Path II Midterm Flashcards
Kidney Functions
excretion of waste products of metabolism
regulation of water and salt concentration in body
maintenance of plasma pH
secretion of some hormones (renin, erythropoietin, prostaglandins)
what is the functional unit of the kidneys
nephron
What are the four compartments of the kidney?
glomeruli
tubules
interstitium
blood vessels
Which part of the kidney contains nociceptors?
capsule- sensitive to distention
glomerulopathy
disease of the glomerulus
Glomerulonephritis
inflammation of glomeruli of kidney
occurs through several different mechanisms
Circulating immune complex deposition glomerulonephritis
Type III hypersensitivity
antigen-antibody immune complexes settle in the walls of the glomerulus
as phagocytes try to digest the complexes, the walls of the vessels are damaged causing local vasculitis
Anti-GBM glomerulonephritis
type II hypersensitivity
antibodies are formed against the basement membrane in the glomerulus
phagocytes release destructive enzymes onto the basement membrane and destroy it
Heymann glomerulonephritis
no specific type of hypersensitivity
immune aggression against the podocytes and some antigens within them
leads to destruction of the podocytes
Nephritic syndrome
Hematuria
oliguria
azotemia
hypertension
Why is there hypertension with nephritic syndrome?
juxtaglomerular cells release renin as a result of a decreased GFR
What is the difference between azotemia and uremia
azotemia is a biochemical abnormality characterized by increased levels of creatine and BUN
uremia is the advanced process with symptoms and clinical manifestations
Diseases associated with Nephritic syndrome
acute proliferative glomerulonephritis rapidly progressive glomerulonephritis Berger's disease Alport Syndrome Chronic glomerulonephritis
Acute Proliferative glomerulonephritis
Type III hypersensitivity
caused by beta hemolytic streptococcus group A
immune complex settles in the subentimal layer of the of the membrane (between basement membrane and endothelium)
Rapidly progressive glomerulonephritis
aka crescentic
a group of disorders marked by hyperplasia of the parietal cells of the bowman’s capsule that merge and form a crescent shape
leads to pressure atrophy of the glomerulus
Type I Rapidly progressive glomerulonephritis
anti- glomerulus basement membrane
type II hypersensitivity
goodpastures syndrome
goodpasture syndrome
Type I Rapidly progressive glomerulonephritis
formation of antibodies against the basement membrane of alveoli and glomeruli
leads to accumulation of RBC’s in the lungs and hemoptysis
Type II Rapidly progressive glomerulonephritis
Type III hypersensitivity
idiopathic
associated with SLE and hemorrhagic vasculitis
SLE
type II Rapidly progressive glomerulonephritis
occurs in young women, kidneys are the most involved organ
anti-nuclear antibodies are produced against ds DNA
Henoch-Schonlein purpura
hemorrhagic vasculitis
skin syndrome –> articular syndrome –> abdominal syndrome –> GMN
GMN is irreversible
Type III rapidly progressive glomerulonephritis
Pauci-immune
not related with a specific type of hypersensitivity
idiopathic vasculitis
associated with Wegener’s granulomatosis and polyarteritits nodosa
Wegener’s granulomatosis
anti-neutrophil cytoplasmic autoantibodies result in necrotic vasculitis of arteries, arterioles and capillaries
necrotic granulomas of the respiratory tract
polyarteritis nodosa
characterized by vasculitis of the body
only areas of the body not involved are aortic arch and vessels of lung
destruction of kidney
wet gangrene as a complication
IgA nephropathy
aka Berger’s disease
deposition of IgA and IgA complex in the kidney
most common glomerular disease in the world
thrombangitis obliterans
aka buerger’s disease
vasculitis of mid and small arteries
inflammation of vessels that supply nerves with blood
associated with smoking
major symptoms of buerger’s
instep claudication
narrowing of vessel lumen
Raynaud’s
ends with gangrene in extremities
Alport syndrome
hereditary glomerulonephritis
develops nephritic syndrome
renal failure by 25 years old
Nephrotic Syndrome
proteinuria
hypoalbuminemia
generalized edema
hyperlipidemia/lipiduria
what ratio changes in nephrotic syndrome
albumin-globulin
Causes of nephrotic syndrom
Minimal change disease membranous glomerulonephritis focal glomerulosclerosis membranoproliferative glomerulonephritis diabetes mellitus amyloidosis
acute pyelonephritis
more common than glomerulonephritis
suppurative inflammation of kidney pelvis and parenchyma
routes of infection with acute pyelonephritis
ascending (most common)
lymphogenic
hematogenic
Diabetic nephropathy
decreased GFR, increased BP
diffuse glomerulosclerosis
nodular glomerulosclerosis, renal vascular lesion
peptic ulcer
breech into mucosa
erosion
aka sloughing
superficial damage to the mucosal wall
Defensive forces to the mucosal layer
surface mucous secretion
bicarbonate secretion
mucosal blood flow
elaboration of prostaglandins
pyloric stenosis
healing of peptic ulcer near pylorus
scar tissue results in dramatic shrinking of lumen of pyloric canal
results in loss of G cells/hypoacidity
hypertrophic pyloric stenosis
congenital
pyloric sphincter is too thick
manifestations of hypertrophic pyloric stenosis
visible peristalsis
dehydration
weight loss
hiatal hernia
separation of diaphragmatic crura
widening of space between muscular crura and esophageal wall
axial hernia
aka sliding
most common
non-axial hernia
aka paraesophageal
results in venous infarct and gangrene
achalasia
failure of the relaxation with consequent dilation of esophagous sphincter
achalasia is associated with
aperistalsis
incomplete relaxation of lower esophageal sphincter with swallowing
increased resting tone of lower esophageal sphincter
Primary achalasia
idiopathic
may be associated with myenteric plexus damage
may be associated with innervation of esophageal wall
secondary achalasia
protozoa trypansome cruzi has toxic effect on myenteric pleuxus
results in chagas disease
Mallory-Weiss syndrome
formation of longitudinal tears of the esophagus
due to multiple retching
Barrett espohagus
replacement of normal stratified squamous with metaplastic columnar epithelial containing goblet cells
Zollinger-Ellison syndrom
associated with marked hypersecretion of gastrin due to a gastrinoma
rheumatic fever
affects joints, skin, heart, and nervous system
associated with beta hemolytic strep group a
rheumatic myocarditis
100% involvement of the myocardium
pathomnemonic sign for rheumatic myocarditis
aschoff’s nodes
rheumatic pericarditis
rare
results in fibrous inflammation
rheumatic endocarditis
80% of cases
inner layer of heart involved
attacks valves and impairs blood flow
