MEDICAL RENAL PATHOLOGY

Question 1

Acute renal failure: Common causes, clinical

presentation and complications

Answer 1

CAUSES:
Pre-renal: reduced blood flow to kidney (most commonly): serve dehydration, hypotension from bleed, septic shock and LVF.
Post renal: urinary tract obstruction: urinary tract tumours, pelvic tumour, calculi, prostatic enlargement
Renal: damage to kidney
PRESENTATION:
Unwell,raised creatinine and urea – malaise, fatigue, nausea, vomiting, arrhythmias
COMPLICATIONS:
cardiac failure (fluid overload), arrhythmias (electrolyte imbalance), GI bleeding (multifactorial), Jaundice (hepatic venous congestion), Infection, esp. lung and urinary tract

Question 2

Chronic kidney disease: Common causes and clinical

presentation

Answer 2

Casues:
- Diabetes
- Vasculitis
- Hypertension
- Myeloma
- Amyloidosis
- Polycstic kidney disease
Clinical presentation:
Slow decline in renal function and haematuria & proteinuria.
Stage 3: Moderate GFR reduction (30-59ml/min/1.73m2)
Stage 4: Severe GFR reduction (15-29ml/min/1.73m2)
Stage 5: Kidney failure (GFR < 15ml/min/1.73m2 or dialysis)

Question 3

myeloma

Answer 3

–> plasma cell tumour deposits ig in tubules causing inflammation and fibrosis.

Question 4

hypertensions.

Answer 4

–> chronic hypoxia and loss of renal tubule. arteries harden, narrow and weaken.

Question 5

diabetes mellitus

Answer 5

–> hypergylcaemia damages basement membrane and ischaemia of tubules.

Question 6

vasculitis

Answer 6

–> inflammation of glomerular vessels can cause clotting and inflammation of larger vessels can cause tubule hypoxia.

Question 7

amyloidosis

Answer 7

Deopsits of amyloid protein in kidney.

Question 8

Glomerulonephritis
(glomerulonephritis = acute nephritis with acute renal failure but is NOT a specific disease)
1) Nephrotic syndrome

Answer 8

Nephrotic syndrom:
Always due to damage to glomerulus
Features: 
Oedema, Proteinuria (>3g in 24h), Hypoalbuminaemia, +/- Hypertension, +/- Hyperlipidaemia
Pitting oedema.
Common causes:
adults = Membranous nephropathy (commonest): Idiopathic primary glomerular disorder
children = Minimal change disease

Question 9

GLOMERULONEPRHRITIS:

2) Acute nephritis (nephritic syndrome)

Answer 9

Causes:
Adults = Post-infective glomerulonephritis
Children = Also post-infective glomerulonephritis and IgA nephropathy, Henoch-Schönlein purpura: Specific IgA nephropathy (systemic vasculitis); often follows throat infection
Presentation:
odema, hameraturia, proteinuria, hypertension, acute renal failure.

Question 10

GLOMERULONEPRHRITIS: 3) Haematuria

Answer 10

Presentation: blood in urine
Common causes:
Renal, IgA nephropathy. Thin basement membrane disease: inherited condition causing abnormally thin glomerular BM; renal function usu. normal
Alport hereditary nephropathy: inherited abnormalities of type IV collagen cause abnormal BM

Question 11

Interstital nephritis

Answer 11

form of nephritis affecting the interstitium of the kidneys surrounding the tubules, i.e., is inflammation of the spaces between renal tubules.
Presents: Oedema, hameraturia, proteinuria, hypertension, acute renal failure

Question 12

Inherited kidney disease: Polycystic kidney disease

Answer 12

Genetic disorder in which abnormal cysts develop and grow in the kidneys. Cystic disorders can express themselves at any point, infancy, childhood, or adulthood.
Imaging tests used to diagnose PKD include: abdominal ultrasound: a non-invasive test that uses sound waves to look at your kidneys for cysts. Abdominal CT scan: can detect smaller cysts in the kidneys