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Pathology -- Nephrology > Introduction to Renal Pathology > Flashcards

Introduction to Renal Pathology Flashcards

1
Q

Effects of vascular disease on kidney fxn

A

Loss of GFR/Ability to excrete nitrogen

This will trigger H2O/Na conservation –> HTN

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2
Q

Effects of glomerular disease

A 
Loss of GFR/Selective Permeability
Filtrate with protein/red cells
Increased BUN/Creatinine
Oliguria
Low Na and Ca. Increased K and P
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3
Q

Glomerular disease results from…

A

Disruption of glomerular architecture

Vascular disease involving the capillaries of the glomerulus

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4
Q

Effect of long term glomerular disease

A

Post glomerular dysfunction, leading to global dysfxn of tubules and interstitium

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5
Q

Three main effects of tubular disease

A

Loss of concentrating ability (high fractional excretion of sodium)
metabolic acidosis
formation of tubular casts

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6
Q

Long term effects of tubular disease

A

Tubules will undergo regeneration if patient is kept alive long enough via dialysis

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7
Q

Interstitial disease is associated with…

A

Loss of EPO–> anemia
Increased RAA –> HTN
Loss of Prostaglandin –> Renal Vasoconstriction/HTN

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8
Q

Important thing to remember about occurance of interstitial disease

A

Almost never occurs alone

Usually with vascular/tubular disease

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9
Q

How might obstruction of the collecting system present

A

Oliguria or Anuria w/out glomerular or tubular dysfxn

Eventually will lead to destruction of renal components, later GFR

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10
Q

90% of the anatomic features are located…

A

in the cortex

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11
Q

Which part of the kidney is at greatest risk for ischemia/infarction?

A

Tubules

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12
Q

Glomerular disease interfering with blood flow will…

A

also affect the tubules because they are supplied by the efferent arterioles

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13
Q

How big are capillary endothelium fenestrations?

A

70-100 nm in diameter

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14
Q

Why are acidic glycoproteins essential to selective filtration in the glomerulus?

A

Anionic molecules are excluded in filtration while cationic molecules are selectively filtered

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15
Q

Size of podocyte openings

A

20-30 nm

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16
Q

Disruption of architecture of glomerulus will cause…

Disruption of foot processes

A

Nonselective loss of protein/cells

Selective loss of protein

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17
Q

Structure of the PT

A

Long microvilli, numberous mitochondria, apical canaliculi, extensive intercellular digitations

18
Q

Loss of tubular function will cause

A

Loss of Na, H20

Loss of Bicarb –> Metabolic acodosis w/ anion gap

19
Q

Decreased Na and CL in the at the juxtoglomerular apparatus will trigger…

A
  1. Increase in the afferent flow to the glomerulus

2. renin secretion (eventually causing efferent constriction via AT)

20
Q

Inchemia/Chronic inflammation of the interstitium will lead to…

A

Fibrosis, Anemia, HTN

21
Q

Broadly speaking, common causes of glomerular disease…

A

immunologic mechanisms of deposition

22
Q

Broadly speaking, most common causes of tubular/interstitial disease?

A

Toxicity, infection, or obstruction

23
Q

End stage renal failure occurs…

A

When all components of the kidney are involved

24
Q

There is a big table of renal syndromes you should probably review

A

sigh.

25
Q

A GFR below ____ results in renal failure. Below ____ is end-stage renal disease.

A

20-25%

5%

26
Q

Effects of acute renal failure on BUN/Creatinine if its a glomerular problem?

A

Can’t make the filtrate, cre and BUN stuck in the blood

27
Q

Effects of acute renal failure on BUN/Creatinine if its a bloodflow problem?

A

Whatever blood gets there is filtered, part of the urea is reabsorbed.
BUN climbs faster than creatinine

28
Q

Effect of acute renal failure on urine

A

Oligouria/Anuria

Urine osmolality increased

29
Q

Electrolyte abnormalities in Acute Renal Failure

A

Up – K and P

Down – Na and Ca

30
Q

How do Kidneys tie in with parathyroidism? So what?

A

Hypocalcemia –> Stim parathyroids to secrete PTH –> Secondary Hyperparathyroidism.
Ca loss from bones –> Renal Osteodystrophy

31
Q

Uremia implies a number of systemic complications associated with renal failure/azotemia. Tell me about them…

A

N/V, Esophagitis/Gastritis, Bleeding, Anemia, etc.

Peripheral neuropathy - Encephalopathy

32
Q

The one glomerular syndrome where treatment can turn it around

A

post-streptococcal glomerulonephritis

33
Q

What is Nephrotic Syndrome?

A

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

34
Q

Why should you second guess giving a diuretic to a person with edema from nephrotic syndrome?

A

Intravascular volume is already low from sending it into the tissues.

35
Q

Important proteins lost in nephrotic syndrome

A

Albumin – Edema
Lipoproteins – hyperlipidemia
Low weight globulins + Complement – Increased infections
Anticoagulants – Hypercoagulable state

36
Q

Common causes of nephrotic syndrome in adults and children

A

Children – Minimal Change Disease

Adults – Diabetes, SLE, Amyloidosis

37
Q

What is glomerulonephritis? (nephritic syndromes)

A

Immune mediated process affecting the glomerulus, typically leading to hematuria, changes in permeability, and GFR alterations.

38
Q

Why do isolated tubular syndromes cause acute renal insufficiency or renal failure?

A

Loss of tubular fxn –> increased glomerular pressure –> decreased GFR

39
Q

Hallmarks of tubular syndrome diagnostic indicators?

A

Presence of broad/granular casts
Polyuria, Nocturia
Renal Tubular Acidosis

40
Q

What do we call it when renal tubular acidosis gets goin…

A

Hyperchloremic Metabolic Acidosis

41
Q

Hallmarks of Chronic Renal Failure

A

Interstitial Fibrosis
Vascular Insufficiency
Loss of GFR
Tubular Dysfxn

42
Q

Which symptoms of renal failure are more pronounced in chronic?

A

Systemic probs – anemia, bleeding, diatheses, renal osteodystrophy, neurological symptoms, pericarditis

Pathology -- Nephrology (12 decks)

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