L1. Renal syndromes and renal biopsy Flashcards
The 3 fucntional categories of renal disease
- Pre-renal disease
- Post renal disease
- Intrinsic renal disease
Define pre-renal disease and give ex. of common causes (6)
Pre-renal = Due to reduced renal perfusion
- Volume depletion: GI, renal, skin losses
- Heat failure: reduction in cardiac output
- Cirrhosis: Splanchnic vessel pooling
- NSAID: renal vasoconstriction
- Renal artery stenosis
- Shock: sepsis, fluid loss
Define post-renal disease and give ex. of common causes
Post-renal = Urinary tract obstruction
- Prostatic disease
- Pelvi retroperitoneal malignancy
- Renal or uretic calculi
- Congenital abnormalities
Define instrinsic renal disease and common causes
Instrinsic renal disease = problem w/ components of kidney
- Glomerular disease
- Tubular disease
- Vascular disease
- Interstitial disease
Common glomerular disease
- Glomerulopathies
- Glomerulonephritis
Common Vascular diseases
- Nephrosclerosis
- Systemic vasculitis
- Thrombotic microangiopathy
Common tubular disease
- Acute tubular necrosis
- Myeloma kideney
- Hypercalcemia
- Polycystic kidney disease
Common interstitial disease
- Acute pyelonephritis
- Chronic pyelonephritis
- Drug-induced nephritis
- Analgesic nephropathy
Why increase glomerular permeability leads to 1.Thromboembolism,
- Tubular dysfunction,
- hypoalbuminemia,
- edema,
- Hyperlipoproteinemia,
- lipiduria,
- Malnutrition,
- increased infections
- Thromboembolism –>Alteration in coagulation factors
- Tubular dysfunction –> Increased tubular reabsorption of filtered protein
- hypoalbuminemia: Albumin wasting
- edema: Decrease oncotic pressure due to Dec. albumin
- Hyperlipoproteinemia: Increase hepatic synthesis of lipoproteins in response to protein wasting
- lipiduria: Due to hyperlipoproteinemia
- Malnutrition: Due to albuminuria
- increased infections: Altered turnover rates of immunoglobins
NEPHOTIC SYNDROME
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
- Mechanisms
GMB or mesangial abnormality –> increased glomerular permeability
- Effects
Heavy proteinuria (>3.5), hypoalbuminemia, edema, hyperlipidemia
ASYMPTOMATIC OR GROSS HEMATURIA
- Mechanisms
- Effects
- Mechanisms
Glomerular abnormality
- Effects: hematuria –> dysmorphic RBC in urine
NEPHRITIC SYNDROME
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
NEPHRITIC SYNDROME
- Mechanisms
Glomerular cellular proliferation –> Decreased glomerular perfusion
- Effects:
Hematuria, oliguria, increased serum creatinine and BUN, hypertension and proteinuria
ACUTE RENAL FAILURE
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
- Mechanisms
Acute tubular or interstitial damage, acute glomerular perfusion failure
- Effects:
Oliguria/anuria, increased serum creatinine and BUN, acidosis, hyperkalemia
CHRONIC RENAL FAILURE
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
- Mechanisms
Chronic irrevesible nephron destruction
- Effects:
Uremia = increased creatinine and BUN, and multiple organ disorders (anemia, endocrine defects and osteodystrophy)
Why anemia, endocrine defects and osteodystrophy in chronic renal failure
Kidney produces EPO –> regulates erythropoiesis, Renin –> angiotensin system (regulated), Important in the regulation of Ca and PO4 absorption and wasting for bone remodeling
Urinary tract infection
Presentation
Effects
Pyelonephritis –> kidney
Cystitis –> Bladder
Effects
Bacteriuria and pyuria = bacteria and leukocytes in urine
Characteristics of normal glomerulus
Delicate turf of capillaries with patent lumens
PAS is used to
Highligh membranes: GBMs, Bowman’s capsule and TBM
Stains Mesangial matrix
What is Silver staine for
All membranes and mesanagial matrix are stain
Six basic glomerular lesions
- Increased cellularity
- Capillary wall thickening
- Necrosis
- Crescents
- Hyalinization
- Sclerosis
Major Causes of nephrotic syndrome in Adults vs Children
Adults
Membranous glomerulopathy
Glomerulopathies of systemic diseases
Focal Segmental glomerulosclerosis
Minimal change disease
Children
Minimal change disease
Focal segmental glomerulopathies
Other primary glomerulopathies
Major causes of nephritic syndrome in adults vs Children
Adult
Glomerulonephritis of systemic disease
IgA nephropathy
Crescentic glomerulonephritis
Membranoproliferative glomerulonephritis
Children
Membrano proliferative glomerulonephritis
IgA nephropathy/Henoch-Schonlein purpura
Glomerulonephritis of systemic disease
Postinfectious glomerulonephritis
Majro glomerular causes of isolated hematuria
IgA nephropathy
Henoch-Scholein purpura
Alport syndrome
Thin basement membrane disease
