L56

Question 1

What are histo changes that indicate chronic kidney disease?

Answer 1

Lose fxn tissue

↑Fibrosis = renal atrophy

Question 2

Name some causes of chronic kidney disease

Answer 2

HTN -> nephrosclerosis
Diabetes
PCKD
Multiple myeloma -> amyloidosis

Question 3

What is nephrosclerosis?

Answer 3

Changes in kidney due to chronic HTN

Implies benign aka long standing HTN

Question 4

Gross appearance of the kidneys due to nephrosclerosis

Answer 4

Granular surface

Small/normal size

Question 5

Histology of nephrosclerosis

Answer 5

1. Hyaline arteriosclerosis: PAS+
2. Medial hypertrophy: hyperplasia of elastic layers in the small vessels
   Looking for
   - Small cortex
   - Thick arteries
   - Crowded glomeruli

Question 6

Describe hyaline arteriosclerosis

Answer 6

Chronic HTN or diabetes
Protein -> vasc wall -> thicker
Seen as pink
↓Vessel diameter -> end organ ISCHEMIA
Glomerular scarring = arteriolo-nephro-sclerosis

Question 7

What are the 2 effects of ischemia due to nephrosclerosis?

Answer 7

1. Interstitial fibrosis

2. Glomerular sclerosis

Question 8

What changes happen to the kidney during malignant HTN?

Answer 8

“Malignant nephrosclerosis”

1. “Flea bitten” hemorrhages as arterioles/capillaries rupture w/ high pressure
2. Fibrinoid necrosis of arterioles
3. Onion skinning = concentric, lumen narrows

Question 9

Describe onion skinning

Answer 9

Ex of hyperplastic arteriolo-sclerosis

Hyperplasia of SM -> thickened vessel wall

Question 10

What are the 2 causes of renal artery sclerosis?

Answer 10

1. Fibromuscular dysplasia - young women
2. Atherosclerosis - older pts
   - Cholesterol plaques

Question 11

When do you care about heterogenous wall thickening of the artery3 in the setting of renal artery sclerosis?

Answer 11

Causes more turbulent BF

Question 12

What is the shape of an infarct caused by an embolus to the kidney?

Answer 12

Wedge!

Infarcted area will then scar

Question 13

What 3 histo changes would make you think diabetic glomerulosclerosis? How do these translate into lab findings?

Answer 13

↑Mesangial matrix (nodules)
Thick basement membranes
Arteriolar hyalinosis 
\:abs:
1. Micro-albiminuria
2. Non-nephrotic and nephrotic proteinuria

Question 14

Pathology of kidney changes in diabetes

Answer 14

Glycosylation structurally alters proteins

Vascular basement membrane becomes thick and leaky

Question 15

PCKD: dominant or recessive? Unilat or bilat?

Answer 15

AD but presents progressively
- PKD1, chr 16
- PKD2, chr 4
Inolved in cell-cell matrix interactions
Bilat always

Question 16

Initial presentation of PCKD

Answer 16

Hematuria

Question 17

What are extra-renal manifestations of PCKD that you should be thinking of?

Answer 17

Cerebral aneurysm
Hepatic cysts
Cysts in other organs

Question 18

Stains for renal amyloidosis

Answer 18

Congo red

Apple green birefringence

Question 19

Pathogenesis of renal amyloidosis

Answer 19

Systemic amyloidosis: deposit of AL or AA`

Question 20

Clinical presentation of renal amyloidosis

Answer 20

Nephrotic: heavy proteinuria
To chronic renal failure
Normal//enlarged size

Question 21

What type of amyloid deposits in the kidney during multiple myeloma

Answer 21

AL - duh excess light chain

Question 22

Findings in multiple myeloma

Answer 22

Cast nephropathy
Bence Jones proteinuria = Ig light chains in urine
HyperCa + uricemia