Kidney Pathology Flashcards
What are more common in Australia, tubular or glomerulus diseases?
Tubular
What are three consequences of ATN?
- Reduced GFR
- Loss of electrolytic balance
- Accumulation of creatinine and urea in blood
Where are mesangial cells located in the glomerulus?
In the stalk that supports the capillaries
What are some causes of nephrotic syndrome/proteinuria?
Diabetes mellitus
Some forms of glomerulo-nephritis
Inherited syndromes
What does diffuse means in the context of GN?
All glomeruli in the kidney are affected
Which kidney disease is systemic lupus erythematosis commonly associated with?
Glomerulonephritis
How do kidneys with appear macroscopically in end stage renal disease?
Pale, atropied, nobbly, scarred
What is glomerulonephritis?
Acute or protracted damage to the glomerulus
Usually due to deposition of immune complexes that leads to complement activation
Do acute post infectious GN ever develop into chronic renal failure?
Yes, depends on how severe the initial injury is
When is GN likely to develop to chronic renal failure?
When the injurious stimuli remains present eg Lupus nephritis
What does the term global mean in the context of GN?
The whole glomerulus is affected
What are the most important causes of injury to kidney tubulointerstitium?
Ischaemia (or toxins rarely) = ATN
Infection = acute pyelonephritis
Acute or chronic tubulointerstitial nephritis
What are some causes of acute interstitial nephritis?
Allergic reaction to drugs
What is the histological abnormality in acute interstitial nephritis?
Immune cells in the interstitium - particularly eosinophils
What condition is more prevalent in forest Finns?
Inherited nephrotic syndrome: mutation in the Nephrin protein
What is the leading cause of chronic renal failure in Australia?
Diabetic nephropathy
What are some renal causes of acute renal failure?
Acute tubular necrosis
Acute glomerulonephritis
Acute interstitial nephritis
Why isn’t protein usually filtered?
- Negatively charged basement membrane
- Physical obstruction of the basement membrane and epithelials
- Fine proteins that connect the spaces between podocytes appendages
What happens to necrosed cells in ATN?
The fall off the basement membrane
What is the most common cause of acute glomerulonephritis in Australia?
IgA nephropathy
T/F Glomerulonephritis only causes oliguria renal failure
False, it can cause haematuria or proteinuria too
What can occur to the interstitium in renal disease?
Oedema
Expansion/fibrosis
What are the symptoms of acute pyelonephritis?
Chills, fever, pain, lumber tenderness
Dysuria (Pain on urination)
What is the GFR in end stage kidney disease?
<15mL/min/1.73m2
What are three way that the glomerulus can react to immune complex deposition?
- Glomerulus cell proliferation
- Immune cell infiltration
- Basement membrane proliferation
What are the top three causes of end stage kidney disease in Australia?
Diabetes mellitus
Glomerulonephritis
Hypertension
What is the most common cause of acute tubular necrosis?
Ischaemia eg during hypotension
What parts of the kidney can be effected in pyelonephritis?
Renal parenchyma
Calyses
Renal pelvis
T/F Type III hypersensitivity is the second highest cause of damage to kidney tubules
False, infection is
Type III hypersensitivity is much more of a problem in glomeruli
What is the pathogenesis in toxic acute tubular necrosis?
Mitochondrial function and oxidative phosphorylation are disturbed
What is Nephrotic syndrome another name for?
Severe proteinuria
If a patient presents with signs of kidney damage after antibiotic use what are the two differential diagnoses?
Post infective glomerulonephritis
Acute interstitial nephritis
T/F ATN is irreversible
False, it is reversible
How do you differentiate different types of GN?
Clinical findings (eg blood tests etc)
Light microscopy
Immunostaining for ab subtype
Electron microscopy
Why are tubule cells more susceptable to ischaemic damage than the glomeruli?
They have a greater O2 and blood demand than the glomeruli
T/F Renal function is lost in pyelonephritis
False, it’s usually preserved
T/F Acute glomerulonephritis never progresses to chronic renal failure
False, it can eg in cases of IgA nephropathy
T/F Acute renal failure is a term for any acute kidney problem
False, it specifically refers to a reduced GFR as reflected by serum creatinine
Is it possible to differentiate the cause of damage in end stage kidney disease?
No, damaged kidneys will the look same at this point
When do you get ‘crescents’ in the glomeruli?
In severe, acute glomerulonephritis with necrosis
They consist of monocytes and epithelial cells
Had do kidneys with pyelonephritis appear macroscopically when dissected?
White streakas = pus filled tubules
What are the signs of nephrotic syndrome?
Proteinuria
Oedema (whole body)
Hypoalbuminaemia
Hyperlipidaemia
What causes hyperlipidaemia in nephrotic syndrome?
Liver damage of some sort
Which type of GN is crescent necrosis associated with?
None of them! It’s non-specific
What are the 4 common aetiological agents of acute pyelonephritis?
E. coli
Klebsiella sp.
Proteus
Pseudomonas
What is the most common cause of acute renal failure?
Acute tubular necrosis
What type of acute glomerulonephritis is most seen in NT Aboriginals?
Acute Post-infectious GN - typically after Grp A Strep
How do bacteria appear in H&E stains?
Purple
When do symptoms appear in end stage kidney disease?
When there is 10% of renal function remaining
