binding to angiotensinogen and the subsequent conversion of angiogenstin 1 to angiogenstin 2
- Inhibits the whole pathway

NOT used as primary pharmocologic treatment because has many side effects

78
Q

Nephrotic syndrome Manifistations

A

Nephrotic syndrome = group of syndromes that indicate the kideny is not functioning

Has 4 manifestaions that indictae disrupted functioning of the kidneys (stem from increase permeability in glaemrus)
1. Protenieura
2. hypoalbumimia
3. Hyperlipidemia
4. Edema

Symptims - swelling + foamy urine + weight gain + loss of apetite

Complications - Infection + blod clots + hypertension + diffuclty breathing + Chronic kidney disease

79
Q

Nephrotic syndrome cause

A

Caused by increase permeability of glomeruli due to kidney disease or systemic diseases

Normal galmeular barrier = has 3 layers (fenstarted epithelium –> Basement Membrane –> protocytes)
- Protocytes prevent protein from going from the blood into the urine)

Nephrotic = protocytes are affected = lose structural integrity = proteins go across glamerous filtration barrier

Caused by disease that affects proteocytes = kidney diseases or systemic diseases

80
Q

Nephrotic syndrome Proteinuria and Hypoalbuminemia

A

Proteinuria - increase in protein in urine
- Layer of protcytes is affected = proteins go through filtration barrier = extrte protein in urine

Hypoalminemia - decrease in albumin in blood
- Decrease albumin = decrease in oncotic pressure
- Lose albumine in urine = low levels of albumin in blood

81
Q

Nephrotic syndrome edema

A

Have Hypoalbiinmeria (decrease in albuine) –> leads to swelling due to fluid accumilation

Albumin = important in oncotic pressure –> low albumin = lower oncotic pressure = less fluid goes into capilaries AND excess fluid in interstitial space/tissue = causes edma

82
Q

Nephrotic syndrome Hyperlipidemia

A

Hypoalbimineria = decrease in albumin in blood –> leads to hyperlipidemia –> leads to increase in cholerstal and fats in blood

Liver tries to compensate for increase of protein blood = makes lipoproteins + cholertral + albumin = can lead to higher lipids

83
Q

Nephrotic syndrome Histology

A

Histology depends on disease causing nephrotic syndrome

Left - Focal (kideny disease) = hardening of glamerular capilaries
- Only sgeemnts of gemeular

Right - AB deposition in glemaeular capilaries

Kidney that causes neropathy = causes layer of protocytes in glamelular filtration layer

84
Q
A
85
Q
A
86
Q
A