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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
What happens to the GFR
Decreases
26
Why does the GFR decrease
Decreased blood passing through the glomerulus
27
If there is decresed blood passing then what happens to the glomerulus and tubules
Tubular injury
28
What are the histological changes that occur in primary glomeruli disease
- 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
What do glomerulopathies present with clinically
- haemutura - proteinuria - oligouria (decreased urine output) - anuria (no urine output)
30
What is acute glomerulonephritis
Acute inflammation of the glomerulus
31
What will acute glomerulonephritis present with
- haematuria - high creatine and urea - oligouria - proteinuria
32
What are the causes of acute glomerulonephritis
1. Post infectios glomerulonephritis | 2. Necrotising/cresenteric glomerulonephritis
33
What is post infectious glomerulonephritis
When children develop streptococcal infection which deposit into the glomerulus and cause an inflammatory process
34
What are the 3 types of necrotising/cresenteric glomerulonephritis
1. Anti GBM 2. Immune complex mediated 3. ANCA associated
35
What is nephrotic syndrome
Massive proteinuria that leads to swelling (oedema)
36
What are the causes of nephrotic syndrome
1. Membranous nephropathy 2. Minimal change disease 3. FSGS
37
What is membranous nephropathy
Diffuse thickening of the base membrane and there are immune deposits
38
What can membranous nephropathy be
Idiopathic Autoimmune due to anti PLA2R antibodies Secondary causes of: malignancy, drugs, infections and metabolic disorders
39
What is minimal change disease
Nephrotic syndroem in children followed by a repsiratory tract infection
40
What is the treatment of minimal change disease
Steroids
41
What does FSGS stand for
Focal segmental glomerular sclerosis
42
What occurs in focal segmental glomerular sclerosis
Podocytes are injured and die and there is podocyte depletion (loss of 40% leads to FSGS)
43
Why are podocytes injured (podocytopathy)
Due to genetic abnormalities against: - podocyte transcription factor - actin cytoskeleton - slit diaphragm - adhesion molecules betwwen podocyte and basement membrane so podocytes fall off
44
What is a common mutation that can occur in africans which can cause podocyte abnormality
APOL1 gene mutation
45
What are the 3 causes of asymptomatic haematuria
1. Iga nephropathy 2. Alports syndrome 3. Thin glomerular basement membrane disesae
46
What is iga nephropathy
Iga deposit in the mesangium
47
What is alports syndrome
Mutations in genes of colagen that leads to splitting of the basement membrane
48
What is thin glomerular membrane disease
Glomeruli is normal but the basement membrane under microscope is thin which allows RBC to pass
49
What is chronic glomerulonephritis
End stage of acute glomerulonephritis which ends up with chronic renal failure
50
What are the secondary causes of glomerular disease
This is secondary to a systemic process: - diabetes - sle - amyloidosis - hypertension - Vasculitis
51
How does diabetic nephropathy cause glomerular lesions
It causes: - thickening of the basement membrane - mesangial increase nodules called kimmelstiel wilson nodule
52
What is amyloidosis
Abnormla portein material deposited into tissue
53
What are the primary and secondary causes of Amyloidosis
Primary: lgiht chain deposition Secondary: due to a chronic disease e,g tb or crohns
54
What is systemic lupus erythematosus (SLE)
An autoimmune disease
55
What does SLE do to casue glomerular lesions
1. Increase in mesangial 2. Necrosis 3. Membranous pattern of disease 4. Deposition of immunoprotein e.g igg, m, a and complement
56
How does hypertension cause glomerular lesions
1. There is intimal (inner lining) thickening of the arterial lumen so it narrows 2. Hyalonosis in the blood vessel
57
What is the end result of hypertension to the kidney
Ischaemia due to reduced blood flow
58
What can ischaemia cause
Glomerular sclerosis (scarring) Tubular atrophy Interstitial fibrosis
59
Name diseases of the tubules and intersitial
- acute pyelonephritis - chronic pyelonephritis - reflux nephropathy - acute interstitial nephritis - acute tubular necrosis - myeloma kidney
60
What is acute pyelonephritis
Infection of the kidney that ascends from a UTI. | It is centred in the tubules
61
What are the risk groups of acute pyelonephritis
Obstructin in urine | Vesicoureteric reflux which lead to intra renal reflux
62
What is chronic pyelonephritis
When acute pyelonephritis leads to chronic pyelonephritis
63
What is chronic pyelonephritis a cause of
Chronic renal failure
64
What are the 2 forms of chronic pyelonephritis
Obstructive | Reflux nephropathy
65
What changes does chronic pyelonephritis result in
Discrete corticomedullary scar overlying a blunted calyx
66
What is tubulointersitital nephritis
Inflammation of the tubules and interstitial
67
What are the causes of tubulointerstial nephritis
Related drugs e.g NSAID but not infection
68
What is acure tubular necrosis
Necrosis of tubular epithelium with acute renal impairment due to ischaemic damage
69
What is myeloma kidney
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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