Introduction to Renal Pathology Flashcards
Effects of vascular disease on kidney fxn
Loss of GFR/Ability to excrete nitrogen
This will trigger H2O/Na conservation –> HTN
Effects of glomerular disease
Loss of GFR/Selective Permeability Filtrate with protein/red cells Increased BUN/Creatinine Oliguria Low Na and Ca. Increased K and P
Glomerular disease results from…
Disruption of glomerular architecture
Vascular disease involving the capillaries of the glomerulus
Effect of long term glomerular disease
Post glomerular dysfunction, leading to global dysfxn of tubules and interstitium
Three main effects of tubular disease
Loss of concentrating ability (high fractional excretion of sodium)
metabolic acidosis
formation of tubular casts
Long term effects of tubular disease
Tubules will undergo regeneration if patient is kept alive long enough via dialysis
Interstitial disease is associated with…
Loss of EPO–> anemia
Increased RAA –> HTN
Loss of Prostaglandin –> Renal Vasoconstriction/HTN
Important thing to remember about occurance of interstitial disease
Almost never occurs alone
Usually with vascular/tubular disease
How might obstruction of the collecting system present
Oliguria or Anuria w/out glomerular or tubular dysfxn
Eventually will lead to destruction of renal components, later GFR
90% of the anatomic features are located…
in the cortex
Which part of the kidney is at greatest risk for ischemia/infarction?
Tubules
Glomerular disease interfering with blood flow will…
also affect the tubules because they are supplied by the efferent arterioles
How big are capillary endothelium fenestrations?
70-100 nm in diameter
Why are acidic glycoproteins essential to selective filtration in the glomerulus?
Anionic molecules are excluded in filtration while cationic molecules are selectively filtered
Size of podocyte openings
20-30 nm
Disruption of architecture of glomerulus will cause…
Disruption of foot processes
Nonselective loss of protein/cells
Selective loss of protein
Structure of the PT
Long microvilli, numberous mitochondria, apical canaliculi, extensive intercellular digitations
Loss of tubular function will cause
Loss of Na, H20
Loss of Bicarb –> Metabolic acodosis w/ anion gap
Decreased Na and CL in the at the juxtoglomerular apparatus will trigger…
- Increase in the afferent flow to the glomerulus
2. renin secretion (eventually causing efferent constriction via AT)
Inchemia/Chronic inflammation of the interstitium will lead to…
Fibrosis, Anemia, HTN
Broadly speaking, common causes of glomerular disease…
immunologic mechanisms of deposition
Broadly speaking, most common causes of tubular/interstitial disease?
Toxicity, infection, or obstruction
End stage renal failure occurs…
When all components of the kidney are involved
There is a big table of renal syndromes you should probably review
sigh.
A GFR below ____ results in renal failure. Below ____ is end-stage renal disease.
20-25%
5%
Effects of acute renal failure on BUN/Creatinine if its a glomerular problem?
Can’t make the filtrate, cre and BUN stuck in the blood
Effects of acute renal failure on BUN/Creatinine if its a bloodflow problem?
Whatever blood gets there is filtered, part of the urea is reabsorbed.
BUN climbs faster than creatinine
Effect of acute renal failure on urine
Oligouria/Anuria
Urine osmolality increased
Electrolyte abnormalities in Acute Renal Failure
Up – K and P
Down – Na and Ca
How do Kidneys tie in with parathyroidism? So what?
Hypocalcemia –> Stim parathyroids to secrete PTH –> Secondary Hyperparathyroidism.
Ca loss from bones –> Renal Osteodystrophy
Uremia implies a number of systemic complications associated with renal failure/azotemia. Tell me about them…
N/V, Esophagitis/Gastritis, Bleeding, Anemia, etc.
Peripheral neuropathy - Encephalopathy
The one glomerular syndrome where treatment can turn it around
post-streptococcal glomerulonephritis
What is Nephrotic Syndrome?
a syndrome of glomerular dysfunction in which the BM loses the ability to retain protein
TECHNICALLY – a daily loss of 3.5 gm of protein
Why should you second guess giving a diuretic to a person with edema from nephrotic syndrome?
Intravascular volume is already low from sending it into the tissues.
Important proteins lost in nephrotic syndrome
Albumin – Edema
Lipoproteins – hyperlipidemia
Low weight globulins + Complement – Increased infections
Anticoagulants – Hypercoagulable state
Common causes of nephrotic syndrome in adults and children
Children – Minimal Change Disease
Adults – Diabetes, SLE, Amyloidosis
What is glomerulonephritis? (nephritic syndromes)
Immune mediated process affecting the glomerulus, typically leading to hematuria, changes in permeability, and GFR alterations.
Why do isolated tubular syndromes cause acute renal insufficiency or renal failure?
Loss of tubular fxn –> increased glomerular pressure –> decreased GFR
Hallmarks of tubular syndrome diagnostic indicators?
Presence of broad/granular casts
Polyuria, Nocturia
Renal Tubular Acidosis
What do we call it when renal tubular acidosis gets goin…
Hyperchloremic Metabolic Acidosis
Hallmarks of Chronic Renal Failure
Interstitial Fibrosis
Vascular Insufficiency
Loss of GFR
Tubular Dysfxn
Which symptoms of renal failure are more pronounced in chronic?
Systemic probs – anemia, bleeding, diatheses, renal osteodystrophy, neurological symptoms, pericarditis
