Intro to Renal Pathology Flashcards
Discuss the normal anatomy and histology of the kidney
List the normal functions of the kidney
- Converts 1700L of blood/day into 1L of urine
- Fluid, electrolyte and acid-base balance
- Excretion of nitrogenous wastes
- Erythropoietin synthesis (RBC production)
- Renin synthesis (decreases blood pressure)
- Prostaglandin synthesis
- Vitamin D activation (Ca2+ and PO43- levels)
What is GFR (Glomerular Filtration Rate)?
- This is a measurement of kidney function.
- GFR is the volume of fluid that is filtered from the glomerular capillaries into the Bowman’s space per unit time (ml/min).
- It tells the filtration rate of all functioning nephrons (estimates the number of working nephrons)
What are the causes of renal failure?
1. Renal (Primary kidney diseases)
- Congenital
- Acquired (glomerular/tubulointerstitial)
2. Pre-renal (inadequate blood supply)
-
Heart failure - low cardiac output
- Low renal perfusion
- Volume depletion
- Sepsis
- Severe bleeding
3. Post-renal (bilateral unrinary obstruction)
- Tumors, BPH (prostate)
Recall the etiology of Kidney Diseases
What are the clinical manifestations of Renal Disease?
What are the systemic manifectations of Chronic Renal Failure & Uremia?
Describe the pathogensis of Primary Glomerular Diseases
Primary Glomerular Diseases may be due to:
1. Immune Mechanisms
- Antibody mediated
- Cell mediated
- Activation of the alternatice complement pathway
-
Non Immune Mechanisms
* Reduction of renal mass
Most glomerular disorders are immune mediated, but majority of the agents causing the immune mediated response are unknown. EXCEPTION: Infectious agents
Antibodies may be formed for endogenous (tumors or kidney antigens) or exogenous (drugs, viruses, fungal, bacteria) antigens.
The antibodies bind to their target antigen either in situ or the periphery to form an Immune Complex. This complex localizes in parts of the glomerulus, initiating inflammatory cells (neutrophil and macrophages) that may cause damage to the glomerular filtration membrane.
Discuss glomerular localization of circulating immune complexes
Glomerular localization of circulating immune complexes mainly depends on the size and charge of the particle.
Discuss Antibody Mediated Immune Mechanism
-
In situ immune coplex (Ag-Ab) formation
- Fixed antigens (intrinsic)/ andti GBM nephritis
- Planted antigens (endogenous/exogenous)
-
Circulating immune complex
- Endogenous antigens (DNA)
- Exogenous (infectious protein)
-
Cytotoxic antibodies
- Direct cell injury
- Without immune complex deposits
Discuss Cell Mediated Immune Mechanism
Discuss activation of alternative complement pathway Immune Mechanism
Discuss the Non-Immune Mechanism of reduction in renal mass.
Discuss the pathological alterations on renal biopsy in renal disease
- Light Microscopy (H&E) {LM}
- Immunofluorescent studies {IF}
- Electron microscopy {EM}
