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Cellular Pathology > Nephropathology > Flashcards

Nephropathology Flashcards

1
Q

What would happen if the arteries in the kidney get blocked

A

Tissue distant to the blockage becomes ischaemic as it gets no blood supply and becomes infarcted (dies)

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2
Q

Which arteriole supplies the glomerulus

A

Efferent arteriole

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3
Q

Which cells are on the outside of the glomerulus and continous with the tubules

A

Epithelial cells

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4
Q

Which cells hold together blood vessels in the glomerulus

A

Mesangial cells

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5
Q

What cells are blood vessels lined by

A

Endothelial cells
Basement membrane
Podocytes

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6
Q

What features do the endothelial cells have on the blood vessels

A

Fenestrations

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7
Q

What features do the podocytes have

A

Foot processes

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8
Q

What is the charge of the basement membrane

A

Negatively charged

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9
Q

Which type of molecules can pass the basement membrane

A

Small and positive

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10
Q

What other molecules is the basement membrane permeable to

A

Water

Small solutes

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11
Q

What is the endothelium lined by

A

Glycocalyx

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12
Q

How do we classify glomerular lesions

A

Focal
Diffused
Segmental
Global

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13
Q

What is a focal glomerular lesion

A

Less than 50% of glomerular is affected

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14
Q

What is a diffused glomerular lesion

A

More than 50% of the glomerular is affected

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15
Q

What is a segmental glomerular lesion

A

Less than 50% of individual glomerular affected

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16
Q

What is global glomerular lesion

A

More than 50% individual glomerular affected

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17
Q

What are the ways in which kidney disease can present

A 
Acute renal failure 
Chronic renal failiure 
Asymptomatic haemautira (blood in urine)
Asymptomatic proteinuria (protein in urine)
Nephrotic syndrome
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18
Q

What is nephrotic syndrome

A

Severe proteinuria that leads to losing protein e.g albumin so that you cant keep fluid in the blood and you swell up

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19
Q

What can glomerular disease be

A

Primary

Secondary

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20
Q

What can secondary glomerular disease be due to

A

A system process of:

  • diabetes mellitus
  • SLE
  • vasculitis
  • amyloidosis (abnormal protein deposited)
  • hypertension
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21
Q

What is the pathogensis of primary glomerular disease

A

Usually immune mediated

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22
Q

What is the pathogenesis of primary glomerular disease

A
  1. You develop antibodies against something in the glomerulus
  2. Antibody becomes deposited in the glomerulus
  3. Deposition of a circulating antigen antibody immune complex
  4. This results in a inflammatory process of compement activation, neutrophil accumuation, activation of mesangial cells, platelet thrombi develop in the capillary loops
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23
Q

What does the inflammatory response lead to

A

Accumulation of cells and release of subtances that lead to further accumulation and proliferation of cells

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24
Q

What does the the inflammatory resposne do to tissues

A

Damage

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25
Q

What happens to the GFR

A

Decreases

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26
Q

Why does the GFR decrease

A

Decreased blood passing through the glomerulus

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27
Q

If there is decresed blood passing then what happens to the glomerulus and tubules

A

Tubular injury

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28
Q

What are the histological changes that occur in primary glomeruli disease

A
  • hypercellularity due to proliferation of mesangial, endotherlial and epithelial cells
  • leukocyte infiltrate
  • formation of crescents (accumualtion of cells in the bowmans space)
  • thickening of the basement membrane
  • sclerosis (scarring)
29
Q

What do glomerulopathies present with clinically

A
  • haemutura
  • proteinuria
  • oligouria (decreased urine output)
  • anuria (no urine output)
30
Q

What is acute glomerulonephritis

A

Acute inflammation of the glomerulus

31
Q

What will acute glomerulonephritis present with

A
  • haematuria
  • high creatine and urea
  • oligouria
  • proteinuria
32
Q

What are the causes of acute glomerulonephritis

A
  1. Post infectios glomerulonephritis

2. Necrotising/cresenteric glomerulonephritis

33
Q

What is post infectious glomerulonephritis

A

When children develop streptococcal infection which deposit into the glomerulus and cause an inflammatory process

34
Q

What are the 3 types of necrotising/cresenteric glomerulonephritis

A
  1. Anti GBM
  2. Immune complex mediated
  3. ANCA associated
35
Q

What is nephrotic syndrome

A

Massive proteinuria that leads to swelling (oedema)

36
Q

What are the causes of nephrotic syndrome

A
  1. Membranous nephropathy
  2. Minimal change disease
  3. FSGS
37
Q

What is membranous nephropathy

A

Diffuse thickening of the base membrane and there are immune deposits

38
Q

What can membranous nephropathy be

A

Idiopathic
Autoimmune due to anti PLA2R antibodies
Secondary causes of: malignancy, drugs, infections and metabolic disorders

39
Q

What is minimal change disease

A

Nephrotic syndroem in children followed by a repsiratory tract infection

40
Q

What is the treatment of minimal change disease

A

Steroids

41
Q

What does FSGS stand for

A

Focal segmental glomerular sclerosis

42
Q

What occurs in focal segmental glomerular sclerosis

A

Podocytes are injured and die and there is podocyte depletion (loss of 40% leads to FSGS)

43
Q

Why are podocytes injured (podocytopathy)

A

Due to genetic abnormalities against:

  • podocyte transcription factor
  • actin cytoskeleton
  • slit diaphragm
  • adhesion molecules betwwen podocyte and basement membrane so podocytes fall off
44
Q

What is a common mutation that can occur in africans which can cause podocyte abnormality

A

APOL1 gene mutation

45
Q

What are the 3 causes of asymptomatic haematuria

A
  1. Iga nephropathy
  2. Alports syndrome
  3. Thin glomerular basement membrane disesae
46
Q

What is iga nephropathy

A

Iga deposit in the mesangium

47
Q

What is alports syndrome

A

Mutations in genes of colagen that leads to splitting of the basement membrane

48
Q

What is thin glomerular membrane disease

A

Glomeruli is normal but the basement membrane under microscope is thin which allows RBC to pass

49
Q

What is chronic glomerulonephritis

A

End stage of acute glomerulonephritis which ends up with chronic renal failure

50
Q

What are the secondary causes of glomerular disease

A

This is secondary to a systemic process:

  • diabetes
  • sle
  • amyloidosis
  • hypertension
  • Vasculitis
51
Q

How does diabetic nephropathy cause glomerular lesions

A

It causes:

  • thickening of the basement membrane
  • mesangial increase nodules called kimmelstiel wilson nodule
52
Q

What is amyloidosis

A

Abnormla portein material deposited into tissue

53
Q

What are the primary and secondary causes of Amyloidosis

A

Primary: lgiht chain deposition
Secondary: due to a chronic disease e,g tb or crohns

54
Q

What is systemic lupus erythematosus (SLE)

A

An autoimmune disease

55
Q

What does SLE do to casue glomerular lesions

A
  1. Increase in mesangial
  2. Necrosis
  3. Membranous pattern of disease
  4. Deposition of immunoprotein e.g igg, m, a and complement
56
Q

How does hypertension cause glomerular lesions

A
  1. There is intimal (inner lining) thickening of the arterial lumen so it narrows
  2. Hyalonosis in the blood vessel
57
Q

What is the end result of hypertension to the kidney

A

Ischaemia due to reduced blood flow

58
Q

What can ischaemia cause

A

Glomerular sclerosis (scarring)
Tubular atrophy
Interstitial fibrosis

59
Q

Name diseases of the tubules and intersitial

A
  • acute pyelonephritis
  • chronic pyelonephritis
  • reflux nephropathy
  • acute interstitial nephritis
  • acute tubular necrosis
  • myeloma kidney
60
Q

What is acute pyelonephritis

A

Infection of the kidney that ascends from a UTI.

It is centred in the tubules

61
Q

What are the risk groups of acute pyelonephritis

A

Obstructin in urine

Vesicoureteric reflux which lead to intra renal reflux

62
Q

What is chronic pyelonephritis

A

When acute pyelonephritis leads to chronic pyelonephritis

63
Q

What is chronic pyelonephritis a cause of

A

Chronic renal failure

64
Q

What are the 2 forms of chronic pyelonephritis

A

Obstructive

Reflux nephropathy

65
Q

What changes does chronic pyelonephritis result in

A

Discrete corticomedullary scar overlying a blunted calyx

66
Q

What is tubulointersitital nephritis

A

Inflammation of the tubules and interstitial

67
Q

What are the causes of tubulointerstial nephritis

A

Related drugs e.g NSAID but not infection

68
Q

What is acure tubular necrosis

A

Necrosis of tubular epithelium with acute renal impairment due to ischaemic damage

69
Q

What is myeloma kidney

A

When light chains enter the tubules through the glomerulus and deposit whcih causes a foreign body response where macrophafes cause further injury

Cellular Pathology (19 decks)

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